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Purpose: To compare between deep neuromuscular blockade (NMB) and moderate NMB with respect to endoscopic surgical conditions and recovery profiles in patients with general anesthesia for transurethral resection of bladder (TURB).Methods: 108 patients undergoing elective TURB were randomized into two groups: the moderate NMB (n = 54) or deep NMB (n = 54) group. After the operation, NMB was reversed with 2 mg/kg sugammadex at a train-of-four (TOF) count of 1 or 2 (moderate NMB group) or with 4 mg/kg sugammadex at post-tetanic count (PTC) of 2 (deep NMB group). Surgeons, who were blinded to the study design, rated the endoscopic surgical condition on a 5-point scale (1 = extremely poor, 2 = poor, 3 = acceptable, 4 = good, 5 = optimal) immediately following the operation. Recovery profiles, including postoperative residual curarization (PORC), respiratory complication, and recovery time, were recorded.Results: No difference was observed between the two groups regarding patients and anesthesia characteristics. There were statistically significant differences in endoscopic surgical conditions between the two groups (P < 0.001). Thirty-eight patients in the deep NMB group (74%) showed optimal surgical conditions, whereas 16 patients in the moderate NMB group (30%) showed optimal endoscopic surgical conditions. No PORC and respiratory complications occurred in both groups, and no difference was found between the two groups in terms of recovery profiles, including recovery time and other adverse events.Conclusions: Deep NMB and reversal with sugammadex improved the endoscopic surgical condition without complications compared with moderate NMB and reversal with sugammadex in patients undergoing TURB. [ABSTRACT FROM AUTHOR]

Background: Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.Methods: Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0.05 μg kg-1 h-1 naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml-1 remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.Results: The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22-3.84) vs 3.84 (3.76-4.00) vs 3.80 (3.69-4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.Conclusions: The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.Clinical trial registration: NCT02856087. [ABSTRACT FROM AUTHOR]

Although Toyoura sand has been widely used as a standard material for physical model tests (particularly centrifuge model tests), its path-dependent stiffness degradation curves are rarely reported in the literature. This leads to difficulties in back-analyzing and understanding the physical tests involving significant changes in the direction of stress paths (such as unloading problems). In this study, path-dependent stiffness degradation curves of medium-dense Toyoura sand were determined by carrying out a series of stress-path triaxial tests, with local strain measurements. In the triaxial tests, four typical recent stress histories (changes of path direction = 0, 90, -90, and 180°) were simulated. The measured small strain stiffnesses of Toyoura sand were then used to calibrate an advanced hypoplastic model that accounts for pathdependent soil stiffness at small strains. To justify the validity of the calibrated hypoplastic model and model parameters, a Type A numerical prediction and a centrifuge model test were carried out to simulate a typical unloading problem (i.e., excavation) in medium-dense Toyoura sand. Triaxial test results show that a 180° reversal in the direction of the stress path increased the initial secant modulus of Toyoura sand by eight times. The path dependency of soil stiffness, however, vanished when the deviatoric strain exceeded 0.3%. The ground deformations (resulting from excavation) predicted by the numerical analysis show reasonable agreement with the measured data from the centrifuge test. This suggests the potential applicability of the calibrated soil model and its model parameters in predicting or back-analyzing other physical model tests in Toyoura sand. [ABSTRACT FROM AUTHOR]

Background: Few studies investigated the optimal timing for tracheostomy and its influence on the clinical outcomes in critically ill pediatric patients. This study evaluated the differences in clinical outcomes between early and late tracheostomy in pediatric intensive care unit (ICU) patients.Methods: We assessed 111 pediatric patients. Patients who underwent a tracheostomy within 14 days of mechanical ventilation (MV) were assigned to the early tracheostomy group, whereas those who underwent tracheostomy after 14 days of MV were included in the late tracheostomy group. Clinical outcomes, including mortality, duration of MV, length of ICU and hospital stays, and incidence of ventilator-associated pneumonia (VAP) were compared between the groups.Results: Of the 111 pediatric patients, 61 and 50 were included in the early and late tracheostomy groups, respectively. Total MV duration and the length of ICU and hospital stay were significantly longer in the late tracheostomy group than in the early tracheostomy group (all P < 0.01). The VAP rate per 1000 ventilator days before tracheostomy was 2.6 and 3.8 in the early and late tracheostomy groups, respectively. There were no significant differences in mortality rate between the groups. No severe complications were associated with tracheostomy itself.Conclusions: Tracheostomy performed within 14 days after the initiation of MV was associated with reduced duration of MV and length of ICU and hospital stay. Although there was no effect on mortality rate, children may benefit from early tracheostomy without severe complications. [ABSTRACT FROM AUTHOR]

To ease water scarcity, dynamic programming, stochastic dynamic programming, and heuristic algorithms have been applied to solve problem matters related to water resources. Development, operation, and management are vital in a reservoir operating policy, especially when the reservoir serves a complex objective. In this study, an attempt via metaheuristic algorithms, namely the Harris Hawks Optimisation (HHO) Algorithm and the Opposite Based Learning of HHO (OBL-HHO) are made to minimise the water deficit as well as mitigate floods at downstream of the Klang Gate Dam (KGD). Due to trade-offs between water supply and flood management, the HHO and OBL-HHO models have configurable thresholds to optimise the KGD reservoir operation. To determine the efficacy of the HHO and OBL-HHO in reservoir optimisation, reliability, vulnerability, and resilience are risk measures evaluated. If inflow categories are omitted, the OBL-HHO meets 71.49% of demand compared to 54.83% for the standalone HHO. The HHO proved superior to OBL-HHO in satisfying demand during medium inflows, achieving 38.60% compared to 20.61%, even though the HHO may have experienced water loss at the end of the storage level. The HHO is still a promising method, as proven by its reliability and resilience indices compared to other published heuristic algorithms: at 62.50% and 1.56, respectively. The Artificial Bee Colony (ABC) outcomes satisfied demand at 61.36%, 59.47% with the Particle Swarm Optimisation (PSO), 55.68% with the real-coded Genetic Algorithm (GA), and 23.5 percent with the binary GA. For resilience, the ABC scored 0.16, PSO scored 0.15, and real coded GA scored 0.14 whilst the binary-GA has the worst failure recovery algorithm with 0.09. [ABSTRACT FROM AUTHOR]

Pretreatment of suspensions of human polymorphonuclear leucocytes (PMNL) with leukotriene B4 (LTB4) induces chemotactic deactivation, characterized by diminished expression of high-affinity ITB4 receptors and selectively decreased chemotactic responsiveness of the PMNL to LTB4. Rabbit anti-idiotypic antibodies (a-Id) to mouse monoclonal anti-LTB4, which bind to the 60,000-80.000 molecular weight (M W) membrane protein of PMNL receptors for LTB4 in Western blots and block binding of [³H]LTB4 to high-affinity receptors of PMNL, detected a reduction in LTB4 receptor antigen during chemotactic deactivation. Loss of high-affinity receptors for LTB4 from the surface of PMNL deactivated by incubation with 10 nm LTB4 was significant after 1 min and after 20 min reached a mean maximum of 82% and 61%, respectively, as assessed by binding of [³H]LTB4 and a-Id. Inhibitors of PMNL proteases did not prevent the deactivation-induced decreases in surface receptors for LTB4. Disruption of deactivated PMNL and solubilization of membrane proteins failed to expose intracellular LTB4 receptors. Incubation of membranes isolated from PMNL with 100 nM LTB4 resulted in a loss of LTB4 receptors similar to that observed in intact PMNL. Changes in LTB4 receptor protein structure or membrane localization, rather than endocytosis or proteolysis, thus appear to explain the rapidly decreased expression of LTB4 receptors, which results from stimulus-specific deactivation. [ABSTRACT FROM AUTHOR]

Human polymorphonuclear (PMN) leucocytes bind synthetic [3H]-labelled leukotriene C4 ([3H]LTC4), with rapid saturation and reversibility of approximately 90%, by a 700-fold higher concentration of non-radioactive LTC4. [3H]LTC4 is recognized specifically by 10,778±6260 (mean ± SD) sites per PMN leucocyte that exhibit a KD of 34·3 ± 1·7 nM. The specificity of the LTC4 receptors is supported by the competitive inhibition of binding of [3H]LTC4 by LTC4, LTC4- sulphone, LTD4, and LTE4 with relative potencies of approximately 100:20:3:1. The four-fold higher level of specific binding of[3H]LTC4 by sonicates than by intact PMN leucocytes is attributable to intracellular receptors. Of the total number of receptors recovered in sonicates of PMN leucocytes, one-third are associated with membranes and the other two-thirds with lysosomal granules. The affinity of the membrane receptors for LTC4 is indistinguishable from that of receptors on intact PMN leucocytes, whereas the affinity of granule receptors is significantly higher. The characteristics of the receptors are consistent with a role in mediating uptake and metabolism of LTC4 by PMN leucocytes. [ABSTRACT FROM AUTHOR]

Development, operations and management of multi-objective reservoirs, is vital for timely water supply. Optimisation studies were done at the Klang Gate Dam (KGD) utilising standard optimisation and dynamic programming; according to the technology then. Taking it further, the KGD was studied using the nature-inspired meta-heuristic algorithms (MHAs). The Whale Optimisation Algorithm (WOA) solves complex technical issues. The Lévy flight and distribution (LFWOA) was incorporated to increase productivity at the KGD. The aim of this study to minimise KGD's water deficit with WOA and LFWOA. The study comprises of two sections. The first section examined observed monthly inflow, demand, and storage data from 2001 to 2019, whilst the second compares performances to established MHAs, from 1097 to 2008. In the first section, LFWOA and WOA reliability were 60.53 and 58.33 %,respectively. For 2010, both methods gave similar vulnerability value. The LFWOA scored 1.04 while the WOA scored 1. In second section, the LFWOA satisfied 69.70% of exact demand, while the WOA met 56.06%. LFWOA had attained the least shortage. The LFWOA algorithm was the most robust among the MHAs (1.88). In short, the LFWOA is better on the count of reliability, resilience, and scarcity scores. [ABSTRACT FROM AUTHOR]

We studied the predictive performance of the Minto pharmacokinetic model during cardiopulmonary bypass in patients undergoing cardiac surgery. Patients received remifentanil target-controlled infusion using the Minto model during total intravenous anaesthesia with propofol. From 56 patients, 275 arterial blood samples were drawn before, during and after bypass to determine the plasma concentration of remifentanil, and the predicted concentrations were recorded at each time. For pooled data, the median prediction error and median absolute prediction error were 21.3% and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were 148.4% during hypothermic circulatory arrest and measured concentrations were more than three times greater than predicted (26.9 (17.0) vs. 7.1 (1.6) ng.ml-1 ). The Minto model showed considerable bias but overall acceptable precision during bypass. The target concentration of remifentanil should be reduced when using the Minto model during hypothermic circulatory arrest. [ABSTRACT FROM AUTHOR]