Search

Background: Thoracic epidural analgesia is considered the gold standard for pain relief in video-assisted thoracoscopic surgery. This neuraxial technique blocks pain sensation by injecting a local anesthetic agent in the epidural space near the spinal cord to block spinal nerve roots. Recently, the erector spinae plane block has been introduced as a practical alternative to the thoracic epidural. This interfascial regional anesthesia technique interrupts pain sensation by injecting a local anesthetic agent in between the muscular layers of the thoracic wall. Several case series and three RCTs described it as an effective pain management technique in video-assisted thoracoscopic surgery (Scimia et al., Reg Anesth Pain Med 42:537, 2017; Adhikary et al., Indian J Anaesth 62:75-8, 2018; Kim, A randomized controlled trial comparing continuous erector spinae plane block with thoracic epidural analgesia for postoperative pain management in video-assisted thoracic surgery, n.d.; Yao et al., J Clin Anesth 63:109783, 2020; Ciftci et al., J Cardiothorac Vasc Anesth 34:444-9, 2020). The objective of this study is to test the hypothesis that a continuous erector spinae plane block incorporated into an opioid-based systemic multimodal analgesia regimen is non-inferior in terms of the quality of postoperative recovery compared to continuous thoracic epidural local anesthetic-opioid analgesia in patients undergoing elective unilateral video-assisted thoracoscopic surgery.Methods: This is a prospective randomized open label non-inferiority trial. A total of 90 adult patients undergoing video-assisted thoracoscopic surgery will be randomized 1:1 to receive pain treatment with either (1) continuous erector spinae plane block plus intravenous patient-controlled analgesia with piritramide (study group) or (2) continuous thoracic epidural analgesia with a local anesthetic-opioid infusate (control group). All patients will receive additional systemic multimodal analgesia with paracetamol and non-steroidal anti-inflammatory drugs. The primary endpoint is the quality of recovery as measured by the Quality of Recovery-15 score. Secondary endpoints are postoperative pain as Numerical Rating Score scores, length of hospital stay, failure of analgesic technique, postoperative morphine-equivalent consumption, itching, nausea and vomiting, total operative time, complications related to surgery, perioperative hypotension, complications related to pain treatment, duration of bladder catheterization, and time of first assisted mobilization > 20 m and of mobilization to sitting in a chair.Discussion: This randomized controlled trial aims to confirm whether continuous erector spinae plane block plus patient-controlled opioid analgesia can equal the analgesic effect of a thoracic epidural local anesthetic-opioid infusion in patients undergoing video-assisted thoracoscopic surgery.Trial Registration: Netherlands Trial Register NL6433 . Registered on 1 March 2018. This trial was prospectively registered. [ABSTRACT FROM AUTHOR]

Carex remota, a widespread species in Europe and Asia, was found for the first time in Armenia in June 2016. It was discovered at two sites in the S of the country. Its distribution and ecology are briefly discussed. Also some notes are given about a few rare Armenian Carex species, which were found during field trips in the last fourteen years. [ABSTRACT FROM AUTHOR]

The hybrid Carex diluta × C. distans has been found new for Armenia. This is the first Carex hybrid mentioned for Armenia. For Carex hartmanii and Carex muricata subsp. ashokae additional localities are reported. Both formerly overlooked species are widely distributed in Armenia. The occurrence of Carex cilicica has been confirmed. [ABSTRACT FROM AUTHOR]

Carex hartmanii (Cyperaceae) was collected for the first time in Armenia in 1957 and identified in 1961 by Egorova. In the Flora of Armenia this species is not mentioned. However, two recent collections confirm the existence of C. hartmanii in Armenia; its distribution is discussed. [ABSTRACT FROM AUTHOR]

The most frequently used model to describe the exponential increase in mortality rate over age is the Gompertz equation. Logarithmically transformed, the equation conforms to a straight line, of which the slope has been interpreted as the rate of senescence. Earlier, we proposed the derivative function of the Gompertz equation as a superior descriptor of senescence rate. Here, we tested both measures of the rate of senescence in a population of patients with end-stage renal disease. It is clinical dogma that patients on dialysis experience accelerated senescence, whereas those with a functional kidney transplant have mortality rates comparable to the general population. Therefore, we calculated the age-specific mortality rates for European patients on dialysis ( n = 274 221; follow-up = 594 767 person-years), for European patients with a functioning kidney transplant ( n = 61 286; follow-up = 345 024 person-years), and for the general European population. We found higher mortality rates, but a smaller slope of logarithmic mortality curve for patients on dialysis compared with both patients with a functioning kidney transplant and the general population ( P < 0.001). A classical interpretation of the Gompertz model would imply that the rate of senescence in patients on dialysis is lower than in patients with a functioning transplant and lower than in the general population. In contrast, the derivative function of the Gompertz equation yielded the highest senescence rates for patients on dialysis, whereas the rate was similar in patients with a functioning transplant and the general population. We conclude that the rate of senescence is better described by the derivative function of the Gompertz equation. [ABSTRACT FROM AUTHOR]

AimsTo describe the incidence and relative frequencies of primary malignant orbital tumours in the Netherlands from 1989 to 2006.MethodsAll registered primary malignant orbital tumours were extracted from the population-based database of the Netherlands Cancer Registry. Age-adjusted incidence of malignant orbital tumours per 10 000 000 persons per year and the estimated annual percentage change (EAPC) were computed.ResultsA total of 367 malignant orbital tumours were registered. The average age-adjusted incidence of malignant orbital tumours is 10.9. Lymphoma has a relative frequency of 67%, rhabdomyosarcoma 12%, adenocarcinoma 6%, and adenoid cystic carcinoma 5%. The incidence of primary malignant orbital tumours has been increasing in the Netherlands (EAPC +2.8%).ConclusionIn the Netherlands, lymphoma is the most common primary malignant orbital tumour, followed by rhabdomyosarcoma, adenocarcinoma, and adenoid cystic carcinoma. The relative frequencies of the different histological tumour types are comparable to the frequencies in other parts of the world. The incidence of malignant primary orbital tumours shows a slight increase between 1989 and 2006. [ABSTRACT FROM AUTHOR]

Background: Despite an increase in knowledge, blood loss during burn excisional surgery remains a major challenge and is an independent predictor of mortality. During burn surgery, limited measures are available to control the bleeding. Increased fibrinolysis could be one of the contributing factors of blood loss during burn excisional surgery. Tranexamic acid inhibits the fibrinolytic response, and a small body of evidence shows positive effects of tranexamic acid on the volume of blood loss. Methods: The main objectives of this study are twofold, (1) to investigate whether tranexamic acid reduces blood loss and (2) to investigate the changes in coagulation after burn trauma and during burn excisional surgery. This study is a multicenter double-blind randomized clinical trial in patients scheduled for burn excisional surgery within the Dutch burn centers. All adult patients scheduled for burn surgery with an expected blood loss of ≥ 250 are eligible for inclusion in this study. The study is powered on a blood loss reduction of 25% in the intervention group. In total, 95 subjects will be included. The intervention group will receive 1500 mg tranexamic acid versus placebo in the other group. Primary endpoint is reduction of blood loss. Secondary endpoints include occurrence of fibrinolysis during surgery, graft take of the split skin graft, and differences in coagulation and blood clot formation. Discussion: This protocol of a randomized controlled trial aims to investigate the efficacy of tranexamic acid in reducing blood loss during burn excisional surgery. Furthermore, this study aims to clarify the coagulation status after burn trauma and during the surgical process. Trial registration: EudraCT: 2020-005405-10; ClinicalTrial.gov: NCT05507983 (retrospectively registered in August 2022, inclusion started in December 2021). [ABSTRACT FROM AUTHOR]

Introduction: The oral cavity is a complex ecosystem, and its highly diverse microbial community comprises bacteria, Archaea, fungi, viruses, and protozoa. In a healthy host, there is a balance between the microbes and the host itself. Perturbations such as frequent exposure to fermentable carbohydrates, may disturb this balance, resulting in an ecological shift towards a diseased state. Potential prebiotics such as the amino acid arginine, may have a beneficial effect by increasing the environmental pH, thus inhibiting microbial shifts. The aim of the present study was to assess the effects of an arginine supplement on oral microcosms under highly cariogenic growth conditions. Methods: The eight-station multi-plaque artificial mouth (MAM) model was inoculated with plaque-enriched saliva from a healthy volunteer. Four of the stations received defined mucin medium (DMM) supplemented with arginine (1.6% w/v) (DMM+ARG). The remaining four stations were exposed to DMM without arginine (DMM-ARG). To mimic cariogenic challenges, all stations received eight 6 min sucrose (10% w/v) pulses a day at 2 h intervals. Each day contained a 'resting period' of medium alone (DMM+ARG or DMM-ARG) lasting 10 h. Organic acid anions (formate, succinate, acetate, lactate, propionate, and butyrate) in resting and fermenting biofilms were measured using capillary ion electrophoresis. The ammonium concentration in the biofilms was measured using an enzymatic ammonium assay. The biofilms were sampled at 14 time points (t) divided over 22 days, including eight time points where the biofilms were 'at rest', four time points following a 6 min sucrose pulse, and two time points following an arginine (8% w/v) pulse. Extracted DNA from the biofilms was used to assess Candida abundance through RT-PCR and to obtain a bacterial ecological profile through denaturing gradient gel electrophoresis (DGGE). Results: Biofilms exposed to arginine had a higher ammonium concentration compared to those not receiving additional arginine (2.96±0.45 and 2.04±0.44 mM/ml). The acid profiles showed that the DMM-ARG biofilms had produced significantly more butyrate and acetate (0.58±0.55 and 1.06±1.02 mmol/mg protein) than the DMM+ARG biofilms (0.17±014 and 0.60±0.33 mmol/mg protein), irrespective of the metabolic state. Candida abundance increased with time and was generally higher in the DMM-ARG biofilms, (t1: DMM+ARG 2.1x10³ CFU/ml, DMM-ARG 6.3x10³ CFU/ ml; t14: DMM+ARG 2.0x104 CFU/ml, DMM-ARG 2.7x105 CFU/ml). Additionally, DGGE of the DMM-ARG and DMM+ARG biofilms resulted in clearly distinguishable profiles for both conditions. Discussion: Arginine reduced the acid challenge induced by sucrose, inhibiting outgrowth of Candida and preventing a shift in microbial composition towards a more aciduric and acidogenic community. The actual compositional changes will be investigated using next generation sequencing approaches in the near future. Based on these preliminary findings, arginine has a strong potential in stabilizing the oral ecosystem during cariogenic perturbations. [ABSTRACT FROM AUTHOR]

Background: The majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at home after day care surgery might improve patient's recovery. Currently patient experiences with smartphone applications are promising; however, we do not know whether remote monitoring with such an application also improves the patient's recovery. This study aims to evaluate the experienced quality of recovery after day care surgery between patients provided with the smartphone application for remote monitoring and patients receiving standard care without remote monitoring. Methods: This non-blinded randomized controlled trial with mixed methods design will include 310 adult patients scheduled for day care surgery. The intervention group receives the smartphone application with text message function for remote monitoring that enables patients to record pain and nausea. An anaesthesia professional trained in empathetic communication, who will contact the patient in case of severe pain or nausea, performs daily monitoring. The control group receives standard care, with post-discharge verbal and paper instructions. The main study endpoint is the difference in perceived quality of recovery, measured with the QoR-15 questionnaire on the 7th day after day care surgery. Secondary endpoints are the overall score on the Quality of Recovery-15 at day 1, 4 and 7-post discharge, the perceived quality of hospital aftercare and experienced psychological effects of remote monitoring during postoperative recovery from day care surgery. Discussion: This study will investigate if facilitating patients and healthcare professionals with a tool for accessible and empathetic communication might lead to an improved quality of the postoperative recovery period. Trial registration: The 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial' is approved and registered on 23 February 2022 by Research Ethics Committees United with registration number R21.076/NL78144.100.21. The protocol NL78144.100.21, 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial', is registered at the ClinicalTrials.gov public website (registration date 16 February 2022; NCT05244772) [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) transmission models that include variability in sexual behavior over time have shown increased incidence, prevalence, and acute-state transmission rates for a given population risk profile. This raises the question of whether dynamic variation in individual sexual behavior is a real phenomenon that can be observed and measured. To study this dynamic variation, we developed a model incorporating heterogeneity in both between-person and within-person sexual contact patterns. Using novel methodology that we call iterated filtering for longitudinal data, we fitted this model by maximum likelihood to longitudinal survey data from the Centers for Disease Control and Prevention's Collaborative HIV Seroincidence Study (1992-1995). We found evidence for individual heterogeneity in sexual behavior over time.We simulated an epidemic process and found that inclusion of empirically measured levels of dynamic variation in individual-level sexual behavior brought the theoretical predictions of HIV incidence into closer alignment with reality given the measured per-act probabilities of transmission. The methods developed here provide a framework for quantifying variation in sexual behaviors that helps in understanding the HIV epidemic among gay men. [ABSTRACT FROM AUTHOR]

Background: Stochastic models of discrete individuals and deterministic models of continuous populations may give different answers to questions about infectious diseases.Goal: Discrete individual model formulations are sought that extend deterministic models of infection transmission systems so that both model forms contribute cooperatively to model-based decision making.Study Design: GERMS models are defined as stochastic processes in continuous time with parameters analogous to those in deterministic models. A GERMS model simulator was developed that insured that the rate of events depended only on the current state of model.Results: The confidence intervals of long-term averages of infection level in simulated GERMS models were shown to contain the deterministic model means.Conclusion: GERMS models provide a convenient framework for testing the sensitivity of model-based decisions to a variety of unrealistic assumptions that are characteristic of differential equation models. GERMS especially facilitates making more realistic assumptions about contact patterns in geographic and social space. [ABSTRACT FROM AUTHOR]

Streptococcal cell wall (SCW)-induced arthritis is a chronic, erosive polyarthritis that can be induced in susceptible Lewis rats by one i.p. injection of an aqueous, slerile suspension of SCW. F344 rats are resistant to chronic joint inflammation. Our previous studies showed a correlation between susceptibility to SCW-induced arthritis and the ability to mount SCW-specific T cell responses, suggesting tolerance to SCW as a putative mechanism. Here we prevented the induction of tolerance lo bacterial epitopes in F344 rats by using them germ-free and analysed susceptibility to arthritis subsequently. In addition, we conventionalized germ-free F344 rats at different times before induction of arthritis. Our results show that germ-free F344 rats are susceptible to SCW-induced arthritis with a similar severity, chronicity. incidence and onset as Lewis rats. Moreover. T cells isolated from germ-free F344 rats were able to respond to SCW. Conventionalization dramatically moderates arthritis and makes T cells unresponsive to SCW again. Thus, in normal rats (F344) a stale of tolerance to arthritogenic epilopes is induced (neonatally) and maintained through life by the bacterial flora, resulting in resistance to bacterium-induced artritides. In arthritis-prone (Lewis) rats, this tolerance is deficient and/or easily broken. [ABSTRACT FROM AUTHOR]

Background: The type of scalding injury known as 'teapot syndrome', where hot liquid is grabbed by the child with the aim of ingestion and falls over a child causing burns on the face, upper thorax and arms, is known to cause peri-oral and facial oedema. Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion of a damaging agent or intraoral burns, Awareness of the possibility of thermal epiglottitis, also in scald burns, is imperative to ensure prompt airway protection. Case presentation: We report the case of a child with thermal epiglottitis after a scalding burn from boiling milk resulting in mixed deep burns of the face, neck and chest, but no history of ingestion. Upon presentation there was a progressive stridor and signs of respiratory distress requiring intubation. Laryngoscopy revealed epiglottis oedema, confirming the diagnosis of thermal epiglottitis. Final extubation took place 5 days after initial burn. Conclusions: Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion and intra-oral damage. Burns to the peri-oral area should raise suspicion of additional damage to oral cavity and supraglottic structures, even in absence of intra-oral injury or initial respiratory distress. Awareness of the occurrence of thermal epiglottitis in absence of intra-oral injury is important to diagnose impending upper airway obstruction requiring intubation. [ABSTRACT FROM AUTHOR]