Association of adiponectin and leptin with relative telomere length in seven independent cohorts including 11,448 participants

Oxidative stress and inflammation are major contributors to accelerated age-related relative telomere length (RTL) shortening. Both conditions are strongly linked to leptin and adiponectin, the most prominent adipocyte-derived protein hormones. As high leptin levels and low levels of adiponectin have been implicated in inflammation, one expects adiponectin to be positively associated with RTL while leptin should be negatively associated. Within the ENGAGE consortium, we investigated the association of RTL with adiponectin and leptin in seven independent cohorts with a total of 11,448 participants. We performed partial correlation analysis on Z-transformed RTL and LN-transformed leptin/adiponectin, adjusting for age and sex. In extended models we adjusted for body mass index (BMI) and C-reactive protein (CRP). Adiponectin showed a borderline significant association with RTL. This appeared to be determined by a single study and when the outlier study was removed, this association disappeared. The association between RTL and leptin was highly significant (r = ?0.05; p = 1.81 × 10^?7). Additional adjustment for BMI or CRP did not change the results. Sex-stratified analysis revealed no difference between men and women. Our study suggests that high leptin levels are associated with short RTL.     

Prevention of wrong route errors in a pediatric hemato-oncology ward

Three consecutive wrong route administration errors are described in detail and the ease by which enteral preparations can be given by the wrong route is discussed. By introducing the use of purple oral liquid dispensers in our pediatric department, we hope to prevent and reduce the risk of similar medications errors in the future and to improve patients safety.     

Safety and pharmacokinetics of intravenous levetiracetam infusion as add-on in status epilepticus

Purpose: To evaluate the feasibility and safety of intravenous (iv) levetiracetam (LEV) added to the standard therapeutic regimen in adults with status epilepticus (SE), and as secondary objective to assess a population pharmacokinetic (PK) model for ivLEV in patients with SE. Methods: In 12 adults presenting with SE, 2,500 mg ivLEV was added as soon as possible to standardized protocol, consisting of iv clonazepam and/or rectal diazepam, as needed followed by phenytoin or valproic acid. ivLEV was administered over approximately 5 min, in general after administration of clonazepam, regardless the need for further treatment. During 24‐h follow‐up, patients were observed for any clinically relevant side‐effects. Blood samples for PK analysis were available in 10 patients. A population PK model was developed by iterative two‐stage Bayesian analysis and compared to PK data of healthy volunteers. Results: Eleven patients with a median age of 60 years were included in the per protocol analysis. Five were diagnosed as generalized‐convulsive SE, five as partial‐convulsive SE, and one as a nonconvulsive SE. The median time from hospital admission to ivLEV was 36 min. No serious side effects could be related directly to the administration of ivLEV. During PK analysis, four patients showed a clear distribution phase, lacking in the others. The PK of the population was best described by a two‐compartment population model. Mean (standard deviation, SD) population parameters included volume of distribution of central compartment: 0.45 (0.084) L/kg; total body clearance: 0.0476 (0.0147) L/h/kg; distribution rate constants, central to peripheral compartment (k₁₂): 0.24 (0.12)/h, and peripheral to central (k₂₁): 0.70 (0.22)/h. Mean maximal plasma concentration was 85 (19) mg/L. Discussion: The addition of ivLEV to the standard regimen for controlling SE seems feasible and safe. PK data of ivLEV in patients with SE correspond to earlier values derived from healthy volunteers, confirming a two‐compartment population model.     

The Effect of Reminiscence Group Work on Life Satisfaction,Self‐Esteem and Mood of Ageing People with Intellectual Disabilities

Background This study evaluates the effects of reminiscence group work on the subjective well‐being of ageing people with intellectual disabilities. Methods The content of the successive group work sessions was manipulated as follows: a control‐phase with three ‘current topics’ sessions, an experimental phase with six ‘reminiscence’ sessions and finally three ‘current topics’ sessions. Life satisfaction, perceived self‐competence and mood were measured by questionnaires, filled in by the participants and direct support workers. Results A quasi‐experimental pre‐test–post‐test design (n = 41) did not detect any changes in life satisfaction and perceived self‐competence. For mood, a quasi‐experimental ABA‐design (n = 41) did not yield an experimental treatment effect, but a significant increase in scores was observed over time. Personality characteristics ‘extraversion’ and ‘emotional stability’, but not memory specificity were found to be significant covariates for the mood scores. Conclusion Although the study’s design did not allow us to confirm the effect of reminiscence group work, the analysis nonetheless revealed some useful indications for further research. Also, interviews conducted before and after the programme resulted in positive appraisals of the programme as a worthwhile and meaningful activity for ageing people with intellectual disability.     

Investigation of the pharmacokinetics and analgesic effects of an intramuscular injection of sustained-release sufentanil for postoperative pain: An open study

Study Objectives: To investigate the pharmacokinetics after an intramuscular (IM) injection of sufentanil in thin vegetable oil in postsurgical patients and to determine whether sustained-release IM sufentanil can provide safe and sufficient analgesia of long duration in these patients.

Design: Open study.

Setting: University hospital.

Patients: 10 ASA physical status I and II patients aged 18 to 65 years who were scheduled for elective surgery.

Interventions: All patients were premeditated with lorazepam and anesthetized with a general anesthetic technique containing nitrous oxide, fentanyl, and isoflurane. As soon as significant pain [visual analog scale score of 5 or greater (range, 0 = no pain to 10 = worst pain imaginable)] occurred during the early postoperative period, the patient received an IM injection of sustained-release sufentanil.

Measurements and Main Results: During the first 48 hours following surgery, blood samples were taken for determination of plasma sufentanil concentrations. Blood pressure, heart rate, respiratory rate, pain scores, and sedation scores were documented at the same time. The IM administration of sufentanil in thin vegetable oil provided sufficient pain relief, although the onset of analgesia was rather slow (± 1 hour). The analgesic effect was still apparent 48 hours later. Plasma concentration of sufentanil at the different time points varied from 0.021 to 0.142 ng/ml, with a mean maximal peak concentration of 0.103 ng/ml. The plasma concentration 48 hours after injection varied from 0.026 to 0.074 ng/ml.

Conclusions: Although an IM injection of sufentanil in thin vegetable oil is effective for postoperative pain relief, it is associated with wide interindividual variability in plasma concentration of sufentanil and long duration of action.     

Late salvage of a ”︁free flap„ phalloplasty: A case report

Three weeks after radial forearm free flap phalloplasty, a 28-year-old female-to-male transsexual presented with ischaemia of the neophallus. A salvage procedure was started 7 hours after onset of ischemia. Thrombectomy of the arterial pedicle did not result in venous return of the arterial inflow. Perfusion of the flap with streptokinase restored venous return. Flap perfusion was confirmed by intraoperative direct angiography of the neophallus. Six months after this salvage procedure, the flap is doing well and tactile sensibility has occurred. © 1993 Wiley-Liss Inc.