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Summary: High‐flow nasal oxygen can be administered at induction of anaesthesia for the purposes of pre‐oxygenation and apnoeic oxygenation. This intervention is claimed to enhance carbon dioxide elimination during apnoea, but the extent to which this occurs remains poorly quantified. The optimal nasal oxygen flow rate for gas exchange is also unknown. In this study, 114 patients received pre‐oxygenation with high‐flow nasal oxygen at 50 l.min‐1. At the onset of apnoea, patients were allocated randomly to receive one of three nasal oxygen flow rates: 0 l.min‐1; 70 l.min‐1; or 120 l.min‐1. After 4 minutes of apnoea, all oxygen delivery was ceased, tracheal intubation was performed, and oxygen delivery was recommenced when SpO2 was 92%. Mean (SD) PaCO2 rise during the first minute of apnoea was 1.39 (0.39) kPa, 1.41 (0.29) kPa, and 1.26 (0.38) kPa in the 0 l.min‐1, 70 l.min‐1 and 120 l.min‐1 groups, respectively; p = 0.16. During the second, third and fourth minutes of apnoea, mean (SD) rates of rise in PaCO2 were 0.34 (0.08) kPa.min‐1, 0.36 (0.06) kPa.min‐1 and 0.37 (0.07) kPa.min‐1 in the 0 l.min‐1, 70 l.min‐1 and 120 l.min‐1 groups, respectively; p = 0.17. After 4 minutes of apnoea, median (IQR [range]) arterial oxygen partial pressures in the 0 l.min‐1, 70 l.min‐1 and 120 l.min‐1 groups were 24.5 (18.6–31.4 [12.3–48.3]) kPa; 36.6 (28.1–43.8 [9.8–56.9]) kPa; and 37.6 (26.5–45.4 [11.0–56.6]) kPa, respectively; p < 0.001. Median (IQR [range]) times to desaturate to 92% after the onset of apnoea in the 0 l.min‐1, 70 l.min‐1 and 120 l.min‐1 groups, were 412 (347–509 [190–796]) s; 533 (467–641 [192–958]) s; and 531 (462–681 [326–1007]) s, respectively; p < 0.001. In conclusion, the rate of carbon dioxide accumulation in arterial blood did not differ significantly between apnoeic patients who received high‐flow nasal oxygen and those who did not. [ABSTRACT FROM AUTHOR]

PurposeMost patients with acute bronchitis who seek medical care are treated with antibiotics, although the effectiveness of this intervention is uncertain. We performed a meta-analysis of randomized, controlled trials to estimate the effectiveness of antibiotics in the treatment of acute bronchitis.Subjects and methodsEnglish-language studies published January 1966 to April 1998 were retrieved using MEDLINE, bibliographies, and consultation with experts. Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included.ResultsWe identified eight randomized controlled trials that satisfied all inclusion criteria. These studies used one of three antibiotics (erythromycin, doxycycline, trimethoprim/sulfamethoxazole). The use of antibiotics decreased the duration of cough and sputum production by approximately one-half day (summary effect size 0.21; 95% CI, 0.05 to 0.36). For specific symptoms, there were nonsignificant trends favoring the use of antibiotics: a decrease of 0.4 days of purulent sputum (95% CI, -0.1 to 0.8), a decrease of 0.5 days of cough (95% CI, -0.1 to 1.1), and a decrease of 0.3 days lost from work (95% CI, -0.6 to 1.1).ConclusionThis meta-analysis suggests a small benefit from the use of the antibiotics erythromycin, doxycycline, or trimethoprim/sulfamethoxazole in the treatment of acute bronchitis in otherwise healthy patients. As this small benefit must be weighed against the risk of side effects and the societal cost of increasing antibiotic resistance, we believe that the use of antibiotics is not justified in these patients.

Critics of the overall value of the MBA have not systematically considered the attitudes of MBA students about the value of their degree. The author used data from a large sample of graduates (N = 16,268) to do so, and to explore predictors of overall degree value. The author developed separate regression models for full-time, part-time, and executive MBA programs. The predictor variables are multi-item scales that measure (a) satisfaction with the MBA degree, and (b) satisfaction with the school or program. Each scale contributes significantly to the prediction of overall value, and there is little difference in their relative importance in the regression models. (Contains 6 tables and 1 note.)

Smokeless tobacco (ST, namely chewing tobacco and snuff) is known to be associated with lesions of the oral mucosa, some of which may become malignant. To better evaluate the effect of ST on the mouth, 1,109 major and minor league baseball players were studied during spring training. Subjects completed a questionnaire regarding education, cigarette smoking, alcohol consumption, dental hygiene, and demographic data. Detailed information about ST use, including brands, amount, and overall usage patterns, was also obtained. The men underwent a dental examination in a mobile unit by examiners who were uninformed about patients' ST habits. Red or white lesions of the mouth were classified as erythroplakia or leukoplakia, respectively, and measured. Based on self-reports, subjects were classified as nonusers, former users, or users. Users were further classified into two groups: those who had used ST during the past week (within-week), and those who had not (within-month). Results showed that 493 (45 percent) men were nonusers; 138 (13 percent) were former users; and 463 (42 percent) were users. Of these, 423 were within-week users. Among users, ST had been used on average for almost six and one-half years and was kept in the mouth about 1.6 hours each day. ST users had a higher risk of leukoplakia; of the 423 current users, 196 men had 214 lesions. This was dramatically different from rates for nonusers, among whom seven men had eight leukoplakic areas. Most areas of leukoplakia were found in the areas of the mouth where the tobacco was most often held. Biopsy specimens from 92 subjects were evaluated, and all were benign. The risk for leukoplakia increased with increasing amounts of ST used, both as a function of more tobacco per day, and longer times in the mouth. Snuff users had a much higher rate of leukoplakia than chewers of tobacco. Brands varied in their association with leukoplakia: Copenhagen and Skoal were associated with leukoplakia more than Hawken. Of the ST user group, 46.3 percent had leukoplakia. The relationship of leukoplakia to oral cancer in this population of healthy young men is not clear, but it is possible that, with continued use, an association could develop. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Volumetric muscle loss overwhelms skeletal muscle’s ordinarily capable regenerative machinery, resulting in severe functional deficits that have defied clinical repair strategies. In this manuscript we pair the early in vivo functional response induced by differing volumetric muscle loss tissue engineering repair strategies that are broadly representative of those explored by the field (scaffold alone, cells alone, or scaffold + cells) to the transcriptomic response induced by each intervention. We demonstrate that an implant strategy comprising allogeneic decellularized skeletal muscle scaffolds seeded with autologous minced muscle cellular paste (scaffold + cells) mediates a pattern of increased expression for several genes known to play roles in axon guidance and peripheral neuroregeneration, as well as several other key genes related to inflammation, phagocytosis, and extracellular matrix regulation. The upregulation of several key genes in the presence of both implant components suggests a unique synergy between scaffolding and cells in the early period following intervention that is not seen when either scaffolds or cells are used in isolation; a finding that invites further exploration of the interactions that could have a positive impact on the treatment of volumetric muscle loss.