Search

Background and Objectives: Using opioid alone for postoperative pain relief is usually inadequate, and higher doses can cause a multitude of complications. A drug, which has anxiolytic property without the adverse effects of traditional analgesics mentioned, may be an attractive choice for postoperative analgesia. This study was done to compare analgesic efficacy of different nonopioid drugs on early postoperative pain and thus opioid-sparing effect. Materials and Methods: It was a randomized controlled trial. Sixty patients scheduled to undergo elective abdominal surgery under general anesthesia were assessed in the study. Primary Objective: The primary objective of this study was to observe the effect of preemptive pregabalin and pregabalin with intravenous (IV) ketamine on Cumulative analgesic requirement postoperatively. Secondary Objective: The secondary objective of this study was to observe the effect of preemptive pregabalin and pregabalin with IV ketamine on (1) analgesia and (2) adverse effects. Patients were randomly divided into two groups each containing 30 patients. Group P received 150 mg of oral pregabalin, 2 h before induction of anesthesia. Group PK received 150 mg of oral pregabalin, 2 h before induction of anesthesia, and injection ketamine 0.15 mg/kg intravenously just before induction of anesthesia. Heart rate and mean blood pressure (MBP) were observed and recorded at different time intervals during surgery. Heart rate, MBP, time to first analgesic demand, visual analog scale (VAS) score, total postoperative analgesic requirement, sedation score, and side effects were recorded in postoperative period. Results: In Group P, the mean total analgesia requirement in postoperative period was 44.47 ± 5.06 mg, whereas in Group PK, it was 41.8 ± 2.34 mg (P = 0.006). VAS score and time to first analgesic demand were insignificantly higher in Group P. No statistically significant difference was found in side effect profile among the two groups. Conclusion: From our study, it could be concluded that a combination of oral pregabalin and IV ketamine when administered preoperatively can decrease opioid consumption while providing good pain control.

Minimal residual disease (MRD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) heralds high risk of relapse. Whether preemptive recombinant interleukin-2 (pre-IL2) is effective for patients with late-onset MRD (LMRD) remains unknown. We retrospectively compared the efficacy and safety of pre-IL2 (n = 30) and pre-DLI (n = 25) for LMRD in patients receiving allo-HSCT for acute leukemia or myelodysplastic syndrome. The 1-year overall survival (OS) and disease-free survival (DFS) rates were 86.7% and 78.4% (P = 0.267), 83.3% and 75.6% (P = 0.329), the cumulative incidence of grades III–IV acute graft-versus-host disease (aGVHD) at 100 days post-preemptive intervention was 3.3% and 12.0% (P = 0.226) in the pre-IL2 group and pre-DLI group, respectively. The 1-year cumulative incidence of moderate/severe chronic GVHD (cGVHD), relapse (CIR), and non-relapse mortality (NRM) were 7.7% and 27.9% (P = 0.018), 13.6% and 20.0% (P = 0.561) and 3.3% and 5.5% (P = 0.321) in the two groups, respectively. No remarkable differences in CIR, OS, and DFS between the two intervention groups were found in multivariate analysis. The GVHD-free and relapse-free survival (GRFS) were better in the pre-IL2 group than in the pre-DLI group (HR = 0.31, 95% confidence interval (CI), 0.12-0.76; P = 0.011). In conclusion, preemptive low-dose IL2 and preemptive DLI yield comparable outcomes for patients with LMRD receiving allo-HSCT, in terms of aGVHD, NRM, relapse, OS, and DFS. However, preemptive low-dose IL2 has a lower incidence of moderate/severe cGVHD and a higher CRFS. Preemptive low-dose IL2 may be an alternative method for patients who develop LMRD after allo-HSCT, particularly for patients who cannot receive preemptive DLI. [ABSTRACT FROM AUTHOR]

Objective: Preemptive kidney transplantation (PKT) is an effective treatment modality that avoids the complications related to dialysis. However, the effect of PKT on graft survival remains controversial. This study aimed to compare graft survival in pediatric recipients of PKT with that of non-PKT recipients. Materials and Methods: The medical records of pediatric kidney transplant recipients between 2005 and 2017 were retrospectively reviewed. We compared glomerular filtration rate, graft, and patient survival rates receiving PKT versus non-PKT. Results: A total of 230 pediatric recipients were included in the study. The majority of recipients were boys (60.4%) who received a living donor kidney (70.8%). In the study group, 46.1% of the patients underwent PKT; 27.8% were on peritoneal dialysis and 26.1% on hemodialysis in the pre-transplant period. The rates of antibody-mediated rejection and BK virus nephropathy were similar between recipients with PKT and non-PKT (p=1.000 and 0.643, respectively). The 3-year graft and patient survival rates were similar between patients with PKT and non-PKT (95.2% vs 93.5%; p=0.776 and 98.1% vs 97.5%; p=1.000, respectively). The dialysis duration, rejection within 6 months after transplantation, and antibody-mediated rejection were independent risk factors for graft failure [Odds ratio (OR) 1.013; 95% confidence interval (CI) 0.992-1.034; p=0.031, OR 0.068; 95% CI 0.105-0.326; p=0.025, and OR 6.029; 95% CI 2.018-7.106; p<0.001]. Conclusion: Evaluation of graft and patient survival shows that PKT is a safe and effective renal replacement treatment option. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the incidence of CVM infection and evaluate the outcome of preemptive treatment. Methods: This prospective, two centers cohort study included recipients who underwent renal transplant between May 2019-May 2020. The incidence of CMV infection and graft outcomes were studied. All managed with preemptive therapy. Results: In this study, 134 renal transplant recipients were recruited. Among them, 30/134 (22.4%) patients tested positive for CMV-RTPCR. We studied the impact of age on the CMV-positivity and we found that the age of the doner was associated with CMV-positivity (P = 0.025; OR = 0.923; CI = 0.8584-0.9943). Smoking and gender showed no association with CMV-positivity. Conclusion: Our data suggest that the course of CMV infection is benign with a high success rate of preemptive treatment. Further evaluation for the universal prophylactic plan is needed. [ABSTRACT FROM AUTHOR]

Background: Adenovirus (AdV) is increasingly recognized as a threat to successful outcomes after allogeneic hematopoietic cell transplantation (allo‐HCT). Guidelines have been developed to inform AdV screening and treatment practices, but the extent to which they are followed in clinical practice in the United States is still unknown. The incidence of AdV in the United States is also not well documented. The main objectives of the AdVance US study were thus to characterize current AdV screening and treatment practices in the United States and to estimate the incidence of AdV infection in allo‐HCT recipients across multiple pediatric and adult transplant centers. Methods: Fifteen pediatric centers and 6 adult centers completed a practice patterns survey, and 15 pediatric centers and four adult centers completed an incidence survey. Results: The practice patterns survey results confirm that pediatric transplant centers are more likely than adult centers to routinely screen for AdV, and are also more likely to have a preemptive AdV treatment approach compared to adult centers. Perceived risk of AdV infection is a determining factor for whether routine screening and preemptive treatment are implemented. Most pediatric centers screen higher‐risk patients for AdV weekly, in blood, and have a preemptive AdV treatment approach. The incidence survey results show that from 2015 to 2017, a total of 1230 patients underwent an allo‐HCT at the 15 pediatric transplant centers, and 1815 patients underwent an allo‐HCT at the 4 adult transplant centers. The incidences of AdV infection, AdV viremia, and AdV viremia ≥ 1000 copies/mL within 6 months after the first allo‐HCT were 23%, 16%, and 9%, respectively, for patients at pediatric centers, and 5%, 3%, and 2%, respectively, for patients at adult centers. Conclusions: These findings provide a more recent estimate of the incidence of AdV infection in the United States, as well as a multicenter view of practice patterns around AdV infection screening and intervention criteria, in pediatric and adult allo‐HCT recipients. [ABSTRACT FROM AUTHOR]

Background: Kidney transplant is the renal replacement therapy (RRT) of choice for children with end stage kidney disease (ESKD). Only 21.3% of children who initiate RRT receive a preemptive kidney transplant (PKT). We characterized the transition to RRT in children in the CKiD cohort including the prevalence of dialysis as first RRT vs. PKT and graft survival. Methods: 258 children enrolled in CKiD have initiated RRT, and 202 had post-RRT initiation data collected through phone or in-person follow-up. Characteristics by first RRT modality were compared using Chi-square and Kruskal-Wallis tests. Parametric-accelerated failure time models were fit for transplantation. Graft failure was characterized using Kaplan-Meier methods and log rank tests. Results: Sixty-one percent received dialysis as first RRT modality and 39% PKT. Those with PKT were less likely to have glomerular disease and to be African-American, and had higher household-income. African-American subjects were nearly twice as likely to undergo dialysis prior to transplant. Those with a living donor and a college-educated mother had 40%-decreased odds of being dialysis experienced. Children with PKT were more likely to receive a living donor transplant. Only 5% of PKT subjects had graft failure by 4 years compared to 16% of those initially treated with dialysis (p = 0.092); however, after adjustment the effect of dialysis exposure was attenuated (p = 0.206). Conclusion: CKiD subjects undergo PKT more often compared to nationally-reported rates, and are more likely to receive a kidney transplant within 1 year of starting dialysis. African-American race and lower household-income are associated with decreased access to PKT. [ABSTRACT FROM AUTHOR]

Nonsurgical scar attenuation options include compression garments, silicone gel, intralesional drug therapy, radiation therapy, laser, and light therapies. Laser application preceding surgical intervention has been shown to modify the wound-healing process and affect subsequent scar formation. The objective of this study was to evaluate the safety, efficacy, and final cosmesis of a single presurgical laser treatment on surgical scar formation. This was a randomized, controlled, intraindividual split-scar pilot study with blinded assessments of treated versus untreated planned incision sites. One half of each planned scar was treated by means of an Erbium glass, 1540 nm laser, 24 h before surgery, and the other half was not treated and served as the control. Clinical evaluations and the measurements of patient and physician POSAS scales were done at 1 and 12 months following surgery. Eleven patients completed the study and were included in the analyses. Laser pretreatment showed a significant beneficial effect compared with no treatment. Both the patient and physician mean Patient and Observer Scar Assessment Scale scores were significantly lower for the laser-treated half of the scars compared with the control side (1.55 to 3.00, p = 0.02 and 2.28 to 4.42, p = 0.03). There was a highly significant interobserver correlation in the evaluation of the overall posttreatment changes (r = 0.904, p < 0.001). A single presurgical laser treatment of a planned incision site is a simple, safe, and painless strategy to significantly improve the final scar appearance. [ABSTRACT FROM AUTHOR]

Purpose: The waiting list period for kidney transplantation can be lengthy and associated with a deteriorated health-related quality of life (HRQoL). It might also be experienced differently depending on the experience of renal replacement therapy (preemptive or dialyzed patients), and the type of dialysis. The main objective of this study is to measure and compare HRQoL changes in preemptive, hemodialysis (HD), and peritoneal dialysis (PD) patients during the waiting list period for kidney transplantation.Methods: A sample of adult patients on kidney transplant waiting list from three French University Hospital centers was recruited. HRQoL was measured using the SF-36 and a specific questionnaire (ReTransQol), which were collected every 6 months before transplantation in preemptive, HD, and PD patients. Mixed-effects models taking into account time and possible confounding factors were used to compare HRQoL changes between the three groups.Results: Preemptive (n = 230), HD (n = 177), and PD patients (n = 39) were enrolled. The renal replacement therapy modalities, time (time on waiting list and age at registration), and gender were associated with HRQoL changes. The HD and PD patients had a significantly lower perceived HRQoL on Role Physical, Social Functioning, and Role Emotional dimensions than the preemptive patients, with lower scores for PD compared to HD patients. The HRQoL scores of all patients were lower compared to the French general population for all dimensions.Conclusions: A better understanding of pre-transplantation patients' experience can help improving patient care with adapted educational programs and psychological support depending on the type of renal replacement therapy. [ABSTRACT FROM AUTHOR]

In this paper, we consider two single server queueing systems to which customers of two distinct priorities (P1 and P2) arrive according to a Marked Markovian arrival process (MMAP). They are served according to two distinct phase type distributions. The probability of a P1 customer to feedback is θ on completion of his service. The feedback (P1) customers, as well as P2 customers, join the low priority queue. Low priority (P2) customers are taken for service from the head of the line whenever the P1 queue is found to be empty at the service completion epoch. We assume a finite waiting space for P1 customers and infinite waiting space for P2 customers. Two models are discussed in this paper. In model I, we assume that the service of P2 customers is according to a non-preemptive service discipline and in model II, the P2 customers service follow a preemptive policy. No feedback is permitted to customers in the P2 line. In the steady state these two models are compared through numerical experiments which reveal their respective performance characteristics.

Abstract Background: The aim of this study is to evaluate the impact of preemptive adding topical Ketorolac to Tetracaine drop on pain intensity and hemodynamic parameters during and after cataract surgery. Materials and Methods: Eighty patients scheduled for elective cataract surgery under sedation and topical anesthesia, were randomly allocated to two equal groups: group T received Tetracaine 0.5%, and group TK received Tetracaine with ketorolac eye drops. One drop of each ophthalmic drug was applied every 10 minutes from 30 minutes before surgery. Pain intensity and hemodynamic parameters were assessed just before starting the operation and 5, 10, 15and 20 minutes during the operation, and then 0, 5, 10, 15 and 20 minutes after arrival of the patient to the recovery room. Results: Mean pain intensity was significantly lower in TK group (1 ± 0.128) compared with T group (2 ± 1.54) during the surgery (p = 0.003), but there was no significant difference between the two groups in this regard during the recovery time (p =0.157). The number of patients requiring additional analgesic was not significantly different between the groups. There was no significant difference between the two groups regarding hemodynamic parameters except at 20th minutes and 15th and 20th minutes (heart rate and respiratory rate) after arrival to the recovery room. Conclusion: Preemptive adding topical Ketorolac to Tetracaine drop is more effective than Tetracaine alone to reduce pain during cataract surgery.

Introduction: Preemptive (P) living donor kidney transplantation (LDKT) provides better survival rates, quality of life and economic saving. However, the extent of these advantages over those with a short period of pre-LDKT dialysis is not known. Objectives: Evaluation of the patients’ characteristics and short-term outcomes of PLDKT and LDKT after a pre-transplant period of hemodialysis (HD) not >6 months. Patient and methods: This study was conducted between June 2010 and June 2012 and included two groups. Group-I included recipients without HD before operation. Group-II included those who had a period of HD ≤6 months. Recipients and donors were evaluated according to the classic work up. Follow-up for 12 months was scheduled. Results: Group-I included 30 recipients and group-II included 15 recipients. Demographic and clinical characteristics were similar except for mean recipient age (44 versus 34.3 years; p = 0.024), recipient donor age difference (p = 0.03), job categories (p = 0.047) and ABO distribution (p = 0.01). Cumulative graft (0.88 versus 0.93) and recipient (0.92 versus 0.100) survival rates were non-significantly different. Graft function and mean serum creatinine level were within normal up to 12 months. Acute graft rejection (AGR) was significantly higher in group-II (16.7% versus 46.7%; p = 0.03). However, lymphoceles were significantly more common in group-I (40% versus 6.7%; p = 0.02). There was no delayed graft function (DGF), major urinary or vascular complications. Conclusion: PLDKT has a lower rate of AGR. Despite it has a higher rate of lymphoceles, it saves the patient the morbidities of vascular access and inconveniences of HD. Hence, PLDKT is recommended as the first choice for each KT-candidate.

The aim of a multi-mode resource-constrained project scheduling problem (MRCPSP) is to assign resource(s) with the restricted capacity to an execution mode of activities by considering relationship constraints, to achieve pre-determined objective(s). These goals vary with managers or decision makers of any organization who should determine suitable objective(s) considering organization strategies. We also introduce the preemptive extension of the problem which allows activity splitting. In this paper the preemption multi-mode resource-constrained project scheduling problem (P-MMRCPSP) with Minimum makespan and the maximization of net present value (NPV) has been considered. Since the considered model is NP-Hard, The performance of our proposed model is evaluated by comparison with two well-known algorithms; non-dominated sorting genetic algorithm (NSGA II), multi-objective imperialist competitive algorithm (MOICA). These metaheuristics have been compared on the basis of a computational experiment performed on a set of instances obtained from standard test problems constructed by the ProGen project generator, where, additionally, cash flows were generated randomly with the uniform distribution. Since the effectiveness of most meta-heuristic algorithms significantly depends on choosing the proper parameters. A Taguchi experimental design method (DOE) was applied to set and estimate the proper values of GAs parameters for improving their performances. The computational results show that the proposed MOICA outperforms the NSGA-II.

Background: Currently, the administration of non-opioid analgesics as a preemptive treatment has been approved by the surgeons of jaw due to lack of side effects of opioids in jaw surgery. However, which medicine as a pre-medication has a good result, is a controversy. Therefore, the aim of this study was to investigate the effect of preemptive therapy by pre-gabalin single dose on opioid consumption rate after surgery on mandibular fractures. Methods: This double-blind clinical trial was conducted in Tabriz Imam Hospital in 2012 on 60 patients who were undergoing mandibular fracture surgery. Patients were classified as intervention and control groups and the intervention group consumed one pregabalin capsule 300 milligrams with 50 ml of water half an hour before surgery. The amount of opioid use in the first eight hours after surgery was measured and recorded in both groups. Results: Opioid use in both groups was decreased with time- spending. There was also a significant relationship between opioid use in both intervention and control groups (P

Study Design: A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery.Objective: Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery.Summary Of Background Data: Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.Methods: Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1 ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e., 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected.Results: In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 hours, 12 hours, 16 hours after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R.Conclusion: The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background: The aim of the current study was to evaluate and compare the postoperative analgesic effects of preemptive intravenous (IV) paracetamol and nefopam versus and their effect on the total requested dose of tramadol postoperatively. Materials and Method: 60 adult female patients, aged 20–55 years, ASA physical status & and were scheduled for anterior and posterior vaginal wall repair (APR) and assigned in a randomized manner into three groups after spinal anesthesia. In control group, 50 ml of normal saline had been infused intravenously over 15 minutes. In group (P), an intravenous infusion of 1 g paracetamol had been given over 15 minutes. In group (N), an intravenous infusion of 20 mg nefopam in 50 ml normal saline had been given over 15 minutes. Visual analogue scale (VAS) were taken at a constant times postoperatively and the total requested postoperative dose of tramadol had been calculated. Results: Both paracetamol and nefopam groups are associated with a significant longer time to first request of postoperative analgesic treatment (group N > P > C) (P < 0.05) with a significant reduction in the total required postoperative analgesics. VAS revealed a significantly lower score in Group N and P, compared to group C. Conclusion: Preemptive i.v. paracetamol and nefopam is a good plan to provide an effective postoperative analgesia following spinal anesthesia in patients undergoing vaginal APR. [ABSTRACT FROM AUTHOR]

Copyright of Computer Measurement & Control is the property of Magazine Agency of Computer Measurement & Control and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen. Methods: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. Results: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). Conclusion: Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period. [ABSTRACT FROM AUTHOR]

This article explains temporal variation in repression as a function of the "dissident calendar," the set of events that serve as natural focal points for coordination. The core argument is that regimes can anticipate the events that create these focal points and engage in preemptive repression to survive their passing. This dynamic produces predictable, often cyclical patterns in repression. An analysis of dissident detentions in China from 1998 to 2014 shows that "focal events" alone appear to be responsible for more than 20 percent of dissident detentions over the analysis period. Such detentions tend to be shorter and rely less on formal criminal procedures, suggesting a "catch-and-release" dynamic. Additional analysis of detentions in Tibet shows how the calendar may vary by issue or group. [ABSTRACT FROM AUTHOR]

Copyright of Al-Anbar University Journal of Economic & Administration Sciences is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cryptococcal antigen (CrAg) screening and targeted preemptive fluconazole in antiretroviral-naive human immunodeficiency virus–infected adults with CD4 cell counts <100/μL seems promising as a strategy to reduce the burden of cryptococcal meningitis (CM). We searched MEDLINE, EMBASE, and Web of Science and used random-effect meta-analysis to assess the prevalence of blood CrAg positivity (31 studies; 35644 participants) and asymptomatic CM in CrAg-positive participants and the incidence of CM and the all-cause mortality rate in screened participants. The pooled prevalence of blood CrAg-positivity was 6% (95% confidence interval [CI], 5%–7%), and the prevalence of asymptomatic CM in CrAg-positive participants was 33% (95% CI, 21%–45%). The incidence of CM was 21.4% (95% CI, 11.6%–34.4%) without preemptive fluconazole and 5.7% (95% CI, 3.0%–9.7%) with preemptive fluconazole therapy initiated at 800 mg/d. In CrAg-positive participants, postscreening lumbar puncture before initiating preemptive fluconazole at 800 mg/d further reduced the incidence of CM to null and showed some survival benefits. However, the all-cause mortality rate remained significantly higher in CrAg-positive than in CrAg-negative participants (risk ratio, 2.2; 95% CI, 1.7–2.9; P <.001). [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of the preemptive analgesic effect of low dose ketamine versus MgSO4 on potentiating postoperative analgesia when compared to placebo in patients undergoing cesarean section under general anesthesia. Methods: This prospective randomized blind study included 60 parturient females scheduled for cesarean section under general anesthesia. They were randomized into three equal groups [20 patients each]: group I [Control]: received 20 ml normal saline 0.9%, group II [Ketamine]: received ketamine 0.3 mg/kg in 20 ml normal saline and group III [MgSO4]: received MgSO4, 30 mg/kg in 20 ml normal saline. Investigated medications infused over 10 min before induction of anesthesia. Fentanyl requirement, mean BP and HR were measured intraoperatively. Pain, sedation and nausea and vomiting were assessed at 2, 6, 12 and 24 h postoperatively. Total postoperative pethidine dose over 24 h was calculated. Results: MBP and HR showed statistically significantly lower value in group (K) and (M) compared to group (C) at postintubation and postincision readings. Intraoperative fentanyl requirement was statistically higher in (C) groups compared to (K) and (M) groups. The time for first request for postoperative analgesia was longer and the total postoperative pethidine dose over 24 h was lower in (K) group compared to (C) and (M) groups. Postoperative VAS scores at 2 and 6 h postoperatively showed statistically highly significantly lower values in (K) group compared to (C) and (M) groups. Apgar, postoperative sedation and PONV scores showed no statistically significant differences among the three groups. Conclusions: Preemptive dose of either ketamine (0.3 mg/kg) or MgSO4 (30 mg/kg) in patients undergoing cesarean section under general anesthesia could suppress the pressor response to endotracheal intubation and skin incision and decreased the intraoperative fentanyl requirement. Ketamine showed a significant preemptive analgesic effect compared to MgSO4 at 2 and 6 h postoperatively.

Background: Breast surgery compromises one of the most common cancer surgeries in females and commonly followed by acute postoperative pain. Pregabalin and ketamine have been used in many previous studies and was found to have a good analgesic profile. We assumed that pregabalin and ketamine can be used in control of postoperative pain in female patients undergoing breast cancer surgery. Material and Methods: Ninety female patients scheduled for cancer breast surgery were allocated in three groups (30 patients each), control group (group c) received preoperative placebo, pregabalin group (group p) received oral 150 mg pregabalin 1 h before surgery, ketamine group (group k) received intravenous (IV) 0.5 mg/kg ketamine with induction of anesthesia followed by 0.25 mg/kg/h IV throughout the surgery. All patients received general anesthesia and after recovery, the three groups were assessed in the first postoperative 24 h for postoperative visual analog scale (VAS) , total 24 h morphine consumption, incidence of postoperative nausea and vomiting (PONV), sedation score >2 and any complications from the drugs used in the study. Results: The use of pregabalin or ketamine was found to reduce total postoperative morphine consumption with P < 0.001. There was no difference between pregabalin and ketamine groups in opioid requirement. There was no difference between the three groups in postoperative VAS scores or incidence of PONV and sedation score >2. Conclusion: The use of preoperative oral 150 mg pregabalin 1 h before surgery or IV 0.5 mg ketamine with induction of anesthesia can reduce postoperative opioid consumption in breast cancer surgery without change in sedation or PONV and with a good safety profile.

Introduction Preemptive analgesia is now an essential step of perioperative pain management. Pregabalin and gabapentin, which are drugs primarily used in the treatment of neuropathic pain, are now being contemplated for use as preemptive analgesics. This study aimed to assess the effectiveness of gabapentin and pregabalin as preemptive analgesics. The primary objective of the study was to compare pregabalin and gabapentin versus placebo with regard to a visual analogue scale (VAS) score for postoperative pain for 24 hours, time to first rescue analgesia, and total analgesic consumption over 24 hours. The level of sedation with the help of a modified Ramsay sedation score was also compared. Methods This randomised, double-blind study was conducted on 90 patients aged 18-60 years of the American Society of Anesthesiologists (ASA) physical status I and II undergoing elective laparoscopic cholecystectomy under general anaesthesia at a tertiary health care institute. The patients were randomly divided into three groups of 30 each, namely, Group A (gabapentin - oral two capsules of 300 mg gabapentin), Group B (pregabalin - oral two capsules of 150 mg pregabalin), and Group C (placebo - oral two capsules). The various parameters that were recorded in both groups included a VAS score for pain, total dose of tramadol consumed in 24 hours, modified Ramsay sedation scores in the immediate postoperative period, and adverse effects related to the study drugs (at zero and one hour and two, four, six, 12, and 24 hours). The data were analysed using the Statistical Package for the Social Sciences (SPSS) (version 25; IBM SPSS Statistics for Windows, Armonk, NY) software. Results VAS scores were significantly lower in groups A and B when compared to Group C. However, the scores were comparable in Group A (gabapentin) and Group B (pregabalin). The difference in the mean time of rescue analgesia was statistically highly significant when Group A (gabapentin) was compared with Group C (placebo) (P value<0.001) and when Group B (pregabalin) was compared with Group C (placebo) (P value<0.001). Thus, gabapentin and pregabalin provide a longer postoperative pain-free period (382.6 min and 502.3 min, respectively) when compared to the placebo group (137.8 min). Moreover, the mean dose of tramadol consumption in 24 hours was significantly lower in pregabalin (170 mg) and gabapentin groups (176.7 mg) when compared to the placebo group (286.7 mg). However, there was no significant difference in the total tramadol consumption between the gabapentin and pregabalin groups. The level of sedation up to six hours postoperatively was higher in Group B (pregabalin) and Group A (gabapentin) patients compared to Group C (placebo). On comparing the mean Ramsay sedation scores of Group A (gabapentin) versus Group C (placebo) and Group B (pregabalin) versus Group C (placebo), it was found that there was a highly significant difference at zero and one-hour time intervals (P value<0.001 in both comparisons). Conclusion A single preoperative dose of pregabalin 300 mg or gabapentin 600 mg can be used for effective preemptive analgesia in patients undergoing laparoscopic cholecystectomy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kaur et al.)

The rapid development of the Real-Time and Embedded System (RTES) has increased the requirement on the processing capabilities of sensors, mobiles and smart devices, etc. Meanwhile, energy efficiency techniques are in desperate need as most devices in RTES are battery powered. Following the above trends, this work explores the memory system energy efficiency for a general multi-core architecture. This architecture integrates a local memory in each processing core, with a large off-chip memory shared among multiple cores. Decisions need to be made on whether tasks will be executed with the shared memory or the local memory to minimize the total energy consumption within real-time constraints. This paper proposes optimal schemes as well as a polynomial-time approximation algorithm with constant ratio. The problem complexity analysis for different task and system models is also presented. Experimental results show that the proposed approximation scheme performs close to the optimal solution in average. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: The impact of preemptive second kidney transplantation (2KT) on graft and patient survival is poorly established. The association between preemptive 2KT (p2KT, N = 93) and outcomes was estimated in a multicenter French cohort of 2KT (N = 1314) recipients using propensity score methods. During the follow‐up, there were 274 returns to dialysis and 134 deaths. p2KT was associated with lower death‐censored graft loss (HR = 0.39 [0.18–0.88], P = 0.024) and graft failure from any cause including death (HR = 0.42 [0.22–0.80], P = 0.008). Similar associations were observed for death with a functioning graft, although not reaching statistical significance (HR = 0.47 [0.17–1.26], P = 0.13). There was a significant interaction between donor type and p2KT (P for interaction = 0.016). Indeed, p2KT was not significantly associated with the risk of graft failure from any cause including death in living donor 2KT (P = 0.39), whereas the association was substantial in the deceased donor subset (HR = 0.30 [0.14–0.64], P = 0.002). Of note, the adjusted graft survival of p2KT with deceased donor paralleled that of 2KT with living donor, either preemptive or not (93.8% vs. 88.6% at 4 years and 76.1% vs. 70.5% at 8 years, P = 0.13). This large French multicenter study analyzed using propensity scores suggests that p2KT is associated with better graft prognosis. [ABSTRACT FROM AUTHOR]

Background. Gabapentin, as a structural analogue of γ-aminobutyric acid, has been investigated to provide pain relief in the early postoperative period following various surgical interventions. Objectives. The objective of this study was to investigate whether preemptive oral administration of gabapentin 800 mg can reduce postoperative pain and modulate the inflammatory cytokine response in comparison to placebo in patients undergoing total knee arthroplasty under general anesthesia. Material and methods. Fifty-two patients were randomly divided into 2 groups before surgery, either to receive peroral gabapentin 800 mg or placebo drug, 1 h before surgery. All patients had general anesthesia with endotracheal intubation, in a standardized fashion, by the same anesthetist. Thirty min before completion of surgery, intramuscular diclofenac sodium 75 mg was administered. Following extubation, visual analogue pain scale (VAS) scores and additional analgesic requirements were recorded at 15 min at post-anesthesia care unit (PACU), and at 4th and 24th h postoperatively. Plasma levels of interleukin 6 (IL-6), and tumor necrosis factor R (TNF-R) were measured at predetermined time points (T0 1 h before administration of gabapentin, T1 at postoperative the 4th h mark, and T2 at postoperative at the 24th h mark). Results. The VAS scores at postoperative 4th h were significantly higher in placebo and gabapentin groups compared with VAS scores at PACU and at 24th h. The groups did not differ in terms of additional analgesic requirements. In gabapentin group, IL-6 levels at T1 and T2 were significantly lower in comparison to values measured in placebo group at the same time points. This difference was not significant in TNF-R levels between the groups. Conclusions. Though preemptive oral gabapentin administration did not reduce postoperative pain and analgesic requirements in total knee arthroplasty surgery, it attenuated IL-6 production on the first postoperative day. [ABSTRACT FROM AUTHOR]

This paper considers two uniform parallel machine scheduling problems with fixed machine cost under the background of cloud manufacturing. The goal is to minimize the makespan with a given budget of total cost, $$\hat{U}$$ . All the jobs are homogeneous, i.e., the processing times of the jobs are identical. Non-preemptive and preemptive problems are studied. For the non-preemptive problem, we give a $$2[1+1{/}(h-1)]$$ -approximation algorithm, where h is the number of the machine which can not be selected the first time. For the preemptive problem, we give an algorithm whose worst-case bound equals to $$1+1{/}(h-1)$$ . Preliminary experimental results indicate that the proposed algorithms are reasonably accurate compared with the lower bounds. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to identify the impact of antifungal prevention in critically ill immunocompetent adult patients on mortality and subsequent infection.Data Sources: A systematic review and meta-analysis of randomized controlled trials comparing any antifungal use versus placebo to prevent candidiasis in ICU patients were performed.Study Selection: Searches were performed on PubMed, Embase, Scopus, main conference proceedings, and ClinicalTrials.gov, as well as reference lists.Data Extraction: The primary outcomes were mortality and invasive candidiasis. The secondary outcome was the rate of Candida albicans and nonalbicans strains after treatment. A random effect model was used, and sensitivity analysis was performed for both outcomes. Results are expressed as risk ratios and their 95% CIs.Data Synthesis: Nineteen trials (10 with fluconazole, four with ketoconazole, one with itraconazole, three with micafungin, and one with caspofungin) including 2,792 patients were identified. No individual trial showed a decreased mortality rate. Combined analysis showed that preventive antifungal did not decrease mortality (risk ratio, 0.88; 95% CI, 0.74-1.04; p = 0.14) but significantly decreased secondary fungal infections by 50% (risk ratio, 0.49; 95% CI, 0.35-0.68; p = 0.0001). No shift across nonalbicans strains was observed during treatment (risk ratio, 0.62; 95% CI, 0.19-1.97; p = 0.42). However, publication biases preclude any definite conclusions for prevention of infection.Conclusions: Antifungal prevention of systemic candidiasis in immunocompetent critically ill adults did not reduce mortality and may have decreased secondary fungal infection rates. However, significant publication bias was present. [ABSTRACT FROM AUTHOR]

BackgroundHypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP).MethodsIn total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began.ResultsPreemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05).ConclusionsPreemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

Background: End-stage liver disease is associated with marked hemodynamic disturbances that are further deteriorated during liver transplantation and is aggressively represented in the form of postreperfusion syndrome (PRS). Aim: The aim was to test the hypothesis that preemptive ephedrine administration pre-reperfusion targeting a rational level of mean arterial blood pressure (MAP) of 85–100 mmHg, may reduce the incidence of PRS. Patient and methods: One hundred recipients for adult living donor liver transplantation (ALDLT) were prospectively randomized into 2 groups; group C, control group and group E, who received ephedrine 2.5–5 mg/min starting 5 min before reperfusion till mean arterial blood pressure (MAP) reached 85–100 mmHg. Hemodynamic parameters including MAP, heart rate (HR), Transesophageal Doppler (TED) parameters including corrected flow time (FTc), systemic vascular resistance (SVR), and cardiac output (COP) were measured; just predrug administration, just before reperfusion, just after reperfusion, 5 min after reperfusion and at the end of surgery. Cold and warm ischemia times (C/WIT), duration of anhepatic phase and total duration of surgery were recorded. The incidence of PRS, the need of rescue vasoconstrictor for hemodynamic instability at time of reperfusion, need for postreperfusion vasoconstrictor infusions, over shooting of hemodynamics, postreperfusion fibrinolysis indicated by fibrinogen level and maximum lysis parameter of rotational thromboelastometry (ROTEM) were compared between both groups. Results: The mean dose of ephedrine required was (12.5 ± 7.5 mg). Group E had statistically significant increase in MAP, SVR, and COP; just before reperfusion, just after reperfusion and 5 min after reperfusion readings. There were no statistical significant differences between the 2 groups at the end of surgery. The incidence of PRS and the need of rescue adrenaline at the time of reperfusion, and the postreperfusion need for vasoconstrictor infusion decreased significantly in group E when compared to group C. Also postoperative mechanical ventilation decreased significantly in group E. Conclusion: The preemptive goal directed titration of ephedrine against a target MAP pre-reperfusion could decrease the incidence of PRS by 40%, attenuated the hypotensive response to reperfusion and decreased the need for postreperfusion vasoconstrictor support without over shooting of any of the monitored hemodynamic indices.

Introduction: Postoperative pain management of high quality is important and in majority of post surgical cases pain is not treated adequately. We have evaluated the efficacy and safety of pregabalin and gabapentine as preemptive analgesic for post operative pain management in patients undergoing lower abdominal and lower limb surgery under spinal anesthesia. Materials and Methods: In a randomized double blind study, 90 patients were divided into three groups. Group G received tab gabapentin 900 mg, Group P received tab pregabalin 300 mg and Group C received placebo tablet orally 1 hour prior to surgery. All patients underwent surgery under spinal anesthesia using 0.5% Bupivacaine. Assessment of postoperative pain was made with visual Analogue Scale (VAS) score at 1, 2, 4, 6, 8, 12, 18, and 24 hours post operatively. Injection tramadol 100 mg was given as rescue analgesic intramuscularly when VAS score was > 7 in all the groups. Time to first rescue analgesics and number of rescue analgesics received were noted in all groups. The occurrences of side effects were noted in all groups. Results: The tramadol as rescue analgesia consumption was less in pregabalin and gabapentin groups compared to control and was statistically significant (P < 0.001). Initial VAS scores were lower in pregabalin (3.2 ± 0.4) and gabapentin (3.63 ± 0.32) groups compared to control (6.60 ± 0.77) and was statistically significant (P < 0.001). Time to first rescue analgesia was significantly longer for pregabalin (24.6 hours) followed by gabapentin (20.76 hours) and control (4.93 hours) groups. Conclusion: Pregabalin 300 mg single dose given 1 hour prior to surgery is superior to 900 mg gabapentin and placebo in attenuating post operative in patients undergoing lower abdominal and lower limb surgery. Both drugs are better than placebo.

Aim: Changes in the metabolic, endocrine, and immune systems caused by surgical trauma and pain are associated with increased concentrations of the biological mediators such as cytokines. Preemptive epidural analgesia may affect pain caused by surgical trauma and the corresponding neurohumoral response induced by the neuromediators. This study investigated the effects of preemptive epidural analgesia on postoperative pain and cytokine levels. Methods: A total of 60 children undergoing urological surgery were randomly assigned to either the preemptive epidural analgesia (Preempt EA, n=31) group or the postoperative epidural analgesia (Postop EA, n=29) group. Epidural infusion was started before the surgical incision in Preempt EA group and after the peritoneal closure in the Postop EA group. Blood samples were collected preoperatively (before anesthesia induction), 1 h and 24 h after surgery. Plasma TNF-α and IL-2 levels were measured by ELISA. Postoperative pain was assessed using the FACES pain scale, and postoperative analgesia was evaluated 1 h and 24 h after surgery. Results: Although TNF-α levels were increased 1 h and 24 h after surgery compared to preoperative levels in both groups, the levels were significantly higher in the Postop EA group. IL-2 levels were significantly higher at both postoperative time points in the Preempt EA group than in the Postop EA group. There were no significant differences in pain scores between the groups. Conclusion: Our results suggest that preemptive epidural analgesia may attenuate the proinflammatory response but has no effect on pain intensity. (The Medical Bulletin of Haseki 2013;51:162-7)

Objectives: To evaluate the effectiveness of preoperative intramuscular diclofenac for pain relief after total abdominal hysterectomy.Methods: A prospective double-blind, randomized study was conducted in 37 patients who underwent total abdominal hysterectomy at our institution between September 2012 and January 2013. The patients were randomly allocated into two groups to receive either single intramuscular 75 mg diclofenac (treatment group; n = 18) or normal saline (control group; n = 19) 20 min before surgery. Total consumption of meperidine over a 24-h period were recorded. The degrees of postoperative pain were assessed at 4, 8, 12, and 24 h postoperatively by using a numeric rating scale and the adverse events relevant to diclofenac were observe. Results: The mean 24-h postoperative meperidine consumption in the treatment group was insignificantly lower compared to that in the control group (46.11+24.77 mg and 68.42+44.63 mg, respectively, p=0.069). Mean pain scores at 4, 8, 12, and 24 h postoperatively in the treatment group were lower than those in the control group (2.83 vs 4.53, p=0.052; 2.83 vs 4.89, p=0.031; 2.78 vs 4.68, p=0.044; 1.28 vs 1.89, p=0.296, respectively). No serious adverse events were observed in both groups.Conclusion: Preoperative intramuscular diclofenac significantly reduced pain scores at 8 and 12 h(while insignificantly decreased 24-h meperidine consumption) after total abdominal hysterectomy.