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Robot-assisted radical prostatectomy causes discomfort in the immediate postoperative period. This randomised controlled trial investigated if intrathecal bupivacaine/morphine, in addition to general anaesthesia, could be beneficial for the postoperative quality of recovery. One hundred and fifty-five patients were randomly allocated to an intervention group that received intrathecal 12.5 mg bupivacaine/300 μg morphine (20% dose reduction in patients > 75 years) or a control group receiving a subcutaneous sham injection and an intravenous loading dose of 0.1 mg.kg-1 morphine. Both groups received standardised general anaesthesia and the same postoperative analgesic regimen. The primary outcome was a decrease in the Quality of Recovery-15 (QoR-15) questionnaire score on postoperative day 1. The intervention group (n = 76) had less reduction in QoR-15 on postoperative day 1; median (IQR [range]) 10% (1-8 [-60% to 50%]) vs. 13% (5-24 [-6% to 50%]), p = 0.019, and used less morphine during the admission; 2 mg (1-7 [0-41 mg]) vs. 15 mg (12-20 [8-61 mg]), p < 0.001. Furthermore, they perceived lower pain scores during exertion; numeric rating scale (NRS) 3 (1-6 [0-9]) vs. 5 (3-7 [0-9]), p = 0.001; less bladder spasms (NRS 1 (0-2 [0-10]) vs. 2 (0-5 [0-10]), p = 0.001 and less sedation; NRS 2 (0-3 [0-10]) vs. 3 (2-6 [0-10]), p = 0.005. Moreover, the intervention group used less rescue medication. Pruritus was more severe in the intervention group; NRS 4 (1-7 [0-10]) vs. 0 (0-1 [0-10]), p = 0.000. We conclude that despite a modest increase in the incidence of pruritus, multimodal pain management with intrathecal bupivacaine/morphine remains a viable option for robot-assisted radical prostatectomy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine possible differences in propulsion technique between propelling the wheelchair with and without a racket in the hand. Eight experienced wheelchair tennis players performed three submaximal exercise tests and six sprint tests on a wheelchair ergometer. Torque and velocity were measured during the tests and power output and timing variables were calculated. Differences between the conditions with and without racket were analyzed. When propelling with the racket, the racket side showed a significantly lower push time ( P = 0.03), lower percentage push time ( P = 0.001), shorter contact angle ( P < 0.001), more power loss before ( P = 0.006) and after ( P = 0.001) the push, a higher peak ( P = 0.009) and mean ( P = 0.005) power output during the push, and a lower mean overall velocity ( P = 0.03). When the same hand is compared when propelling with and without racket or when the sprint data were analyzed, similar significant differences were found. Propelling the wheelchair while holding a racket has negative effects on the propulsion technique and may lead to injuries of the upper extremity. The longer time needed to couple the hand with the racket to the rim leads to higher power losses and subsequently higher power output generation during the shorter push phase. [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]

Summary In a cross-over trial, five healthy dogs were fed a dry food without or with 1% (w/w) oligofructose to assess any oligofructose-induced effects on the faecal bacterial profile, nitrogen excretion and mineral absorption. The diets were given for a period of 3 weeks. Oligofructose feeding significantly raised the number of Bifidobacteria , Streptococci and Clostridia in faeces. The numbers of faecal anaerobic and aerobic bacteria were raised after ingestion of oligofructose. The faecal pH was unchanged. There was no effect of oligofructose feeding on the route of nitrogen excretion which was associated with a lack of effect on faecal ammonium and urinary urea excretion. It is suggested that the absence or presence of an effect of oligofructose on urinary and faecal nitrogen excretion depends on the background composition of the diet, in particular the content of non-digestible, fermentable carbohydrates. In the diets used, the content of non-digestible, fermentable carbohydrates was not measured. Both apparent magnesium and calcium absorption were significantly raised by oligofructose feeding, but phosphorus absorption was unaffected. The data presented may contribute to the qualification of the use of oligofructose in dog foods. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of the OrCam MyEye 2.0 (OrCam) on the quality of life and rehabilitation needs in patients with advanced retinitis pigmentosa (RP) or cone-rod dystrophies (CRD). The OrCam is a wearable low-vision aid that converts visual information to auditive feedback (e.g. text-to-speech, barcode and facial recognition)., Methods: Patients with a clinical diagnosis of RP (n = 9, 45%) or CRD (n = 11; 55%), and a best-corrected visual acuity of ≤20/400 Snellen were invited to participate in this study. Questionnaires were administered at baseline and after 5.2 (standard deviation ± 1.5) weeks, which included the Dutch version of the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), the Participation and Activity Inventory (PAI) and the OrCam Function Questionnaire (OFQ)., Results: Following OrCam testing, significant improvements were observed in the 'near activities' subscale of the NEI-VFQ (p < 0.001); the 'visual functioning' subscale of the re-engineered NEI-VFQ (p = 0.001); the 'reading' rehabilitation goal of the PAI (p = 0.005) and the overall score of the OFQ (p < 0.001). The observed changes in questionnaire scores did not differ between phenotypes. Advantages and limitations of the OrCam were reported by patients. Three patients (15%) continued rehabilitation with the OrCam after completion of this study., Conclusions: The OrCam mainly improves reading domains in patients with advanced stages of RP or CRD. Further improvements in the OrCam are needed to address current limitations, which may enhance its utility for patients with RP or CRD., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

A model for the spread of human immunodeficiency virus (HIV) in a population of male homosexuals is presented. The population is divided into five groups on the basis of degree of sexual activity. Within each group, the individuals are classified as 1) susceptible; 2) infective; or 3) removed because of a lack of sexual activity associated with advanced acquired immunodeficiency disease (AIDS). The infective individuals are further subdivided into four stages of infection. Analyses of the model address two questions with regard to the spread of HIV: (1) What is the effect of level of sexual activity on an individual's risk for infection, and (2) What is the effect that assumptions about mixing between groups have on both individual risk and transmission throughout a population? Results from analyses using a number of different parameter estimates show that increased levels of sexual activity increase the likelihood that an individual will become infected. In addition, the initial spread of the disease is markedly affected by variation in the amount of contact among individuals from different subpopulations. The steady-state incidence of the disease is not markedly affected by variation in the contact patterns, but the size of the steady-state population and therefore the proportion of infected individuals in the population does vary significantly with changes in the degree of mixing among subpopulations. These results show clearly the sensitivity of model outcomes to variation in the patterns of contact among individuals and the need for better data on such interactions to aid in understanding and predicting the spread of HIV.