Effects of Ondansetron and Granisetron on Postoperative Nausea and Vomiting in Adult Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%.Objective: The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery.Methods: Patients classified by the American Society of Anesthesiologist's physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours.Results: Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01).Conclusions: Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.     

Comparison of ramosetron, dexamethasone, and a combination of ramosetron and dexamethasone for the prevention of postoperative nausea and vomiting in Korean women undergoing thyroidectomy: A double-blind, randomized, controlled study

Background: Thyroidectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV), ranging from 51% to 76%. Because these symptoms are distressing for patients, prophylactic medication to avoid or reduce PONV is recommended.Objective: The aim of the present study was to compare the efficacy of ramosetron, dexamethasone, and a combination of ramosetron and dexamethasone in preventing PONV in Korean women undergoing thyroidectomy.Methods: In this double-blind, randomized, controlled trial, consecutive adult female patients who were scheduled to undergo thyroidectomy under general anesthesia at the Kyungpook National University Hospital (Daegu, Korea) were randomly assigned to receive ramosetron 0.3 mg alone, dexamethasone 8 mg alone, or a combination of ramosetron 0.3 mg and dexamethasone 8 mg administered intravenously as a single dose immediately after induction of anesthesia. The primary end point of this study was the total PONV rate up to 24 hours postanesthesia. The secondary end points were the incidence of nausea, incidence of vomiting, severity of nausea (0 = no nausea to 10 = nausea as bad as it could be), use of rescue antiemetic drugs, and the occurrence of adverse events (AEs) determined through interview or spontaneous patient report for 24 hours postanesthesia.Results: A total of 198 female patients were approached for study inclusion, 18 of whom were excluded. Therefore, 180 Korean women (mean [SD] age, 46.5 [12.6] years; height, 159.8 [2.7] cm; weight, 53.2 [3.6] kg) were enrolled and completed the study. The total PONV rates up to 24 hours postanesthesia were 35%, 13%, and 10% in the dexamethasone, ramosetron, and combination groups, respectively. The PONV rate was significantly lower in the combination group than in the dexamethasone alone group (P = 0.006). The PONV rate was not significantly different in the combination group compared with the ramosetron alone group. The PONV rate in the dexamethasone alone group was significantly higher than that in the ramosetron alone group (P = 0.03). The severity of nausea (median [25th-75th percentiles], 0 [0-0] vs 0 [0-4]; P = 0.009) and rate of use of rescue antiemetic drugs (5% vs 27%; P = 0.006) were significantly lower in the combination group than in the dexamethasone alone group, whereas the severity of nausea (median [25th-75th percentiles], 0 [0-0] vs 0 [0-0]) and rate of use of rescue antiemetic drugs (5% vs 7%) were not significantly different between the combination and ramosetron alone groups. The severity of nausea (median [25th-75th percentiles], 0 [0-4] vs 0 [0-0]; P = 0.033) and the rate of use of rescue antiemetic drugs (27% vs 7%; P = 0.018) were significantly higher in the dexamethasone alone group than in the ramosetron alone group. The rates of AEs (headache: 15%, 20%, and 18%; dizziness: 18%, 22%, and 15%) were not significantly different in the dexamethasone alone, ramosetron alone, or combination groups, respectively.Conclusions: The combination of ramosetron and dexamethasone was more effective in reducing PONV than was dexamethasone monotherapy. However, the combination did not show additional benefits compared with ramosetron alone in preventing PONV after thyroidectomy in these Korean women.     

Abstract 9: Maximal bladder capacity as the predictor of response to desmopressin on nocturnal enuresis in patients with spinal cord injuries.

Objectives: To evaluate the efficacy of intranasal desmopressin inhalation on nocturnal enuresis in patients with spinal cord injury (SCI) and to investigate the validity of maximal bladder capacity as the predictor of response to intranasal desmopressin inhalation. Design: Before and after interventional trial. Setting: University-affiliated hospital. Participants: 22 adults SCI with nocturnal enuresis were divided into 2 groups: the large bladder capacity group (bladder capacity, >250mL; n=11) and the small bladder capacity group (bladder capacity, <250mL; n=11). Intervention: All participants were treated with intranasal desmopressin, 10μg daily at bedtime for 4 weeks. Main Outcome Measures: Total volume of daily nocturnal incontinence and serum electrolytes. Maximal bladder capacities were measured by urodynamic evaluation. Results: After intranasal desmopressin inhalation, mean volume of nocturnal incontinence decreased significantly in the large bladder capacity group (P<.05), but not in the small bladder capacity group (P>.05). The mean maximal bladder capacity of responders was larger than that of nonresponders (P<.05). Neither hyponatremia nor serum electrolytes abnormalities occurred. Conclusions: Intranasal desmopressin inhalation is safe and effective in symptomatic management of neurogenic bladder dysfunction in selected patients with SCI. Maximal bladder capacity is a valuable predictor of response to desmopressin.     

Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study

Background:Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy.Objective: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility.Methods: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 μg/kg) or desflurane (4%-6%) and alfentanil (20 μg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale.Results: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03).Conclusion: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.     

Abstract 4: Acupuncture analgesia and electromyography

Objectives: To evaluate the analgesic effect of a simple acupuncture protocol with needle electromyography and to validate independently a telescopic sham acupuncture needle. Design: Randomized, double-blinded, controlled study. Setting: University-based electrodiagnostics laboratory. Participants: 38 subjects referred for electrodiagnostic evaluation. Intervention: Before the electromyographic examination, an independent provider applied either real acupuncture needles or telescopic sham needles to the acupuncture points Large Intestine 4 and Liver 3 bilaterally. Main Outcome Measures: 100-mm visual analog scale (VAS) of the subjects’ pain before electromyography as well as pain and unpleasantness related to electromyography after 3 muscles were examined. Subjects were also asked if they thought they had received true acupuncture or sham needles. Pretest pain was subtracted from electromyography-related pain to give a measurement of pain attributable to the electromyography. Results: 21 subjects were randomized to the treatment group and 17 to the sham group. The subjects in the two treatment arms did not differ by age (P=0.9) or gender (P=0.4). The pain attributable to electromyography in the treatment group (mean, −5.38±27.6) was significantly less than the pain attributable to electromyography in the control group (mean, 11.3±17.3) (P=.037; 95% CI, −32.3 to −1.1) The percentage of subjects who thought they had received real needles in the acupuncture group (67%) did not differ from the proportion in the control group (53%) (Fisher exact test, P=.51). Conclusion: Acupuncture may represent an effective form of analgesia for electromyography. This is the first study of which we are aware that independently validates the telescopic sham acupuncture needle as an effective control.     

Dexmedetomidine as an adjunct to epidural analgesia after abdominal surgery in elderly intensive care patients: A prospective, double-blind, clinical trial

Background: The ideal postoperative analgesia management of elderly surgical patients in intensive care units (ICUs) is continually being investigated.Objective: The purpose of this study was to assess the effectiveness and tolerability of IV administration of dexmedetomidine as an adjunct to a low-dose epidural bupivacaine infusion for postoperative analgesia after abdominal surgery in elderly patients in the ICU.Methods: ICU patients aged >70 years undergoing abdominal surgery were eligible for the study. A lumbar epidural catheter was inserted at the beginning of the surgery with no medication. On arrival at the ICU, the catheter was loaded with 0.25% bupivacaine 25 mg at the T8 to T10 sensory level, and a continuous infusion of 0.125% bupivacaine was started at 4 to 6 mL/h in combination with patient-controlled epidural analgesia (PCEA) of fentanyl (4 μg/bolus) for pain treatment. Patients in the treatment group received dexmedetomidine as an IV loading dose of 0.6 pg/kg for 30 minutes followed by continuous infusion at 0.2 μg/kg · h^-1. Patients in the control group were not administered dexmedetomidine. The effectiveness of the pain relief was determined using a visual analog scale (VAS) (0 = no pain to 10 = worst pain imaginable) at rest. VAS score, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure, and arterial blood gases were monitored periodically for 24 hours after surgery. If required, tenoxicam (20-mg IV bolus) was used to ensure a VAS score of ≤3. The number of times PCEA and tenoxicam were administered and the occurrence of adverse events (AEs) were also recorded.Results: Sixty patients (34 men, 26 women; mean [SD] age, 75.96 [4.25] years; mean [SD] weight, 74.13 [10.62] kg) were included in the study. VAS scores were significantly lower in the dexmedetomidine group compared with the control group at hours 1, 2, and 12 (VAS [hour 1]: 2.8 [0.4], P < 0.001; VAS [hour 2]: 2.7 [0.5], P < 0.001; and VAS [hour 12]: 0.9 [0.7], P 0.044). The mean number of administrations of fentanyl via PCEA was significantly greater in the control group compared with the dexmedetomidine group (2.20 vs 6.63 times; P < 0.001). The mean number of administrations of tenoxicam was significantly lower in the treatment group than the control group (0.27 vs 1.07 times; P < 0.001). In the control group, the decreases in sedation at 0, 8, 12, 16, and 20 hours were significant compared with baseline (P = 0.024, P = 0.001, P = 0.020, P < 0.001, and P = 0.005, respectively). Mean HR, SBR and AEs (eg, bradycardia [HR <60 beats/min], respiratory depression [respiratory rate <8 breaths/min], hypotension \SBP <90 mm Hg], oversedation, hypoxia, and hypercapnia) decreased significantly in the dexmedetomidine group (all, P < 0.05). Significantly more patients in the dexmedetomidine group rated their satisfaction with postoperative pain control as excellent compared with the control group (12 vs 6 patients; P = 0.014).Conclusion: Intravenous dexmedetomidine was effective and generally well tolerated as an analgesic adjunct to epidural low-dose bupivacaine infusion for pain treatment, with lower need for opioids after abdominal surgery in these elderly intensive care patients than in the control group.     

Effects of a weight-reduction program with orlistat on serum leptin levels in obese women: A 12-week, randomized, placebo-controlled study

Background: Leptin, which has been identified as an antiobesity hormone, regulates body weight by controlling food intake and energy expenditure via the hypothalamic-pituitary-gonadal axis. It appears that leptin may be an important factor in obesity management. Orlistat, a pancreatic lipase inhibitor, could reduce fat absorption and promote weight loss due to leptin metabolism.Objective: The purpose of this study was to investigate the effects of orlistat therapy on serum leptin levels.Methods: Obese women (body mass index [BMI], 30 kg/m²) aged 18 to 50 years were randomly assigned to receive 12 weeks of oral treatment with diet-orlistat (120 mg TID) (DO group) or diet-placebo (DP group). During the treatment period, patients were asked to eat a balanced diet of -1200 to 1600 kcal/d. Body composition was determined by bioelectrical impedance. Serum leptin levels were measured using radioimmunoassay at baseline and at study end.Results: A total of 24 patients entered the study; 14 patients (mean [SE] BMI, 37.7 [1.1] kg/m²) received orlistat and 10 patients (mean [SE] BMI, 39.4 [1.3] kg/m²) received placebo. Compared with baseline, mean percentages of loss of body weight and fat mass after 12 weeks of treatment were significant in the DO group (9.1% and 14.8%, respectively; both P = 0.001) and in the DP group (9.5% and 17.6%; both P = 0.005). The between-group differences were not statistically significant. Mean (SE) serum leptin levels also decreased significantly after treatment in the DO group (16.2 [1.2] vs 9.0 [1.0] ng/mL; P = 0.001) and in the DP group (19.3 [2.1] vs 9.7 [1.4] ng/mL; P = 0.005). The between-group difference was not statistically significant.Conclusions: In this study of obese women, orlistat treatment was associated with a similar decrease in body weight, fat mass, and serum leptin levels as placebo over a 12-week period. In this regard, short-term orlistat therapy may not provide an additional effect on serum leptin levels, and reduction in leptin levels were closely related to the decrease in fat mass.     

Poster 28: Comparison of hemi-field fresnel prisms versus patching for visual neglect after stroke

Objective: To assess the effect of bilateral hemi-field prisms versus patches for treatment of visual neglect after stroke. Design: Randomized, prospective, controlled trial. Setting: Inpatient stroke unit. Participants: 38 patients with stroke, visual neglect defined by the Behavioral Inattention Test (BIT), and visual acuity ≥20/200. Interventions: The prism group received 15 diopter Fresnel prisms over the affected hemi-field bilaterally; patch group received black tape of the unaffected visual hemi-field bilaterally; controls received no visual intervention. The interventions lasted 14 days. Main Outcome Measures: 3 subtests of BIT were recorded at baseline and on days 2, 7, 14, and 16. Results: Admissions demographic were similar for all 3 groups. There were no significant differences in BIT scores while wearing the optical devices. The prism group showed a trend for improvement in all 3 BIT scores 2 days after removal of the optical device. This reached statistical significance for the line bisection scores (prism group ± SEM, 1.5±0.3; patch group, .12±.12; controls, .33±.33; P=.004). Dropouts were highest for prism group (10/16) versus patch group (4/12) and controls (1/10) (P=0.2). Conclusion: Hemi-field Fresnel prisms showed a beneficial effect on visual neglect 2 days after their removal.     

Poster 33: Evaluation of balance function on a standing platform in subjects with spina bifida occulta

Objective: To evaluate the balance tests in subjects with spina bifida (SB) occulta. Design: Prospective study. Setting: Academic hospital. Participants: 52 patients, grouped as follows: normal (group I), SB occulta at L5-S1 (group II), and SB occulta of whole sacrum (group III). Interventions: All subjects performed 12 standing balance tests, 60 seconds in each, on a plate tilting at 0°, 10°, 20°, 30°, with dorsiflexion and plantarflexion, along with eyes open and closed. Main Outcome Measures: Balance profiles (including the swing velocity and sway area) were identified and measured using CATSYS plate system. Results: The sway area in group III was significantly larger than that of groups I and II, in both the eyes-open or eyes-closed tests, and at 0° to 30° tilting (P<.05). At 20°, the sway velocity in group III was significantly higher than that of groups I and II (P<.05), however, we found no significant difference at 0°, 10°, or even 30° between groups I and II. Conclusions: The value of balance profiles increased along with the variable challenges in standing balance and with severity of SB occulta, which manifested in patients with whole-sacral SB occulta.     

Abstract 18: Plantar fasciitis: a new treatment approach.

Objective: To evaluate the efficacy of a new approach that shortens the duration of plantar fasciitis treatment. Design: Randomized controlled study. Setting: Outpatient clinic. Participants: 64 patients were randomly assigned to intensive conventional physical therapy (PT) (n=34) or needling and infiltration of the myofascial trigger points at the proximal portion of the medial gastrocnemius muscle (n=30). Interventions: Patients in the PT group received ultrasound and electric stimulation at the origin of the plantar fascia followed by stretching exercises of the gastrocnemius muscle. The other group was treated by needling and infiltration (1% lidocaine) of the taut band at the proximal portion of the medial gastrocnemius muscle of the involved limb(s). Injections were performed at weekly intervals. PT was administered for 3 consecutive days after the injections. Patients were instructed to perform stretching of the gastrocnemius muscles and of the plantar fascia at home twice a day. Main Outcome Measures: Visual analog scale and hindfoot functional test (American Orthopaedic Foot and Ankle Society Hindfoot Questionnaire) were performed before and after treatment by an independent evaluator. Duration of treatment was compared between the 2 groups. Results: Statistically significant reduction of pain and improvement in function were observed in both groups, without any differences between them. The time required to achieve the same improvement was significantly less (80%) in the injected group than in the control group (P<.001). The number of PT sessions needed was also significantly reduced (P<.001). Postinjection soreness and local hematoma were found in 30% of the patients. No local infection or other major complications were noticed in any cases. Conclusions: Although treatment in both groups was equally successful, needling and infiltration of the medial gastrocnemius muscle provided faster pain relief and functional recovery in patients with plantar fasciitis.     

Article 10: Effect of cognitive retraining on reorganization of attention network in patients with traumatic brain injury

Objective: To identify the areas of reorganization in the neural network for attention after cognitive retraining in the patients with traumatic brain injury (TBI) using functional MRI (fMRI). Design: Controlled clinical trials. Setting: Department of physical medicine and rehabilitation in general hospital. Participants: Ten TBI patients and 12 healthy volunteers participated. Interventions: Patients had received computer-assisted cognitive retraining to practice diverse attention skills for 3 to 4 weeks. Main Outcome Measures: fMRI was performed on a 3T ISOL Forte scanner with single-shot echoplanar imaging sequences before and after the intervention using a modified Posner paradigm as an activation task. Data were analyzed using Statistical Parametric Mapping 99. Results: The accuracy was lower and reaction time was slower in the patient group (P<.001). fMRI results showed more activation in the right prefrontal and less activation in the cingulate, occipitotemporal, and cerebellar regions in the patients than in the normal group. After cognitive retraining, reaction time improved significantly (P<.05). fMRI analysis showed a decrease in activation of the bilateral frontal and an increase in activation of the medial frontal areas after cognitive retraining. Conclusion: The effect of cognitive retraining was accompanied by reorganization of attention networks in frontal areas.     

Poster 19: Upper-body function and other health outcomes in breast cancer survivors

Objective: To research the relationship among upper-body function and patient characteristics, type of breast cancer treatment, and emotional health among breast cancer survivors participating in a trial of nurse case management. Design: Prospective, randomized controlled trial. Setting: Patients were recruited from 60 surgeons in 13 community and 2 public hospitals in southeast Texas from November 1, 1993, to October 31, 1996. Participants: Women (N=335) with newly diagnosed breast cancer, who were at least 65 years old in community hospitals or at least 60 years old in public hospitals. Intervention: Receipt of nurse case management services. Main Outcome Measures: Upper-extremity range of motion (ROM) and emotional health (depression, anxiety, life satisfaction, mood) at 2 and 12 months after breast cancer diagnosis. Results: 55% of patients who received nurse case management demonstrated full ROM at 2 months in contrast to 40% for the control group (P=.025). Controlling for nurse case management status, women treated with mastectomy were less likely to have full ROM at 2 months compared with women treated with breast-conserving surgery plus radiation (44% vs 74%, P<.003). At 12 months, African-American women were less likely to have full ROM than white women (66% vs 81%, P=.40). Full ROM was significantly associated (P<.05) with all measures of positive emotional health at both time periods. Conclusion: Women with nurse case management had significantly better upper-body function at 2 months after diagnosis compared with women without case management. The type of breast surgery and race were risk factors for decreased arm mobility at 2 months and 12 months. Full ROM was associated with better emotional health at both time periods.     

Poster 13: Validation of the assessment of motor and process skills among older adults in the community

Objective: To assess the validity of the Assessment of Motor and Process Skills (AMPS), an occupational therapy tool, for epidemiologic research. Design: Population-based sample. Setting: Northern New York City. Participants: 217 elders aged ≥70 years were recruited from Medicare beneficiary files. Interventions: Not applicable. Main Outcome Measures: The AMPS composite motor and cognitive process scores. Results: In this sample of nondemented older people (32% men; mean age, 78.5±5.6y; two thirds minorities), motor scores correlated highly with gait speed (.53), grip strength (.34), and tandem stand time (.36) (P<.001). Process scores were significantly lower in people with mild cognitive impairment relative to those with normal cognition (P<.001). Correlations between process scores and physical indicators, and motor scores and cognitive performance, were much lower, indicating discriminant validity. 25% of participants scored in the impaired range in motor skills, 10% in process skills, and 7.5% in both. Self-reported deficits were related to both motor and process scores. Conclusions: The AMPS appears to be a valid tool for epidemiologic research.     

Poster 41: Objectively measured personality traits in the prediction of early neurobehavioral symptoms after mild traumatic brain injury

Objective: To determine if objectively measured preinjury personality predicts early neurobehavioral symptoms after mild traumatic brain injury (TBI) compared with orthopedic injury. Design: Cohort study with matched controls; participants and significant others completed questionnaires of preinjury personality and early postinjury symptoms. Setting: Inpatient hospital and outpatient follow-up. Participants: 87 people hospitalized with mild TBI and 82 with orthopedic injury. Interventions: Not applicable. Main Outcome Measures: The NEO Personality Inventory-Revised (NEOPI-R) and Neurobehavioral Functioning Inventory (NFI). Results: For both mild TBI and orthopedic injury groups, personality traits were generally normal; concordance rates between self and significant others personality and symptoms scales were moderate. Self and significant others’ ratings of conscientiousness on the NEOPI-R were higher in the orthopedic injury than in the mild TBI group. Significant others’ reports of NFI somatic symptoms were higher in the orthopedic injury than in the mild TBI group. Stepwise linear regression showed that, in both groups, NEOPI-R agreeableness and neuroticism accounted for a significant proportion of aggressive symptoms (orthopedic injury group, R²=.56; mild TBI group, R²=.46; P<.01). In the mild TBI group, NEOPI-R neuroticism accounted for a significant proportion of depressive symptoms (R²=.44, P<.01). Unfortunately, significant findings appear to be the result of substantial content overlap between the NEOPI-R and the NFI, rather than reflecting predictive relationships. Conclusion: Objectively measured personality holds limited predictive value in understanding early neurobehavioral symptoms after mild TBI.     

Thiopurine derivatives containing triazole and steroid: Synthesis, antimalarial and antileishmanial activities

A series of novel 6-thiopurine derivates containing 1,2,3-triazole were synthesized and their in vivo antimalarial activity and in vitro antileishmanial activity were examined. The compounds 10, 11, 12 and 14 presented higher values of inhibition of parasite multiplication than chloroquine. For antileishmanial activity, the compound 14 showed activity against the three species of Leishmania tested. None of compounds showed cytotoxicity against mammalian cells.     

Article 5: A multidimensional measure of acute confusion after traumatic brain injury: the confusion assessment protocol

Objective: To provide preliminary validation of a new measure of posttraumatic confusional state (PTCS), the Confusion Assessment Protocol (CAP), that assesses 7 key symptoms of PTCS (disorientation, cognitive impairment, restlessness, fluctuation in presentation, nighttime sleep disturbance, decreased daytime arousal, psychotic-type symptoms). Design: Criterion standard investigation. Setting: Inpatient traumatic brain injury (TBI) rehabilitation program. Participants: 62 consecutive patients with moderate or severe TBI admitted for inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measure: Clinical diagnosis of delirium based on Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. Results: 38 of 44 (86%) patients who were classified as confused on the CAP met the DSM-IV criteria for delirium while only 2 of 18 (11%) patients classified as nonconfused on the CAP met the DSM-IV criteria. Overall agreement between the CAP and the DSM-IV classification was 87%. Conclusions: The CAP is a brief, structured, repeatable measure of multiple aspects of PTCS. Classification of patients as confused versus nonconfused with the CAP showed excellent agreement with clinical diagnosis of delirium using DSM-IV criteria.     

Poster 4: Comparative efficacy of 3 in-hospital rehabilitation programs on knee flexion after total knee arthroplasty: a randomized controlled trial

Objective: To compare the efficacy of 3 in-hospital rehabilitation programs with and without continuous passive motion (CPM) on knee flexion after a primary total knee arthroplasty (TKA). Design: Randomized controlled trial. Setting: Acute care hospital. Patients: 81 patients who underwent a TKA for a diagnosis of osteoarthritis were randomly assigned to 3 groups immediately after TKA: group I: conventional rehabilitation (CONV) only (n=27); group II: CONV and CPM 35min/d (n=26); and group III: CONV and CPM 2h/d (n=28). Interventions: Rehabilitation programs began the day after TKA and continued once a day until discharge. All patients were evaluated twice: before TKA and 7 to 8 days after. Main Outcome Measure: The primary measure was active knee flexion as measured with a manual goniometer in seated position by a physical therapist blinded to the study. Results: Patients’ baseline characteristics were similar. No difference between groups was found for knee flexion after intervention (ANOVA, P=.33; 95% CI of group differences: groups I-II: −5.8° to 9.2°; groups I-III: −10.3° to 4.5°; groups II-III: −12.1° to 2.9°). Conclusion: Our results did not support the use of CPM, as applied in this study, during the acute phase of rehabilitation after TKA.     

Abstract 17: A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in 3 clinically distinct groups: normal, latent, and active.

Objectives: To determine (1) whether a novel microdialysis needle can successfully sample the biochemical milieu of trigger point 1 (TP1) in the upper trapezius muscle in healthy subjects and (2) whether there are measurable differences among those with symptoms and physical findings related to myofascial trigger points (MTrPs). Design: Prospective, controlled trial. Setting: Biomedical research hospital. Participants: 3 subjects were selected based on history and physical examination for 3 groups (N=9): group 1, normal (no neck pain, no MTrP); group 2, latent (no neck pain, MTrP present); and group 3, active (neck pain, MTrP present). Intervention: Pressure algometry was performed at TP1 to determine pain pressure threshold (PPT). Samples were obtained continuously with a microdialysis needle at regular intervals, starting with needle insertion, elicitation of a local twitch response, and then posttwitch. Main Outcome Measures: PPT and levels of pH, substance P, calcitonin gene-related peptide (CGRP), bradykinin, norepinephrine, tumor necrosis factor-alpha (TNF_α), and interleukin-1β (IL-1β). Results: The active group had a lower PPT (P<.08). Overall, the amount of substance P, CGRP, bradykinin, norepinephrine, TNF_α, and IL-1β was significantly higher in the active group than in the other 2 groups (P<.01). Overall, pH was significantly lower in the active group than in the other 2 groups (P<.03). At 5 minutes, peak levels of substance P and CGRP differed significantly in all 3 groups (3>2>1, P<.02). Conclusions: This technique recovered extremely small quantities (<0.5μL) of very small substances (molecular weight, <100kd) directly from soft tissue. There were significant differences in the levels of pH, substance P, CGRP, bradykinin, norepinephrine, TNF_α, and IL-1β in those subjects with an active MTrP (symptoms, MTrP present) compared with subjects with a latent MTrP (no symptoms, MTrP present) and normal subjects (no symptoms, no MTrP).     

A Multicenter, Case-Control Study of the Effects of Antihypertensive Therapy on Orthostatic Hypotension, Postprandial Hypotension, and Falls in Octo- and Nonagenarians in Residential Care Facilities

Background: Orthostatic hypotension, postprandial hypotension, and falls are considered to be adverse drug reactions of antihypertensive therapy in older people with comorbidities. Concerns regarding these adverse events may limit the use of antihypertensive agents in this group of people.Objective: The aim of this study was to determine the relationship between antihypertensive therapy in octo- and nonagenarians and the risk for orthostatic hypotension, postprandial hypotension, and falls.Methods: This was a case-control study of octo- and nonagenarians living in residential care facilities who were receiving antihypertensive therapy and a control group who were not receiving antihypertensive therapy.Results: A total of 119 patients, 77 who were receiving regular antihypertensive therapy and 42 who were not taking any antihypertensive agents, were enrolled in the study. The prevalence of antihypertensive use, orthostatic hypotension, postprandial hypotension, and falls was high (65%, 29%, 57%, and 45%, respectively). There were no associations between antihypertensive therapy and orthostatic hypotension, postprandial hypotension, and falls. When individual classes of antihypertensive agents were examined, the only observed association was a negative association (ie, a protective effect) between potassium-sparing diuretics and falls (odds ratio, 0.2; 95% CI, 0.04-1.0).Conclusion: Antihypertensive therapy was not associated with an increased risk for orthostatic hypotension, postprandial hypotension, or falls in this case-control study of octo- and nonagenarians living in residential care facilities.