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In this article, we report on the preparation and cell culture performance of a novel fibrous matrix that has an interbonded fiber architecture, excellent pore interconnectivity, and controlled pore size and porosity. The fibrous matrices were prepared by combining melt-bonding of short synthetic fibers with a template leaching technique. The microcomputed tomography and scanning electron microscopy imaging verified that the fibers in the matrix were highly bonded, forming unique isotropic pore architectures. The average pore size and porosity of the fibrous matrices were controlled by the fiber/template ratio. The matrices having the average pore size of 120, 207, 813, and 994 μm, with the respective porosity of 73%, 88%, 96%, and 97%, were investigated. The applicability of the matrix as a three-dimensional (3D) tissue scaffold for cell culture was demonstrated with two cell lines, rat skin fibroblast and Chinese hamster ovary, and the influences of the matrix porosity and surface area on the cell culture performance were examined. Both cell lines grew successfully in the matrices, but they showed different preferences in pore size and porosity. Compared with two-dimensional tissue culture plates, the cell number on 3D fibrous matrices was increased by 97.27% for the Chinese hamster ovary cells and 49.46% for the fibroblasts after 21 days of culture. The fibroblasts in the matrices not only grew along the fiber surface but also bridged among the fibers, which was much different from those on two-dimensional scaffolds. Such an interbonded fibrous matrix may be useful for developing new fiber-based 3D tissue scaffolds for various cell culture applications.

It is commonly accepted that titanium and the titanium alloying elements of tantalum, niobium, zirconium, molybdenum, tin, and silicon are biocompatible. However, our research in the development of new titanium alloys for biomedical applications indicated that some titanium alloys containing molybdenum, niobium, and silicon produced by powder metallurgy show a certain degree of cytotoxicity. We hypothesized that the cytotoxicity is linked to the ion release from the metals. To prove this hypothesis, we assessed the cytotoxicity of titanium and titanium alloying elements in both forms of powder and bulk, using osteoblast-like SaOS2cells. Results indicated that the metal powders of titanium, niobium, molybdenum, and silicon are cytotoxic, and the bulk metals of silicon and molybdenum also showed cytotoxicity. Meanwhile, we established that the safe ion concentrations (below which the ion concentration is non-toxic) are 8.5, 15.5, 172.0, and 37,000.0 µg/L for molybdenum, titanium, niobium, and silicon, respectively.

To provide health care providers, patients, and the general public with a responsible assessment of currently available data on vaginal birth after cesarean (VBAC).A non-DHHS, nonadvocate 15-member panel representing the fields of obstetrics and gynecology, urogynecology, maternal and fetal medicine, pediatrics, midwifery, clinical pharmacology, medical ethics, internal medicine, family medicine, perinatal and reproductive psychiatry, anesthesiology, nursing, biostatistics, epidemiology, health care regulation, risk management, and a public representative, and a public representative. In addition, 21 experts from pertinent fields presented data to the panel and conference audience.Presentations by experts and a systematic review of the literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.Given the available evidence, trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision. The data reviewed in this report show that both trial of labor and elective repeat cesarean delivery for a pregnant woman with one prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus. This poses a profound ethical dilemma for the woman, as well as her caregivers, because benefit for the woman may come at the price of increased risk for the fetus and vice versa. This conundrum is worsened by the general paucity of high-level evidence about both medical and nonmedical factors, which prevents the precise quantification of risks and benefits that might help to make an informed decision about trial of labor compared with elective repeat cesarean delivery. The panel was mindful of these clinical and ethical uncertainties in making the following conclusions and recommendations. One of the panel’s major goals is to support pregnant women with one prior transverse uterine incision to make informed decisions about trial of labor compared with elective repeat cesarean delivery. The panel recommends that clinicians and other maternity care providers use the responses to the six questions, especially questions 3 and 4, to incorporate an evidence-based approach into the decisionmaking process. Information, including risk assessment, should be shared with the woman at a level and pace that she can understand. When trial of labor and elective repeat cesarean delivery are medically equivalent options, a shared decisionmaking process should be adopted and, whenever possible, the woman’s preference should be honored. The panel is concerned about the barriers that women face in gaining access to clinicians and facilities that are able and willing to offer trial of labor. Given the low level of evidence for the requirement for "immediately available" surgical and anesthesia personnel in current guidelines, the panel recommends that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess this requirement with specific reference to other obstetric complications of comparable risk, risk stratification, and in light of limited physician and nursing resources. Healthcare organizations, physicians, and other clinicians should consider making public their trial of labor policies and VBAC rates, as well as their plans for responding to obstetric emergencies. The panel recommends that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor. The panel is concerned that medical-legal considerations add to, and in many instances exacerbate, these barriers to trial of labor. Policymakers, providers, and other stakeholders must collaborate in developing and implementing appropriate strategies to mitigate the chilling effect the medical-legal environment has on access to care. High-quality research is needed in many areas. The panel has identified areas that need attention in response to question 6. Research in these areas should be given appropriate priority and should be adequately funded--especially studies that would help to characterize more precisely the short-term and long-term maternal, fetal, and neonatal outcomes of trial of labor and elective repeat cesarean delivery.

Rhesus- (Rh-) negative women receiving anti-D antibodies antenatally often have a positive antibody screen at delivery. We investigated the incidence of positive antibody screens at delivery in this population and examined how the presence of positive antibody screens affected the time required to obtain type and screen or type and crossmatch results.Records of parturients who had type and screen or type and crossmatch done upon presentation for delivery from June to October 2007 were examined to determine estimated gestational age at admission, Rh-status, the presence of positive antibody screens, and the time interval from receipt of specimen in the blood bank to the availability of antibody screen results.Of the 480 specimens sent for type and screen or type and crossmatch, 20% of parturients were Rh-negative, with 57% of those demonstrating a positive antibody screen compared with 4% of the Rh-positive parturients (P0.01). In the Rh-negative group, 100% (95% CI 98-102) of positive antibody screens were anti-D antibodies. There was a longer median laboratory time for Rh-negative vs Rh-positive parturients (146 vs 65 min), for antibody positive vs antibody negative parturients (243 vs 65 min) (P0.001 for both), but not for Rh-positive/antibody positive vs Rh-negative/antibody positive patients (312 vs 218 min) (P = 0.09). The antibody screen was positive in 100% of Rh-negative parturients until 37 weeks gestation, after which there was a decline.Rh-negative parturients who receive anti-D antibodies antenatally have a higher incidence of positive antibody screens at delivery than Rh-positive parturients due to the presence of anti-D antibodies.

To estimate the prevalence of epistaxis among pregnant women and to investigate if epistaxis of pregnancy is associated with an increased risk of postpartum hemorrhage.A cohort of 1,475 pregnant women presenting to labor and delivery at term were asked to complete a survey about epistaxis and other traditional risk factors for bleeding. Results were compared with those from a cohort of 275 nonpregnant women presenting for routine gynecologic care to estimate the effect of pregnancy on the prevalence of epistaxis. The association between epistaxis of pregnancy and risk of bleeding was estimated by comparing rates of postpartum hemorrhage between pregnant women with and without epistaxis.Final data analysis was performed on 1,470 pregnant women and 275 nonpregnant women. The prevalence of epistaxis was significantly increased in pregnant women compared with nonpregnant women (20.3% compared with 6.2%; P.001). Women with epistaxis of pregnancy were at increased risk of postpartum hemorrhage compared with women without epistaxis (10.7% compared with 6.7%; P=.02). The increased risk of hemorrhage remained after controlling for cesarean delivery and after exclusion of women who reported epistaxis before pregnancy. Other traditional risk factors for bleeding such as gingival bleeding, O blood type, and easy bruising were not associated with increased risk of postpartum hemorrhage.Epistaxis is a common problem during pregnancy that may be associated with an increased risk of postpartum hemorrhage. As in the nonpregnant population, eliciting a history of epistaxis may help to identify women at risk of disordered hemostasis.II.

The Oxford English Dictionary defines ‘‘acceptable’’ as capable, worthy, or likely to be accepted or gladly received; hence, pleasing, agreeable, gratifying, or welcome. Therefore, ‘‘unacceptable’’ means not capable, worthy, or likely to be accepted or gladly received; not pleasing, agreeable, gratifying, or welcome. Of course, cesarean deliveries can be performed under either neuraxial or general anesthesia. However, for most elective deliveries, and many urgent deliveries, general anesthesia is not acceptable for cesarean delivery. There are benefits to the mother of neuraxial anesthesia and significant risks associated with general anesthesia. Similarly, there are benefits to the neonate of neuraxial anesthesia and risks of general anesthesia. Generally, the benefits of neuraxial anesthesia outweigh the risks, and the risks of general anesthesia outweigh the benefits. This discussion will review these risks and benefits.

Background Ketamine at subanesthetic doses has analgesic properties that have been shown to reduce postoperative pain and morphine consumption. We hypothesized that intravenous ketamine 10mg administered during spinal anesthesia for cesarean delivery, in addition to intrathecal morphine and intravenous ketorolac, would decrease the incidence of breakthrough pain and need for supplemental postoperative analgesia. Methods Using a randomized double-blind placebo-controlled design, healthy women scheduled for cesarean delivery receiving hyperbaric spinal bupivacaine, fentanyl and morphine were randomized to intravenous ketamine 10mg or saline following delivery. Postoperative analgesia included scheduled ketorolac and acetaminophen/hydrocodone tablets as needed for breakthrough pain. The primary outcome was the incidence of breakthrough pain in the first 24h. Secondary outcomes included the number of acetaminophen/hydrocodone tablets administered and numeric rating scale for pain (0–10). Results Group characteristics did not differ. There was no difference in the incidence of breakthrough pain (ketamine 75% VS. saline 74%, P =0.86). There was no difference in 24-h or 72-h use of supplemental acetaminophen/hydrocodone tablets between groups. Pain scores in the first 24h were similar, but lower in the ketamine compared to the saline group 2weeks postpartum (difference −0.6, 95% CI −1.1 to −0.9). Conclusions We found no additional postoperative analgesic benefit of low-dose ketamine during cesarean delivery in patients who received intrathecal morphine and intravenous ketorolac. Subjects who received ketamine reported lower pain scores 2weeks postpartum.

Background The purpose of this two-part prospective observational and blinded trial was to determine whether the single nucleotide polymorphism of the μ-opioid receptor gene (OPRM1:c.304A>G) modifies (1) the duration of intrathecal fentanyl labor analgesia and (2) supplemental analgesic requirements after intrathecal morphine analgesia following cesarean delivery. Methods Labor analgesia was initiated with intrathecal fentanyl 25 μg. Patients undergoing primary cesarean delivery under spinal anesthesia received intrathecal morphine 150 μg. The primary outcome variables were duration of intrathecal fentanyl analgesia in the labor study and the requirement for supplemental systemic analgesia in the cesarean study. Outcomes were compared between 304A homozygotes (group A) and 304A>G heterozygotes and 304G homozygotes (group G). Results The labor study included 190 participants and the post-cesarean study included 103 participants; 24% subjects carried the 304A>G allele. The median (95% CI) duration of intrathecal fentanyl analgesia was 70 min (62, 78) in group A and 63 min (50, 76) in group G ( P = 0.54). There was no difference in the amount of supplemental oral morphine equivalents required to treat breakthrough pain within 72 h after intrathecal morphine between groups A and G (median [IQR] 68 mg (37, 97) and 75 mg (37, 90) respectively, P = 0.99) or in the duration of intrathecal morphine analgesia ( P = 0.84). The incidence of pruritus was greater in group A. Conclusions Using the two outcome parameters duration of analgesia and treatment for breakthrough pain, we did not find a simple association between intrathecal opioid analgesia and OPRM1 304A/G polymorphism.

Despite early promising patient and graft outcomes with steroid-free (SF) immunosuppression in pediatric kidney transplant recipients, data on long-term safety and efficacy results are lacking. We present our single-center experience with 129 consecutive pediatric kidney transplant recipients on SF immunosuppression, with a mean follow-up of 5 years. Outcomes are compared against a matched cohort of 57 concurrent recipients treated with steroid-based (SB) immunosuppression. In the SF group, 87% of kidney recipients with functioning grafts remain corticosteroid-free. Actual intent-to-treat SF (ITT-SF) and still-on-protocol SF patient survivals are 96% and 96%, respectively, actual graft survivals for both groups are 93% and 96%, respectively and actual death-censored graft survivals for both groups are 97% and 99%, respectively. Unprecedented catch-up growth is observed in SF recipients below 12 years of age. Continued low rates of acute rejection, posttransplant diabetes mellitus (PTDM), hypertension and hyperlipidemia are seen in SF patients, with sustained benefits for graft function. In conclusion, extended enrollment and longer experience with SF immunosuppression for renal transplantation in low-risk children confirms protocol safety, continued benefits for growth and graft function, low acute rejection rates and reduced cardiovascular morbidity.

Porous titanium (Ti) and titanium alloys are promising scaffold biomaterials for bone tissue engineering, because they have the potential to provide new bone tissue ingrowth abilities and low elastic modulus to match that of natural bone. In the present study, a new highly porous Ti6Ta4Sn alloy scaffold with the addition of biocompatible alloying elements (tantalum (Ta) and tin (Sn)) was prepared using a space-holder sintering method. The strength of the Ti6Ta4Sn scaffold with a porosity of 75% was found to be significantly higher than that of a pure Ti scaffold with the same porosity. The elastic modulus of the porous alloy can be customized to match that of human bone by adjusting its porosity. In addition, the porous Ti6Ta4Sn alloy exhibited an interconnected porous structure, which enabled the ingrowth of new bone tissues. Cell culture results revealed that human SaOS(2) osteoblast-like cells grew and spread well on the surfaces of the solid alloy, and throughout the porous scaffold. The surface roughness of the alloy showed a significant effect on the cell behavior, and the optimum surface roughness range for the adhesion of the SaOS(2) cell on the alloy was 0.15 to 0.35 mum. The present study illustrated the feasibility of using the porous Ti6Ta4Sn alloy scaffold as an orthopedic implant material with a special emphasis on its excellent biomechanical properties and in vitro biocompatibility with a high preference by osteoblast-like cells.

BACKGROUND: The number of women in medicine has increased steadily in the last half century. In this study, we reassessed the status of women in academic anesthesiology departments in the United States in 2006. METHODS: Medical student, resident, and faculty rank gender data were obtained from the Association of American Medical Colleges. Data regarding the make-up and gender of anesthesia subspecialty society leadership, the editorial boards of Anesthesia & Analgesia and Anesthesiology, the awardees of anesthesia research grants, American Board of Anesthesiology examiners, and department chairs were obtained from websites, organization management personnel, and the Wood Library-Museum of Anesthesiology. Anesthesiology data were compared with composite data from medical school departments in other clinical specialties and to data from previous years, beginning in 1985. RESULTS: The percentage of medical school graduates, anesthesiology residents, and anesthesiology faculty members who are women has increased since 1985; however, the rate of increase in the percentage of women is significantly faster for medical school graduates compared with anesthesiology residents (P < 0.001) and faculty (P < 0.05). The percentage of women anesthesiology faculty members who were full professors in 2006 was 6.5% compared with 17.7% of men faculty (P < 0.001) and is not significantly different than in 1986 (P = 0.27). Fourteen percent of full anesthesiology professors were women and this does not differ from all clinical specialties combined (15%). Women comprised 12.7% of academic anesthesiology chairs and 10% of all medical school department chairs in 2006, significantly higher compared with 1993 (P < 0.05). Currently, 8% and 11% of editors and associate editors of Anesthesiology and Anesthesia & Analgesia are women, respectively. Eighteen percent of American Board of Anesthesiology oral board examiners in 2007 were women compared with 8% in 1985 (P < 0.05). The percentage of time in which women have served as anesthesiology society leaders was significantly greater during 1997-2006 compared with 1987-1996 (P < 0.001). The proportion of competitive research grants awarded to women has not changed over several decades. CONCLUSIONS: The status of women in academic anesthesiology in the first decade of the millennium has, by some measures, advanced compared with 20 yr ago. However, by other measures, there has been no change. The task ahead is to identify factors that discourage qualified women medical students, residents, and junior faculty members from pursuing careers in academic anesthesiology and advancing in academic rank.

Improvements in health care and treatment of diseases have led to an increase in life expectancy in developed countries. However, this achievement has also inadvertently increased the prevalence of chronic illnesses such as cardiovascular disease, adding to the growing burden of health care cost globally. Unfortunately, this trend is expected to escalate in the foreseeable future. Cardiovascular disease remains one of the main problems in contemporary health care worldwide, accounting for approximately one third of the world’s total death (Poole-Wilson, 2005). This article focuses on a subgroup of cardiovascular disease known as valvular heart disease whereby abnormalities or malfunctions of the heart valves are detected. It is estimated that 93,000 valvular surgeries were conducted in the United States in 2002 (American Stroke Association & American Heart Association, 2005) and valve replacement surgeries accounted for 75% of the surgery performed for valvular defects in Australia and, of that, 56% were for aortic valves (Davies & Senes, 2003).

Supraventricular tachydysrhythmias are a commonly encountered clinical problem after cardiothoracic surgery. Current choices for acute drug therapy of these dysrhythmias include intravenous verapamil as well as esmolol, but no data yet exist comparing the relative negative dromotropic (atrioventricular [A-V] nodal blocking) and negative inotropic effects of these agents. The purpose of this study was to compare the effects of esmolol with those of verapamil on systemic hemodynamics, coronary blood flow, and cardiac contractility at doses that produce a similar ventricular response rate in an animal model of a supraventricular tachydysrhythmia. Rapid electrical stimulation (800 impulses/min) of the left atrium in 14 dogs resulted in a rapid and irregularly irregular ventricular rhythm. Esmolol or verapamil were administered by bolus and then infusion to incrementally slow the average ventricular rate. Regional myocardial contractility was measured using the end-systolic pressure-length relationship (Ees). At drug doses that produced similar decreases in ventricular rate, esmolol produced a greater decrease in contractility (Ees: 284 +/- 46 to 40 +/- 22 mmHg/mm, LV dp/dt: 2,400 +/- 450 to 1,360 +/- 450 mmHg/sec) compared with that following verapamil (Ees: 297 +/- 57 to 116 +/- 25 mmHg/mm, LV dp/dt: 2,040 +/- 580 to 1,950 +/- 520 mmHg/sec). This was accompanied by a modest decrease in cardiac output in the esmolol group (2,800 +/- 940 to 2,290 +/- 730 ml/min) compared with an unchanged cardiac output as ventricular rate slowed in verapamil-treated animals. Stroke volume increased significantly in the verapamil-treated animals (10.9 +/- 4.0 to 18.5 +/- 4.6 ml), but remained unchanged following esmolol.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction Tissue engineering (TE) is a multidisciplinary field that combines the principles of engineering and biological sciences to contribute to the development of tissues and organs for the purpose of regeneration, repair or replacement. Although TE was a term that was used and gained popularity in 1987 at the National Science Foun- dation, the concept of TE had been explored as early as the 1930s whereby living cells and tissues were maintained in a bioreactor by Carrel and Lindbergh (Nerem 2006). Langer and Vacanti, eminent research ers of TE, described a technique using bioabsorbable synthetic polymer as matrices for cell transplantation in 1988 and this formed the basis for the concept of T E (Vacanti et al. 1988). S ince isolated cells cannot form new tissue on their own, three-dimensional (3D) scaffolds are required to provide architectural support for the cells and define the anatomical shape of the tissue (Yang et al. 2001)...

Background:In 1997, the International Classification of Diseases (ICD), 9th Revision Clinical Modification (ICD-9) coding system introduced the code for malignant hyperthermia (MH) (995.86). The aim of this study was to estimate the accuracy of coding for MH in hospital discharge records.Methods:An expert panel of anesthesiologists reviewed medical records for patients with a discharge diagnosis of MH based on ICD-9 or ICD-10 codes from January 1, 2006 to December 31, 2008 at six tertiary care medical centers in North America. All cases were categorized as possible, probable, or fulminant MH, history of MH (family or personal) or other.Results:A total of 47 medical records with MH diagnoses were reviewed; 68.1% had a documented surgical procedure and general anesthesia, and 23.4% (95% CI, 12.3–38.0%) had a possible, probable, or fulminant MH event. Dantrolene was given in 81% of the MH events. All patients judged to have an incident MH event survived to discharge. Family and personal history of MH accounted for 46.8% of cases. High fever without evidence of MH during admission accounted for 23.4%, and the reason for MH coding was unclear in 6.4% of cases.Conclusions:Approximately one quarter of ICD-9 or ICD-10 coded MH diagnoses in hospital discharge records refer to incident MH episodes and an additional 47% to MH susceptibility (including personal history or family history). Information such as surgical procedure, anesthesia billing data, and dantrolene administration may aid in identifying incident MH cases among those with an ICD-9 or ICD-10 coded MH diagnosis in their hospital discharge records.

BACKGROUND: The clinical response to spinal anesthesia is influenced by lumbosacral cerebrospinal fluid (CSF) volume, which is highly variable among patients. METHODS: Lumbosacral magnetic resonance images were obtained in 71 patients using a long echo time (TE 198 msec), fast spin echo sequence with fat suppression. Three-dimensional images were created and lumbosacral CSF volume was estimated using a threshold-based region growing algorithm. RESULTS: A validation experiment using a water bath and cadaveric spinal cord demonstrated that the technique was accurate (1.4 0.4% difference between estimated and measured). The coefficient of variance was 0.42% among the three estimated CSF values per subject. The mean calculated volume was 35.8 10.9 mL with a range of 10.6–61.3 mL. Lumbosacral CSF volume was widely variable among patients and was inversely proportional to body mass index (r .276, P 0.02). Mean calculated lumbosacral CSF volumes were smaller in the group of subjects that had radiographic diagnoses of spinal stenosis when compared with subjects with no diagnosis (mean difference 8.4 mL, 95% CI of the difference, 16.1 to 0.8 mL, P 0.03) and were not different when compared with those with herniated disk disease (mean difference 6.4 mL, 95% CI of the difference 14.7 to 1.9 mL, P 0.19). CONCLUSIONS: Application of this technique to clinical investigations may further enhance our understanding of spinal anesthesia.

Background The decrease in the percentage of patients having cesarean delivery during general anesthesia has led some educators to advocate the increased use of simulation-based training for this anesthetic. The authors developed a scoring system to measure resident performance of this anesthetic on the human patient simulator and subjected the system to tests of validity and reliability. Methods A modified Delphi technique was used to achieve a consensus among several experts regarding a standardized scoring system for evaluating resident performance of general anesthesia for emergency cesarean delivery on the human patient simulator. Eight third-year and eight first-year anesthesiology residents performed the scenario and were videotaped and scored by four attending obstetric anesthesiologists. Results Third-year residents scored an average of 150.5 points, whereas first-year residents scored an average of 128 points (P = 0.004). The scoring instrument demonstrated high interrater reliability with an intraclass correlation coefficient of 0.97 (95% confidence interval, 0.94-0.99) compared with the average score. Conclusions The developed scoring tool to measure resident performance of general anesthesia for emergency cesarean delivery on the patient simulator seems both valid and reliable in the context in which it was tested. This scoring system may prove useful for future studies such as those investigating the effect of simulator training on objective assessment of resident performance.

This paper described the production of a novel biosynthetic material using the manufacturing technique of electro spinning for the construction of scaffold for organ replacement. This electrostatic technique uses an electric field to control the deposition of polymer fibres onto a specific substrate to fabricate fibrous polymer constructs composed of fibre diameters ranging from several microns down to 100 nm or less. Two areas of research, in particular, heart valve leaflets and blood vessel will be discussed. Here, a sandwich structure nanofibre mesh was used to construct materials for leaflets of heart valve and blood vessel. In the case of heart valve leaflet, the randomly oriented polyurethane nanofibres were prepared as the first layer, followed by gelatin-chitosan complex layer. Complex nanofibres were initially used to spin on the PU layer with cross orientation to mimic the fibrosa layer. A gelatin and chitosan complex was then spun onto the other side of PU nanofibre mesh to mimic the ventricularis layer. This particular sandwich structure using the PU layer was designed to simulate the mechanical properties of natural tissue. In addition, this design was aimed to provide good biocompatibility and improved cellular environment to assist in adhesion and proliferation. Smooth muscle cells adhered and flattened out onto the surface of the gelatin-chitosan complex as early as 1 day post seeding. There is great potential for this biosynthetic biocompatible nanofibrous material to be developed for various clinical applications.

Women undergoing postoperative postpartum tubal ligation (PPTL) often experience considerable pain. We hypothesized that epidural morphine, as part of a multi-modal analgesic regimen, would decrease postoperative pain and the need for systemic analgesia after PPTL. In a double-blinded study, patients were randomized to receive epidural saline or morphine 2 mg, 3 mg, or 4 mg after epidural anesthesia for PPTL. Postoperatively, ibuprofen 600 mg was administered every 6 h and patients could request acetaminophen 325 mg/hydrocodone 10 mg. The primary outcome variable was time to first request for supplemental analgesia. Verbal rating scores for pain and the incidence and severity of side effects were recorded for 24 h. Morphine group subjects requested supplemental analgesia later and received fewer doses compared with the saline group subjects. Peak cramping and incisional verbal rating scores for pain and the area under the verbal rating scores for pain x time curve for cramping pain were less after epidural morphine compared with saline, but there were no differences among morphine groups. Nausea, vomiting, and pruritus occurred more often in all morphine groups and subjects who received morphine 4 mg required treatment for these side effects more frequently than the saline or morphine 2 mg groups. In conclusion, epidural morphine 2 mg as part of a multi-modal analgesic regimen improved analgesia and decreased the need for supplemental analgesics after PPTL. The need to treat side effects with morphine 2 mg was not increased compared to a regimen of oral acetaminophen/opioid/nonsteroidal antiinflammatory analgesics.

Racial and ethnic disparities in the treatment of pain have been well documented, and there is evidence of such disparities in neuraxial analgesia use. Our objectives of this study were to analyze racial/ethnic disparities in neuraxial analgesia use, as well as anticipated use, among laboring Hispanic, African-American, and Caucasian women, and to evaluate sociodemographic, clinical, and decision-making predictors of actual and anticipated neuraxial analgesia use among these women.Laboring women, in a large urban academic hospital, were interviewed using a face-to-face survey to determine individual factors that may influence choice of labor analgesia. After delivery, the type of labor analgesia used was recorded. The primary outcome was use of neuraxial analgesia. Multivariable logistic regression models were estimated to test the likelihood that race and ethnicity were significantly associated with neuraxial analgesia use, anticipated neuraxial analgesia use, and the intrapartum decision to use neuraxial analgesia.There was a univariate association between race/ethnicity and anticipated as well as actual use of neuraxial analgesia. However, there was no association between race/ethnicity and the intrapartum decision to use neuraxial analgesia. After controlling for confounders, the association between race/ethnicity and actual use of neuraxial analgesia no longer remained significant (adjusted odds ratio: Hispanic versus Caucasian women 0.66, 95% confidence interval [CI]: 0.24 to 1.80; African-American versus Caucasian women 0.93, 95% CI: 0.31 to 2.77). In contrast, Hispanic women were less likely than Caucasian women to anticipate using neuraxial analgesia even after controlling for confounders (adjusted odds ratio 0.40, 95% CI: 0.20 to 0.82).After controlling for confounding variables, Hispanic women anticipated using neuraxial analgesia at a lower rate than other racial/ethnic groups; however, actual use was similar among groups.

Soluble fibres, such as guar gum, promote and wheat bran or methylcellulose protect from chemically induced colon carcinogenesis, relative to the effect of a fibre-free diet in rats. Mechanisms are poorly understood. Whereas all fibres are trophic to the colonic epithelium, the heterogeneity of effects on carcinogenesis may reflect different effects on the total number of crypts and, therefore, the size of the stem cell population. This study aimed to assess this hypothesis. Sprague-Dawley rats were fed one of fibre-free diets with or without 10% wheat bran, methylcellulose or guar gum for 4 weeks. The distal colons were stained with methylene blue and quantified for the number and density of crypts using an image analysis system. Epithelial proliferative kinetics was measured stathmokinetically. Methodology for quantifying crypts was valid and reproducible. Rats fed a fibre-free diet had atrophic distal colon, as shown by a decrease in crypt column height and a lower mitotic index. Fibre supplementation prevented the atrophy and was associated with crypt mouth areas that were 30-60% larger than those in the fibre-free group (P0.001, ANOVA), with the methylcellulose group being the largest (1.16 microm(2)). The crypt density of the fibre-free group was 16-19% greater than those in fibre fed groups (P + 0.006), due to the smaller size of the crypts. However, there was no difference in the total number of crypts across the four dietary groups (P0.1). Distal colons in all of the dietary groups contained approximately 10(5) crypts. In conclusion, although variation in the amount or type of dietary fibre exerts heterogeneous effects on the growth of the colonic epithelium and on colon carcinogenesis, the total number of crypts in the distal colon remains constant. It is, therefore, unlikely that fibres influence carcinogenic events by altering the size of the stem cell population.

Objective Neurological injury associated with present day labor and delivery is thought to be unusual. The purpose of this study was to estimate the incidence, severity, and duration of postpartum lumbosacral spine and lower extremity nerve injury and identify factors related to nerve injury. Methods All women who delivered a live-born infant from July 1997 through June 1998 were asked about symptoms of lumbosacral spine and lower extremity nerve injury the day after delivery. Women with symptoms were examined by a physiatrist to confirm injury, and their cases were then followed by telephone until the symptoms resolved. Maternal variables (including prospective documentation of time spent pushing in various positions) and fetal variables that might be associated with risk of nerve injury were compared between women with injury and those without. Results Six thousand fifty-seven women delivered live-born infants; 6048 were interviewed and 56 had a confirmed new nerve injury, an incidence of 0.92%. Factors found by logistic regression analysis to be associated with nerve injury were nulliparity and prolonged second stage of labor. Women with nerve injury spent more time pushing in the semi-Fowler–lithotomy position than women without injury. The median duration of symptoms was 2 months. Conclusion The estimated incidence of postpartum nerve injury was greater than reported from previous studies and is associated with nulliparity and prolonged second stage of labor.

BACKGROUND: Programmed intermittent bolus administration of epidural anesthetic solution compared with continuous infusion results in decreased anesthetic consumption and increased patient satisfaction. In this randomized and blinded study, we evaluated bupivacaine consumption and other analgesic outcomes when the programmed intermittent bolus time interval and volume were manipulated during the maintenance of epidural labor analgesia. METHODS: Healthy, term, nulliparous women in spontaneous labor had combined spinal-epidural labor analgesia initiated with intrathecal bupivacaine 1.25 mg and fentanyl 15 μg, followed by an epidural test dose (lidocaine 45 mg with epinephrine 15 μg). Subjects were randomized to 1 of 3 programmed intermittent bolus dose regimens for maintenance of analgesia: 2.5 mL every 15 minutes (2.5/15), 5 mL every 30 minutes (5/30), or 10 mL every 60 minutes (10/60). The maintenance epidural solution consisted of bupivacaine 0.625 mg/mL with fentanyl 1.95 μg/mL. Breakthrough pain was treated initially with patient-administered epidural bolus doses, followed by manual boluses administered by the anesthesiologist if necessary. The primary outcome was total bupivacaine consumption per hour of labor. A linear mixed-effects model was used to model each patient's overall bupivacaine consumption per hour; the fixed effect was basal bupivacaine administration rate and the random effect was the area under the pain score versus time curve. RESULTS: One hundred ninety women were studied. The median (interquartile range) adjusted bupivacaine consumption per hour of labor was 8.8 mg (8.0-9.7 mg) in group 10/60 compared with 10.0 mg (9.3-10.8 mg) in group 5/30 and 10.4 mg (9.6-11.2 mg) in group 2.5/15 (P = 0.005). There were no differences in area under the pain score versus time curve, pain scores at delivery, patient-controlled epidural analgesia requests or administrations, number of manual bolus doses for breakthrough pain, time to first patient-controlled epidural analgesia or manual bolus dose, or patient satisfaction with labor analgesia. CONCLUSIONS: Extending the programmed intermittent bolus interval and volume from 15 minutes to 60 minutes, and 2.5 mL to 10 mL, respectively, decreased bupivacaine consumption without decreasing patient comfort or satisfaction.

Background Healthy nonpregnant patients may ingest clear liquids until 2 h before induction of anesthesia without adversely affecting gastric volume. The purpose of this study was to compare gastric emptying in term, nonlaboring pregnant women after ingestion of 50 ml water (control) with that after ingestion of 300 ml water. Methods Gastric emptying was assessed in healthy, nonobese, term pregnant volunteers using both serial gastric ultrasound examinations (n = 9) and acetaminophen absorption (n = 11) in a crossover study design. After an overnight fast, volunteers ingested 1.5 g acetaminophen and 50 or 300 ml water (assigned in random order) on two occasions separated by at least 2 days. Serial gastric antrum cross-sectional areas were determined using gastric ultrasound imaging, and the half-time to gastric emptying was calculated. Serial plasma acetaminophen concentrations were measured. Areas under the plasma acetaminophen concentration versus time curve, peak concentrations, and time to peak concentration for 50- and 300-ml ingestions were compared. Results Gastric emptying half-time was significantly shorter after ingestion of 300 ml water than after ingestion of 50 ml (24 +/- 6 vs. 33 +/- 8 min). There were no differences in acetaminophen areas under the curve at 60, 90, or 120 min, or in acetaminophen peak concentration. Time to peak concentration of acetaminophen was significantly shorter after ingestion of 300 ml water than after ingestion of 50 ml (25 +/- 12 vs. 41 +/- 19 min). Conclusions Gastric emptying in healthy, term, nonobese, nonlaboring pregnant women is not delayed after ingestion of 300 ml water compared with that after an overnight fast.