Meptazinol, a new analgesic. Hemodynamic and respiratory effects

In a prospective, randomized double-blind study the hemodynamic and respiratory effects of i.v. meptazinol, a new synthetic narcotic agonist-antagonist analgesic given in 2 dosages (2 mg/kg and 4 mg/kg), were compared over 15 min to a control group that received 0.9% saline solution as placebo. In a total of 80 patients scheduled for elective aortocoronary bypass surgery, the study was performed before and during general anesthesia and during extracorporeal circulation (ECC). A dose-dependent increase in mean arterial pressure (MAP) and total systemic resistance (TSR) were the predominant hemodynamic effects of meptazinol before and during anaesthesia (Tables 1 and 2). Within the study period no change in heart rate (HR) or cardiac index (CI) could be observed. Directly measured left ventricular parameters revealed a significant increase in left ventricular pressure (LVEDP, and dp/dtmax (Fig. 1). During ECC meptazinol injection was followed by a dose-dependent increase in perfusion pressure, indicating a direct vasoconstrictive effect; no influence on the capacitance system ("venous pooling") could be observed (Fig. 2). In the spontaneously breathing, premedicated patients (morphine hydrochloride 0.15 mg/kg and flunitrazepam 0.03 mg/kg) paO2 increased and paCO2 decreased, especially after injection of the higher dosage of meptazinol; there was no influence on intrapulmonary right-to-left shunting (Qs/Qt).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of COVID-19 on University Student Food Security

During COVID-19 restrictions in spring 2020, college students experienced closed dormitories and increased unemployment and many students moved in with their families. College students were vulnerable to food insecurity pre-pandemic and this study examined how the living situations and food security status changed for Midwestern university students due to COVID-19 restrictions. An email survey administered to Iowa State University students between the ages of 18 and 30 who physically attended campus prior to its closure produced 1434 responses. Students living with a parent or guardian increased by 44% and were less likely to experience food insecurity or less likely to work. They had lower stress and ate more home-cooked meals. Students living on their own had higher rates of food insecurity, greater stress, poorer health status, higher cooking self-efficacy, and worked more hours. Seventeen percent of all students were food insecure; related factors were non-White ethnicity, lower cooking self-efficacy, undergraduate status, receipt of financial aid, employment, stress, living in the same situation as before the campus closure, and consumption of more take-out or fast food. These individuals had more barriers to food access. Knowledge of these factors provide useful information to inform future support services for this population in similar conditions.     

Accidents related to manure in eastern Switzerland: an epidemiological study.

OBJECTIVES: Liquid manure systems and manure pits are major hazards in the agricultural workplace. The incidence of accidents related to manure is unknown. The objective of this study was to survey the liquid manure facilities of farms in eastern Switzerland and find the incidence of accidents related to manure in the region. METHODS: Retrospective cohort study and cross sectional survey of 210 farms in eastern Switzerland. RESULTS: The incidence of accidents related to manure was found to be 10.4/1000 person-years. Most accidents were categorised as minor--that is, had a benign outcome for the people involved or involved animals only. One in 33 of the farms surveyed was the scene of an accident related to manure each year. CONCLUSIONS: The medical literature on accidents related to manure mostly reports accidents with catastrophic outcomes. This study shows that this type of accident is only the tip of the iceberg. Most of the accidents reported in this study belong to a category that has hitherto been un-noticed and unreported. The term "accident related to manure" covers a broad range of events, and those resulting in serious human illness or death represent only a small part of this spectrum. A wide variety of liquid manure systems were found on the farms surveyed. Very few liquid manure facilities conformed to published safety standards.     

Use of animal models to search for candidate genes associated with essential hypertension

The use of inbred genetically hypertensive animal models enables the dissection of the underlying complex genetic traits into its individual components, and thus the elucidation and characterization of causative genes and gene variants. In addition, genetically hypertensive animal models will also be useful for the investigation of genetic characteristics that influence the effectiveness of antihypertensive therapy with specific pharmacologic agents. This report will discuss three different strategies that have recently been used for the identification of candidate gene loci or candidate genes for hypertension. The possibility to transfer of genetic data derived in animal models to human hypertension will also be considered.     

Anatomy of hierarchy: Feedforward and feedback pathways in macaque visual cortex

The laminar location of the cell bodies and terminals of interareal connections determines the hierarchical structural organization of the cortex and has been intensively studied. However, we still have only a rudimentary understanding of the connectional principles of feedforward (FF) and feedback (FB) pathways. Quantitative analysis of retrograde tracers was used to extend the notion that the laminar distribution of neurons interconnecting visual areas provides an index of hierarchical distance (percentage of supragranular labeled neurons [SLN]). We show that: 1) SLN values constrain models of cortical hierarchy, revealing previously unsuspected areal relations; 2) SLN reflects the operation of a combinatorial distance rule acting differentially on sets of connections between areas; 3) Supragranular layers contain highly segregated bottom‐up and top‐down streams, both of which exhibit point‐to‐point connectivity. This contrasts with the infragranular layers, which contain diffuse bottom‐up and top‐down streams; 4) Cell filling of the parent neurons of FF and FB pathways provides further evidence of compartmentalization; 5) FF pathways have higher weights, cross fewer hierarchical levels, and are less numerous than FB pathways. Taken together, the present results suggest that cortical hierarchies are built from supra‐ and infragranular counterstreams. This compartmentalized dual counterstream organization allows point‐to‐point connectivity in both bottom‐up and top‐down directions. J. Comp. Neurol. 522:225–259, 2014. © 2013 Wiley Periodicals, Inc.     

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Introduction

The high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes.

Methods

Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 – July 2009) and after (August 2009 – July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality.

Results

There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (Mann– Whitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77.8%) in 2008–2009 to 6 (16.7%) in 2009–2010 (chi-squared test, p<0.0001).

Conclusions

The introduction of an enhanced recovery programme following oesophagogastric surgery resulted in a significant decrease in length of median patient stay in hospital without a significant increase in associated morbidity and mortality.     

High frequency oscillation in newborn infants with respiratory failure

Objective: To report ventilation strategies, survival and complications in 39 outborn infants treated with high frequency oscillatory ventilation (HFOV).
Methodology Data were collected prospectively between 1 May 1992 and 31 December 1993 on all infants treated with HFOV who had severe respiratory failure despite optimal conventional ventilation.
Results Twenty-eight out of 39 (72%) survived. Of the 15 infants with birthweights <1500g, eight survived. Best survival rates were for infants with pulmonary interstitial emphysema with air leak (4/5) and for infants of birthweight >1500g with hyaline membrane disease (8/8), and meconium aspiration syndrome (7/7). Three infants deteriorated while on HFOV and required extracorporeal membrane oxygenation. Complications were: (i) development of pulmonary interstitial emphysema (1); (ii) recurrence of pneumothorax (3); (iii) hypotension (2); and (iv) bronchopulmonary dysplasia (9). One of the eight infants weighing <1500g who received HFOV in the first week of life developed periventricular haemorrhage.
Conclusion The initial results of HFOV for severe respiratory failure were encouraging although a learning curve was encountered with its introduction.