Search

Summary: Chronic post‐surgical pain is known to be a common complication of thoracic surgery and has been associated with a lower quality of life, increased healthcare utilisation, substantial direct and indirect costs, and increased long‐term use of opioids. This systematic review with meta‐analysis aimed to identify and summarise the evidence of all prognostic factors for chronic post‐surgical pain after lung and pleural surgery. Electronic databases were searched for retrospective and prospective observational studies as well as randomised controlled trials that included patients undergoing lung or pleural surgery and reported on prognostic factors for chronic post‐surgical pain. We included 56 studies resulting in 45 identified prognostic factors, of which 16 were pooled with a meta‐analysis. Prognostic factors that increased chronic post‐surgical pain risk were as follows: higher postoperative pain intensity (day 1, 0–10 score), mean difference (95%CI) 1.29 (0.62–1.95), p < 0.001; pre‐operative pain, odds ratio (95%CI) 2.86 (1.94–4.21), p < 0.001; and longer surgery duration (in minutes), mean difference (95%CI) 12.07 (4.99–19.16), p < 0.001. Prognostic factors that decreased chronic post‐surgical pain risk were as follows: intercostal nerve block, odds ratio (95%CI) 0.76 (0.61–0.95) p = 0.018 and video‐assisted thoracic surgery, 0.54 (0.43–0.66) p < 0.001. Trial sequential analysis was used to adjust for type 1 and type 2 errors of statistical analysis and confirmed adequate power for these prognostic factors. In contrast to other studies, we found that age had no significant effect on chronic post‐surgical pain and there was not enough evidence to conclude on sex. Meta‐regression did not reveal significant effects of any of the study covariates on the prognostic factors with a significant effect on chronic post‐surgical pain. Expressed as grading of recommendations, assessment, development and evaluations criteria, the certainty of evidence was high for pre‐operative pain and video‐assisted thoracic surgery, moderate for intercostal nerve block and surgery duration and low for postoperative pain intensity. We thus identified actionable factors which can be addressed to attempt to reduce the risk of chronic post‐surgical pain after lung surgery. [ABSTRACT FROM AUTHOR]

Background: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care.Methods: A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres.Results: After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001).Conclusion: In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix. [ABSTRACT FROM AUTHOR]

• Development of physiologically based kinetic models for cattle, sheep, and swine. • Validation through prediction of tissue concentration for melamine and oxytetracycline. • Adequate model predictions despite uncertainties on model parameters. The development of three generic multi-compartment physiologically based kinetic (PBK) models is described for farm animal species, i.e. cattle, sheep, and swine. The PBK models allow one to quantitatively link external dose and internal dose for risk assessment of chemicals relevant to food and feed safety. Model performance is illustrated by predicting tissue concentrations of melamine and oxytetracycline and validated through comparison with measured data. Overall, model predictions were reliable with 71% of predictions within a 3-fold of the measured data for all three species and only 6% of predictions were outside a 10-fold of the measured data. Predictions within a 3-fold change were best for cattle, followed by sheep, and swine (82%, 76%, and 63%). Global sensitivity analysis was performed to identify the most sensitive parameters in the PBK model. The sensitivity analysis showed that body weight and cardiac output were the most sensitive parameters. Since interspecies differences in metabolism impact on the fate of a wide range of chemicals, a key step forward is the introduction of species-specific information on transporters and metabolism including expression and activities. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence suggests that postoperative troponin release is a strong and independent predictor of short-term mortality. However, evaluating elevated troponins in patients with chronic kidney disease (CKD) is still controversial and is often disregarded. This study examines morbidity along with short- and long-term mortality risk associated with elevated high-sensitivity troponin T (hsTnT) in patients with different stages CKD undergoing noncardiac surgery.Methods: This observational cohort comprised 3262 patients aged ≥60 yr who underwent noncardiac surgery. Postoperative hsTnT concentrations were divided into normal [<14 ng l-1 (reference)], low (14-49 ng l-1), moderate (50-149 ng l-1), and high (≥150 ng l-1) groups. A threshold of 50 ng l-1 was used to dichotomize hsTnT. The study endpoints were 30-day and long-term all-cause mortality, and postoperative myocardial infarction.Results: Postoperative hsTnT was associated with a stepwise increase in 30-day and long-term mortality risk: low hsTnT adjusted hazard ratio (HR) 1.4 [95% confidence interval (CI): 1.1-1.7], moderate hsTnT adjusted HR 3.1 (95% CI: 2.3-4.3), high hsTnT adjusted HR 5.5 (95% CI: 3.6-8.4). Postoperative hsTnT ≥50 ng l-1 was associated with 30-day and long-term mortality risk for each stage of CKD. Elevated troponin concentrations in severe CKD (estimated glomerular filtration rate <30 mL min-1 1.73 m-2), however, did not predict short-term death.Conclusions: Elevated postoperative hsTnT is associated with a dose-dependent increase in 30-day and long-term mortality risk in each stage of CKD with an estimated glomerular filtration rate ≥30 ml min-1 1.73 m-2. [ABSTRACT FROM AUTHOR]

Background: A relatively new uncalibrated arterial pressure waveform cardiac output (CO) measurement technique is the Pulsioflex-ProAQT® system. Aim of this study was to validate this system in cardiac surgery patients with a specific focus on the evaluation of a difference in the radial versus the femoral arterial access, the value of the auto-calibration modus and the ability to show fluid-induced changes. Methods: In twenty-five patients scheduled for ascending aorta, aortic arch replacement, or both we measured CO simultaneously by transpulmonary thermodilution (COtd) and by using the ProAQT® system connected to the radial (COpR), as well as the femoral artery catheter (COpF). Hemodynamic data were assessed at predefined time points; from incision until 16 h after ICU admission. Results: In total 175 (radial) and 179 (femoral) pairs of CO measurement were collected. The accuracy of COpR/ COpF was evaluated showing a mean bias of -0.31 L/min (±2.9 L/min) and -0.57 L/min (± 2.8 L/min) with percentage errors of 49 and 46% respectively. Trending ability of the ProAQT® device was evaluated; the four quadrant concordance rates in the radial and femoral artery were 74 and 75% and improved to 77 and 85% after auto-calibration. The mean angular biases in the radial and femoral artery were 6.4° and 6.0° and improved to 5° and 3.3° after auto-calibration. The polar concordance rates in the radial and femoral artery were 65 and 70% and improved to 76 and 84% after auto-calibration. Considering the fluid-induced changes in stroke volume(SV), the coefficient of correlation between the changes in SVtd and SVp was 0.57 (p < 0.01) in the radial artery and 0.60 (p < 0.01) in the femoral artery. Conclusions: The ProAQT® system can be of additional value if the clinician wants to determine fluid responsiveness in cardiac surgery patients. However, the ProAQT® system provided inaccurate CO measurements compared to transpulmonary thermodilution. The trending ability was poor for COpR but moderate for COpF. Auto-calibration of the system did not improve accuracy of CO measurements nor did it improve the prediction of fluid responsiveness. However, the trending ability was improved by auto-calibration, possibly by correcting a drift over a longer time period. [ABSTRACT FROM AUTHOR]

We analysed the association of independent variables with non-verbal cognition at 6 years in children with complete data (3441 from a cohort of 9901), of whom 415 were anaesthetised before the age of 5 years. Using multivariable regression, cognition was reduced by a mean (95% CI) score for children: anaesthetised before the age of 5 years, 2.1 (0.7-3.5), p = 0.004; born prematurely, 9.8 (4.1-15.4), p = 0.001; whose mothers smoked while pregnant, 2.3 (0.8-3.8), p = 0.004; whose mothers had lower IQ scores, 0.3 (0.2-0.3) for each unit reduction in maternal IQ, p < 0.0001. The association of child IQ with exposure to anaesthetic drugs was sensitive to missing data. [ABSTRACT FROM AUTHOR]

Purpose: Vascular intervention studies generally consider patency and limb salvage as primary outcomes. However, quality of life is increasingly considered an important patient-oriented outcome measurement of vascular interventions. Existing literature was analyzed to determine the effect of different treatments on quality of life for patients suffering from either claudication or critical limb ischemia.Basic Methods: A review of the literature was undertaken in the Medline library. A search was performed on quality of life in peripheral arterial disease. Results were stratified according to treatment groups.Principal Findings: Twenty-one articles described quality of life in approximately 4600 patients suffering from peripheral arterial disease. Invasive treatment generally results in better quality of life scores (at a maximum of 2 years of follow-up), compared with non-invasive treatment. In patients with critical limb ischemia, successful revascularization improves quality of life scores. Only one study reported long-term results.Conclusions: Increase in quality of life scores can be found for any intervention performed for peripheral arterial disease. However, there is scarce information on long-term quality of life after vascular intervention. [ABSTRACT FROM AUTHOR]

Previous reports on the prognostic value of diabetes mellitus for cardiac complications after vascular surgery show divergent results, especially in regards to the role of type 2 diabetes as a cardiac risk factor, which remains unclear. The aim of this study was to assess the impact of type 2 diabetes on 30-day cardiac complications after vascular surgery. Patients undergoing elective vascular surgery between 2002 and 2011 were included in this retrospective cohort study. Previous diagnosis of type 1 and 2 diabetes and use of oral glucose-lowering medications and insulin were recorded. Patients with type 1 diabetes were excluded from the analysis. The main outcome parameter was cardiac complications, a composite of cardiovascular death, non-fatal myocardial infarction, congestive heart failure, severe arrhythmia and asymptomatic troponin release within 30 days of surgery. In multivariate analysis, corrections were made for comorbidities, demographics, medication use and surgical risk. Of 1462 patients, 329 (22.5%) patients had type 2 diabetes. Cardiac complications occurred in 155 (13.7%) patients without diabetes and in 68 (20.7%) with type 2 diabetes. In multivariate analysis, type 2 diabetes was associated with a significantly increased risk of 30-day cardiac complications (odds ratio 1.80; 95% confidence interval 1.25 to 2.60). Results were similar for type 2 diabetes patients managed with (odds ratio 1.84; 95% confidence interval 1.01 to 3.37) and without (odds ratio 1.79; 95% confidence interval 1.19 to 2.70) insulin. Type 2 diabetes is an independent risk factor for cardiac complications after vascular surgery and should be treated as such in preoperative cardiac risk stratification. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The objective was to evaluate the impact of gender on long-term survival of patients who underwent non-cardiac vascular surgery. Design, Material and Methods: Our prospectively collected data contained information on 560 patients undergoing carotid endarterectomy (CEA), 923 elective abdominal aortic aneurysm repairs (AAA) and 1046 lower limb reconstructions (LLR). Patient characteristics and long-term mortality of women were compared to that of men. Kaplan–Meier (KM) survival curves were constructed for men and women, on which we superimposed age- and sex-matched KM survival curves of the general population. Cox proportional hazards regression was used to identify risk factors for mortality. Results: Men in the CEA group had statistically significant higher all-cause mortality, hazard rate ratio (HRR) 1.41 (95% CI 1.01–1.98) No differences in mortality between the genders were observed in the AAA and LLR groups. Overall, men had more co-morbidities but received more disease-specific medication compared to women. Women retained their higher life expectancy after CEA but lost it in the AAA and LLR groups. Conclusion: Women retain their higher life expectancy after CEA; however, after AAA repair and LLR, this advantage is lost. Both men and women received too little disease-specific medication, but women were worse off. [Copyright &y& Elsevier]

β-Blockers are known to improve postoperative outcome after major vascular surgery. We studied the effects of β-blockers in 2126 vascular surgery patients with and without kidney disease followed for 14 years. Creatinine clearance was calculated using the Cockcroft–Gault equation, and kidney function was categorized as Stage 1 for a reference group of 550 patients, Stage 2 with 808 patients, Stage 3 with 627 patients, and combined Stages 4 and 5 with 141 patients. Outcome measures were 30-day and long-term all-cause mortality with a mean follow-up of 6 years. Cox proportional hazards models were used to control cardiovascular risk factors, including propensity for β-blocker use. In all, 129 (6%) and 1190 (56%) patients died respectively. Mortality rates were three- and two-fold higher, respectively, for patients at Stages 3–5 compared to the reference group for the two outcomes. β-Blocker use was significantly associated with a lower risk of mortality after surgery. The overall adjusted hazard ratio was 0.35 and 0.62, respectively, for individuals at Stages 3–5 compared to the reference group for 30-day and long-term mortality. This study shows that kidney function is a predictor of all-cause mortality and β-blocker use is associated with a lower risk of death in kidney disease patients undergoing elective vascular surgery.Kidney International (2007) 72, 1527–1534; doi:10.1038/sj.ki.5002554; published online 19 September 2007 [ABSTRACT FROM AUTHOR]

Introduction: In-hospital cardiac arrest (IHCA) is an adverse event associated with high mortality. Because of the impact of IHCA more data is needed on incidence, outcomes and associated factors that are present prior to cardiac arrest. The aim was to assess one-year survival, patient-centred outcomes after IHCA and their associated pre-arrest factors.Methods: A multicentre prospective cohort study in 25 hospitals between January 1st 2017 and May 31st 2018. Patients ≥ 18 years receiving cardiopulmonary resuscitation (CPR) for IHCA were included. Data were collected using Utstein and COSCA-criteria, supplemented by pre-arrest Modified Rankin Scale (MRS, functional status) and morbidity through the Charlson Comorbidity Index (CCI). Main outcomes were survival, health-related quality of life (HRQoL, EuroQoL) and functional status (MRS) after one-year.Results: A total of 713 patients were included, 64.5% was male, median age was 63 years (IQR 52-72) and 72.8% had a non-shockable rhythm, 394 (55.3%) achieved ROSC, 231 (32.4%) survived to hospital discharge and 198 (27.8%) survived one year after cardiac arrest. Higher pre-arrest MRS, age and CCI were associated with mortality. At one year, patients rated HRQoL 72/100 points on the EQ-VAS and 69.7% was functionally independent.Conclusion: One-year survival after IHCA in this study is 27.8%, which is relatively high compared to previous studies. Survival is associated with a patient's pre-arrest functional status and morbidity. HRQoL appears acceptable, however functional rehabilitation warrants attention. These findings provide a comprehensive insight in in-hospital cardiac arrest prognosis. [ABSTRACT FROM AUTHOR]

Background: I.V. and perineural dexamethasone have both been found to prolong loco-regional analgesia compared with controls without dexamethasone. It is unclear whether perineural administration offers advantages when compared with i.v. dexamethasone.Methods: A systematic literature search was performed to identify randomized controlled double-blind trials that compared i.v. with perineural dexamethasone in patients undergoing surgery. Using the random effects model, risk ratio (for binary variables), weighted mean difference (for continuous variables) and 95% confidence intervals were calculated. We applied trial sequential analysis to assess the risks of type I and II error, meta-regression for the study of the doseresponsive relationship, and the Grading of Recommendations Assessment, Development, and Evaluation system.Results: We identified 10 randomized controlled double-blind trials (783 patients). When using conventional meta-analysis of nine low risk of bias trials, we found a statistically significantly longer duration of analgesia, our primary outcome with perineural dexamethasone (241 min, 95%CI, 87, 394 min). When trial sequential analysis was applied, this result was confirmed. Meta-regression did not show a dose-response relationship. Despite the precision in the results, using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE), we assessed the quality of the evidence for our primary outcome as low.Conclusions: There is evidence that perineural dexamethasone prolongs the duration of analgesia compared with i.v. dexamethasone. Using GRADE, this evidence is low quality. [ABSTRACT FROM AUTHOR]

Background: Myocardial injury after noncardiac surgery is common, although the exact pathophysiology is unknown. It is plausible that hypotension after surgery is relevant for the development of myocardial injury. The authors evaluated whether low mean arterial pressures (MAPs) after surgery are related to an increased incidence in postoperative cardiac-troponin elevation.Methods: A prospective cohort of 2211 patients aged ≥60 yr, undergoing major or moderate noncardiac surgery in The Netherlands, was retrospectively analysed for the occurrence of postoperative cardiac-troponin elevation [high-sensitive troponin T (hsTnT) >14 ng L-1]. Blood pressures after surgery were recorded and divided into quartiles based on the lowest MAP prior to peak troponin recording. The association between MAP and extent of postoperative cardiac-troponin elevation was analysed.Results: The patients were divided into quartiles based on their lowest MAP in the period preceding the peak hsTnT, ranging from a median of 62 in the lowest quartile to 94 in the highest quartile. Postoperative hsTnT elevation was present in 53.2% of the population. An association between MAP quartile and postoperative peak hsTnT was predominantly observed in the lowest quartile (P<0.001): median hsTnT 17.6 (10.3-37.3), 14.9 (9.4-24.6), 13.8 (9.1-22.5), and 14.0 (9.2-22.4). The multivariable logistic-regression analysis showed an increased risk for postoperative cardiac-troponin elevation with decreasing MAP thresholds.Conclusions: Lower postoperative blood pressure is associated with an increased incidence of postoperative cardiac hsTnT elevation, irrespective of pre- and intraoperative variables. [ABSTRACT FROM AUTHOR]

Tandem photovoltaics applying perovskite on silicon are considered to be a possible route to sustaining continuous efficiency improvements and price reductions. A meaningful market share for such tandems is, however, at least a decade away. Herein, a comprehensive prospective life cycle assessment was conducted, comparing the full life cycle of monofacial and bifacial silicon/perovskite tandem panels with single-junction silicon panels produced up to 2050. The end-of-life included the recovery of silicon and silver. Climate change impacts per kilowatt hour were projected to decrease by two-thirds over time. Tandem panels are expected to reach impacts of 8-10 g CO 2 -eq/kWh in 2050, while single-junction panels may reach 11-13 g CO 2 -eq/kWh in 2050. Other midpoint impact categories with substantial contributions to damaging human health and ecosystem quality were toxicity, particulate matter formation, and acidification, with tandems having lower impacts in each category. Reductions in impacts over time are mainly the result of grid mix decarbonization and panel efficiency improvements. Balance-of-system and recycling were found to contribute substantially to these impact categories. To ensure that tandem panels provide environmental benefits, annual degradation rates should not exceed 1% for monofacial or 3% for bifacial tandems, and refurbishment of panels with advanced degradation is crucial., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Lyme borreliosis (LB) is the most commonly diagnosed tick-borne disease in the northern hemisphere. Since an efficient vaccine is not yet available, prevention of transmission is essential. This, in turn, requires a thorough comprehension of the spatiotemporal dynamics of LB transmission as well as underlying drivers. This study aims to identify spatiotemporal trends and unravel environmental and socio-economic covariates of LB incidence in Poland, using consistent monitoring data from 2010 through 2019 obtained for 320 (aggregated) districts. Using yearly LB incidence values, we identified an overall increase in LB incidence from 2010 to 2019. Additionally, we observed a large variation of LB incidences between the Polish districts, with the highest risks of LB in the eastern districts. We applied spatiotemporal Bayesian models in an all-subsets modeling framework to evaluate potential associations between LB incidence and various potentially relevant environmental and socio-economic variables, including climatic conditions as well as characteristics of the vegetation and the density of tick host species. The best-supported spatiotemporal model identified positive relationships between LB incidence and forest cover, the share of parks and green areas, minimum monthly temperature, mean monthly precipitation, and gross primary productivity. A negative relationship was found with human population density. The findings of our study indicate that LB incidence in Poland might increase as a result of ongoing climate change, notably increases in minimum monthly temperature. Our results may aid in the development of targeted prevention strategies., (© 2024. The Author(s).)

As animal home range size (HRS) provides valuable information for species conservation, it is important to understand the driving factors of HRS variation. It is widely known that differences in species traits (e.g. body mass) are major contributors to variation in mammal HRS. However, most studies examining how environmental variation explains mammal HRS variation have been limited to a few species, or only included a single (mean) HRS estimate for the majority of species, neglecting intraspecific HRS variation. Additionally, most studies examining environmental drivers of HRS variation included only terrestrial species, neglecting marine species. Using a novel dataset of 2800 HRS estimates from 586 terrestrial and 27 marine mammal species, we quantified the relationships between HRS and environmental variables, accounting for species traits. Our results indicate that terrestrial mammal HRS was on average 5.3 times larger in areas with low human disturbance (human footprint index [HFI] = 0), compared to areas with maximum human disturbance (HFI = 50). Similarly, HRS was on average 5.4 times larger in areas with low annual mean productivity (NDVI = 0), compared to areas with high productivity (NDVI = 1). In addition, HRS increased by a factor of 1.9 on average from low to high seasonality in productivity (standard deviation (SD) of monthly NDVI from 0 to 0.36). Of these environmental variables, human disturbance and annual mean productivity explained a larger proportion of HRS variance than seasonality in productivity. Marine mammal HRS decreased, on average, by a factor of 3.7 per 10°C decline in annual mean sea surface temperature (SST), and increased by a factor of 1.5 per 1°C increase in SST seasonality (SD of monthly values). Annual mean SST explained more variance in HRS than SST seasonality. Due to the small sample size, caution should be taken when interpreting the marine mammal results. Our results indicate that environmental variation is relevant for HRS and that future environmental changes might alter the HRS of individuals, with potential consequences for ecosystem functioning and the effectiveness of conservation actions., (© 2024 The Authors. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.)

Trees are pivotal to global biodiversity and nature's contributions to people, yet accelerating global changes threaten global tree diversity, making accurate species extinction risk assessments necessary. To identify species that require expert-based re-evaluation, we assess exposure to change in six anthropogenic threats over the last two decades for 32,090 tree species. We estimated that over half (54.2%) of the assessed species have been exposed to increasing threats. Only 8.7% of these species are considered threatened by the IUCN Red List, whereas they include more than half of the Data Deficient species (57.8%). These findings suggest a substantial underestimation of threats and associated extinction risk for tree species in current assessments. We also map hotspots of tree species exposed to rapidly changing threats around the world. Our data-driven approach can strengthen the efforts going into expert-based IUCN Red List assessments by facilitating prioritization among species for re-evaluation, allowing for more efficient conservation efforts., (© 2024. The Author(s).)

Background: The design of the optimal preoperative evaluation is a much debated topic, with the anaesthetist-led in-person evaluation being most widely used. This approach is possibly leading to overuse of a valuable resource, especially in low-risk patients. Without compromising patient safety, we hypothesised that not all patients would require this type of elaborate evaluation., Objective: The current scoping review aims to critically appraise the range and nature of the existing literature investigating alternatives to the anaesthetist-led preoperative evaluation and their impact on outcomes, to inform future knowledge translation and ultimately improve perioperative clinical practice., Design: A scoping review of the available literature., Data Sources: Embase, Medline, Web-of-Science, Cochrane Library and Google Scholar. No date restriction was used., Eligibility Criteria: Studies in patients scheduled for elective low-risk or intermediate-risk surgery, which compared anaesthetist-led in-person preoperative evaluation with non-anaesthetist-led preoperative evaluation or no outpatient evaluation. The focus was on outcomes, including surgical cancellation, perioperative complications, patient satisfaction and costs., Results: Twenty-six studies with a total of 361 719 patients were included, reporting on various interventions: telephone evaluation, telemedicine evaluation, evaluation by questionnaire, surgeon-led evaluation, nurse-led evaluation, other types of evaluation and no evaluation up to the day of surgery. Most studies were conducted in the United States and were either pre/post or one group post-test-only studies, with only two randomised controlled trials. Studies differed largely in outcome measures and were of moderate quality overall., Conclusions: A number of alternatives to the anaesthetists-led in-person preoperative evaluation have already been researched: that is telephone evaluation, telemedicine evaluation, evaluation by questionnaire and nurse-led evaluation. However, more high-quality research is needed to assess viability in terms of intraoperative or early postoperative complications, surgical cancellation, costs, and patient satisfaction in the form of Patient-Reported Outcome Measures and Patient-Reported Experience Measures., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.)

Background: By preventing hypoxia and hypercapnia, advanced airway management can save lives among patients with traumatic brain injury. During endotracheal intubation (ETI), tracheal stimulation causes an increase in intracranial pressure (ICP), which may impair brain perfusion. It has been suggested that intravenous lidocaine might attenuate this ICP response. We hypothesized that adding lidocaine to the standard induction medication for general anesthesia might reduce the ICP response to ETI. Here, we measured the optical nerve sheath diameter (ONSD) as a correlate of ICP and evaluated the effect of intravenous lidocaine on ONSD during and after ETI in patients undergoing anesthesia., Methods: This double-blinded, randomized placebo-controlled trial included 60 patients with American Society of Anesthesiologists I or II physical status that were scheduled for elective surgery under general anesthesia. In addition to the standard anesthesia medication, 30 subjects received 1.5 mg/kg 1% lidocaine (0.15 mL/kg, ONSD lidocaine) and 30 received 0.15 mL/kg 0.9% NaCl (ONSD placebo). ONSDs were measured with ultrasound on the left eye, before (T0), during (T1), and 4 times after ETI (T2-5 at 5-min intervals)., Results: Compared to placebo, lidocaine did not significantly affect the baseline ONSD after anesthesia induction measured at T0. During ETI, the ONSD lidocaine was significantly smaller (β=-0.24 mm P=0.022) than the ONSD placebo. At T4 and T5, the ONSD placebo increased steadily, up to 20 min after ETI, but the ONSD lidocaine tended to return to baseline levels., Conclusions: We found that the ONSD was distended during and after ETI in anesthetized patients, and intravenous lidocaine attenuated this effect.

Among mammals, the order Primates is exceptional in having a high taxonomic richness in which the taxa are arboreal, semiterrestrial, or terrestrial. Although habitual terrestriality is pervasive among the apes and African and Asian monkeys (catarrhines), it is largely absent among monkeys of the Americas (platyrrhines), as well as galagos, lemurs, and lorises (strepsirrhines), which are mostly arboreal. Numerous ecological drivers and species-specific factors are suggested to set the conditions for an evolutionary shift from arboreality to terrestriality, and current environmental conditions may provide analogous scenarios to those transitional periods. Therefore, we investigated predominantly arboreal, diurnal primate genera from the Americas and Madagascar that lack fully terrestrial taxa, to determine whether ecological drivers (habitat canopy cover, predation risk, maximum temperature, precipitation, primate species richness, human population density, and distance to roads) or species-specific traits (body mass, group size, and degree of frugivory) associate with increased terrestriality. We collated 150,961 observation hours across 2,227 months from 47 species at 20 sites in Madagascar and 48 sites in the Americas. Multiple factors were associated with ground use in these otherwise arboreal species, including increased temperature, a decrease in canopy cover, a dietary shift away from frugivory, and larger group size. These factors mostly explain intraspecific differences in terrestriality. As humanity modifies habitats and causes climate change, our results suggest that species already inhabiting hot, sparsely canopied sites, and exhibiting more generalized diets, are more likely to shift toward greater ground use.

Introduction: Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), functional independence and psychological distress 3 and 12 months post-IHCA., Methods: A multicenter prospective cohort study in 25 hospitals between January 2017 - May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA., Results: At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65-0.87) at 3 months and 0.81 (0.70-0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8-46.5) and mental component scale (MCS) of 43.5 (34.0-39.7) and at 12 months a PCS of 43.1 (34.6-52.3) and MCS 46.9 (38.5-54.5)., Discussion: Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL., Competing Interests: Declaration of Competing Interest This study was funded by Departmental Funds of the Participating Hospitals. Licensing of the SF-12 software (€800) was funded by the ESA Air Liquide unrestricted research grant 2017, as well as printing and postage costs (approx. €300)., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)