ResearchPad - clinical-research-article https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort]]> https://www.researchpad.co/article/elastic_article_15141 Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment.

Objective: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents.

Method: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors.

Results: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change.

Conclusions: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.

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<![CDATA[The development and validation of a cerebral ultrasound scoring system for infants with hypoxic-ischaemic encephalopathy]]> https://www.researchpad.co/article/Ne6611d1c-1aa3-4f16-89bb-eedd39dbdeee

Background

Hypoxic-ischaemic encephalopathy (HIE) is an important cause of morbidity and mortality in neonates. When the gold standard MRI is not feasible, cerebral ultrasound (CUS) might offer an alternative. In this study, the association between a novel CUS scoring system and neurodevelopmental outcome in neonates with HIE was assessed.

Methods

(Near-)term infants with HIE and therapeutic hypothermia, a CUS on day 1 and day 3–7 after birth and available outcome data were retrospectively included in cohort I. CUS findings on day 1 and day 3–7 were related to adverse outcome in univariate and the CUS of day 3–7 also in multivariable logistic regression analyses. The resistance index, the sum of deep grey matter and of white matter involvement were included in multivariable logistic regression analyses. A comparable cohort from another hospital was used for validation (cohort II).

Results

Eighty-three infants were included in cohort I and 35 in cohort II. The final CUS scoring system contained the sum of white matter (OR = 2.6, 95% CI 1.5–4.7) and deep grey matter involvement (OR = 2.7, 95% CI 1.7–4.4). The CUS scoring system performed well in cohort I (AUC = 0.90) and II (AUC = 0.89).

Conclusion

This validated CUS scoring system is associated with neurodevelopmental outcome in neonates with HIE.

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<![CDATA[Electroacupuncture Mimics Exercise-Induced Changes in Skeletal Muscle Gene Expression in Women With Polycystic Ovary Syndrome]]> https://www.researchpad.co/article/N1c408ac9-45c8-49da-af3d-3ab504cb21bb

Abstract

Context

Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture but the mechanisms are largely unknown.

Objective

To identify the molecular mechanisms underlying electroacupuncture-induced glucose uptake in skeletal muscle in insulin-resistant overweight/obese women with and without polycystic ovary syndrome (PCOS).

Design/Participants

In a case-control study, skeletal muscle biopsies were collected from 15 women with PCOS and 14 controls before and after electroacupuncture. Gene expression and methylation was analyzed using Illumina BeadChips arrays.

Results

A single bout of electroacupuncture restores metabolic and transcriptional alterations and induces epigenetic changes in skeletal muscle. Transcriptomic analysis revealed 180 unique genes (q < 0.05) whose expression was changed by electroacupuncture, with 95% of the changes towards a healthier phenotype. We identified DNA methylation changes at 304 unique sites (q < 0.20), and these changes correlated with altered expression of 101 genes (P < 0.05). Among the 50 most upregulated genes in response to electroacupuncture, 38% were also upregulated in response to exercise. We identified a subset of genes that were selectively altered by electroacupuncture in women with PCOS. For example, MSX1 and SRNX1 were decreased in muscle tissue of women with PCOS and were increased by electroacupuncture and exercise. siRNA-mediated silencing of these 2 genes in cultured myotubes decreased glycogen synthesis, supporting a role for these genes in glucose homeostasis.

Conclusion

Our findings provide evidence that electroacupuncture normalizes gene expression in skeletal muscle in a manner similar to acute exercise. Electroacupuncture might therefore be a useful way of assisting those who have difficulties performing exercise.

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<![CDATA[Novel Roles of Chloroquine and Hydroxychloroquine in Graves’ Orbitopathy Therapy by Targeting Orbital Fibroblasts]]> https://www.researchpad.co/article/N84dfa519-4574-43b4-a8a6-e9dda5033454

Abstract

Context

Graves’ orbitopathy (GO) causes infiltrative exophthalmos by inducing excessive proliferation, adipogenesis, and glycosaminoglycan production in orbital fibroblasts (OFs). Interference with OF autophagy is a potential therapy for proptosis.

Objectives

Here, we aimed to evaluate the effects of chloroquine (CQ) and hydroxychloroquine (HCQ), the autophagy inhibitors commonly used in clinical practice, on OFs.

Design/Setting/Participants

OFs isolated from patients with GO (GO-OFs) or control individuals (non-GO-OFs) were cultured in proliferation medium (PM) or subjected to differentiation medium. OFs were treated with CQ or HCQ (0, 0.5, 2, and 10 μM), and subsequently examined in vitro.

Main Outcome Measures

CCK-8, EdU incorporation, and flow cytometry assays were used to assess cellular viability. Adipogenesis was assessed with Western blot analysis, real-time polymerase chain reaction (PCR) , and Oil Red O staining. Hyaluronan production was determined by real-time PCR and enzyme-linked immunosorbent assay. Autophagy flux was detected through red fluorescent protein (RFP)-green fluorescent protein (GFP)-LC3 fluorescence staining and Western blot analyses.

Results

CQ/HCQ halted proliferation and adipogenesis in GO-OFs in a concentration-dependent manner through blockage of autophagy, phenotypes that were not detected in non-GO-OFs. The inhibitory effect of CQ/HCQ on hyaluronan secretion of GO-OFs was also concentration dependent, mediated by downregulation of hyaluronan synthase 2 rather than hyaluronidases. Moreover, CQ (10 μM) induced GO-OF apoptosis without aggravating oxidative stress.

Conclusions

The antimalarials CQ/HCQ affect proliferation, adipogenesis, and hyaluronan generation in GO-OFs by inhibiting autophagy, providing evidence that they can be used to treat GO as autophagy inhibitors.

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<![CDATA[Clinical MEN-1 Among a Large Cohort of Patients With Acromegaly]]> https://www.researchpad.co/article/N350e9404-9e87-4100-8a41-d56c68f00bac

Abstract

Context

Clinical multiple endocrine neoplasia type 1 (MEN-1) is diagnosed by the presence of at least 2 MEN-1–associated tumors. Many patients with acromegaly and clinical MEN-1 yield negative testing for MEN1 mutations. While cases of acromegaly and primary hyperparathyroidism (PHP) with negative genetic testing have been reported, its prevalence among patients with acromegaly is undetermined, and the clinical presentation has not been well characterized.

Objectives

The main goals of this study are: (1) To determine the prevalence of clinical MEN-1 with PHP in patients with acromegaly and characterize their clinical features; and (2) to evaluate the genetic basis for the coexistence of acromegaly and PHP.

Design

Retrospective record review and genetic analysis.

Setting

Clinical Research Centers.

Participants

414 patients with acromegaly.

Interventions

Clinical evaluation and DNA sequencing for MEN1, CDKN1A, CDKN1B, CDKN2B, CDKN2C, and AIP genes.

Main outcome measurements

Clinical and genetic analysis.

Results

Among patients with acromegaly, clinical MEN-1, as defined by the presence of at least one other MEN-1-associated tumor, was present in 6.6%. PHP occurred in 6.1%; more than half had parathyroid hyperplasia. DNA sequencing was unrevealing for genetic mutations, except for 1 case of a CDC73 mutation. Acromegaly was diagnosed at an older age with a higher prevalence of malignancies (specifically breast and thyroid) in patients with coexisting PHP than those with isolated acromegaly.

Conclusions

A distinct phenotype is described in patients with clinical MEN-1 and negative genetic testing for mutations previously associated with this syndrome. Further studies are needed to identify other genes that may explain the association between PHP and acromegaly.

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<![CDATA[Acute Effects of Glucagon on Reproductive Hormone Secretion in Healthy Men]]> https://www.researchpad.co/article/Nf332f4c6-a5c1-4e2e-8936-2d428235dc5b

Abstract

Context

Glucagon increases energy expenditure; consequently, glucagon receptor agonists are in development for the treatment of obesity. Obesity negatively affects the reproductive axis, and hypogonadism itself can exacerbate weight gain. Therefore, knowledge of the effects of glucagon receptor agonism on reproductive hormones is important for developing therapeutics for obesity; but reports in the literature about the effects of glucagon receptor agonism on the reproductive axis are conflicting.

Objective

The objective of this work is to investigate the effect of glucagon administration on reproductive hormone secretion in healthy young men.

Design

A single-blinded, randomized, placebo-controlled crossover study was conducted.

Setting

The setting of this study was the Clinical Research Facility, Imperial College Healthcare NHS Trust.

Participants

Eighteen healthy eugonadal men (mean ± SEM: age 25.1 ± 1.0 years; body mass index 22.5 ± 0.4 kg/m2; testosterone 21.2 ± 1.2 nmol/L) participated in this study.

Intervention

An 8-hour intravenous infusion of 2 pmol/kg/min glucagon or rate-matched vehicle infusion was administered.

Main Outcome Measures

Luteinizing hormone (LH) pulsatility; LH, follicle-stimulating hormone (FSH), and testosterone levels were measured.

Results

Although glucagon administration induced metabolic effects (insulin area under the curve: vehicle 1065 ± 292 min.µU/mL vs glucagon 2098 ± 358 min.µU/mL, P < .001), it did not affect LH pulsatility (number of LH pulses/500 min: vehicle 4.7 ± 0.4, glucagon 4.2 ± 0.4, P = .22). Additionally, there were no significant differences in circulating LH, FSH, or testosterone levels during glucagon administration compared with vehicle administration.

Conclusions

Acute administration of a metabolically active dose of glucagon does not alter reproductive hormone secretion in healthy men. These data are important for the continued development of glucagon-based treatments for obesity.

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<![CDATA[Presenting Features in 269 Patients With Clinically Nonfunctioning Pituitary Adenomas Enrolled in a Prospective Study]]> https://www.researchpad.co/article/N2221b254-eac2-4e6e-b4ce-ef1f6ce3d808

Abstract

Context

Clinically nonfunctioning pituitary adenomas (CNFPAs) typically remain undetected until mass effect symptoms develop. However, currently, head imaging is performed commonly for many other indications, which may increase incidental discovery of CNFPAs. Since current presentation and outcome data are based on older, retrospective series, a prospective characterization of a contemporary CNFPA cohort was needed.

Objective

To determine the prevalence of incidental presentation and hypopituitarism and its predictors in a CNFPA cohort that spanned 6 to 9 mm micro- to macroadenoma included observational and surgical therapy.

Methods

At enrollment in a prospective, observational study, 269 patients with CNFPAs were studied by history, examination, blood sampling, and pituitary imaging analysis and categorized into incidental or symptoms presentation groups that were compared.

Results

Presentation was incidental in 48.7% of patients and due to tumor symptoms in 51.3%. In the symptoms and incidental groups, 58.7% and 27.4% of patients had hypopituitarism, respectively, and 25% of patients with microadenomas had hypopituitarism. Many had unappreciated signs and symptoms of pituitary disease. Most tumors were macroadenomas (87%) and were larger in the symptoms than incidental and hypopituitary groups than in the eupituitary groups. The patients in the incidental group were older, and males were older and had larger tumors in both the incidental and symptoms groups.

Conclusions

Patients with CNFPAs commonly present incidentally and with previously unrecognized hypopituitarism and symptoms that could have prompted earlier diagnosis. Our data support screening all large micro and macro-CNFPAs for hypopituitarism. Most patients with CNFPAs still have mass effect signs at presentation, suggesting the need for more awareness of pituitary disease. Our ongoing, prospective observation of this cohort will assess outcomes of these CNFPA groups.

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<![CDATA[Adipocyte Fatty Acid-Binding Protein 4 is Altered in Growth Discordant Dichorionic, but not in Monochorionic Twins]]> https://www.researchpad.co/article/Ne54c23c1-fba9-4b79-9fa9-9c736943675d

Abstract

Context

The fetal period has a critical and long-lasting impact on the regulation of metabolic processes and a life-long predisposition for obesity and metabolic syndrome. The exact mechanisms are unknown, but epigenetic regulation likely plays a major role. Twins represent an excellent model to study these mechanisms, as they share the same intrauterine environment and similar or even the same genetic information. We examined cord blood levels of adipocyte fatty-acid binding protein 4 (A-FABP or FABP4), a novel adipokine correlated with obesity and metabolic disease in children and adults.

Objective

To examine A-FABP levels in the cord blood of twins with concordant and discordant growth and in singletons with intrauterine growth restriction (IUGR).

Design

Cohort study of 36 twin pairs (25 growth concordant and 11 growth discordant), and 42 singleton pregnancies (28 IUGR and 13 normally grown controls, 1 HELLP).

Outcome Measures

Cord blood A-FABP levels measured by enzyme-linked immunosorbent assay (ELISA).

Results

A-FABP levels were higher in the smaller of growth discordant dichorionic (DC) twins versus their co-twins (109.46 ± 62.80 ng/mL vs. 72.93 ± 36.66 ng/mL, P = 0.028). A-FABP was negatively correlated with birth weight and gestational age (P < 0.001), but not with birth weight z-score (P = 0.37).

Conclusions

Increased A-FABP levels might be associated with an increased metabolic risk in growth-restricted (twins) and prematurely born infants.

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<![CDATA[Predicting Skeletal Muscle and Whole-Body Insulin Sensitivity Using NMR-Metabolomic Profiling]]> https://www.researchpad.co/article/N445ae5fa-0dab-45f1-90a5-5b9731a3b64c

Abstract

Purpose

Abnormal lipoprotein and amino acid profiles are associated with insulin resistance and may help to identify this condition. The aim of this study was to create models estimating skeletal muscle and whole-body insulin sensitivity using fasting metabolite profiles and common clinical and laboratory measures.

Material and Methods

The cross-sectional study population included 259 subjects with normal or impaired fasting glucose or type 2 diabetes in whom skeletal muscle and whole-body insulin sensitivity (M-value) were measured during euglycemic hyperinsulinemic clamp. Muscle glucose uptake (GU) was measured directly using [18F]FDG-PET. Serum metabolites were measured using nuclear magnetic resonance (NMR) spectroscopy. We used linear regression to build the models for the muscle GU (Muscle-insulin sensitivity index [ISI]) and M-value (whole-body [WB]-ISI). The models were created and tested using randomly selected training (n = 173) and test groups (n = 86). The models were compared to common fasting indices of insulin sensitivity, homeostatic model assessment—insulin resistance (HOMA-IR) and the revised quantitative insulin sensitivity check index (QUICKI).

Results

WB-ISI had higher correlation with actual M-value than HOMA-IR or revised QUICKI (ρ = 0.83 vs −0.67 and 0.66; P < 0.05 for both comparisons), whereas the correlation of Muscle-ISI with the actual skeletal muscle GU was not significantly stronger than HOMA-IR’s or revised QUICKI’s (ρ = 0.67 vs −0.58 and 0.59; both nonsignificant) in the test dataset.

Conclusion

Muscle-ISI and WB-ISI based on NMR-metabolomics and common laboratory measurements from fasting serum samples and basic anthropometrics are promising rapid and inexpensive tools for determining insulin sensitivity in at-risk individuals.

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<![CDATA[Revisiting the Population Genetics of Human Height]]> https://www.researchpad.co/article/Nadb9a432-37d4-4d50-b23b-2a8d2fd4fac3

Abstract

Context

Recent advances in genetics and genomics present unique opportunities for enhancing knowledge of human physiology and disease susceptibility. An outstanding example of these new insights may be seen in the study of human height, of which it has been estimated that approximately 80% is genetically determined. Over the past decade, large-scale population analyses have led to the identification of novel variation in genes and loci individually associated with changes in adult height of as much as 2 cm.

Objective

To assess these same variants in the genomes of 213 158 individuals compiled by the Genome Aggregation Database (GnomAD) consortium, representing different population groups from around the world.

Results

The majority of these height-changing alleles are substantially less prevalent in GnomAD than found previously in other cohorts, with 4 of 5 amino acid substitution variants with the largest impact on adult height being more frequent in the European population than in other groups.

Conclusions

A larger-scale analysis of individuals from diverse backgrounds will be necessary to ensure a full and accurate understanding of the genetic underpinnings of human height throughout the world, and additional studies will be needed to discern the biochemical and molecular mechanisms governing the physiological processes that explain how these variant proteins might selectively impact the biology of the growth plate. Broader understanding of the genetics of height also should set the stage for more comprehensive investigation into the causes of prevalent polygenic human diseases.

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<![CDATA[Inter-rater reliability of the modified Sarnat examination in preterm infants at 32–36 weeks’ gestation]]> https://www.researchpad.co/article/N71c873e1-a425-4de0-84b8-a460713cf195

Objective

To test the inter-rater reliability of the modified Sarnat neurologic examination in preterm neonates and to correlate abnormalities with the presence of perinatal acidosis.

Methods

Prospective study of 32–36 weeks’ gestational age infants admitted to the neonatal intensive care unit. Each infant had two Sarnat examinations performed at <6 h, one by a gold standard (GS) study investigator, and the second either by (a) another GS examiner or (b) an attending physician (28 examiners), all blinded to clinical variables. Agreement was calculated using kappa (k) statistics.

Results

One hundred and two (9, fetal acidosis) infants underwent a modified Sarnat examination. Among GS examiners, agreement was excellent (k > 0.8) except for Moro, while among all examiners agreement was very good (k > 0.7) except for both Moro and tone. Subgroup analysis at 32–34 weeks’ showed fair/poor Moro compared to excellent agreement at ≥35 weeks. Increasing abnormalities correlated with acidosis (r = −0.6, P < 0.01).

Conclusions

Strong inter-rater reliability for the modified Sarnat was observed except for tone and Moro in preterm infants. Experience of the examiners resulted in improved reliability in tone, while for the Moro agreement improved only beyond 35 weeks. Findings suggest the need of adjustment of the examination form specific for preterm infants.

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<![CDATA[Defining and distinguishing infant behavioral states using acoustic cry analysis: is colic painful?]]> https://www.researchpad.co/article/N4a6f460a-6236-4005-bd4b-a619b09f4e03

Background

To characterize acoustic features of an infant’s cry and use machine learning to provide an objective measurement of behavioral state in a cry-translator. To apply the cry-translation algorithm to colic hypothesizing that these cries sound painful.

Methods

Assessment of 1000 cries in a mobile app (ChatterBabyTM). Training a cry-translation algorithm by evaluating >6000 acoustic features to predict whether infant cry was due to a pain (vaccinations, ear-piercings), fussy, or hunger states. Using the algorithm to predict the behavioral state of infants with reported colic.

Results

The cry-translation algorithm was 90.7% accurate for identifying pain cries, and achieved 71.5% accuracy in discriminating cries from fussiness, hunger, or pain. The ChatterBaby cry-translation algorithm overwhelmingly predicted that colic cries were most likely from pain, compared to fussy and hungry states. Colic cries had average pain ratings of 73%, significantly greater than the pain measurements found in fussiness and hunger (p < 0.001, 2-sample t test). Colic cries outranked pain cries by measures of acoustic intensity, including energy, length of voiced periods, and fundamental frequency/pitch, while fussy and hungry cries showed reduced intensity measures compared to pain and colic.

Conclusions

Acoustic features of cries are consistent across a diverse infant population and can be utilized as objective markers of pain, hunger, and fussiness. The ChatterBaby algorithm detected significant acoustic similarities between colic and painful cries, suggesting that they may share a neuronal pathway.

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<![CDATA[Peripheral nerve block combined with general anesthesia for lower extremity amputation in hemodialysis patients: case series]]> https://www.researchpad.co/article/N8212b20e-f968-4854-88ee-b60709f3c339

Background

Anesthetic management of lower extremity amputation in chronic hemodialysis (HD) patients can be challenging because of their poor cardiovascular status. As previously reported, peripheral nerve block (PNB) may be beneficial in these complicated cases. We report the effects of PNB combined with general anesthesia on hemodynamic stability in HD patients undergoing elective lower extremity amputation.

Methods

We retrospectively analyzed 13 HD patients who underwent lower extremity amputation. Patients received general anesthesia (GA group, n = 7) or general anesthesia combined with PNB (GA with PNB group, n = 6), as decided by the anesthesiologists. Mean blood pressure (MBP), systolic blood pressure (SBP), lowest BP, heart rate (HR), blood loss, fluid and blood infusion volumes, and doses of vasopressors required were compared for hemodynamic assessment. The coefficient of variation ([TeX:] \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \mathrm{CV}=\upsigma /\overline{\mathcal{X}} $$\end{document}CV=σ/X¯) of MBP (CVMBP) and SBP (CVSBP) was calculated to compare hemodynamic stability. Intraoperative opioid use and postoperative pain scores at rest using a numerical rating scale (NRS) on postoperative days 0 and 1 were compared for pain assessment. We also assessed 30-day mortality.

Results

CVMBP in the GA group was significantly higher than that in the GA with PNB group (0.15 ± 0.05 and 0.08 ± 0.04, respectively, p = 0.03). The CVSBP in the GA group was also significantly higher than that in the GA with PNB group (0.16 ± 0.02 and 0.09 ± 0.01, respectively, p = 0.03). No significant differences in other hemodynamic parameters were observed. Intraoperative fentanyl doses were significantly lower in the GA with PNB group (GA 210.7 ± 99.9 μg vs. GA with PNB 113.0 ± 75.6 μg, p = 0.04). There were no significant differences in other pain parameters and 30-day mortality between the groups.

Conclusion

Our results suggest that PNB combined with general anesthesia contributes to intraoperative hemodynamic stability through better pain control in HD patients undergoing lower extremity amputation.

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<![CDATA[The effects of intravenous anesthetics on QT interval during anesthetic induction with desflurane]]> https://www.researchpad.co/article/N3d05a860-b5d8-4fc8-ad97-cadc1a48a5fb

Introduction

This study aimed to determine the effects of the interaction between intravenous anesthetics and desflurane on the QT interval.

Methods

Fifty patients who underwent lumbar spine surgery were included. The patients received 3 μg/kg fentanyl and were randomly divided into two groups: group P patients received 1.5 mg/kg propofol and group T patients received 5 mg/kg thiamylal 2 min after fentanyl injection. All patients received rocuronium and desflurane (6% inhaled concentration) after loss of consciousness. Tracheal intubation was performed 3 min after rocuronium injection. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and the heart rate-corrected QT (QTc) interval on a 12-lead electrocardiograms were recorded before fentanyl injection (T1), 2 min after fentanyl injection (T2), 1 min after propofol or thiamylal injection (T3), immediately before intubation (T4), and 2 min after intubation (T5).

Results

There were no significant intergroup differences in patient characteristics. BIS and MAP decreased after anesthesia induction in both groups. MAP values at T3, T4, and T5 in group T were higher than those in group P. HR did not change over time or differ between the groups. The QTc intervals at T4 and T5 in group T were longer than those at T1. In group P, the QTc interval at T3 was significantly shorter than that at T1. The QTc intervals at T3, T4, and T5 in group T were significantly longer than those in group P.

Conclusions

A propofol injection could counteract the QTc interval prolongation during desflurane anesthesia induction.

Trial registration

UMIN Clinical Trials Registry database reference number: UMIN000023707. This study was registered on August 21, 2016.

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<![CDATA[The Surgical Apgar Score can help predict postoperative complications in femoral neck fracture patients: a 6-year retrospective cohort study]]> https://www.researchpad.co/article/N822ad469-9dca-47d9-9a38-ddefff77b522

Introduction

The postoperative mortality rate following a femoral neck fracture remains high. The Surgical Apgar Score (SAS), based on intraoperative blood loss, the lowest mean arterial pressure, and the lowest heart rate, was created to predict 30-day postoperative major complications. Here, we evaluated the relationship between the SAS and postoperative complications in patients who underwent femoral neck surgeries.

Methods

We retrospectively collected data from patients with femoral neck surgeries performed in 2012–2017 at Kumamoto Central Hospital. The variables required for the SAS and the factors presumably associated with postoperative complications including the patients’ characteristics were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity in category variables. The Mann-Whitney U test was used to test for differences in continuous variables. We assessed the power of the SAS value to distinguish patients who died ≤ 90 days post-surgery from those who did not, by calculating the area under the receiver operating characteristic curve (AUC).

Results

We retrospectively examined the cases of 506 patients (94 men, 412 women) aged 87 ± 6 (range 70–102) years old. The 90-day mortality rate was 3.4% (n = 17 non-survivors). There were significant differences between the non-survivors and survivors in body mass index (BMI), the presence of moderate to severe valvular heart disease, albumin concentration, the American Society of Anesthesiologists (ASA) classification, and the SAS. The 90-day mortality rate in the SAS ≤ 6 group (n = 97) was 10.3%, which was significantly higher than that in the SAS ≥ 7 group (n = 409), 1.7%. The AUC value to predict the 90-day mortality was 0.70 for ASA ≥ 3 only, 0.71 for SAS ≤ 6 only, 0.81 for SAS ≤ 6 combined with ASA ≥ 3, and 0.85 for SAS ≤ 6 combined with albumin concentration < 3.5 g/dl, BMI ≤ 20, and the presence of moderate to severe valvular heart disease.

Conclusions

Our results suggest that the SAS is useful to evaluate postoperative complications in patients who have undergone a femoral neck surgery. The ability to predict postoperative complications will be improved when the SAS is used in combination with the patient’s preoperative physical status.

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<![CDATA[Dexmedetomidine attenuates the positive chronotropic effects of intravenous atropine in patients with bradycardia during spinal anaesthesia: a retrospective study]]> https://www.researchpad.co/article/Nba2150ce-c6ab-47a5-add0-998ec4350954

Introduction

Dexmedetomidine is a sedative used during spinal anaesthesia. However, it frequently induces bradycardia. Although intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives.

Methods

We examined the effects of atropine used for treating bradycardia during spinal anaesthesia among patients receiving dexmedetomidine (D group), propofol (P group), or neither (nonDnonP group) for sedation, retrospectively.

Results

A total of 108 patients were included. Heart rate was significantly slower at all time points in the D group (n = 69) than in the nonDnonP group (n = 14) (p <  0.025 for all). On the other hand, heart rate was significantly slower only 60 min after administration of atropine in the P group (n = 25) than in the nonDnonP group (p = 0.002). There were differences in the overall values of heart rate (including all the values from time 0 to 60 min) among the three groups (p = 0.026).

Conclusions

The positive chronotropic effects of atropine might be attenuated with the use of dexmedetomidine or propofol during spinal anaesthesia. Although atropine may be administered when bradycardia occurs, a dose of atropine might result in an insufficient effect against the bradycardia. The sufficient number of subjects may change the results of the investigation, and large-scale randomised controlled trials will be necessary.

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<![CDATA[The eutectic mixture local anesthetics (EMLA) cream is more effective on venipuncture pain compared with lidocaine tape in the same patients]]> https://www.researchpad.co/article/Ncb4a9cc4-3617-4e8d-b404-f5fdd466cf2a

Introduction

Although venous cannulation is imperative during perioperative period, it inevitably causes venipuncture pain. Eutectic mixture local anesthetics (EMLA) has been used to reduce this pain, and various studies have been conducted to evaluate the efficacy of EMLA. But these studies did not elucidate the effect of EMLA exactly, because there were large individual differences in pain sensitivity. The aim of this study is to accurately evaluate the efficacy of EMLA cream for venipuncture pain relief compared with lidocaine tape in the same patients.

Methods

Participants were randomly allocated into EL or LE group. Participants received EMLA cream at one side dorsum of hand and lidocaine tape at another dorsum of hand before entering operation room. Local anesthetics were strictly applied according to their manufacturers’ instruments, respectively. In the EL group, participants received venipuncture at EMLA cream site firstly. In LE group, participants, conversely, received venipuncture at lidocaine tape site firstly. Before anesthetic induction, local anesthetics were removed followed by venous cannulations. After cannulation, participants evaluated the pain by visual analog scale (VAS) and verbal rating scale (VRS).The primary outcome was VAS, and the secondary outcome was VRS.

Results

Data from 24 patients were analyzed. The VAS of EMLA cream was significantly lower than that of lidocaine tape (4 [0–18] vs 17 [8–45], p = 0.001, 95% CI − 25 to − 6). The VRS of EMLA cream was also significantly lower than that of lidocaine tape (2 [1–2] vs 2 [2–3], p = 0.002, 95% CI − 0.8 to − 0.2). The local skin adverse events were observed in five patients at EMLA cream applied hands.

Conclusions

We conducted a comparative study to elucidate the efficacy of EMLA cream for venipuncture-pain comparing with lidocaine tape in the same patients. Our results strongly suggest that EMLA cream is more effective for venipuncture pain relief than lidocaine tape.

Trial registrations

UMIN Clinical Trials Registry, UMIN000023030. Registered 5 July 2016.

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<![CDATA[Retrospective investigation about anesthetic management of biliary atresia in children: laparoscopic versus conventional Kasai portoenterostomy]]> https://www.researchpad.co/article/Nc9c34581-8d47-4d5b-9b89-a67997d7ed6b

Purpose

Biliary atresia can be fatal if surgery is not performed early. Laparoscopic Kasai portoenterostomy was recently introduced in our hospital. Despite laparoscopic surgery generally provides advantages, there are few studies of laparoscopic surgery performed in infants.

We retrospectively compared anesthesia management of patients undergoing laparoscopic Kasai portoenterostomy and conventional Kasai portoenterostomy and investigated anesthetic complications of laparoscopic Kasai portoenterostomy.

Methods

Fifty-three biliary atresia patients who underwent surgery from April 2010 to September 2017 were assessed: 28 who underwent laparoscopy (L group) and 25 who underwent laparotomy (O group) were included. We compared body temperature, cases of hypothermia, the lowest mean blood pressure, bleeding volume, infusion volume and urine volume (ml/kg and ml/kg/h), age, weight, operation time, and the number of patients postoperatively admitted to the intensive care unit.

Results

In the L group, volume of bleeding was significantly smaller, and the lowest body temperature was significantly lower in the L group than in the O group (22 ± 35.1 mL vs 70 ± 34.5 mL, respectively, P < 0.01; 35.6 ± 0.8 °C vs 36.5 ± 0.4 °C, respectively, P < 0.01). And severe hypothermia was significantly more in the L group (7 cases vs 0 cases P = 0.01). There was an inverse correlation between the lowest body temperature and anesthesia time (r = − 0.464, P < 0.01). Multiple linear regression analysis revealed that anesthesia time was a significant predictor of hypothermia.

Conclusion

Our study revealed that laparoscopic surgery in infants reduced bleeding, but induced hypothermia and upper airway edema may be caused by relatively excessive infusion. At laparoscopic Kasai surgery, anesthesiologist is recommended to prevent hypothermia and need to pay attention to amount of infusion.

Trial registration

This study was approved by the Ethics Committee of Nagoya University (2017-0290) and registered with the UMIN Clinical Trial Registry (UMIN000033158).

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<![CDATA[Effect of sex and polymorphisms of CYP2B6 and UGT1A9 on the difference between the target-controlled infusion predicted and measured plasma propofol concentration]]> https://www.researchpad.co/article/N0cdbf615-6b22-4c2b-8d0c-9dad6722f8eb

Introduction

To examine whether sex and polymorphisms of cytochrome P450 (CYP) 2B6 and UDP-glucuronosyltransferase (UGT) 1A9 affect the difference between predicted and measured plasma propofol concentration during continuous infusion by target-controlled infusion.

Results

Blood samples of 69 patients (48 men and 21 women) were obtained at 4 h after initial propofol infusion. Percentage performance error (PE) was calculated to assess the difference between measured and predicted propofol concentration. Regression coefficients (β) and 95% confidence intervals (CI) of sex and the polymorphisms of CYP2B6 and UGT1A9 for PE were, separately and mutually, estimated with linear regression. Covariates included age and body mass index in the minimal adjusted model, and additionally included clinical factors (mean blood pressure, heart rate, volume of intravenous fluid, surgical site, surgical position, and pneumoperitoneum) in the full adjusted model. PE was higher in men than in women (28.7% versus 10.5%, p = 0.015). Female sex was inversely associated with PE: the minimal adjusted β = − 8.84 (95% CI, − 16.26 to − 1.43); however, the fully adjusted β with clinical factors became not significant. The average of PE did not differ between polymorphisms of CYP2B6 and UGT1A9, and β of CYP2B6 516G>T polymorphisms mutually adjusted with female sex was not significant. Mean blood pressure, heart rate, and volume of intravenous fluid were independently associated with PE in the full adjusted model.

Conclusions

Under 4 h anesthesia with propofol target-controlled infusion in our population, sex differences appeared to exist in the propofol concentration, which might be largely mediated by clinical factors, such as hemodynamic status.

Trial registration

UMIN-CTR UMIN000009015, Registered 1 October 2012

Electronic supplementary material

The online version of this article (10.1186/s40981-018-0196-8) contains supplementary material, which is available to authorized users.

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<![CDATA[Use of remifentanil in general anesthesia for neonatal non-cardiac surgery: a case series]]> https://www.researchpad.co/article/N600f95ad-f7a8-4901-9357-a04de4700be5

Objective

This case series aimed to summarize our experience in usage of remifentanil in neonates undergoing non-cardiac surgery.

Background

Physiology of neonates and infants is different from that of adults. Immaturity of their vital organ systems narrows a safety margin of perioperative management including anesthesia. Remifentanil has favorable characteristics for pediatrics such as short duration of action and rapid elimination. Although remifentanil was introduced into clinical practice since 1996, its application to neonatal anesthesia has not been validated yet.

Methods

This is a 14-month retrospective case series of neonates receiving remifentanil during non-cardiac surgery at a tertiary care pediatric hospital in Japan. Patients’ characteristics, intraoperative data, and complications were retrieved from medical records.

Results

A total of 68 neonates underwent non-cardiac surgery under general anesthesia, of whom 48 received remifentanil. Infusion rate was 0.14 (0.04–0.35) mcg/kg/min (median, range). No intractable adverse events including postoperative apnea were detected.

Conclusion

Remifentanil is generally feasible to neonatal surgical population.

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