Dose-dependent immune response to Mycobacterium bovis BCG vaccination in neonates

In 10-week-old infants vaccinated at birth with Japanese Mycobacterium bovis BCG, the number of dermal needle penetrations correlated positively with frequency of proliferating CD4(+) T cells in whole blood following BCG stimulation for 6 days but did not correlate with secreted cytokine levels after 7 h or interferon CD4(+) T-cell frequency after 12 h of BCG stimulation.     

An inulin-type fructan enhances calcium absorption primarily via an effect on colonic absorption in humans

Calcium absorption efficiency and bone mineral mass are increased in adolescents who regularly consume inulin-type fructans (ITF). The mechanism of action in increasing absorption is unknown but may be related to increased colonic calcium absorption. We conducted a study in young adults designed to evaluate these mechanisms with a kinetic technique using (42)Ca orally and (46)Ca dosed i.v. Those who responded to 8 wk of supplementation with 8 g of a mixed short and long degree of polymerization ITF by increasing their calcium absorption had kinetic measurements analyzed to evaluate the time course of absorption. The area under the curve of the oral tracer in the blood during the 26 h after dosing was calculated and the time dependence of increased absorption determined. Eight young adults (of 13 studied), with mean calcium intake approximately 900 mg/d, responded to the ITF with an increased calcium absorption of at least 3%. In responders, absorption increased from 22.7 +/- 11.3% to 31.0 +/- 15.3%. Colonic absorption, defined as absorption that occurred >7 h after oral dosing, represented 69.6 +/- 18.6% of the increase, or 49 +/- 28 mg/d. These findings suggest that, in those who respond to ITF, its effects on calcium absorption occur principally in the colon. This benefit to ITF may be especially important when absorption in the small intestine is impaired for anatomic or physiological reasons.     

The consistency of myocardial strain derived from heart deformation analysis

The purpose of this study was to assess the consistency of semi-automated myocardial strain analysis by prototype software across field strengths, temporal resolutions, and examinations. 35 volunteers (48?±?13 years; 20% women) and 25 patients (54?±?12 years; 44% women) without significant cardiac dysfunction underwent cine cardiac magnetic resonance imaging (CMR) at 1.5 T with a temporal resolution of 39.2 msec. 34 subjects also underwent imaging at 3.0 T; 16 had repeat examinations within 14 days; and 9 underwent CMR with temporal resolutions of 12.5 and 39.2 msec on the same day. Prototype heart deformation analysis (HDA) software was used to retrospectively quantify strain from segmented balanced steady state free precession (bSSFP) cinegraphic images. Myocardial contours were automatically generated on short axis images and drawn at end-diastole by two independent reviewers on long-axis images. Contours were automatically propagated throughout the cardiac cycle. Global and regional peak systolic strain were compared across observers, field strengths, temporal resolutions, and examinations. Inter-observer agreement was excellent (ICC?>?0.87, p?<?0.01). Inter-examination variability was low, ranging from 1.7 (1.0–2.4)% to 2.5 (1.9–3.1)%, except for radial strain: 9.2 (7.6–10.5)%. Most global and regional strain values were not significantly different across field strengths and temporal resolutions (p?>?0.05). Normal global peak systolic strain values with HDA were ?25.0 (?24.0 to ?26.1)% (LV circumferential), 60.5 (55.3 to 65.6)% (LV radial), ?22.3 (?20.5 to ??24.0)% (LV longitudinal), and ?26.0 (?23.8 to ?28.2)% (RV longitudinal). HDA prototype software enabled efficient and consistent quantification of myocardial strain from conventional bSSFP cine CMR data, demonstrating clinical feasibility.     

CO<Subscript>2</Subscript> embolism can complicate transanal total mesorectal excision

Background

Carbon dioxide (CO₂) embolism is a rare but potentially devastating complication of minimally invasive abdominal and retroperitoneal surgery. Characterized by a decrease in end-tidal CO₂ (ETCO₂) and oxygen saturation (SpO₂), CO₂ emboli can cause rapid intraoperative hypotension and cardiovascular collapse. Transanal total mesorectal excision (taTME) is a novel surgical approach for rectal resection, which requires high flow CO₂ insufflation in a low volume operative field. In this setting, the incidence of CO₂ embolism is unknown; we evaluate three cases of intraoperative CO₂ embolism that occurred during the transanal portion of the TME dissection.

Methods

All taTME cases from December 2014 to March 2018 at a single institution were reviewed. Cases of CO₂ embolism were identified intraoperatively and characterized using the operative reports and anesthesia records. The transanal/pelvic insufflation included a targeted pressure of 15 mm Hg, high flow and high smoke evacuation. Physiologic derangements and management of these instances were analyzed. The postoperative course was evaluated and any complications were noted.

Results

A total of 80 taTME were performed for benign and malignant disease. Three patients (4%) developed intraoperative evidence of CO₂ embolism. Each instance occurred during the transanal portion of the dissection. Physiologic changes were marked by abrupt decrease in end-tidal ETCO₂, SpO₂, and blood pressure (BP). Management included immediate release of pneumopelvis, hemodynamic support with crystalloid or vasopressors, and placement of the patient in the Trendelenburg position with left side down. Within 10 min of the acute event, all patients had return of ETCO₂, SpO₂, and BP to pre-event levels. There were no intraoperative or postoperative sequelae including arrhythmia, myocardial infarction, stroke or death. No cases required conversion to open.

Conclusions

During taTME, rare CO₂ emboli may occur in the setting of venous bleeding during pneumopelvis, causing sudden, transient cardiovascular instability. Immediate recognition of rapid decrease in ETCO₂, SpO₂, and BP should be followed by desufflation of pneumopelvis, patient positioning in Trendelenburg and left lateral decubitus, and hemodynamic support. Increased awareness of this potential complication and maintaining a high index of suspicion will lead to preparedness of the anesthesia and surgery teams.

     

Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy

Background  

Clinicians interested in assessment and outcome measurement of upper extremity (UE) function and performance in children with cerebral palsy (CP) must choose from a wide range of tools.     

Buprenorphine in the treatment of opioid dependence.

Buprenorphine has become of increasing interest to be an alternative to methadone in the treatment of heroin addicts. The aim of the paper is to review, from a clinical perspective, the current status of what is known about the pharmacology of buprenorphine, with a particular emphasis on the issues of maintenance therapy in heroin addiction. A systematic review of published follow-up data, from observational and experimental studies was done. Electronic databases Medline and PSYNDEXplus were searched from their earliest entries. Buprenorphine appears to be a well-tolerated drug, with a benign overall side effect. Buprenorphine is an additional treatment option for heroin dependent patients, especially for those who do not wish to start or continue with methadone or for those who do not seem to benefit from adequate dosages of methadone.     

Influence of instrument taper on the resistance to fracture of endodontically treated roots.

OBJECTIVE: The aim was to compare the force required to fracture uninstrumented and instrumented canines and to investigate the root-reinforcing capability of AH Plus sealer. STUDY DESIGN: In groups 1-3 (n = 24) canals were instrumented with either GT files, FlexMaster, or stainless steel hand instruments. Twelve teeth from each group were obturated with lateral compaction using gutta-percha and AH Plus. Group 4 (n = 12) acted as uninstrumented controls. The force required to fracture the roots was measured. ANOVA, Scheffé, and t test were used for statistical analysis. RESULTS: The intact roots were significantly stronger than all groups with instrumented and unobturated roots (P < .05). Roots enlarged with GT files were significantly weaker (P < .05) than those instrumented with FlexMaster or hand instruments. Between the obturated and unobturated roots there were no significant differences (P > .05). CONCLUSIONS: The roots were significantly weakened by the preparation with greater taper instruments. An obturation with AH Plus did not increase the fracture resistance.