Search

Mumin Hakim,1 Candice Burrier,1 Tarun Bhalla,1 Vidya T Raman,1 David P Martin,1,2 Olamide Dairo,1 Joel L Mayerson,3,4 Joseph D Tobias1,2 1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 2Department of Anesthesiology and Pain Medicine, The Ohio State University, 3Department of Orthopedic Surgery, Nationwide Children's Hospital, 4Department of Orthopedic Surgery, The Ohio State University, Columbus, OH, USA Abstract: Tumor progression during end-of-life care can lead to significant pain, which at times may be refractory to routine analgesic techniques. Although regional anesthesia is commonly used for postoperative pain care, there is limited experience with its use during home hospice care. We present a 24-year-old male with end-stage metastatic osteosarcoma who required anesthetic care for a right-sided above-the-elbow amputation. The anesthetic management was complicated by the presence of a large mediastinal mass, limited pulmonary reserve, and severe chronic pain with a high preoperative opioid requirement. Intraoperative anesthesia and postoperative pain management were provided by regional anesthesia using an interscalene catheter. He was discharged home with the interscalene catheter in place with a continuous local anesthetic infusion that allowed weaning of his chronic opioid medications and the provision of effective pain control. The perioperative applications of regional anesthesia in palliative and home hospice care are discussed. Keywords: osteosarcoma, peripheral nerve block, palliative care

The objective of this study was to investigate the influence of propyl gallate antioxidant on the performance and emission characteristics of a diesel engine fueled with blends of khaya senegalensis (Mahogany) biodiesel on a TD 110-TD 115 single cylinder four-stroke internal combustion diesel engine under constant speed (1500 rpm) and varying load (L1, L2, L3 and L4) conditions coupled with SV 5Q automobile exhaust gas analyser. Khaya senegalensis biodiesel was produced at 6:1 methanol/oil molar ratio, 0.84% wt. catalyst concentration, 70°C temperature and 60 min reaction time. Physicochemical properties of the biodiesel blends were determined using ASTM standard procedures. The fuels used in the analyses are B0, B20, B30 and B100. Propyl gallate antioxidant were added at 1000 ppm concentration to B20, B30 and B100 to study their effect. The results showed that the PG-treated blends decreased the BP by 21.94%, 12.12% and 36.17% as compared to B20, B30 and B100 fuel blends, but increase by 0.99% for B20PG at L4, and increased BSFC by 21.47%, 15.42% and 22.63%. At load L4, the break specific fuel consumption (BSFC) increases for B20PG and B100PG by 12.70% and 1.35%, and reduces for B20PG by 8.09%. Break thermal efficiency (BTE) decreases for B20 and B100 by 28.39%, 18.63% and 34.42%, while B30PG show an increase of 8.02%. Also, B20PG recorded a drop in exhaust gas temperature (EGT) by 15.40%, while B30PG and B100PG had 1.90% and 3.33% increases at a higher load. CO reduces by 0.02% and 0.01% for B30 and B100, CO2 emission reduces by 2.13%, 2.26% and 15.0%, while, HC emission reduce by 12.73%, 18.18% and 25.45% respectively at engine load L1 and 14.81%, 20.37% and 24.07% at engine load L4 and NOx decreases by B20 (13.85%), B30 (21.54%), B100 (41.54%) compared to that of diesel (B0). However, further research to incorporate the use of this additive in actual automobile applications is recommended to be carry out. [ABSTRACT FROM AUTHOR]

A data acquisition system that utilised the open-source Arduino platform was developed to take real-time ground measurements of primary radio climatological variables of pressure, temperature, and relative humidity at Ede, a tropical station in southwest Nigeria (7.7349° N, 4.4439° E). Surface radio refractivity was deduced from these variables and used to estimate refractivity gradients at 100 m and 1000 m heights from the exponential reference atmosphere model for terrestrial propagation. Secondary radio propagation parameters such as refractivity gradients, the effective-earth-radius-factor, k, and geoclimatic factor, K, essential parameters for quick application in the planning and design of line-of-sight radio link systems, were also deduced. Data acquired from the device were compared to those obtained from the Re-Analyses (ERA-5) satellite database of the European Centre for Medium-Range Weather Forecast (ECMWF) 2020/2021. Aside from logging data on a micro secure digital (SD) card, measurements were displayed on a liquid crystal display (LCD). The peripheral Arduino-compatible meteorological sensors were connected to the analog inputs of the ATMega328 in the Arduino independent development environment (IDE), and the unit was powered by a 12 V battery charged by a 50-watt solar module. Results showed that slightly higher values of the ERA-5 data characterise the dry months from November to March, while the wet months displayed higher values of the Arduino-derived measured data. The accuracies of the data collected were compared using Mean Percentage Error (MPE) performance indicator. The interpretation is that the mean difference between the Arduino inferred measurements and the ERA-5 data is less than 10%, which is an indication of the measurement accuracy. [ABSTRACT FROM AUTHOR]

This study investigated the effects of variety and drying methods on nutrient retention in dried tomato slices. Four tomato varieties (UC82B, Roma, Eva-F1 and Kerewa) were subjected to three drying methods (sun, oven and cabinet). The proximate, carotenoids, vitamins (A, C and E), flavonoids, phenolic acid and total dietary fibre contents of the fresh and dried tomatoes were determined using standard laboratory procedures. Percentage retention was calculated using the true retention formula. Data obtained were subjected to multivariate analysis of variance and means separated using Duncan's multiple range test. For fresh tomato samples; moisture, total dietary fibre, lycopene, betacarotene, vitamins C, E, retinol equivalent vitamin A, flavonoid and phenolic acid contents ranged from 89.62-95.41%, 2.65-38.52%, 26.5-44.67 mg/kg, 1.82-3.54 mg/kg, 5.52-8.62 mg/100g, 0.16-0.23 mg/100g, 30.3-59.1 µg/100g, 5.13-19.24 mg/100g and 22.43-31.89 mg/100g, respectively. For dried tomato slices; moisture, ash and total dietary fibre contents ranged from 5.74-9.83%, 6.70-10.94% and 18.63-38.52%, respectively. Lycopene, beta-carotene, flavonoid, phenolic, vitamins C, E and retinol equivalent vitamin A contents ranged from 36.50-54.70 mg/kg, 2.78-4.5 mg/kg, 13.07-70.98 mg/100g, 51.50-352.00 mg/100g, 34.35-94.46 mg/100g, 0.54-2.04 mg/100g and 46.4-75.1 µg/100g, respectively. Percentage retention of lycopene, beta carotene, flavonoids, phenolic acid and total dietary fibre ranged from 4.23-13.48%, 4.45-16.21%, 9.76-73.11%, 8.49-57.19% and 31.40-61.64%, respectively. While it ranged from 20.59-73.81%, 9.00-72.10%, and 4.45-16.21% for vitamins C, E and A, respectively. In conclusion, the oven-dried tomato slices retained more nutrients than the sun and cabinet-dried samples irrespective of tomato variety. [ABSTRACT FROM AUTHOR]

In-situ measurements of ultraviolet (UV) and solar irradiance is very sparse in Nigeria because of cost; it is estimated using meteorological parameters. In this work, a low-cost UV and pyranometer device, using locally sourced materials, was developed. The instrument consists of a UV sensor (ML8511), a photodiode (BPW34) housed in a carefully sealed vacuumed glass bulb, the UV and solar irradiance sensor amplifiers, a 16-bit analog-to-digital converter (ADS1115), Arduino mega 2560, liquid crystal display (LCD) and microSD card for data logging. The designed amplifier has an offset voltage of 0.8676 mV. The sensitivity of the irradiance device is 86.819 Wm-2/mV with a correcting factor of 27.77 Wm-2 and a maximum range of 1200 Wm-2. The instrument validation error is 9.67% and a correlation coefficient of 0.89 when compared with a standard SRS100 pyranometer. The UV sensor showed a close response with a correlation of 0.99 in comparison with a standard Skye instrument. From 08:00 to 16:00 local time (LT), there is a very close agreement between the standard device and the developed counterpart, with marginal differences of about 9.6% observed at the two extremes. [ABSTRACT FROM AUTHOR]

We describe the clinical, serologic, and molecular findings of a new human rickettsiosis in Colombia. Antibodies against Rickettsia spp. were detected. PCR showed amplification of genes for R. parkeri strain Atlantic Rainforest. This new rickettsiosis of minor virulence could explain some of the undifferentiated acute febrile diseases in Colombia.

This work reports the evaluation of calorific energy content, the agro-biological morphology of gliricida sepium in a derived forest in Ado Ekiti South-western Nigeria and its CO2 absorption capacity. The wood biomass density was found to be 620.15 kg/m³, the calorific energy content 16.67 MJ.kg which was similar to that of green oak wood. A One Tonne Gliricidia Tree has the capacity to sequestrate 3.0 Tonnes of CO2 and by extension, one Ha of gliricidia can sequestrate 146.8 Tonnes of CO2. 20 trees having average of 25 branches can sustain yam staking in a one hectare farmland. The report concluded that gliricidia has the potential to resolve the perennial cooking energy and environmental protection management conflict in the rural Sub-tropical Africa. It is capable of alleviating the stress associated with fuel wood sourcing and the poverty level among the rural dwellers of Africa particularly women and children. [ABSTRACT FROM AUTHOR]

Two cassava tuber wastes (CTW): cassava peels and cassava starch residues were enriched through solid substrate fermentation using Lactobacillus delbrueckii, Lactobacillus coryneformis and Aspergillus fumigatus, a process which took the advantage of the lysine and linamarase secreting ability of the two lactic acid bacteria and cellulose degrading potential of the fungus. The enriched wastes were used to formulate broilers diets in which each was included at 0, 20, 40 and 60% in a completely randomized design in an 8-week trial. Three hundred and fifty (350) day old (Ross 308) broiler chicks were randomly allotted to 7 treatment diets at 10 chicks per replicate of five. The control diet contained no enriched CTW (0%) while diets 2-4 contained 20-60% microbially fermented cassava peel [MFCP], diets 5-7 contained 20-60% microbially fermented cassava starch residues [MFCSR]. Growth performance, blood variables, serum biochemistry and economy of production were the response criteria. The final body weight (1.20-1.48 kg) and weight gain (1.16-1.44 kg) and weight gain (1.16-1.44kg) were not significantly (P>0.05) affected. Total feed intake increased with increased MFCP inclusion but decreased with increasing level of MFCSR with bird fed control diet having the best FCR (2.56). Only the Mean Corpuscular Haemoglobin Concentration (MCHC) was not significantly (P>0.05) affected of all the blood haematological indices measured. Of the entire serum metabolites measured only the albumin and globulin were significantly (P<0.05) affected. The feed cost per kilogram body weight decreased by 27.3-39.4% when the CTW was included. However, within the limit of this study, the inclusion of 40% and 60% of MFCP (27.3% and 23.9% cost reduction, respectively), could lead to profitable broiler production in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Drying characteristics of cassava slices was investigated in a mixed mode natural convection solar dryer to obtain a suitable mathematical model describing the drying. The average drying chamber temperature was between 34 ±2 °C and 50 ±1.8 °C, while 10 commonly used thin layer drying models were used for drying curve modelling. Coefficient of determination (R2) and root mean square error (RMSE) were used to determine the models performances. The drying curve of cassava slices showed a reduction of moisture content with increased drying time in the solar dryer, and the variation of moisture ratio exponentially decreased with increased drying time. The Midilli and Logarithmic models showed better fit to the experimental drying data of cassava slices. As compared with other models tested, there were no significant differences (p >0.05) in the R2 values obtained for the Midilli and Logarithmic models; hence, the Logarithmic model was preferable because of the lower RMSE. The diffusion mechanism could be used to describe the drying of cassava slices that was found to be in the falling rate period. A diffusion coefficient (Deff) of 1.22 × 10-8 m2 s-1 was obtained, which was within the established standard for food products.

El artículo compara las concepciones de actividad artística en Platón y Aristóteles y se divide en tres partes. En la primera, se discuten la mimesis y la technē en el Ion de Platón, así como el papel de la poesía en la República. En la segunda, se hace un recuento de la idea de felicidad de Aristóteles como fin de la acción. En la última se discute el intento de reconciliación de las posiciones de Platón y Aristóteles realizado por el pensador neoplatónico renacentista, Torquato Tasso.

DISEÑO: estudio prospectivo observacional. Participantes: 38 pacientes nuevos atendidos en la consulta de “baja visión” del Hospital Universitario San Vicente de Paúl en el período comprendido entre julio de 2005 y junio de 2006. OBJETIVOS: determinar si existe mejoría en el desempeño en las áreas de autocuidado, socialización, lectura, escritura y actividades productivas, así como el grado de satisfacción personal de los pacientes rehabilitados en esta consulta. Además, determinar si esta mejoría se relaciona con el grado de “baja visión”. MÉTODOS: aplicación del cuestionario de evaluación de “baja visión” (CEBAVI) diseñado por los investigadores para cuantificar el desempeño de los participantes antes y después de la aplicación de las ayudas brindadas por el estudio. Se analizaron los puntajes totales obtenidos sumando los de cada actividad o área evaluada. Los puntajes podían estar entre 0 y 73 puntos. PRINCIPALES RESULTADOS: se encontraron diferencias significativas (p < 0,001) entre todos los promedios de los puntajes inicial y final para todos los grupos de “baja visión” así: compromiso leve 55,2 vs 56,4; compromiso moderado 52,2 vs 62,1; compromiso grave 34,9 vs 48,5 y compromiso profundo 28,3 vs 36,1. Globalmente, hubo cambios positivos en el desempeño de las actividades del programa relacionadas con la rehabilitación de los diferentes grupos de “baja visión”; en el de “baja visión” grave se logró la máxima mejoría. CONCLUSIONES: se observó una mejoría tanto en el desempeño global como en la satisfacción personal de los pacientes en cada uno de los grupos estudiados. En términos generales, a mayor compromiso visual mayor fue la mejoría después de la intervención.

This study evaluated a de-feathering machine with scalding tank. The machine was evaluated in terms of machine plucking time, machine capacity and machine efficiency. A 3×3×3 completely randomized experimental design was carried out using three poultry birds (broiler, cockerel and layer) and three scalding temperatures (60oC, 70oC and 80oC) at machine constant speed of 7.54 m s -1 and at three replicates. The average machine capacities were 175, 179 and 159 birds hr-1 for broiler, layer and cockerel birds respectively while the average machine efficiencies were 95%, 93% and 90% for broiler, layer and cockerel birds respectively. The machine plucking time reduced from 28 s to 19 s with an increase in scalding temperature from 60oC to 80oC for the different poultry breeds. The highest machine efficiency obtained were 96%, 94% and 95% for broiler, layer and cockerel birds respectively at 70oC temperature. The machine capacity increased from 131 to 197 birds hr-1 with an increase in temperature from 60oC to 80oC for the different poultry breeds. The optimum machine capacity was obtained at 80oC with values 194, 197 and 180 birds hr-1 for broiler, layer and cockerel birds respectively. The machine was able to de-feather two smaller birds but performed better with one bird at a time. [ABSTRACT FROM AUTHOR]

Background: Salvage radiation therapy (SRT) is a mainstay of treatment for biochemical relapse following radical prostatectomy; however, few studies have examined genomic biomarkers in this context., Objective: We characterized the prognostic impact of previously identified deleterious molecular phenotypes-loss of PTEN, ERG expression, and TP53 mutation-for patients undergoing SRT., Design, Setting, and Participants: We leveraged an institutional database of 320 SRT patients with available tissue and follow-up. Tissue microarrays were used for genetically validated immunohistochemistry assays., Intervention: All men underwent SRT with or without androgen deprivation therapy OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable Cox-proportional hazard models assessed the association of molecular phenotypes with biochemical recurrence-free (bRFS) and metastasis-free (MFS) survival after SRT., Results and Limitations: Loss of PTEN (n = 123, 43%) and ERG expression (n = 118, 39%) were common in this cohort, while p53 overexpression (signifying TP53 missense mutation) was infrequent (n = 21, 7%). In univariable analyses, any loss of PTEN portended worse bRFS (hazard ratio [HR] 1.86; 95% confidence interval 1.36-2.57) and MFS (HR 1.89; 1.21-2.94), with homogeneous PTEN loss being associated with the highest risk of MFS (HR 2.47; 1.54-3.95). Similarly, p53 overexpression predicted worse bRFS (HR 1.95; 1.14-3.32) and MFS (HR 2.79; 1.50-5.19). ERG expression was associated with worse MFS only (HR 1.6; 1.03-2.48). On the multivariable analysis adjusting for known prognostic features, homogeneous PTEN loss remained predictive of adverse bRFS (HR 1.82; 1.12-2.96) and MFS (HR 2.08; 1.06-4.86). The study is limited by its retrospective and single-institution design., Conclusions: PTEN loss by immunohistochemistry is an independent adverse prognostic factor for bRFS and MFS in prostate cancer patients treated with SRT. Future trials will determine the optimal approach to treating SRT patients with adverse molecular prognostic features., Patient Summary: Loss of the PTEN tumor suppressor protein is associated with worse outcomes after salvage radiotherapy, independent of other clinical or pathologic patient characteristics., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Gleason grade group (GG) is the most powerful prognostic variable in localized prostate cancer; however, interobserver variability remains a challenge. Artificial intelligence algorithms applied to histopathologic images standardize grading, but most have been tested only for agreement with pathologist GG, without assessment of performance with respect to oncologic outcomes. We compared deep learning-based and pathologist-based GGs for an association with metastatic outcome in three surgical cohorts comprising 777 unique patients. A digitized whole slide image of the representative hematoxylin and eosin-stained slide of the dominant tumor nodule was assigned a GG by an artificial intelligence-based grading algorithm and was compared with the GG assigned by a contemporary pathologist or the original pathologist-assigned GG for the entire prostatectomy. Harrell's C-indices based on Cox models for time to metastasis were compared. In a combined analysis of all cohorts, the C-index for the artificial intelligence-assigned GG was 0.77 (95% confidence interval [CI]: 0.73-0.81), compared with 0.77 (95% CI: 0.73-0.81) for the pathologist-assigned GG. By comparison, the original pathologist-assigned GG for the entire case had a C-index of 0.78 (95% CI: 0.73-0.82). PATIENT SUMMARY: Artificial intelligence-enabled prostate cancer grading on a single slide was comparable with pathologist grading for predicting metastatic outcome in men treated by radical prostatectomy, enabling equal access to expert grading in lower resource settings., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Fatty acid synthase (FASN) catalyzes the synthesis of long-chain saturated fatty acids and is overexpressed during prostatic tumorigenesis, where it is the therapeutic target in several ongoing trials. However, the mechanism of FASN upregulation in prostate cancer remains unclear. Here, we examine FASN gene CpG methylation pattern by InfiniumEPIC profiling and whole-genome bisulfite sequencing across multiple racially diverse primary and metastatic prostate cancer cohorts, comparing with FASN protein expression as measured by digitally quantified IHC assay and reverse phase protein array analysis or FASN gene expression. We demonstrate that the FASN gene body is hypomethylated and overexpressed in primary prostate tumors compared with benign tissue, and FASN gene methylation is significantly inversely correlated with FASN protein or gene expression in both primary and metastatic prostate cancer. Primary prostate tumors with ERG gene rearrangement have increased FASN expression and we find evidence of FASN hypomethylation in this context. FASN expression is also significantly increased in prostate tumors from carriers of the germline HOXB13 G84E mutation compared with matched controls, consistent with a report that HOXB13 may contribute to epigenetic regulation of FASN in vitro. However, in contrast to previous studies, we find no significant association of FASN expression or methylation with self-identified race in models that include ERG status across two independent primary tumor cohorts. Taken together, these data support a potential epigenetic mechanism for FASN regulation in the prostate which may be relevant for selecting patients responsive to FASN inhibitors., Significance: Here, we leverage multiple independent primary and metastatic prostate cancer cohorts to demonstrate that FASN gene body methylation is highly inversely correlated with FASN gene and protein expression. This finding may shed light on epigenetic mechanisms of FASN regulation in prostate cancer and provides a potentially useful biomarker for selecting patients in future trials of FASN inhibitors., (© 2024 The Authors; Published by the American Association for Cancer Research.)

The United States continues to be impacted by decades of an opioid misuse epidemic, worsened by the COVID-19 pandemic and by the growing prevalence of highly potent synthetic opioids (HPSO) such as fentanyl. In instances of a toxicity event, first-response administration of reversal medications such as naloxone can be insufficient to fully counteract the effects of HPSO, particularly when there is co-occurring substance use. In an effort to characterize and study this multi-faceted problem, the Camden Opioid Research Initiative (CORI) has been formed. The CORI study has collected and analyzed post-mortem toxicology data from 42 cases of decedents who expired from opioid-related toxicity in the South New Jersey region to characterize substance use profiles. Co-occurring substance use, whether by intent or through possible contamination of the illicit opioid supply, is pervasive among deaths due to opioid toxicity, and evidence of medication-assisted treatment is scarce. Nearly all (98%) of the toxicology cases show the presence of the HPSO, fentanyl, and very few (7%) results detected evidence of medication-assisted treatment for opioid use disorder, such as buprenorphine or methadone, at the time of death. The opioid toxicity reversal drug, naloxone, was detected in 19% of cases, but 100% of cases expressed one or more stimulants, and sedatives including xylazine were detected in 48% of cases. These results showing complex substance use profiles indicate that efforts at mitigating the opioid misuse epidemic must address the complications presented by co-occurring stimulant and other substance use, and reduce barriers to and stigmas of seeking effective medication-assisted treatments., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kusic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Microscopic examination of prostate cancer has failed to reveal a reproducible association between molecular and morphologic features. However, deep-learning algorithms trained on hematoxylin and eosin (H&E)-stained whole slide images (WSI) may outperform the human eye and help to screen for clinically-relevant genomic alterations. We created deep-learning algorithms to identify prostate tumors with underlying ETS-related gene (ERG) fusions or PTEN deletions using the following 4 stages: (1) automated tumor identification, (2) feature representation learning, (3) classification, and (4) explainability map generation. A novel transformer-based hierarchical architecture was trained on a single representative WSI of the dominant tumor nodule from a radical prostatectomy (RP) cohort with known ERG/PTEN status (n = 224 and n = 205, respectively). Two distinct vision transformer-based networks were used for feature extraction, and a distinct transformer-based model was used for classification. The ERG algorithm performance was validated across 3 RP cohorts, including 64 WSI from the pretraining cohort (AUC, 0.91) and 248 and 375 WSI from 2 independent RP cohorts (AUC, 0.86 and 0.89, respectively). In addition, we tested the ERG algorithm performance in 2 needle biopsy cohorts comprised of 179 and 148 WSI (AUC, 0.78 and 0.80, respectively). Focusing on cases with homogeneous (clonal) PTEN status, PTEN algorithm performance was assessed using 50 WSI reserved from the pretraining cohort (AUC, 0.81), 201 and 337 WSI from 2 independent RP cohorts (AUC, 0.72 and 0.80, respectively), and 151 WSI from a needle biopsy cohort (AUC, 0.75). For explainability, the PTEN algorithm was also applied to 19 WSI with heterogeneous (subclonal) PTEN loss, where the percentage tumor area with predicted PTEN loss correlated with that based on immunohistochemistry (r = 0.58, P = .0097). These deep-learning algorithms to predict ERG/PTEN status prove that H&E images can be used to screen for underlying genomic alterations in prostate cancer., (Copyright © 2023 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights reserved.)

Pharmacogenetics (PGx) has the potential to improve opioid medication management. Here, we present patient perception data, pharmacogenetic data and medication management trends in patients with chronic pain (arm 1) and opioid use disorder (arm 2) treated at Cooper University Health Care in Camden City, NJ. Our results demonstrate that the majority of patients in both arms of the study (55% and 65%, respectively) are open to pharmacogenetic testing, and most (66% and 69%, respectively) believe that genetic testing has the potential to improve their medical care. Our results further support the potential for CYP2D6 PGx testing to inform chronic pain medication management for poor metabolizers (PMs) and ultrarapid metabolizers (UMs). Future efforts to implement PGx testing in chronic pain management, however, must address patient concerns about genetic test result access and genetic discrimination.

Purpose: Recent case reports raise the question as to whether anesthetic agents injected into the epidural space could lead to a 'compartment syndrome' and neurovascular sequelae. Single-shot caudal epidural anesthesia has been established as a safe technique, but changes in pressure in the caudal epidural space have not been described. Our aim was to study pressure changes to provide preliminary information for future studies design., Methods: We prospectively measured the pressure changes in the caudal epidural space in 31 pediatric patients. The pressures were measured at loss of resistance, immediately after the bolus dose of local anesthetic (1 ml/kg), and at 15-s intervals up to 3 min., Results: The pressure at loss of resistance was 35.6 ± 27.8 mmHg. A pulsatile waveform was observed once the epidural space was accessed. The pressure after administration of the local anesthetic bolus (1 ml/kg 0.2 % ropivacaine/bupivacaine with 1:200,000 epinephrine) was 192.5 ± 93.3 mmHg. The pressure decreased to 51.5 ± 39.0 mmHg at 15 s, 26.9 ± 9.9 mmHg after 2 min, and 24.7 ± 11.7 after 3 min. The return to baseline occurred at approximately 45-60 s., Conclusions: Following the administration of the local anesthetic into the caudal epidural space, there was a marked, but transient, increase in the pressure within the epidural space. It appears unlikely that a slow epidural catheter infusion could lead to a sustained increase in epidural pressure.

TBI and its sequelae remain a major healthcare issue throughout the world. With an improved understanding of the pathophysiology of TBI, refinements of monitoring technology, and ongoing research to determine optimal care, the prognosis of TBI continues to improve. In 2003, the Society of Critical Care Medicine published guidelines for the acute management of severe TBI in infants, children, and adolescents. As pediatric anesthesiologists are frequently involved in the perioperative management of such patients including their stabilization in the emergency department, familiarity with these guidelines is necessary to limit preventable secondary damage related to physiologic disturbances. This manuscript reviews the current evidence-based medicine regarding the care of pediatric patients with TBI as it relates to the perioperative care of such patients. The issues reviewed include those related to initial stabilization, airway management, intra-operative mechanical ventilation, hemodynamic support, administration of blood and blood products, positioning, and choice of anesthetic technique. The literature is reviewed regarding fluid management, glucose control, hyperosmolar therapy, therapeutic hypothermia, and corticosteroids. Whenever possible, management recommendations are provided., (© 2012 Blackwell Publishing Ltd.)