BOOK REVIEWS

A note of encouragement to those hesitant or waiting to write for our journal, together with a guide to some of the ‘props’ of the trade.     

Inhibitory effects of sigma‐1 ligands on handling‐induced tachycardia in conscious tethered rats

We used conscious tethered Sprague‐Dawley rats to evaluate the cardiovascular effects of four sigma‐1 (σ₁) agonists and five antagonists, given alone or in combination. All drugs were administered as a single intraperitoneal dose. The agonists were given at doses reported as efficacious in rodent cognition models, while the antagonists were administered at doses neutralizing agonist effects in vivo. Systolic blood pressure (SBP) and heart rate (HR) were continuously recorded for 20 min before and 60 min postadministration. Immediately after injection, a sudden, transitory increase in HR and SBP was noted in all animals, because of the stress induced by handling. For both parameters, a peak value (ΔHR_max and ΔSBP_max) and an area under the curve of changes from baseline over the period 5–20 min postinjection (ΔHR_AUC_{5–20 min} and ΔSBP_AUC_{5–20 min}) were calculated. Three of the four σ₁ agonists (SKF‐10,047, dehydroepiandrosterone (DHEAS), Compound 14) significantly reduced ΔHR_AUC_{5–20 min} value without changing ΔHR_max, while the fourth one, SA‐4503, had no significant effect. None of the antagonists (haloperidol, rimcazole, NE‐100, and BD1047) reduced, and even one (progesterone) enhanced the stress‐induced effects on HR. No changes in SBP were noted with any compound. When the antagonist NE‐100 was administered just before SKF‐10,047, it completely reversed the inhibitory effects of the σ₁ agonist on HR increase. In conclusion, we demonstrated for the first time the involvement of σ₁ receptors in the regulation of handling‐induced tachycardia in the conscious rat. Although additional investigations are needed to fully understand this role, it might offer new therapeutic perspectives to σ₁ ligands in the cardiovascular sphere.     

A miniature and mobile intermittent pneumatic compression device for the prevention of deep-vein thrombosis after joint replacement

The WizAir-DVT is a miniature, lightweight (690 g), battery-operated and mobile intermittent pneumatic compression device (ICD), which enables continuous intraoperative use and immediate patient mobilization postoperatively. We compared its efficacy with a commonly used ICD, the Kendall SCD. Peak femoral vein flow velocity was measured in 20 apparently healthy volunteers at rest and with each device: we found no significant differences between them. A second prospective, randomized, clinical trial was used to compare the efficiency of the device in preventing deep venous thrombosis (DVT) after joint replacement in 50 patients (n=25/group). None developed DVT. Doppler ultrasonography revealed no significant differences. The WizAir-DVT antithrombotic compression device is as safe and effective as the Kendall SCD.     

Suicidality among military-connected adolescents in California schools

Previous research indicates that suicidal ideation is higher among military-connected youth than non military-connected youth. This study extends prior work by examining suicidal ideation, plans, and attempts in military-connected and non military-connected adolescents. Data were gathered from 390,028 9th and 11th grade students who completed the 2012–2013 California Healthy Kids Survey. Bivariate comparisons and multivariate logistic analyses were conducted to examine differences in suicidal ideation, plans, attempts, and attempts requiring medical attention between military and not military-connected youth. In multivariate logistic analyses, military-connected youth were at increased risk for suicidal ideation (OR = 1.43, 95 % CI = 1.37–1.49), making a plan to harm themselves (OR = 1.19, CI = 1.06–1.34), attempting suicide (OR = 1.67, CI = 1.43–1.95), and an attempted suicide which required medical treatment (OR = 1.71, CI = 1.34–2.16). These results indicate that military-connected youth statewide are at a higher risk for suicidal ideation, plans, attempts, and attempts requiring medical care because of suicidal behaviors. It is suggested that policies be implemented to increase awareness and screening among primary care providers, school personnel, and military organizations that serve military-connected youth.     

基于基因表达综合数据库筛选调控急性T淋巴细胞白血病超高剂量率放疗敏感性的枢纽基因

目的 通过生物信息学方法对基因表达综合(GEO)数据库中超高剂量率(FLASH)放疗的数据进行分析,寻找参与调控急性T淋巴细胞白血病FLASH放疗敏感性的枢纽(Hub)基因。方法 从GEO数据库中下载和提取接受FLASH放疗恶性肿瘤基因表达谱芯片数据,采用R软件进行差异基因的筛选,并对这些基因进行生物学功能、信号传导通路等分析。通过STRING在线软件分析差异基因的蛋白质相互作用(PPI) 网络,Cytoscape插件筛选Hub基因。最后,应用肿瘤基因组图谱(TCGA)和GTEx数据库验证Hub基因在急性T淋巴细胞白血病中的表达情况。结果 自GEO数据库中获得GSE100718芯片数据,共有12 800个基因与急性T淋巴细胞白血病放疗敏感性相关。选择表达量显著改变的61个基因进行进一步分析,这些基因参与代谢、应激反应、免疫应答等生物学过程。主要涉及氧化磷酸化、未折叠蛋白应答、脂质代谢等信号转导通路。通过PPI分析筛选出的Hub基因及后续验证表明HSPA5及SCD参与调控FLASH放疗敏感性,且在合并TRD/LMO2融合基因的急性T淋巴细胞白血病中显著高表达。结论 通过生物信息学分析可以有效筛选出调控FLASH放疗敏感性的Hub基因,基因表达谱可用于指导肿瘤患者分层以实现精准放疗。     

Oral bisphosphonate use in the elderly is not associated with acute kidney injury

Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR <60?ml/min per 1.73?m(2)). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.     

Doppler‐guided haemorrhoidal artery ligation in patients with Crohn’s disease

Aim: The outcome of Doppler‐guided haemorrhoidal artery ligation (DGHAL) was assessed in patients with Crohn’s disease (CD) suffering from grade III haemorrhoids. Method: A retrospective study was carried out of patients with CD and symptomatic Grade III haemorrhoids treated by DGHAL. Perioperative and follow‐up data were retrieved from our database of patients undergoing DGHAL. Results: The study included seven men and six women. The mean age was 34 years old. All had CD without anorectal involvement. The median duration of haemorrhoidal symptoms was 6.3 years. There was no mortality, new incontinence, faecal impaction, urinary retention, abscess formation or persistent pain following the procedure. Mean pain score based on a visual analogue scale (VAS) decreased from 2.4 at 24 h postoperatively to 1.6 on the seventh postoperative day. All patients had completely recovered by the third postoperative day. At 18 months, three (77%) of the patients were asymptomatic and three had recurrent symptoms. Conclusion: Doppler‐guided haemorrhoidal artery ligation is safe and effective in treating Grade III haemorrhoids in patients with CD without rectal involvement.     

Successful fixation of Mason type 2 radial head fractures using Meniscus Arrows

Purpose

Previous experience has revealed excellent outcomes when using the Meniscus Arrow (Conmed Linvatec Ltd., Tampere, Finland) bioabsorable meniscal repair system for the fixation of small fracture fragments. This study describes the results of the fixation of Mason type 2 radial head fractures with these Arrows in a prospective series of 21 patients.

Methods

Between 2006 and 2010, a total of 21 patients were treated with Meniscus Arrows for the fixation of Mason type 2 fractures of the radial head during an open procedure. Twenty-one, twenty and seventeen patients were followed up at 2 and 6 post-operative weeks, 18 weeks and 24 months, respectively. Radiographs were obtained during follow-up visits, and range of motion was classified according to the Weseley classification.

Results

At 24 post-operative months, 88 % of patients showed ‘excellent’ and 12 % showed ‘good’ results in terms of extension. All patients (100 %) showed ‘excellent’ results for flexion, supination and pronation. Uneventful healing of the fracture was observed in all patients. No complications were noted.

Conclusion

This study shows promising outcomes for the use of Meniscus Arrows as fixation devices in the treatment for Mason type 2 fractures of the radial head.

Level of evidence

Prospective therapeutic study, Level IV.     

Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways: A survey

PURPOSE: To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways. METHODS: Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway. RESULTS: General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51%) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bronchoscope as an alternate technique (17% and 44%). CONCLUSION: Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.