Tissue hypoxaemia causes oedema, inflammation and fibrosis in porcine bronchial transsection

Abstract Objectives. Bronchial artery revascularization in lung transplantation is disputed. This study examined the physiological consequences of porcine bronchial transsection and reanastomosis with and without bronchial artery blood supply with relation to lung transplantation. Design. Translational, controlled animal study. Twelve pigs were operated through a left lateral thoracotomy. The left bronchus was transsected and reanastomosed. In the control group (n =?6), the bronchial arteries were preserved and in the study group (n =?6) they were severed. Bronchial mucosa blood flow (BMBF) was measured with laser-Doppler velocimetry and bronchial mucosa haemoglobin saturation and concentration with diffuse reflectance spectrophotometry. Measurements were made preoperatively, postoperatively and after 1 week. Results. In the study group, left postoperative BMBF was significantly lower than preoperatively (115 vs. 210 PU/s, p =?0.0001) and lower than in the control group (115 vs. 205 PU/s, p =?0.002). Repeated measurement ANOVA showed a significant treatment effect depending on time (p =?0.0034). The left mucosal haemoglobin saturation in the study group was significantly reduced postoperatively, 92% versus 61%, with a treatment effect depending on time (p =?0.0080). The reduction in left/right ratio of the mucosal haemoglobin concentration 1 week postoperatively in the study group was insignificant. Conclusion. Bronchial transsection and reanastomosis without bronchial artery blood supply was followed by significant decrease in mucosal blood flow and saturation postoperatively, and also in tissue haemoglobin concentration at section, and provides a physiologic explanation of histological changes.     

Relationship between sperm viability as determined by flow cytometry and nonreturn rate of dairy bulls

A newly developed flow cytometric method for determination of sperm concentration and viability was tested in an insemination trial with cryopreserved bull sperm to establish the relationship between sperm viability and nonreturn rates. Semen for experimental inseminations was produced from 157 young sires (114 Holstein and 43 Jersey), each contributing 4 experimental semen collections. Straws containing approximately 15 x 10(6) motile sperm before freezing were used in 118,680 experimental inseminations performed by 254 artificial insemination technicians in 6352 Danish herds. Statistical analysis based on 44,946 experimental first inseminations showed that the major part (95.4%) of variation in the 56-day nonreturn rate (NRR56) was residual. Only 0.38% of the total variation in NRR56 was due to bulls and differences between ejaculate within bull. However, bulls were preselected, and a relatively high insemination dose was used. Correlations between sperm viability as assessed by flow cytometry and NRR56 was slightly lower than observed for microscopic assessment of sperm motility. However, flow cytometry makes it possible to achieve an objective and precise determination of sperm viability. It was therefore possible to calculate the effect on NRR56 provided selection of semen is based on the flow cytometric method. Three freezing extenders were used in this experiment, but a significant difference in NRR56 was not observed. Flow cytometric results for 1 extender (Biociphos Plus) indicated poorer sperm survival during postthaw incubation compared with Triladyl extender with whole and with clarified egg yolk.     

Antagonism of atracurium-induced block in obese patients

Purpose

To investigate the relationship between total body weight (TBW) or body mass index (BMI) and atracurium reversal time.

Methods

The study population comprised 25 patients with TBW < 80 kg and 25 patients with TBW ≥80 kg anaesthetised with midazolam, thiopentone, fentanyl, nitrous oxide and halothane. Neuromuscular block was induced with 0.5 mg· kg^?1 atracurium and maintained with doses of 0.15 mg· kg^?1. Neuromuscular transmission was recorded using train-of-four (TOF) nerve stimulation and mechanomyography. Neostigmine, 0.07 mg· kg^?1, was administered when the first twitch in TOF had recovered to 10% of control. Reversal time was defined as: time from administration of neostigmine until TOF ratio recovered to 0.70.

Results

There was no difference in reversal time between patients with TBW < 80 kg (7.2 ± 2.6 min, mean ± SD), and patients with TBW ≥80 kg (6.9 ± 3.6 min). When patients were grouped according to BMI there was no difference in reversal time between groups with low BMI (6.9 ± 2.6 min) or high BMI (7.1 ± 3.6 min). There was, furthermore, no difference in reversal time between the 15 patients in the study population with the smallest TBW or BMI and the 15 patients with the greatest TBW or BMI. There was no correlation between TBW or BMI and reversal time.

Conclusion

When atracurium-induced neuromuscular block is antagonised with 0.07 mg· kg^?1 neostigmine, TBW or BMI have no influence on reversal time.     

Are conventional microbiological diagnostics sufficiently expedient in the era of rapid diagnostics? Evaluation of conventional microbiological diagnostics of orthopedic implant-associated infections (OIAI)

Background and purpose — In a time when rapid diagnostics are increasingly sought, conventional procedures for detection of microbes causing orthopedic implant-associated infections (OIAI) seem extensive and time-consuming, but how extensive are they? We assessed time to (a) pathogen identification, (b) antibiotic susceptibility patterns, and (c) targeted antibiotic treatment using conventional microbiological diagnostics of OIAI in a consecutive series of patients.Patients and methods — Consecutive patients aged ≥18 years undergoing first revision surgery for acute OIAI, including prosthetic joints, fracture, and osteotomy implants, in 2017–2018 at Akershus University Hospital (Ahus), Norway were included. Information regarding microbiological diagnostics and clinical data was collected retrospectively from the hospital’s diagnostic and clinical databases.Results — 123 patients fulfilled the inclusion criteria. Median time to pathogen identification was 2.5 days and to antibiotic treatment recommendations was 3.5 days. The most common pathogens were S. aureus (52%) and S. epidermidis (15%). Cultures were inconclusive in 11% of the patients. Of the 109 patients with culture-positive results, antibiotic treatment was changed in 66 (61%) patients within a median of 4 days (0–24) after the recommendation was given.Interpretation — Conventional microbiological diagnostics of OIAI is time-consuming, taking days of culturing. Same-day diagnostics would vastly improve treatment efficacy, but is dependent on rapid implementation by clinicians of the treatment recommendations given by the microbiologist.

The majority of orthopedic procedures include the use of implants, which increase the risk of infection due to the reduced number of bacteria needed to establish an infection (Zimmerli et al. 1982). Orthopedic implant-associated infections (OIAI) are infrequent per se, with an overall surgical site infection rate following implant surgery of 3% (Skråmm et al. 2012). However, the number of patients undergoing orthopedic implant surgery is high and increasing (Norwegian National Advisory Unit on Arthroplasty and Hip Fractures 2020).A microbiological diagnosis is vital for providing the best treatment, with regards to both surgical options and providing targeted and narrow-spectrum antimicrobial therapy (Beam and Osmon 2018). Today’s conventional diagnostics include microbiological culturing of 5 biopsies from each infected patient on several different media for at least 5 days dependent on growing and dividing bacteria (Bergh et al. 2011, Osmon et al. 2013). More rapid diagnostic tools are being developed, but with varying degrees of sensitivity and specificity (Bonanzinga et al. 2017, Jun and Jianghua 2018, Aamot et al. 2019).We assessed time to (a) pathogen identification, (b) antibiotic susceptibility patterns, and (c) targeted antibiotic treatment using conventional microbiological diagnostics of OIAI in a consecutive series of patients.     

Influence of Preoperative and Postoperative Pelvic Floor Muscle Training (PFMT) Compared with Postoperative PFMT on Urinary Incontinence After Radical Prostatectomy: A Randomized Controlled Trial

Background

The efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear.

Objective

To determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP.

Design, setting, and participants

A randomized controlled trial enrolled 180 men who planned to undergo ORP/RARP.

Intervention

The experimental group (E, n = 91) started PFMT 3 wk before surgery and continued after surgery. The control group (C, n = 89) started PFMT after catheter removal.

Outcome measurements and statistical analysis

The primary end point was time to continence. Patients measured urine loss daily (24-h pad test) until total continence (three consecutive days of 0 g of urine loss) was achieved. Secondary end points were 1-h pad test, visual analog scale (VAS), International Prostate Symptom Score (IPSS), and quality of life (King's Health Questionnaire [KHQ]). Kaplan-Meier analysis and Cox regression with correction for two strata (age and type of surgery) compared time and continence. The Fisher exact test was applied for the 1-h pad test and VAS; the Mann-Whitney U test was applied for IPSS and KHQ.

Results and limitations

Patients with additional preoperative PFMT had no shorter duration of postoperative UI compared with patients with only postoperative PFMT (p = 0.878). Median time to continence was 30 and 31 d, and median amount of first-day incontinence was 108 g and 124 g for groups E and C, respectively. Cox regression did not indicate a significant difference between groups E and C (p = 0.773; hazard ratio: 1.047 [0.768–1.425]). The 1-h pad test, VAS, and IPSS were comparable between both groups. However, “incontinence impact” (KHQ) was in favor of group E at 3 mo and 6 mo after surgery.

Conclusions

Three preoperative sessions of PFMT did not improve postoperative duration of incontinence.

Trial registration

Netherlands Trial Register No. NTR 1953.     

Evaluating Components of Dental Utilization among Adults with Diabetes and Matched Controls via Hurdle Models

ABSTRACT: BACKGROUND: About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes. METHODS: Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002-2006. Dental and medical records from WDS and GH were linked for enrolees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups. RESULTS: We found that adults with diabetes had lower odds of visiting a dentist (OR=0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxes (OR=0.77), fillings (OR=0.80) and crowns (OR=0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR=1.24), non-surgical periodontal procedures (OR=1.30), extractions (OR=1.38) and removable prosthetics (OR=1.36) (p < 0.001 for all). CONCLUSIONS: Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.     

Superficial pemphigus during the treatment of rheumatoid polyarthritis with D-penicillamine and piroxicam (Feldene)

The authors report a new case of induced pemphigus: a 64-year-old man has had rheumatoid arthritis for 10 years. When he developed his pemphigus, he had been taking D-penicillamine and piroxicam for about 8 months. He needed high doses of prednisolone associated with azathioprine to clear his eruption. The case had a fatal outcome.     

An update on airborne contact dermatitis: 2007–2011

Background. Reviews on irritant and allergic airborne contact dermatitis have been previously reported in the literature. Materials and methods. Here, we present an update based on recently published airborne‐induced skin reactions. For this survey, we screened the journals Contact Dermatitis, Dermatitis, and included relevant articles from other journals during the period January 2007 to December 2011. We also present the airborne cases observed in our department during the same time period. Results. This survey provides an updated list of causal agents that have produced airborne allergic contact dermatitis, and briefly mentions some other types of skin reaction induced by airborne exposure. The sources of the reactions are multiple: drugs; plants, natural resins, and wood allergens; plastics, rubbers, and glues; preservatives and other chemicals; and metals. Conclusions. Airborne contact dermatitis is frequent, and most of the airborne allergens (and irritants) identified are in occupational settings. Drugs and preservatives have recently become more important causes. Dermatologists and occupational physicians need to be aware of them.