Can I improve postoperative outcome after abdominal surgery?

Most of the textbooks of anesthesia do not devote any chapter to anesthesia for abdominal surgery. Whereas the choice of anesthetics has minimal impact on postoperative outcome of the patient scheduled for these procedures global perioperative anesthetic management however affects postoperative recovery, convalescence, or even morbidity. This presentation highlights practical measures susceptible of reducing postoperative complications and of shortening patient convalescence.     

Households that harbour zero-dose children after door-to-door national immunization campaigns

Data from two consecutive rounds of national immunization days were analysed to identify households that harboured zero-dose children after door-to-door immunization campaigns, and to highlight settings and features associated with these households in Chad. The proportion of households harbouring zero-dose children were higher among rural than among urban dwellers and were prevalent among parents who did not know the benefit of polio immunization. These results show the need for more attention to be given to rural dwellers and parent awareness of the benefit of polio immunization.     

Enrichment of a population of mammary gland cells that form mammospheres and have in vivo repopulating activity

The identification of mammary gland stem cells (MGSC) or progenitors is important for the study of normal breast development and tumorigenesis. Based on their immunophenotype, we have isolated a population of mouse mammary gland cells that are capable of forming "mammospheres" in vitro. Importantly, mammospheres are enriched for cells that regenerate an entire mammary gland on implantation into a mammary fat pad. We also undertook cytogenetic analyses of mammosphere-forming cells after prolonged culture, which provided preliminary insight into the genomic stability of these cells. Our identification of new cell surface markers for enriching mammosphere-initiating cells, including endoglin and prion protein, will facilitate the elucidation of the cell biology of MGSC.     

Lateral hypothalamic region excites the activity of vasopressin neurons in the supraoptic nucleus through subfornical organ neurons

In urethane-anesthetized male rats, microinjection of angiotensin II into the lateral hypothalamic area excited the activity of about half (N = 7) of subfornical organ neurons (N = 15) antidromically identified as projecting to the hypothalamic supraoptic nucleus. Microinjection of angiotensin II also excited the activity of approximately one-quarter (N = 8) of putative vasopressin-secreting neurons (N = 28) in the hypothalamic supraoptic nucleus and these excitatory responses of putative vasopressin-secreting neurons were blocked (N = 3) or attenuated (N = 3) by pretreatment with the angiotensin II antagonist saralasin, but not by isotonic saline (N = 2), in the subfornical organ.     

Growth hormone co-treatment within a GnRH agonist long protocol in patients with poor ovarian response: a prospective,randomized, clinical trial

Objective The efficacy of growth hormone co-stimulation to long luteal GnRHa regimen in poor responders to COH for IVF was assessed. Methods This prospective, randomized, clinical trial was performed in a private assisted reproduction center. The study involved 61 patients who responded poorly to high dose gonadotropin treatment in their first cycles in the same center. Study group of 31 patients were given growth hormone co-treatment, daily subcutaneous injection of 4 mg from day 21 of preceding cycle along with GnRHa, until the day of hCG. Control group of 30 patients received the same treatment protocol except the growth hormone co-treatment. Primary end-point of the study was the number of oocytes fertilized whereas the pregnancy rate was the secondary end-point. Results Patients’ demographic characteristics did not differ significantly between the two groups. 2PNs in growth hormone co-treatment group was significantly higher than the control group (4.4 ± 1.8 vs 1.5 ± 0.9, p < 0.001). Although more pregnancies and more clinical pregnancies with fetal heart beat were achieved in growth hormone group (12/31), compared to the control group (6/30), the difference did not reach to statistical significance. Conclusion Poor responder women undergoing repeated assisted reproduction treatment and co-stimulated with GH achieve more oocytes, higher fertilization rate if growth hormone started in the luteal phase of previous cycle, as compared with women of the same status treated with GnRHa long protocol. The study was unable to show that clinical pregnancy rate was increased significantly.     

How does baseline anthropometry affect anthropometric outcomes in children receiving treatment for severe acute malnutrition? A secondary analysis of a randomized controlled trial

Mid‐upper arm circumference (MUAC) < 11.5 cm and weight‐for‐height Z‐score (WHZ) < −3 are used for screening for severe acute malnutrition (SAM). Underweight and concurrent wasting and stunting may better target those at the highest risk of mortality. We compared anthropometric outcomes in children enrolled in a trial of antibiotics for SAM based on categories of baseline anthropometry, including indicators for programme admission (WHZ < −3, MUAC < 11.5) and alternative indicators (weight‐for‐age Z‐score [WAZ] < −3, concurrent wasting and stunting [WHZ < −3 and height‐for‐age Z‐score < −3]). Participants were followed weekly until nutritional recovery and at 8 weeks. We evaluated changes in weight gain (g/kg/day), MUAC, and WHZ in children admitted by admissions criteria (MUAC only, WHZ only, or MUAC and WHZ) and by underweight or concurrent wasting and stunting. Of 301 admitted children, 100 (33%) were admitted based on MUAC only, 41 (14%) WHZ only, and 160 (53%) both MUAC and WHZ, 210 (68%) were underweight and 67 (22%) were concurrently wasted/stunted. Low MUAC and low WHZ children had the lowest probability of nutritional recovery (17% vs. 50% for MUAC‐only and 34% for WHZ‐only). There was no difference in weight gain velocity or WHZ by admissions criteria (WHZ and/or MUAC). Underweight and concurrently wasted/stunted children had lower MUAC and WHZ at 8 weeks compared with those who were not underweight or concurrently wasted and stunted. Children with both low MUAC and low WHZ had the worst outcomes. Relying on MUAC alone may miss children who have poor outcomes. Other indicators, such as WAZ, may be useful for identifying vulnerable children.     

Staff-rated ability to provide post-diagnosis support for patients with mild cognitive impairment and related factors

Background

Proactive interventions for patients with mild cognitive impairment (MCI) are required. We aimed to determine the staff-rated ability to provide post-diagnosis support for patients with MCI at a medical centre for dementia and the related factors.

Methods

We conducted a web-based survey on post-diagnosis support for patients with MCI among healthcare personnel, such as mental health social workers and public health nurses (hereafter referred to as ‘staff’), in consultation and support roles at medical centres for dementia nationwide. The latent characteristic value for ‘staff's self-rated ability to provide post-diagnosis support to patients with MCI’, which was estimated using the one-parameter logistic model of item response theory, was used as the dependent variable. Multivariate linear regression analysis was used to examine the factors associated with the dependent variable.

Results

We conducted the study at 482 medical centres for dementia. We received responses from 162 participants, 158 of which were valid. We applied item response theory to 45 staff-rated items regarding post-diagnosis support for patients with MCI and found that item difficulty ranged from −2.56 to 1.02; 40 items had negative values and were deemed relatively easy. The staff-rated ability to provide post-diagnosis support was significantly higher for ‘The role in assisting patients with MCI is clear’ (P < 0.005), ‘A reasonable number of personnel is available to assist immediately after MCI diagnosis’ (P = 0.001), and ‘Collaboration with family physician available immediately after MCI diagnosis’ (P < 0.001).

Conclusions

The results of this study showed that staff rated their ability to provide post-diagnosis support for patients with MCI as relatively easy. The staff-rated ability to provide post-diagnosis support to patients with MCI may be enhanced by increased availability of staff immediately after MCI diagnosis, clarification of staff roles, and collaboration with family doctors.