Sample records for neuraxial blockade-assisted cnb

  1. Central Neuraxial Blockade-Assisted External Cephalic Version in Reducing Caesarean Section Rate: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Ibrahim Bolaji


    Full Text Available We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.5 times more likely than women not receiving anaesthesia to have a successful ECV. The number to treat is six women needed to receive anaesthesia for 1 baby to be turned from breech to cephalic presentation. Feto-maternal morbidity was not increased in the CNB-aided group consisting of only transient bradycardia. Although the appropriate amount of force for safe version has not been quantified, there was no report of uterine rupture despite removal of these patients from “excessive force-pain biofeedback loop” induced through motor nerve blockade. We can attribute 30% of cost savings amounting to £42,150.00 directly to CNB using the most up to date Health Resource Group Code (HRG4. The initial results are encouraging but until the benefits and safety of CNB-aided ECV are substantiated by large randomized, blinded controlled trials, this practice cannot be universally recommended.

  2. Rabies vaccine and neuraxial anaesthesia | Rewari | Southern ...

    African Journals Online (AJOL)

    This case report of neuraxial anaesthesia for emergency orthopaedic surgery serves to highlight the dilemma faced by anaesthetists when surgical intervention becomes necessary in a patient on anti-rabies vaccine. The two issues of importance are the possible reduction in the efficacy of vaccination by an ...

  3. Neuraxial blockade for external cephalic version: Cost analysis. (United States)

    Yamasato, Kelly; Kaneshiro, Bliss; Salcedo, Jennifer


    Neuraxial blockade (epidural or spinal anesthesia/analgesia) with external cephalic version increases the external cephalic version success rate. Hospitals and insurers may affect access to neuraxial blockade for external cephalic version, but the costs to these institutions remain largely unstudied. The objective of this study was to perform a cost analysis of neuraxial blockade use during external cephalic version from hospital and insurance payer perspectives. Secondarily, we estimated the effect of neuraxial blockade on cesarean delivery rates. A decision-analysis model was developed using costs and probabilities occurring prenatally through the delivery hospital admission. Model inputs were derived from the literature, national databases, and local supply costs. Univariate and bivariate sensitivity analyses and Monte Carlo simulations were performed to assess model robustness. Neuraxial blockade was cost saving to both hospitals ($30 per delivery) and insurers ($539 per delivery) using baseline estimates. From both perspectives, however, the model was sensitive to multiple variables. Monte Carlo simulation indicated neuraxial blockade to be more costly in approximately 50% of scenarios. The model demonstrated that routine use of neuraxial blockade during external cephalic version, compared to no neuraxial blockade, prevented 17 cesarean deliveries for every 100 external cephalic versions attempted. Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.

  4. Neuraxial opioid-induced pruritus: a review.

    LENUS (Irish Health Repository)

    Szarvas, Szilvia


    When intrathecal and epidural opioids are administered, pruritus occurs as an unwanted and troublesome side effect. The reported incidence varies between 30% and 100%. The exact mechanisms of neuraxial opioid-induced pruritus remain unclear. Postulated mechanisms include the presence of an "itch center" in the central nervous system, medullary dorsal horn activation, and antagonism of inhibitory transmitters. The treatment of intrathecal opioid-induced pruritus remains a challenge. Many pharmacological therapies, including antihistamines, 5-HT(3)-receptor antagonists, opiate-antagonists, propofol, nonsteroid antiinflammatory drugs, and droperidol, have been studied. In this review, we will summarize pathophysiological and pharmacological advances that will improve understanding and ultimately the management of this troublesome problem.

  5. Neuraxial Opioid-Induced Itch and Its Pharmacological Antagonism (United States)


    Given its profound analgesic nature, neuraxial opioids are frequently used for pain management. Unfortunately, the high incident rate of itch/pruritus after spinal administration of opioid analgesics reported in postoperative and obstetric patients greatly diminishes patient satisfaction and thus the value of the analgesics. Many endeavors to solve the mystery behind neuraxial opioid-induced itch had not been successful, as the pharmacological antagonism other than the blockade of mu opioid receptors remains elusive. Nevertheless, as the characteristics of all opioid receptor subtypes have become more understood, more studies have shed light on the potential effective treatments. This review discusses the mechanisms underlying neuraxial opioid-induced itch and compares pharmacological evidence in nonhuman primates with clinical findings across diverse drugs. Both nonhuman primate and human studies corroborate that mixed mu/kappa opioid partial agonists seem to be the most effective drugs in ameliorating neuraxial opioid-induced itch while retaining neuraxial opioid-induced analgesia. PMID:25861787

  6. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J


    (6.9% vs 5.5%; OR, 0.91; 95% CI, 0.74-1.12; P=0.36) or stroke (0.3% vs 0.4%; OR, 1.05; 95% CI, 0.44-2.49; P=0.91). Neuraxial block was associated with less clinically important hypotension (39% vs 46%; OR, 0.90; 95% CI, 0.81-1.00; P=0.04). Postoperative epidural analgesia was not associated...... with the primary outcome (11.8% vs 6.2%; OR, 1.48; 95% CI, 0.89-2.48; P=0.13), death (1.3% vs 0.8%; OR, 0.84; 95% CI, 0.35-1.99; P=0.68], myocardial infarction (11.0% vs 5.7%; OR, 1.53; 95% CI, 0.90-2.61; P=0.11], stroke (0.4% vs 0.4%; OR, 0.65; 95% CI, 0.18-2.32; P=0.50] or clinically important hypotension (63...

  7. Ultrasonography for neuraxial blocks: a review of the evidence. (United States)

    Elgueta, Maria F; Duong, Silvia; Finlayson, Roderick J; Tran, De Q


    This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) pertaining to the use of adjunctive ultrasonography (US) for neuraxial blocks. The literature search was conducted using the MEDLINE, EMBASE and PUBMED databases. For the MEDLINE and EMBASE searches, the MESH terms "ultrasonography" and key word "ultrasound" were queried; using the operator "and", they were combined with the MESH terms "neuraxial block," "epidural anesthesia," "epidural analgesia," "spinal anesthesia," "spinal analgesia," "intrathecal anesthesia," "intrathecal analgesia," "caudal anesthesia," and "caudal analgesia." For the PUBMED search, the search terms "ultrasound neuraxial," "ultrasound intrathecal," "ultrasound epidural" (limited to clinical trials), "ultrasound spinal" (limited to clinical trials), and "ultrasound caudal" (limited to clinical trials) were queried. Seventeen RCTs were retained for analysis. Compared to conventional palpation of landmarks, US assistance (i.e., preprocedural scanning) results in fewer needle passes/insertions and skin punctures for neuraxial blocks in obstetrical and surgical patients. These benefits seem most pronounced when expert operators carry out the sonographic exams and for patients displaying difficult spinal anatomy. Preliminary findings also suggest that US provides similar pain relief and functional improvement to fluoroscopy for epidural/caudal steroid injection in patients afflicted with chronic spinal pain. Although one trial demonstrated shorter needling time with US guidance (i.e., real-time scanning of needle advancement) compared to US assistance, these findings require further validation. Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US for neuraxial blocks. Further well-designed RCTs are warranted.

  8. Evidence for the use of ultrasound in neuraxial blocks. (United States)

    Perlas, Anahi


    To summarize the existing evidence behind the role of ultrasonography in neuraxial anesthesia techniques. A literature search of the MEDLINE, PubMed, ACP Journal Club databases, and the Cochrane Database of Systematic Reviews was performed using the term ultrasonography combined with each of the following: spinal, intrathecal, epidural, and lumbar puncture. Only studies related to regional anesthesia or acute pain practice were included. Case reports and letters to the editor were excluded. Seventeen relevant studies were identified and included in this review. Neuraxial ultrasonography is a recent development in regional anesthesia practice. Most clinical studies to date come from a limited number of centers and have been performed by very few and highly experienced operators. The existing evidence may be classified in 2 main content areas: (a) ultrasound-assisted neuraxial techniques and (b) real-time ultrasound-guided neuraxial techniques. Neuraxial ultrasonography has been recently introduced to regional anesthesia practice. The limited data available to date suggest that it is a useful adjunct to physical examination, allowing for a highly precise identification of regional landmarks and a precise estimation of epidural space depth, thus facilitating epidural catheter insertion. Further research is needed to conclusively establish its impact on procedure success and safety profile, particularly in the adult nonobstetric population.

  9. In vitro antioxidant potential and deoxyribonucleic acid protecting activity of CNB-001, a novel pyrazole derivative of curcumin

    Directory of Open Access Journals (Sweden)

    Richard L Jayaraj


    Full Text Available Background: Free radicals are underpinned to initiate cascade of toxic events leading to oxidative stress and resultant cell death in many neurodegenerative disorders. Now-a-days antioxidants have become mandatory in the treatment of various diseases apart from the drug′s modes of action. CNB-001, a novel hybrid molecule synthesized by combining curcumin and cyclohexyl bisphenol A is known to possess various biological activities, but the antioxidative property of the compound has not yet been elucidated. Aim: The present study is aimed to analyze various free radicals scavenging by employing in vitro antioxidant assays and to evaluate the deoxyribonucleic acid (DNA protecting the ability of CNB-001 against hydroxyl radicals. Materials and methods: The in vitro antioxidant potential of CNB-001 was evaluated by analyzing its ability to scavenge DPPH, ABTS, nitric oxide, superoxide, hydrogen peroxide, superoxide anion, hydroxyl, hydrogen peroxide radicals and reducing power using spectroscopic method. The DNA protecting activity of CNB-001 was also evaluated on pUC19 plasmid DNA subjected to hydroxyl radicals using standard agarose gel electrophoresis. Results: From the assays, it was observed that CNB-001 scavenged free radicals effectively in a dose dependent manner. CNB-001 scavenged 2,2-diphenyl-1-picrylhydrazyl (IC50 = 44.99 μg/ml, 2,2-azinobis (3-ethylbenzothiazoline-6-sulfonic acid (IC50 = 17.99 μg/ml, nitric oxide (IC50 = 1.36 μg/ml, superoxide radical (IC50 = 77.17 μg/ml, hydrogen peroxide (IC50 = 492.7 μg/ml, superoxide (IC50 = 36.92 μg/ml and hydroxyl (IC50 = 456.5 μg/ml radicals effectively and the reducing power was found to be 11.53 μg/ml. CNB-001 showed considerable protecting activity against plasmid DNA (pUC19 strand scission by ·OH at dose dependent manner. Conclusion: Results from these assays concluded that CNB-001 has a good antioxidant potential by reducing reactive oxygen and reactive nitrogen radicals and it

  10. Trans-thoracic biopsy of lung lesions: FNAB or CNB? Our experience and review of the literature. (United States)

    Capalbo, Emanuela; Peli, Michela; Lovisatti, Maria; Cosentino, Maria; Mariani, Paola; Berti, Eisabetta; Cariati, Maurizio


    This study was performed to determine the type and incidence of complications of fine-needle aspiration biopsy (FNAB) and core biopsy (CNB) performed under computed tomography (CT) guidance to characterise lung lesions, and assess the diagnostic accuracy of the two techniques. In 2009-2011, we performed 124 lung biopsies (66 CNB and 56 FNAB) on 121 patients with a mean age of 72.4 years. Exclusion criteria were pulmonary resection, pleural lesions and/or effusions, and inadequate blood-coagulation profile. All examinations were acquired after contrast-agent administration in a craniocaudal direction from the lung apex to base during a single inspiratory breath-hold, with standardised parameters. Each lesion was scanned with 13-15 slices that could be repeated whenever necessary to document the needle track and for lesion centring, by positioning a metallic marker perpendicular to the centring light to indicate the point of needle access. Unless otherwise clinically indicated, 4 h after the procedure chest radiography was performed. Age was found to be a factor influencing the complications: pneumothorax in young subjects (31 %) and parenchymal haemorrhage in the elderly (30 %), with CNB but not with FNAB. We had more complications with the right lung: 50 % of pneumothorax cases in the upper lobe with CNB and 40 % of cases of haemorrhage in the lower lobe with FNAB. The anterior approach gave rise to more complications with CNB, while the posterior approach with FNAB. CNB had more complications than FNAB for lesions ≤ 3.5 cm (31 vs. 18 % pneumothorax), and >3.5 cm (34 vs. 9 % haemorrhage). There was no significant correlation with lesion histology, needle calibre or number of passes (probably due to the small number of procedures done with needles other than 18 G in CNB or 22 G in FNAB or involving more than one needle pass). The diagnostic accuracy of FNAB, done with a pathologist's extemporaneous assessment of sample adequacy, was 94.83 % against 81.82. % of CNB

  11. The evidence of neuraxial administration of analgesics for cancer-related pain

    DEFF Research Database (Denmark)

    Kurita, G P; Benthien, K S; Nordly, M


    retrieved was 2147, and 84 articles were selected for full reading. The final selection comprised nine articles regarding randomised controlled trials (RCTs) divided in four groups: neuraxial combinations of opioid and adjuvant analgesic compared with neuraxial administration of opioid alone (n = 4); single...... neuraxial drug in bolus compared with continuous administration (n = 2); single neuraxial drug compared with neuraxial placebo (n = 1); and neuraxial opioid combined with or without adjuvant analgesic compared with other comprehensive medical management than neuraxial analgesics (n = 2). The RCTs presented...... clinical and methodological diversity that precluded a meta-analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences...

  12. CNB-001 a Novel Curcumin Derivative, Guards Dopamine Neurons in MPTP Model of Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Richard L. Jayaraj


    Full Text Available Copious experimental and postmortem studies have shown that oxidative stress mediated degeneration of nigrostriatal dopaminergic neurons underlies Parkinson’s disease (PD pathology. CNB-001, a novel pyrazole derivative of curcumin, has recently been reported to possess various neuroprotective properties. This study was designed to investigate the neuroprotective mechanism of CNB-001 in a subacute 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP rodent model of PD. Administration of MPTP (30 mg/kg for four consecutive days exacerbated oxidative stress and motor impairment and reduced tyrosine hydroxylase (TH, dopamine transporter, and vesicular monoamine transporter 2 (VMAT2 expressions. Moreover, MPTP induced ultrastructural changes such as distorted cristae and mitochondrial enlargement in substantia nigra and striatum region. Pretreatment with CNB-001 (24 mg/kg not only ameliorated behavioral anomalies but also synergistically enhanced monoamine transporter expressions and cosseted mitochondria by virtue of its antioxidant action. These findings support the neuroprotective property of CNB-001 which may have strong therapeutic potential for treatment of PD.

  13. Genome-scale reconstruction of Salinispora tropica CNB-440 metabolism to study strain-specific adaptation. (United States)

    Contador, C A; Rodríguez, V; Andrews, B A; Asenjo, J A


    The first manually curated genome-scale metabolic model for Salinispora tropica strain CNB-440 was constructed. The reconstruction enables characterization of the metabolic capabilities for understanding and modeling the cellular physiology of this actinobacterium. The iCC908 model was based on physiological and biochemical information of primary and specialised metabolism pathways. The reconstructed stoichiometric matrix consists of 1169 biochemical conversions, 204 transport reactions and 1317 metabolites. A total of 908 structural open reading frames (ORFs) were included in the reconstructed network. The number of gene functions included in the reconstructed network corresponds to 20% of all characterized ORFs in the S. tropica genome. The genome-scale metabolic model was used to study strain-specific capabilities in defined minimal media. iCC908 was used to analyze growth capabilities in 41 different minimal growth-supporting environments. These nutrient sources were evaluated experimentally to assess the accuracy of in silico growth simulations. The model predicted no auxotrophies for essential amino acids, which was corroborated experimentally. The strain is able to use 21 different carbon sources, 8 nitrogen sources and 4 sulfur sources from the nutrient sources tested. Experimental observation suggests that the cells may be able to store sulfur. False predictions provided opportunities to gain new insights into the physiology of this species, and to gap fill the missing knowledge. The incorporation of modifications led to increased accuracy in predicting the outcome of growth/no growth experiments from 76 to 93%. iCC908 can thus be used to define the metabolic capabilities of S. tropica and guide and enhance the production of specialised metabolites.

  14. The use of lumbar X-rays to facilitate neuraxial anaesthesia during ...

    African Journals Online (AJOL)


    May 10, 2012 ... Original Research: Lumbar X-rays to facilitate neuraxial anaesthesia during knee replacement. 319. 2012;18(6). South Afr J Anaesth Analg. Introduction. The performance of knee replacement surgery, traditionally an operation that is performed on older patients, is ideally carried out under neuraxial ...

  15. The role of genes AMPD1, CNB and COL1A1 in the propensity to employment rowing.

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    Kozyrev A.V.


    Full Text Available The question of the frequency distribution of polymorphic alleles of genes AMPD1, CNB and COL1A1. In the experiment, was attended by athletes, rowers qualifications at the age of 21 to 28 years, and people without experience of regular sport at the age of 20 to 22 years. Established that certain combinations of alleles can be recommended as a diagnostic complex genetic markers to assess the propensity to develop and display of strength, endurance and speed. It is shown that upon receipt of positive results may conduct a successful selection in rowing, the implementation of the individualization of the training process and improve its efficiency.

  16. Functional characterization of calcineurin homologs PsCNA1/PsCNB1 in Puccinia striiformis f. sp. tritici using a host-induced RNAi system.

    Directory of Open Access Journals (Sweden)

    Hong Zhang

    Full Text Available Calcineurin plays a key role in morphogenesis, pathogenesis and drug resistance in most fungi. However, the function of calcineurin genes in Puccinia striiformis f. sp. tritici (Pst is unclear. We identified and characterized the calcineurin genes PsCNA1 and PsCNB1 in Pst. Phylogenetic analyses indicate that PsCNA1 and PsCNB1 form a calcium/calmodulin regulated protein phosphatase belonging to the calcineurin heterodimers composed of subunits A and B. Quantitative RT-PCR analyses revealed that both PsCNA1 and PsCNB1 expression reached their maximum in the stage of haustorium formation, which is one day after inoculation. Using barely stripe mosaic virus (BSMV as a transient expression vector in wheat, the expression of PsCNA1 and PsCNB1 in Pst was suppressed, leading to slower extension of fungal hyphae and reduced production of urediospores. The immune-suppressive drugs cyclosporin A and FK506 markedly reduced the germination rates of urediospores, and when germination did occur, more than two germtubes were produced. These results suggest that the calcineurin signaling pathway participates in stripe rust morphogenetic differentiation, especially the formation of haustoria during the early stage of infection and during the production of urediospores. Therefore PsCNA1 and PsCNB1 can be considered important pathogenicity genes involved in the wheat-Pst interaction.

  17. Self-reported post-discharge symptoms following obstetric neuraxial blockade.

    LENUS (Irish Health Repository)

    Hayes, N E


    Economic pressures are leading to earlier hospital discharge following delivery, before complications of obstetric neuraxial block may become apparent. Our aim was to estimate the incidence of symptoms presenting post-discharge at a single tertiary obstetric centre.

  18. The value of Tuffier's line for neonatal neuraxial procedures. (United States)

    van Schoor, A; Bosman, M C; Bosenberg, A T


    The spine of L4 usually lies on a line drawn between the highest points of the iliac crests (Tuffier's line) in adults. Although its accuracy has been questioned, it is still commonly used to identify the spinous process of the 4th lumbar vertebra before performing lumbar neuraxial procedures. In children, this line is said to cross the midline at the level of L5. A literature search revealed that the description this surface anatomical line is vague in neonates. The aims of this study were to determine the vertebral level of Tuffier's line, as well as its distance from the apex of the sacrococcygeal membrane (ASM), in 39 neonatal cadavers in both a prone and flexed position. It was found that when flexed, Tuffier's line shifted from the level of L4/L5 (prone position) to the upper third of L5. The mean distance from the ASM to Tuffier's line was 23.64mm when prone and 25.47 mm when flexed, constituting a statistically significant increase in the distance (P=0.0061). Therefore, in the absence of advanced imaging modalities, Tuffier's line provides practitioners with a simple method of determining a level caudal to the termination of the spinal cord, at approximately the L4/L5 in a prone neonate and the upper margins of L5 when flexed. Copyright © 2013 Wiley Periodicals, Inc.

  19. Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). (United States)

    Arnedos, M; Nerurkar, A; Osin, P; A'Hern, R; Smith, I E; Dowsett, M


    Analysis of estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC) is increasingly being conducted in core needle biopsies (CNBs) taken at diagnosis but the concordance with the excisional biopsy (EB) is poorly documented. Patients with EBC presenting to The Royal Marsden Hospital from June 2005 to September 2007 who had CNB and subsequent EB were included. ER and PgR were determined by immunohistochemistry (IHC) and graded from 0 to 8 (Allred score). HER2 was determined by IHC and scored from 0 to 3+. FISH analysis was carried out in HER2 2+ cases and in discordant cases. In all, 336 pairs of samples were compared. ER was positive in 253 CNBs (75%) for 255 EBs (76%) and was discordant in six patients (1.8%). PgR was positive in 221 CNBs (66%) and 227 (67.6%) EBs being discordant in 52 cases (15%). HER2 was positive in 41 (12.4%) of the 331 CNBs in which it was determined compared with 44 (13.3%) EBs and discordant in four cases (1.2%). CNB can be used with confidence for ER and HER2 determination. For PgR, due to a substantial discordance between CNB and EB, results from CNB should be used with caution.

  20. Nitrous oxide for labor analgesia: Utilization and predictors of conversion to neuraxial analgesia. (United States)

    Sutton, Caitlin D; Butwick, Alexander J; Riley, Edward T; Carvalho, Brendan


    We examined the characteristics of women who choose nitrous oxide for labor analgesia and identified factors that predict conversion from nitrous oxide to labor neuraxial analgesia. Retrospective descriptive study. Labor and Delivery Ward. 146 pregnant women who used nitrous oxide for analgesia during labor and delivery between September 2014 and September 2015. Chart review only. Demographic, obstetric, and intrapartum characteristics of women using nitrous oxide were examined. Multivariable logistic regression was performed to identify factors associated with conversion from nitrous oxide to neuraxial analgesia. Data are presented as n (%), median [IQR], adjusted relative risk (aRR), and 95% confidence intervals (CI) as appropriate. During the study period, 146 women used nitrous oxide for labor analgesia (accounting for 3% of the total deliveries). The majority (71.9%) of women who used nitrous oxide were nulliparous, and over half (51.9%) had expressed an initial preference for "nonmedical birth." The conversion rate to neuraxial blockade was 63.2%, compared to a concurrent institutional rate of 85.1% in women who did not use nitrous oxide. Factors associated with conversion from nitrous oxide to neuraxial blockade were labor induction (aRR=2.0, CI 1.2-3.3) and labor augmentation (aRR=1.7, CI 1.0-2.9). Only a small number of women opted to use nitrous oxide during labor, analgesia was minimal, and most converted to neuraxial analgesia. Women with induced and augmented labors should be counseled about the increased likelihood that they will convert to neuraxial analgesia. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Neuraxial drug administration: a review of treatment options for anaesthesia and analgesia. (United States)

    Schug, Stephan A; Saunders, David; Kurowski, Irina; Paech, Michael J


    Neuraxial drug administration describes techniques that deliver drugs in close proximity to the spinal cord, i.e. intrathecally into the CSF or epidurally into the fatty tissues surrounding the dura, by injection or infusion. This approach was initially developed in the form of spinal anaesthesia over 100 years ago. Since then, neuraxial drug administration has evolved and now includes a wide range of techniques to administer a large number of different drugs to provide anaesthesia, but also analgesia and treatment of spasticity in a variety of acute and chronic settings. This review concentrates on the pharmacological agents used and the clinical basis behind currently utilised approaches to neuraxial drug administration. With regard to local anaesthetics, the main focus is on the development of the enantiomer-specific compounds ropivacaine and levobupivacaine, which provide similar efficacy to bupivacaine with a reduced risk of severe cardiotoxicity. Opioids are the other group of drugs widely used neuraxially, in particular to provide analgesia alone or more commonly in combination with other agents. The physicochemical properties of the various opioids explain the main differences in efficacy and safety between these drugs when used intrathecally, of which morphine, fentanyl and sufentanil are most commonly used. Another group of drugs including clonidine, dexmedetomidine and epinephrine (adrenaline) provide neuraxial analgesia via alpha-adrenergic receptors and are used mainly as adjuvants to local anaesthetics and opioids. Furthermore, intrathecal baclofen is in routine clinical use to treat spasticity in a number of neurological conditions. Beside these established approaches, a wide range of other drugs have been assessed for neuraxial administration to provide analgesia; however, most are in various early stages of investigation and are not used routinely. These drugs include neostigmine, ketamine, midazolam and adenosine, and the conotoxin ziconotide. The

  2. Risk of epilepsy in surgical patients undergoing general or neuraxial anaesthesia. (United States)

    Chang, H C; Liao, C C; Chang, C C; Huang, S Y; Yeh, C C; Hu, C J; Cherng, Y G; Chen, T L


    Limited information is available on the risks of epilepsy after surgery in patients receiving general or neuraxial anaesthesia. Using Taiwan's National Health Insurance Research Database, we identified 1,478,977 patients aged ≥ 20 years who underwent surgery (required general or neuraxial anaesthesia with hospitalisation for more than one day) between 2004 and 2011. We selected 235,066 patients with general anaesthesia and 235,066 patients with neuraxial anaesthesia using a frequency-matching procedure for age and sex. We did not study those with co-existing epilepsy-related risk factors. The adjusted rate ratios (RRs) and 95% confidence intervals (CIs) of newly diagnosed epilepsy 1 year after surgery associated with general anaesthesia were analysed in the multivariate Poisson regression model. The one-year incidence of postoperative epilepsy for patients with general anaesthesia and neuraxial anaesthesia were 0.41 and 0.32 per 1000 persons, respectively, and the corresponding RR was 1.27 (95%CI 1.15-1.41). The association between general anaesthesia and postoperative epilepsy was significant in men (RR = 1.22; 95%CI 1.06-1.40), women (RR = 1.33; 95%CI 1.15-1.55) and 20-39-year-old patients. The risk of postoperative epilepsy increased in patients with general anaesthesia who had co-existing medical conditions and postoperative complications. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  3. The use of lumbar X-rays to facilitate neuraxial anaesthesia during ...

    African Journals Online (AJOL)

    Background: Knee replacement surgery is an operation that is performed on older patients, with a few exceptions. Many of these patients have co-existing diseases and have had previous surgery, of which lumbar spinal surgery is of particular relevance. Neuraxial anaesthesia is the anaesthetic of choice. Method: This ...

  4. Brief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation. (United States)

    Carvalho, Brendan; Tan, Jonathan M; Macario, Alex; El-Sayed, Yasser Y; Sultan, Pervez


    In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. Using a computer cost model, which considers possible outcomes and probability uncertainties at the same time, we estimated total expected delivery costs for breech presentation managed by a trial of ECV with and without neuraxial anesthesia. From published studies, the average probability of successful ECV with neuraxial anesthesia was 60% (with individual studies ranging from 44% to 87%) compared with 38% (with individual studies ranging from 31% to 58%) without neuraxial anesthesia. The mean expected total delivery costs, including the cost of attempting/performing ECV with anesthesia, equaled $8931 (2.5th-97.5th percentile prediction interval $8541-$9252). The cost was $9207 (2.5th-97.5th percentile prediction interval $8896-$9419) if ECV was attempted/performed without anesthesia. The expected mean incremental difference between the total cost of delivery that includes ECV with anesthesia and ECV without anesthesia was $-276 (2.5th-97.5th percentile prediction interval $-720 to $112). The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.

  5. Central neuraxial blockade for splenectomy in myeloproliferative disease: A word of caution

    Directory of Open Access Journals (Sweden)

    S N Myatra


    Full Text Available We describe management of portal vein thrombosis (PVT in a patient with myeloproliferative disease after splenectomy. This case posed a unique therapeutic challenge in maintaining a fine balance between life-saving thrombolysis and the risk of neuraxial complications due to bleeding. The incidence of PVT after splenectomy in patients with myeloproliferative disorders is high (40%. Anaesthesiologists should be aware of this and avoid central neuraxial blockade in such cases. If post-operative emergency thrombolysis is required in a patient having an epidural catheter in situ, it should be done under close monitoring, weighing the risks and benefits. Fibrinogen levels should be monitored to evaluate the presence of residual thrombolytic effects and to time the catheter removal.

  6. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. (United States)

    Van Waesberghe, Julia; Stevanovic, Ana; Rossaint, Rolf; Coburn, Mark


    Hip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients' outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010. To compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed. Twenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (-0.36 to -0.17); p anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.

  7. Parturient recall of neuraxial analgesia risks: Impact of labor pain vs no labor pain. (United States)

    Burkle, Christopher M; Olsen, David A; Sviggum, Hans P; Jacob, Adam K


    Information exchange between anesthesia providers and parturients about neuraxial analgesia risks often occurs in the presence of labor pain. This study examined whether the presence of pain impacted the level of recall of information provided to parturients regarding risks of neuraxial techniques. Single-center, nonrandomized study. Labor and delivery suite and postpartum patient rooms in a large academic medical center. Two hundred six primigravidas admitted to our labor and delivery suites and receiving neuraxial analgesia were included. Informed consent for epidural and spinal placement was obtained by an obstetric anesthesia resident as per our standard practice. At the time of consent, parturients' self-reported level of pain was recorded. After delivery, patients completed a questionnaire asking which risks they recalled. Also queried were patient self-reported levels of anxiety at the time of consent, patient satisfaction with the informed consent process, overall satisfaction with pain control, as well as their preferred method and timing of information exchange. Only 20.9% of the 206 participating parturients recalled all risks and none of the distractors. There was no difference in recall between those with pain and those without pain at the time of consent. Women experiencing any pain at the time of consent were more likely to be very satisfied with the communication of risks compared with women without pain (96.2% vs 85.5%, P=.005). There was no difference in the preferred method (P=.780) or timing (P=.779) of discussion of risks between women in active labor compared with women with a scheduled induction of labor. Although parturients' recall of neuraxial risks did not differ based on the existence of labor pain, those having pain reported greater satisfaction with the informed consent process. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Prothrombin Complex Concentrate for Rapid Reversal of Warfarin Anticoagulation to Allow Neuraxial Blockade

    Directory of Open Access Journals (Sweden)

    Conor Skerritt


    Full Text Available The development of Prothrombin Complex Concentrates (PCCs has led to better outcomes in patients receiving emergency reversal of warfarin. However, most published data describes the use of PCCs in the setting of major bleeding or emergent major surgery, with little information on neuraxial blockade. We describe a case of rapid warfarin reversal using PCC and subsequent surgery under spinal anaesthesia in an 87-year-old lady, for whom general anaesthesia was deemed high risk. Her international normalised ratio (INR on the morning of surgery was 1.8, precluding neuraxial blockade; however, it was felt that given, the need for imminent surgery, immediate reversal of the warfarin was indicated. We administered a single dose of 23 units/kg PCC and 5 mg vitamin K. Her INR 1 hour following PCC was 1.2, and spinal anesthetic was administered. The patient then underwent excision of melanoma deposits from her leg and groin dissection. There were no complications, the patient recovered satisfactorily, and there were no thrombotic or hemorrhagic events at 30 days postoperatively. This case study demonstrates a novel use of PCCs; in certain patients, PCCs may be safely used for immediate reversal of warfarin to allow for neuraxial blockade, safer anaesthesia, and better outcomes.

  9. Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    Full Text Available CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. The aim of this study was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for orthopedic surgery. DESIGN AND SETTING: Systematic review at Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials (Issue 10, 2012, PubMed (1966 to November 2012, Lilacs (1982 to November 2012, SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903, stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259, myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291, length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870, postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479 or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167. CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia.

  10. Combined use of neuraxial and general anesthesia during major abdominal procedures in neonates and infants. (United States)

    Goeller, Jessica K; Bhalla, Tarun; Tobias, Joseph D


    With the advent of ultrasound and improvements in equipment, the applications of regional anesthesia in the pediatric population have continued to expand. Although frequently used for postoperative analgesia or as a means of avoiding general anesthesia in patients with comorbid conditions, the adjunctive use of regional anesthesia during general anesthesia may effectively decrease the intraoperative requirements for intravenous and volatile agents, thereby providing a more rapid awakening and earlier tracheal extubation. More recently, the limitation of the requirements for volatile and other anesthetic agents may be desirable, given concerns regarding the potential impact of these agents on neurocognitive outcome in neonates and infants. Several authors have demonstrated the potential utility of combining a neuraxial technique (spinal or epidural anesthesia) with general anesthesia in neonates and infants undergoing intraabdominal procedures. We review the literature regarding the combined use of neuraxial and general anesthesia in neonates and infants during major abdominal surgery, discuss its potential applications in this population, and review the techniques of such practice. © 2014 John Wiley & Sons Ltd.

  11. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Li J


    Full Text Available Jinlei Li, Thomas Halaszynski Department of Anesthesiology, Yale University, Yale New Haven Hospital, New Haven, CT, USA Abstract: Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000. Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes. No laboratory model identifies patients at risk, and rarity of neuraxial hematoma defies prospective randomized study so “patient-specific” factors and “surgery-related” issues should be considered to improve patient-oriented outcomes. Details of advanced age, older females, trauma patients, spinal cord and vertebral column abnormalities, organ function compromise, presence of underlying coagulopathy, traumatic or difficult needle placement, as well as indwelling catheter(s during anticoagulation pose risks for significant bleeding. Therefore, balancing between thromboembolism, bleeding risk, and introduction of more potent antithrombotic medications in combination with regional anesthesia has resulted in a need for more than “consensus statements” to safely manage regional interventions during anticoagulant/thromboprophylactic therapy. Keywords: antithrombotics, novel oral anticoagulant, regional, neurologic dysfunction, hematoma, peripheral nerve blockade

  12. Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: Systematic review and meta-analyses. (United States)

    Longo, Marcelo A; Cavalheiro, Bárbara T; de Oliveira Filho, Getúlio R


    Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC. To quantify the prevalence of intraoperative pain and to verify whether evidence on the maintenance of ventilation, circulation and surgical anesthesia during NA compared with GA is consistent. Systematic review with meta-analyses. Anesthesia for laparoscopic cholecystectomy. We searched Medline, Cochrane and EBSCO databases up to 2016 for randomized controlled trials that compared LC in the two groups under study, neuraxial (subarachnoid or epidural) and general anesthesia. The primary outcome was the prevalence of intraoperative pain referred to the shoulder in the NA group. Hemodynamic and respiratory outcomes and adverse effects in both groups were also collected. Eleven comparative studies were considered eligible. The pooled prevalence of shoulder pain was 25%. Intraoperative hypotension and bradycardia occurred more frequently in patients who received NA, with a risk ratio of 4.61 (95% confidence interval [CI] 1.70-12.48, p=0.003) and 6.67 (95% CI 2.02-21.96, p=0.002), respectively. Postoperative nausea and vomiting was more prevalent in patients who submitted to GA. The prevalence of postoperative urinary retention did not differ between the techniques. Postoperative headache was more prevalent in patients who received NA, while the postoperative pain intensity was lower in this group. Performing meta-analyses on hypertension, hypercapnia and hypoxemia was not possible. NA as sole anesthetic technique, although feasible for LC, was associated with intraoperative pain referred to the shoulder, required anesthetic conversion in 3.4% of the cases and did not demonstrate evidence of respiratory benefits for patients with normal pulmonary

  13. 17.6 kWp installation with thin-film modules on the flat roof of the CNB building at the Swiss Federal Institute of Technology (ETH) in Zuerich - Final report; 17.6 kWp Installation with Thin-Film modules on the flat roof at the CNB Building of the ETHZ - Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Schudel, P.; Kottmann, A.


    The CNB-building of the Swiss Federal Institute of Technology (ETH), Zuerich, is located downtown. As a part of the renovation of the building, a new photovoltaic installation has been realized. The building is subject of local historical monument preservation and protection codes. Therefore, the PV modules are of one colour and installed as symmetrical as possible. The installation has a power of 17.6 kW peak and consists of standard thin-film-modules. A display in the new cafeteria provides information about the service of the installation. Together with the engineering office 'energiebuero ag', 'BE Netz' installed the plant in June 2006. The objective to integrate the photovoltaic installation in the roof landscape as decent as possible has been accomplished. With a production of 18,409 kWh in the first year, the performance is at least equal to standard crystalline solutions. (author)

  14. The timing of amniotomy, oxytocin and neuraxial analgesia and its association with labour duration and mode of birth. (United States)

    Gross, Mechthild M; Frömke, Cornelia; Hecker, Hartmut


    The objective was to study the association of different timings of intrapartum interventions with labour duration and mode of birth. A longitudinal cohort study of 2,090 nulliparae and 1,873 multiparae with a singleton in cephalic presentation was conducted. We assessed the association between, on the one hand, the timing of augmentation with oxytocin, neuraxial analgesia and amniotomy, and, on the other hand, the time to complete dilatation, spontaneous or operative vaginal delivery or caesarean delivery, using a Cox regression model accounting for standard confounders. From amniotomy onwards labour was accelerated. In multiparae, amniotomy was associated with an initial 6.6-fold acceleration, decreasing first stage duration until the hazard ratio reached around 3.5, where the intervention was performed 5 h after labour onset; thereafter, acceleration continued with a hazard ratio of around 3. In nulliparae, neuraxial analgesia was associated with a shorter first stage when administered between 7 and 11 h after labour onset; the later it was performed, the less likely was spontaneous birth and the more likely an operative vaginal birth in nulliparae or a caesarean section in multiparae. The start of oxytocin augmentation was associated with acceleration towards both full dilatation and caesarean section during first stage and an increased risk of operative vaginal birth during second stage. The later oxytocin augmentation started, the more likely it was that spontaneous birth would be retarded in multiparous women. Applying amniotomy, oxytocin and neuraxial analgesia at their optimal timing may improve the progress and outcome of labour.

  15. A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: A case report. (United States)

    Tseng, Wei-Cheng; Wu, Zhi-Fu; Liaw, Wen-Jinn; Hwa, Su-Yang; Hung, Nan-Kai


    Combined spinal anesthesia and postoperative epidural analgesia is widely used in orthopedic surgery. Uncommon but serious neurologic complications of neuraxial anesthesia (NA) include direct trauma during needle or catheter insertion, central nervous system infections, and neurotoxicity of local anesthetics. Cauda equina syndrome (CES) is a rare complication after NA but can result in severe neurologic deterioration that may require surgical intervention. We present a case of a 69-year-old woman with postpolio syndrome who developed CES after combined spinal anesthesia and postoperative epidural analgesia. Perioperative observations and follow-up examinations, including magnetic resonance imaging, revealed no evidence of direct needle- or catheter-induced trauma, spinal hematoma, spinal ischemia, intraneural anesthetic injection, or infection. We speculate that CES symptoms were observed because of enhanced sensitivity to a combination of regional anesthetic technique-related microtrauma and neurotoxicity of bupivacaine and ropivacaine. Thus, practitioners should be aware that patients with preexisting neurologic diseases may be at increased risk for CES after NA. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Pilot study of neuraxial imaging by ultrasound in infants and children. (United States)

    Marhofer, Peter; Bösenberg, Adrian; Sitzwohl, Christian; Willschke, Harald; Wanzel, Oliver; Kapral, Stephan


    Ultrasonography is becoming an important adjunct in regional anesthesia. Epidural anesthesia may pose significant challenges in infants and children because of difficulties in identifying the epidural space. In addition, epidural catheters are sometimes difficult to advance. The present study was performed to evaluate an optimal ultrasound technique for direct visualization of neuraxial structures in children. A total of 32 infants and children scheduled for minor surgery were prospectively included in a high-resolution ultrasound study. Scans were performed using either a sector or linear probe and views from a longitudinal paramedian, median and transversal angle at lumbar and thoracic levels of the spinal cord were analyzed. In all children investigated, the linear probe generated better images than the sector probe. Of the various scanning perspectives, the paramedian longitudinal approach offered the best views at both cord levels. Broken down by age groups, the best visibility was clearly obtained in neonates up to 3 months of age (P epidural anesthesia for neonates and infants at lumbar and thoracic levels of the spinal cord is planned.

  17. Optimal hand washing technique to minimize bacterial contamination before neuraxial anesthesia: a randomized control trial. (United States)

    Siddiqui, N; Friedman, Z; McGeer, A; Yousefzadeh, A; Carvalho, J C; Davies, S


    Infectious complications related to neuraxial anesthesia may result in adverse outcomes. There are no best practice guidelines regarding hand-sanitizing measures specifically for these procedures. The objective of this study was to compare the growth of microbial organisms on the operator's forearm between five common techniques of hand washing for labor epidurals. In this single blind randomized controlled trial, all anesthesiologists performing labor epidurals in a tertiary care hospital were randomized into five study groups: hand washing with alcohol gel only up to elbows (Group A); hand washing with soap up to elbows, sterile towel to dry, followed by alcohol gel (Group B); hand washing with soap up to elbows, non-sterile towel to dry, followed by alcohol gel (Group C); hand washing with soap up to elbows, non-sterile towel to dry (Group D) or hand washing with soap up to elbows, sterile towel to dry (Group E). The number of colonies for each specimen/rate per 100 specimens on one or both arms per group was measured. The incidence of colonization was 2.5, 23.0, 18.5, 114.5, and 53.0 in Groups A, B, C, D and E, respectively. Compared to Group A, the odds ratio of bacterial growth for Group B was 1.52 (P=0.519), Group C 5.44 (P=0.003), Group D 13.82 (Phand-sanitizing practices among epidural practitioners. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Optimal point of insertion of the needle in neuraxial blockade using a midline approach: study in a geometrical model

    Directory of Open Access Journals (Sweden)

    Vogt M


    Full Text Available Mark Vogt,1 Dennis J van Gerwen,2 John J van den Dobbelsteen,2 Martin Hagenaars,3 1Department of Anesthesiology, Erasmus MC Sophia Children Hospital, Rotterdam, the Netherlands; 2Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; 3Department of Anesthesiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands Abstract: Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms. The length, the steepness relative to the skin, and the distance between the parallelograms were varied. The influence of the chosen point of insertion of the needle on the range of angles at which the epidural and subarachnoid space could be reached was studied. The optimal point of insertion was defined as the point where this range is the widest. The geometrical model clearly demonstrated, that the range of angles at which the epidural or subarachnoid space can be reached, is dependent on the point of insertion between the tips of the adjacent spinous processes. The steeper the spinous processes run, the more cranial the point of insertion should be. Assuming that the model is representative for patients, the performance of neuraxial blockade using a midline approach might be improved by choosing the optimal point of insertion. Keywords: neuraxial blockade, midline approach, optimal point of insertion, geometrical model

  19. State-Resolved Dynamics of the CN(B2Sigma+) and CH(A2Delta)Excited Products Resulting from the VUV Photodissociation of CH3CN

    Energy Technology Data Exchange (ETDEWEB)

    Howle, Chris R.; Arrowsmith, Alan N.; Chikan, Viktor; Leone,Stephen R.


    Fourier transform visible spectroscopy, in conjunction withVUV photons produced by a synchrotron, is employed to investigate thephotodissociation of CH3CN. Emission is observed from both theCN(B2Sigma+ - X2Sigma+) and CH(A2Delta - X2PI) transitions; only theformer is observed in spectra recorded at 10.2 and 11.5 eV, whereas bothare detected in the 16 eV spectrum. The rotational and vibrationaltemperatures of both the CN(B2Sigma+) and CH(A2Delta) radical productsare derived using a combination of spectral simulations and Boltzmannplots. The CN(B2Sigma+) fragment displays a bimodal rotationaldistribution in all cases. Trot(CN(B2Sigma+)) ranges from 375 to 600 K atlower K' and from 1840 to 7700 K at higher K' depending on the photonenergy used. Surprisal analyses indicate clear bimodal rotationaldistributions, suggesting CN(B2Sigma+) is formed via either linear orbent transition states, respectively, depending on the extent ofrotational excitation in this fragment. CH(A2Delta) has a singlerotational distribution when produced at 16 eV which results inTrot(CH(A2Delta)) = 4895 +- 140 K in nu' = 0 and 2590 +- 110 K in nu' =1. From thermodynamic calculations, it is evident that CH(A2Delta) isproduced along with CN(X2Sigma+) + H2. These products can be formed by atwo step mechanism (via excited CH3* and ground state CN(X2Sigma+) or aprocess similar to the "roaming" atom mechanism; the data obtained hereare insufficient to definitively conclude whether either pathway occurs.A comparison of the CH(A2Delta) and CN(B2Sigma+) rotational distributionsproduced by 16 eV photons allows the ratio between the two excitedfragments at this energy to be determined. An expression that considersthe rovibrational populations of both band systems results in aCH(A2Delta):CN(B2Sigma+) ratio of (1.2 +- 0.1):1 at 16 eV, therebyindicating that production of CH(A2Delta) is significant at 16eV.

  20. Optimal point of insertion of the needle in neuraxial blockade using a midline approach: study in a geometrical model. (United States)

    Vogt, Mark; van Gerwen, Dennis J; van den Dobbelsteen, John J; Hagenaars, Martin


    Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms. The length, the steepness relative to the skin, and the distance between the parallelograms were varied. The influence of the chosen point of insertion of the needle on the range of angles at which the epidural and subarachnoid space could be reached was studied. The optimal point of insertion was defined as the point where this range is the widest. The geometrical model clearly demonstrated, that the range of angles at which the epidural or subarachnoid space can be reached, is dependent on the point of insertion between the tips of the adjacent spinous processes. The steeper the spinous processes run, the more cranial the point of insertion should be. Assuming that the model is representative for patients, the performance of neuraxial blockade using a midline approach might be improved by choosing the optimal point of insertion.

  1. Improving Adherence to Practice Guidelines for Anticoagulation in Patients Receiving Neuraxial Anesthesia Using an Electronic Order Entry Alert System. (United States)

    Jajosky, Jessica; Howell, Stephen M; Honaker, John; Moriarty, Allison; Shea, Joy Marie


    Epidural analgesia is frequently used to alleviate postoperative pain. Though rare, epidural hematoma continues to be a feared complication of neuraxial analgesia. The risk of epidural hematoma is likely increased when certain regimens are used for prophylaxis/treatment of venous thromboembolism. To help decrease the risk, we developed an alert in our electronic medical record to assist providers with adherence to published guidelines addressing neuraxial analgesia and anticoagulation. Patient data were collected retrospectively 3 months before and 3 months after the initiation of the computerized alert to assess the effectiveness of the alert. Patients were included if they had a procedure code associated with epidural analgesia. Pregnant patients and children were excluded. Type and frequency of antithrombotic medications were recorded for comparison to published practice guidelines. Using Poisson regression to describe the data, patients with epidurals after the best practice alert observed a 61% decrease in the expected number of days of exposure to inappropriate doses of anticoagulation versus patients treated before implementation of the alert. Unapproved antithrombotic administration was significantly reduced after initiation of the alert system. This simple electronic alert was found to have a protective effect for patients receiving both anticoagulation and epidural analgesia.

  2. Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP. (United States)

    Pereira, Ivan Dias Fernandes; Grando, Marcela Miguel; Vianna, Pedro Thadeu Galvão; Braz, José Reinaldo Cerqueira; Castiglia, Yara Marcondes Machado; Vane, Luís Antônio; Módolo, Norma Sueli Pinheiro; do Nascimento, Paulo; Amorim, Rosa Beatriz; Rodrigues, Geraldo Rolim; Braz, Leandro Gobbo; Ganem, Eliana Marisa


    Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital--HCFMB-UNESP. A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27). Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  3. Postoperative pain management of liver transplantation in cystic fibrosis: Is it time to start US-guided neuraxial blocks? (United States)

    Piazza, M; Martucci, G; Arcadipane, A


    Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy. There is a growing evidence that thoracic epidural anesthesia is feasible in pediatric patients. Concerns about coagulopathy and immunosuppression have limited its use in liver transplantation. Ultrasonography is becoming an adjunct tool in neuraxial blocks, allowing faster and easier recognition of the epidural space, and reducing vertebral touch and number of attempts. In pediatric patients, it is still debated whether anesthesia has detrimental effects on cognitive development. Efforts to make regional techniques easier and safer by ultrasonography are ongoing. We report the first case of continuous thoracic epidural analgesia after pediatric liver transplantation in a 10-year-old boy affected with CF with macronodular cirrhosis. Despite a challenging coagulation profile, the echo-assisted procedure was safely performed and allowed extubation in the odds ratio, postoperative awakening and comfort, and quick resumption of respiratory physiotherapy.

  4. Postoperative pain management of liver transplantation in cystic fibrosis: Is it time to start US-guided neuraxial blocks?

    Directory of Open Access Journals (Sweden)

    M Piazza


    Full Text Available Cystic fibrosis (CF is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy. There is a growing evidence that thoracic epidural anesthesia is feasible in pediatric patients. Concerns about coagulopathy and immunosuppression have limited its use in liver transplantation. Ultrasonography is becoming an adjunct tool in neuraxial blocks, allowing faster and easier recognition of the epidural space, and reducing vertebral touch and number of attempts. In pediatric patients, it is still debated whether anesthesia has detrimental effects on cognitive development. Efforts to make regional techniques easier and safer by ultrasonography are ongoing. We report the first case of continuous thoracic epidural analgesia after pediatric liver transplantation in a 10-year-old boy affected with CF with macronodular cirrhosis. Despite a challenging coagulation profile, the echo-assisted procedure was safely performed and allowed extubation in the odds ratio, postoperative awakening and comfort, and quick resumption of respiratory physiotherapy.

  5. Optimal Point of Insertion and Needle Angle in Neuraxial Blockade Using a Midline Approach: A Study in Computed Tomography Scans of Adult Patients. (United States)

    Vogt, Mark; van Gerwen, Dennis J; Lubbers, Wouter; van den Dobbelsteen, John J; Hagenaars, Martin

    Neuraxial blockade using a midline approach can be challenging. Part of this challenge lies in finding the optimal approach of the needle to its target. The present study aimed at finding (1) the optimal point of insertion of the needle between the tips of 2 adjacent spinous processes and (2) the optimal angle relative to the skin at which the needle should approach the epidural or subarachnoid space. A computer algorithm systematically analyzed computed tomography scans of vertebral columns of a cohort of 52 patients. On midsagittal sections, the possible points of insertion of a virtual needle and the corresponding angles through which the epidural or subarachnoid space can be reached were calculated. The point chosen to introduce the needle between 2 adjacent spinous processes determines the range of angles through which the epidural or subarachnoid space can be reached. At the thoracic interspaces 1-2 through 3-4, thoracic interspaces 5-6 through 9-10, and at the lumbar vertebral interspaces 2-3 through 4-5, the optimal point of insertion is slightly inferior to the point halfway between the tips of the spinous processes. For thoracic interspace 4-5, the optimal point of insertion is slightly superior to the point halfway between the tips of the spinous processes. For the other interspaces, the optimal point of insertion is approximately halfway between the tips of the spinous processes. The optimal angle to direct the needle varies from 9 degrees at the thoracolumbar junction and at the lumbar interspaces 3-4 and 4-5, to 53 degrees at the thoracic interspace 7-8. Our study has resulted in practical suggestions-based on accurate, reproducible measurements in patients-as to where to insert the needle and how to angulate the needle when performing neuraxial anesthesia using a midline approach.

  6. Comparative study of the neuronal plasticity along the neuraxis of the vibrissal sensory system of adult rat following unilateral infraorbital nerve damage and subsequent regeneration. (United States)

    Kis, Z; Farkas, T; Rábl, K; Kis, E; Kóródi, K; Simon, L; Marusin, I; Rojik, I; Toldi, J


    The aim of the present study was to examine the physiological consequences of a unilateral infraorbital nerve lesion and its regeneration at different levels of the somatosensory neuraxis. In animals whose right infraorbital nerve had been crushed, a large unresponsive area was found in the main brainstem trigeminal nucleus (Pr5). Responses evoked by ipsilateral vibrissal deflection in the middle of Pr5 reappeared only on days 22-35 after the nerve had been transected, whereas recovery from the nerve crush took only 7-9 days. However, no sign of short-term neuronal plasticity was observed in Pr5 after peripheral nerve injury. An enlargement of the receptive fields in two-thirds of the units and a lengthening in the delay of the evoked responses were observed as long-term plastic changes in Pr5 neurons after peripheral-nerve regeneration. In the ventral posteromedial nucleus of the thalamus (VPM) of partly denervated animals, however, only minutes or hours after the nerve crush, certain units were found to respond in some cases not only to the vibrissae, but also to mechanical stimulation of the face over the eye (two units), the nose (one unit), and the midline (one unit). Apart from the experiments involving incomplete denervation, the vibrissal representation areas of the VPM were unresponsive to stimulation of both the vibrissae and other parts of the face until nerve regeneration had occurred. In the somatosensory cortex, an infraorbital nerve crush immediately resulted in a large cortical area being unresponsive to vibrissal deflection. It was noteworthy, however, that shortly after the nerve crush, this large unresponsive whisker representation cortical area was invaded from the rostromedial direction by responses evoked by stimulation of the forepaw digits. In spite of the reappearance of vibrissa-evoked responses 7-10 days after the nerve crush, an expanded digital representation could still be observed 3 weeks after the nerve crush, resulting in an

  7. Rabies vaccine and neuraxial anaesthesia

    African Journals Online (AJOL)


    Mar 8, 2010 ... Various reasons can be postulated to explain why the anti-rabies vaccine treatment was successful in our patient, despite him undergoing surgery under anaesthesia. Firstly and most importantly, it is possible that the dog was not rabid. However, the description of the dog (abnormal behaviour, unprovoked ...

  8. Rabies vaccine and neuraxial anaesthesia | Rewari | Southern ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 16, No 5 (2010) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF ...

  9. The role of dexamethasone in peripheral and neuraxial nerve blocks ...

    African Journals Online (AJOL)

    axillary, lumbar plexus, femoral, 3 in 1, sciatic, popliteal, ankle block, caudal, epidural or nerve block. The 'and' function was used to combine these terms with dexamethasone, corticosteroid, or steroid with the definition exploded. The initial search terms with the keywords with the definition exploded were utilised. We.

  10. Systemic 5-Bromo-2-Deoxyuridine Induces Conditioned Flavor Aversion and C-Fos in the Visceral Neuraxis (United States)

    Kimbrough, Adam; Kwon, Bumsup; Eckel, Lisa A.; Houpt, Thomas A.


    5-bromo-2-deoxyuridine (BrdU) is often used in studies of adult neurogenesis and olfactory learning, but it can also have toxic effects on highly proliferative tissue. We found that pairing Kool-Aid flavors with acute systemic injections of BrdU induced strong conditioned flavor aversions. Intermittent injections during Kool-Aid-glucose…

  11. Genotyping of bovine kappa-casein (kappa-CNA, kappa-CNB, kappa-CNC, kappa-CNE) following DNA sequence amplification and direct sequencing of kappa-CNE PCR product. (United States)

    Schlieben, S; Erhardt, G; Senft, B


    Genomic DNA isolated from blood and semen of dairy cattle with known kappa-casein (kappa-CN) genotypes was subjected to Southern blot hybridization and polymerase chain reaction (PCR) using up to 14 restriction endonucleases. kappa-casein genotypes AA, AB and BB were identified using Hin dIII and Hin fI while genotypes with kappa-CNC and kappa-CNE were misidentified. Direct sequencing of the PCR product (kappa-CN EE) showed a substitution of guanine (kappa-CNA,B) by adenine (kappa-CNE) which creates a HaeIII restriction site. Therefore using PCR followed by Hin dIII or HinfI and Hae III digest allows discrimination between kappa-casein A, B and E directly at the DNA level.

  12. Effect of Epidural Neuraxial Blockade-dependent Sedation on the Ramsay Sedation Scale and the Composite Auditory Evoked Potentials Index in Surgical Intensive Care Patients

    Directory of Open Access Journals (Sweden)

    Chueng-He Lu


    Conclusion: Epidural lidocaine analgesia could potentiate sedation in patients evaluated by the AAI, but had no effect on the RSS. The present study suggests that the AAI could provide an objective and more precise index than the RSS in evaluation of sedation level in patients who are undergoing epidural pain management in the intensive care unit.

  13. The value of touch imprint cytology of prostate core needle biopsy ...

    African Journals Online (AJOL)

    S. Hussein


    PSA) level or abnormal findings on rectal examination. All biopsies were taken under transrectal ultrasound (TRUS) guidance. Two touch imprints were prepared from each CNB. The TIC results were correlated with CNB.

  14. Fine-needle aspiration versus core needle biopsy for diagnosis of thyroid malignancy and neoplasm: a matched cohort study. (United States)

    Kim, Soo-Yeon; Lee, Hye Sun; Moon, Jieun; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kwak, Jin Young


    To compare the diagnostic performances of fine-needle aspiration (FNA) and core needle biopsy (CNB) in the diagnosis of thyroid malignancy and neoplasm in patients who underwent surgery for thyroid nodules. This retrospective study was approved by the institutional review board, and the need to obtain informed consent was waived. 3192 patients who underwent FNA (n = 3048) or CNB (n = 144) for diagnosis of thyroid nodules and then proceeded with surgery were included. Surgical pathologic diagnosis was the reference standard. Diagnostic performances of FNA and CNB to predict malignancy and neoplasm were compared. Propensity score matching was used to match patients with FNA with those with CNB because there were significant differences in the number of nodules and nodule characteristics between the FNA and CNB groups. Before matching, the sensitivity and accuracy of FNA were significantly higher or comparable with those of CNB, and the specificity, negative predictive value and positive predictive value were comparable. After matching, the diagnostic performances were similar, with the exception of specificity for predicting neoplasm being higher with CNB than with FNA. FNA showed comparable diagnostic performance to CNB; therefore, there may be no benefit in performing CNB to diagnose papillary thyroid carcinoma and neoplasm. • Diagnostic performances of FNA and CNB for thyroid malignancy and neoplasm were compared. • FNA showed comparable performances to CNB both before and after statistical matching. • There may be no benefit in performing CNB, given the comparable performances.

  15. The effects of anticipated future change in monetary policy regime

    Czech Academy of Sciences Publication Activity Database

    Antal, J.; Brázdik, František

    -, č. 15 (2007), s. 1-53 ISSN 1803-2397 Institutional research plan: CEZ:AV0Z70850503 Keywords : macroeconomics * new Keynesian DSGE models * small open economy Subject RIV: AH - Economics

  16. Measuring and explaining inflation persistence: disaggregate evidence on the Czech Republic

    Czech Academy of Sciences Publication Activity Database

    Babetskii, Ian; Coricelli, F.; Horváth, R.

    -, č. 1 (2007), s. 1-36 Keywords : inflation dynamics * inflation targeting * persistence Subject RIV: AH - Economics

  17. Inflation persistence in new EU member states: is it different than in the euro area members?

    Czech Academy of Sciences Publication Activity Database

    Franta, Michal; Saxa, Branislav; Šmídková, Kateřina

    -, č. 10 (2007), s. 1-37 ISSN 1803-2397 Institutional research plan: CEZ:AV0Z70850503 Keywords : inflation persistence * new hybrid Phillips curve * new EU member states Subject RIV: AH - Economics

  18. Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results. (United States)

    Perlman, Katherine L; Shelby, Rebecca A; Wren, Anava A; Kelleher, Sarah A; Dorfman, Caroline S; O'Connor, Erin; Kim, Connie; Johnson, Karen S; Soo, Mary Scott


    Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.

  19. Ultrasound-guided core needle biopsy of superficial lymph nodes: an alternative to fine-needle aspiration cytology for the diagnosis of lymph node metastasis in cutaneous melanoma. (United States)

    Bohelay, Gérôme; Battistella, Maxime; Pagès, Cécile; de Margerie-Mellon, Constance; Basset-Seguin, Nicole; Viguier, Manuelle; Kerob, Delphine; Madjlessi, Nika; Baccard, Michel; Archimbaud, Alain; Comte, Christelle; Mourah, Samia; Porcher, Raphael; Bagot, Martine; Janin, Anne; De Kerviler, Eric; Lebbé, Céleste


    To investigate the diagnostic value of ultrasound-guided core needle biopsy (US-CNB) in suspected cases of lymph node metastasis from cutaneous melanoma. All patients with cutaneous melanoma followed in Saint-Louis Hospital between 2006 and 2010 who underwent US-CNB for suspicion of melanoma lymph node metastasis were reviewed retrospectively. Histopathological results of US-CNB samples were classified as melanoma, other malignancy, suspicious, inadequate, or benign. The diagnostic accuracy of US-CNB was assessed by comparison with two reference standards: histopathological examination of the radical lymph node dissection or, when this was not available, clinical and radiological follow-up. The data from 72 US-CNB were analyzed. Forty-four melanomas, 22 benign, three other malignancies, three inadequate samples, and no inconclusive specimens were diagnosed. Seventy-one US-CNB results were confirmed (98.6%). US-CNB achieved high sensitivity, specificity, and positive predictive value (respectively, 97.9, 100, and 100%). No adverse events were reported after the procedure. US-CNB provided a mean tissue volume of 16.7 mm per lymphadenopathy. US-CNB has diagnostic value similar to that of fine-needle aspiration cytology. It represents a reliable alternative method in melanoma lymph node metastasis to avoid surgery in patients who will not benefit from it. US-CNB provides relatively large samples of tissue suitable for comprehensive genomic analyses currently needed for research and personalized care of melanoma patients.

  20. Expression of Lactobacillus reuteri Pg4 collagen-binding protein gene in Lactobacillus casei ATCC 393 increases its adhesion ability to Caco-2 cells. (United States)

    Hsueh, Hsiang-Yun; Yueh, Pei-Ying; Yu, Bi; Zhao, Xin; Liu, Je-Ruei


    The collagen-binding protein gene cnb was cloned from the probiotic Lactobacillus reuteri strain Pg4. The DNA sequence of the cnb gene (792 bp) has an open reading frame encoding 263 amino acids with a calculated molecular weight of 28.5 kDa. The cnb gene was constructed so as to constitutively express under the control of the Lactococcus lactis lacA promoter and was transformed into Lactobacillus casei ATCC 393, a strain isolated from dairy products with poor ability to adhere to intestinal epithelial cells. Confocal immunofluorescence microscopic and flow cytometric analysis of the transformed strain Lb. casei pNZ-cnb indicated that Cnb was displayed on its cell surface. Lb. casei pNZ-cnb not only showed a higher ability to adhere to Caco-2 cells but also exhibited a higher competition ability against Escherichia coli O157:H7 and Listeria monocytogenes adhesion to Caco-2 cells than Lb. casei ATCC 393.

  1. Core Needle Biopsy of the Thyroid: 2016 Consensus Statement and Recommendations from Korean Society of Thyroid Radiology (United States)

    Na, Dong Gyu; Jung, So Lyung; Kim, Ji-hoon; Sung, Jin Yong; Kim, Kyu Sun; Lee, Jeong Hyun; Shin, Jung Hee; Choi, Yoon Jung; Ha, Eun Ju; Lim, Hyun Kyung; Kim, Soo Jin; Hahn, Soo Yeon; Lee, Kwang Hwi; Choi, Young Jun; Youn, Inyoung; Kim, Young Joong; Ahn, Hye Shin; Ryu, Ji Hwa; Baek, Seon Mi; Sim, Jung Suk; Jung, Chan Kwon; Lee, Joon Hyung


    Core needle biopsy (CNB) has been suggested as a complementary diagnostic method to fine-needle aspiration in patients with thyroid nodules. Many recent CNB studies have suggested a more advanced role for CNB, but there are still no guidelines on its use. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology has developed the present consensus statement and recommendations for the role of CNB in the diagnosis of thyroid nodules. These recommendations are based on evidence from the current literature and expert consensus. PMID:28096731

  2. Core needle biopsy of the thyroid: 2016 consensus statement and recommendations from Korea society of thyroid radiology

    Energy Technology Data Exchange (ETDEWEB)

    Na, Dong Gyu [Dept. of Radiology, Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of); Baek, Jung Hwan; Lee, Jeong Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); and others


    Core needle biopsy (CNB) has been suggested as a complementary diagnostic method to fine-needle aspiration in patients with thyroid nodules. Many recent CNB studies have suggested a more advanced role for CNB, but there are still no guidelines on its use. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology has developed the present consensus statement and recommendations for the role of CNB in the diagnosis of thyroid nodules. These recommendations are based on evidence from the current literature and expert consensus.

  3. Practical guidelines for ultrasound-guided core needle biopsy of soft-tissue lesions: Transformation from beginner to specialist

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Yoon; Chung, Hye Won; Oh, Tack Sun; Lee, Jong Seok [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)


    Ultrasound-guided core needle biopsy (US-CNB) is an important step in the diagnosis of musculoskeletal soft-tissue lesions. To maximize efficacy and minimize the complications of US-CNB, it is critical to collaborate with a multidisciplinary team and to understand the particular considerations of US-CNB for these lesions. The purpose of this article is to provide a systematic review and step-by-step tips for using US-CNB to diagnose musculoskeletal soft-tissue lesions.

  4. Meta-analysis of the concordance of histological grade of breast cancer between core needle biopsy and surgical excision specimen

    NARCIS (Netherlands)

    Knuttel, F. M.; Menezes, G. L G; Van Diest, P. J.; Witkamp, A. J.; Van Den Bosch, M. A A J; Verkooijen, H. M.


    Background With the increasing use of neoadjuvant chemotherapy and minimally invasive ablative therapy in breast cancer, pretreatment assessment of tumour grade on core needle biopsy (CNB) is increasingly needed. However, grading on CNB is possibly less accurate than grading based on the surgical

  5. Reliability of core needle biopsy for determining ER and HER2 status in breast cancer

    NARCIS (Netherlands)

    Dekker, T. J. A.; Smit, V. T. H. B. M.; Hooijer, G. K. J.; van de Vijver, M. J.; Mesker, W. E.; Tollenaar, R. A. E. M.; Nortier, J. W. R.; Kroep, J. R.


    Several studies have assessed the concordance of estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status between core needle biopsy (CNB) and resection specimens, usually in small patient series and with discordant results. ER and HER2 status determined on CNB and tissue

  6. Carbon nanobuds based on carbon nanotube caps: a first-principles study (United States)

    Choi, Ji Il; Kim, Hyo Seok; Kim, Han Seul; Lee, Ga In; Kang, Jeung Ku; Kim, Yong-Hoon


    Based on density functional theory calculations, we here show that the formation of a fullerene C60 carbon ``nanobud'' (CNB) on carbon nanotube (CNT) caps is energetically more favorable than that on CNT sidewalls. The dominant CNB formation mode for CNT caps is found to be the [2 + 2] cycloaddition reaction as in the conventional CNT sidewall case. However, it is identified to be exothermic in contrast to the endothermic reaction on CNT sidewalls. Computed reaction pathways further demonstrate that the formation (dissociation) barrier for the CNT cap-based CNB is slightly lower (significantly higher) than that of the CNT sidewall-based CNB, indicating an easier CNB formation as well as a higher structural stability. Additionally, performing matrix Green's function calculations, we study the charge transport properties of the CNB/metal electrode interfaces, and show that the C60 bonding to the CNT cap or open end induces resonant transmissions near the Fermi level. It is also found that the good electronic linkage in the CNT cap-C60 cycloaddition bonds results in the absence of quantum interference patterns, which contrasts with the case of the CNB formed on an open-ended CNT that shows a Fano resonance profile.Based on density functional theory calculations, we here show that the formation of a fullerene C60 carbon ``nanobud'' (CNB) on carbon nanotube (CNT) caps is energetically more favorable than that on CNT sidewalls. The dominant CNB formation mode for CNT caps is found to be the [2 + 2] cycloaddition reaction as in the conventional CNT sidewall case. However, it is identified to be exothermic in contrast to the endothermic reaction on CNT sidewalls. Computed reaction pathways further demonstrate that the formation (dissociation) barrier for the CNT cap-based CNB is slightly lower (significantly higher) than that of the CNT sidewall-based CNB, indicating an easier CNB formation as well as a higher structural stability. Additionally, performing matrix Green

  7. Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors (United States)

    Zhou, Zhi-Rui; Wang, Chen-Chen; Sun, Xiang-Jie; Yang, Zhao-Zhi


    Background A retrospective analysis of diagnoses was performed in patients with phyllodes tumors of the breast (PTB) who received preoperative core needle biopsy (CNB) and had breast surgery at Fudan University Shanghai Cancer Center from January 1, 2002 to April 1, 2013. The resulting data allowed us to compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in preoperative diagnosis. Methods Data from 128 patients with PTB who had undergone preoperative CNB and breast surgery were retrospectively analyzed. We reviewed the medical history, clinical follow-up data, and CNB diagnostic data. A diagnostic test was used to evaluate the sensitivity and specificity of CNB in diagnosing benign, borderline, and malignant phyllodes tumors. Results The accuracy of CNB for diagnosing PTB was 13.3% (17/128). Of the remaining patients, 98 (75.5% of the PTB patients) were diagnosed with fibroadenoma or fibroepithelial lesions. The sensitivity of CNB at diagnosing benign, borderline, and malignant phyllodes tumors were 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, whereas the corresponding specificity were 92.0%, 98.2%, and 100%, respectively. Some clinical features, such as large tumor size, rapid growth, or surgical history of fibroadenomas, were indicative of an increased possibility of PTB. Conclusions CNB provides a pathological basis for the preoperative diagnosis of PTB, but it has a poor accuracy and offers limited guidance for surgical decisions. Considering CNB along with multiple histologic features may improve the ability to accurately diagnose PTB. An integrated assessment using CNBs in combination with clinical data and imaging features is suggested as a reliable strategy to assist PTB diagnosis. PMID:28066593

  8. Cluster solvation models of carbon nanostructures: extension to fullerenes, tubes, and buds. (United States)

    Torrens, Francisco; Castellano, Gloria


    Carbon nanobud (CNB), a hybrid material consisting of single-wall C-nanotubes (CNTs) (SWNTs) with covalently attached fullerenes, in cluster form is discussed in organic solvents. Theories are developed based on bundlet and droplet models describing size-distribution functions. Phenomena present a unified explanation in bundlet model in which free energy of CNBs involved in cluster is combined from two parts: a volume one proportional to the number of molecules n in aggregate and a surface one, to n(1/2). Bundlet model enables describing distribution function of CNB clusters by size. From purely geometrical considerations bundlet (SWNT/CNB) and droplet (fullerene) models predict dissimilar behaviors. Interaction-energy parameters of CNBs are taken from C60. A C60/SWNT in-between behavior is expected; however, properties of CNBs result closer to SWNTs. Smaller CNB clusters result less stable but greater ones are more stable than SWNT bundles. The solubility decays with temperature result smaller for SWNT/CNB than C60 in agreement with lower number of units in aggregates. Discrepancy between the experimental data of heat of solution of fullerenes and CNT/CNBs is ascribed to sharp concentration dependence of heat of solution. Diffusion coefficient decays with temperature and results greater for CNB than SWNT or C60. Clusters (C60)13 and SWNT/CNB7 are representative of droplet and bundlet models.

  9. Combined ultrasound-guided cutting-needle biopsy and standard pleural biopsy for diagnosis of malignant pleural effusions. (United States)

    Wang, Jinlin; Zhou, Xinghua; Xie, Xiaohong; Tang, Qing; Shen, Panxiao; Zeng, Yunxiang


    The most efficient approach to diagnose malignant pleural effusions (MPEs) is still controversial and uncertain. This study aimed to evaluate the utility of a combined approach using ultrasound (US)-guided cutting-needle biopsy (CNB) and standard pleural biopsy (SPB) for diagnosing MPE. Pleural effusions were collected from 172 patients for biochemical and microbiological analyses. US-guided CNB and SPB were performed in the same operation sequentially to obtain specimens for histological analysis. US-guided CNB and SPB procedures provided adequate material for histological analysis in 90.7 and 93.0% of cases, respectively, while a combination of the 2 techniques was in 96.5% of cases. The sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and diagnostic accuracy of US-guided CNB versus SPB were: 51.2 vs 63.4%, 100 vs 100%, 100 vs 100%, 64.9 vs 72.2% and 74.4 vs 81.3%, respectively. When CNB was combined with SPB, the corresponding values were 88.6, 100, 100, 88.6 and 93.9%, respectively. Whereas sensitivity, NPV and diagnostic accuracy were not significantly different between CNB and SPB, the combination of CNB and SPB significantly improved the sensitivity, NPV and diagnostic accuracy versus each technique alone (p < 0.05). Significant pain (eight patients), moderate haemoptysis (two patients) and chest wall haematomas (two patients) were observed following CNB, while syncope (four patients) and a slight pneumothorax (four patients) were observed following SPB. Use of a combination of US-guided CNB and SPB afforded a high sensitivity to diagnose MPEs, it is a convenient and safe approach.

  10. A cost analysis of thyroid core needle biopsy vs. diagnostic surgery. (United States)

    Trimboli, Pierpaolo; Nasrollah, Naim; Amendola, Stefano; Crescenzi, Anna; Guidobaldi, Leo; Chiesa, Carlo; Maglio, Riccardo; Nigri, Giuseppe; Pontecorvi, Alfredo; Romanelli, Francesco; Giacomelli, Laura; Valabrega, Stefano


    Twenty percent of thyroid fine needle aspiration (FNA) is indeterminate. Because 3 in 4 of these are actually benign, a method of clarifying the pathology could help patients to avoid diagnostic thyroidectomy. Recently, core needle biopsy (CNB) has been proven to be highly reliable for this purpose. However, there are no reports of any potential cost benefit provided by CNB. Here we analyzed the impact on management costs of CNB compared with traditional diagnostic surgery in indeterminate FNA. Over 24 months, 198 patients with thyroid indeterminate cytology underwent CNB at Ospedale Israelitico of Rome or diagnostic surgery at the Department of Surgery of Sapienza University of Rome. We tabulated costs of the medical instruments, operating theater, surgical team, patient recovery, and pathologic examination for each method. In CNB group, 42.4% of patients had benign lesions and avoided surgery, 20.8% was cancer, and the remaining 36.8% uncertain. The malignancy rate in CNB group was 26.4%, and mean cost of CNB per nodule was 1,032€. In diagnostic surgery group, 24.7% had cancer and 75.3% had benign lesions, and mean expense for each thyroidectomy was 6,364€. In an ideal cohort of 100 patients with indeterminate FNA, the cost of CNB is 33.8% lower than that of diagnostic surgery. CNB can detect a large proportion of the benign thyroid nodules that are classified as indeterminate by FNA. These patients can avoid diagnostic thyroidectomy and hospitals can reduce their surgical costs by one-third.

  11. Cesarean section under combined spinal epidural in parturient with frontal glioma

    Directory of Open Access Journals (Sweden)

    Caitlin VanDeCappelle


    Full Text Available Our patient presented to hospital in acute asthma exacerbation and foetal distress. Past history was remarkable for pregnancy at 35 weeks, morbid obesity, uncontrolled asthma, seizure disorder and known frontal glioma. Here we highlight the neuraxial management of this patient for cesarean section and discuss the central dogma of neuraxial technique in the face of known intracranial neoplasm.

  12. Breast metastasis nine years after nephrectomy for renal cell carcinoma: A case report

    Directory of Open Access Journals (Sweden)

    Takayuki Ishigaki


    Conclusion: It is important that histological diagnosis be determined by CNB and by other methods if the patient has a history of malignancy, and minimally invasive therapy should be performed in accordance with the prognosis.

  13. Economic research bulletin (2008, No.1)


    Česká národní banka


    The CNB has been targeting inflation for ten years now. We have decided to take this opportunity to present recent CNB research related to the inflation targeting strategy. The first two articles contribute to the discussion about how the inflation targeting strategy should be evaluated. They both point out that it is not enough simply to count how many times inflation was on target. One alternative way of measuring the success of the strategy is suggested in the first article. Partial simula...

  14. Ethics committees in Italy--a time for change? (United States)

    Wray, E


    The Comitato Nazionale per la Bioetica (CNB) in Italy has recently produced an unprecedented discussion document on the state of ethics committees in Italy, with an invitation to interested parties to comment on proposed changes to their fundamental structure. After this consultation, and taking note of relevant official publications and the most recent national and international literature on the subject, the CNB proposes to produce a final, definitive document that will consider options for the future development of such committees.

  15. Randomized controlled trial of stereotactic 11-G vacuum-assisted core biopsy for the diagnosis and management of mammographic microcalcification. (United States)

    Bundred, Sara M; Maxwell, Anthony J; Morris, Julie; Lim, Yit Y; Harake, Md Janick; Whiteside, Sigrid; Bundred, Nigel J


    To compare the accuracy of 11-G vacuum-assisted biopsy (VAB) with 14-G core needle biopsy (CNB) to diagnose mammographic microcalcification (MM) and effect on surgical outcomes. Following ethical approval, VAB and CNB (control) were compared in a randomized prospective study for first-line diagnosis of MM and subsequent surgical outcomes in two breast-screening units. Participants gave written informed consent. Exclusions included comorbidity precluding surgery, prior ipsilateral breast cancer and lesions >40 mm requiring mastectomy as first surgical procedure. The final pathological diagnosis was compared with the initial biopsy result. Quality-of-life (QOL) questionnaires were administered at baseline, 2, 6 and 12 months. 110 participants were required to show a 25% improvement in diagnosis with VAB compared with CNB (90% power). Eligibility was assessed for 787 cases; 129 females recalled from the National Health Service breast screening programme were randomized. Diagnostic accuracy of VAB was 86% and that of CNB was 84%. Using VAB, 2/14 (14.3%) cases upgraded from ductal carcinoma in situ to invasion at surgery and 3/19 (15.8%) using CNB. Following VAB 7/16 (44%) cases required repeat surgery vs 7/24 (29%) after CNB. Both groups recorded significant worsening of functional QOL measures and increased breast pain at follow-up. VAB and CNB were equally accurate at diagnosing MM, and no significant differences in surgical outcomes were observed. The first randomized controlled study of VAB for diagnosis of microcalcification using digital mammography showed no difference in diagnostic accuracy of VAB and CNB, or in the proportion of participants needing repeat non-operative biopsy or second therapeutic operation to treat malignancy.

  16. Utility of core biopsy with concurrent ROSE FNA in the diagnosis of pancreatic tumor-does the biopsy add any diagnostic benefit? (United States)

    Yan, Lei; Ikemura, Kenji; Park, Ji-Weon


    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound-guided core-needle biopsy (EUS-CNB) are widely used for diagnosis of pancreatic tumors. The aim of our study was to compare the diagnostic performance of ROSE EUS-FNA and EUS-CNB for diagnosis of pancreatic malignancy during the same EUS. Patients who underwent both FNA and CNB during the same EUS for pancreatic solid lesion were reviewed retrospectively. Sample adequacy, diagnostic yield (defined as percentage of definitive diagnosis), sensitivity and specificity for malignancy were compared between FNA and CNB. A total of 48 patients with solid pancreatic lesions were evaluated. The proportions of adequate samples were 48/48 (100%) for FNA and 45/48 (93.7%) for core biopsy (P = .24). The diagnostic yield was 42/48 (87.5%) and 33/48 (68.7%) for FNA and CNB respectively (P = .046). The incremental increase in diagnostic yield by combining both methods was 2/48 (4%). The diagnostic yield for malignancy was 30/32 (93.7%) for FNA and 23/32 (71.8%) for CNB (P = .043). The sensitivity for the diagnosis of malignancy for FNA and CNB were 90.6% and 69%, respectively (P = .045). The specificity was 100% for both methods. The sensitivity for diagnosing malignancy increased to 93.8% when the two methods were combined. The difference in diagnostic yield was not associated with lesion size or location. EUS-guided FNA is a superior method of assessing solid pancreatic lesion and pancreatic malignancy with better diagnostic yield and higher sensitivity than EUS-CNB. © 2017 Wiley Periodicals, Inc.

  17. Laryngeal chondrosarcoma diagnosed by core-needle biopsy. (United States)

    Miyamaru, Satoru; Haba, Koichi


    We report a case of chondrosarcoma of the larynx, diagnosed by a percutaneous core-needle biopsy (CNB). Cartilaginous tumors of the larynx are usually diagnosed by biopsy with direct laryngomicroscopy under general anesthesia. However, patients find it difficult to undergo a biopsy under general anesthesia, for physical, economic, and social reasons. Instead, we can readily detect and sample tumors of the larynx using ultrasound under local anesthesia with reduced stress. Concerning needle-puncture biopsies, including fine-needle aspiration cytology (FNAC) and CNB, some studies have reported needle track dissemination, a possible complication in patients with malignant tumors. Thus, in the head and neck region, we generally use FNAC for biopsies, not CNB. However, it can be difficult to diagnose bone tumors by cytology alone. Regarding primary bone tumors, only one study has reported needle track dissemination by CNB, in osteosarcoma of the femur. Additionally, this complication has not been reported before with chondrosarcoma anywhere in the body. To our knowledge, this is the first report concerning chondrosarcoma of the larynx diagnosed by percutaneous CNB. We recommend CNB as a useful and safe diagnostic technique for primary bone tumors in the head and neck region. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy. (United States)

    Li, Xin; Weaver, Olena; Desouki, Mohamed Mokhtar; Dabbs, David; Shyum, Susan; Carter, Gloria; Zhao, Chengquan


    The follow-up excision (FUE) results were analyzed from 370 cases diagnosed as intraductal papilloma on breast core needle biopsy (CNB) with no history of malignancy or other risk factors. Of these cases, 98.6% were rendered a Breast Imaging Reporting and Data System score of 4 on mammography before the CNB. Fifty-one cases (13.8%) were found to have microcalcifications on microscopic examination of CNB. A total of 7 (1.9%) of 370 cases were upgraded to invasive carcinoma, ductal carcinoma in situ, or pleomorphic lobular carcinoma in situ on FUE. Six of 51 (11.8%) cases with microcalcifications found on imaging and CNB were upgraded to ductal carcinoma in situ or invasive carcinoma, whereas only 1 (0.3%) of 319 cases without microcalcifications was upgraded to pleomorphic lobular carcinoma in situ (P = .003). Results of a multivariate analysis adjusted for age confirmed that microcalcifications was a risk factor for upgrading to cancer, independent of age. Our results indicate that surgical excision is required for intraductal papilloma diagnosed on CNB if microcalcifications are present. However, excision may not be required for those who have no microcalcifications on CNB and no other known risk factors.

  19. Anesthetic Complications in Pregnancy. (United States)

    Hoefnagel, Amie; Yu, Albert; Kaminski, Anna


    Anesthesia complications in the parturient can be divided into 2 categories: those related to airway manipulation and those related to neuraxial anesthesia. Physiologic changes of pregnancy can lead to challenging intubating conditions in a patient at risk of aspiration. Neuraxial techniques are used to provide analgesia for labor and anesthesia for surgical delivery. Therefore, complications associated with neuraxial techniques are often seen in this population. In the event of maternal cardiac arrest, modification to advanced cardiac life support algorithms must be made to accommodate the gravid uterus and to deliver the fetus if return of maternal circulation is not prompt. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Changes in quality of goat meat after alterations in animal Handling - doi:10.5020/18061230.2007.p33

    Directory of Open Access Journals (Sweden)

    Frederico José Beserra


    Full Text Available This study aimed at evaluating the effect of animal handling, consisting in castration and cashew nut diet supplementation, on the cholesterol content and percentage composition of the muscles that constitute the leg meat cut from crossbred goats, grown in Ceará State. A case experimental design was applied with twenty male-animals with 5-6 months age and mean weight of 12 Kg, randomly divided in two groups of castrated (10 and intact (10 animals. In individual bays, they received during 5 months, two food regimen based on dried elephant grass (Pennisetum purpureum and a standard isoproteic ration (corn and soy oil, one of them with the addition of 13% cashew nut bran (CNB, forming four sub-groups: A1 (intact with no CNB supplemented diet; A2 (intact with CNB supplemented diet; B1 (castrated with no CNB supplemented diet and B2 (castrated with CNB supplemented diet. The castration associated with the CNB supplementation increased the meat’s fat yield from 1.16% to 3.57% and the cholesterol content from 36.47 mg/100g to 62.30 mg/100g. The ash yield decreased from 1.14% to 1.04%. The castration isolated only reduced moisture yield from 75.98% on sub-group A2 to 74.19% on sub-group B2. In intact animals that fed diet supplemented with CNB the protein decreased from 20.58% to 18.85% (P < 0.05 (sub-groups A1 and A2. The increased cholesterol content was highly correlated with the increase of the fat (93% In conclusion, these results showed that the combined use of castration and cashew nut bran (13% diet negatively influenced the dietetic and nutritional quality of goat leg meat.

  1. Core-needle biopsy of breast cancer is associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNA biopsy. (United States)

    Sennerstam, Roland B; Franzén, Bo S H; Wiksell, Hans O T; Auer, Gert U


    The literature offers discordant results regarding whether diagnostic biopsy is associated with the dissemination of cancer cells, resulting in local and/or distant metastasis. The long-term outcomes of patients with breast cancer were compared between those who were diagnosed using either fine-needle aspiration biopsy (FNAB) or core-needle biopsy (CNB) during 2 decades: the 1970s and 1990s. In the 1970s, the only diagnostic needle biopsy method used for breast cancer in Sweden was FNAB. CNB was introduced 1989 and became established in Stockholm Gotland County in the early 1990s. The authors compared the clinical outcomes of patients diagnosed using FNAB from 1971 to 1976 (n = 354) versus those of patients diagnosed using CNB from 1991 to 1995 (n = 1729). Adjusting for differences in various treatment modalities, mammography screening, tumor size, DNA ploidy, and patient age between the 2 decades, 2 strictly matched samples representing FNAB (n = 181) and CNB (n = 203) were selected for a 15-year follow-up study. In a comparison of the rates of distant metastasis in the strictly matched patient groups from the FNAB and CNB cohorts, significantly higher rates of late-appearing (5-15 years after diagnosis) distant metastasis were observed among the patients who were diagnosed on CNB compared with those who were diagnosed on FNAB. No significant difference in local metastasis was observed between the 2 groups. At 5 to 15 years after diagnosis of the primary tumor, CNB-diagnosed patients had significantly higher rates of distant metastases than FNAB-diagnosed patients. Cancer Cytopathol 2017;125:748-56. © 2017 American Cancer Society. © 2017 American Cancer Society.

  2. Magnetic resonance metabolic profiling of breast cancer tissue obtained with core needle biopsy for predicting pathologic response to neoadjuvant chemotherapy.

    Directory of Open Access Journals (Sweden)

    Ji Soo Choi

    Full Text Available The purpose of this study was to determine whether metabolic profiling of core needle biopsy (CNB samples using high-resolution magic angle spinning (HR-MAS magnetic resonance spectroscopy (MRS could be used for predicting pathologic response to neoadjuvant chemotherapy (NAC in patients with locally advanced breast cancer. After institutional review board approval and informed consent were obtained, CNB tissue samples were collected from 37 malignant lesions in 37 patients before NAC treatment. The metabolic profiling of CNB samples were performed by HR-MAS MRS. Metabolic profiles were compared according to pathologic response to NAC using the Mann-Whitney test. Multivariate analysis was performed with orthogonal projections to latent structure-discriminant analysis (OPLS-DA. Various metabolites including choline-containing compounds were identified and quantified by HR-MAS MRS in all 37 breast cancer tissue samples obtained by CNB. In univariate analysis, the metabolite concentrations and metabolic ratios of CNB samples obtained with HR-MAS MRS were not significantly different between different pathologic response groups. However, there was a trend of lower levels of phosphocholine/creatine ratio and choline-containing metabolite concentrations in the pathologic complete response group compared to the non-pathologic complete response group. In multivariate analysis, the OPLS-DA models built with HR-MAS MR metabolic profiles showed visible discrimination between the pathologic response groups. This study showed OPLS-DA multivariate analysis using metabolic profiles of pretreatment CNB samples assessed by HR- MAS MRS may be used to predict pathologic response before NAC, although we did not identify the metabolite showing statistical significance in univariate analysis. Therefore, our preliminary results raise the necessity of further study on HR-MAS MR metabolic profiling of CNB samples for a large number of cancers.

  3. Simultaneous oxidation and adsorption of As(III) from water by cerium modified chitosan ultrafine nanobiosorbent

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Lingfan [School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai 200237 (China); Research Center of Analysis and Test, East China University of Science and Technology, Shanghai 200237 (China); Zhu, Tianyi [School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai 200237 (China); Liu, Xin, E-mail: [School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai 200237 (China); Zhang, Wenqing, E-mail: [School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai 200237 (China)


    Highlights: • A novel ultrafine nanobiosorbent of cerium modified chitosan (Ce-CNB) was prepared. • The Ce-CNB possessed properties for simultaneous oxidation and adsorption As(III). • Adsorption of As(III) by Ce-CNB was in high efficiency. • Mechanisms for As(III) adsorption on Ce-CNB were elucidated. - Abstract: Since most existing arsenic removal adsorbents are difficult to effectively remove arsenite (As(III)), an urgent need is to develop an efficient adsorbent for removing As(III) from contaminated water. In this study, a novel ultrafine nanobiosorbent of cerium modified chitosan (Ce-CNB) with simultaneous oxidation and adsorption As(III) performance has been successfully developed. The resulting Ce-CNB with or without As(III) adsorption was characterized by FTIR, XRD, SEM, EDS, TEM, EMI and XPS analysis. Batch of adsorption experiments were performed to investigate the effects of various conditions on the As(III) adsorption. The adsorption behaviors were well described by the Langmuir isotherm and the pseudo-second-order kinetic model, with the maximum adsorption capacities of 57.5 mg g{sup −1}. The adsorption mechanisms for As(III) were (i) formed monodentate and bidentate complexes between hydroxyl groups and arsenite; and (ii) partial As(III) oxidized to As(V) followed by simultaneously adsorbed on the surface of Ce-CNB. This novel nanocomposite can be reused while maintaining a high removal efficiency and can be applied to treat 5.8 L of As(III)-polluted water with the effluent concentration lower than the World Health Organization standard, which suggests its great potential to remove As(III) from contaminated water.

  4. Midazolam activates the intrinsic pathway of apoptosis independent of benzodiazepine and death receptor signaling

    NARCIS (Netherlands)

    Stevens, Markus F.; Werdehausen, Robert; Gaza, Nina; Hermanns, Henning; Kremer, David; Bauer, Inge; Küry, Patrick; Hollmann, Markus W.; Braun, Sebastian


    Midazolam has neurotoxic properties when administered neuraxially in vivo. Furthermore, midazolam induces neurodegeneration in neonatal animal models in combination with other general anesthetics. Therefore, this study focuses on the mechanism of neurotoxicity by midazolam in neuronal and

  5. Comparison of dexmedetomidine, pethidine and tramadol in the ...

    African Journals Online (AJOL)

    However, dexmedetomidine caused a higher incidence of hypotension and bradycardia. Keywords: dexmedetomidine, pethidine, post-neuraxial anaesthesia shivering, tramadol. Introduction. Shivering may be defined as an involuntary, repetitive activity in the skeletal muscle. Shivering usually occurs as a thermoregulatory.

  6. Plaadid / Urmas Piht, Katrin Malt, Virko Pirrus...[jt.

    Index Scriptorium Estoniae


    Uutest heliplaatidest Destruction "D.E.V.O.L. U.T.I.O.N.", Ihsahn "angL", Neuraxis "The Thin Line Between", Kamphar "Heimgang", Satyricon """My Skin Is Cold", Venom "Hell", Bloodbath "The Waken Carnage"

  7. Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies: Rate of upgrade to carcinoma at excision. (United States)

    Pareja, Fresia; Corben, Adriana D; Brennan, Sandra B; Murray, Melissa P; Bowser, Zenica L; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth A; Brogi, Edi


    The surgical management of mammary intraductal papilloma without atypia (IDP) identified at core-needle biopsy (CNB) is controversial. This study assessed the rate of upgrade to carcinoma at surgical excision (EXC). This study identified women with a CNB diagnosis of intraductal papilloma without atypia or carcinoma at a cancer center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. The radiologic and clinicopathologic features of patients with a CNB diagnosis of IDP were correlated with an upgrade to carcinoma at EXC. The study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent EXC. The upgrade rate was 2.3% (4 of 171). The upgraded lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥ 8 mm away. Twenty-four women (25 IDPs) did not undergo EXC and had stable imaging on follow-up (median, 23.5 months). The upgrade rate at EXC for IDPs diagnosed at CNB with radiologic-pathologic concordance was 2.3%. These findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2819-2827. © 2016 American Cancer Society. © 2016 American Cancer Society.

  8. Breast Intraductal Papillomas without Atypia in Radiologic-Pathologic Concordant Core Needle Biopsies: Predictors of Upgrade to Carcinoma at Excision (United States)

    Pareja, Fresia; Corben, Adriana; Brennan, Sandra; Murray, Melissa P.; Bowser, Zenica; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth; Brogi, Edi


    Background The surgical management of breast intraductal papilloma without atypia (IDP) identified at core needle biopsy (CNB) is controversial. We assessed the rate of upgrade to carcinoma at surgical excision, and identified parameters predictive of upgrade. Methods We identified women with CNB diagnosis of intraductal papilloma without atypia or carcinoma at our center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. We correlated the radiologic and clinicopathologic features of patients with CNB diagnosis of IDP with upgrade to carcinoma at surgical excision. Results Our study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent excision. The upgrade rate was 2.3% (4/171). The upgrade lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥8 mm away. Twenty-four women (25 IDPs) did not undergo excision, and had stable imaging at follow-up (median of 23.5 months). Conclusions The upgrade rate at excision of IDP diagnosed at CNB with radiologic-pathologic concordance is 2.3%. Our findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. PMID:27315013

  9. Determining whether excision of all fibroepithelial lesions of the breast is needed to exclude phyllodes tumor: upgrade rate of fibroepithelial lesions of the breast to phyllodes tumor. (United States)

    Van Osdol, Andrew D; Landercasper, Jeffrey; Andersen, Jeremiah J; Ellis, Richard L; Gensch, Erin M; Johnson, Jeanne M; De Maiffe, Brooke; Marcou, Kristen A; Al-Hamadani, Mohammed; Vang, Choua A


    Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to determine the safety of selective rather than routine excision of FELs and to determine the factors associated with upgrading diagnosis of FELs to phyllodes tumors without definitive phyllodes tumor diagnosis by CNB. Of 313 patients, 261 (83%) with FELs diagnosed by CNB received observation with long-term follow-up (mean, 8 years). Of the observed patients, 3 (1%) were diagnosed with phyllodes tumor on follow-up. Eighteen of 52 patients (35%) who received excision had an upgrade of diagnosis to phyllodes tumor. Sensitivity and specificity of the pathologist's comment of concern for phyllodes tumor on a CNB demonstrating FELs without definitive phyllodes tumor diagnosis were 82% and 93%, respectively. Our policy of selective excision of FELs without definitive phyllodes tumor diagnosis resulted in safe avoidance of many surgical procedures.

  10. Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy (United States)

    Wiratkapun, Cholatip; Piyapan, Pawat; Lertsithichai, Panuwat; Larbcharoensub, Noppadol


    PURPOSE We aimed to identify factors that might help differentiate phyllodes tumors from fibroadenomas among cases in which a fibroepithelial breast lesion was diagnosed from core needle biopsy (CNB) under imaging guidance. MATERIALS AND METHODS A retrospective review was performed on 213 lesions in 200 patients who had undergone both CNB and excisional biopsy during a four-year period between 2008 and 2011. The final pathology revealed 173 fibroadenomas and 40 phyllodes tumors. The data, including patient characteristics, clinical presentation, and mammography, ultrasonography (US), and pathology findings were analyzed. RESULTS Upon univariable analysis, the factors that significantly helped to identify phyllodes tumors consisted of the presenting symptoms (palpable mass or breast pain), increased size on clinical examination, hyperdense mass on mammogram, and the following three US features: heterogeneous echo, presence of round cysts within the mass, and presence of clefts within the mass. The pathologist’s suggestion of a phyllodes tumor was also helpful. The factors that remained statistically significant upon multivariable analysis consisted of symptoms of breast pain, the presence of clefts on US, the presence of round cysts on US and the pathologist’s favoring of phyllodes tumors from a CNB specimen. CONCLUSION A multidisciplinary approach was needed to distinguish phyllodes tumors from fibroadenomas in patients who had undergone CNB. US findings (clefts and round cysts), suggestive pathological diagnoses, and clinical symptoms were all useful for the decision to surgically remove the fibroepithelial lesions diagnosed from CNB. PMID:24356293

  11. Factors associated with phyllodes tumor of the breast after core needle biopsy identifies fibroepithelial neoplasm. (United States)

    Gould, Daniel J; Salmans, Jessica A; Lassinger, Brian K; Contreras, Alejandro; Gutierrez, Carolina; Bonefas, Elizabeth; Liscum, Kathleen R; Silberfein, Eric J


    Phyllodes tumors represent less than 1% of all breast neoplasms and can mimic fibroadenoma on core needle biopsy (CNB). The treatment of fibroepithelial (FE) neoplasms identified on CNB is controversial. We sought to identify factors that were associated with phyllodes tumors after CNB suggested FE neoplasm. A retrospective database was queried for all patients diagnosed with FE neoplasm on CNB at Ben Taub General Hospital over a 10-y period. One hundred twenty-three patients were identified and demographic, clinical, and outcome data were analyzed. Of the 123 patients, 46 (37%) were found to have fibroadenomatous features and 59 (48%) were found to have FE features. All went on to have surgical excision. Forty (38%) contained phyllodes tumors, and 65 (62%) found no phyllodes tumor on final pathology. There were significant differences in the median size of the masses (4 cm versus 2.4 cm P phyllodes tumors and the group that did not on preoperative imaging. Further evaluation did not show any significant differences on preoperative imaging between benign and borderline/malignant phyllodes tumors. Hispanic ethnicity correlated with a higher chance of phyllodes tumor after CNB (P phyllodes tumor, surgical excision remains the standard of care; however, patients with suspicious FE neoplasms represent a treatment dilemma as many will prove to be benign. Preoperative size and the density of the mass on imaging and ethnicity were associated with phyllodes tumors on final pathology. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Delayed treatment with a novel neurotrophic compound reduces behavioral deficits in rabbit ischemic stroke. (United States)

    Lapchak, Paul A; Schubert, David R; Maher, Pamela A


    Acute ischemic stroke is a major risk for morbidity and mortality in our aging population. Currently only one drug, the thrombolytic tissue plasminogen activator, is approved by the US Food and Drug Administration to treat stroke. Therefore, there is a need to develop new drugs that promote neuronal survival following stroke. We have synthesized a novel neuroprotective molecule called CNB-001 (a pyrazole derivative of curcumin) that has neurotrophic activity, enhances memory, and blocks cell death in multiple toxicity assays related to ischemic stroke. In this study, we tested the efficacy of CNB-001 in a rigorous rabbit ischemic stroke model and determined the molecular basis of its in vivo activity. CNB-001 has substantial beneficial properties in an in vitro ischemia assay and improves the behavioral outcome of rabbit ischemic stroke even when administered 1 h after the insult, a therapeutic window in this model comparable to tissue plasminogen activator. In addition, we elucidated the protein kinase pathways involved in neuroprotection. CNB-001 maintains the calcium-calmodulin-dependent kinase signaling pathways associated with neurotrophic growth factors that are critical for the maintenance of neuronal function. On the basis of its in vivo efficacy and novel mode of action, we conclude that CNB-001 has a great potential for the treatment of ischemic stroke as well as other CNS pathologies.

  13. Targeted next-generation sequencing at copy-number breakpoints for personalized analysis of rearranged ends in solid tumors.

    Directory of Open Access Journals (Sweden)

    Hyun-Kyoung Kim

    Full Text Available BACKGROUND: The concept of the utilization of rearranged ends for development of personalized biomarkers has attracted much attention owing to its clinical applicability. Although targeted next-generation sequencing (NGS for recurrent rearrangements has been successful in hematologic malignancies, its application to solid tumors is problematic due to the paucity of recurrent translocations. However, copy-number breakpoints (CNBs, which are abundant in solid tumors, can be utilized for identification of rearranged ends. METHOD: As a proof of concept, we performed targeted next-generation sequencing at copy-number breakpoints (TNGS-CNB in nine colon cancer cases including seven primary cancers and two cell lines, COLO205 and SW620. For deduction of CNBs, we developed a novel competitive single-nucleotide polymorphism (cSNP microarray method entailing CNB-region refinement by competitor DNA. RESULT: Using TNGS-CNB, 19 specific rearrangements out of 91 CNBs (20.9% were identified, and two polymerase chain reaction (PCR-amplifiable rearrangements were obtained in six cases (66.7%. And significantly, TNGS-CNB, with its high positive identification rate (82.6% of PCR-amplifiable rearrangements at candidate sites (19/23, just from filtering of aligned sequences, requires little effort for validation. CONCLUSION: Our results indicate that TNGS-CNB, with its utility for identification of rearrangements in solid tumors, can be successfully applied in the clinical laboratory for cancer-relapse and therapy-response monitoring.

  14. Core-needle biopsy under CT fluoroscopy guidance and fine-needle aspiration cytology: Comparison of diagnostic yield in the diagnosis of lung and mediastinum tumors. Analysis of frequency and types of complications. (United States)

    Szlęzak, Przemysław; Srutek, Ewa; Gorycki, Tomasz; Kowalewski, Janusz; Studniarek, Michał


    Patients with pathological tissue mass in thoracic cage found with imaging require histopathological or cytological confirmation of malignancy before treatment. The tissue material essential for patomorphological evaluation can be acquired with fine-needle aspiration biopsies (FNAB) controlled with CT and core-needle biopsy (CNB) under real-time CT fluoroscopy guidance. The purpose of this work is to carry out a retrospective analysis of the two methods with regards to their informativity, frequency and the kind of complications. From January, 2012 to May 2013, 76 core-needle biopsies of lung and mediastinum tumors were conducted and compared with 86 fine-needle aspiration biopsies(FNAB) of lung and mediastinum tumors, including 30 patients who underwent FNAB and were referred to CNB in order to specify the diagnosis. Complete histopathological diagnosis was made in 91% with the use of CNB and in 37% when FNAB was the chosen method. Early complications were observed in 32% patients who underwent BG and in group of 11% who underwent FNAB. Late complications, however, appeared in 29% patients after CNB and 13% after FNAB. In 24 cases CNB specified the complete diagnosis. Core-needle biopsy in comparison to fine-needle aspiration biopsy has more frequent rate of negligible complications, however, it offers higher diagnostic yield for diagnostic of lung and mediastinum neoplastic disease and allows for more precise diagnosis of focal lesions.

  15. Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision? (United States)

    Seely, Jean M; Verma, Raman; Kielar, Ania; Smyth, Karl R; Hack, Kalesha; Taljaard, Monica; Gravel, Denis; Ellison, Erin


    To evaluate whether biopsy with vacuum-assisted biopsy (VAB) devices improves histologic underestimation rates of benign papillomas when compared to smaller bore core needle biopsy (CNB) devices. Patients with biopsy-proven benign papillomas with surgical resection or minimum 12 months follow-up were selected. Two breast pathologists reviewed all pathology slides of percutaneous and excisional biopsy specimens. Histologic underestimation rates for lesions biopsied with 10-12 Gauge (G) VAB were compared to those with 14G CNB. A total of 107 benign papillomas in 107 patients from two centers were included. There were 60 patients (mean age 57 years, SD 10.3 years) diagnosed with VAB and 47 patients (mean age 57.6 years, SD 11.3 years) with 14G CNB who underwent surgical excision or imaging follow-up. The upgrade rate to ductal carcinoma in situ or invasive carcinoma was 1.6% (1/60) with VAB and 8.5% (4/47) with 14G. Upgrade to atypia was 3.3% (2/60) after VAB and 10.6% (5/47) with CNB. The total underestimation rates were 5% (3/60) with VAB and 19.1% (9/47) with CNB. The odds of an upgrade to malignancy was 5.5 times higher with a 14G needle than VAB (95% CI: 0.592-50.853, p = 0.17). We observed a lower but not statistically significant upgrade rate to malignancy and atypia with the use of the 10-12 G VAB as compared with 14G CNB. When a papilloma without atypia is diagnosed with vacuum biopsy there is a high likelihood that it is benign; however, if surgical excision is not performed, long-term follow-up is still required. © 2016 Wiley Periodicals, Inc.

  16. Comparison of the accuracy of US-guided biopsy of breast masses performed with 14-gauge, 16-gauge and 18-gauge automated cutting needle biopsy devices, and review of the literature. (United States)

    Huang, Monica L; Hess, Kenneth; Candelaria, Rosalind P; Eghtedari, Mohammad; Adrada, Beatriz E; Sneige, Nour; Fornage, Bruno D


    To compare the diagnostic accuracy of ultrasound (US)-guided core needle biopsy (CNB) of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. We retrospectively reviewed the charts of 1,112 patients who underwent US-guided breast CNB with 14-gauge, 16-gauge and 18-gauge needles. Cases with surgical excision or a minimum of 2 years of imaging follow-up were included. Rates of sample inadequacy, discordance with surgical or imaging findings and upgrade of DCIS to invasive cancer or high-risk lesion to in situ or invasive cancer were computed for each needle size. The study included 703 CNBs: 203 performed with 14-gauge, 235 with 16-gauge and 265 with 18-gauge needles. There were no significant differences between 14-gauge, 16-gauge and 18-gauge needles in rates of specimen inadequacy (0 %, 0.4 % and 1.9 %, respectively) (p = 0.084); surgical discordance (2.6 %, 2.9 % and 3.8 %) (p = 0.76); imaging discordance (0 %, 0 % and 2 %) (p = 1.0); DCIS upgrade (43 %, 43 % and 36 %) (p = 1.00) or high-risk lesion upgrade (38 %, 25 % and 55 %) (p = 0.49). There was no statistically significant difference in diagnostic accuracy of US-guided CNB of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. • Percutaneous image-guided breast core needle biopsy (CNB) is the standard of care. • Breast CNB with 14-gauge, 16-gauge and 18-gauge needles has similar diagnostic accuracy. • Smaller gauge needles can be confidently used for ultrasound-guided breast CNB.

  17. Comparison of Core Needle Biopsy and Surgical Specimens in Determining Intrinsic Biological Subtypes of Breast Cancer with Immunohistochemistry. (United States)

    You, Kiho; Park, Sungmin; Ryu, Jai Min; Kim, Isaac; Lee, Se Kyung; Yu, Jonghan; Kim, Seok Won; Nam, Seok Jin; Lee, Jeong Eon


    We evaluated the concordance between core needle biopsy (CNB) and surgical specimens on examining intrinsic biological subtypes and receptor status, and determined the accuracy of CNB as a basic diagnostic method. We analyzed breast cancer patients with paired CNB and surgical specimen samples during 2014. We used monoclonal antibodies for nuclear staining, and estrogen receptor (ER) and progesterone receptor (PR) status evaluation. A positive test was defined as staining greater than or equal to 1% of tumor cells. Human epidermal growth factor receptor 2 (HER2) was graded by immunohistochemistry and scored as 0 to 3+ according to the recommendations of the American Society of Clinical Oncology/College of American Pathologists. Ki-67 immunostaining was performed using the monoclonal antibody Ki-67, and the results were divided at 10% intervals. The cutoff value for high Ki-67 was defined as 20%. Concordance analysis of ER, PR, HER2, Ki-67, and five intrinsic biological subtypes was performed on CNB and surgical specimens. Statistical analysis for concordance was calculated using κ-tests. We found very good agreement for ER and PR with a concordance of 96.7% for ER (κ=0.903), and 94.3% for PR (κ=0.870). HER2 and Ki-67 showed concordance rates of 84.8% (κ=0.684) and 83.5% (κ=0.647), respectively, which were interpreted as good agreement. Five subgroups analysis showed 85.8% agreement and κ-value of 0.786, also indicating good agreement. CNB showed high diagnostic accuracy compared with surgical specimens, and good agreement for ER, PR, HER2, and Ki-67. Our findings reaffirmed the recommendation of CNB as an initial procedure for breast cancer diagnosis, and the assessment of receptor status and intrinsic biological subtypes to determine further treatment plans.

  18. [Comparison of touch imprint cytology of core needle biopsy and section histopathology in breast cancer diagnosis]. (United States)

    Zhang, Zhi-Hui; Zhao, Lin-Lin; Guo, Hui-Qin; Zheng, Shan; Zhang, Bai-Lin; Xu, Xiao-Zhou; Pan, Qin-Jing; Zhang, Bao-Ning


    To evaluate the sensitivity, specificity of touch imprint cytology (TIC), and to compare its conformity rate with histopathology, to observe the consistence of immunocytochemistry (ICC) with immunohistochemistry (IHC), and to assess the diagnostic value of TIC prior to neoadjuvant chemotherapy for breast cancer. 289 cases of TIC and 287 cases with core needle biopsy (CNB) histopathology accumulated from October 2005 to October 2008 in our hospital were included in this study. One hundred ninety cases TIC results were compared with that of final histopathology. 64 cases were tested for ER, PR, HER-2 by immunocytochemistry. Twenty-four benign cases and 263 malignant cases were diagnosed. 4 specimens were unsatisfactory. False negative rate and unsatisfactory rate were 1.4%, both, and false positive rate was 0.35%. The accuracy rate of TIC and CNB was 95.8% and 95.3%, respectively (P = 0.804). The sensitivity of TIC and CNB was 96.2% and 95.0% (P = 0.601), specificity 87.5% and 100% (P = 0.471) were found, when compared with the results of routine histopathology. 52 cases had a control with IHC of CNB in 64 ICC, and 43 cases had a final histopathology IHC. The ICC conformity rate of ER, PR, HER-2 with IHC of CNB was 86.5%, 75.0%, 78.8%, and that with IHC of final histopathology was 88.4%, 74.4%, 75.6%, respectively. The conformity rate of IHC between CNB and final histopathology was 83.7%, 74.4%, 76.5%, respectively. There was no significant statistical difference between them. Compared with routine CNB histopathology, TIC has a high accuracy and sensitivity, and can provide a rapid and reliable cytological diagnosis to complement CNB for breast lesions. The conformity rates are high in ER, PR, HER-2 expression between ICC and IHC. ICC of TIC can be used to determine the estrogen and progesterone receptor levels in breast cancer before neoadjuvant chemotherapy.

  19. HER2 testing on core needle biopsy specimens from primary breast cancers: interobserver reproducibility and concordance with surgically resected specimens

    Directory of Open Access Journals (Sweden)

    Yamamoto Sohei


    Full Text Available Abstract Background Accurate evaluation of human epidermal growth factor receptor type-2 (HER2 status based on core needle biopsy (CNB specimens is mandatory for identification of patients with primary breast cancer who will benefit from primary systemic therapy with trastuzumab. The aim of the present study was to validate the application of HER2 testing with CNB specimens from primary breast cancers in terms of interobserver reproducibility and comparison with surgically resected specimens. Methods A total of 100 pairs of archival formalin-fixed paraffin-embedded CNB and surgically resected specimens of invasive breast carcinomas were cut into sections. All 100 paired sections were subjected to HER2 testing by immunohistochemistry (IHC and 27 paired sections were subjected to that by fluorescence in situ hybridization (FISH, the results being evaluated by three and two observers, respectively. Interobserver agreement levels in terms of judgment and the concordance of consensus scores between CNB samples and the corresponding surgically resected specimens were estimated as the percentage agreement and κ statistic. Results In CNB specimens, the percentage interobserver agreement of HER2 scoring by IHC was 76% (κ = 0.71 for 3 × 3 categories (0-1+ versus 2+ versus 3+ and 90% (κ = 0.80 for 2 × 2 categories (0-2+ versus 3+. These levels were close to the corresponding ones for the surgically resected specimens: 80% (κ = 0.77 for 3 × 3 categories and 92% (κ = 0.88 for 2 × 2 categories. Concordance of consensus for HER2 scores determined by IHC between CNB and the corresponding surgical specimens was 87% (κ = 0.77 for 3 × 3 categories, and 94% (κ = 0.83 for 2 × 2 categories. Among the 13 tumors showing discordance in the mean IHC scores between the CNB and surgical specimens, the results of consensus for FISH results were concordant in 11. The rate of successful FISH analysis and the FISH positivity rate in cases with a HER2 IHC score of

  20. Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness. (United States)

    Richardson, Michael G; Lopez, Brandon M; Baysinger, Curtis L; Shotwell, Matthew S; Chestnut, David H


    Evidence on the analgesic effectiveness of nitrous oxide for labor pain is limited. Even fewer studies have looked at patient satisfaction. Although nitrous oxide appears less effective than neuraxial analgesia, it is unclear whether labor analgesic effectiveness is the most important factor in patient satisfaction. We sought to compare the relationship between analgesic effectiveness and patient satisfaction with analgesia in women who delivered vaginally using nitrous oxide, neuraxial analgesia (epidural or combined spinal-epidural [CSE]), or both (neuraxial after a trial of nitrous oxide). A standardized survey was recorded on the first postpartum day for all women who received anesthetic care for labor and delivery. Data were queried for women who delivered vaginally with nitrous oxide and/or neuraxial labor analgesia over a 34-month period in 2011 to 2014. Parturients with complete data for analgesia quality and patient satisfaction were included. Analgesia and satisfaction scores were grouped into 8 to 10 high, 5 to 7 intermediate, and 0 to 4 low. These scores were compared with the use of ordinal logistic regression across 3 groups: nitrous oxide alone, epidural or CSE alone, or nitrous oxide followed by neuraxial (epidural or CSE) analgesia. A total of 6507 women received anesthesia care and delivered vaginally. Complete data were available for 6242 (96%) women; 5261 (81%) chose neuraxial analgesia and 1246 (19%) chose nitrous oxide. Of the latter, 753 (60%) went on to deliver with nitrous oxide alone, and 493 (40%) switched to neuraxial analgesia. Most parturients who received neuraxial analgesia (>90%) reported high analgesic effectiveness. Those who used nitrous oxide alone experienced variable analgesic effectiveness, with only one-half reporting high effectiveness. Among all women who reported poor analgesia effectiveness (0-4; n = 257), those who received nitrous oxide alone were more likely to report high satisfaction (8-10) than women who received

  1. Movements of native C505 during channel gating in CNGA1 channels.

    NARCIS (Netherlands)

    Nair, A.V.; Anselmi, C.; Mazzolini, M.


    We investigated conformational changes occurring in the C-linker and cyclic nucleotide-binding (CNB) domain of CNGA1 channels by analyzing the inhibition induced by thiol-specific reagents in mutant channels Q409C and A414C in the open and closed state. Cd(2+) (200 microM) inhibited irreversibly

  2. Role of Ultrasound Guided Biopsy of Thoracic Lesions | Elameen ...

    African Journals Online (AJOL)

    Objective: This prospective study is to evaluate and enhance the role of ultrasound in biopsy guidance of thoracic lesions. Methods: 55 patients were subjected for fine needle aspiration (FNA) and/or core needle biopsy (CNB) from peripheral chest lesions in Ribat University Hospital during the period from April 2011 and ...

  3. The multiple faces of calcineurin signaling in Caenorhabditis ...

    Indian Academy of Sciences (India)

    Analyses of cna-1/tax-6 and cnb-1 interacting proteins and regulators of the phosphatase in this fascinating worm model have an immense scope to identify potential drug targets in various parasitic nematodes, which cause many diseases inflicting huge economic loss; and also for many human diseases, particularly ...

  4. The value of touch imprint cytology of prostate core needle biopsy ...

    African Journals Online (AJOL)

    S. Hussein


    Nov 10, 2015 ... Abstract. Objectives: Touch imprint cytology (TIC) is a reliable, cost-effective technique for the diagnosis of cancer. The aim of this study was to determine the diagnostic value and accuracy of TIC of prostate core needle biopsy (CNB) specimens in predicting the final histology in patients with suspected ...

  5. The value of touch imprint cytology of prostate core needle biopsy ...

    African Journals Online (AJOL)

    Objectives: Touch imprint cytology (TIC) is a reliable, cost-effective technique for the diagnosis of cancer. The aim of this study was to determine the diagnostic value and accuracy of TIC of prostate core needle biopsy (CNB) specimens in predicting the final histology in patients with suspected prostate cancer. Subjects and ...

  6. Metastatic renal cell carcinoma in the thyroid gland: ultrasonographic features and the diagnostic role of core needle biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ok Kyu; Koo, Ja Seung; Kwak, Jin Young; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Eun Kyung [Severance Hospital, Yonsei University College of Medicine, Seoul(Korea, Republic of)


    The aims of this study were to present the ultrasonographic (US) features of metastatic renal cell carcinoma (RCC) in the thyroid gland and to evaluate the diagnostic utility of fine needle aspiration (FNA) and core needle biopsy (CNB). Eight patients with nine metastatic RCC nodules in the thyroid glands who were treated from January 2002 to March 2015 in a single tertiary hospital were consecutively selected and retrospectively reviewed. US features and clinical history were obtained from the institution’s medical database. FNA was performed nine times on eight nodules and CNB was performed six times on six nodules. The diagnostic utility of FNA and CNB was evaluated. All nine nodules showed mass formation without diffuse thyroid involvement. On ultrasonography, metastatic RCC nodules were solid (100%), hypoechoic (100%), and ovalshaped nodules with a well-defined smooth margin (88.9%) and increased vascularity (100%, with 55% showing extensive vascularity). No calcifications were noted in any nodules. Lymph node metastasis and direct extension to nearby structures beyond the thyroid gland were not found. One FNA (11%) was able to confirm metastatic RCC, whereas all six CNBs confirmed metastatic RCC. Metastatic RCC appears as oval-shaped hypoechoic solid nodules with well-defined smooth margins, no calcifications, and increased vascularity on ultrasonography. Characteristic US features along with a previous history of RCC should raise clinical suspicion, and CNB should be performed to make an accurate diagnosis.

  7. Diabetic mastopathy

    African Journals Online (AJOL)


    identified at ultrasound. Fine needle aspi- ration cytology (FNAC), core needle biopsy. (CNB) ... left side 4 years previously. The ultrasound examination revealed 2 poorly defined hypo-echoic masses 4.3 cm ... tory of breast problems presented with a lump in the right breast. The patient was also being treated with insulin ...

  8. Author Details

    African Journals Online (AJOL)

    Tagoe, CNB. Vol 54, No 2 (2013) - Articles Beneficial effects of low dose Musa paradisiaca on the semen quality of male Wistar rats. Abstract. ISSN: 2229-774X. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and ...

  9. Can concurrent core biopsy and fine needle aspiration biopsy improve the false negative rate of sonographically detectable breast lesions?

    Directory of Open Access Journals (Sweden)

    Chang Tsai-Wang


    Full Text Available Abstract Background The aims of this study were to determine the accuracy of concurrent core needle biopsy (CNB and fine needle aspiration biopsy (FNAB for breast lesions and to estimate the false-negative rate using the two methods combined. Methods Over a seven-year period, 2053 patients with sonographically detectable breast lesions underwent concurrent ultrasound-guided CNB and FNAB. The sonographic and histopathological findings were classified into four categories: benign, indeterminate, suspicious, and malignant. The histopathological findings were compared with the definitive excision pathology results. Patients with benign core biopsies underwent a detailed review to determine the false-negative rate. The correlations between the ultrasonography, FNAB, and CNB were determined. Results Eight hundred eighty patients were diagnosed with malignant disease, and of these, 23 (2.5% diagnoses were found to be false-negative after core biopsy. After an intensive review of discordant FNAB results, the final false-negative rate was reduced to 1.1% (p-value = 0.025. The kappa coefficients for correlations between methods were 0.304 (p-value p-value p-value Conclusions Concurrent CNB and FNAB under ultrasound guidance can provide accurate preoperative diagnosis of breast lesions and provide important information for appropriate treatment. Identification of discordant results using careful radiological-histopathological correlation can reduce the false-negative rate.

  10. Mean square number fluctuation for a fermion source and its ...

    Indian Academy of Sciences (India)

    ultra- relativistic case) or of the same order as the thermal energy kBT. Application of our results to the detection of the universal very low energy cosmic neutrino background. (CNB), from any of the three species of neutrinos, shows that it is ...

  11. Modified Core Wash Cytology: A reliable same day biopsy result for breast clinics. (United States)

    Bulte, J P; Wauters, C A P; Duijm, L E M; de Wilt, J H W; Strobbe, L J A


    Fine Needle Aspiration Biopsy (FNAB), Core Needle biopsy (CNB) and hybrid techniques including Core Wash Cytology (CWC) are available for same-day diagnosis in breast lesions. In CWC a washing of the biopsy core is processed for a provisional cytological diagnosis, after which the core is processed like a regular CNB. This study focuses on the reliability of CWC in daily practice. All consecutive CWC procedures performed in a referral breast centre between May 2009 and May 2012 were reviewed, correlating CWC results with the CNB result, definitive diagnosis after surgical resection and/or follow-up. Symptomatic as well as screen-detected lesions, undergoing CNB were included. 1253 CWC procedures were performed. Definitive histology showed 849 (68%) malignant and 404 (32%) benign lesions. 80% of CWC procedures yielded a conclusive diagnosis: this percentage was higher amongst malignant lesions and lower for benign lesions: 89% and 62% respectively. Sensitivity and specificity of a conclusive CWC result were respectively 98.3% and 90.4%. The eventual incidence of malignancy in the cytological 'atypical' group (5%) was similar to the cytological 'benign' group (6%). CWC can be used to make a reliable provisional diagnosis of breast lesions within the hour. The high probability of conclusive results in malignant lesions makes CWC well suited for high risk populations. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  12. Genetic diversity and spatial structure in cacao (Theobroma cacao L.) germplasm from Bolivia (United States)

    Cacao (Theobroma cacao L.) is an important economic crop widely cultivated in the Bolivian Amazon. The germplasm group used by the Bolivian farmers was called “Cacao Nacional Boliviano” (CNB). Wild cacao populations are also found in the Beni River and in the valleys of Andes foot hills. Using DNA...

  13. Investigating the Ustilago maydis/Zea mays pathosystem: transcriptional responses and novel functional aspects of a fungal calcineurin regulatory B subunit. (United States)

    Donaldson, Michael E; Meng, Shaowu; Gagarinova, Alla; Babu, Mohan; Lambie, Scott C; Swiadek, Alexander A; Saville, Barry J


    The sustainable control of basidiomycete biotrophic plant pathogenesis requires an understanding of host responses to infection, as well as the identification and functional analysis of fungal genes involved in disease development. The creation and analysis of a suppressive subtractive hybridization (SSH) cDNA library from Ustilago maydis-infected Zea mays seedlings enabled the identification of fungal and plant genes expressed during disease development, and uncovered new insights into the interactions of this model system. Candidate U. maydis pathogenesis genes were identified by using the current SSH cDNA library analysis, and by knowledge generated from previous cDNA microarray and comparative genomic analyses. These identifications were supported by the independent determination of transcript level changes in different cell-types and during pathogenic development. The basidiomycete specific um01632, the highly in planta expressed um03046 (zig1), and the calcineurin regulatory B subunit (um10226, cnb1), were chosen for deletion experiments. um01632 and zig1 mutants showed no difference in morphology and did not have a statistically significant impact on pathogenesis. cnb1 mutants had a distinct cell division phenotype and reduced virulence in seedling assays. Infections with reciprocal wild-type×Δcnb1 haploid strain crosses revealed that the wild-type allele was unable to fully compensate for the lack of a second cnb1 allele. This haploinsufficiency was undetected in other fungal cnb1 mutational analyses. The reported data improves U. maydis genome annotation and expands on the current understanding of pathogenesis genes in this model basidiomycete. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Predictive factors for breast cancer in patients diagnosed atypical ductal hyperplasia at core needle biopsy

    Directory of Open Access Journals (Sweden)

    Lee Ahwon


    Full Text Available Abstract Background Percutaneous core needle biopsy (CNB is considered to be the standard technique for histological diagnosis of breast lesions. But, it is less reliable for diagnosing atypical ductal hyperplasia (ADH. The purpose of the present study was to predict, based on clinical and radiological findings, which cases of ADH diagnosed by CNB would be more likely to be associated with a more advanced lesion on subsequent surgical excision. Methods Between February 2002 and December 2007, consecutive ultrasound-guided CNBs were performed on suspicious breast lesions at Seoul St. Mary's Hospital. A total of 69 CNBs led to a diagnosis of ADH, and 45 patients underwent follow-up surgical excision. We reviewed the medical records and analyses retrospectively. Results Sixty-nine patients were diagnosed with ADH at CNB. Of these patients, 45 underwent surgical excision and 10 (22.2% were subsequently diagnosed with a malignancy (ductal carcinoma in situ, n = 8; invasive cancer, n = 2. Univariate analysis revealed age (≥ 50-years at the time of core needle biopsy (p = 0.006, size (> 10 mm on imaging (p = 0.033, and combined mass with microcalcification on sonography (p = 0.029 to be associated with underestimation. When those three factors were included in multivariate analysis, only age (p = 0.035, HR 6.201, 95% CI 1.135-33.891 was an independent predictor of malignancy. Conclusion Age (≥ 50 at the time of biopsy is an independent predictive factor for breast cancer at surgical excision in patients with diagnosed ADH at CNB. For patients diagnosed with ADH at CNB, only complete surgical excision is the suitable treatment option, because we could not find any combination of factors that can safely predict the absence of DCIS or invasive cancer in a case of ADH.

  15. Occult Spinal Dysraphism in Obstetrics: A Case Report of Caesarean Section with Subarachnoid Anaesthesia after Remifentanil Intravenous Analgesia for Labour

    Directory of Open Access Journals (Sweden)

    A. Valente


    Full Text Available Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications.

  16. Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. (United States)

    Law, Lawrence Siu-Chun; Tan, Mingjuan; Bai, Yaowu; Miller, Timothy E; Li, Yi-Ju; Gan, Tong-Joo


    Paravertebral block (PVB) is a safe and effective anesthetic technique for thoracotomy and mastectomy. However, no systematic review or meta-analysis has focused on PVB for inguinal herniorrhaphy. Our study compares PVB with general anesthesia/systemic analgesia, neuraxial blocks, and other peripheral nerve blocks. We analyzed 14 randomized controlled trials from PubMed, MEDLINE, CENTRAL, EMBASE, and CINAHL up to February 2015, without language restriction, comparing PVB under sedation with general anesthesia/systematic analgesia (135 vs 133 patients), neuraxial blocks (191 vs 186 patients), and other peripheral nerve blocks (119 vs 117 patients). We investigated pain scores, consumption of postoperative analgesia, incidence of postoperative nausea and vomiting (PONV), length of hospital stay, postanesthesia care unit bypassing rate, time to perform blocks, intraoperative hemodynamics, and incidence of urinary retention. Joint hypothesis testing was adopted for pain and analgesics, PONV, and hemodynamic variables. All analyses were performed with RevMan 5.2.11 (Cochrane Collaboration, Copenhagen). Hartung-Knapp-Sidik-Jonkman method was used for post hoc testing. PVB reduced PONV (nausea: risk ratio [RR] = 0.22; 95% confidence interval [CI], 0.05-0.93; numbers needed to treat [NNT] = 4.5; I = 15% and vomiting: RR = 0.15; 95% CI, 0.03-0.76; NNT = 8.3; I = 0%) compared with general anesthesia/systematic analgesia (quality of evidence [QoE]: high). Compared with neuraxial blocks, PVB resulted in less postoperative nausea (RR = 0.34 [95% CI, 0.13-0.91], NNT = 8.3, I = 0%) and urinary retention (RR = 0.14 [95% CI, 0.05-0.42], NNT = 7.4, I = 0%) than neuraxial blocks (QoE: high). More time was needed to perform PVB than neuraxial blocks (standardized mean difference = 1.90 [95% CI, 0.02-3.77], I = 92%; mean difference = 5.33 minutes; QoE: moderate). However, the available data could not reject the null hypothesis of noninferiority on all pain scores and analgesic

  17. Preoperative Diagnostic Strategy for Parotid Gland Tumors Using Diffusion-Weighted MRI and Technetium-99m Pertechnetate Scintigraphy: A Prospective Study.

    Directory of Open Access Journals (Sweden)

    Masahiro Kikuchi

    Full Text Available Fine needle aspiration cytology (FNAC for diagnosis of a parotid gland tumor is widely used but its sensitivity is low and non-diagnostic rate is relatively high. In contrast, core needle biopsy (CNB has a higher sensitivity and lower rate of sampling errors but has a higher risk of injury to adjacent organs such as facial nerve than FNAC. Screening of patients with parotid gland tumors to identify cases of pleomorphic adenoma (PA and Warthin tumor (WT may allow CNB to be confined to patients without PA and WT. We established an algorithm for preoperative diagnosis and management of parotid gland tumor using diffusion-weighted MRI and 99mTc pertechnetate scintigraphy. This algorithm was developed with the goal of maximal reduction of the number of patients in whom CNB is required. The purpose of the study is to validate our algorithm prospectively.A prospective study was conducted in 71 cases who were newly diagnosed with parotid gland tumor and 53 cases were enrolled in the study. In the algorithm, PA (high apparent diffusion coefficient (ADC mean≥1.5×10(-3 mm(2/s and non-PA (low ADCmean<1.5×10(-3 mm(2/s cases are first distinguished based on the ADCmean on diffusion-weighed MRI. Second, among suspected non-PA cases, WT and non-WT are distinguished using technetium-99m pertechnetate scintigraphy. CNB is then performed only in probable non-PA and non-WT cases.Although CNB was only required in 40% (21/53 of all cases, we made a preoperative histopathological diagnosis with an accuracy of 87% (46/53 and we correctly diagnosed whether a tumor was benign or malignant with an accuracy of 96% (51/53. Preoperative surgical planning had to be changed during surgery in only one case (2%.Our algorithm is valuable in terms of clinical practice with highly potential for preoperative diagnosis and with less risk of CNB procedure.

  18. Computed tomography-guided needle aspiration and biopsy of pulmonary lesions - A single-center experience in 1000 patients

    Energy Technology Data Exchange (ETDEWEB)

    Poulou, Loukia S.; Tsagouli, Paraskevi; Thanos, Loukas [Dept. of Medical Imaging and Interventional Radiology, General Hospital of Chest Diseases ' Sotiria' , Athens (Greece)], e-mail:; Ziakas, Panayiotis D. [Program of Outcomes Research, Div. of Infectious Diseases, Warren Alpert Medical School, Brown Univ., RI, and Div. of Infectious Diseases, Rhode Island Hospital, Rhode Island (United States); Politi, Dimitra [Dept. of Cythopathology, General Hospital of Chest Diseases ' Sotiria' Athens (Greece); Trigidou, Rodoula [Dept. of Pathology, General Hospital of Chest Diseases ' Sotiria' Athens (Greece)


    Background: Computed tomography (CT)-guided fine needle aspiration (FNA) and biopsies are well-established, minimally invasive diagnostic tools for pulmonary lesions. Purpose: To analyze retrospectively the results of 1000 consecutive lung CT-guided FNA and/or core needle biopsies (CNB), the main outcome measures being diagnostic yield, and complication rates. Material and Methods: Patients considered eligible were those referred to our department for lung lesions. The choice of FNA, CNB, or both was based upon the radiologist's judgment. Diagnostic yield was defined as the probability of having a definite result by cytology/histology. Results: The study included 733 male patients and 267 female patients, with a mean (SD) age of 66.4 (11.4) years. The mean (SD) lesion size was 3.7 (2.4) cm in maximal diameter. Six hundred and forty-one (64%) patients underwent an FNA procedure, 245 (25%) a CNB, and 114 (11%) had been subjected to both. The diagnostic yield was 960/994 (96.6%); this decreased significantly with the use of CNB only (odds ratio [OR] 0.32; 95% CI 0.12 - 0.88; P = 0.03), while it increased with lesion size (OR 1.35; 95% CI 1.03 - 1.79; P = 0.03 per cm increase). In 506 patients (52.7%), a malignant process was diagnosed by cytopathology/histology. The complication rate reached 97/1000 (9.7%); complications included: hemorrhage, 62 (6.2%); pneumothorax, 28 (2.8%); hemorrhage and pneumothorax, 5 (0.5%); and hemoptysis, 2 (0.2%). It was not significantly affected by the type of procedure or localization of the lesion. The overall risk for complications was three times higher for lesions <4 cm (OR 3.26; 95% CI 1.96 - 5.42; P < 0.001). Conclusion: CT-guided lung biopsy has a high diagnostic yield using FNA, CNB, or both. The CNB procedure alone will not suffice. Complication rates were acceptable and correlated inversely with lesion size, not localization or type of procedure.

  19. Taylor Approach of Spinal Anaesthesia in a case of Ankylosing Spondylitis for Hip Fracture Surgery

    Directory of Open Access Journals (Sweden)

    Urmila Palaria


    Full Text Available Ankylosing Spondylitis (AS is a chronic inflammatory rheumatic disease primarily affecting the axial joints manifesting as stiffnesss of the spine. Patient with ankylosing spondylitis is a challenge to anaesthesiologists in terms of airway management and neuraxial blocks. Modified paramedian approach (Taylor approach of spinal anaesthesia can be used as an alternative to technically difficult cases in patients undergoing lower limb surgeries.

  20. Transient aphasia following spinal anaesthesia in an orthopaedic ...

    African Journals Online (AJOL)


    May 18, 2012 ... Spinal anaesthesia is commonly used for infraumbilical surgeries. Although it is considered to be a safe and reliable technique, the actual spread of block depends on many factors.1 Occasionally, during the performance of a neuraxial block, an unexpectedly high or low level of block is achieved due to ...

  1. Cerebellar Syndrome


    Krumdieck, Carlos F.; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú


    In order to fully understand the seemingly complex symptomatology of disorders of the cerebellum, it must be remembered the anatomy and physiology of this important segment of the neuraxis. Para poder comprender bien la aparentemente compleja sintomatología de las afecciones del cerebelo, preciso es recordar la anatomía y fisiología de tan importante segmento del neuroeje.

  2. Sectio og Brugadas syndrom

    DEFF Research Database (Denmark)

    Ammundsen, Henriette Berg; Ekelund, Kim; Afshari, Arash


    to induce fatal arrhythmias in patients with BS and in particular sodium channel blockers i.e. local anaesthetics such as bupivacaine. We report the anaesthetic management of two women with BS during caesarean section and provide a general discussion on the use of bupivacain for neuraxial blockade...

  3. Neuropathological findings after continuous intrathecal administration of S(+)-ketamine for the management of neuropathic cancer pain

    NARCIS (Netherlands)

    Vranken, J. H.; Troost, D.; Wegener, J. T.; Kruis, M. R.; van der Vegt, M. H.


    Questions have been raised about the potential neurotoxicity of the neuraxial use of ketamine although ketamine and its active enantiomer S(+)-ketamine have been used intrathecally and epidurally (caudally) for the management of perioperative pain and in a variety of chronic pain syndromes. Clinical

  4. The febrile parturient: choice of anesthesia

    African Journals Online (AJOL)


    etiology of fever in a parturient may be pregnancy specific, such as chorioamnionitis, or not specific to pregnancy, such as ... The diagnosis of infection in pregnancy often raises questions about the safety of neuraxial anesthesia in febrile patients. Despite this .... rients with viral hepatitis provided thrombocytopenia is ab-.

  5. Ketamine induces apoptosis via the mitochondrial pathway in human lymphocytes and neuronal cells

    NARCIS (Netherlands)

    Braun, S.; Gaza, N.; Werdehausen, R.; Hermanns, H.; Bauer, I.; Durieux, M. E.; Hollmann, M. W.; Stevens, M. F.


    BACKGROUND: Ketamine has been shown to have neurotoxic properties, when administered neuraxially. The mechanism of this local toxicity is still unknown. Therefore, we investigated the mechanism of cytotoxicity in different human cell lines in vitro. METHODS: We incubated the following cell types for

  6. Author Details

    African Journals Online (AJOL)

    Rewari, V. Vol 16, No 5 (2010) - Articles Rabies vaccine and neuraxial anaesthesia. Abstract PDF. ISSN: 2220-1173. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL · News. OTHER ...

  7. Vasovagal Bradycardia During Subarachnoid Anaesthesia for ...

    African Journals Online (AJOL)

    There is an increasing use of central neuraxial blocks for lower abdominal surgeries. Increased vagal tone under subarachnoid block is a well-known phenomenon and can have non-classical presentations. It can manifest with bradycardia, hypotension, bronchospasm, coronary artery spasm and cardiac arrest. In a patient ...

  8. Skin temperature after interscalene brachial plexus blockade

    NARCIS (Netherlands)

    Hermanns, Henning; Braun, Sebastian; Werdehausen, Robert; Werner, Andreas; Lipfert, Peter; Stevens, Markus F.


    Background and Objectives: In neuraxial anesthesia, increase of skin temperature is an early sign of successful block. Yet, during peripheral nerve block of the lower extremity, increase in skin temperature is a highly sensitive, but late sign of a successful block. We hypothesized that after

  9. Activity-dependent plasticity in spinal cord injury

    National Research Council Canada - National Science Library

    Lynskey, James V; Belanger, Adam; Jung, Ranu


    ... after spinal cord injury (SCI) by promoting adaptive structural and functional plasticity while mitigating maladaptive changes at multiple levels of the neuraxis. In this review, we will discuss CNS plasticity that occurs both spontaneously after SCI and in response to rehabilitative therapies.

  10. Role of Cdx and Hox genes in posterior axial extension in the mouse

    NARCIS (Netherlands)

    Young, T.|info:eu-repo/dai/nl/304081302


    Hox and Cdx genes are phylogenetically related transcription factor-encoding genes that control positional tissue identity during embryonic develop- ment. In addition, mutations impairing Cdx activity in mice elicit poste- rior body truncations, affecting the axial skeleton, the neuraxis and cau-

  11. Simian varicella virus infection of Chinese rhesus macaques produces ganglionic infection in the absence of rash

    NARCIS (Netherlands)

    W.J.D. Ouwendijk (Werner ); R. Mahalingam (Ravi); V. Traina-Dorge (Vicki); G. van Amerongen (Geert); M. Wellish (Mary); A.D.M.E. Osterhaus (Albert); D. Gilden (Don); G.M.G.M. Verjans (George)


    textabstractVaricella-zoster virus (VZV) causes varicella (chickenpox), becomes latent in ganglia along the entire neuraxis, and may reactivate to cause herpes zoster (shingles). VZV may infect ganglia via retrograde axonal transport from infected skin or through hematogenous spread. Simian

  12. Epidural abscess: diagnosis and management

    African Journals Online (AJOL)


    gest a risk for abscess formation, especially in a diabetic. Dia-. Correspondence: Dr M Hakl email: Introduction. Neurological complications of neuraxial anaesthesia are rare but potentially catastrophic. Major complications include me- chanical damage to spinal cord or nerve roots, infection, and.

  13. Epidural anaesthesia in a child with possible spinal muscular atrophy

    NARCIS (Netherlands)

    Veen, A; Molenbuur, B; Richardson, FJ

    Spinal muscular atrophy (SMA) is a rare lower motor neurone disease in which anaesthetic management is often difficult as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents. Neuraxial anaesthesia is controversial in these patients; however, some cases have been

  14. International Conference on Hypertonic Resuscitation (6th) (SALT 6), Held in Teton Village, Wyoming on 2-3 Jun 1994. Program and Abstracts (United States)


    animals were divided into the following three groups: intact group, animals with intact neuraxis (N=5); vagotomy group, cervical vagotomized animals with...that there was no apparent plasma binding of D70, & others have shown there is no renal tubular reabsorption or secretion of D70. There may be a

  15. Skin temperature during regional anesthesia of the lower extremity

    NARCIS (Netherlands)

    Stevens, Markus F.; Werdehausen, Robert; Hermanns, Henning; Lipfert, Peter


    Increase in skin temperature (Ts) occurs early during neuraxial blocks. However, the reliability of Ts to predict successful peripheral block is unknown. Therefore, we investigated whether an increase in Ts more than 1 degrees C precedes or follows an impairment of sensation after combined femoral


    African Journals Online (AJOL)

    The extensively illustrated text includes a review of ENT anatomy and physiology, a structured ... spinal cord electrical stimulation and the long-term placement of neuraxial catheters is described. As 'pain medicine' .... Bone Marrow Transplantation" By Richard K Burt, H Joachim. Deeg, Scott T. Lothian and George W Santos.

  17. Severe toxic damage to the rabbit spinal cord after intrathecal administration of preservative-free S(+)-ketamine

    NARCIS (Netherlands)

    Vranken, Jan H.; Troost, Dirk; de Haan, Peter; Pennings, Fritz A.; van der Vegt, Marinus H.; Dijkgraaf, Marcel G. W.; Hollmann, Markus W.


    BACKGROUND: Ketamine and S(+)-ketamine have been advocated for neuraxial use in the management of postoperative pain and severe intractable pain syndromes unresponsive to opioid escalation. Although clinical experience has accumulated with S(+)-ketamine, safety data on toxicity in the central

  18. A Pregnant Woman with Spina Bifida: Need for a Multidisciplinary Labor Plan

    Directory of Open Access Journals (Sweden)

    Mary Angela O’Neal


    Full Text Available Women with spina bifida present both obstetrical and anesthesia challenges. They are more likely to require a caesarian delivery and traditionally neuraxial anesthesia has been avoided due to concerns of worsening neurologic disability. The case of a pregnant woman with a history of a surgically corrected lipomeningocele and tethered cord is presented to illustrate the need for a comprehensive labor plan.

  19. A randomised controlled trial comparing the effect of adjuvant ...

    African Journals Online (AJOL)

    Abstract. Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the ... Methods: A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two ... ciceptive stimuli, and the discovery of opioid receptors in.

  20. Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A Secondary Analysis of a French Prospective, Multicenter, Cohort Study. (United States)

    Kantor, Elie; Guglielminotti, Jean; Azria, Elie; Luton, Dominique; Laurent, Mandelbrot; Oury, Jean-François; Mahieu-Caputo, Dominique; Ravaud, Philippe; Estellat, Candice


    Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor. Data were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics. Preanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79-0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87-1.07]; P = .540). In a country providing universal health care coverage, women who were socioeconomically deprived

  1. A case of rare primary cystic-type squamous cell carcinoma of the breast that could be preoperatively diagnosed. (United States)

    Takahashi, Keiichi; Wakasa, Tomoko; Shintaku, Masayuki


    Primary squamous cell carcinoma of the breast (SCCB) is a rare disease, with a worldwide incidence breast cancer. If the cyst is large, the solid tumor shadow outside the cyst behind or around the cyst may be masked or hidden by the large cyst, which can sometimes yield an unclear view of the tumor shadow or make it impossible to visualize the shadow. In the present case, the contents within the cyst were completely aspirated and collected during the first step (FNA), thereby yielding a clearer, complete view of the solid tumor located outside the cyst. Thus, the subsequent step (CNB) was able to be performed in a more accurate and reliable manner. The combined use of FNA and CNB proved to be useful in making a preoperative diagnosis of SSCB accompanying a cyst. Copyright © 2017. Published by Elsevier Taiwan.

  2. Systemic Sarcoidosis with Thyroid Involvement (United States)

    Okuma, Hideyuki; Hashimoto, Koshi; Wang, Xin; Ohkiba, Noriaki; Murooka, Nozomi; Akizuki, Norikazu; Inazawa, Takeshi; Ogawa, Yoshihiro


    A 66-year-old woman, who was diagnosed with iritis, visited our hospital due to general malaise. A blood analysis revealed hypercalcemia. Computed tomography revealed mediastinal and hilar lymph node hyperplasia. Moreover, 67Gallium scintigraphy demonstrated strong accumulation in the lesions, suggesting sarcoidosis. A core needle biopsy (CNB) of the hypoechoic areas of the thyroid was performed because the patient refused to undergo a bronchoscopic examination. The scattering of slightly acidophilic epithelioid cell granulomas was observed in the pathological examination of the biopsy specimen. Based on this finding, the patient was diagnosed with sarcoidosis. Although sarcoidosis rarely involves the thyroid gland, in the present case, thyroid CNB was an alternative diagnostic method that allowed a pathological diagnosis to be obtained. PMID:28781308

  3. Genetic Basis for Geosmin Production by the Water Bloom-Forming Cyanobacterium, Anabaena ucrainica

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    Zhongjie Wang


    Full Text Available Geosmin is a common, musty-smelling sesquiterpene, principally produced by cyanobacteria. Anabaena ucrainica (Schhorb. Watanabe, a water bloom-forming cyanobacterium, is the geosmin producer responsible for odor problems in Dianchi and Erhai lakes in China. In this study, the geosmin synthase gene (geo of A. ucrainica and its flanking regions were identified and cloned by polymerase chain reaction (PCR and genome walking. The geo gene was found to be located in a transcription unit with two cyclic nucleotide-binding protein genes (cnb. The two cnb genes were highly similar and were predicted members of the cyclic adenosine monophosphate (cAMP receptor protein/fumarate nitrate reductase regulator (Crp–Fnr family. Phylogenetic and evolutionary analyses implied that the evolution of the geosmin genes involved a horizontal gene transfer process in cyanobacteria. These genes showed a close relationship to 2-methylisoborneol genes in origin and evolution.


    Directory of Open Access Journals (Sweden)

    YIP CH


    Full Text Available Background: Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC, to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies. Methods: We conducted a retrospective study of all women who had excision biopsy of a breast lump in the University Malaya Medical Centre from January 2005 to December 2006. All patients with malignant preoperative biopsies were excluded. Results: Of 717 lesions in 664 patients, 459 (64% were fibroadenoma, 114 (15.9% were fibrocystic disease, 20 (2.8% were phylloides tumour, 27 (3.8% were papilloma, 59 (8.2% were malignant and 38 (5.3% were of other pathology. Of the 717 open biopsies, 449 (62.6% had fine-needle aspiration cytology (FNAC, 31 (4.3% had core needle biopsy (CNB, while 14 (2.0% had both FNAC and CNB done prior to excision biopsy. 251 (35% had neither FNAC nor CNB. The incidence of fibroadenoma decreased with increasing age and the incidence of fibrocystic changes and papilloma increased with increasing age. There was no association of age with phylloides tumour. The incidence of unexpected malignancy increased with increasing age. The incidence rates were 0.3%, 4.5%, 19.4%, 29.7% and 29.6% for the age group below 30, 30-39, 40-49, 50-59 and above 60 years of age respectively. Of the 59 malignant lesions, FNAC was performed on 47 (79.7% and CNB on 16 (27.1%. 9 had both FNAC and CNB and 3 had neither FNAC nor CNB. Out of the 56 lesions where FNAC/CNB were done, 23 (41.1% were reported as benign, 20 (35.7% as suspicious, 4 (7.1% as atypical, 5 (8.9% as inadequate, 2 (3.6% as equivocal and 2 (3.6% as lymphoid lesions. Out of the 23 prior biopsies reported as

  5. Dohled nad finanční činností


    Drahota, Jiří


    The aim of this diploma thesis is to describe and analyze supervision of financial activities in the Czech Republic. The thesis is structured into three chapters, which focuses on analysis of actual acts of CNB supervision in connection to the legal basis. The first chapter defines supervision of financial activities reflecting its historical development, economical aspect and basic trends in financial market regulation. The second chapter is the main part which describes the status and activ...

  6. Impact of Reclassification on Thyroid Nodules with Architectural Atypia: From Non-Invasive Encapsulated Follicular Variant Papillary Thyroid Carcinomas to Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. (United States)

    Jeon, Min Ji; Song, Dong Eun; Jung, Chan Kwon; Kim, Won Gu; Kwon, Hyemi; Lee, Yu-Mi; Sung, Tae-Yon; Yoon, Jong Ho; Chung, Ki-Wook; Hong, Suck Joon; Baek, Jung Hwan; Lee, Jeong Hyun; Kim, Tae Yong; Shong, Young Kee; Kim, Won Bae


    The follicular variant of papillary thyroid cancer (FVPTC), especially the encapsulated non-invasive subtype, is a controversial entity. Recent study suggested using 'non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)' for these indolent carcinomas. We evaluated the impact of reclassification from non-invasive encapsulated FVPTCs (EFVPTCs) to NIFTPs in the diagnosis of thyroid nodules with architectural atypia. We reviewed 1301 thyroid nodules with architectural atypia in core needle biopsy (CNB) specimens obtained from March 2012 to February 2013. Nodules were classified into atypia of undetermined significance with architectural atypia (AUS-A, 984, 76%) or follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN, 317, 24%). Among them, diagnostic surgery was performed in 384 nodules (30%). In total, 160 nodules (42%) presented final malignant diagnoses including 39 non-invasive encapsulated FVPTCs (10%). The malignancy rate was estimated to be 7-35% in AUS-A nodules and 28-49% in FN/SFN nodules. After reclassification, the malignancy rate was much decreased and estimated to be 5-24% in AUS-A nodules, and 23-39% in FN/SFN nodules. Thyroid nodules with final malignant diagnoses were significantly more likely to have a FN/SFN CNB diagnosis, malignant US features and concomitant nuclear atypia in CNB specimens. However, these factors could not differentiate NIFTPs from other malignancies. After reclassification of non-invasive EFVPTCs to NIFTPs, the malignancy rate of thyroid nodules with architectural atypia in CNB specimens was decreased. However, there were no preoperative factors differentiating other malignancies from NIFTPs. The presence of malignant US features or concomitant nuclear atypia might help clinicians deciding diagnostic surgery but, these features also might indicate NIFTPs.

  7. Impact of Reclassification on Thyroid Nodules with Architectural Atypia: From Non-Invasive Encapsulated Follicular Variant Papillary Thyroid Carcinomas to Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features.

    Directory of Open Access Journals (Sweden)

    Min Ji Jeon

    Full Text Available The follicular variant of papillary thyroid cancer (FVPTC, especially the encapsulated non-invasive subtype, is a controversial entity. Recent study suggested using 'non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP' for these indolent carcinomas. We evaluated the impact of reclassification from non-invasive encapsulated FVPTCs (EFVPTCs to NIFTPs in the diagnosis of thyroid nodules with architectural atypia.We reviewed 1301 thyroid nodules with architectural atypia in core needle biopsy (CNB specimens obtained from March 2012 to February 2013. Nodules were classified into atypia of undetermined significance with architectural atypia (AUS-A, 984, 76% or follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN, 317, 24%. Among them, diagnostic surgery was performed in 384 nodules (30%.In total, 160 nodules (42% presented final malignant diagnoses including 39 non-invasive encapsulated FVPTCs (10%. The malignancy rate was estimated to be 7-35% in AUS-A nodules and 28-49% in FN/SFN nodules. After reclassification, the malignancy rate was much decreased and estimated to be 5-24% in AUS-A nodules, and 23-39% in FN/SFN nodules. Thyroid nodules with final malignant diagnoses were significantly more likely to have a FN/SFN CNB diagnosis, malignant US features and concomitant nuclear atypia in CNB specimens. However, these factors could not differentiate NIFTPs from other malignancies.After reclassification of non-invasive EFVPTCs to NIFTPs, the malignancy rate of thyroid nodules with architectural atypia in CNB specimens was decreased. However, there were no preoperative factors differentiating other malignancies from NIFTPs. The presence of malignant US features or concomitant nuclear atypia might help clinicians deciding diagnostic surgery but, these features also might indicate NIFTPs.

  8. Cu and Boron Doped Carbon Nitride for Highly Selective Oxidation of Toluene to Benzaldehyde. (United States)

    Han, Hongling; Ding, Guodong; Wu, Tianbin; Yang, Dexin; Jiang, Tao; Han, Buxing


    A novel Cu and boron doped graphitic carbon nitride catalyst (Cu-CNB) was synthesized using cheap precursors and systematically characterized. The selective oxidation of toluene proceeded very smoothly over the catalyst at 70 °C using tert-butyl hydroperoxide (TBHP) as the oxidant to exclusively afford benzaldehyde. The catalyst can be used for at least five cycles without decrease in activity and selectivity.

  9. Cu and Boron Doped Carbon Nitride for Highly Selective Oxidation of Toluene to Benzaldehyde

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    Hongling Han


    Full Text Available A novel Cu and boron doped graphitic carbon nitride catalyst (Cu-CNB was synthesized using cheap precursors and systematically characterized. The selective oxidation of toluene proceeded very smoothly over the catalyst at 70 °C using tert-butyl hydroperoxide (TBHP as the oxidant to exclusively afford benzaldehyde. The catalyst can be used for at least five cycles without decrease in activity and selectivity.

  10. Cu and Boron Doped Carbon Nitride for Highly Selective Oxidation of Toluene to Benzaldehyde


    Han, Hongling; Ding, Guodong; Wu, Tianbin; Yang, Dexin; Jiang, Tao; Han, Buxing


    A novel Cu and boron doped graphitic carbon nitride catalyst (Cu-CNB) was synthesized using cheap precursors and systematically characterized. The selective oxidation of toluene proceeded very smoothly over the catalyst at 70 °C using tert-butyl hydroperoxide (TBHP) as the oxidant to exclusively afford benzaldehyde. The catalyst can be used for at least five cycles without decrease in activity and selectivity.

  11. Vyrovnávací procesy platební bilance a význam ČNB


    OHRAZDOVÁ, Jiřina


    In this bachelor thesis I dealt with balance of payments, its structure and role in international relations and first of all with compensatory processes balance of payments. I analyzed the meaning of the Czech national bank for balance of payments, position of CNB, its purposes, functions and tools. I did the balance of payments development, its partial segments and other important indicators from 1993 till 2008. I judged functionality of compensatory mechanism on the example of the Czech Rep...

  12. Comparison of hormonal receptor and HER2 status between ultrasound-guided 14-gauge core needle biopsy and surgery in breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yun Joo; Youk, Ji Hyun; Son, Eun Ji; Gweon, Hye Mi; Kim, Jeong Ah [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the concordance of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) statuses between ultrasound (US)-guided 14-gauge core needle biopsy (CNB) and surgery and to analyze whether the clinicopathological and imaging features including those from mammography and ultrasonography can predict the concordance in breast cancer patients. The concordance of receptor status between CNB and surgery was assessed for 55 breast cancers in 55 women who underwent CNB before treatment. The clinicopathological and imaging features and the concordance rates were compared between the non-neoadjuvant chemotherapy (non-NAC) group and the NAC group according to the initial treatment. The concordance rates were analyzed according to the clinicopathological and imaging features, by using the chi-square or Fisher exact test and McNemar test for the categorical and the independent t-test for continuous variables. Among 55 women, 22 women (40%) were part of the non-NAC group and 33 women (60%) were part of the NAC group. The concordance rates were 0.86-1.00 in the non-NAC group and 0.76-0.88 in the NAC group. In all three receptors, the difference in the concordance rate between the two groups was not significant. In the NAC group, the absence of axillary lymph node metastasis (1.00, P=0.02) and visibility of cancer on mammography (0.93, P=0.04) showed the higher concordance of the HER2 status. Concordance of the receptor status between surgery and US-guided 14-gauge CNB was feasible in breast cancer patients. The absence of axillary lymph node metastasis after NAC and the visibility of cancer on mammography prior to NAC may be helpful for predicting the concordance of HER2 in breast cancer patients.

  13. A case of rare primary cystic-type squamous cell carcinoma of the breast that could be preoperatively diagnosed

    Directory of Open Access Journals (Sweden)

    Keiichi Takahashi


    Full Text Available Primary squamous cell carcinoma of the breast (SCCB is a rare disease, with a worldwide incidence <0.1%. In many cases, it is clinically characterized by rapid growth. Cyst formation due to central necrosis of the tumor accompanies its growth of the tumor in approximately 60–80% of all cases. Furthermore, it is considered difficult to diagnose SCCB solely on the basis of findings from diagnostic imaging. For large intracystic tumors, mammotome biopsy or core needle biopsy (CNB is rarely performed. Instead, fine-needle aspiration (FNA targeted at the tumor inside the cyst is often performed. The accurate diagnosis rate of SCCB using FNA is lower than that for ordinary-type breast cancer. If the cyst is large, the solid tumor shadow outside the cyst behind or around the cyst may be masked or hidden by the large cyst, which can sometimes yield an unclear view of the tumor shadow or make it impossible to visualize the shadow. In the present case, the contents within the cyst were completely aspirated and collected during the first step (FNA, thereby yielding a clearer, complete view of the solid tumor located outside the cyst. Thus, the subsequent step (CNB was able to be performed in a more accurate and reliable manner. The combined use of FNA and CNB proved to be useful in making a preoperative diagnosis of SSCB accompanying a cyst.

  14. Coordination between the monetary and public debt management policies in Croatia

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    •Zorica Raspudić Golomejić


    Full Text Available This paper explains the main characteristics of and prerequisites for coordination between the measures and instruments of monetary and public debt management policies in Croatia and evaluates current practice, particularly over the last two recession years. Attention is drawn to the importance of coordination for achieving macroeconomic stability and to the main problems and challenges obstructing successful coordination. It is assessed that the Croatian National Bank (CNB, with its measures and instruments, has consistently contributed to improving coordination with the public debt management policy, despite the narrowing of its room for manoeuvre due to a complex economic environment and the specific functioning of the transmission mechanism of monetary policy. Notwithstanding some contribution to coordination made by the Government and Ministry of Finance, they must take measures and employ instruments to make more significant adjustments and, together with the CNB, define an optimum fiscal and monetary policy mix for the future that will ensure stable economic growth. This paper gives an overview of major CNB measures aimed at facilitating the public debt management and improving coordination with the Ministry of Finance, and presents a detailed analysis of open market operations. It also points to a certain contribution of the Ministry of Finance to the coordination improvement, indicating major barriers to effective coordination between these important policies.

  15. A histomorphologic predictive model for axillary lymph node metastasis in preoperative breast cancer core needle biopsy according to intrinsic subtypes. (United States)

    Yoo, Su Hyun; Park, In Ae; Chung, Yul Ri; Kim, Hyojin; Lee, Keehwan; Noh, Dong-Young; Im, Seock-Ah; Han, Wonshik; Moon, Hyeong-Gon; Lee, Kyung-Hun; Ryu, Han Suk


    The aim of this study is construction of a pathologic nomogram that can predict axillary lymph node metastasis (LNM) for each intrinsic subtype of breast cancer with regard to histologic characteristics in breast core needle biopsy (CNB) for use in routine practice. A total of 534 CNBs with invasive ductal carcinoma classified into 5 intrinsic subtypes were enrolled. Eighteen clinicopathological characteristics and 8 molecular markers used in CNB were evaluated for construction of the best predictive model of LNM. In addition to conventional parameters including tumor multiplicity (P predictive factors for LNM. A combination of 8 statistically independent parameters yielded the strongest predictive performance with an area under the curve of 0.760 for LNM. A combination of 6 independent variables, including tumor number, tumor size, histologic grade, lymphatic invasion, micropapillary structure, and small cell-like crush artifact produced the best predictive performance for LNM in luminal A intrinsic subtype (area under the curve, 0.791). Thus, adding these combinations of clinical and morphologic parameters in preoperative CNB is expected to enhance the accuracy of prediction of LNM in breast cancer, which might serve as another valuable tool in determining optimal surgical strategies for breast cancer patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. CT-guided needle biopsy performed with modified coaxial technique in patients with refractory or recurrent lymphomas. (United States)

    Gaudio, Francesco; Pedote, Pasquale; Ferrante, Annunziata; Perrone, Tommasina; Ingravallo, Giuseppe; Ianora, Amato Antonio Stabile; Angelelli, Giuseppe; Specchia, Giorgina


    The aim of this study was to evaluate the role of computed tomography (CT)-guided core needle biopsy (CNB) performed by modified coaxial technique as an alternative tool to surgical biopsy in patients with refractory or recurrent lymphomas. Between May 2005 and May 2012, 57 CT-guided CNB of deep lesions were performed in patients with a previous diagnosis of lymphoma and suspected for refractory or recurrent disease. A modified coaxial technique was used in all cases and multiple samples were obtained for histological and immunohistochemical studies. A diagnosis of lymphoma with specification of subtype according to the World Health Organization (WHO) classification was established in 30/57 cases (52.6 %). The previous diagnosis of lymphoma was confirmed in 27/57 patients (47.4 %), whereas histological progression in 3/57 (5.3 %) and other malignant neoplasms in 17/57 (29.8 %) were found. Lymphoma without subtype specification was diagnosed in 6/57 (10.5 %), and no conclusive diagnosis could be established in 4/57 cases (7 %). Overall diagnostic accuracy was 82.5 %. In patients with a final diagnosis of malignant lymphoma, accuracy was 75 %. No complications occurred. Percutaneous CT-guided CNB is a safe, effective and reliable tool in the management of patients with refractory or recurrent lymphomas without superficial lymphadenopathy and can be considered as alternative to surgical sampling.

  17. Probing the properties of relic neutrinos using the cosmic microwave background, the Hubble Space Telescope and galaxy clusters (United States)

    Nunes, Rafael C.; Bonilla, Alexander


    We investigate the observational constraints on the cosmic neutrino background (CNB) given by the extended ΛCDM scenario (ΛCDM + N_eff + \\sum m_{ν } + c^2_eff + c^2_vis + ξ _{ν }) using the latest observational data from the cosmic microwave background (CMB) as observed by Planck (i.e. temperature power spectrum, low-polarization and lensing reconstruction), baryon acoustic oscillations (BAOs), the new recent local value of the Hubble constant from the Hubble Space Telescope (HST) and information on the abundance of galaxy clusters (GCs). We study the constraints on the CNB background using CMB + BAO + HST data with and without the GC data. We find ΔNeff = 0.614 ± 0.26 at the 68 per cent confidence level when the GC data are added to the analysis. We do not find any significant deviation for sound speed in the CNB rest frame. We also analyse the particular case ΛCDM +Neff + ∑mν + ξν with the observational data. Within this scenario, we find ΔNeff = 0.60 ± 0.28 at the 68 per cent confidence level. In both scenarios, no mean deviations are found for the degeneracy parameter.

  18. Laparoscopic and Percutaneous Core Needle Biopsy Plays a Central Role for the Diagnosis of Autoimmune Pancreatitis in a Single-Center Study from Denmark

    DEFF Research Database (Denmark)

    Detlefsen, Sönke; Mortensen, Michael Bau; Kjærulf Pless, Torsten


    organ involvement was observed in 40% of type 1 and 13% of type 2, but inflammatory bowel disease only in type 2 (P = 0.001). One patient had IgG4-related chronic perisplenitis as a hitherto undescribed manifestation of IgG4-related disease. Nineteen (91%) of 21 biopsied patients had diagnostic CNB...... Hospital from 2007 to 2013 were included (n = 30; mean follow-up, 26.2 months). Data from laparoscopic or percutaneous ultrasound-guided core needle biopsy (CNB), resection specimens, endoscopic ultrasound (EUS), EUS-guided CNB, computed tomography, serum immunoglobulin G4 (IgG4), and pancreatography were...... retrospectively analyzed according to ICDC. RESULTS: Twenty patients were diagnosed with type 1, 8 with type 2, and 2 with not otherwise specified AIP. Twenty-eight patients (93%) could correctly be classified when ICDC were retrospectively applied. Serum IgG4 was elevated in 44% of type 1 and 0% of type 2. Other...

  19. Solid state synthesis, crystal growth and optical properties of urea and p-chloronitrobenzene solid solution

    Energy Technology Data Exchange (ETDEWEB)

    Rai, R.N., E-mail: [Department of Chemistry, Centre of Advanced Study, Banaras Hindu University, Varanasi 221005 (India); Kant, Shiva; Reddi, R.S.B. [Department of Chemistry, Centre of Advanced Study, Banaras Hindu University, Varanasi 221005 (India); Ganesamoorthy, S. [Materials Science Group, Indira Gandhi Centre for Atomic Research, Kalpakkam 603102, Tamilnadu (India); Gupta, P.K. [Laser Materials Development & Devices Division, Raja Ramanna Centre for Advanced Technology, Indore 452013 (India)


    Urea is an attractive material for frequency conversion of high power lasers to UV (for wavelength down to 190 nm), but its usage is hindered due to its hygroscopic nature, though there is no alternative organic NLO crystal which could be transparent up to 190 nm. The hygroscopic character of urea has been modified by making the solid solution (UCNB) of urea (U) and p-chloronitrobenzene (CNB). The formation of the solid solution of CNB in U is explained on the basis of phase diagram, powder XRD, FTIR, elemental analysis and single crystal XRD studies. The solubility of U, CNB and UCNB in ethanol solution is evaluated at different temperatures. Transparent single crystals of UCNB are grown from its saturated solution in ethanol. Optical properties e.g., second harmonic generation (SHG), refractive index and the band gap for UCNB crystal were measured and their values were compared with the parent compounds. Besides modification in hygroscopic nature, UCNB has also shown the higher SHG signal and mechanical hardness in comparison to urea crystal. - Highlights: • The hygroscopic character of urea was modified by making the solid solution • Solid solution formation is support by elemental, powder- and single crystal XRD • Crystal of solid solution has higher SHG signal and mechanical stability. • Refractive index and band gap of solid solution crystal have determined.

  20. Ultrasound assisted arylation of benzyl alcohol with 4-nitrochlorobenzene under a new multi-site phase-transfer catalyst in solid-liquid condition. (United States)

    Selvaraj, Varathan; Abimannan, Pachaiyappan; Rajendran, Venugopal


    The ultrasound assisted preparation of 1-(benzyloxy)-4-nitrobenzene from the reaction of 4-chloronitrobenzene (CNB) and benzyl alcohol was carried out successfully using potassium hydroxide and catalyzed by a new multi-site phase-transfer catalyst (MPTC) viz., 1,3,5-triethyl-1,3,5-trihexyl-1,3,5-triazinane-1,3,5-triium trichloride in a solid-liquid reaction condition (SL-MPTC). The advantage of using SL-MPTC is to avoid a serious hydration of potassium salt of benzyl alcohol in the reaction between 4-chloronitrobenzene (CNB) and benzyl alcohol. The reaction is greatly enhanced in the solid-liquid system, catalyzed by multi-site quaternary ammonium salt (MPTC) and ultrasound irradiation (40 kHz, 300 W) in a batch reactor, it shows that the overall reaction greatly enhanced with ultrasound irradiation than without ultrasound. The reaction mechanism is proposed and verified by examining the experimental evidence. A kinetic model is proposed in which a pseudo first-order rate law is sufficient to describe the results, such as the effects of agitation speed, ultrasound, different phase transfer catalysts and the effect of organic solvents, the amount of newly prepared MPTC, the effect of temperature, the amount of water, the concentration of 4-chloronitrobenzene (CNB) and potassium hydroxide concentrations. The apparent rate constant (kapp) were investigated in detail. Rational explanations to account for the phenomena on the results were made. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Altervalent cation-doped MCM-41 supported palladium catalysts and their catalytic properties

    Directory of Open Access Journals (Sweden)



    Full Text Available Metal cation-doped MCM-41 (M-MCM-41, M = Al, Ce, Co, V or Zr supported Pd catalysts (Pd/M-MCM-41 were prepared by a solution-based reduction method. The catalysts were characterized by X-ray diffraction (XRD analysis, infrared spectroscopy (IR, scanning electron microscopy (SEM and transmission electron microscopy (TEM, and further evaluated by selective hydrogenation of para-chloronitrobenzene (p-CNB in anhydrous ethanol. The metal cation-containing Pd catalysts can efficiently enhance the selectivity for para-chloroaniline (p-CAN. The highest selectivity of 96.5 % in the molar distribution for p-CNB to p-CAN was acquired over Pd (1.8 wt. %/V-MCM-41 (Si/V = 30, molar ratio catalyst, and the corresponding turnover frequency (TOF was 1.24×10-2 mol p-CNB mol-1 Pd s-1. Water molecules adsorbed by the support have important effects on both the catalytic activity of the sample and the selectivity for p-CAN. A water molecule-mediated catalytic hydrogenation is discussed.

  2. Metabolomics of Breast Cancer Using High-Resolution Magic Angle Spinning Magnetic Resonance Spectroscopy: Correlations with 18F-FDG Positron Emission Tomography-Computed Tomography, Dynamic Contrast-Enhanced and Diffusion-Weighted Imaging MRI.

    Directory of Open Access Journals (Sweden)

    Haesung Yoon

    Full Text Available Our goal in this study was to find correlations between breast cancer metabolites and conventional quantitative imaging parameters using high-resolution magic angle spinning (HR-MAS magnetic resonance spectroscopy (MRS and to find breast cancer subgroups that show high correlations between metabolites and imaging parameters.Between August 2010 and December 2013, we included 53 female patients (mean age 49.6 years; age range 32-75 years with a total of 53 breast lesions assessed by the Breast Imaging Reporting and Data System. They were enrolled under the following criteria: breast lesions larger than 1 cm in diameter which 1 were suspicious for malignancy on mammography or ultrasound (US, 2 were pathologically confirmed to be breast cancer with US-guided core-needle biopsy (CNB 3 underwent 3 Tesla MRI with dynamic contrast-enhanced (DCE and diffusion-weighted imaging (DWI and positron emission tomography-computed tomography (PET-CT, and 4 had an attainable immunohistochemistry profile from CNB. We acquired spectral data by HR-MAS MRS with CNB specimens and expressed the data as relative metabolite concentrations. We compared the metabolites with the signal enhancement ratio (SER, maximum standardized FDG uptake value (SUV max, apparent diffusion coefficient (ADC, and histopathologic prognostic factors for correlation. We calculated Spearman correlations and performed a partial least squares-discriminant analysis (PLS-DA to further classify patient groups into subgroups to find correlation differences between HR-MAS spectroscopic values and conventional imaging parameters.In a multivariate analysis, the PLS-DA models built with HR-MAS MRS metabolic profiles showed visible discrimination between high and low SER, SUV, and ADC. In luminal subtype breast cancer, compared to all cases, high SER, ADV, and SUV were more closely clustered by visual assessment. Multiple metabolites were correlated with SER and SUV in all cases. Multiple metabolites

  3. The reliability of ultrasound-guided core needle biopsy in the evaluation of non-palpable solid breast lesions using 18-gauge needles

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Sung Chul; Kim, Young Sook [Chosun University College of Medicine, Gwangju (Korea, Republic of); Sneige, Nour [The University of Texas M.D. Andreson Carcer Canter, Houston (United States)


    Ultrasound-guided core needle biopsy (US CNB) is increasingly used in the histologic evaluation of non-palpable solid breast lesions. We retrospectively investigated the diagnostic accuracy of this technique, using an 18-gauge needle in 422 non-palpable breast lesions. 583 female patients with an average age 56 (range, 22-90) years underwent 590 US CNBs. Between January 1994 and December 1999, using 18-gauge needles, an average of four cores per lesion was obtained. Three hundred and eighty-five lesions were subsequently surgically excised; for 14 of these, the pathologic diagnosis was breast carcinoma metastasis, while 23 with benign diagnoses were clinically followed up for {>=}2.5 years and were considered for analysis. Of the 422 lesions, 340 (80.6%) were malignant [308 invasive, 24 ductal carcinoma in situ (DCIS), 7 DCIS with undetermined invasion and 1 DCIS vs. lobular carcinoma in situ], 67 (15.9%) were benign [30 fibroadenoma (FA) and 37 other diagnoses], and five (1.2%) were fibroepithelial lesions. The remaining ten samples (2,4%) included six cases of atypical ductal hyperplasia (ADH), two of atypical hyperplasia (AH), and two of lobular neoplasia. The sensitivity, specificity, positive predictive value, and negative predictive value of CNBs were 99%, 100%, 100%, and 96%, respectively. Two cases of invasive carcinoma were missed at CNB; there was no false-positive diagnosis. Five of six ADHs and one of two AHs were found to be carcinomas (3 DCIS and 3 infiltrating duct carcinomas). Sixteen of 24 (66.7%) cases of DCIS were found at excision to be invasion carcinomas. Of 31 FAs, two (6.5%) were found to be low-grade phyllodes tumor (PT). The five fibroepithelial lesions were shown at excision to be either PT (n=4) or FA (n=1). US CNB using an 18-gauge needle is a safe and reliable means of diagnosing breast carcinoma. Because of the high prevalence of ductal carcinoma is these lesions; findings of ADH/AH at US CNB indicate that surgical excision is needed

  4. Iatrogenic streptococcus salivarius meningitis: a case report

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    Kristina Praper


    Full Text Available We present a case of a 28-year-old patient who underwent spinal anaesthesia for caesarean section, and developed meningitis, Streptococcus salivarius was isolated in the cerebrospinal fluid. The Viridans streptococci are a part of a normal human mouth flora, therefore the patient most likely developed iatrogenic meningitis due to droplet transmission of bacteria intrathecally. We discuss etiology, pathogenesis, clinical presentation, diagnostic tools, treatment and prognosis of meningitis afer intrathecal procedures and we emphasize the importance of strict aseptic technique while performing neuraxial procedures. Iatrogenic meningitis should be considered as a possible differential diagnosis in patients who present with symptoms and signs of meningitis after neuraxial blockade.

  5. Current Status of Obstetric Anaesthesia: Improving Satisfaction and Safety

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    J Sudharma Ranasinghe


    Full Text Available The Centers for Disease Control and Prevention (CDC reported in 2003 that although the maternal mortal-ity rate has decreased by 99% since 1900, there has been no further decrease in the last two decades [1] . A more recent report indicates a rate of 11.8 per 100,000 live births [2] , although anaesthesia-related maternal mortality and morbidity has considerably decreased over the lastfew decades. Despite the growing complexity of problems and increasing challenges such as pre-existing maternal disease, obesity, and the increasing age of pregnant mothers, anaesthesia related maternal mortality is extremely rare in the developed world. The current safety has been achievedthrough changes in training, service, technical advances and multidisciplinary approach to care. The rates of general anaesthesia for cesarean delivery have decreased and neuraxial anaesthetics have become the most commonly used techniques. Neuraxial techniques are largely safe and effective, but potential complications, though rare, can be severe.

  6. Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

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    Clark K. Choi


    Full Text Available Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

  7. Temperature Monitoring and Perioperative Thermoregulation (United States)

    Sessler, Daniel I.


    Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature measuring sites are completely non-invasive and easy to use — especially in patients not having general anesthesia. Nonetheless, temperature can be reliably measured in most patients. Body temperature should be measured in patients having general anesthesia exceeding 30 minutes in duration, and in patients having major operations under neuraxial anesthesia. Core body temperature is normally tightly regulated. All general anesthetics produce a profound dose-dependent reduction in the core temperature triggering cold defenses including arterio-venous shunt vasoconstriction and shivering. Anesthetic-induced impairment of normal thermoregulatory control, and the resulting core-to-peripheral redistribution of body heat, is the primary cause of hypothermia in most patients. Neuraxial anesthesia also impairs thermoregulatory control, although to a lesser extant than general anesthesia. Prolonged epidural analgesia is associated with hyperthermia whose cause remains unknown. PMID:18648241


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    Full Text Available Complex Regional Pain Syndrome or CRPS is a chronic disabling heterogenous pain disorder due to trauma, resulting in sensory changes, motor function impairment, psychological changes. Diagnosis is based on clinical features and investigations. The patho - physiology is not clearly known. There is no single drug therapy, only combinations work. Treatment is multidisplinary involving medical, psychological and rehabi li tation. Newer modes of spinal cord stimulations, neuraxial mode of analgesics and newe r drugs are promising

  9. Cell Proliferation in the Forebrain and Midbrain of the Adult Bullfrog, Rana catesbeiana


    Simmons, Andrea Megela; Horowitz, Seth S.; Brown, Rebecca A.


    The distribution of proliferating cells in the midbrain, thalamus, and telencephalon of adult bullfrogs (Rana catesbeiana) was examined using immunohistochemistry for the thymidine analog 5-bromo-2′-deoxyuridine (BrdU) and DNA dot-blotting. At all time points examined (2 to 28 days post-injection), BrdU-labeled cells were located in ventricular zones at all levels of the neuraxis, but with relatively more label around the telencephalic ventricles. Labeled cells, some showing profiles indicati...

  10. Remote neuroimmune signaling: a long-range mechanism of nociceptive network plasticity. (United States)

    Saab, Carl Y; Hains, Bryan C


    Chronic pain secondary to neuronal injury is actively and continuously modulated at multiple locations along the sensory neuraxis. Here, we describe how nociceptive neurons of the spinal cord and thalamus process and communicate nociceptive information in terms of precisely calibrated firing patterns. We then discuss how several cell types with immunogenic properties (e.g. blood cells and glia) cause system-wide interference in nociceptive processing through novel signaling schema, thus contributing to nociceptive network plasticity and chronic pain.

  11. A Survey of Perioperative and Postoperative Anesthetic Practices for Cesarean Delivery

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    Leinani Aiono-Le Tagaloa


    Full Text Available The aim of this survey was to review cesarean delivery anesthetic practices. An online survey was sent to members of the Society of Obstetric Anesthesia and Perinatology (SOAP. The mode of anesthesia, preferred neuraxial local anesthetic and opioid agents, postoperative analgesic regimens, and monitoring modalities were assessed. 384 responses from 1,081 online survey requests were received (response rate = 36%. Spinal anesthesia is most commonly used for elective cesarean delivery (85% respondents, with 90% of these respondents preferring hyperbaric bupivacaine 0.75%. 79% used intrathecal fentanyl and 77% used morphine (median [range] dose 200 mcg [50–400]. 91% use respiratory rate, 61% use sedation scores, and 30% use pulse oximetry to monitor for postoperative respiratory depression after administration of neuraxial opioids. Postoperative analgesic regimens include: nonsteroidal anti-inflammatory agents, acetaminophen, oxycodone, and hydrocodone by 81%, 45%, 25%, and 27% respondents respectively. The majority of respondents use spinal anesthesia and neuraxial opioids for cesarean delivery anesthesia. There is marked variability in practices for monitoring respiratory depression postdelivery and for providing postoperative analgesia. These results may not be indicative of overall practice in the United States due to the select group of anesthesiologists surveyed and the low response rate.

  12. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D


    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  13. A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients. (United States)

    Marcus, Norman J; Shrikhande, Allyson Augusta; McCarberg, Bill; Gracely, Edward


    To assess the effectiveness of a muscle protocol to treat patients diagnosed with neuraxial low back pain (LBP) before and after invasive treatments. Patients with chronic (>6 months) LBP-postinvasive treatment and pre-spine surgery-were assessed and treated. An electrical device rather than palpation was used to determine muscle(s) as possible sources of pain. Patients testing positive for muscle pain were treated with a comprehensive protocol and were followed for >3 months to determine the effect of treatment on pain severity and interference in function. Study 1: In 56 (postinvasive treatment) patients who had failed back surgery, epidural steroid injections, facet blocks, and/or trigger point injections, mean Brief Pain Inventory (BPI) pain severity dropped from 5.54 at baseline to 3.96 (P muscle protocol, canceled their surgeries, and obtained significant relief at the 16-19 month follow-up point. In patients thought to have neuraxial pain, identification and treatment of painful muscles had statistically significant long-lasting and clinically meaningful reductions in pain and improvement in function. Muscle and tendon attachments may be an important and treatable source of pain in patients diagnosed with pre and postsurgical neuraxial pain. Wiley Periodicals, Inc.

  14. The use of pain relief during labor among migrant obstetric populations. (United States)

    Husarova, Viera; Macdarby, Laura; Dicker, Patrick; Malone, Fergal D; McCaul, Conan L


    To identify patterns in intrapartum analgesia use in the migrant obstetric population. A retrospective analysis included all deliveries with neonates above 500g in weight at a university hospital in Dublin, Ireland between 2009 and 2013. Analgesia was classified as neuraxial or non-neuraxial. Parturients were excluded owing to missing data, elective cesarean deliveries, and the use of analgesia during treatment for obstetric complications. There were 36 689 deliveries included in the present study. Increased odds of not using neuraxial analgesia during delivery were observed among migrant parturients from North Africa, Sub-Saharan Africa, the Far East, India, and Eastern Europe compared with western Europe (all PNorth Africa, Sub-Saharan Africa, the Far East, North America, Eastern Europe, and India compared with western Europe (all Pmigrant and western European populations in Ireland. Migrants from Africa were the least likely to use any analgesia. The reasons for this are speculative but could be influenced by expectations of care in the region of origin. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  15. Practice effects distort translational validity estimates for a Neurocognitive Battery. (United States)

    Ibrahim, Ibtihal; Tobar, Salwa; Elassy, Mai; Mansour, Hader; Chen, Kehui; Wood, Joel; Gur, Ruben C; Gur, Raquel E; El Bahaei, Wafaa; Nimgaonkar, Vishwajit


    With the globalization of biomedical research and the advent of "precision medicine," there is increased need for translation of neuropsychological tests, such as computerized batteries that can be incorporated in large-scale genomic studies. Estimates of translational validity are obtained by administering the test in the original and the translated versions to bilingual individuals. We investigated the translation of a neuropsychological battery from English to Arabic and how practice effects influence translational validity estimates. The Penn computerized neurocognitive battery (Penn CNB) includes tests that were validated with functional neuroimaging and provides measures of accuracy and speed of performance in several cognitive domains. To develop an Arabic version of the CNB, the English version was translated into Arabic, then back translated and revised. The Arabic and the original English versions were administered in a randomized crossover design to bilingual participants (N = 22). Performance varied by cognitive domain, but generally improved at the second session regardless of the language of the initial test. When performance on the English and Arabic version was compared, significant positive correlations were detected for accuracy in 8/13 cognitive domains and for speed in 4/13 domains (r = .02 to .97). When the practice estimates using linear models were incorporated, the translational validity estimates improved substantially (accuracy, r = .50-.96, speed, r = .63-.92, all correlations, p = .05 or better). While crossover designs control for order effects on average performance, practice effects, regardless of language, still need to be removed to obtain estimates of translational validity. When practice effect is controlled for, the Arabic and English versions of the Penn-CNB are well correlated, and the Arabic version is suitable for use in research.

  16. Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: Preoperative predictors of invasive breast cancer

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    Park, Ah Young; Gweon, Hye Mi; Son, Eun Ju; Yoo, Miri; Kim, Jeong-Ah; Youk, Ji Hyun, E-mail:


    Objectives: To identify preoperative features that could be used to predict invasive breast cancer in women with a diagnosis of ductal carcinoma in situ (DCIS) at ultrasound (US)-guided 14-gauge core needle biopsy (CNB). Methods: A total of 86 DCIS lesions that were diagnosed at US-guided 14-gauge CNB and excised surgically in 84 women were assessed. We retrospectively reviewed the patients’ medical records, mammography, US, and MR imaging. We compared underestimation rates of DCIS for the collected clinical and radiologic variables and determined the preoperative predictive factors for upstaging to invasive cancer. Results: Twenty-seven (31.4%) of 86 DCIS lesions were upgraded to invasive cancer. Preoperative features that showed a significantly higher underestimation of DCIS were palpability or nipple discharge (p = 0.040), number of core specimens less than 5 (p = 0.011), mammographic maximum lesion size of 25 mm or larger (p = 0.022), mammographic mass size of 40 mm or larger (p = 0.046), sonographic mass size of 32 mm or larger (p = 0.009), lesion size of 30 mm on MR (p = 0.004), lower signal intensity (SI) on fat-saturated T2-weighted MR images (FS-T2WI) (p = 0.005), heterogeneous or rim enhancement on MR images (p = 0.009), and apparent diffusion coefficient (ADC) values lower than 1.04 × 10{sup −3} mm{sup 2}/s on diffusion-weighted MR imaging (DWI) (p < 0.001). Conclusion: Clinical symptom of palpability or nipple discharge, number of core specimen, mammographic maximum lesion or mass size, SI on FS-T2WI, heterogeneous or rim enhancement on MR, and ADC value may be helpful in predicting the upgrade to invasive breast cancer for DCIS diagnosed at US-guided 14-gauge CNB.

  17. Comparison of HER2 and phospho-HER2 expression between biopsy and resected breast cancer specimens using a quantitative assessment method.

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    Yalai Bai

    Full Text Available BACKGROUND: HER2/Neu (ErbB-2 overexpression, which occurs in 15-20% of breast cancer cases, is associated with better response to treatment with the drug trastuzumab. PhosphoHER2 (pHER2 has been evaluated for prediction of response to trastuzumab. Both markers are heterogeneously detected and are potentially subject to loss as a consequence of delayed time to fixation. Here, we quantitatively assess both markers in core needle biopsies (CNBs and matched tumor resections to assess concordance between the core and the resection and between HER2 and pHER2. METHODS: A selected retrospective collection of archival breast cancer cases yielded 67 cases with both core and resection specimens. Both HER2 and pTyr(1248HER2 were analyzed by the AQUA® method of quantitative immunofluorescence on each specimen pair. RESULTS: Both HER2 immunoreactivity (P<0.0001 and pTyr(1248HER2 immunoreactivity (P<0.0001 were lower in resections relative to CNB specimens. However, clinical implications of this change may not be evident since no case changed from 3+ (CNB to negative (resection. Assessment of pTyr(1248HER2 showed no direct correlation with HER2 in either CNB or resection specimens. CONCLUSIONS: The data suggest that measurement of both HER2 and phospho- Tyr(1248HER2, in formalin-fixed tissue by immunological methods is significantly affected by pre-analytic variables. The current study warrants the adequate handling of resected specimens for the reproducible evaluation of HER2 and pHER2. The level of pTyr(1248HER2, was not correlated to total HER2 protein. Further studies are required to determine the significance of these observations with respect to response to HER2 directed therapies.

  18. Crystal structure of triaqua(4-cyanobenzoato-κ2O,O′(nicotinamide-κN1zinc 4-cyanobenzoate

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    Gülçin Şefiye Aşkın


    Full Text Available The asymmetric unit of the title salt, [Zn(C8H4NO2(C6H6N2O(H2O3](C8H4NO2, contains one complex cation and one 4-cyanobenzoate (CNB counter-anion. The ZnII atom in the cation is coordinated by one 4-cyanobenzoate ligand, one nicotinamide (NA ligand and three water molecules, the CNB anion thereby coordinating in a bidentate O,O′-mode through the carboxylate group. The latter, together with one water O atom and the N atom of the NA ligand, form a distorted square-planar arrangement, while the considerably distorted octahedral coordination sphere of the ZnII atom is completed by the two O atoms of additional water molecules in the axial positions. The dihedral angles between the planar carboxylate groups and the adjacent benzene rings in the two anions are 10.25 (10 and 5.89 (14°. Intermolecular O—H...O hydrogen bonds link two of the coordinating water molecules to two free CNB anions. In the crystal, further hydrogen-bonding interactions are present, namely N—H...O, O—H...O and C—H...O hydrogen bonds that link the molecular components, enclosing R22(12, R33(8 and R33(9 ring motifs and forming layers parallel to (001. π–π contacts between benzene rings [centroid-to-centroid distances = 3.791 (1 and 3.882 (1 Å] may further stabilize the crystal structure.

  19. Assessment of EGFR and KRAS mutation status from FNAs and core-needle biopsies of non-small cell lung cancer. (United States)

    Lozano, Maria D; Labiano, Tania; Echeveste, Jose; Gurpide, Alfonso; Martín-Algarra, Salvador; Zhang, Guili; Sharma, Abha; Palma, John F


    Molecular testing to determine gene mutation status is now the recommended standard of care for patients with advanced or metastatic Non-small cell lung cancer (NSCLC). Because the majority of patients with NSCLC present with metastatic disease, minimally invasive procedures are necessary for diagnosis, staging, and molecular analysis. However, the resulting samples have perceived limitations in the oncology community, and most commercially available tests have not been validated for these sample types. The current study was undertaken to assess the feasibility of determining epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status in fine-needle aspirates (FNAs) and core-needle biopsies (CNBs) after staining with Papanicolaou or hematoxylin and eosin, respectively. Gene mutation status was determined in 140 NSCLC tumor samples with proprietary tests for EGFR and KRAS mutations (cobas tests) followed by Sanger sequencing of exons 18 through 21 of the EGFR gene and exon 2 of the KRAS gene. The results were analyzed based on FNA (n = 91) or CNB (n = 49) sampling. The cobas tests yielded valid results in the majority of FNA and CNB samples for both EGFR (97.9%) and KRAS (93.6%). Moreover, valid results were obtained for 90% of samples that had DNA concentrations below the values recommended by the manufacturer. For samples with valid results from both cobas testing and Sanger sequencing, 95.7% and 93% agreement were observed for EGFR status and KRAS status, respectively. Gene mutation testing can be successfully performed on cytology and CNB samples, expanding the potential of personalized cancer treatment to patients who have limited tissue samples. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.


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    Gabriela Rueda Martínez


    Full Text Available El presente trabajo objetiva sustentar teóricamente el impacto de la ausencia del Consejo Nacional de Bioética (CNB en la normatividad sobre investigación en seres humanos de Colombia (Resolución 8430/1993 del Ministerio de Salud. Para tal fin, fue dividido el abordaje del tema en tres partes: la primera trata sobre la experiencia previa del país en relación con la implementación del CNB; la segunda revisa la normatividad colombiana actual sobre experimentación en humanos, y la tercera analiza críticamente el contenido de la resolución referida. En Colombia, los debates sobre temas que exigen la reflexión bioética se dan a nivel del Estado, sin la asesoría de un consejo nacional de bioética que facilite una orientación desde dicha perspectiva. Por esta razón, es urgente la reglamentación de la Ley 1374/2010 que crea el CNB; además, considerando la protección de los sujetos participantes de las investigaciones, es pertinente que la bioética en Colombia transforme su fundamentación epistemológica, adoptando referenciales bioéticos consonantes con su realidad social. Por lo tanto, se propone la Declaración Universal sobre Bioética y Derechos Humanos de la Unesco como directriz bioética internacional de la investigación en seres humanos.

  1. Belief change

    CSIR Research Space (South Africa)

    Booth, R


    Full Text Available and the area of nonmonotonic reasoning, while Section 8 takes a brief look at recent developments in belief change. Finally, we conclude in Section 9. 2 Preliminaries First the logical framework. We start with a quite abstract formulation (L,Cn), where we... just have a set L whose elements are the sentences, together with a consequence operator Cn which takes sets of sentences B ? L to sets of sentences Cn(B) which intuitively represents all the sentences which are entailed by B. Cn is assumed to be a...

  2. Accelerated inactivation of the L-type calcium current due to a mutation in CACNB2b underlies Brugada syndrome

    DEFF Research Database (Denmark)

    Cordeiro, Jonathan M; Marieb, Mark; Pfeiffer, Ryan


    S in which loss of function is caused by accelerated inactivation of I(Ca). The proband, a 32 year old male, displayed a Type I ST segment elevation in two right precordial ECG leads following a procainamide challenge. EP study was positive with induction of polymorphic VT/VF. Interrogation of implanted ICD...... significantly faster in mutant channels between 0 and + 20 mV. Action potential voltage clamp experiments showed that total charge was reduced by almost half compared to WT. We report the first BrS mutation in CaCNB2b resulting in accelerated inactivation of L-type calcium channel current. Our results suggest...

  3. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape. (United States)

    Masood, Shahla; Rosa, Marilin; Kraemer, Dale F; Smotherman, Carmen; Mohammadi, Amir


    Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis. After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined. Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most

  4. VizieR Online Data Catalog: SDSS Stripe 82 VLA 1-2GHz survey (Heywood+, 2016) (United States)

    Heywood, I.; Jarvis, M. J.; Baker, A. J.; Bannister, K. W.; Carvalho, C. S.; Hardcastle, M.; Hilton, M.; Moodley, K.; Smirnov, O. M.; Smith, D. J. B.; White, S. V.; Wollack, E. J.


    The data (Project code: 13B-272) were taken with the array in the CnB configuration. Standard wide-band mode was employed with the correlator splitting the 1-2GHz of frequency coverage into 16 spectral windows (SPWs) with 64x1MHz channels each, and an integration time per visibility point of 3s. A total of 1368 target pointings were scheduled, 608 and 760 in the eastern and western regions, respectively, coincident with the two eastern and western areas of the existing Hodge et al. (2011, Cat. J/AJ/142/3) data. (2 data files).

  5. Synergistic Effect of Fluconazole and Calcium Channel Blockers against Resistant Candida albicans.

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    Shuyuan Liu

    Full Text Available Candidiasis has increased significantly recently that threatens patients with low immunity. However, the number of antifungal drugs on the market is limited in comparison to the number of available antibacterial drugs. This fact, coupled with the increased frequency of fungal resistance, makes it necessary to develop new therapeutic strategies. Combination drug therapy is one of the most widely used and effective strategy to alleviate this problem. In this paper, we were aimed to evaluate the combined antifungal effects of four CCBs (calcium channel blockers, amlodipine (AML, nifedipine (NIF, benidipine (BEN and flunarizine (FNZ with fluconazole against C. albicans by checkerboard and time-killing method. In addition, we determined gene (CCH1, MID1, CNA1, CNB1, YVC1, CDR1, CDR2 and MDR1 expression by quantitative PCR and investigated the efflux pump activity of resistant candida albicans by rhodamine 6G assay to reveal the potential mechanisms. Finally, we concluded that there was a synergy when fluconazole combined with the four tested CCBs against resistant strains, with fractional inhibitory concentration index (FICI <0.5, but no interaction against sensitive strains (FICI = 0.56 ~ 2. The mechanism studies revealed that fluconazole plus amlodipine caused down-regulating of CNA1, CNB1 (encoding calcineurin and YVC1 (encoding calcium channel protein in vacuole membrane.

  6. [Synchronous and ipsilateral invasive ductal carcinoma of the breast occurring near a phyllodes tumor - a case report]. (United States)

    Nagashima, Saki; Sakurai, Kenichi; Suzuki, Shuhei; Sakagami, Masashi; Enomoto, Katsuhisa; Amano, Sadao; Koshinaga, Tsugumichi


    We report 2 cases of invasive ductal carcinoma of the breast occurring near a phyllodes tumor. The first case was ofa 58- year-old woman who had a tumor in her right breast and visited our hospital. Following a core needle biopsy (CNB), a malignant phyllodes tumor was diagnosed. We performed a lumpectomy for the phyllodes tumor, with 1.5-cm surgical margins. Pathological diagnosis of the resected specimen confirmed the malignant phyllodes tumor. A ductal carcinoma in situ (DCIS) was also discovered near the phyllodes tumor. The second case was of another 58-year-old woman who had a big tumor in her right breast and visited our hospital. CNB resulted in pathological diagnosis ofa benign phyllodes tumor. The tumor was removed by a lumpectomy with 1.5-cm surgical margins. The pathological diagnosis from the resected specimen was borderline phyllodes tumor with invasive ductal carcinoma in the proximity. In both cases, DCIS could not have been diagnosed preoperatively.

  7. Synergistic Effect of Fluconazole and Calcium Channel Blockers against Resistant Candida albicans (United States)

    Liu, Shuyuan; Yue, Longtao; Gu, Wenrui; Li, Xiuyun; Zhang, Liuping; Sun, Shujuan


    Candidiasis has increased significantly recently that threatens patients with low immunity. However, the number of antifungal drugs on the market is limited in comparison to the number of available antibacterial drugs. This fact, coupled with the increased frequency of fungal resistance, makes it necessary to develop new therapeutic strategies. Combination drug therapy is one of the most widely used and effective strategy to alleviate this problem. In this paper, we were aimed to evaluate the combined antifungal effects of four CCBs (calcium channel blockers), amlodipine (AML), nifedipine (NIF), benidipine (BEN) and flunarizine (FNZ) with fluconazole against C. albicans by checkerboard and time-killing method. In addition, we determined gene (CCH1, MID1, CNA1, CNB1, YVC1, CDR1, CDR2 and MDR1) expression by quantitative PCR and investigated the efflux pump activity of resistant candida albicans by rhodamine 6G assay to reveal the potential mechanisms. Finally, we concluded that there was a synergy when fluconazole combined with the four tested CCBs against resistant strains, with fractional inhibitory concentration index (FICI) fluconazole plus amlodipine caused down-regulating of CNA1, CNB1 (encoding calcineurin) and YVC1 (encoding calcium channel protein in vacuole membrane). PMID:26986478

  8. Identity and status of the Italian National Bioethics Committee: contrasting paradigms (1990-2006). (United States)

    Incorvati, Giovanni


    So far the activities of the Comitato Nazionale per la Bioetica (CNB) have been subject to desultory and fragmentary analyses, stuck to the paradigm (in the way Kuhn means it) which claims the division between the issues of "frontier bioethics" and those of "everyday bioethics" (and between the respective types of communication). According to the above mentioned paradigm, bioethics should just deal with the problems coming from the application of technological progress to extreme cases (which imply a type of communication internal to the scientific communities), and only subordinately with other issues, even if of a more general interest and widespread public involvement. Nonetheless, in the last years another paradigm has come out and it is emphasizing the importance of the interaction between the two models of bioethics and of a type of external communication not just limited to the scientific communities in the strict sense of the word, but based on "open opinions ". The present notes are supposed to be an introduction to a historical comprehension of the CNB activity and of its impact, in the light of the rising of the new paradigm and of the Italian adherence to the Oviedo Convention of the Council of Europe.

  9. Morpholine-Modified Pd/γ-Al2O3@ASMA Pellet Catalyst with Excellent Catalytic Selectivity in the Hydrogenation of p-Chloronitrobenzene to p-Chloroaniline

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    Wei Wang


    Full Text Available An amino poly (styrene-co-maleic anhydride polymer (ASMA encapsulated γ-Al2O3 pellet material has been synthesized successfully. After loading with Pd species and modified with morpholine, the inorganic-organic hybrid material shows an excellent catalytic property in the selective hydrogenation of p-chloronitrobenzene (p-CNB to p-chloroaniline (p-CAN. In this procedure, morpholine can connect with the polymer layer in a form of amide bond and acts as an unparalleled immobilized dechlorination inhibitor, which can avoid further dechlorination efficiently and keeps stability due to the repulsive effect from the surviving C-O-C bond. The catalyst as prepared was characterized by using XRD, TGA, SEM, TEM, FT-IR, and ICP-OES, and it was further tested in the selective hydrogenation of p-CNB. It shows a supreme catalytic activity (almost 100% and selectivity (up to 99.51% after recycling for even 10 times, much superior to the blank alumina supported palladium (47.09%.

  10. The reliability of histological grade in breast cancer core needle biopsies depends on biopsy size: a comparative study with subsequent surgical excisions. (United States)

    Focke, Cornelia M; Decker, Thomas; van Diest, Paul J


    In breast cancer patients undergoing neoadjuvant chemotherapy, histological grading needs to be performed on core needle biopsies (CNBs) that may not be representative of the whole tumour when they are small. Our aim was to study the influence of biopsy size on agreement rates for histological grade between CNBs and subsequent surgical excision biopsies (SEBs). We calculated agreement and Cohen's κ between CNBs and SEBs of 300 early-stage breast cancers. The number of cores, total core length, total tumour length and tumour/tissue ratio were assessed for each CNB set. Agreement rates for grade were calculated for different classes of core number and tumour/tissue ratio, and for total core lengths and tumour lengths per CNB set in 5-15-mm intervals. Agreement on grade between CNBs and SEBs was 73% (κ = 0.59), with underestimation of grade in CNBs in 26% of cases and overestimation in 1% of cases. There was significantly higher concordance between CNBs and SEBs at a total core length of ≥50 mm than at a total core length of cores than at fewer than three cores (75% versus 58% agreement, P = 0.048). The tumour/tissue ratio, pathological tumour size and radiological tumour size were not statistically different between concordant and discordant cases. Agreement rates for histological grade in CNBs versus SEBs improve with increasing biopsy sample size. © 2016 John Wiley & Sons Ltd.

  11. The determinants of exchange rate in Croatia

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    Manuel BENAZIC


    Full Text Available The dilemma for every country with an independent monetary policy is which kind of exchange rate arrangement should be applied. Through the exchange rate policy, countries can influence their economies, i.e. price stability and export competiveness. Croatia is a new EU member state, it has its own monetary policy and currency but it is on the way to euro introduction. Regarding the experiences from the beginning of the 1990s when Croatia was faced with serious monetary instabilities and hyperinflation, the goal of Croatian National Bank (CNB is to ensure price stability and one way to do so is through exchange rate policy. Croatia, as a small and open economy, has applied a managed floating exchange rate regime. The exchange rate is determined primarily by the foreign exchange supply and demand on the foreign exchange market, with occasional market interventions by the CNB. Therefore, in order to maintain exchange rate stability, policymakers must be able to recognize how changes in these factors affect changes in the exchange rate. This research aims to find a relationship among the main sources of foreign currency inflow and outflow and the level of exchange rate in Croatia. The analysis is carried out by using the bounds testing (ARDL approach for co-integration. The results indicate the existence of a stable co-integration relationship between the observed variables, whereby an increase in the majority of variables leads to an exchange rate appreciation.

  12. Econometric Analysis of Croatia’s Proclaimed Foreign Exchange Rate

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    Mance Davor


    Full Text Available The officially proclaimed foreign exchange policy of the Croatian National Bank (CNB is a managed float with a discretionary right of intervention on the Croatian kuna/euro foreign exchange (FX market in order to maintain price stability. This paper examines the validity of three monetary policy hypotheses: the stability of the nominal exchange rate, the stability of exchange rate changes, and the exchange rate to inflation pass-through effect. The CNB claims a direct FX to inflation rate pass-through channel for which we find no evidence, but we find a strong link between FX rate changes and changes in M4, as well as between M4 changes and inflation. Changes in foreign investment Granger cause changes in monetary aggregates that further Granger cause inflation. Changes in FX rate Granger cause a reaction in M4 that indirectly Granger causes a further rise in inflation. Vector Autoregression Impulse Response Functions of changes in FX rate, M1, M4, and CPI confirm the Granger causalities in the established order.

  13. Operating unit time use is associated with anaesthesia type in below-knee surgery in adults. (United States)

    Lohela, T J; Chase, R P; Hiekkanen, T A; Kontinen, V K; Hynynen, M J


    Peripheral nerve blocks could reduce the operating unit and theatre time spent on high-risk patients who are particularly vulnerable to complications of general anaesthesia or have medications that prevent application of central neuraxial blocks. Medical record data of 617 and 254 elderly adults undergoing below-knee surgery in Jorvi and Meilahti hospitals (Helsinki University Hospital) between January 2010 and December 2012 were used to investigate the influence of anaesthetic technique on operating theatre times and on operating unit times using flexible parametric survival models. We report operating theatre and unit exit ratios (i.e. hazard ratios but using ratios of exit rates) for different types of anaesthesia. Adjusted analyses: In Jorvi Hospital, anaesthesia type was associated with large initial differentials in operating theatre times. The theatre exit ratios remained lower for general anaesthesia and central neuraxial blocks compared to peripheral nerve blocks until 30 min. In Meilahti Hospital, anaesthesia type did not influence theatre time, but was the best predictor of operating unit times. Compared to peripheral nerve blocks, the exit ratio remained lower for general anaesthesia until five operating unit hours in both hospitals and for central neuraxial blocks until 1 h in Meilahti Hospital and until 3 h in Jorvi Hospital. Holding area was used more in Jorvi Hospital compared to Meilahti Hospital. Peripheral nerve block anaesthesia reduces time spent in the operating unit and can reduce time spent in the operating theatre if induced in holding area outside of theatre. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. The timing of interventions during labour: descriptive results of a longitudinal study. (United States)

    Petersen, Antje; Ayerle, Gertrud M; Frömke, Cornelia; Hecker, Hartmut; Gross, Mechthild M


    To describe the timing and frequency of interventions during labour, and in addition to compare the timings of the interventions against the partogram action lines. Longitudinal prospective and retrospective cohort study. 47 Hospitals in Lower Saxony, Germany. 3963 Births of nulliparae and multiparae with singletons in vertex presentation giving birth between April and October 2005. The participation rate for the prospectively recruited sample (n = 1169) was 4.7%. Time intervals until intrapartal interventions were calculated by Kaplan-Meiers estimation. Outcome variables were duration of labour and mode of birth. Multiparae had slightly longer median time intervals between the onset of labour and the beginning of care by the midwife than nulliparae. With regard to the intervals between the onset of labour and the occurrence of interventions, multiparae had shorter median durations than nulliparae in respect of amniotomy, oxytocin augmentation and neuraxial analgesia. By three hours after onset of labour 8.4% of nulliparae had received oxytocin augmentation, 10.7% neuraxial analgesia and 8.9% an amniotomy. Of multiparae, 9.1% had received oxytocin augmentation but only 5.6% neuraxial analgesia; 20.0% had had an amniotomy. The median time interval before the initiation of water immersion and massage was between three and four hours; that before the initiation of vertical positioning was 1.8 hours. Current German practice without the use of partogram action lines reveals that early interventions were performed before the partogram action lines were met. Interventions applying midwifery care techniques such as vertical positioning preceded more invasive medical interventions during the process of childbirth. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Phantom limb pain: a case of maladaptive CNS plasticity? (United States)

    Flor, Herta; Nikolajsen, Lone; Staehelin Jensen, Troels


    Phantom pain refers to pain in a body part that has been amputated or deafferented. It has often been viewed as a type of mental disorder or has been assumed to stem from pathological alterations in the region of the amputation stump. In the past decade, evidence has accumulated that phantom pain might be a phenomenon of the CNS that is related to plastic changes at several levels of the neuraxis and especially the cortex. Here, we discuss the evidence for putative pathophysiological mechanisms with an emphasis on central, and in particular cortical, changes. We cite both animal and human studies and derive suggestions for innovative interventions aimed at alleviating phantom pain.

  16. Should Nitrous Oxide Be Used for Laboring Patients? (United States)

    Richardson, Michael G; Lopez, Brandon M; Baysinger, Curtis L


    Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Analgesic effectiveness is highly variable, yet maternal satisfaction is often high among the women who choose to use it. Despite being less effective in treating labor pain than neuraxial analgesic modalities, nitrous oxide serves the needs and preferences of a subset of laboring parturients. Nitrous oxide should, therefore, be considered for inclusion in the repertoire of modalities used to alleviate pain and facilitate effective coping during labor. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Transversus abdominis plane block for an emergency laparotomy in a high-risk, elderly patient

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    Surekha S Patil


    Full Text Available A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anaesthesia (general or neuraxial, a transversus abdominis plane block via combined Petit triangle and subcostal technique was administered and supplemented with Propofol sedation.

  18. An uncommon presentation of hexosaminidase deficiency

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    Iype Mary


    Full Text Available Focal muscular atrophy (FMA can occur due to several causes. We report three cases of FMA associated with deficiency of hexosaminidase A. The serum level of hexosaminidase A was assayed in seven patients with FMA without any definite aetiology identified over a period of two years. Three cases of FMA showed deficiency of hexosaminidase A. All these patients had clinical features of isolated lower motor neurone involvement in one limb without any evidence of involvement of the rest of the neuraxis. Detailed laboratory tests were negative. Electromyography confirmed neurogenic involvement without any evidence of radiculopathy or neuropathy. Hexosaminidase deficiency as a possible association for FMA is highlighted.

  19. [Selected medical closed claims in the field of regional anaesthesia]. (United States)

    Kessler, Paul; Schaffartzik, Walter; Neu, Johann


    Legal malpractice cases in regional anaesthesia comprise a significant number of all cases before the expert commissions and arbitration boards of the state medical associations. One reason for this is the increasing use of neuraxial and peripheral regional blocks in orthopaedics and traumatology. Only in about one fourth of the reviewed cases could either a causal relationship between substandard performance and patient injury or an inadequate obtaining of informed consent be established. In the great majority of cases patients' claims were unfounded, since the patients' injuries were adjudged to be unavoidable and adequate consent had been abtained prior to performance of the blocks. © Georg Thieme Verlag Stuttgart · New York.

  20. A case of severe ankylosing spondylitis posted for hip replacement surgery

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    Nalini Kotekar


    Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

  1. Ultrasound in obstetric anaesthesia: a review of current applications.

    LENUS (Irish Health Repository)

    Ecimovic, P


    Ultrasound equipment is increasingly used by non-radiologists to perform interventional techniques and for diagnostic evaluation. Equipment is becoming more portable and durable, with easier user-interface and software enhancement to improve image quality. While obstetric utilisation of ultrasound for fetal assessment has developed over more than 40years, the same technology has not found a widespread role in obstetric anaesthesia. Within the broader specialty of anaesthesia; vascular access, cardiac imaging and regional anaesthesia are the areas in which ultrasound is becoming increasingly established. In addition to ultrasound for neuraxial blocks, these other clinical applications may be of value in obstetric anaesthesia practice.

  2. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E


    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  3. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E


    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  4. Acurácia da punção aspirativa por agulha fina e da punção por agulha grossa no diagnóstico de lesões mamárias Diagnostic accuracy of the fine needle aspiration cytologyand core needle biopsy as a diagnostic method for breast lesions

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    Patrícia Pontes Frankel


    Full Text Available OBJETIVO: avaliar a acurácia da punção aspirativa por agulha fina (PAAF e da punção por agulha grossa (PAG no diagnóstico da lesão mamária e do câncer de mama. MÉTODOS: trata-se de um estudo transversal, retrospectivo e descritivo, baseado na busca em prontuários médicos. A PAAF e a PAG foram realizadas sequencialmente, como rotina do serviço de Mastologia. Os dois procedimentos percutâneos foram realizados em 233 pacientes, no período de março de 2005 a fevereiro de 2007. Foram incluídas mulheres com idade igual ou superior a 18 anos, com alterações no exame clínico e/ou de imagem das mamas ou com histórico familiar de câncer de mama e/ou ovário. A PAAF e a PAG foram realizadas de acordo com as recomendações técnicas do Instituto Nacional de Câncer. Foram calculados o percentual de concordância, o coeficiente Kappa de Cohen, a sensibilidade, a especificidade, os valores preditivos positivo e negativo e a acurácia da PAAF e da PAG, considerando como padrão-ouro a biópsia cirúrgica. RESULTADOS: a média de idade das pacientes foi de 49 anos (±12,7, os tumores mediam em média 26,9 mm (±23,1, e em 47,2% dos casos, tinham mais de 20 mm. A sensibilidade, a especificidade, os valores preditivos positivo e negativo e a acurácia foram maiores na PAG do que na PAAF, independentemente do tamanho da lesão mamária, tendo a PAG uma acurácia diagnóstica de 97,5% e a PAAF de 77,5%. CONCLUSÃO: apesar de a PAG mostrar maiores valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia que a PAAF, tanto para as lesões palpáveis quanto para as impalpáveis, o método permanece útil no diagnóstico minimamente invasivo das lesões mamárias, sobretudo quando seus resultados são analisados em conjunto com o exame clínico e de imagem.PURPOSE: to determine the accuracy of fine-needle aspiration biopsy (FNAB and of core-needle biopsy (CNB in diagnosing breast lumps and breast

  5. Effectiveness of computer-aided diagnosis (CADx) of breast pathology using immunohistochemistry results of core needle biopsy samples for synaptophysin, oestrogen receptor and CK14/p63 for classification of epithelial proliferative lesions of the breast. (United States)

    Maeda, Ichiro; Kubota, Manabu; Ohta, Jiro; Shinno, Kimika; Tajima, Shinya; Ariizumi, Yasushi; Doi, Masatomo; Oana, Yoshiyasu; Kanemaki, Yoshihide; Tsugawa, Koichiro; Ueno, Takahiko; Takagi, Masayuki


    The aim of this study was to develop a computer-aided diagnosis (CADx) system for identifying breast pathology. Two sets of 100 consecutive core needle biopsy (CNB) specimens were collected for test and validation studies. All 200 CNB specimens were stained with antibodies targeting oestrogen receptor (ER), synaptophysin and CK14/p63. All stained slides were scanned in a whole-slide imaging system and photographed. The photographs were analysed using software to identify the proportions of tumour cells that were positive and negative for each marker. In the test study, the cut-off values for synaptophysin (negative and positive) and CK14/p63 (negative and positive) were decided using receiver operating characteristic (ROC) analysis. For ER analysis, samples were divided into groups with 10% positive cells and decided using receiver operating characteristic (ROC) analysis. Finally, these two groups categorised as ER-low, ER-intermediate (non-low and non-high) and ER-high groups. In the validation study, the second set of immunohistochemical slides were analysed using these cut-off values. The cut-off values for synaptophysin, 10% ER positive and CK14/p63 were 0.14%, 2.17%, 77.93% and 18.66%, respectively. The positive predictive value for malignancy (PPV) was 100% for synaptophysin-positive/ER-high/(CK14/p63)-any or synaptophysin-positive/ER-low/(CK14/p63)-any. The PPV was 25% for synaptophysin-positive/ER-intermediate/(CK14/p63)-positive. For synaptophysin-negative/(CK14/p63)-negative, the PPVs for ER-low, ER-intermediate and ER-high were 100%, 80.0% and 95.8%, respectively. The PPV was 4.5% for synaptophysin-negative/ER-intermediate/(CK14/p63)-positive. The CADx system was able to analyse sufficient data for all types of epithelial proliferative lesions of the breast including invasive breast cancer. This system may be useful for pathological diagnosis of breast CNB in routine investigations. © Article author(s) (or their employer(s) unless otherwise stated

  6. Effect of an anaesthesia information video on preoperative maternal anxiety and postoperative satisfaction in elective caesarean section: a prospective randomised trial. (United States)

    Eley, V A; Searles, T; Donovan, K; Walters, E


    Video-based patient information supplementing clinician interview has been shown to reduce anxiety and improve satisfaction in patients undergoing procedures. In Queensland more than 90% of caesarean sections are performed under regional anaesthesia. We aimed to assess the effect of using an information video about neuraxial blockade in patients having regional anaesthesia for elective caesarean section. Subjects were randomised to undergo usual care (Group C), or to view a video and undergo usual care (Group V). Subjects completed the Spielberger State-Trait Anxiety Inventory preoperatively and the Maternal Satisfaction with Caesarean Section Score questionnaire postoperatively. Satisfaction with, and duration of the preoperative anaesthetic interview, were noted. One-way analysis of variance (ANOVA) and Chi-squared tests were used in statistical analysis. One-hundred and forty three subjects were randomised and 110 completed the protocol and analysis. Group C and Group V were similar in terms demographic and anaesthesia data. There was no difference in anxiety score (41.2 versus 39.8, P=0.50), maternal satisfaction score (118.5 versus 122.7, P=0.22) or interview duration (16.3 versus 15.8 min, P=0.69) between the two groups. The use of an anaesthesia information video does not reduce preoperative anxiety or increase the duration of the anaesthetic interview. Maternal satisfaction with neuraxial blockade for elective caesarean is high and not improved by an anaesthesia information video.

  7. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. (United States)

    Killeen, T; Kamat, A; Walsh, D; Parker, A; Aliashkevich, A


    A 27-year-old woman developed severe adhesive arachnoiditis after an obstetric spinal anaesthetic with bupivacaine and fentanyl, complicated by back pain and headache. No other precipitating cause could be identified. She presented one week postpartum with communicating hydrocephalus and syringomyelia and underwent ventriculoperitoneal shunting and foramen magnum decompression. Two months later, she developed rapid, progressive paraplegia and sphincter dysfunction. Attempted treatments included exploratory laminectomy, external drainage of the syrinx and intravenous steroids, but these were unsuccessful and the patient remains significantly disabled 21 months later. We discuss the pathophysiology of adhesive arachnoiditis following central neuraxial anaesthesia and possible causative factors, including contamination of the injectate, intrathecal blood and local anaesthetic neurotoxicity, with reference to other published cases. In the absence of more conclusive data, practitioners of central neuraxial anaesthesia can only continue to ensure meticulous, aseptic, atraumatic technique and avoid all potential sources of contamination. It seems appropriate to discuss with patients the possibility of delayed, permanent neurological deficit while taking informed consent. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  8. Value of magnetic resonance imaging for muscle denervation syndromes of the shoulder girdle. (United States)

    Elsayes, Khaled M; Shariff, Anjum; Staveteig, Paul T; Mukundan, Govind; Khosla, Anil; Rubin, David A


    Clinical evaluation of neuromuscular disorders typically consists of obtaining a detailed clinical history, physical examination, and electrophysiologic examinations. Electrodiagnostic examinations significantly aid in distinguishing between myopathy, neuropathy, and neuromuscular disorders. Electrodiagnostic examinations also assist in determining the severity and extent of disease. Progress can also be monitored on follow-up testing. The benefit of magnetic resonance imaging (MRI) in neuromuscular disease evaluation lies primarily in identifying a specific underlying gross pathologic cause and its location in the neuraxis as well as in identifying associated secondary findings. In some cases, MRI is particularly helpful when a solitary, small, deep muscle is affected. Imaging can be useful in assessing clinical progress in some cases. Causes of muscle denervation include mass lesions and trauma as well as infectious, autoimmune, and idiopathic causes. This article illustrates the common denervation syndromes that involve the shoulder girdle: Parsonage-Turner syndrome, quadrilateral space syndrome, and suprascapular neuropathy. By demonstrating the exact muscles involved and spared, MRI noninvasively identifies the level of nerve insult in the neuraxis. Furthermore, in cases in which a mass is responsible for denervation, MRI can directly show the cause and aid in treatment planning.

  9. Neural progenitor cell engraftment corrects lysosomal storage throughout the MPS VII mouse brain. (United States)

    Snyder, E Y; Taylor, R M; Wolfe, J H


    Many metabolic diseases affecting the central nervous system are refractory to treatment because the blood-brain barrier restricts entry of therapeutic molecules. It may be possible to deliver therapeutic gene products directly to the brain by transplantation of neural progenitor cells, which can integrate into the murine central nervous system in a cytoarchitecturally appropriate manner. We tested this approach in mucopolysaccharidosis VII (Sly disease), a lysosomal storage disorder of humans, dogs and mice caused by an inherited deficiency of beta-glucuronidase. Lysosomal accumulation of glycosaminoglycans occurs in the brain and other tissues, causing a fatal progressive degenerative disorder, including mental retardation. Treatments are designed to provide a source of normal enzyme for uptake by diseased cells. We report here that by transplanting beta-glucuronidase-expressing neural progenitors into the cerebral ventricles of newborn mice, donor cells engrafted throughout the neuraxis. At maturity, donor-derived cells were present as normal constituents of diverse brain regions. beta-Glucuronidase activity was expressed along the entire neuraxis, resulting in widespread correction of lysosomal storage in neurons and glia in affected mice.

  10. Phosphoproteomics and bioinformatics analyses of spinal cord proteins in rats with morphine tolerance.

    Directory of Open Access Journals (Sweden)

    Wen-Jinn Liaw

    Full Text Available Morphine is the most effective pain-relieving drug, but it can cause unwanted side effects. Direct neuraxial administration of morphine to spinal cord not only can provide effective, reliable pain relief but also can prevent the development of supraspinal side effects. However, repeated neuraxial administration of morphine may still lead to morphine tolerance.To better understand the mechanism that causes morphine tolerance, we induced tolerance in rats at the spinal cord level by giving them twice-daily injections of morphine (20 µg/10 µL for 4 days. We confirmed tolerance by measuring paw withdrawal latencies and maximal possible analgesic effect of morphine on day 5. We then carried out phosphoproteomic analysis to investigate the global phosphorylation of spinal proteins associated with morphine tolerance. Finally, pull-down assays were used to identify phosphorylated types and sites of 14-3-3 proteins, and bioinformatics was applied to predict biological networks impacted by the morphine-regulated proteins.Our proteomics data showed that repeated morphine treatment altered phosphorylation of 10 proteins in the spinal cord. Pull-down assays identified 2 serine/threonine phosphorylated sites in 14-3-3 proteins. Bioinformatics further revealed that morphine impacted on cytoskeletal reorganization, neuroplasticity, protein folding and modulation, signal transduction and biomolecular metabolism.Repeated morphine administration may affect multiple biological networks by altering protein phosphorylation. These data may provide insight into the mechanism that underlies the development of morphine tolerance.

  11. Combined Fascia Iliaca and Sciatic Nerve Block for Hip Surgery in the Presence of Severe Ankylosing Spondylitis: A Case-Based Literature Review. (United States)

    Chen, Lingmin; Liu, Jin; Yang, Jing; Zhang, Yanzi; Liu, Yue


    Selecting an appropriate anesthetic technique for patients with ankylosing spondylitis undergoing hip surgery is challenging because of a potentially difficult airway, the risk of cardiovascular and respiratory complications, and the technical difficulty of performing central neuraxial blocks in patients with ankylosing spondylitis. Our objective was to report a case in which combination neural blockade was used successfully in an elderly patient with ankylosing spondylitis undergoing hip fracture surgery. In addition, a literature review of the anesthetic techniques reported for these patients was conducted. A 70-year-old man with severe ankylosing spondylitis and respiratory dysfunction was scheduled for a closed intertrochanteric fracture reduction and internal fixation. Combined fascia iliaca block and parasacral sciatic nerve block were used successfully for the surgery. Postoperative analgesia was accomplished by continuous fascia iliaca block. According to the literature review, general anesthesia is the most commonly performed anesthetic technique for patients with ankylosing spondylitis undergoing hip surgeries. Special intubation techniques and cautious airway management were very important for these patients. Although both general anesthesia and central neuraxial blockade pose considerable risks to the patients, this case report suggests that combined fascia iliaca block and sciatic nerve block might be a promising option.

  12. Management of pre-eclampsia: issues for anaesthetists. (United States)

    Dennis, A T


    Pre-eclampsia is a leading cause of maternal morbidity and mortality. Substandard care is often present and many deaths are preventable. The aim of this review is to summarise the key management issues for anaesthetists in the light of the current literature. A systematic literature search of electronic databases was undertaken including MEDLINE, EMBASE and the Cochrane Library using the key words obstetrics, pregnancy, pregnancy complications, maternal, pre-eclampsia, preeclampsia, cardiac function, haemodynamics, haemolysis, elevated liver enzymes, low platelets (HELLP), eclampsia, anaesthesia, anesthesia, neuraxial. Relevant Colleges and Societies websites were examined for pertinent guidelines. The disease is defined within the context of hypertensive diseases, and early recognition of pre-eclampsia and its complications, as well as multidisciplinary expert team management is highlighted. Accurate monitoring and recording of observations including the use of transthoracic echocardiography is discussed. The importance of the treatment of systolic blood pressure>180 mmHg and the use of intravenous antihypertensive medication as well as the use of parenteral magnesium sulphate for the treatment and prevention of eclampsia is emphasised . Restricted intravenous fluid therapy and avoidance of ergometrine is discussed. Neuraxial analgesia and anaesthesia, and general anaesthesia for birth is summarised as well as postpartum management including analgesia, thromboprophylaxis, management of acute pulmonary oedema and the use of pharmacological agents in the setting of breastfeeding. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  13. Effect of informational internet web pages on patients' decision-making: randomised controlled trial regarding choice of spinal or general anaesthesia for orthopaedic surgery. (United States)

    Groves, N D; Humphreys, H W; Williams, A J; Jones, A


    This study explored whether patients' preference for particular types of anaesthesia could be influenced pre-operatively by giving them the addresses of various relevant websites. Patients at an orthopaedic pre-assessment education clinic completed a questionnaire, which included a short multiple-choice general knowledge quiz about anaesthesia, and also questioned them as to their choice of anaesthesia (general or neuraxial). Patients were randomly assigned to intervention or control groups. Intervention group members were given the addresses of three relevant anaesthesia and health related websites to access at home. All patients were asked to complete the questionnaires on a second occasion, before surgery. Initially, most patients stated a preference for general anaesthesia. Subsequently, the intervention group altered their preference towards neuraxial anaesthesia compared to the control group (p 4.0]) to 13.0 (11.0-14.0 [6.0-14.0])) than in the control group (from 10.0 (9.0-11.5 [3.0-13.0]) to 11.0 (9.0-12.0 [4.0-14.0]); p = 0.0068).

  14. Perioperative Pain Management Strategies for Amputation: A Topical Review. (United States)

    Kent, Michael L; Hsia, Hung-Lun John; Van de Ven, Thomas J; Buchheit, Thomas E


    To review acute pain management strategies in patients undergoing amputation with consideration of preoperative patient factors, pharmacologic/interventional modalities, and multidisciplinary care models to alleviate suffering in the immediate post-amputation setting. Regardless of surgical indication, patients undergoing amputation suffer from significant residual limb pain and phantom limb pain in the acute postoperative phase. Most studies have primarily focused on strategies to prevent persistent pain with inclusion of immediate postoperative outcomes as secondary measures. Pharmacologic agents, including gabapentin, ketamine, and calcitonin, and interventional modalities such as neuraxial and perineural catheters, have been examined in the perioperative period. Focused Literature Review. Pharmacologic agents (gabapentin, ketamine, calcitonin) have not shown consistent efficacy. Neuraxial analgesia has demonstrated both an opioid sparing and analgesic benefit while results have been mixed regarding perineural catheters in the immediate post-amputation setting. However, several early studies of perineural catheters employed sub-optimal techniques (distal surgical placement), and prolonged use of perineural catheters may provide a sustained benefit. Regardless of analgesic technique, a multidisciplinary approach is necessary for optimal care. Patient-tailored analgesic regimens utilizing catheter-based techniques are essential in the acute post-amputation phase and should be implemented in all patients undergoing amputation. Future research should focus on improved measurement of acute pain and comparisons of effective analgesic regimens instead of single techniques.

  15. Cherokee Wind Energy Development - Feasibility and Pre-Construction Studies

    Energy Technology Data Exchange (ETDEWEB)

    McMillan, Andy [Cherokee Nation Businesses, LLC, Catoosa, OK (United States)


    Cherokee Nation Businesses (CNB) received a grant from the US Department of Energy to explore feasibility and pursue development of a wind power generation facility on Cherokee land in north-central Oklahoma. This project followed several years of initial study exploring the possibility of commercial-scale wind power generation on primarily agricultural land owned by the Cherokee Nation. This project produced detailed analysis of the legal, financial and market viability of such generation facilities, and encompassed a full technical evaluation of the engineering, environmental, and geotechnical aspects of installing this capacity. During the course of this project, information gleaned from this exploration changed CNB’s thinking about the best course of action for Cherokee participation in the development, eventually moving away from an equity-owner model and towards utilization of the land asset as a resource while mitigating Cherokee financial and operational risk.

  16. Dicty_cDB: Contig-U04081-1 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available ns SRS3021... 100 1e-19 AE016879_1614( AE016879 |pid:none) Bacillus anthracis str. Ames, c...t of Drosop... 68 6e-10 CU468135_2286( CU468135 |pid:none) Erwinia tasmaniensis strain...ices mRNA for zinc ... 147 1e-33 CR382126_380( CR382126 |pid:none) Kluyveromyces lactis strain...-22 DQ465596_1( DQ465596 |pid:none) Charina bottae solute carrier fami... 108 3e-22 EU391006_1( EU391006 |pid:none) Atractaspis...e) Salinispora tropica CNB-440, com... 83 2e-14 CP000759_479( CP000759 |pid:none) Ochrobactr

  17. Common criteria among States for storage and use of dried blood spot specimens after newborn screening

    Directory of Open Access Journals (Sweden)

    Carlo Petrini


    Full Text Available Biological samples collected in biobanks are a resource with significant research potential. The Italian Joint Group cNB - cNBBSV (National committee of Bioethics - National committee for Biosecurity, Biotechnologies and Life Sciences published a document reporting recommendations on storage and use of dried blood spot (DBS and on the development of a National Network of Regional Newborn Screening Repositories for collection of residual DBS. Several ethical questions (about consent, possible use of genetic information, unanticipated possible usages for research purposes rise from residual newborn screening specimens collections. Moreover, legal and ethical controversies are accentuated by the conflicts between the interests of sample donors, biobank holders, researchers and the public. To overcome these difficulties the identification of a few criteria for storage and research usage of DBS is crucial.

  18. PRIDEViewer: a novel user-friendly interface to visualize PRIDE XML files. (United States)

    Medina-Aunon, J Alberto; Carazo, José M; Albar, Juan Pablo


    Current standardization initiatives have greatly contributed to share the information derived by proteomics experiments. One of these initiatives is the XML-based repository PRIDE (PRoteomics IDEntification database), although an XML-based document does not appear to present a user-friendly view at the first glance. PRIDEViewer is a novel Java-based application that presents the information available in a PRIDE XML file in a user-friendly manner, facilitating the interaction among end users as well as the understanding and evaluation of the compiled information. PRIDEViewer is freely available at: Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Primary B-cell Lymphoma of the Thyroid Featuring the Different Ultrasonographic Findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Na; Choi, Yoon Jung; Kim, Dong Hoon [Kangbuk Samsung Medical Center, Seoul (Korea, Republic of)


    We review here 3 cases of primary thyroid lymphoma that we experienced during the past 5 years (age range: 39-55, all of the patients were female). The clinical and various ultrasonographic characteristics together with the other imaging modalities of primary thyroid lymphomas are described. The clinical features at presentation for one patient were a goiter with rapid growth and this was accompanied by compressive symptoms. The tumors of the other 2 patients were incidentally found during screening thyroid ultrasound exams. The pathologic studies of 2 cases showed a diffuse B-cell lymphoma with associated Hashimoto's thyroiditis and one case was a B-cell lymphoma of the MALT type. An extra-thyroid extension was shown in one case. The treatments included surgery alone for two cases, and chemotherapy and radiation therapy for one case. A US exam of thyroid lymphoma can show various morphological features, and US-CNB is helpful for diagnosing thyroid lymphoma.

  20. Análise da microestrutura e da resistência ao desgaste de revestimento duro utilizado pela indústria sucroalcooleira Analysis of microstructure and wear strength of hardfacing used by the sugar and alcohol industry

    Directory of Open Access Journals (Sweden)

    Aldemi Coelho Lima


    Full Text Available O setor sucroalcooleiro tem apresentado um expressivo crescimento nos últimos anos no Brasil, entretanto, a manutenção das indústrias apresenta um elevado custo devido à perda de metal dos equipamentos por mecanismos de desgaste. O objetivo deste trabalho é avaliar a resistência ao desgaste abrasivo e a microestrutura de revestimentos duros depositados em camada única. Foram utilizados quatro tipos de consumíveis utilizados na indústria sucroalcooleira: um eletrodo revestido da liga FeCrC de 4,0 mm de diâmetro e três arames tubulares autoprotegidos de 1,6 mm de diâmetro, de ligas FeCrC, FeCrCNb, FeCrCTiMo. O metal de base utilizado foi um aço SAE 1020. As soldagens com os arames tubulares foram efetuadas no modo de transferência por curto-circuito, com mesmos valores de corrente e tensão de soldagem. Para o ensaio de desgaste utilizou-se o abrasômetro Roda de Borracha, segundo a norma ASTM G65-91. Os corpos de prova de desgaste foram retirados da região central das chapas de testes e da mesma região retirou-se dois conjuntos de amostras para análise microestrutural (microscopia ótica. Os resultados dos ensaios com a roda de borracha mostrou que a liga FeCrCNb apresenta maior resistência ao desgaste, seguida do eletrodo revestido e com pior desempenho a liga FeCrCMoTi e a liga FeCrC. A liga FeCrC (tanto para o eletrodo revestido como para o arame tubular apresentou microestrutura formada por carbonetos primários M7C3 distribuídos em uma matriz de menor dureza; a liga contendo Nb apresentou microestrutura similar além da presença de carbonetos NbC; por sua vez, a liga com adição de Ti e Mo apresentou a presença de grandes carbonetos primários de titânio.The Brazilian sugar/alcohol sector presented expressive growth in recent years. However, maintenance cost is high due to metallic losses by wear. This paper studies the application of hardfacing by flux cored arc welding on the wear resistance and microstructure of

  1. Preparation and characterization of biocompatible Nb-C coatings

    Energy Technology Data Exchange (ETDEWEB)

    Braic, M.; Braic, V.; Balaceanu, M. [National Institute for Optoelectronics, 409 Atomistilor, Magurele (Romania); Vladescu, A., E-mail: alinava@inoe.r [National Institute for Optoelectronics, 409 Atomistilor, Magurele (Romania); Zoita, C.N. [National Institute for Optoelectronics, 409 Atomistilor, Magurele (Romania); Titorencu, I. [Petru Poni Institute of Macromolecular Chemistry, 41A, Aleea G.G.Voda, Iasi (Romania); Institute of Cellular Biology and Pathology ' Nicolae Simionescu' , 8 B.P. Hasdeu, Bucharest (Romania); Jinga, V. [Petru Poni Institute of Macromolecular Chemistry, 41A, Aleea G.G.Voda, Iasi (Romania); Miculescu, F. [University Politehnica of Bucharest, 313 Sp. Independentei, Bucharest (Romania)


    Nb-C composite films, obtained by DC magnetron sputtering method, were investigated as possible candidates for the protective layers used in medical implants. Coatings of different carbon/niobium ratios were prepared and analyzed for elemental and phase composition, crystallographic structure, texture, corrosion behavior, and cell viability. The coating with the highest C/Nb ratio ({approx} 1.9) was found to have a nanocomposite structure, in which NbC nanocrystalline phase coexists with an amorphous a-C one. The coated samples exhibited an improved corrosion resistance as compared with the Ti alloy. Cell viability measurements proved that human osteosarcoma cells are adherent to the coating surfaces, the highest viability being found for the film with the highest carbon content.

  2. Regulation of ENA1 Na+-ATPase Gene Expression by the Ppz1 Protein Phosphatase Is Mediated by the Calcineurin Pathway (United States)

    Ruiz, Amparo; Yenush, Lynne; Ariño, Joaquín


    Saccharomyces cerevisiae strains lacking the Ppz1 protein phosphatase are salt tolerant and display increased expression of the ENA1 Na+-ATPase gene, a major determinant for sodium extrusion, while cells devoid of the similar Ppz2 protein do not show these phenotypes. However, a ppz1 ppz2 mutant displays higher levels of ENA1 expression than the ppz1 strain. We show here that the increased activity of the ENA1 promoter in a ppz1 ppz2 mutant maps to two regions: one region located at −751 to −667, containing a calcineurin-dependent response element (CDRE), and one downstream region (−573 to −490) whose activity responds to intracellular alkalinization. In contrast, the increased ENA1 expression in a ppz1 mutant is mediated solely by an intact calcineurin/Crz1 signaling pathway, on the basis that (i) this effect maps to a single region that contains the CDRE and (ii) it is blocked by the calcineurin inhibitor FK506, as well as by deletion of the CNB1 or CRZ1 gene. The calcineurin dependence of the increased ENA1 expression of a ppz1 mutant would suggest that Ppz1 could negatively regulate calcineurin activity. In agreement with this notion, a ppz1 strain is calcium sensitive, and this mutation does not result in a decrease in the calcium hypertolerance of a cnb1 mutant. It has been shown that ENA1 can be induced by alkalinization of the medium and that a ppz1 ppz2 strain has a higher intracellular pH. However, we present several lines of evidence that show that the gene expression profile of a ppz1 mutant does not involve an alkalinization effect. In conclusion, we have identified a novel role for calcineurin, but not alkalinization, in the control of ENA1 expression in ppz1 mutants. PMID:14555476

  3. Risks of Being Malignant or High Risk and Their Characteristics in Breast Lesions 20 mm or Larger After Benign Results on Ultrasonography-Guided 14-Gauge Core Needle Biopsy. (United States)

    Moon, Hee Jung; Kim, Min Jung; Yoon, Jung Hyun; Kim, Eun-Kyung


    The malignancy risk, risk of being high-risk lesions after benign results on ultrasonography-guided 14-gauge core needle biopsies (US-CNBs), and their characteristics in breast lesions of 20 mm or greater were investigated. Eight hundred forty-seven breast lesions with benign results on US-CNB were classified as benign, high risk, and malignant through excision and clinical follow-up. The risks of being malignant or high risk were analyzed in all lesions, lesions 20 to 29 mm, and lesions 30 mm or greater. Their clinicopathological characteristics were evaluated. Of 847, 18 (2.1%) were malignant, 53 (6.3%) were high-risk lesions, and 776 (91.6%) were benign. Of 18 malignancies, 6 (33.3%) were malignant phyllodes tumors and 12 (66.7%) were carcinomas. In benign lesions 20 to 29 mm, risks of being malignant or high risk were 1.6% (9 of 566) and 4.4% (25 of 566). In 281 lesions 30 mm or greater, the risks of being malignant or high risk were 3.2% and 10%. The risk of being high risk in lesions 30 mm or greater was 10%, significantly higher than 4.4% of lesions 20 to 29 mm (P = 0.002). Excision can be considered in lesions measuring 20 mm or larger because of the 2.1% malignancy risk and the 6.3% risk of being high-risk lesions despite benign results on US-CNB. Excision should be considered in lesions measuring 30 mm or larger because of the 3.2% malignancy risk and the 10% risk of being high-risk lesions.

  4. Room-Temperature Processed Nb2O5as the Electron-Transporting Layer for Efficient Planar Perovskite Solar Cells. (United States)

    Ling, Xufeng; Yuan, Jianyu; Liu, Dongyang; Wang, Yongjie; Zhang, Yannan; Chen, Si; Wu, Haihua; Jin, Feng; Wu, Fupeng; Shi, Guozheng; Tang, Xun; Zheng, Jiawei; Liu, Shengzhong Frank; Liu, Zhike; Ma, Wanli


    In this work, we demonstrate high-efficiency planar perovskite solar cells (PSCs), using room-temperature sputtered niobium oxide (Nb 2 O 5 ) as the electron-transporting layer (ETL). Widely spread ETL-like TiO 2 often requires high-temperature (>450 °C) sintering, which is not desired for the fabrication of flexible devices. The amorphous Nb 2 O 5 (labeled as a-Nb 2 O 5 ) ETL, without any heat treatment, can give a best power conversion efficiency (PCE) of 17.1% for planar PSCs. Interestingly, the crystalline Nb 2 O 5 (labeled as c-Nb 2 O 5 ), with high-temperature (500 °C) annealing, results in a very similar PCE of 17.2%, indicating the great advantage of a-Nb 2 O 5 in energy saving. We thus carried out a systematical investigation on the properties of the a-Nb 2 O 5 film. The Hall effect measurements indicate both high mobility and conductivity of the a-Nb 2 O 5 film. Kelvin probe force microscopy measurements define the Fermi levels of a-Nb 2 O 5 and c-Nb 2 O 5 as -4.31 and -4.02 eV, respectively, which allow efficient electron extraction at the Nb 2 O 5 /perovskite interface, regardless of the additional heat treatment on Nb 2 O 5 film. Benefitting from the low-temperature process, we further demonstrated flexible PSCs based on a-Nb 2 O 5 , with a considerable PCE of 12.1%. The room-temperature processing and relatively high device performance of a-Nb 2 O 5 suggest a great potential for its application in optoelectrical devices.

  5. Influence of axial tensile strain on the electronic and structural properties as well as NO gas sensitivity and reactivity of C-doped SW-BNNTs (United States)

    Roohi, Hossein; Maleki, Layla


    The insulating character of BNNTs strongly imposes a great restriction on their applicability in nano-electronic devices. Therefore, it is desirable to find the practical routes for reducing the H-L gap. In this work, we demonstrate that the structural and electronic properties of the C-doped SW-BNNT can be significantly engineered and tuned by applying the axial tensile strain. Defect formation energies, cohesive energies, dipole moments, NBO charges, and global reactivity descriptors for un-doped SW-BNNT and C1-3-doped SW-BNNTs are calculated upon the axial strain. The B3LYP/6-31 +G(d) calculated H-L gap for five C-doped SW-BNNTs are expected to be smaller than that of un-doped SW-BNNT. At 10% axial tensile strain, CB NT is a suitable conductance with a 1.947 eV H-L gap. The decrease in the H-L gap for 2C-doped CN,B (-0.839 eV) NT within 15% strain is greater than 1C- and 3C-doped SW-BNNTs. In the second part of this work, reactivity and the sensitivity of strained C1-2-doped SW-BNNTs toward NO gas were evaluated at M06-2X/6-31 ++G(d,p) level of theory. Optimized structures, molecular graphs, adsorption energies (AE), dispersion corrected AEs, H-L gap, NBO charges, charge transfer values, density of states and electrostatic potentials were calculated. The strained C1-doped SW-BNNTs showed an increased ability for the sensitivity and adsorption of NO molecule, as compared with unstrained doped SW-BNNT. In general, the CN,B NTs have practically less potential for the adsorption of NO molecule than CB and CN ones.

  6. Feasibility of cognitive functional assessment in cardiac arrest survivors using an abbreviated laptop-based neurocognitive battery. (United States)

    Iannacone, Stephen; Leary, Marion; Esposito, Emily C; Ruparel, Kosha; Savitt, Adam; Mott, Allison; Richard, Jan A; Gur, Ruben C; Abella, Benjamin S


    Cardiac arrest survivors exhibit varying degrees of neurological recovery even in the setting of targeted temperature management (TTM) use, ranging from severe impairments to making a seemingly full return to neurologic baseline function. We sought to explore the feasibility of utilizing a laptop-based neurocognitive battery to identify more subtle cognitive deficits in this population. In a convenience sample of cardiac arrest survivors discharged with a cerebral performance category (CPC) of 1, we evaluated the use of a computerized neurocognitive battery (CNB) in this group compared to a healthy control normative population. The CNB was designed to test 11 specific neurocognitive domains, including such areas as working memory and spatial processing. Testing was scored for both accuracy and speed. In a feasibility convenience sample of 29 cardiac arrest survivors, the mean age was 52.9±16.7 years; 12 patients received postarrest TTM and 17 did not receive TTM. Patients tolerated the battery well and performed at normative levels for both accuracy and speed on most of the 11 domains, but showed reduced accuracy of working memory and speed of spatial memory with large magnitudes (>1 SD), even among those receiving TTM. Across all domains, including those using speed and accuracy, 7 of the 29 subjects (24%) achieved statistically significant scores lower from the normative population in two or more domains. In this population of CPC 1 cardiac arrest survivors, a sensitive neurocognitive battery was feasible and suggests that specific cognitive deficits can be detected compared to a normative population, despite CPC 1 designation. Such testing might allow improved measurement of outcomes following TTM interventions in future trials.

  7. A Novel Synthesis of Gold Nanoparticles Supported on Hybrid Polymer/Metal Oxide as Catalysts for p-Chloronitrobenzene Hydrogenation

    Directory of Open Access Journals (Sweden)

    Cristian H. Campos


    Full Text Available This contribution reports a novel preparation of gold nanoparticles on polymer/metal oxide hybrid materials (Au/P[VBTACl]-M metal: Al, Ti or Zr and their use as heterogeneous catalysts in liquid phase hydrogenation of p-chloronitrobenzene. The support was prepared by in situ radical polymerization/sol gel process of (4-vinyl-benzyltrimethylammonium chloride and 3-(trimethoxysilylpropyl methacrylate in conjunction with metal-alkoxides as metal oxide precursors. The supported catalyst was prepared by an ion exchange process using chloroauric acid (HAuCl4 as gold precursor. The support provided the appropriate environment to induce the spontaneous reduction and deposition of gold nanoparticles. The hybrid material was characterized. TEM and DRUV-vis results indicated that the gold forms spherical metallic nanoparticles and that their mean diameter increases in the sequence, Au/P[VBTACl]-Zr > Au/P[VBTACl]-Al > Au/P[VBTACl]-Ti. The reactivity of the Au catalysts toward the p-CNB hydrogenation reaction is attributed to the different particle size distributions of gold nanoparticles in the hybrid supports. The kinetic pseudo-first-order constant values for the catalysts in the hydrogenation reaction increases in the order, Au/P[VBTACl]-Al > Au/P[VBTACl]-Zr > Au/P[VBTACl]-Ti. The selectivity for all the catalytic systems was greater than 99% toward the chloroaniline target product. Finally the catalyst supported on the hybrid with Al as metal oxide could be reused at least four times without loss in activity or selectivity for the hydrogenation of p-CNB in ethanol as solvent.

  8. Brulures par Diluant (United States)

    Benbrahim, A.; Jerrah, H.; Diouri, M.; Bahechar, N.; Boukind, E.H.


    Summary La flamme de diluant est une cause non rare de brûlure dans le contexte marocain. Nous avons jugé intéressant de faire une étude épidémiologique sur la brûlure par flamme de diluant (BFD) au centre national des brûlés (CNB) du CHU Ibn-Rochd de Casablanca. Ce travail a été réalisé sur une période de 10 mois (septembre 2007/juin 2008). Le but du travail est de montrer les caractéristiques de ce type de brûlures pour les prévenir et ce par l'information sur le diluant, produit causant ces brûlures, et ses différents dangers, la brûlure notamment. Durant cette période, nous avons colligé 17 cas de BFD sur un total de 356 patients admis au CNB pour brûlures aiguës toute étiologie confondue. La moyenne d'age des patients concernés est de 32 ans. Ils sont presque tous de sexe masculin (16 hommes/1 femme) et ont des antécédents de toxicomanie et/ou de délinquance. Tous nos patients sont de bas niveau socio-économique et habitent dans des bidonvilles pour la plupart. La brûlure est souvent secondaire à une agression dans la rue (92% des cas). Concernant les caractéristiques de la brûlure, la surface cutanée brûlée moyenne est de 23%; elle est souvent profonde et siège surtout au niveau des membres supérieurs et du tronc. PMID:21991179

  9. Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy.

    Directory of Open Access Journals (Sweden)

    Ga Ram Kim

    Full Text Available We evaluated shear-wave elastography (SWE and color Doppler ultrasonography (US features for fibroepithelial lesions (FELs, and to evaluate their utility to differentiate fibroadenomas (FAs and phyllodes tumors (PTs.This retrospective study included 67 FELs pathologically confirmed (49 FAs, 18 PTs. B-mode US, SWE and color Doppler US were performed for each lesion. Mean elasticity (Emean, maximum elasticity (Emax, and vascularity were determined by SWE and Doppler US. Diagnostic performances were calculated to differentiate FAs and PTs. Equivocal FELs diagnosed by core needle biopsy (CNB were further analyzed.Median Emean and Emax were significantly lower for FAs than PTs (Emean, 15.7 vs. 66.7 kPa; Emax, 21.0 vs. 76.7 kPa, P43.9 kPa, 89.8%; Emax >46.1 kPa, 79.6% than B-mode US (42.9% (P0.05. The combination of SWE and Doppler US with 'Emean>43.9 kPa or high vascularity (≥2 vessel flows' showed a higher area under the curve (0.786 vs. 0.687 and higher diagnostic values than B-mode US (sensitivity, 100 vs. 94.4%; specificity, 57.1 vs. 42.9%; positive predictive value, 46.2 vs. 37.8%; negative predictive value, 100 vs. 95.5%, without statistical significance (P>0.05. Of the 30 equivocal FELs, all lesions with 'Emean≤43.9 kPa and low vascularity (0-1 vessel flow' (23.3%, 7/30 were finally confirmed as FAs by excision.FAs have a tendency to have less stiffness and lower vascularity than PTs. Combined SWE and color Doppler US may help patients with equivocal FELs diagnosed by CNB avoid unnecessary excision.

  10. The fitness of copings constructed over UCLA abutments and the implant, constructed by different techniques: casting and casting with laser welding Adaptação de copings de ritânio ao implante, construídos sobre pilares UCLA por duas técnicas: fundição e fundição com soldagem de bordo laser

    Directory of Open Access Journals (Sweden)

    Elza Maria Valadares da Costa


    Full Text Available The alternative for the reposition of a missing tooth is the osteointegrated implant being the passive adaptation between the prosthodontic structure and the implant a significant factor for the success of this experiment, a comparative study was done between the two methods for confectioning a single prosthodontic supported by an implant. To do so a screwed implant with a diameter of 3.75mm and a length of 10.0mm (3i Implant innovations, Brasil was positioned in the middle of a resin block and over it we screwed 15 UCLA abutments shaped and anti-rotationable (137CNB, Conexão Sistemas de Próteses, Brasil with a torque of without any laboratorial procedure (control group - CTRLG. From a silicon model 15 UCLA-type calcinatable compounds (56CNB, Conexão Sistemas de Próteses, Brasil were screwed (20, received a standard waxing (plain buccal surface and were cast in titanium (casting group - CG and other 15 compounds, UCLA - type shaped in titanium (137 CNB, Conexão Sistemas de Próteses, Brasil received the same standard waxing. These last copings were cast in titanium separated from each other and were laser-welded to the respective abutments on their border (Laser-welding group - LWG. The border adaptation was observed in the implant/compound interface, under measurement microscope, on the y axis, in 4 vestibular, lingual, mesial and distal referential points previously marked on the block. The arithmetical means were obtained and an exploratory data analysis was performed to determine the most appropriate statistical test. Descriptive statistics data (µm for Control (mean±standard deviation: 13.50 ± 21.80; median 0.00, for Casting (36.20±12.60; 37.00, for Laser (10.50 ±12.90; 3.00 were submitted to Kruskal-Wallis ANOVA, alpha = 5%. Results test showed that distorsion median values differ statistically (kw = 17.40; df =2; p = 0.001A reposição de um elemento dentário pode ser feita por um implante osseointegrado sendo que a

  11. Acurácia diagnóstica da biópsia percutânea com agulha grossa orientada por estereotaxia nas lesões mamárias categoria BI-RADS® 4 Diagnostic accuracy of stereotactic core-needle biopsy of non-palpable breast lesions categorized as BI-RADS® 4

    Directory of Open Access Journals (Sweden)

    Maria Silvia Petty Moutinho


    positivo, orienta o planejamento terapêutico, e, quando negativo (em imagens radiográficas de baixa suspeição, permite o acompanhamento.PURPOSE: to assess the accuracy (rate of correct predictions of stereotactic core needle biopsy (CNB of risk category BI-RADS® 4 breast lesions. METHODS: a retrospective analysis of category BI-RADS® 4 breast lesions that had been submitted to a stereotactic core-needle biopsy from June 1998 to June 2003. Patients with histological benign results consistent with the radiographic image were referred to mammographic follow-up. Patients with malign diagnosis and papillary lesions were submitted to standard specific treatment. Excisional biopsies were performed when results were benign, but in disagreement with the mammographic image. It was considered as a gold-standard attendance: (1 the mammographic follow-up of low suspicion lesions with benign results at CNB, which stayed unchanged for, at least, three years, and (2 surgical resection when specimen results were malign or benign, but with a high suspicion on mammography. Sensitivity (S specificity (E and overall accuracy of stereotactic CNB were statistically analyzed. RESULTS: among the 118 non-palpable lesions of category BI-RADS® 4 submitted to CNB, the results obtained were: 27 malign cases, 81 benign, and ten lesions with atypical or papillary lesions. The statistical analysis comprised 108 patients (atypical and papillary lesions were excluded. CNB sensitivity was 87.1% and specificity 100%. The positive predictive value was 100% and the negative, 95.1%. False negatives occurred in 3.7% (4/108 of cases. The prevalence of malign diagnostics in the BI-RADS® 4 lesions of this sample was 29.7 (31/118.The accuracy of this method in this casuistic was 96.3%. CONCLUSIONS: these results support stereotactic CNB as an extremely reliable alternative to open biopsy, in the diagnosis and definition of breast lesions. In positive results, it is possible to indicate the appropriate therapy

  12. Biopsy in Musculoskeletal Tumors

    Directory of Open Access Journals (Sweden)

    Mohammad Gharehdaghi


    Full Text Available Diagnosis of bone tumors is based on careful evaluation of clinical, imaging and a pathologic findings. So the biopsy of bone and soft tissue sarcomas is the final step in evaluation and a fundamental step in the diagnosis of the lesion. It should not be performed as a shortcut to diagnosis (1. The biopsy should be performed in order to confirm the diagnosis and differentiate among few diagnoses after careful staged studies. Real and artificial changes in imaging studies will be superimposed after performing biopsy, which may alter the interpretation if done after biopsy is taken (1. The correct management of a sarcoma depends on the accurate diagnosis. Inadequate, inapprppriate, or inaccurate non-representative biopsy leads to poorer outcome in terms of survivorship and limb salvage. An incorrect, unplanned incision and biopsy may unnecessarily contaminate uninvolved compartments which may convert a salvageable limb to amputation. Anatomic approach along with the proper biopsy techniques may lead to success or catastrophe. It is clear that in patients with inappropriate biopsy, the chance of the need to change the treatment to more radical than would originally be expected is significantly higher. Also it is more probable to need to  convert curative to palliative treatment and to require adjuvant radiotherapy in patients with inappropriate biopsies. Patients with sarcoma are best served by early referral to a specialized center where staged investigations and biopsy can be performed with minimal morbidity (3. Open biopsy is still considered the gold standard; however, recent studies suggest comparable results with percutaneous core needle biopsy. Our study on 103 consecutive CNB and open biopsy showed comparable results as well. Surgeons need to answer to two questions prior to performing a biopsy: 1-          Where is the best part of the lesion to be biopsied? 2-          What is the safest route without contaminating

  13. Maladaptive plasticity, memory for pain and phantom limb pain: review and suggestions for new therapies. (United States)

    Flor, Herta


    A number of studies have shown that phantom limb pain is associated with plastic changes along the neuraxis, with a close correlation between changes in the cortical representation of the affected limb and phantom limb pain. Mechanisms underlying these maladaptive plastic changes are related to a loss of GABAergic inhibition, glutamate-mediated long-term potentiation-like changes and structural alterations such as axonal sprouting. These plastic changes and phantom limb pain seem to be more extensive when chronic pain precedes the amputation. Behavioral interventions, stimulation, feedback and pharmacological interventions that are designed to reverse these maladaptive memory traces and enhance extinction may be beneficial for the treatment and prevention of phantom limb pain.

  14. Pilocytic astrocytoma: A rare presentation as intraventricular tumor (United States)

    Sattar, Sidra; Akhunzada, Naveed Z.; Javed, Gohar; Uddin, Zeeshan; Khan, Yasir A.


    Background: Pilocytic astrocytoma (PA) is the most prevalent central nervous system (CNS) tumor in pediatric population and accounts for an approximate of 5–6% of all gliomas. This neoplasm can occur at all levels of the neuraxis, with majority (67%) arising in the cerebellum and optic pathway. PAs are World Health Organization Grade I tumors and are the most benign of all astrocytomas characterized by an excellent prognosis. Other differentials include subependymal giant cell astrocytoma (SEGA), ependymoma, meningioma, and low-grade gliomas such as pilocytic or diffuse astrocytoma; calcification is more commonly regarded as a feature of benign or slow-growing tumors. Case Description: We present a case of a 17-year-old female presenting with an unusual cause of hydrocephalus, a rare case of a calcified pilocytic astrocytoma as an intraventricular tumor. Conclusion: PA rarely presents as an intraventricular tumor and should be included in the differential diagnosis of a large mass with massive intratumoral calcification. PMID:28680735

  15. Isolated cysticercosis of the cauda equina

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    Maurizio Iacoangeli


    Full Text Available Cysticercosis is the most common parasitic infection of the central nervous system. It is an endemic condition in developing countries, but the incidence rate is increasing in developed countries as well because of rising immigration. Spinal involvement is quite rare and it is usually associated with concomitant intracranial infective lesions. We present an unusual case of a 44-year-old woman who experienced a cauda equina syndrome. Magnetic resonance imaging disclosed two intradural cystic lesions at L4-L5 level. Only after histological examination the diagnosis of cysticercosis was definitively determined. The entire neuraxis evaluation confirmed that it was a rare form of isolated intradural racemosus type cysticercosis of the cauda equina. Steroids and albendazole were administered and post-operative course was uneventful. In this paper we discuss clinical, pathogenic and therapeutic aspects of this infective pathology.

  16. Neoplastic meningitis as the presentation of occult primitive neuroectodermal tumors. (United States)

    Jennings, M T; Slatkin, N; D'Angelo, M; Ketonen, L; Johnson, M D; Rosenblum, M; Creasy, J; Tulipan, N; Walker, R


    Seven children and young adults initially presented with subacute meningitis and/or increased intracranial pressure. The diagnosis of neoplastic meningitis secondary to a primitive neuroectodermal neoplasm was delayed by the absence of an obvious primary tumor. The neuroradiologic appearance was that of a basimeningeal infiltrative process, complicated by communicating hydrocephalus or "pseudotumor cerebri." Myelography was important in the diagnosis of disseminated meningeal malignancy in four cases. Cerebrospinal fluid cytologic diagnosis was insensitive but ultimately confirmed in five cases. All seven patients experienced progressive disease despite neuraxis radiotherapy and intensive chemotherapy; six have died. Systemic dissemination to bone and/or peritoneum occurred in three patients while on therapy. In two, a primary parenchymal brain or spinal cord tumor could not be identified at postmortem examination. The presentation of a primitive neuroectodermal tumor as subacute meningitis without an evident primary tumor heralds an aggressive and refractory neoplasm.

  17. Dynamic visualization of the developing nervous system of the bullfrog Rana catesbeiana (United States)

    Horowitz, Seth S.; Simmons, Andrea Megela


    Anuran amphibians undergo a rapid and dramatic process of metamorphosis featuring widespread structural reorganization of the central nervous system. Although morphological changes during embryonic stages of anuran development have been well-documented, much less information is available describing structural changes in the brain during larval (tadpole) stages. Using still images from cresyl violet stained material, we present an adaptation of the digital image and video manipulation technique of morphing that allows these images to be compiled in such a manner as to highlight key periods in tadpole brain development in a dynamic fashion. We present three morphed video data sets from ranid tadpoles that facilitate the identification of developmental changes in nuclear boundaries at different levels of the neuraxis. The use of animation allows dynamic examination of anatomical changes across long developmental spans without requiring additional anatomical preparations or specialized expensive equipment. Section: Structural Organization of the Brain PMID:17550783

  18. Dynamic visualization of the developing nervous system of the bullfrog, Rana catesbeiana. (United States)

    Horowitz, Seth S; Simmons, Andrea Megela


    Anuran amphibians undergo a rapid and dramatic process of metamorphosis featuring widespread structural reorganization of the central nervous system. Although morphological changes during embryonic stages of anuran development have been well documented, much less information is available describing structural changes in the brain during larval (tadpole) stages. Using still images from cresyl-violet-stained material, we present an adaptation of the digital image and video manipulation technique of morphing that allows these images to be compiled in such a manner as to highlight key periods in tadpole brain development in a dynamic fashion. We present three morphed video data sets from ranid tadpoles that facilitate the identification of developmental changes in nuclear boundaries at different levels of the neuraxis. The use of animation allows dynamic examination of anatomical changes across long developmental spans without requiring additional anatomical preparations or specialized expensive equipment.

  19. Development of Phantom Limb Pain after Femoral Nerve Block

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    Sadiah Siddiqui


    Full Text Available Historically, phantom limb pain (PLP develops in 50–80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment.

  20. Sex and gender differences in pain and analgesia. (United States)

    Mogil, Jeffrey S; Bailey, Andrea L


    It is a clinical reality that women make up the large majority of chronic pain patients, and there is now consensus from laboratory experiments that when differences are seen, women are more sensitive to pain than men. Research in this field has now begun to concentrate on finding explanations for this sex difference. Although sex differences in sociocultural, psychological, and experiential factors likely play important roles, evidence largely from animal studies has revealed surprisingly robust and often qualitative sex differences at low levels of the neuraxis. Although not yet able to affect clinical practice, the continued study of sex differences in pain may have important implications for the development of new analgesic strategies. Copyright © 2010 Elsevier B.V. All rights reserved.

  1. The use of Targeted MicroCurrent Therapy in postoperative pain management. (United States)

    Gabriel, Allen; Sobota, Rachel; Gialich, Shelby; Maxwell, G Patrick


    Effective postoperative analgesia is a prerequisite to enhance the recovery process and reduce morbidity. The use of local anesthetic techniques is well documented to be effective, but single-dose techniques (infiltration, peripheral blocks, neuraxial blocks) have been of limited value in major operations because of their short duration of analgesia. Recent advances in technology have led to the development of a noninvasive device, targeted MicroCurrent Therapy, which enhances postsurgical recovery by stimulating the body's natural healing process. This therapy transmits gentle, short bursts of electrical current targeted to the tissue cells at the surgical site. This article reviews recent clinical experience and evidence of this device in plastic and reconstructive surgery.

  2. Varicella Zoster Virus in the Nervous System [version 1; referees: 3 approved

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    Don Gilden


    Full Text Available Varicella zoster virus (VZV is a ubiquitous, exclusively human alphaherpesvirus. Primary infection usually results in varicella (chickenpox, after which VZV becomes latent in ganglionic neurons along the entire neuraxis. As VZV-specific cell-mediated immunity declines in elderly and immunocompromised individuals, VZV reactivates and causes herpes zoster (shingles, frequently complicated by postherpetic neuralgia. VZV reactivation also produces multiple serious neurological and ocular diseases, such as cranial nerve palsies, meningoencephalitis, myelopathy, and VZV vasculopathy, including giant cell arteritis, with or without associated rash. Herein, we review the clinical, laboratory, imaging, and pathological features of neurological complications of VZV reactivation as well as diagnostic tests to verify VZV infection of the nervous system. Updates on the physical state of VZV DNA and viral gene expression in latently infected ganglia, neuronal, and primate models to study varicella pathogenesis and immunity are presented along with innovations in the immunization of elderly individuals to prevent VZV reactivation.

  3. Revision of loop colostomy under regional anaesthesia and sedation. (United States)

    Ng, Oriana; Thong, Sze Ying; Chia, Claramae Shulyn; Teo, Melissa Ching Ching


    Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.

  4. Epidural Hematoma Following Interlaminar Epidural Injection in Patient Taking Aspirin. (United States)

    Sanders, Rebecca A; Bendel, Markus A; Moeschler, Susan M; Mauck, William D


    We present a case report of a patient who developed an epidural hematoma following an interlaminar epidural steroid injection with no risk factors aside from old age and aspirin use for secondary prevention. A 79-year-old man developed an epidural hematoma requiring surgical treatment following an uncomplicated interlaminar epidural steroid injection performed for neurogenic claudication. In the periprocedural period, he continued aspirin for secondary prophylaxis following a myocardial infarction. For patients taking aspirin for primary or secondary prophylaxis, the American Society of Regional Anesthesia and Pain Medicine antiplatelet and anticoagulation guidelines for spine and pain procedures recommend a shared assessment and risk stratification when deciding to hold the medication for intermediate-risk neuraxial procedures. Cases such as this serve to highlight the importance of giving careful consideration to medical optimization of a patient even when a low- or intermediate-risk procedure is planned.

  5. A case of double meningomyelocoele with hydrocephalous in a four months′ infant

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    Anuja A Goyal


    Full Text Available Meningomyelocoele is a developmental congenital disorder caused by failure of the neural tube to close during the first month of embryonic development thus presenting with herniation of neural elements along with meninges. Myelomeningocoeles most commonly occur in the lumbosacral region, but can also occur at any level in the neuraxis, including occipital/suboccipital areas or nasally (encephalocoele.We report a rare case of double meningomyelocoele in a 4-month-old infant (cervical as well as thoracic meningocele with weakness in the left lower limb (power grade 0 posted for resection with difficult intubation because of obstructive hydrocephalus, fear of rupture of neuroplaque, positioning and care of blood loss and temperature. The infant was discharged within 15 days, and his hospital stay was uneventful.

  6. Disorders of coagulation in pregnancy. (United States)

    Katz, D; Beilin, Y


    The process of haemostasis is complex and is further complicated in the parturient because of the physiological changes of pregnancy. Understanding these changes and the impact that they have on the safety profile of the anaesthetic options for labour and delivery is crucial to any anaesthetist caring for the parturient. This article analyses current theories on coagulation and reviews the physiological changes to coagulation that occur during pregnancy and the best methods with which to evaluate coagulation. Finally, we examine some of the more common disorders of coagulation that occur during pregnancy, including von Willebrand disease, common factor deficiencies, platelet disorders, the parturient on anticoagulants, and the more rare acute fatty liver of pregnancy, with a focus on their implications for neuraxial anaesthesia. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email:

  7. Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports. (United States)

    Ke, Xijian; Li, Ji; Liu, Yong; Wu, Xi; Mei, Wei


    Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

  8. [Anesthetic management for caesarean delivery in a parturient with achondroplasia]. (United States)

    Ando, Akira; Hishinuma, Norimasa; Shirotori, Toru; Sasao, Junichi; Tanaka, Satoshi; Kawamata, Mikito


    A 27-year-old parturient (height, 130 cm; weight, 43 kg) with achondroplasia, which is characterized by rhizomeric short stature, large head and frontal bossing, was scheduled for elective caesarean section (C/S) because of her contracted pelvis. Her first delivery had been performed by C/S under general anesthesia at a regional hospital 6 years before. Preoperative airway assessment showed normal mouth opening and mobile cervical spine. Since she had anxiety about needle puncture and refused neuraxial blockade and since we considered the trachea could be intubated, we decided to perform C/S under general anesthesia at 37 weeks of gestation. The patient and baby had an uneventful perioperative course. Underdevelopment of bone formation results in characteristic craniofacial and vertebral abnormalities in patients with achondroplasia. Anesthetic management of achondroplastic parturients should be specified to individual basis based on careful preoperative assessment of craniofacial and vertebral deformities.

  9. Safe removal of an epidural catheter 72 hours after clopidogrel and aspirin administrations guided by platelet function analysis and thromboelastography

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    Eric Glenn


    Full Text Available Management of neuraxial anesthesia/analgesia in anticoagulated patient can be challenging. The shortest safe time to remove epidural catheter, after a patient receives long-acting dual antiplatelet agents (clopidogrel and aspirin, is unclear. American Society of Regional Anesthesiology (ASRA guidelines recommend seven days interval for the epidural placement after clopidogrel administration. However ASRA Guideline did not specify the time for epidural catheter removal, and did not specify how much time elapse necessary after dual antiplatelet therapy with clopidogrel and aspirin. We report a case of safe removal of epidural catheter 72 hours after oral dose of clopidogrel and aspirin with a normal platelet function analysis and normal thromboelastography before removal.

  10. Successful spinal anaesthesia in a patient with a Tarlov cyst. (United States)

    Pfund, N; Oh, A; Cyna, A


    Perineural (Tarlov) cysts are cerebrospinal fluid-containing perineural sacs that are usually located in the sacral spine. While often asymptomatic, they can cause progressive neurological symptoms including pain, paraesthesia and weakness. We present a case of a 24-year-old patient who had uneventful spinal anaesthesia at the L3-4 level for an elective caesarean section. Prior to her procedure, she had reported a two-year history of intermittent back pain and lower-limb paraesthesia, secondary to an S1 segment perineural cyst. Recurrent cyst-related symptoms were managed using serial radiologically-guided injection and cerebrospinal fluid aspiration, rather than a more invasive neurosurgical approach. Successful neuraxial anaesthesia for caesarean section, in the context of Tarlov cysts, is described; and the management options are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Peculiarities of surgical treatment of gastrointestinal tract combined congenital malformations in newborns

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    М. О. Makarova


    Full Text Available Congenital gastrointestinal (GI malformations make up 21–25 % of all congenital anomalies and require surgical correction in the neonatal period. The aim was to analyze the methods of operative treatment of hard composite congenital gastrointestinal malformations in infants. Materials and Methods: There were 13 newborns with gastroschisis, omphalocele and esophageal atresia combined with intestinal atresia, anal atresia and also with congenital heart defects in our study. Results. We have designed new preoperative care strategies for the newborns. All combined GI defects were corrected in one step. In gastroschisis and omphalocele in combination with small intestine atresia we made a plastic of anterior abdominal wall, bowel segment resection and anastomosis end-to-end. In esophageal atresia and atresia of the anus direct esophago-esophagoanastomosis was applied with suturing of tracheoesophageal fistula, also in two patients proctoplasty by Pena 2 was carried out, and in one patient with high anal atresia colostomy was applied, which was closed in the age of 6 months. In case of esophageal atresia combined with small intestine atresia direct esophago-esophagoanastomosis with tracheoesophageal fistula suturing was carried out, and resection of the bowel segment with anastomosis end-to-end was applied. In a patient with a combination of esophageal atresia and duodenal obstruction esophagoplasty and closure of tracheoesophageal fistula with anastomosis by Kimur was made. Preference was given to the combined anesthesia with neuraxial blockade. Postoperative care included prolonged artificial lung ventilation, anesthesia, parenteral nutrition, antibacterial and antifungal medicines. Conclusions. One-step correction of the congenital GI malformations in newborns is effective and it gives opportunity to achieve the best results with a single surgical intervention. Extremely important links of the combined GI defects therapy is timely and balanced

  12. The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study. (United States)

    Ruzbarsky, Joseph J; Gausden, Elizabeth B; Goldwyn, Elan M; Lowenwirt, Isaac P; Kotlyar, Vitaly


    Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia. The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile. A retrospective chart review was conducted to identify patients with intertrochanteric hip fractures who underwent anesthesia with a fascia iliaca block over a 1.5-year period. In the six patients identified, there were no intraoperative conversions to general anesthesia requiring airway support. Additionally, there were no intraoperative complications, no mortalities within 30 days, 2 patients on anticoagulation who required a blood transfusion, and a single patient who developed a postoperative hospital-acquired pneumonia that resolved with an antibiotic course. In this series of patients, we demonstrate that a fascia iliaca block can reliably be utilized as the primary anesthetic for patients undergoing surgical fixation of intertrochanteric hip fractures, with an acceptable perioperative complication profile. Although concomitant sedation was provided with the block, this anesthesia strategy has the potential to reduce preoperative delays and minimize the overall burden of sedative and anesthetic medications in a geriatric population. These initial findings may serve as a basis for future, higher-quality prospective and comparative studies.

  13. [YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia]. (United States)

    Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha

    Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. A Virtual Reality Simulation Model of Spinal Ultrasound: Role in Teaching Spinal Sonoanatomy. (United States)

    Ramlogan, Reva; Niazi, Ahtsham U; Jin, Rongyu; Johnson, James; Chan, Vincent W; Perlas, Anahi

    Ultrasound assessment of the lumbar spine improves the success of spinal and epidural anesthesia, especially for patients with underlying difficult anatomy. To assist with the teaching and learning of ultrasound-guided neuraxial anesthesia, we have created an online interactive educational model ( and The aim of the current study was to determine whether the virtual spine model improved the knowledge of neuraxial anatomy and sonoanatomy. After obtaining ethics board approval and written participant consent, 14 anesthesia trainees with no prior experience with spine ultrasound imaging were included in this study. Construct validity was assessed using a pretest/posttest design to measure the knowledge acquired from self-study of the virtual spine simulation modules. Two tests (A and B) with 20 multiple-choice questions were used either for the pretest or posttest, at random in order to account for possible differences in difficulty between the 2 tests. These tests were administered immediately before and after a 1-hour training session using the spine ultrasound model. Fourteen anesthesia trainees completed the study. Seven used test A as the pretest (group A), and 7 used test B as the pretest (group B). Both groups showed a statistically significant improvement (P < 0.05) in test scores after a 1-hour session with the spine ultrasound model. The mean scores were 55% (SD, 11.2%) on the pretest and 77% (SD, 8.7%) on the posttest. The study demonstrated that after 1 hour of self-study by the trainees on the spine ultrasound model test scores improved by 40%.

  15. Prevalence and descriptive analysis of congenital heart disease in parturients: obstetric, neonatal, and anesthetic outcomes. (United States)

    Warrick, Christine M; Hart, Jan E; Lynch, Anne M; Hawkins, Joy A; Bucklin, Brenda A


    The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe outcomes of pregnancies in women with CHD, (3) compare outcomes in women with and without CHD, and (4) characterize neonatal outcomes in pregnancies complicated by CHD. This was a retrospective cohort study of women who delivered at the University of Colorado Hospital. Diagnosis of CHD was identified based on history of cardiac disease, pulmonary disease, or subacute bacterial endocarditis prophylaxis during labor and confirmed with echocardiogram when available. Comprehensive retrospective review of anesthetic, obstetric, and neonatal outcomes was performed. University of Colorado Hospital. 18,226 women. Medical record review. Valvular abnormalities, New York Heart Failure Association classification scores, types of CHD, maternal age, race, gravidity, parity, maternal prepregnancy body mass index, cigarette use, type of delivery, type of analgesia used, early initiation of neuraxial analgesia, arrhythmias, need for peripartum diuretics, prolonged maternal hospital stay, preterm birth, small for gestational age, neonatal CHD, neonatal or maternal intensive care unit (ICU) admissions, and maternal or neonatal death. We identified 117 pregnancies in 110 women with CHD. Parturients with CHD were more likely to have operative vaginal delivery (P disease was associated with increased rates of operative vaginal delivery, early initiation of neuraxial labor analgesia, cardiac complications (including arrhythmia and use of diuretics), prolonged hospital stay, and maternal ICU admission. However, most deliveries and births were uncomplicated; and there were one case each of maternal mortality and fetal death after birth. Operative abdominal deliveries and neonatal ICU admissions are more common in women with CHD, but these pregnancies are generally well tolerated with low mortality rates. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

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    Serkan Tulgar

    Full Text Available Abstract Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. Material and method A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1 evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2 was designed for evaluating patient information. Results After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p > 0.05. There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p > 0.05. Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87 ± 4.28 vs. 5.84 ± 2.90, p = 0.044 and 3.89 ± 5.43 vs. 1.19 ± 3.35, p = 0.01 respectively. Conclusion Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions.

  17. [Regional anesthesia practice in Chile: an online survey]. (United States)

    Corvetto, M; McCready, M; Cook, C; Pietrobon, R; Altermatt, F


    To conduct a survey to profile the practice of regional anesthesia in Chile and determine the limitations on its use. A link to an online questionnaire was sent by e-mail to anesthesiologists who were members of their national professional association (Sociedad Chilena de Anestesiologia). The survey was processed anonymously. Multiple choice items elicited responses concerning general demographic information, professional experience as an anesthetist, academic degree, hospital size, and the use of regional anesthesia in clinical practice (number of procedures and types of techniques). Finally, the questionnaire focused on the use of nerve and plexus blocks. A total of 209 completed questionnaires were received, for a response rate of 54%. Regional anesthesia was part of routine practice for 97% of the respondents; 68% reported that regional techniques were used in more than 30% of their caseload. Most performed neuraxial techniques: 98.1% were spinal blocks, 96.2% lumbar epidural blocks, and 66.9% thoracic epidural blocks. Routine use of peripheral nerve blockade was reported by 73.7%. Upper limb anesthesia was provided significantly more often than lower limb anesthesia (P =.011). The most common technique involved use of a peripheral nerve stimulator (64%). Skills were mainly acquired through residency programs (68.9%) and self-teaching (20.1%). Peripheral nerve blocks were never performed by 26.3% of the respondents; the reason given most often was lack of training. Although regional anesthesia is commonly used in Chile, neuraxial blocks remain the most frequently used types. Peripheral nerve blocks are used fairly often, mostly on an upper limb. Training should stimulate attempts to promote more widespread use of all forms of regional anesthesia.

  18. Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal–Fetal Medicine Units Network Caesarean Registry†‡ (United States)

    Butwick, A. J.; El-Sayed, Y. Y.; Blumenfeld, Y. J.; Osmundson, S. S.; Weiniger, C. F.


    Background Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. Methods Women undergoing Caesarean delivery between 24+0 and 36+6 weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. Results Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7–2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2–1.8), other race (aOR=1.4; 95% CI=1.1–1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2–3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1–3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. Conclusions In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery. PMID:25956901

  19. Experimental determination of carbon partitioning between upper mantle minerals and silicate melts: initial results and comparison to trace element partitioning (Nb, Rb, Ba, U, Th, K) (United States)

    Rosenthal, A.; Hauri, E. H.; Hirschmann, M. M.; Davis, F. A.; Withers, A. C.; Fogel, M. L.


    Inventories of C in the mantle and magmatic fluxes of C between the mantle and the Earth's outer envelopes are poorly constrained in part owing to challenges in determining undegassed C concentrations of pristine basalts. Saal et al. [1] proposed that the behavior of Nb could be used as a proxy for C, owing to apparently similar behavior of the two elements in Siqueiros Transform MORB, but higher C/Nb ratios in popping rocks [2] call into question the applicability of the C/Nb proxy. Here, we present experimentally determined carbon partition coefficients (D's) between nominally volatile-free mantle minerals (olivine, OL; orthopyroxene, OPX; clinopyroxene, CPX; garnet, GA) and melts at 0.8-3 GPa, and 1250-1500°C. We conducted piston-cylinder experiments using an olivine-tholeiite + 4 wt% CO2, doped with Nb, Rb, U, Th, and 13C to enhance detection limits. To promote growth of crystals big enough for SIMS analyses, experiments were either long (D12C, but a few have the opposite. Continuous exchange of the liquid (initially rich in 13C) with the graphite capsules (rich in 12C) may yield D's with 13C>12C. D's with 12C>13C are likely owing to either low count rates or comparatively high analytical contamination. Concentrations in minerals vary from 0.20-3.46 ppm for C, 25-176 ppm for H2O, and 0.05-1.21 ppm for F, whereas liquids tend to much higher values (C≤0.9 wt%; H2O≤1.5 wt%; F≤34 ppm; P≤0.25 wt%; S≤43 ppm; Cl≤77 ppm). Resulting D's indicate that C is highly incompatible in all major mantle mineral phases, with D's for OL, OPX and CPX of close to 5x10-4, and for GA ~2.2x10-4. D's for H2O (2x10-4 to ~3x10-2) and F (~2.3x10-3 to ~5.8x10-2) are comparable to those found in previous studies. Trace element partition determinations are in progress, but comparison to previous studies indicates that carbon is significantly more incompatible during mantle melting than Nb, U, or Th, and has behavior approximately similar to Ba. We therefore suggest that

  20. Evaluation of The Value of Core Needle Biopsy in The Diagnosis of a Breast Mass

    Directory of Open Access Journals (Sweden)

    Asieh Sadat Fattahi


    Full Text Available Background: Core needle biopsy (CNB with histological findings is regarded as one of the most important diagnostic measures that make preoperative assessment and planning for appropriate treatment possible. The aim of this study was to determine the sensitivity and specificity of core biopsy results in our patients with benign and malignant breast lumps, especially for borderline breast lesions, by using a classification method.Methods: In this study, 116 patients who were referred to the Surgery Clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran with breast lump and underwent diagnostic procedures such as mammography and ultrasound were selected. Core needle biopsy (Tru-cut #14 or 16 was performed. After that, excisional biopsy was done. The benign, malignant and unspecified samples obtained by core needle biopsy were evaluated with the samples of the surgical and pathological findings. Then, false positive, false negative, sensitivity, specificity, and diagnostic accuracy of the core needle biopsy method were calculated. Also, the National Health Service Breast Screening Program (NHSBSP classification was employed.Results: The mean age of the participants in this study was 39±13.13 years and the mean tumor size was 2.7 cm. An average of 3.35 biopsies was taken from all patients. Most of the pathology samples taken from CNB and excisional biopsy were compatible with invasive ductal carcinoma. Of the B type classifications, B5 was the most frequent in both methods. Borderline lesions B3 and B4 had a change in their category after surgery. About 2.5% of the samples in core biopsy were inadequate. Skin bruising was the most common core biopsy complication reported. While, the most common complication of excisional biopsy was hematoma. Accuracy, sensitivity, specificity, positive and negative predictive values of the core needle biopsy procedure compared with excisional biopsy was 95.5%, 92.6%, 100%, 100%, and 91

  1. Accuracy of 3 T versus 1.5 T breast MRI for pre-operative assessment of extent of disease in newly diagnosed DCIS

    Energy Technology Data Exchange (ETDEWEB)

    Rahbar, Habib, E-mail:; DeMartini, Wendy B.; Lee, Amie Y.; Partridge, Savannah C.; Peacock, Sue; Lehman, Constance D.


    Highlights: •We compared sizes of known ductal carcinoma in situ (DCIS) on pre-operative breast MRI at 3 T and 1.5 T with final pathology sizes. •DCIS sizes on 3 T MRI correlated better with pathologic sizes than 1.5 T MRI. •Imaging features of DCIS, including morphology and kinetics, were similar at 3 T and 1.5 T MRI. -- Abstract: Objectives: While 3 T breast magnetic resonance imaging has increased in use over the past decade, there is little data comparing its use for assessing ductal carcinoma in situ (DCIS) versus 1.5 T. We sought to compare the accuracies of DCIS extent of disease measures on pre-operative 3 T versus 1.5 T MRI. Methods: This institutional review board-approved prospective study included 20 patients with ductal carcinoma in situ diagnosed by core needle biopsy (CNB) who underwent pre-operative breast MRI at both 3 T (resolution = 0.5 mm × 0.5 mm × 1.3 mm) and 1.5 T (0.85 mm × 0.85 mm × 1.6 mm). All patients provided informed consent, and the study was HIPPA compliant. Lesion sizes and imaging characteristics (morphologic and kinetic enhancement) were recorded for the 3 T and 1.5 T examinations. Lesion size measures at both field strengths were correlated to final pathology, and imaging characteristics also were compared. Results: Of the initial cohort of 20 patients with CNB-diagnosed DCIS, 19 underwent definitive surgery. Median DCIS sizes of these 19 patients were 6 mm (range: 0–67 mm) on 3 T, 13 mm (0–60 mm) on 1.5 T, and 6 mm (0–55 mm) on surgical pathology. Size correlation between MRI and pathology was higher for 3 T (Spearman's ρ = 0.66, p = 0.002) than 1.5 T (ρ = 0.36, p = 0.13). In 10 women in which a residual area of suspicious enhancement was identified on both field strengths, there was agreement of morphologic description (NME vs. mass) in nine, and no significant difference in dynamic contrast enhanced kinetics at 3 T compared to 1.5 T. Conclusions: Pre-operative breast MRI at 3 T provided higher

  2. Construction of a Recyclable Genetic Marker and Serial Gene Deletions in the Human Pathogenic Mucorales Mucor circinelloides

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    Alexis Garcia


    Full Text Available Mucor circinelloides is a human pathogen, biofuel producer, and model system that belongs to a basal fungal lineage; however, the genetics of this fungus are limited. In contrast to ascomycetes and basidiomycetes, basal fungal lineages have been understudied. This may be caused by a lack of attention given to these fungi, as well as limited tools for genetic analysis. Nonetheless, the importance of these fungi as pathogens and model systems has increased. M. circinelloides is one of a few genetically tractable organisms in the basal fungi, but it is far from a robust genetic system when compared to model fungi in the subkingdom Dikarya. One problem is the organism is resistant to drugs utilized to select for dominant markers in other fungal transformation systems. Thus, we developed a blaster recyclable marker system by using the pyrG gene (encoding an orotidine-5′-phosphate decarboxylase, ortholog of URA3 in Saccharomyces cerevisiae. A 237-bp fragment downstream of the pyrG gene was tandemly incorporated into the upstream region of the gene, resulting in construction of a pyrG-dpl237 marker. To test the functionality of the pyrG-dpl237 marker, we disrupted the carRP gene that is involved in carotenoid synthesis in pyrG− mutant background. The resulting carRP::pyrG-dpl237 mutants exhibit a white colony phenotype due to lack of carotene, whereas wild type displays yellowish colonies. The pyrG marker was then successfully excised, generating carRP-dpl237 on 5-FOA medium. The mutants became auxotrophic and required uridine for growth. We then disrupted the calcineurin B regulatory subunit cnbR gene in the carRP::dpl237 strain, generating mutants with the alleles carRP::dpl237 and cnbR::pyrG. These results demonstrate that the recyclable marker system is fully functional, and therefore the pyrG-dpl237 marker can be used for sequential gene deletions in M. circinelloides.

  3. Valence shell charge concentrations at pentacoordinate d0 transition-metal centers: non-VSEPR structures of Me2NbCl3 and Me3NbCl2. (United States)

    McGrady, G Sean; Haaland, Arne; Verne, Hans Peter; Volden, Hans Vidar; Downs, Anthony J; Shorokhov, Dmitry; Eickerling, Georg; Scherer, Wolfgang


    The molecular structures of the monomeric, pentacoordinated methylchloroniobium(IV) compounds Me3NbCl2 and Me2NbCl3 have been determined by gas electron diffraction (GED) and density functional theory (DFT) calculations, and, for Me3NbCl2, by single crystal X-ray diffraction. Each of the molecules is found to have a heavy-atom skeleton in the form of a trigonal bipyramid (TBP) with Cl atoms in the axial positions, in accord with their vibrational spectra. The TBP is somewhat distorted in the case of Me2NbCl3 with the two axial Nb--Cl bonds bent away from the equatorial, slightly shorter Nb--Cl bond. In the case of Me3NbCl2, moreover, the X-ray model suggests structural distortions away from the idealized C3h geometry, in line with the results of quantum chemical calculations. Structure optimizations by DFT calculations and least-squares refinement to the GED data yield the following structural parameters (calcd/exptl; eq=equatorial; ax=axial; distances in A, angles in degrees; average values in brackets): Me3NbCl2, in C(3v) symmetry, Nb--Cl 2.370/2.319(3), Nb--C 2.173/2.152(4), C--H 1.096/1.124(5), angle-spherical NbCH 109.3/105.2(8), angle-spherical ClNbC 92.2/93.3(2), angle-spherical CNbC 119.9/119.7(1); Me2NbCl3, in C(2v) symmetry, Nb--Cl(ax) 2.361/2.304(5), Nb--Cl(eq) 2.321/2.288(9), Nb--C 2.180/2.135(9), C--H 1.094/1.12(1), angle-spherical Cl(ax)NbCl(eq) 98.5/96.5(6), angle-spherical CNbC 121.0/114(2), angle-spherical NbCH 108.9/109(2). The electronic structures of Me2NbCl3 and Me3NbC(2 have been explored by rigorous analysis of both the wavefunction and the topology of the electron density, employing DFT calculations. Hence the structures of these compounds are shown to reflect repulsion between the Nb--C and Nb--Cl bonding electron density and charge concentrations induced by the methyl ligands in the valence shell of the Nb atom and arising mainly from use of Nb(4d) functions in the Nb--C bonds.

  4. Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. (United States)

    Marcil, Gabriel; Wong, Stephanie; Trabulsi, Nora; Allard-Coutu, Alexandra; Parsyan, Armen; Omeroglu, Atilla; Atinel, Gulbeyaz; Mesurolle, Benoit; Meterissian, Sarkis


    Fibroepithelial lesions of the breast (FEL) are atypical lesions diagnosed on core-needle biopsy. The purpose of this study was to determine the rate at which FELs are upstaged to phyllodes tumor on excision, and to examine the clinical and radiological factors that may be predictive of upstaging. A retrospective review from the medical records of patients diagnosed with FEL on CNB at a single institution between 2010 and 2015 was performed. Patients diagnosed with benign or borderline phyllodes tumors were compared to those diagnosed with fibroadenoma. Of 74 patients diagnosed with FEL, 48 underwent excision (64.9%). Of the 48 lesions excised, pathology revealed 30 fibroadenomas (62.5%), 14 benign phyllodes tumors (29.2%), and 4 borderline phyllodes tumor (8.3%). No malignant phyllodes tumors were identified. On preoperative ultrasound, heterogeneous echotexture (p = 0.03) and lack of internal vascularity (p = 0.03) were significantly associated with upstaging to phyllodes tumor. Surgical excision of FELs yield a pathological diagnosis of benign and borderline phyllodes tumor in 37.5% of cases. A high BIRADs score (≥4b), heterogeneous echotexture and lack of internal vascularity on ultrasound may help predict upstaging to phyllodes tumor. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Evaluation of principal cannabinoids in airborne particulates

    Energy Technology Data Exchange (ETDEWEB)

    Balducci, C., E-mail: [Italian National Research Council, Institute for Atmospheric Pollution (CNR-IIA), Monterotondo Stazione (Italy); Nervegna, G.; Cecinato, A. [Italian National Research Council, Institute for Atmospheric Pollution (CNR-IIA), Monterotondo Stazione (Italy)


    The determination of delta(9)-tetrahydrocannabinol ({Delta}{sup 9}-THC), cannabidiol (CND) and cannabinol (CNB), primary active components in cannabis preparation, was carried out on airborne particulates by applying a specific procedure consisting of soot extraction by ultrasonic bath, purification by solvent partitioning, derivatization with N-(t-butyldimethylsilyl)-N-methyl-trifluoroacetamide, and separation/detection through gas chromatography coupled with tandem mass spectrometry. The optimized procedure was found suitable for measuring the three psychotropic substances at concentrations ranging from ca. 0.001 to ca. 5.0 ng cm{sup -3} of air, with recoveries always higher than 82%, accuracy >7.3% and precision >90%. Application of the procedure performed on field in Rome and Bari, Italy, demonstrated that all three compounds contaminate the air in Italian cities whereas in Algiers, Algeria, only cannabinol, the most stable in the atmosphere, exceeded the limit of quantification of the method. The relative percentages of the three cannabinoids in general reproduced those typical of the Cannabis sativa plant and were very different from those found in human blood, urine and sweat.

  6. Genome sequencing reveals complex secondary metabolome in themarine actinomycete Salinispora tropica

    Energy Technology Data Exchange (ETDEWEB)

    Udwary, Daniel W.; Zeigler, Lisa; Asolkar, Ratnakar; Singan,Vasanth; Lapidus, Alla; Fenical, William; Jensen, Paul R.; Moore, BradleyS.


    Recent fermentation studies have identified actinomycetes ofthe marine-dwelling genus Salinispora as prolific natural productproducers. To further evaluate their biosynthetic potential, we analyzedall identifiable secondary natural product gene clusters from therecently sequenced 5,184,724 bp S. tropica CNB-440 circular genome. Ouranalysis shows that biosynthetic potential meets or exceeds that shown byprevious Streptomyces genome sequences as well as other naturalproduct-producing actinomycetes. The S. tropica genome features ninepolyketide synthase systems of every known formally classified family,non-ribosomal peptide synthetases and several hybrid clusters. While afew clusters appear to encode molecules previously identified inStreptomyces species,the majority of the 15 biosynthetic loci are novel.Specific chemical information about putative and observed natural productmolecules is presented and discussed. In addition, our bioinformaticanalysis was critical for the structure elucidation of the novelpolyenemacrolactam salinilactam A. This study demonstrates the potentialfor genomic analysis to complement and strengthen traditional naturalproduct isolation studies and firmly establishes the genus Salinispora asa rich source of novel drug-like molecules.

  7. The environmental fate of organic pollutants through the global microbial metabolism. (United States)

    Gómez, Manuel J; Pazos, Florencio; Guijarro, Francisco J; de Lorenzo, Víctor; Valencia, Alfonso


    The production of new chemicals for industrial or therapeutic applications exceeds our ability to generate experimental data on their biological fate once they are released into the environment. Typically, mixtures of organic pollutants are freed into a variety of sites inhabited by diverse microorganisms, which structure complex multispecies metabolic networks. A machine learning approach has been instrumental to expose a correlation between the frequency of 149 atomic triads (chemotopes) common in organo-chemical compounds and the global capacity of microorganisms to metabolise them. Depending on the type of environmental fate defined, the system can correctly predict the biodegradative outcome for 73-87% of compounds. This system is available to the community as a web server ( The application of this predictive tool to chemical species released into the environment provides an early instrument for tentatively classifying the compounds as biodegradable or recalcitrant. Automated surveys of lists of industrial chemicals currently employed in large quantities revealed that herbicides are the group of functional molecules more difficult to recycle into the biosphere through the inclusive microbial metabolism.

  8. Current status of core needle biopsy of the thyroid

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jung Hwan [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)


    Thyroid nodules are a common clinical problem. Fine-needle aspiration (FNA) and large-needle biopsy have been used to diagnose thyroid nodules. Before the 1980s, large-needle biopsy was the standard procedure for the thyroid, but FNA became the standard diagnostic tool in the 1980s because it is a safe procedure that leads to accurate diagnoses. With advances in core needle biopsy (CNB) devices (i.e., spring-activated core needles) and development of high-resolution ultrasound, it has become possible to make accurate diagnoses while minimizing complications. Although 18- to 21-gauge core needles can be used to biopsy thyroid nodules, 18-gauge needles are most commonly used in Korea. The relationships among the size of the needle, the number of core specimens, and diagnostic accuracy have not yet been conclusively established, but the general tendency is that thinner needles cause less damage to the normal thyroid, but allow a smaller amount of thyroid tissue to be biopsied to be obtained. These relationships may be validated in the future.

  9. Development and characterization of a bioglass/chitosan composite as an injectable bone substitute. (United States)

    Khoshakhlagh, Parastoo; Rabiee, Sayed Mahmood; Kiaee, Gita; Heidari, Pedram; Miri, Amir K; Moradi, Roshanak; Moztarzadeh, Fathollah; Ravarian, Roya


    SiO 2 -CaO-P 2 O 5 based bioglass (BG) systems constitute a group of materials that have wide applications in bone implants. Chitosan (Cn) is a biocompatible and osteoconductive natural polymer that can promote wound healing. In this study, bioactivity of chitosan/bioglass (CnB) composites as minimally invasive bone regenerative materials was assessed both in vitro and in vivo. Injectability tests and scanning electron microscopy (SEM) results demonstrated the formation of uniform injectable paste-like composites using BG particles and Cn. Fourier transform infrared spectroscopy (FTIR) and SEM images confirmed hydroxyapatite deposition in vitro after incubation in simulated body fluid (SBF). Higher BG content in the composite correlated with increased human osteoblast proliferation. An in vivo study in a rat spinal fusion model confirmed that increasing the amount of BG improved osteoconductivity. Manual palpation, radiographic images and pathological assessments proved that the composites promote bone formation. Based on these data, the synthesized composites have a potential application in orthopedic and reconstructive surgeries as a minimally invasive bone substitute. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Measuring the Real Fracture Toughness of Ceramics: ASTM C 1421 (United States)

    Salem, Jonathan; Quinn, George; Jenkins, Michael

    ASTM C 1421 "Standard Test Methods for Determination of Fracture Toughness of Advanced Ceramics at Ambient Temperature" is a high-quality, technicallyrigorous, full-consensus standard that may have finally answered the question, "What is the 'real' fracture toughness of ceramics?" This document was eight years in the actual standardization process (although an estimated two decades of preparation work may have preceded the actual standardization process). Three different types of notch/crack geometries are employed in flexure beams: single edge precracked beam (SEPB); chevron-notched beam (CNB), and surface crack in flexure (SCF). Extensive experimental, analytical, and numerical evaluations were conducted in order to mitigate interferences that frequently lower the accuracy of fracture toughness test results. Several round robins (e.g. Versailles Advanced Materials and Standards {VAMAS}) verified and validated the choice of dimensions and test parameters included in the standard. In addition, the standard reference material NIST SRM 2100 was developed and can be used in concert with ASTM C 1421 to validate a fracture toughness test setup or test protocol.

  11. Assessment of protein set coherence using functional annotations

    Directory of Open Access Journals (Sweden)

    Carazo Jose M


    Full Text Available Abstract Background Analysis of large-scale experimental datasets frequently produces one or more sets of proteins that are subsequently mined for functional interpretation and validation. To this end, a number of computational methods have been devised that rely on the analysis of functional annotations. Although current methods provide valuable information (e.g. significantly enriched annotations, pairwise functional similarities, they do not specifically measure the degree of homogeneity of a protein set. Results In this work we present a method that scores the degree of functional homogeneity, or coherence, of a set of proteins on the basis of the global similarity of their functional annotations. The method uses statistical hypothesis testing to assess the significance of the set in the context of the functional space of a reference set. As such, it can be used as a first step in the validation of sets expected to be homogeneous prior to further functional interpretation. Conclusion We evaluate our method by analysing known biologically relevant sets as well as random ones. The known relevant sets comprise macromolecular complexes, cellular components and pathways described for Saccharomyces cerevisiae, which are mostly significantly coherent. Finally, we illustrate the usefulness of our approach for validating 'functional modules' obtained from computational analysis of protein-protein interaction networks. Matlab code and supplementary data are available at

  12. Evaluation of principal cannabinoids in airborne particulates. (United States)

    Balducci, C; Nervegna, G; Cecinato, A


    The determination of delta(9)-tetrahydrocannabinol (Delta9-THC), cannabidiol (CND) and cannabinol (CNB), primary active components in cannabis preparation, was carried out on airborne particulates by applying a specific procedure consisting of soot extraction by ultrasonic bath, purification by solvent partitioning, derivatization with N-(t-butyldimethylsilyl)-N-methyl-trifluoroacetamide, and separation/detection through gas chromatography coupled with tandem mass spectrometry. The optimized procedure was found suitable for measuring the three psychotropic substances at concentrations ranging from ca. 0.001 to ca. 5.0 ng cm(-3) of air, with recoveries always higher than 82%, accuracy >7.3% and precision >90%. Application of the procedure performed on field in Rome and Bari, Italy, demonstrated that all three compounds contaminate the air in Italian cities whereas in Algiers, Algeria, only cannabinol, the most stable in the atmosphere, exceeded the limit of quantification of the method. The relative percentages of the three cannabinoids in general reproduced those typical of the Cannabis sativa plant and were very different from those found in human blood, urine and sweat.

  13. Development of Low Carbon Niobium Bearing High Strength F-B Dual Phase Steel with High Hole Expansion Property (United States)

    Zhang, Lin; Xia, Ming-sheng; Xiong, Zi-liu; Du, Yan-bing; Qiao, Zhi-ming; Zhang, Hong-bo

    In the study a low carbon niobium bearing high strength F-B dual phase automobile steel with high hole expansion property has been investigated. Steels of different chemical composition have been investigated by simulation experiments of controlled rolling and cooling process to study the influences of chemical elements, especially for C,Nb and Ti, and cooling pattern on the mechanical properties, flangeability and microstructure of strips. So-called 3-stages cooling pattern was adopted in simulation experiments, combining ultra fast cooling in first stage, air cooling in middle stage and fast cooling in the last stage, and at the end of run-out table the temperature of rolled pieces drop to below Bs point. Optical microstructure and SEM morphology have been observed. Results indicate that it is possible to obtain dual phase microstructure of polygonal ferrite plus bainite in adopting 3-stages cooling pattern. The low temperature coiling method using 3-step controlled cooling pattern after hot rolling is effective to produce low carbon Nb bearing steel with high balance of strength-ductility-flangeability, in addition, higher carbon content of steel tend to be detrimental to flangeability of steel, due to much carbide precipitation at ferrite boundary. Based on the results of simulation experiments mill trial has been carried out and hot rolled high strength steel with tensile strength higher as 600Mpa and hole expansion ratio higher as 100% has been developed successfully.

  14. Modulation of yeast alkaline cation tolerance by Ypi1 requires calcineurin. (United States)

    Marquina, Maribel; González, Asier; Barreto, Lina; Gelis, Samuel; Muñoz, Iván; Ruiz, Amparo; Alvarez, Mari Carmen; Ramos, José; Ariño, Joaquín


    Ypi1 was discovered as an essential protein able to act as a regulatory subunit of the Saccharomyces cerevisiae type 1 protein phosphatase Glc7 and play a key role in mitosis. We show here that partial depletion of Ypi1 causes lithium sensitivity and that high levels of this protein confer a lithium-tolerant phenotype to yeast cells. Remarkably, this phenotype was independent of the role of Ypi1 as a Glc7 regulatory subunit. Lithium tolerance in cells overexpressing Ypi1 was caused by a combination of increased efflux of lithium, mediated by augmented expression of the alkaline cation ATPase ENA1, and decreased lithium influx through the Trk1,2 high-affinity potassium transporters. Deletion of CNB1, encoding the regulatory subunit of the calcineurin phosphatase, blocked Ypi1-induced expression of ENA1, normalized Li(+) fluxes, and abolished the Li(+) hypertolerant phenotype of Ypi1-overexpressing cells. These results point to a complex role of Ypi1 on the regulation of cation homeostasis, largely mediated by the calcineurin phosphatase.

  15. A fast iterative convolution weighting approach for gridding-based direct Fourier three-dimensional reconstruction with correction for the contrast transfer function. (United States)

    Abrishami, V; Bilbao-Castro, J R; Vargas, J; Marabini, R; Carazo, J M; Sorzano, C O S


    We describe a fast and accurate method for the reconstruction of macromolecular complexes from a set of projections. Direct Fourier inversion (in which the Fourier Slice Theorem plays a central role) is a solution for dealing with this inverse problem. Unfortunately, the set of projections provides a non-equidistantly sampled version of the macromolecule Fourier transform in the single particle field (and, therefore, a direct Fourier inversion) may not be an optimal solution. In this paper, we introduce a gridding-based direct Fourier method for the three-dimensional reconstruction approach that uses a weighting technique to compute a uniform sampled Fourier transform. Moreover, the contrast transfer function of the microscope, which is a limiting factor in pursuing a high resolution reconstruction, is corrected by the algorithm. Parallelization of this algorithm, both on threads and on multiple CPU's, makes the process of three-dimensional reconstruction even faster. The experimental results show that our proposed gridding-based direct Fourier reconstruction is slightly more accurate than similar existing methods and presents a lower computational complexity both in terms of time and memory, thereby allowing its use on larger volumes. The algorithm is fully implemented in the open-source Xmipp package and is downloadable from Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Crystal structure of trans-diaquabis(4-cyanobenzoato-κObis(nicotinamide-κN1cobalt(II

    Directory of Open Access Journals (Sweden)

    Gülçin Şefiye Aşkın


    Full Text Available In the title complex, [Co(C8H4NO22(C6H6N2O2(H2O2], the CoII atom is located on an inversion centre and is coordinated by two 4-cyanobenzoate (CNB anions, two nicotinamide (NA ligands and two water molecules. The four O atoms in the equatorial plane form a slightly distorted square-planar arrangement, while the slightly distorted octahedral coordination sphere is completed by the two N atoms of the NA ligands in the axial positions. The dihedral angle between the carboxylate group and the adjacent benzene ring is 22.11 (15°, while the pyridine and benzene rings are oriented at a dihedral angle of 89.98 (5°. In the crystal, intermolecular N—H...O and O—H...O hydrogen bonds link the molecules, enclosing R22(8 and R44(8 ring motifs, forming layers parallel to (100. The layers are linked via C—H...O and C—H...N hydrogen bonds, resulting in a three-dimensional network. A weak C—H...π interaction is also observed.

  17. Calcineurin Antagonizes AMPK to Regulate Lipolysis in Caenorhabditis elegans. (United States)

    Wang, Yanli; Xie, Cangsang; Diao, Zhiqing; Liang, Bin


    Calcineurin is a calcium- and calmodulin-dependent serine/threonine protein phosphatase, and the target of immunosuppressive agent tacrolimus (TAC). The dysfunction of calcineurin, or clinical applications of tacrolimus, have been reported to be associated with dyslipidemia. The underlying mechanisms of calcineurin and tacrolimus in lipid metabolism are largely unknown. Here, we showed that mutations of tax-6 and cnb-1, which respectively encode the catalytic subunit and the regulatory subunit of calcineurin, together with tacrolimus treatment, consistently led to decreased fat accumulation and delayed growth in the nematode Caenorhabditis elegans. In contrast, disruption of the AMP-activated protein kinase (AMPK) encoded by aak-1 and aak-2 reversed the above effects in worms. Moreover, calcineurin deficiency and tacrolimus treatment consistently activated the transcriptional expression of the lipolytic gene atgl-1, encoding triglyceride lipase. Furthermore, RNAi knockdown of atgl-1 recovered the decreased fat accumulation in both calcineurin deficient and tacrolimus treated worms. Collectively, our results reveal that immunosuppressive agent tacrolimus and their target calcineurin may antagonize AMPK to regulate ATGL and lipolysis, thereby providing potential therapy for the application of immunosuppressive agents.

  18. Calcineurin Antagonizes AMPK to Regulate Lipolysis in Caenorhabditis elegans

    Directory of Open Access Journals (Sweden)

    Yanli Wang


    Full Text Available Calcineurin is a calcium- and calmodulin-dependent serine/threonine protein phosphatase, and the target of immunosuppressive agent tacrolimus (TAC. The dysfunction of calcineurin, or clinical applications of tacrolimus, have been reported to be associated with dyslipidemia. The underlying mechanisms of calcineurin and tacrolimus in lipid metabolism are largely unknown. Here, we showed that mutations of tax-6 and cnb-1, which respectively encode the catalytic subunit and the regulatory subunit of calcineurin, together with tacrolimus treatment, consistently led to decreased fat accumulation and delayed growth in the nematode Caenorhabditis elegans. In contrast, disruption of the AMP-activated protein kinase (AMPK encoded by aak-1 and aak-2 reversed the above effects in worms. Moreover, calcineurin deficiency and tacrolimus treatment consistently activated the transcriptional expression of the lipolytic gene atgl-1, encoding triglyceride lipase. Furthermore, RNAi knockdown of atgl-1 recovered the decreased fat accumulation in both calcineurin deficient and tacrolimus treated worms. Collectively, our results reveal that immunosuppressive agent tacrolimus and their target calcineurin may antagonize AMPK to regulate ATGL and lipolysis, thereby providing potential therapy for the application of immunosuppressive agents.

  19. Predictors of invasive breast cancer in mammographically detected microcalcification in patients with a core biopsy diagnosis of flat epithelial atypia, atypical ductal hyperplasia or ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy. (United States)

    Catteau, Xavier; Simon, Philippe; Noël, Jean-Christophe


    15±30% of malignancies detected through screening programs are ductal carcinoma in situ (DCIS), and the majority of DCIS cases present in the form of mammographic microcalcification. This study was performed in order to determine the value of features in predicting invasive disease in patients with mammographic calcification and to help determine which patients (with, Core Needle Biopsy-diagnosed DCIS) are the most appropriate candidates for Sentinel Lymph Node (SLN) biopsy. The original aspect of this study was to select patients with mammographic microcalcification but without an associated mass. The factor that we identified to be associated with invasive disease at final surgical excision was the presence of necrosis at core histology. SLN biopsy or complete axillary lymph node dissection was performed in 22 (40%) patients of whom only one (4.5%) had a micrometastasis. Further larger studies are needed to see if it would be interesting to propose a SLN biopsy in case of necrosis on CNB-diagnosed DCIS with microcalcifications but not associated with a mass. Copyright © 2012 Elsevier GmbH. All rights reserved.

  20. CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Sklair-Levy, M.; Shaham, D.; Applbaum, Y.H.; Libson, E. [Dept. of Radiology, Hadassah University Hospital, Jerusalem (Israel); Polliack, A.; Gillis, S.; Ben-Yehuda, D. [Dept. of Haematology, Hadassah University Hospital, Jerusalem (Israel); Sherman, Y. [Dept. of Pathology, Hadassah University Hospital, Jerusalem (Israel)


    The advent of radiologic guidance techniques for percutaneous biopsy has changed the approach to the routine diagnosis of mediastinal lymphoma. The aim of the present study was to evaluate the diagnostic accuracy of CT-guided percutaneous core-needle biopsy (PCNB) in the clinical management of patients with mediastinal lymphoma. The results of 49 CT-guided PCNB of mediastinal lymphoma performed under local anesthesia in 42 ambulatory patients were analyzed. A positive diagnosis of lymphoma was obtained in 30 of 42 patients, with an overall success rate of 71.5 %. The technique was equally successful in the diagnosis of Hodgkin's and non-Hodgkin's lymphoma. There were no major complications. Percutaneous CT-guided CNB of mediastinal lymphoma is a quick, safe, accurate, and efficient alternative to open biopsy in the evaluation of mediastinal lymphoma, mainly at presentation. It should become the preferred initial diagnostic procedure for obtaining histologic samples in patients with suspected mediastinal lymphoma. (orig.)

  1. Pleomorphic lobular carcinoma in situ: Current evidence and a systemic review (United States)

    Wazir, Umar; Wazir, Ali; Wells, Clive; Mokbel, Kefah


    Pleomorphic lobular carcinoma in situ (PLCIS) has only recently been identified as a distinct pathological entity within classic lobular carcinoma in situ (CLCIS). As such, there is currently no consensus among clinicians regarding the optimal treatment of this disease. The present study determined the risk of concomitant invasive disease and ductal carcinoma in situ (DCIS) if PLCIS is observed on core needle biopsy (CNB) and collated the evidence regarding the risk of recurrence in relation to surgical margins and adjuvant therapy. In addition, the pertinent literature available through MedLine, PubMed, the WHO Clinical Trials Registry Platform and Google Scholar using appropriate keywords was reviewed. The pooled results of studies in the literature demonstrated a concomitant presence of invasive disease of 40%, and 15% for DCIS. The studies that examined recurrence rates indicated that the risk is reduced with ample resection margins (>2 mm) and adjuvant radiotherapy. However, recent studies raise concerns regarding breast conservation when pursuing clear margins. No level 1 evidence from prospective studies, randomized controlled trials (RCTs), or meta-analyses based on such RCTs was identified. This is a clinical issue that warrants investigation in appropriately powered well designed prospective studies for a satisfactory resolution of all concerns. PMID:28105193

  2. SEVA 2.0: an update of the Standard European Vector Architecture for de-/re-construction of bacterial functionalities. (United States)

    Martínez-García, Esteban; Aparicio, Tomás; Goñi-Moreno, Angel; Fraile, Sofía; de Lorenzo, Víctor


    The Standard European Vector Architecture 2.0 database (SEVA-DB 2.0, is an improved and expanded version of the platform released in 2013 (doi: 10.1093/nar/gks1119) aimed at assisting the choice of optimal genetic tools for de-constructing and re-constructing complex prokaryotic phenotypes. By adopting simple compositional rules, the SEVA standard facilitates combinations of functional DNA segments that ease both the analysis and the engineering of diverse Gram-negative bacteria for fundamental or biotechnological purposes. The large number of users of the SEVA-DB during its first two years of existence has resulted in a valuable feedback that we have exploited for fixing DNA sequence errors, improving the nomenclature of the SEVA plasmids, expanding the vector collection, adding new features to the web interface and encouraging contributions of materials from the community of users. The SEVA platform is also adopting the Synthetic Biology Open Language (SBOL) for electronic-like description of the constructs available in the collection and their interfacing with genetic devices developed by other Synthetic Biology communities. We advocate the SEVA format as one interim asset for the ongoing transition of genetic design of microorganisms from being a trial-and-error endeavor to become an authentic engineering discipline. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

  3. The Standard European Vector Architecture (SEVA): a coherent platform for the analysis and deployment of complex prokaryotic phenotypes. (United States)

    Silva-Rocha, Rafael; Martínez-García, Esteban; Calles, Belén; Chavarría, Max; Arce-Rodríguez, Alejandro; de Las Heras, Aitor; Páez-Espino, A David; Durante-Rodríguez, Gonzalo; Kim, Juhyun; Nikel, Pablo I; Platero, Raúl; de Lorenzo, Víctor


    The 'Standard European Vector Architecture' database (SEVA-DB, was conceived as a user-friendly, web-based resource and a material clone repository to assist in the choice of optimal plasmid vectors for de-constructing and re-constructing complex prokaryotic phenotypes. The SEVA-DB adopts simple design concepts that facilitate the swapping of functional modules and the extension of genome engineering options to microorganisms beyond typical laboratory strains. Under the SEVA standard, every DNA portion of the plasmid vectors is minimized, edited for flaws in their sequence and/or functionality, and endowed with physical connectivity through three inter-segment insulators that are flanked by fixed, rare restriction sites. Such a scaffold enables the exchangeability of multiple origins of replication and diverse antibiotic selection markers to shape a frame for their further combination with a large variety of cargo modules that can be used for varied end-applications. The core collection of constructs that are available at the SEVA-DB has been produced as a starting point for the further expansion of the formatted vector platform. We argue that adoption of the SEVA format can become a shortcut to fill the phenomenal gap between the existing power of DNA synthesis and the actual engineering of predictable and efficacious bacteria.

  4. What Adverse Events and Injuries Are Cited in Anesthesia Malpractice Claims for Nonspine Orthopaedic Surgery? (United States)

    Kent, Christopher D; Stephens, Linda S; Posner, Karen L; Domino, Karen B


    Malpractice claims that arise during the perioperative care of patients receiving orthopaedic procedures will frequently involve both orthopaedic surgeons and anesthesiologists. The Anesthesia Closed Claims database contains anesthesia malpractice claim data that can be used to investigate patient safety events arising during the care of orthopaedic patients and can provide insight into the medicolegal liability shared by the two specialties. (1) How do orthopaedic anesthetic malpractice claims differ from other anesthesia claims with regard to patient and case characteristics, common events and injuries, and liability profile? (2) What are the characteristics of patients who had neuraxial hematomas after spinal and epidural anesthesia for orthopaedic procedures? (3) What are the characteristics of patients who had orthopaedic anesthesia malpractice claims for central ischemic neurologic injury occurring during shoulder surgery in the beach chair position? (4) What are the characteristics of patients who had malpractice claims for respiratory depression and respiratory arrests in the postoperative period? The Anesthesia Closed Claims Project database was the source of data for this study. This national database derives data from a panel of liability companies (national and regional) and includes closed malpractice claims against anesthesiologists representing > 30% of practicing anesthesiologists in the United States from all types of practice settings (hospital, surgery centers, and offices). Claims for damage to teeth or dentures are not included in the database. Patient characteristics, type of anesthesia, damaging events, outcomes, and liability characteristics of anesthesia malpractice claims for events occurring in the years 2000 to 2013 related to nonspine orthopaedic surgery (n = 475) were compared with claims related to other procedures (n = 1592) with p events arising from the use of regional anesthesia (125 of 475 [26%], OR 6.18 (4.59-8.32) than in

  5. Anaesthesia for foetoscopic Laser ablation- a retrospective study

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    Vaishali Kumbhar


    Full Text Available Background and Aims: Twin pregnancy with monochorionic placenta may be associated with arteriovenous vascular anastomosis of the placental vessels resulting in twin-to-twin transfusion syndrome (TTTS and twin reversed arterial perfusion syndrome (TRAP. Foetoscopic LASER ablation (FLA is the treatment of choice in reducing foetal mortality related to this. Methods: A retrospective review of medical records of 41 FLA procedures for TTTS and TRAP were analysed for anaesthetic management. Thirty-four patients received subarachnoid block, three combined spinal-epidural block, three general anaesthesia and one local anaesthesia with sedation. Nitroglycerine 5 mg patch was used for tocolysis 1 h before the procedure and continued for 24-48 h postoperatively. Results: Bupivacaine was used in 34 patients, and ropivacaine in three patients. Mean dose of bupivacaine 0.5% was 2.43 ± 0.32 ml and ropivacaine 0.75% was 2.85 ± 0.19 ml. The mean duration of surgery was 117.07 ± 28 min. Mild hypotension occurred in all patients under spinal anaesthesia and was treated with vasopressors. The foetal outcome among all 41 patients were 13 delivered live twins, 15 had a single live baby with intrauterine death of other twin baby. In 12 patients, both babies were intrauterine death. One patient was lost for follow-up. Conclusion: Foetoscopic procedures can be done under central neuraxial block, however occasionally general anaesthesia may be required.

  6. Anaesthesia for parturients with severe cystic fibrosis: a case series.

    LENUS (Irish Health Repository)

    Deighan, M


    Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.

  7. Emergency bedside cesarean delivery: lessons learned in teamwork and patient safety

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    Kinney Michelle A O


    Full Text Available Abstract Background Maternal cardiovascular and pulmonary events during labor and delivery may result in adverse maternal and fetal outcome. Potential etiologies include primary cardiac events, pulmonary embolism, eclampsia, maternal hemorrhage, and adverse medication events. Remifentanil patient-controlled analgesia is an alternative when conventional neuraxial analgesia for labor is contraindicated. Although remifentanil is a commonly used analgesic, its use for labor analgesia is not clearly defined. Case presentation We present an unexpected and unique case of remifentanil toxicity resulting in the need for an emergent bedside cesarean delivery. A 30-year-old G3P2 woman receiving subcutaneous heparin anticoagulation due to a recent deep vein thrombosis developed cardiopulmonary arrest during labor induction due to remifentanil toxicity. Conclusion A rapid discussion among the attending obstetric, anesthesia, and nursing teams resulted in consensus to perform an emergent bedside cesarean delivery resulting in an excellent fetal outcome. During maternal cardiopulmonary arrest, a prompt decision to perform a bedside cesarean delivery is essential to avoid significant maternal and fetal morbidity. Under these conditions, rapid collaboration among obstetric, anesthesia, and nursing personnel, and an extensive multi-layered safety process are integral components to optimize maternal and fetal outcomes.

  8. Feeling form: the neural basis of haptic shape perception (United States)

    Kim, Sung Soo; Thakur, Pramodsingh H.; Bensmaia, Sliman J.


    The tactile perception of the shape of objects critically guides our ability to interact with them. In this review, we describe how shape information is processed as it ascends the somatosensory neuraxis of primates. At the somatosensory periphery, spatial form is represented in the spatial patterns of activation evoked across populations of mechanoreceptive afferents. In the cerebral cortex, neurons respond selectively to particular spatial features, like orientation and curvature. While feature selectivity of neurons in the earlier processing stages can be understood in terms of linear receptive field models, higher order somatosensory neurons exhibit nonlinear response properties that result in tuning for more complex geometrical features. In fact, tactile shape processing bears remarkable analogies to its visual counterpart and the two may rely on shared neural circuitry. Furthermore, one of the unique aspects of primate somatosensation is that it contains a deformable sensory sheet. Because the relative positions of cutaneous mechanoreceptors depend on the conformation of the hand, the haptic perception of three-dimensional objects requires the integration of cutaneous and proprioceptive signals, an integration that is observed throughout somatosensory cortex. PMID:26581869

  9. EEG effect of orexin A in freely moving rats. (United States)

    Toth, A; Balatoni, B; Hajnik, T; Detari, L


    Orexin A and orexin B are neuropeptides produced by a group of neurons located in the lateral hypothalamus which send widespread projections virtually to the whole neuraxis. Several studies indicated that orexins play a crucial role in the sleep-wake regulation and in the pathomechanism of the sleep disorder narcolepsy. As no data are available related to the EEG effects of orexin A in healthy, freely moving rats, the aim of the present experiments was to analyze EEG power changes in the generally used frequency bands after intracerebroventricular orexin A administration.Orexin A administration (0.84 and 2.8 nM/rat) differently affected fronto-occipital EEG waves in the different frequency bands recorded for 24 hours. Delta (1-4 Hz) and alpha (10-16 Hz) power decreased, while theta (4-10 Hz) and beta (16-48 Hz) power increased. Decrease of the delta power was followed by a rebound in case of the higher orexin A dose. This complex picture might be explained by the activation of several systems by the orexin A administration. Among these systems, cortical and thalamic circuits as well as the role of the neurons containing corticotrophin-releasing factor might be of significant importance.

  10. Foetal responses to dexmedetomidine in parturients undergoing caesarean section: a systematic review and meta-analysis. (United States)

    Zhang, Jian; Zhou, Haibin; Sheng, Kaihua; Tian, Tian; Wu, Anshi


    Objective This current meta-analysis was conducted to evaluate effects of dexmedetomidine on neonatal maternal factors. Methods The electronic databases of PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched. The primary outcomes were neonatal parameters, including umbilical blood gases and Apgar scores. The secondary outcomes were maternal parameters. Results We identified six randomized controlled trials (RCTs). No differences in neonatal umbilical blood gases, and Apgar scores at 1 min (WMD: -0.09; 95% CI: -0.21 to 0.04; I(2 )= 0%) and 5 min (weighted mean difference (WMD): 0.03; 95% CI: -0.05 to 0.11; I(2 )= 37%) were observed with dexmedetomidine. For maternal parameters, characteristics of motor and sensory block and postoperative analgesia (standard mean difference (SMD): 3.99; 95% CI: 2.85 to 5.12; I(2 )= 78%) were significantly improved after dexmedetomidine treatment. Adverse events, including nausea/vomiting and shivering (risk ratio (RR): 0.26; 95% CI: 0.11 to 0.60; I(2 )= 0%), were lower after dexmedetomidine treatment. Conclusion This meta-analysis shows that dexmedetomidine is safe for neonates who are delivered by caesarean section. Moreover, dexmedetomidine used in neuraxial anaesthesia can improve the characteristics of motor and sensory block and prolong the maternal pain-free period. Dexmedetomidine can also reduce the maternal incidence of postoperative adverse effects.

  11. Experience with Sugar Modifies Behavioral but not Taste-Evoked Medullary Responses to Sweeteners in Mice (United States)


    Dietary exposure to sugars increases the preference for and intake of sugar solutions in mice. We used brief-access lick tests and multiunit electrophysiological recordings from the nucleus of the solitary tract (NST) to investigate the role of taste in diet-induced changes in sucrose responsiveness. We exposed C57BL/6J (B6) and 129X1/SvJ (129) mice to either a sucrose diet (chow, water, and a 500mM sucrose solution) or a control diet (chow and water) for 3 days. In B6 mice, exposure to the sucrose diet decreased the appetitive response (i.e., number of trials initiated) but had no effect on the consummatory response (i.e., rate of licking) to 500mM sucrose and 20mM saccharin. In 129 mice, exposure to the sucrose diet increased the appetitive response but had no effect on the consummatory response to the sweetener solutions. In the NST recordings, the B6 mice exhibited larger multiunit responses to sweeteners than 129 mice, but there was no effect of the sucrose diet in either strain. Our results indicate that sucrose exposure alters the appetitive response of B6 and 129 mice to sweeteners in diametrically opposed ways and that these changes are mediated by structures in the gustatory neuraxis above the NST (e.g., ventral forebrain). PMID:24084168

  12. Some proposals regarding the organization of the central nervous system control of penile erection. (United States)

    McKenna, K E


    Recent research on the central nervous control of penile erection is discussed. A framework for this control is based upon principles put forward by Frank Beach regarding the neuroendocrine regulation of male copulatory behavior. The current discussion is focused primarily on a subset, penile erection. The spinal cord contains all the necessary components for the production of penile erection. This requires a multisegmental coordination among penile vasodilator and vasoconstrictor autonomic neurons, pudendal motoneurons responsible for penile rigidity and autonomic neurons which control extra-penile blood flow. Genital sensory stimulation can activate this spinal network. The spinal cord is also under excitatory and inhibitory control from supraspinal sites. Penile erection can be driven by supraspinal input alone and supraspinal control can inhibit the erectile effects of genital stimulation.An important aspect of the CNS control of penile erection is that there are extensive interconnections between most of the brain sites identified to date. Most of the pathways are characterized by reciprocal connections. A large number of the CNS sites also receive genital sensory information. Thus, descending control may itself be modulated by ascending sensory pathways which relay information from the genitalia. This raises the possibility that penile erection may involve a positive feedback system. Receptors for gonadal hormones have been identified throughout the neuraxis. However, strong evidence for the control of male sexual function by gonadal hormones has been identified only for forebrain sites. The functional role of brainstem and spinal gonadal hormone receptors has not yet been clarified.

  13. Primary Spinal Intramedullary Neurocysticercosis: A Report of 3 Cases. (United States)

    Datta, Subramanya G S; Mehta, Ritu; Macha, Shrikant; Tripathi, Sanjog


    We describe a series of 3 cases of the rare intramedullary form of primary spinal neurocysticercosis. The cases were seen in varied age groups and showed different profiles at presentation. All the cases were thoroughly evaluated clinically and radiologically. Serologic tests were not conducted. In all cases, magnetic resonance imaging showed a large intramedullary lesion in the thoracic spinal cord consisting of a cystic lesion with a well-defined intramural nodule. One case was managed with steroids and cysticidal therapy, a second case was managed with steroids and surgery (2 emergency procedures), while the third case was managed without any medical or surgical intervention, as the patient was unwilling for either. All cases showed good neurologic recovery. In the second case where surgery was done, histologic examination of the resected specimen demonstrated the cysticercal parasite surrounded by mixed inflammatory infiltrate. As there were no intracranial lesions in all 3 cases, the final diagnosis was primary isolated intramedullary neurocysticercosis. Primary isolated intramedullary-neurocysticercosis remains a rare condition afflicting the spinal cord. It forms a small subset of cysticercal infestation of the neuraxis. Such evidence is rare, and only anecdotal reports are available. Our case series captures the wide spectrum of presentations, as well as the management options, and highlights the varied ways in which these cases were managed. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Plxdc2 is a mitogen for neural progenitors.

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    Suzanne F C Miller-Delaney


    Full Text Available The development of different brain regions involves the coordinated control of proliferation and cell fate specification along and across the neuraxis. Here, we identify Plxdc2 as a novel regulator of these processes, using in ovo electroporation and in vitro cultures of mammalian cells. Plxdc2 is a type I transmembrane protein with some homology to nidogen and to plexins. It is expressed in a highly discrete and dynamic pattern in the developing nervous system, with prominent expression in various patterning centres. In the chick neural tube, where Plxdc2 expression parallels that seen in the mouse, misexpression of Plxdc2 increases proliferation and alters patterns of neurogenesis, resulting in neural tube thickening at early stages. Expression of the Plxdc2 extracellular domain alone, which can be cleaved and shed in vivo, is sufficient for this activity, demonstrating a cell non-autonomous function. Induction of proliferation is also observed in cultured embryonic neuroepithelial cells (ENCs derived from E9.5 mouse neural tube, which express a Plxdc2-binding activity. These experiments uncover a direct molecular activity of Plxdc2 in the control of proliferation, of relevance in understanding the role of this protein in various cancers, where its expression has been shown to be altered. They also implicate Plxdc2 as a novel component of the network of signalling molecules known to coordinate proliferation and differentiation in the developing nervous system.

  15. Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain? (United States)

    Ghaly, Ramis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick


    Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. Case Description: We present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology. Conclusions: We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures. PMID:25883840

  16. Non-analgesic effects of opioids: opioids and the endocrine system. (United States)

    Elliott, Jennifer A; Opper, Susan E; Agarwal, Sonali; Fibuch, Eugene E


    Opioids are among the oldest known and most widely used analgesics. The application of opioids has expanded over the last few decades, especially in the treatment of chronic non-malignant pain. This upsurge in opioid use has been accompanied by the increasingly recognized occurrence of opioid-associated endocrinopathy. This may arise after exposure to enteral, parenteral, or neuraxial opioids. Opioid-associated endocrinopathy consists primarily of hypothalamic-pituitary-gonadal axis or hypothalamic-pituitary-adrenal axis dysfunction and may manifest with symptoms of hypogonadism, adrenal dysfunction, and other hormonal disturbances. Additionally, opioid related endocrine dysfunction may be coupled with such disorders as osteoporosis and mood disturbances including depression. Undesirable changes in pain sensitivity such as opioid-induced hyperalgesia, and reduced potency of opioid analgesia may also be potential consequences of chronic opioid consumption. Few studies to date have been able to establish what degree of opioid exposure, in terms of dose or duration of therapy, may predispose patients to opioid-associated endocrinopathy. This article will review the currently available literature concerning opioid-associated endocrinopathy and will provide recommendations for the evaluation, monitoring, and management of opioid-associated endocrinopathy and its other accompanying undesired effects.


    Directory of Open Access Journals (Sweden)

    Iraola Ferrer MD


    Full Text Available Neurocysticercosis is the most frequent parasitism in the central nervous system. It consists on the localization of the larval form of the Taenia solium in the neuraxis or in the meningeal- ventricular compartment of the central nervous system. At present it represents a serious health problem. Several anatomoclinical syndromes of neurocysticercosis have been described. A case of mild parenchymal neurocysticercosis in degenerating cyst form where cephalalgia was the predominant symptom resulted into several evaluations without any definite diagnosis. After a year, a simple and contrastive skull CT scan was performed on the patient. Suggested lesions of parenchymal neurocysticercosis appeared. A treatment with praziquantel and prednisone was given to the patient without any clinical and tomographic improvement on the patient. This brought about the admission of the patient into the hospital. A treatment with dexamethasone and albendazole began. As a result of this treatment, the patient began to improve her clinical and tomographic condition. During the patient's follow up, she continued asymptomatic.

  18. Unjoined primary and secondary neural tubes: junctional neural tube defect, a new form of spinal dysraphism caused by disturbance of junctional neurulation. (United States)

    Eibach, Sebastian; Moes, Greg; Hou, Yong Jin; Zovickian, John; Pang, Dachling


    Primary and secondary neurulation are the two known processes that form the central neuraxis of vertebrates. Human phenotypes of neural tube defects (NTDs) mostly fall into two corresponding categories consistent with the two types of developmental sequence: primary NTD features an open skin defect, an exposed, unclosed neural plate (hence an open neural tube defect, or ONTD), and an unformed or poorly formed secondary neural tube, and secondary NTD with no skin abnormality (hence a closed NTD) and a malformed conus caudal to a well-developed primary neural tube. We encountered three cases of a previously unrecorded form of spinal dysraphism in which the primary and secondary neural tubes are individually formed but are physically separated far apart and functionally disconnected from each other. One patient was operated on, in whom both the lumbosacral spinal cord from primary neurulation and the conus from secondary neurulation are each anatomically complete and endowed with functioning segmental motor roots tested by intraoperative triggered electromyography and direct spinal cord stimulation. The remarkable feature is that the two neural tubes are unjoined except by a functionally inert, probably non-neural band. The developmental error of this peculiar malformation probably occurs during the critical transition between the end of primary and the beginning of secondary neurulation, in a stage aptly called junctional neurulation. We describe the current knowledge concerning junctional neurulation and speculate on the embryogenesis of this new class of spinal dysraphism, which we call junctional neural tube defect.

  19. Perception of MBBS students to "flipped class room" approach in neuroanatomy module. (United States)

    Veeramani, Raveendranath; Madhugiri, Venkatesh S; Chand, Parkash


    A flipped classroom is a learner centered approach in which the learner is responsible to attend the class with basic understanding of the subject to fully participate and engage in discussions. The aim of this study was to evaluate students' perception of flipped classroom approach for neuroanatomy module and assess the impact on their performance and attitudes. The subject chosen to evaluate the flipped classroom model for first year medical students was clinical neuroanatomy. One hundred and thirty first year medical students participated in the study module. Students were divided into five groups and five case scenarios pertaining to various clinically relevant regions of the neuraxis, with varying anatomical complexity were generated. The pre- and post-tests were designed to specifically test the declared learning objectives of the session. The perception of the students regarding this model of teaching and learning was also evaluated. Eighty-six percent of students felt that the flipped classroom approach was better at fulfilling the stated learning objectives than the conventional didactic teaching, 92% felt that the work-sheet with questions provided prior to the class enabled a better understanding of the subject and 87% were of the opinion that the web sources with references kindled a greater interest to read as compared with didactic lectures. The paired t test showed highly significant differences between the pre and post-test scores. Student response to the flipped classroom structure was largely positive, indicating it to be an approach worth pursuing in future years.

  20. MND2: A new mouse model of inherited motor neuron disease

    Energy Technology Data Exchange (ETDEWEB)

    Jones, J.M.; Albin, R.L.; Feldman, E.L.; Simin, K.; Schuster, T.G.; Dunnick, W.A.; Collins, J.T.; Chrisp, C.E.; Meisler, M.H. (Univ. of Michigan, Ann Arbor, MI (United States)); Taylor, B.A. (Jackson Lab., Bar Harbor, ME (United States))


    The autosomal recessive mutation mnd2 results in early onset motor neuron disease with rapidly progressive paralysis, severe muscle wasting, regression of thymus and spleen, and death before 40 days of age. mnd2 has been mapped to mouse chromosome 6 with the gene order: centromere-Tcrb-Ly-2-Sftp-3-D6Mit4-mnd2-D6Mit6, D6Mit9-D6Rck132-Raf-1, D6Mit11-D6Mit12-D6Mit14. mnd2 is located within a conserved linkage group with homologs on human chromosome 2p12-p13. Spinal motor neurons of homozygous affected animals are swollen and stain weakly, and electromyography revealed spontaneous activity characteristic of muscle denervation. Myelin staining was normal throughout the neuraxis. The clinical observations are consistent with a primary abnormality of lower motor neuron function. This new animal model will be of value for identification of a genetic defect responsible for motor neuron disease and for evaluation of new therapies. 36 refs., 7 figs., 2 tabs.

  1. Lateral hypothalamus as a sensor-regulator in respiratory and metabolic control (United States)

    Burdakov, Denis; Karnani, Mahesh M.; Gonzalez, Antonio


    Physiological fluctuations in the levels of hormones, nutrients, and gasses are sensed in parallel by interacting control systems distributed throughout the brain and body. We discuss the logic of this arrangement and the definitions of “sensing”; and then focus on lateral hypothalamic (LH) control of energy balance and respiration. LH neurons control diverse behavioral and autonomic processes by projecting throughout the neuraxis. Three recently characterized types of LH cells are discussed here. LH orexin/hypocretin (ORX) neurons fire predominantly during wakefulness and are thought to promote reward-seeking, arousal, obesity resistance, and adaptive thermogenesis. Bidirectional control of ORX cells by extracellular macronutrients may add a new regulatory loop to these processes. ORX neurons also stimulate breathing and are activated by acid/CO2 in vivo and in vitro. LH melanin-concentrating hormone (MCH) neurons fire mostly during sleep, promote physical inactivity, weight gain, and may impair glucose tolerance. Reported stimulation of MCH neurons by glucose may thus modulate energy homeostasis. Leptin receptor (LepR) neurons of the LH are distinct from ORX and MCH neurons, and may suppress feeding and locomotion by signaling to the mesolimbic dopamine system and local ORX neurons. Integration within the ORX–MCH–LepR microcircuit is suggested by anatomical and behavioral data, but requires clarification with direct assays of functional connectivity. Further studies of how LH circuits counteract evolutionarily-relevant environmental fluctuations will provide key information about the logic and fragilities of brain controllers of healthy homeostasis. PMID:23562864

  2. Can ultrasound-guided subcostal transverse abdominis plane block be used as sole anesthetic technique?

    Directory of Open Access Journals (Sweden)

    Pooja Bihani


    Full Text Available Subcostal transverse abdominis plane (TAP block anesthetizes area of the abdomen with cutaneous innervation of T6–T10 dermatomes. These abdominal field blocks become very advantageous when cardiac patient presents for noncardiac surgeries as sole anesthetic or as a part of multimodal anesthesia. A 58-year-male came for open surgical repair of subxiphoid incisional hernia developed post coronary artery bypass grafting (CABG. Echocardiography showed hypokinesia of left ventricle (LV in the left anterior descending (LAD artery territory, dilated LV, and ejection fraction of 30%, and coronary angiography after 6 months of CABG showed 70% stenosis of LAD. Surgery was successfully accomplished under ultrasound-guided bilateral subcostal TAP block except for a brief period of pain and discomfort when hernia was being reduced which required narcotic supplementation. The patient remained comfortable throughout the procedure as well as 24 h postoperatively without any analgesic supplementation. Thus, subcostal TAP block can be a safe alternative to neuraxial or general anesthesia for epigastric hernia repair in selected patients.

  3. Cardiac Innervation and Sudden Cardiac Death (United States)

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L.; Shivkumar, Kalyanam


    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  4. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving? (United States)


    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  5. Phantom limb pain and bodily awareness: current concepts and future directions. (United States)

    Giummarra, Melita J; Moseley, G Lorimer


    Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management. This review first discusses the mechanisms associated with phantom pain and summarizes the current treatments. The mechanisms underlying phantom pain primarily relate to peripheral/spinal dysfunction, and supraspinal and central plasticity in sensorimotor body representations. The most promising methods for managing phantom pain address the maladaptive changes at multiple levels of the neuraxis, for example, complementing pharmacological administration with physical, psychological or behavioural intervention. These supplementary techniques are even efficacious in isolation, perhaps by replacing the absent afferent signals from the amputated limb, thereby restoring disrupted bodily representations. Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.

  6. Gray matter changes following limb amputation with high and low intensities of phantom limb pain. (United States)

    Preissler, Sandra; Feiler, Johanna; Dietrich, Caroline; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas


    Limb amputation and chronic phantom limb pain (PLP) are both associated with neural alterations at all levels of the neuraxis. We investigated gray matter volume of 21 upper limb amputees and 14 healthy control subjects. Results demonstrate that amputation is associated with reduced gray matter in areas in the motor cortex representing the amputated limb. Additionally, patients show an increase in gray matter in brain regions that belong to the dorsal and ventral visual stream. We subdivided the patient group into patients with medium to high PLP (HPLP; N = 11) and those with slight PLP (SPLP; N = 10). HPLP patients showed reduced gray matter in brain areas involved in pain processing. SPLP patients showed a significant gray matter increase in regions of the visual stream. Results indicate that all patients may have an enhanced need for visual control to compensate the lack of sensory feedback of the missing limb. As we found these alterations primarily in the SPLP patient group, successful compensation may have an impact on PLP development. Therefore, we hypothesize that visual adaptation mechanisms may compensate for the lack of sensorimotor feedback and may therefore function as a protection mechanism against high PLP development.

  7. [Why and how to perform an ultrasound-guided transversus abdominis plane block: A step-by-step approach]. (United States)

    Nohuz, E; El Drayi, B; Triki, A; Grossmannova, K; Boudier, B; Koffi, K; Albaut, M; Dualé, C


    Used in clinical practice as part of a multimodal analgesic regimen, the transversus abdominis plane block (TAP block) is a relative novel procedure in which local anaesthetic agents are injected into the anatomic neurofascial space between the internal oblique and the transversus abdominis muscle. It allows a significantly prolonged duration of analgesia during the early postoperative stage in abdominal surgery. This regional anesthesia technique provides analgesia to the skin, muscles of the anterior abdominal wall and parietal peritoneum in order to decrease the incision-related pain. Thus, it reduces postoperative opiate requirements and opioids-related side effects (nausea, vomiting, delayed resumption of intestinal transit, drowsiness, respiratory depression, urine retention). Additionally, the TAP block appears particularly interesting when neuraxial techniques or opioids are contraindicated. Moreover, the ultrasound-guided procedure provides a significant success rate of this block and additionally avoids major complications. We describe our technique of ultrasound-guided TAP block and discuss its indications, contraindication and potential complications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring. (United States)

    Skinner, Stanley A; Cohen, Bernard Allan; Morledge, David Eric; McAuliffe, John J; Hastings, John Daniel; Yingling, Charles D; McCaffrey, Michael


    The American Society of Neurophysiological Monitoring (ASNM) was founded in 1988 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during monitored procedures along the neuraxis. This goal is accomplished through programs in education, advocacy of basic and clinical research, and publication of guidelines. The ASNM is committed to the development of medically sound and clinically relevant guidelines for intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative monitoring were established by a committee of nearly 30 total participants and ultimately endorsed by the Board of Directors of ASNM on January 24th 2013. That document follows.

  9. Development of a high frequency single-element ultrasound needle transducer for anesthesia delivery (United States)

    Ameri, Golafsoun; Son, Jungik; Liang, Jingwei; Foster, F. Stuart; Ganapathy, Sugantha; Peters, Terry M.


    Epidural anesthesia is one of the most commonly used and yet challenging techniques employed for pain management and anesthesia delivery. The major complications of this procedure are due to accidental dural puncture, with an incidence of 1-3%, which could lead to both temporary and irreversible permanent neurological complications. Needle placement under ultrasound (US) guidance has received increasing interest for improving needle placement accuracy. However, poor needle visibility in US, difficulties in displaying relevant anatomical structure such as dura mater due to attenuation and bone shadowing, and image interpretation variability among users pose significant hurdles for any US guidance system. As a result, US guidance for epidural injections has not been widely adopted for everyday use for the performance of neuraxial blocks. The difficulties in localizing the ligamentum flavum and dura with respect to the needle tip can be addressed by integrating A-mode US, provided by a single-element transducer at the needle tip, into the B-mode US guidance system. We have taken the first steps towards providing such a guidance system. Our goal is to improve the safety of this procedure with minimal changes to the clinical workflow. This work presents the design and development of a 20 MHz single-element US transducer housed at the tip of a 19 G needle hypodermic tube, which can fit inside an epidural introducer needle. In addition, the results from initial transducer characterization tests and performance evaluation of the transducer in a euthanized porcine model are provided.

  10. Perioperative opioid usage: avoiding adverse effects. (United States)

    Funk, Robert D; Hilliard, Paul; Ramachandran, Satya Krishna


    Opioids remain the most common analgesic tool for the surgeon, owing to their cost-effectiveness in both the inpatient and outpatient setting. Aside from these attributes, opioids have significant side effects that are associated with morbidity and mortality. Specifically, obese patients, patients with sleep apnea, and the elderly may be at an increased risk of experiencing sedation and respiratory depression in response to opioids. Opioid reduction strategies prove useful for decreasing total opioid dose and, in turn, their associated adverse effects. Such strategies may include adjuvant nonopioid analgesics such as α-2 agonists, gabapentinoids, and N-methyl-D-aspartate receptor agonists as well as local, regional, or neuraxial anesthesia and modification of surgical technique where possible for operative patients. Patients may also present to surgeons while taking chronic opioids, including high-dose opioids and opioid agonist/antagonists. These clinical scenarios are associated with extreme challenges in postoperative analgesic management. With all opioid prescribing, other sedative medications should be limited or avoided as the risk for additive sedation is significant. This review aims to describe systematic methods to reduce opioid side effects and identify specific risk-reduction strategies within each risk group.

  11. A randomised controlled trial of the effect of a head-elevation pillow on intrathecal local anaesthetic spread in caesarean section. (United States)

    Elfil, H; Crowley, L; Segurado, R; Spring, A


    A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11 mg, morphine 100 μg and fentanyl 15 μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10 min. Sensory block to T6 was achieved within 10 min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (PPillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, Ppillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. (United States)

    D'Angelo, Robert; Smiley, Richard M; Riley, Edward T; Segal, Scott


    Because of the lack of large obstetric anesthesia databases, the incidences of serious complications related to obstetric anesthesia remain unknown. The Society for Obstetric Anesthesia and Perinatology developed the Serious Complication Repository Project to establish the incidence of serious complications related to obstetric anesthesia and to identify risk factors associated with each. Serious complications were defined by the Society for Obstetric Anesthesia and Perinatology Research Committee which also coordinated the study. Thirty institutions participated in the approximately 5-yr study period. Data were collected as part of institutional quality assurance and sent to the central project coordinator quarterly. Data were captured on more than 257,000 anesthetics, including 5,000 general anesthetics for cesarean delivery. There were 157 total serious complications reported, 85 of which were anesthesia related. High neuraxial block, respiratory arrest in labor and delivery, and unrecognized spinal catheter were the most frequent complications encountered. A serious complication occurs in approximately 1:3,000 (1:2,443 to 1:3,782) obstetric anesthetics. The Serious Complication Repository Project establishes the incidence of serious complications in obstetric anesthesia. Because serious complications related to obstetric anesthesia are rare, there were too few complications in each category to identify risk factors associated with each. However, because many of these complications can lead to catastrophic outcomes, it is recommended that the anesthesia provider remains vigilant and be prepared to rapidly diagnose and treat any complication.

  13. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. (United States)

    Chin, Ki Jinn; Perlas, Anahi; Chan, Vincent; Brown-Shreves, Danielle; Koshkin, Arkadiy; Vaishnav, Vandana


    Poor surface anatomic landmarks are highly predictive of technical difficulty in neuraxial blockade. The authors examined the use of ultrasound imaging to reduce this difficulty. The authors recruited 120 orthopedic patients with one of the following: body mass index more than 35 kg/m² and poorly palpable spinous processes; moderate to severe lumbar scoliosis; or previous lumbar spine surgery. Patients were randomized to receive spinal anesthetic by the conventional surface landmark-guided technique (group LM) or by an ultrasound-guided technique (group US). Patients in group US had a preprocedural ultrasound scan to locate and mark a suitable needle insertion point. The primary outcome was the rate of successful dural puncture on the first needle insertion attempt. Normally distributed data were summarized as mean ± SD and nonnormally distributed data were summarized as median [interquartile range]. The first-attempt success rate was twice as high in group US than in group LM (65% vs. 32%; P ultrasound imaging facilitates the performance of spinal anesthesia in the nonobstetric patient population with difficult anatomic landmarks.

  14. Perioperative Management of Anticoagulants. (United States)

    Irizarry-Alvarado, Joan M; Seim, Lynsey A


    The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications-specifically, their half-lives-are important in timing an interruption of anticoagulant therapy. The authors review the current guidelines and recommendations for therapeutic interruption of anticoagulants and the involved pharmacologic factors. Guidelines and other literature are summarized with discussion of the pharmacology of each medication. Recommendations on how and when to provide bridging for anticoagulants are discussed. Newer oral anticoagulants also are discussed, as well as interruption recommendations. Literature reveals a conservative approach at using bridging when anticoagulation is interrupted because of higher risks of bleeding. Caution is advised when resuming anticoagulant therapy when neuraxial anesthesia is used. Perioperative healthcare providers need to balance risks and benefits of anticoagulant therapy with its interruption preoperatively. Copyright© Bentham Science Publishers; For any queries, please email at

  15. Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults. (United States)

    Guay, Joanne; Johnson, Rebecca L; Kopp, Sandra


    It is estimated that over 300,000 total hip replacements are performed each year in the USA. For European countries, the number of hip replacement procedures per 100,000 people performed in 2007 varied from less than 50 to over 250. To facilitate postoperative rehabilitation, pain must be adequately treated. Peripheral nerve blocks and neuraxial blocks have been proposed to replace or supplement systemic analgesia. We aimed to compare the relative effects (benefits and harms) of the different nerve blocks that may be used to relieve pain after elective hip replacement in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2016), MEDLINE (Ovid SP) (1946 to December Week 49, 2016), Embase (Ovid SP) (1980 to December week 49, 2016), CINAHL (EBSCO host) (1982 to 6 December 2016), ISI Web of Science (1973 to 6 December 2016), Scopus (from inception to December 2016), trials registers, and relevant web sites. We included all randomized controlled trials (RCTs) performed in adults undergoing elective primary hip replacement and comparing peripheral nerve blocks to any other pain treatment modality. We applied no language or publication status restrictions. Data were extracted independently by two review authors. We contacted study authors. We included 51 RCTs with 2793 participants; of these 45 RCTs (2491 participants: peripheral nerve block = 1288; comparators = 1203) were included in meta-analyses. There are 11 ongoing studies and three awaiting classification.Compared to systemic analgesia alone, peripheral nerve blocks reduced: pain at rest on arrival in the postoperative care unit (SMD -1.12, 95% CI -1.67 to -0.56; 9 trials, 429 participants; equivalent to 3.2 on 0 to 10 scale; moderate-quality evidence); risk of acute confusional status: risk ratio (RR) 0.10 95% CI 0.02 to 0.54; 1 trial, 225 participants; number needed to treat for additional benefit (NNTB) 12, 95% CI 11 to 22; very low-quality evidence); pruritus (RR 0.16, 95

  16. Resting state functional connectivity of the striatum in Parkinson's disease. (United States)

    Hacker, Carl D; Perlmutter, Joel S; Criswell, Susan R; Ances, Beau M; Snyder, Abraham Z


    Classical accounts of the pathophysiology of Parkinson's disease have emphasized degeneration of dopaminergic nigrostriatal neurons with consequent dysfunction of cortico-striatal-thalamic loops. In contrast, post-mortem studies indicate that pathological changes in Parkinson's disease (Lewy neurites and Lewy bodies) first appear primarily in the lower brainstem with subsequent progression to more rostral parts of the neuraxis. The nigrostriatal and histological perspectives are not incompatible, but they do emphasize different anatomical structures. To address the question of which brain structures are functionally most affected by Parkinson's disease, we performed a resting-state functional magnetic resonance imaging study focused on striatal functional connectivity. We contrasted 13 patients with advanced Parkinson's disease versus 19 age-matched control subjects, using methodology incorporating scrupulous attention to minimizing the effects of head motion during scanning. The principal finding in the Parkinson's disease group was markedly lower striatal correlations with thalamus, midbrain, pons and cerebellum. This result reinforces the importance of the brainstem in the pathophysiology of Parkinson's disease. Focally altered functional connectivity also was observed in sensori-motor and visual areas of the cerebral cortex, as well the supramarginal gyrus. Striatal functional connectivity with the brainstem was graded (posterior putamen > anterior putamen > caudate), in both patients with Parkinson's disease and control subjects, in a manner that corresponds to well-documented gradient of striatal dopaminergic function loss in Parkinson's disease. We hypothesize that this gradient provides a clue to the pathogenesis of Parkinson's disease.

  17. Management of direct oral anticoagulants in patients undergoing elective surgeries and invasive procedures: Updated guidelines from the French Working Group on Perioperative Hemostasis (GIHP) - September 2015. (United States)

    Albaladejo, Pierre; Bonhomme, Fanny; Blais, Normand; Collet, Jean-Philippe; Faraoni, David; Fontana, Pierre; Godier, Anne; Llau, Juan; Longrois, Dan; Marret, Emmanuel; Mismetti, Patrick; Rosencher, Nadia; Roullet, Stéphanie; Samama, Charles-Marc; Schved, Jean-François; Sié, Pierre; Steib, Annick; Susen, Sophie


    Since 2011, data on patients exposed to direct oral anticoagulants (DOAs) while undergoing invasive procedures have accumulated. At the same time, an increased hemorrhagic risk during perioperative bridging anticoagulation without thrombotic risk reduction has been demonstrated. This has led the GIHP to update their guidelines published in 2011. For scheduled procedures at low bleeding risk, it is suggested that patients interrupt DOAs the night before irrespective of type of drug and to resume therapy six hours or more after the end of the invasive procedure. For invasive procedures at high bleeding risk, it is suggested to interrupt rivaroxaban, apixaban and edoxaban three days before. Dabigatran should be interrupted according to the renal function, four days and five days if creatinine clearance is higher than 50mL/min and between 30 and 50mL/min, respectively. For invasive procedures at very high bleeding risk such as intracranial neurosurgery or neuraxial anesthesia, longer interruption times are suggested. Finally, bridging with parenteral anticoagulation and measurement of DOA concentrations can no longer routinely be used. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  18. Varicella Zoster Virus (VZV-Human Neuron Interaction

    Directory of Open Access Journals (Sweden)

    Don Gilden


    Full Text Available Varicella zoster virus (VZV is a highly neurotropic, exclusively human herpesvirus. Primary infection causes varicella (chickenpox, wherein VZV replicates in multiple organs, particularly the skin. Widespread infection in vivo is confirmed by the ability of VZV to kill tissue culture cells in vitro derived from any organ. After varicella, VZV becomes latent in ganglionic neurons along the entire neuraxis. During latency, virus DNA replication stops, transcription is restricted, and no progeny virions are produced, indicating a unique virus-cell (neuron relationship. VZV reactivation produces zoster (shingles, often complicated by serious neurological and ocular disorders. The molecular trigger(s for reactivation, and thus the identity of a potential target to prevent it, remains unknown due to an incomplete understanding of the VZV-neuron interaction. While no in vitro system has yet recapitulated the findings in latently infected ganglia, recent studies show that VZV infection of human neurons in SCID mice and of human stem cells, including induced human pluripotent stem cells and normal human neural progenitor tissue-like assemblies, can be established in the absence of a cytopathic effect. Usefulness of these systems in discovering the mechanisms underlying reactivation awaits analyses of VZV-infected, highly pure (>90%, terminally differentiated human neurons capable of prolonged survival in vitro.

  19. Ultrasound in regional anaesthesia. (United States)

    Griffin, J; Nicholls, B


    Ultrasound guidance is rapidly becoming the gold standard for regional anaesthesia. There is an ever growing weight of evidence, matched with improving technology, to show that the use of ultrasound has significant benefits over conventional techniques, such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anaesthesia will help promote its use and realise the benefits that regional anaesthesia has over general anaesthesia, such as decreased morbidity and mortality, superior postoperative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course. In this review we consider the evidence behind the improved safety and efficacy of ultrasound-guided regional anaesthesia, before discussing its use in pain medicine, paediatrics and in the facilitation of neuraxial blockade. The Achilles' heel of ultrasound-guided regional anaesthesia is that anaesthetists are far more familiar with providing general anaesthesia, which in most cases requires skills that are achieved faster and more reliably. To this ends we go on to provide practical advice on ultrasound-guided techniques and the introduction of ultrasound into a department.

  20. [Cisterno-medullary anomalies. Diagnostic problems, surgical treatment (author's transl)]. (United States)

    Contamin, F; Mignot, B; Ollat, H; Comoy, J

    Under the term cisterno-medullary anomalies are included several disorders: bony and nervous malformations, arachnoiditis of the posterior fossa. As they are frequently associated, a thorough investigation, both anatomical and dynamic, is a prerequisite to any therapeutic attempt. Along with causing damage to the neuraxis, these anomalies interfere with the dynamics of the CSF and may lead to the development of a communicating syringomyelia, whatever the theory proposed. The presenting symptoms are varied, and diagnosis should be accordingly suspected. Of fundamental importance are instrumental investigations. A complete evaluation is in most of the cases obtainable with: bone X-rays, air-myelography (or "bulle"), intrathecal ou ventricular radio-isotope scan. Surgery is the only treatment. The aim is both decompression of the neural structures and restoration of a normal CSF dynamic flow. Opening of the posterior fossa is successful in the case of developmental abnormalities, But it seems to prove a failure when the chief anomaly is arachnoiditis. In such cases, ventricular drainage alone may be followed by improvement. It appears from this that the problem is twofold: the technical problem of the drainage, and the pre-operatory diagnosis of a posterior fossa arachnoiditis.

  1. Estimation of the minimum motor blocking potency ratio for intrathecal bupivacaine and lidocaine. (United States)

    Camorcia, M; Capogna, G; Columb, M O


    The up-down sequential allocation model has been adapted to investigate a variety of clinical and pharmacological issues in neuraxial anaesthesia including the estimation of relative potency ratios for analgesia and motor block of the most commonly used epidural and intrathecal local anaesthetics. The aim of this study was to establish the median effective doses (ED50) for motor block with intrathecal lidocaine and bupivacaine and to define the relative motor blocking potency ratio. In this prospective, randomised, double blind, parallel group, up-down sequential allocation study, we enrolled 71 parturients undergoing elective caesarean section under combined spinal-epidural anaesthesia. The women received either intrathecal lidocaine 2% w/v or bupivacaine 0.5% w/v. The initial dose was 4 mg for bupivacaine and 12 mg for lidocaine. Subsequent doses were determined by the outcome in the previous parturient, according to the up-down sequential allocation technique. The end point was the occurrence of any motor block in either lower limb within 5 min. The intrathecal ED50 for motor block was 13.7 mg for lidocaine (95% CI, 13.1 to 14.4) and 3.4 mg for bupivacaine (95% CI, 2.6 to 4.1) (Pmotor blocking potency ratio was 4.1 (95% CI 3.3 to 5.2). Intrathecal bupivacaine was 4.1 times more potent than lidocaine for motor block.

  2. Epithelioid sarcoma of the spine: case report and literature review. (United States)

    Chamadoira, Clara; Pereira, Paulo; Silva, Pedro S; Castro, Ligia; Vaz, Rui


    Epithelioid sarcomas are rare mesenchymal neoplasms mainly arising in the limbs of young adults. We report the case of a 24-year-old male presenting low back pain radiating to both lower limbs, constipation and urinary retention. The MRI scan showed an intraspinal lesion extending from L4 to S2. Surgery resulted in gross total removal of the extradural lesion and partial removal of the intradural component. The immunohistological study of the lesion was consistent with an epithelioid sarcoma. The patient was submitted to radiotherapy and chemotherapy, but a local recurrence of the lesion and dissemination along the neuraxis were observed 3 months after surgery. Despite treatment, the patient died 4 months after the surgical procedure due to multiorgan failure. Despite there being isolated reports of epithelioid sarcomas appearing in the spine, this is, to our knowledge, the first case with intradural extension. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  3. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar


    Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.

  4. JÁNOS SZENTÁGOTHAI. 31 October 1912 - 8 September 1994: Elected ForMemRs 20 April 1978. (United States)

    Gulyás, Balázs; Somogyi, Peter


    János Szentágothai was an eminent, creative and renowned neuroscientist, who made pioneering and seminal discoveries contributing to our current understanding of brain functions. His vision of the brain as a network of specific populations of nerve cells, each engaging in selective operations and self-organizing into modules, has provided the framework and stimulus for generations of neuroscientists. His irrepressible curiosity and enthusiasm for the beauty in the organization of the brain never faded. He had a towering intellect and was a great humanist. Szentágothai was born in Budapest, Hungary, in 1912 and died in his native city in 1994. He was educated and worked in Hungary. During the six decades of his scientific activity, he made remarkably original and lasting contributions to the neurosciences, including the exploration of basic architectural features of many brain areas, the functional-anatomical bases of elementary brain operations such as reflex arcs, the vestibulo-ocular system, the brain control of hormonal regulation, general organizational principles of the neuraxis, the organization of the cerebellum and the modular organization of the neocortex. He left for posterity not only his discoveries, which have stood the test of time, but also a vigorous school of pupils as well as a large number of friends and admirers. Thanks to him neuroscience is one of the strongest scientific fields in Hungary today.

  5. Hypovolemia stimulates intraoral intake of water and NaCl solution in intact rats but not in chronic decerebrate rats. (United States)

    Flynn, Francis W; Stricker, Edward M


    This experiment tested the hypothesis that afferent signals from cardiac baroreceptors to the caudal brain stem are integrated by hindbrain systems to control ingestive behavior in response to plasma volume deficits in rats. A supracollicular transection was made which should not interfere with the neural signal of volume depletion to the hindbrain. Decerebrate (n=5) and control rats (n=7) were given subcutaneous injections of 30% polyethylene glycol (PEG) to induce hypovolemia or of isotonic saline as a control. Four hours after the injection, either water or 0.1 M NaCl was administered through an intraoral cannula, and intakes were measured. Decerebrate rats did not ingest significantly more water or saline after PEG treatment than after the control treatment, whereas control rats ingested both fluids in significantly larger volumes after PEG treatment. In another test using the same animals, heart rate was monitored after intravenous injections of phenylephrine (to raise blood pressure) and nitroprusside (to lower it). Similar reflexive changes in heart rate were observed in control and decerebrate rats, showing that baroreflex function was not impaired by decerebration. These results indicate that baroafferent signals are processed at multiple levels of the neuraxis, with hindbrain systems mediating autonomic cardiovascular reflexes in response to changes in blood pressure, and midbrain or forebrain systems mediating behavioral responses associated with thirst.

  6. Current applications of big data in obstetric anesthesiology. (United States)

    Klumpner, Thomas T; Bauer, Melissa E; Kheterpal, Sachin


    The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients. Also, large national databases have been used to better understand trends in anesthesia-related adverse events during cesarean delivery as well as outline potential racial/ethnic disparities in obstetric anesthesia care. Finally, real-time analysis of patient data across a number of disparate health information systems through the use of sophisticated clinical decision support and surveillance systems is one promising application of big data technology on the labor and delivery unit. 'Big data' research has important implications for obstetric anesthesia care and warrants continued study. Real-time electronic surveillance is a potentially useful application of big data technology on the labor and delivery unit.

  7. Key considerations in designing a somatosensory neuroprosthesis. (United States)

    Delhaye, Benoit P; Saal, Hannes P; Bensmaia, Sliman J


    In recent years, a consensus has emerged that somatosensory feedback needs to be provided for upper limb neuroprostheses to be useful. An increasingly promising approach to sensory restoration is to electrically stimulate neurons along the somatosensory neuraxis to convey information about the state of the prosthetic limb and about contact with objects. To date, efforts toward artificial sensory feedback have consisted mainly of demonstrating that some sensory information could be conveyed using a small number of stimulation patterns, generally delivered through single electrodes. However impressive these achievements are, results from different studies are hard to compare, as each research team implements different stimulation patterns and tests the elicited sensations differently. A critical question is whether different stimulation strategies will generalize from contrived laboratory settings to activities of daily living. Here, we lay out some key specifications that an artificial somatosensory channel should meet, discuss how different approaches should be evaluated, and caution about looming challenges that the field of sensory restoration will face. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Fluorescence imaging of lymphatic outflow of cerebrospinal fluid in mice. (United States)

    Kwon, Sunkuk; Janssen, Christopher F; Velasquez, Fred Christian; Sevick-Muraca, Eva M


    Cerebrospinal fluid (CSF) is known to be reabsorbed by the lymphatic vessels and drain into the lymph nodes (LNs) through peripheral lymphatic vessels. In the peripheral lymphatics, the contractile pumping action of lymphangions mediates lymph drainage; yet it is unknown whether lymphatic vessels draining cranial and spinal CSF show similar function. Herein, we used non-invasive near-infrared fluorescence imaging (NIRFI) to image (i) indocyanine green (ICG) distribution along the neuraxis and (ii) routes of ICG-laden CSF outflow into the lymphatics following intrathecal lumbar administration. We demonstrate lymphatic contractile function in peripheral lymphatics draining from the nasal lymphatics to the mandibular LNs. In addition, we observed afferent sciatic lymphatic vessels, which also show contractile activity and transport spinal CSF into the sciatic LNs. This drainage pattern was also visualized by NIRFI following intrathecal thoracic injection. In situ intravital imaging following intrathecal lumbar injection of blue dye shows similar distributions to that seen in vivo with ICG. NIRFI could be used as a tool to probe CSF pathology including neurological disorders by imaging CSF outflow dynamics to lymphatics. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Duodenal lipid sensing activates vagal afferents to regulate non-shivering brown fat thermogenesis in rats.

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    Clémence Blouet

    Full Text Available Previous evidence indicates that duodenal lipid sensing engages gut-brain neurocircuits to determine food intake and hepatic glucose production, but a potential role for gut-brain communication in the control of energy expenditure remains to be determined. Here, we tested the hypothesis that duodenal lipid sensing activates a gut-brain-brown adipose tissue neuraxis to regulate thermogenesis. We demonstrate that direct administration of lipids into the duodenum increases brown fat temperature. Co-infusion of the local anesthetic tetracaine with duodenal lipids abolished the lipid-induced increase in brown fat temperature. Systemic administration of the CCKA receptor antagonist devazepide blocked the ability of duodenal lipids to increase brown fat thermogenesis. Parenchymal administration of the N-methyl-d-aspartate receptor blocker MK-801 directly into the caudomedial nucleus of the solitary tract also abolished duodenal lipid-induced activation of brown fat thermogenesis. These findings establish that duodenal lipid sensing activates a gut-brain-brown fat axis to determine brown fat temperature, and thereby reveal a previously unappreciated pathway that regulates thermogenesis.

  10. The state of implantable pain therapies in the United States: a nationwide survey of academic teaching programs. (United States)

    Fanciullo, G J; Rose, R J; Lunt, P G; Whalen, P K; Ross, E


    The purpose of this questionnaire survey was to provide an overview of anesthesiology pain fellowship programs in the United States with regard to implantation of spinal cord stimulators (SCS) and opioid infusion devices. Of the 95 programs solicited, 80% responded to questions pertaining to the prevalence of use and technical considerations of implantation. Of the responding programs, 87% report implanting SCS, and 84% report implanting neuraxial infusion pumps. All programs perform a stimulation or infusion trial before implantation, although the duration varied from a trial in the operating room at the time of implantation to 25 days. Of the programs, 83% implant cylindrical leads, and 17% implant flat leads via laminectomy for their nonrevision SCS implants. Morphine, bupivacaine, hydromorphone, and baclofen are the most commonly used drugs and are used in implanted pumps by >50% of respondents. The question of industry-sponsored pain fellow education in implantable techniques is addressed. Of the pain teaching programs in the United States, 80% responded to a questionnaire eliciting information about the implantation of spinal cord-stimulating and opioid infusion devices. The range and diversity of responses imply a lack of agreement about implantation techniques, drugs, and protocols.

  11. Neuromaturation of the human fetus. (United States)

    Flower, M J


    The fetal human possesses an active central nervous system from at least the eighth week of development. Until mid-gestation the most significant center of activity is the brainstem. By the end of the first trimester, it appears that the brainstem could be acting as a rudimentary modulator of sensory information and motor activity. What importance ought to be attached to such regulatory activity is uncertain. Some argue that it represents a level of integrated activity sufficient to bolster an argument for conferring some measure of standing at this point. Our thinking about sentience is not advanced a great deal, as we as yet have no good way of talking about it at the brainstem level. As for the neocortex, available evidence indicates that it does not become a functional part of the neuraxis until at least mid-gestation. It is not until then that the thalamus--the major gateway for sensory input to the cerebrum--makes its first afferent contacts with the neocortex.

  12. The Role of Orexins/Hypocretins in Alcohol Use and Abuse. (United States)

    Walker, Leigh C; Lawrence, Andrew J

    Addiction is a chronic relapsing disorder characterized by compulsive drug seeking and drug taking despite negative consequences. Alcohol abuse and addiction have major social and economic consequences and cause significant morbidity and mortality worldwide. Currently available therapeutics are inadequate, outlining the need for alternative treatments. Detailed knowledge of the neurocircuitry and brain chemistry responsible for aberrant behavior patterns should enable the development of novel pharmacotherapies to treat addiction. Therefore it is important to expand our knowledge and understanding of the neural pathways and mechanisms involved in alcohol seeking and abuse. The orexin (hypocretin) neuropeptide system is an attractive target, given the recent FDA and PMDA approval of suvorexant for the treatment of insomnia. Orexin is synthesized exclusively in neurons located in the lateral (LH), perifornical (PEF), and dorsal medial (DMH) hypothalamus. These neurons project widely throughout the neuraxis with regulatory roles in a wide range of behavioral and physiological responses, including sleep-wake cycle neuroendocrine regulation, anxiety, feeding behavior, and reward seeking. Here we summarize the literature to date, which have evaluated the interplay between alcohol and the orexin system.

  13. Preeclampsia: pathophysiology, old and new strategies for management. (United States)

    Stocks, Gary


    Preeclampsia continues to be a leading cause of maternal and foetal mortality and morbidity worldwide. It is defined as hypertension and proteinuria after 20 weeks' gestation, which resolves after delivery. It is complicated by intracerebral haemorrhage, pulmonary oedema and respiratory and hepatic failure, which form the commonest causes of death. There is a genetic and immunological element to the pathophysiology of the disease, which is still not completely understood, but the underlying cause is an abnormality of placentation and placental hypoxia. This is thought to result in an imbalance of angiogenic and antiangiogenic proteins that leads to systemic endothelial disruption and multiorgan involvement. Successful treatment requires delivery of the placenta and management should be undertaken by a multidisciplinary team, aiming primarily to stabilise the condition of the mother before delivery is contemplated. Guidelines and protocols all have common management goals which are to treat hypertension, prevent seizures, control fluid intake and optimise the timing of delivery. Hypertension can be treated with a range of antihypertensive drugs, but labetalol is regarded as first-line therapy. Magnesium sulphate is the treatment of choice for eclampsia because it reduces the risk of seizures by more than 50%. A fluid restriction policy should be used to prevent iatrogenic pulmonary oedema. Effective anaesthetic management relies on neuraxial techniques. Epidural, combined spinal-epidural and single-shot spinal anaesthetic techniques are all perfectly acceptable and should be actively promoted to the mother unless contraindications such as thrombocytopaenia exist.

  14. Severe preeclampsia: anesthetic implications of the disease and its management. (United States)

    Turner, Judi A


    Preeclampsia is a significant, multifactorial, multiorgan disease affecting 6%-8% of all pregnancies in the United States and is the third leading cause of maternal mortality. As such, it is incumbent upon any anesthesia provider involved in obstetric cases to be familiar with the varied manifestations of the disease, management goals from an obstetric standpoint, and the implications for provision of anesthesia in this patient group. Despite improvements in the diagnosis and management of preeclampsia, severe complications can occur in both the mother and the fetus. A systematic approach to the anesthetic evaluation is therefore necessary to reduce morbidity and mortality and to improve outcomes. The potential pitfalls of general anesthesia, including failed intubation, in these complicated patients make regional anesthesia the preferred choice in many cases. Recent studies have shown that spinal anesthesia is often appropriate for preeclamptic patients, even in severe cases. Nevertheless, it is important to be aware of the potential contraindications to neuraxial anesthesia and to prepare for the possibility of encountering a difficult airway.

  15. Spinal cord injury arising in anaesthesia practice. (United States)

    Hewson, D W; Bedforth, N M; Hardman, J G


    Spinal cord injury arising during anaesthetic practice is a rare event, but one that carries a significant burden in terms of morbidity and mortality. In this article, we will review the pathophysiology of spinal cord injury. We will then discuss injuries relating to patient position, spinal cord hypoperfusion and neuraxial techniques. The most serious causes of spinal cord injury - vertebral canal haematoma, spinal epidural abscess, meningitis and adhesive arachnoiditis - will be discussed in turn. For each condition, we draw attention to practical, evidence-based measures clinicians can undertake to reduce their incidence, or mitigate their severity. Finally, we will discuss transient neurological symptoms. Some cases of spinal cord injury during anaesthesia can be ascribed to anaesthesia itself, arising as a direct consequence of its conduct. The injury to a spinal nerve root by inaccurate and/or incautious needling during spinal anaesthesia is an obvious example. But in many cases, spinal cord injury during anaesthesia is not caused by, related to, or even associated with, the conduct of the anaesthetic. Surgical factors, whether direct (e.g. spinal nerve root damage due to incorrect pedicle screw placement) or indirect (e.g. cord ischaemia following aortic surgery) are responsible for a significant proportion of spinal cord injuries that occur concurrently with the delivery of regional or general anaesthesia. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

  16. Epidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance. (United States)

    Schier, Robert; Guerra, Diana; Aguilar, Jorge; Pratt, Gregory F; Hernandez, Mike; Boddu, Krishna; Riedel, Bernhard


    The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. The MEDLINE, EMBASE, and Cochrane databases were searched for prospective, randomized studies comparing air versus liquid as the medium for loss of resistance during epidural space identification in adults. Data were abstracted from 5 studies (4 obstetric and 1 nonobstetric) (n = 4422 patients) that met inclusion criteria and analyzed for the following 6 outcomes: difficult catheter insertion, paresthesia, intravascular catheter insertion, accidental dural puncture, postdural puncture headache, and partial block. The overall risk differences for adverse outcome between the different mediums were not statistically different for the obstetric population. A small, but statistically significant, risk difference for postdural puncture headache was observed when fluid was used during epidural placement for chronic pain management. Larger studies that overcome limitations of heterogeneity across studies and a relatively infrequent occurrence of complications are required to determine the optimal medium for loss of resistance during epidural block.

  17. Labor analgesia: An update on the effect of epidural analgesia on labor outcome

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    Samina Ismail


    Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

  18. Severe spinal stenosis in an adult achondroplastic dwarf – case report

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    B. Iliescu1, S. Gaivas1, C. Apetrei1, I. Poeată1,2


    Full Text Available Achondroplasia is the most commonform of human short-limbed dwarfism andis one of a spectrum of diseases caused bymutations in the FGFR3 gene.Achondroplasia is estimated to occur in 1 in10,000–30,000 live births4,7. The disease isautosomal dominant, but 80% of patientshave new mutations. It is commonlyassociated with several neurologicalconditions such as hydrocephalus,cervicomedullary compression, cervical orthoracic cord compression, and lumbarspinal compression due to bone stenosisalong the neuraxis. We report a case withsevere spinal stenosis at the lumbar andthoracic levels, with minimal involvementof the cervical spine with late neurologicalonset in an adult patient withachondroplasia. Neurological andradiological findings and surgicalprocedures are discussed. The patient wasadmitted with profound spastic lowerparaparesis and urinary incontinence. In thefirst operation we performed lumbardecompression and the patient improvedand on the fifth day she was able to take ashort walk. 3 months after the first surgerywe intervened on the thoracic spine with amulti-level decompression which allowedfor further neurological improvement,continued in a specialized medical facility.The case stands out as the clinical picturewas dominated by the lumbar stenosis(although both lumbar and thoracicstenosis were severe at the time ofpresentation with a late onset and sparingof the cervical spine.

  19. Caudal epidural blockade for major orthopedic hip surgery in adolescents

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    Brian Schloss


    Full Text Available Background: There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased medication-related adverse effects, decreased postanesthesia recovery room time and hospital stay, and increased patient satisfaction. Materials and Methods: The authors present a case-controlled series evaluating the use of a single caudal epidural injection prior to incision as an adjunct to general anesthesia for the open repair of slipped capital femoral epiphysis. Opiate consumption, pain scores, and hospital stay were compared between the two cohorts of 16 adolescent patients. All patients received a demand-only patient-controlled opiate delivery system. Results: Although the failed block rate was high (31%, there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block. Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block. Conclusion: The potential utility of caudal epidural block as an adjunct to general anesthesia during major hip surgery in adolescents is presented. Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.

  20. Physiology and pathology of saccades and gaze holding. (United States)

    Shaikh, Aasef G; Ghasia, Fatema F


    Foveation is the fundamental requirement for clear vision. Saccades rapidly shift the gaze to the interesting target while gaze holding ensures foveation of the desired object. We will review the pertinent physiology of saccades and gaze holding and their pathophysiology leading to saccadic oscillations, slow saccades, saccadic dysmetria, and nystagmus. Motor commands for saccades are generated at multiple levels of the neuraxis. The frontal and parietal eye field send saccadic commands to the superior colliculus. Latter then projects to the brain-stem saccadic burst generator. The brain-stem burst generators guarantee optimum signal to ensure rapid saccadic velocity, while the neural integrator, by mathematically integrating the saccadic pulse, facilitates stable gaze holding. Reciprocal innervations that ensure rapid saccadic velocity are prone to inherent instability leading to saccadic oscillations. In contrast, suboptimal function of the burst generators causes slow saccades. Impaired error correction, either at the cerebellum or the inferior olive, leads to impaired saccade adaptation and ultimately saccadic dysmetria and oculopalatal tremor. Impairment in the function of neural integrator causes nystagmus. Neurophysiology of saccades, gaze holding, and their deficits are well recognized. These principles can be implemented to define novel therapeutic and rehabilitation approaches.

  1. Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

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    Neha Baduni


    Full Text Available Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM, and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

  2. Visceral pain hypersensitivity in functional gastrointestinal disorders. (United States)

    Farmer, A D; Aziz, Q


    Functional gastrointestinal disorders (FGIDs) are a highly prevalent group of heterogeneous disorders whose diagnostic criteria are symptom based in the absence of a demonstrable structural or biochemical abnormality. Chronic abdominal pain or discomfort is a defining characteristic of these disorders and a proportion of patients may display heightened pain sensitivity to experimental visceral stimulation, termed visceral pain hypersensitivity (VPH). We examined the most recent literature in order to concisely review the evidence for some of the most important recent advances in the putative mechanisms concerned in the pathophysiology of VPH. VPH may occur due to anomalies at any level of the visceral nociceptive neuraxis. Important peripheral and central mechanisms of sensitization that have been postulated include a wide range of ion channels, neurotransmitter receptors and trophic factors. Data from functional brain imaging studies have also provided evidence for aberrant central pain processing in cortical and subcortical regions. In addition, descending modulation of visceral nociceptive pathways by the autonomic nervous system, hypothalamo-pituitary-adrenal axis and psychological factors have all been implicated in the generation of VPH. Particular areas of controversy have included the development of efficacious treatment of VPH. Therapies have been slow to emerge, mainly due to concerns regarding safety. The burgeoning field of genome wide association studies may provide further evidence for the pleiotropic genetic basis of VPH development. Tangible progress will only be made in the treatment of VPH when we begin to individually characterize patients with FGIDs based on their clinical phenotype, genetics and visceral nociceptive physiology.

  3. Beverage patterns and trends among school-aged children in the US, 1989-2008

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    Popkin Barry M


    Full Text Available Abstract Background High intake of sugar-sweetened beverages in childhood is linked to increased risk of obesity and type II diabetes later in life. Using three nationally representative surveys of dietary intake, we investigated beverage patterns and trends among US school-aged children from 1989/91 to 2007/08. Methods 3, 583 participants ages 6-11 y old were included. We reported per capita trends in beverage consumption, percent consuming, and amount per consumer for the following categories of beverages: sugar-sweetened beverages (SSB, caloric nutritional beverages (CNB and low calorie beverages (LCB. Statistically significant differences were tested using the Student's t test in Stata 11. Results While per capita kcal contribution from total beverages remained constant over the study period, per capita consumption of SSBs increased and CNBs decreased in similar magnitude. The substantial increase in consumption of certain SSBs, such as fruit drinks and soda, high fat high sugar milk, and sports drinks, coupled with the decrease in consumption of high fat low sugar milk was responsible for this shift. The percent consuming SSBs as well as the amount per consumer increased significantly over time. Per capita intake of total milk declined, but the caloric contribution from high fat high sugar milk increased substantially. Among ethnicities, important differences in consumption trends of certain SSBs and 100% juice indicate the complexity in determining strategies for children's beverage calorie reduction. Conclusions As upward trends of SSB consumption parallel increases in childhood obesity, educational and policy interventions should be considered.

  4. नैनो टेक्नोलॉजी - मत्स्य क्षेत्र मे रामबाण

    Digital Repository Service at National Institute of Oceanography (India)

    Abidi, S.A; Ansari, Z.A; Bhagat, D.; Gupta, N

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  5. Light-Activated Hydrogel Formation via the Triggered Folding and Self-Assembly of a Designed Peptide (United States)

    Haines, Lisa A.; Rajagopal, Karthikan; Ozbas, Bulent; Salick, Daphne A.; Pochan, Darrin J.; Schneider, Joel P.


    Photopolymerization can be used to construct materials with precise temporal and spatial resolution. Applications such as tissue engineering, drug delivery, the fabrication of microfluidic devices and the preparation of high-density cell arrays employ hydrogel materials that are often prepared by this technique. Current photopolymerization strategies used to prepare hydrogels employ photoinitiators, many of which are cytotoxic and require large macromolecular precursors that need to be functionalized with moieties capable of undergoing radical cross-linking reactions. We have developed a simple light-activated hydrogelation system that employs a designed peptide whose ability to self-assemble into hydrogel material is dependent on its intramolecular folded conformational state. An iterative design strategy afforded MAX7CNB, a photocaged peptide that, when dissolved in aqueous medium, remains unfolded and unable to self-assemble; a 2 wt % solution of freely soluble unfolded peptide is stable to ambient light and has the viscosity of water. Irradiation of the solution (260 < λ < 360 nm) releases the photocage and triggers peptide folding to produce amphiphilic β-hairpins that self-assemble into viscoelastic hydrogel material. Circular dichroic (CD) spectroscopy supports this folding and self-assembly mechanism, and oscillatory rheology shows that the resulting hydrogel is mechanically rigid ( G′ = 1000 Pa). Laser scanning confocal microscopy imaging of NIH 3T3 fibroblasts seeded onto the gel indicates that the gel surface is noncytotoxic, conducive to cell adhesion, and allows cell migration. Lastly, thymidine incorporation assays show that cells seeded onto decaged hydrogel proliferate at a rate equivalent to cells seeded onto a tissue culture-treated polystyrene control surface. PMID:16316249

  6. Critical Assessment of Information Extraction Systems in Biology

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    Christian Blaschke


    Full Text Available An increasing number of groups are now working in the area of text mining, focusing on a wide range of problems and applying both statistical and linguistic approaches. However, it is not possible to compare the different approaches, because there are no common standards or evaluation criteria; in addition, the various groups are addressing different problems, often using private datasets. As a result, it is impossible to determine how well the existing systems perform, and particularly what performance level can be expected in real applications. This is similar to the situation in text processing in the late 1980s, prior to the Message Understanding Conferences (MUCs. With the introduction of a common evaluation and standardized evaluation metrics as part of these conferences, it became possible to compare approaches, to identify those techniques that did or did not work and to make progress. This progress has resulted in a common pipeline of processes and a set of shared tools available to the general research community. The field of biology is ripe for a similar experiment. Inspired by this example, the BioLINK group (Biological Literature, Information and Knowledge [1] is organizing a CASP-like evaluation for the text data-mining community applied to biology. The two main tasks specifically address two major bottlenecks for text mining in biology: (1 the correct detection of gene and protein names in text; and (2 the extraction of functional information related to proteins based on the GO classification system. For further information and participation details, see


    Energy Technology Data Exchange (ETDEWEB)

    De Pree, C. G.; Monsrud, A. [Agnes Scott College, 141 East College Avenue, Decatur, GA 30030 (United States); Peters, T. [Institut für Theoretische Physik, Universität Zürich, CH-8057 Zürich (Switzerland); Mac Low, M.-M. [American Museum of Natural History, New York, NY 10024 (United States); Wilner, D. J.; Keto, E. R. [Harvard-Smithsonian CfA, Cambridge, MA 02138 (United States); Goss, W. M. [National Radio Astronomy Observatory, Socorro, NM 87801 (United States); Galván-Madrid, R. [European Southern Observatory, Karl-Schwarzschild-Str. 2, D-85748 Garching (Germany); Klessen, R. S. [Zentrum für Astronomie, Institut für Theoretische Astrophysik, Universität Heidelberg, Albert-Ueberle-Str. 2, D-69120 Heidelberg (Germany)


    Accretion flows onto massive stars must transfer mass so quickly that they are themselves gravitationally unstable, forming dense clumps and filaments. These density perturbations interact with young massive stars, emitting ionizing radiation, alternately exposing and confining their H II regions. As a result, the H II regions are predicted to flicker in flux density over periods of decades to centuries rather than increase monotonically in size as predicted by simple Spitzer solutions. We have recently observed the Sgr B2 region at 1.3 cm with the Very Large Array in its three hybrid configurations (DnC, CnB, and BnA) at a resolution of ∼0.''25. These observations were made to compare in detail with matched continuum observations from 1989. At 0.''25 resolution, Sgr B2 contains 41 ultracompact (UC) H II regions, 6 of which are hypercompact. The new observations of Sgr B2 allow comparison of relative peak flux densities for the H II regions in Sgr B2 over a 23 year time baseline (1989-2012) in one of the most source-rich massive star forming regions in the Milky Way. The new 1.3 cm continuum images indicate that four of the 41 UC H II regions exhibit significant changes in their peak flux density, with one source (K3) dropping in peak flux density, and the other three sources (F10.303, F1, and F3) increasing in peak flux density. The results are consistent with statistical predictions from simulations of high mass star formation, suggesting that they offer a solution to the lifetime problem for UC H II regions.

  8. 3DIANA: 3D Domain Interaction Analysis: A Toolbox for Quaternary Structure Modeling (United States)

    Segura, Joan; Sanchez-Garcia, Ruben; Tabas-Madrid, Daniel; Cuenca-Alba, Jesus; Sorzano, Carlos Oscar S.; Carazo, Jose Maria


    Electron microscopy (EM) is experiencing a revolution with the advent of a new generation of Direct Electron Detectors, enabling a broad range of large and flexible structures to be resolved well below 1 nm resolution. Although EM techniques are evolving to the point of directly obtaining structural data at near-atomic resolution, for many molecules the attainable resolution might not be enough to propose high-resolution structural models. However, accessing information on atomic coordinates is a necessary step toward a deeper understanding of the molecular mechanisms that allow proteins to perform specific tasks. For that reason, methods for the integration of EM three-dimensional maps with x-ray and NMR structural data are being developed, a modeling task that is normally referred to as fitting, resulting in the so called hybrid models. In this work, we present a novel application—3DIANA—specially targeted to those cases in which the EM map resolution is medium or low and additional experimental structural information is scarce or even lacking. In this way, 3DIANA statistically evaluates proposed/potential contacts between protein domains, presents a complete catalog of both structurally resolved and predicted interacting regions involving these domains and, finally, suggests structural templates to model the interaction between them. The evaluation of the proposed interactions is computed with DIMERO, a new method that scores physical binding sites based on the topology of protein interaction networks, which has recently shown the capability to increase by 200% the number of domain-domain interactions predicted in interactomes as compared to previous approaches. The new application displays the information at a sequence and structural level and is accessible through a web browser or as a Chimera plugin at PMID:26772592

  9. Preparation of gold-containing binary metal clusters by co-deposition-precipitation method and for hydrogenation of chloronitrobenzene

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    Ya-Ting Tsu


    Full Text Available Nano-gold catalyst has been reported to have high activity and selectivity for liquid phase hydrogenation reaction. In this study, gold-containing bimetals were loaded on TiO2. For bimetallic catalysts, gold and different metals were prepared by the deposition-precipitation method, and then used NaBH4 to reduce metal cations. The catalysts were characterized by X-ray diffraction, transmission electron microscopy, high resolution transmission electron microscopy, and X-ray photoelectron spectroscopy. The catalytic properties of these catalysts were tested by hydrogenation of p-chloronitrobenzene (p-CNB in a batch reactor at 1.1 MPa H2 pressure, 373 K and 500 rpm. Cu, Ag, Ru, and Pd formed nano-alloy with Au. In addition, Cu–Au, Ag–Au, and Ru–Au alloy had Cu-, Ag-, and Ru-enriched surface, respectively. Instead, Pd–Au alloy had Pd-enriched surface. There are two kinds of alloy effects: (1 geometric effects, i.e., the surface-enriched metal would change the distance of Au–Au atoms that is required for facilitating the hydrogenation of chloronitrobenzene; and (2 electronic effects, which involve charge transfer between the metals. The activity decreased in the following order: PdAu/TiO2 > Au/TiO2 > NiAu/TiO2 > AgAu/TiO2 > RuAu/TiO2 > CuAu/TiO2. Comparing with other metals, adding Pd in Au showed a higher activity. Adding palladium could reduce gold-valence state, and increased active sites for reaction.

  10. Five-year Study of Patients with Lactating Adenoma and Review of the Literature

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    Asiie Olfatbakhsh


    Full Text Available Background: Lactating adenoma is a benign breast mass related to physiological changes during pregnancy and increased estrogen level. Fibroadenoma and breast cancer should be considered in the differential diagnosis of this lesion. The purpose of this study was to report cases of lactating adenoma in Breast Cancer Research Center (BCRC and review the relevant literature.Methods: All patients with histological diagnosis of lactating adenoma between April 2010 and December 2015 were selected. Patients’ data were extracted from their medical records and follow-up of the patients were done through in-person examination or rarely by telephone call.Results: A total of 22 patients with pathological diagnosis of lactating adenoma were enrolled. The mean age of patients was 27±4.6 years. Fourteen patients were in breast-feeding period and eight were pregnant at the time of diagnosis. The chief complaint was breast mass in 16 patients and pain 6 patients. The mean size of masses was 4.1 cm (1.8-8 cm. For 13 patients, core needle biopsy (CNB and for 6 patients open biopsy were performed and for the other 3 patients vacuum-assisted biopsy were done. In 5 patients, excisional biopsy was done in the follow-up period that one of them proved to be medullary carcinoma and other cases were benign.Conclusions: Lactating adenoma commonly presents as a palpable mass during the breastfeeding period or the third trimester of pregnancy. The most common ultrasonographic appearance is a hypoechoic mass with regular borders. It usually regresses after cessation of breastfeeding, however in patients with mass enlargement during the follow-up, period pathologic evaluation of the lesion through core needle biopsy should be performed to rule out coexistent carcinoma.

  11. Tolerance to Caspofungin in Candida albicans Is Associated with at Least Three Distinctive Mechanisms That Govern Expression of FKS Genes and Cell Wall Remodeling. (United States)

    Yang, Feng; Zhang, Lulu; Wakabayashi, Hironao; Myers, Jason; Jiang, Yuanying; Cao, Yongbing; Jimenez-Ortigosa, Cristina; Perlin, David S; Rustchenko, Elena


    Expanding echinocandin use to prevent or treat invasive fungal infections has led to an increase in the number of breakthrough infections due to resistant Candida species. Although it is uncommon, echinocandin resistance is well documented for Candida albicans, which is among the most prevalent bloodstream organisms. A better understanding is needed to assess the cellular factors that promote tolerance and predispose infecting cells to clinical breakthrough. We previously showed that some mutants that were adapted to growth in the presence of toxic sorbose due to loss of one chromosome 5 (Ch5) also became more tolerant to caspofungin. We found here, following direct selection of mutants on caspofungin, that tolerance can be conferred by at least three mechanisms: (i) monosomy of Ch5, (ii) combined monosomy of the left arm and trisomy of the right arm of Ch5, and (iii) an aneuploidy-independent mechanism. Tolerant mutants possessed cell walls with elevated chitin and showed downregulation of genes involved in cell wall biosynthesis, namely, FKS, located outside Ch5, and CHT2, located on Ch5, irrespective of Ch5 ploidy. Also irrespective of Ch5 ploidy, the CNB1 and MID1 genes on Ch5, which are involved in the calcineurin signaling pathway, were expressed at the diploid level. Thus, multiple mechanisms can affect the relative expression of the aforementioned genes, controlling them in similar ways. Although breakthrough mutations in two specific regions of FKS1 have previously been associated with caspofungin resistance, we found mechanisms of caspofungin tolerance that are independent of FKS1 and thus represent an earlier event in resistance development. Copyright © 2017 American Society for Microbiology.

  12. Microstructure and fracture toughness of the in-situ NiAl-Ni(3)Al intermetallic composites (United States)

    Gao, Qian


    An overview of the toughening mechanisms in the intermetallic-base in-situ composites is presented. Based on the literature review and preliminary research, the two phase (beta+gammasp') region of Ni-Al system was chosen as a model in-situ composite to study fracture toughness of the in-situ NiAl-Nisb3Al intermetallic composites and explore the fracture toughening mechanisms in these intermetallic materials. The composition ranges investigated were 25-35 at.% Al for both as-solidified and as-heat-treated composites. To evaluate fracture toughness, a three point bending of Chevron-notched beam (CNB) specimens were used. The values of fracture toughness were calculated either directly from the maximum load at unstable crack propagation or by using a modified J-integral approach. Compressive testing was also carried out to obtain yield strength of tested in-situ intermetallic composites. Micromechanical properties of individual phases were probed by Vickers microhardness testing. The relationship between fracture toughness (Ksb{Ivm},\\ Ksb{Ivc}) and volume fraction of second phase Vsb{d}, in the following form: Ksb{Ivc}=f(Vsbsp{d}{n}) has been established. Also, boron-doped (0.2 and 0.3 at.%,) Nisb3Al was fabricated. Fracture mechanisms and boron effect on fracture toughness of the Nisb3Al phase were explored. The obtained results of fracture toughness (Ksb{Ivm},\\ Ksb{Ivc}) are compared with the existing models, which describe the second phase toughening mechanisms, and rule of mixtures (ROM). Weibull analysis is also applied for the analysis of the fracture toughness distribution of the investigated Nisb3Al/NiAl in-situ composites. The important features of the K-Delta a and J-Delta a curves by a CNB bend test have been explored in this research. The stress intensity factor K decreases with increasing crack extension (Delta a) and a PLATEAU usually appears with increasing of the crack extension only until the critical crack extension (Delta asb{m}), then K starts to

  13. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series. (United States)

    Forero, Mauricio; Rajarathinam, Manikandan; Adhikary, Sanjib; Chin, Ki Jinn


    Post thoracotomy pain syndrome (PTPS) remains a common complication of thoracic surgery with significant impact on patients' quality of life. Management usually involves a multidisciplinary approach that includes oral and topical analgesics, performing appropriate interventional techniques, and coordinating additional care such as physiotherapy, psychotherapy and rehabilitation. A variety of interventional procedures have been described to treat PTPS that is inadequately managed with systemic or topical analgesics. Most of these procedures are technically complex and are associated with risks and complications due to the proximity of the targets to neuraxial structures and pleura. The ultrasound-guided erector spinae plane (ESP) block is a novel technique for thoracic analgesia that promises to be a relatively simple and safe alternative to more complex and invasive techniques of neural blockade. We have explored the application of the ESP block in the management of PTPS and report our preliminary experience to illustrate its therapeutic potential. The ESP block was performed in a pain clinic setting in a cohort of 7 patients with PTPS following thoracic surgery with lobectomy or pneumonectomy for lung cancer. The blocks were performed with ultrasound guidance by injecting 20-30mL of ropivacaine, with or without steroid, into a fascial plane between the deep surface of erector spinae muscle and the transverse processes of the thoracic vertebrae. This paraspinal tissue plane is distant from the pleura and the neuraxis, thus minimizing the risk of complications associated with injury to these structures. The patients were followed up by telephone one week after each block and reviewed in the clinic 4-6 weeks later to evaluate the analgesic response as well as the need for further injections and modification to the overall analgesic plan. All the patients had excellent immediate pain relief following each ESP block, and 4 out of the 7 patients experienced prolonged

  14. Cytotoxic effect of commercially available methylprednisolone acetate with and without reduced preservatives on dorsal root ganglion sensory neurons in rats. (United States)

    Knezevic, Nebojsa Nick; Candido, Kenneth D; Cokic, Ivan; Krbanjevic, Aleksandar; Berth, Sarah L; Knezevic, Ivana


    Epidural and intrathecal injections of methylprednisolone acetate (MPA) have become the most commonly performed interventional procedures in the United States and worldwide in the last 2 decades. However neuraxial MPA injection has been dogged by controversy regarding the presence of different additives used in commercially prepared glucocorticoids. We previously showed that MPA could be rendered 85% free of polyethylene glycol (PEG) by a simple physical separation of elements in the suspension. The objective of the present study was to explore a possible cytotoxic effect of commercially available MPA (with intact or reduced preservatives) on rat sensory neurons. We exposed primary dissociated rat dorsal root ganglia (DRG) sensory neurons to commercially available MPA for 24 hours with either the standard (commercial) concentration of preservatives or to different fractions following separation (MPA suspension whose preservative concentration had been reduced, or fractions containing higher concentrations of preservatives). Cells were stained with the TUNEL assay kit to detect apoptotic cells and images were taken on the Bio-Rad Laser Sharp-2000 system. We also detected expression of caspase-3, as an indicator of apoptosis in cell lysates. We exposed sensory neurons from rat DRG to different concentrations of MPA from the original commercially prepared vial. TUNEL assay showed dose-related responses and increased percentages of apoptotic cells with increasing concentrations of MPA. Increased concentrations of MPA caused 1.5 - 2 times higher caspase-3 expression in DRG sensory neurons than in control cells (ANOVA, P = 0.001). Our results showed that MPA with reduced preservatives caused significantly less apoptosis observed with TUNEL assay labeling (P neurons exposed to MPA from a commercially prepared vial or "clear phase" that contained higher concentrations of preservatives. Even though MPA with reduced preservatives caused 12.5% more apoptosis in DRG sensory


    Directory of Open Access Journals (Sweden)

    Radha Korumbil Raghavan


    Full Text Available BACKGROUND Neuraxial blocks are the most common method of anaesthesia in abdominal hysterectomies and epidural technique has been used widely to provide both anaesthesia and postoperative analgesia. It has become a common practice to use polypharmacy approach for treatment of intra and postoperative pain, because no drug has yet been identified that specifically inhibit nociception without side effects. The aim of the study is to compare the effects of magnesium sulphate versus preservative-free ketamine as an adjunct to epidural bupivacaine for postoperative analgesia in abdominal hysterectomy. MATERIALS AND METHODS After obtaining informed consent, the patients were divided into 3 groups of 40 each to receive 20 mL 0.5% bupivacaine (group B, 19 mL 0.5% bupivacaine + 50 mg magnesium sulphate (group BM, 19 mL 0.5% bupivacaine + 50 mg preservative-free ketamine (group BK. Epidural catheter was inserted at L1-L2 space using standard technique. Correct placement was confirmed by a test dose of 2% lignocaine + adrenaline 1 in 2 lakhs. Postoperative analgesia were assessed by VAS score and 0.125% bupivacaine infusion and 1 g paracetamol IV infusion was given as rescue analgesics when VAS ≥4. Onset duration, motor block and side effects were also monitored. RESULTS Mean time of duration of onset in group B, BM, BK were 20, 14, 18 minutes, respectively. Mean time for rescue analgesia were 180, 240 and 480 minutes in group 1, 2 and 3, respectively. These differences were statistically significant. The side effects noticed in each group were not statistically significant. CONCLUSION The onset of effect is faster when magnesium sulphate were added as an adjunct to bupivacaine as compared to preservativefree ketamine. The postoperative analgesia is found to be more with preservative-free ketamine as compared to magnesium sulphate without any significant side effects.

  16. Development of a new method for identification and quantification in cerebrospinal fluid of malignant cells from breast carcinoma leptomeningeal metastasis

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    Le Rhun Emilie


    Full Text Available Abstract Background The diagnosis of leptomeningeal metastasis (LM in patients with solid tumors remains difficult. The usual diagnostic methods of cytomorphological assessment of cerebro-spinal fluid (CSF and gadolinium enhanced MRI of the entire neuraxis lack both specificity and sensitivity. The Veridex CellSearch® technology has been designed for the detection of circulating tumor cells (CTC in blood from cancer patients and validated for the follow-up and prognosis of breast, prostate, colorectal, and lung cancer. Our aim was to adapt this technology for the detection and the enumeration of tumor cells in the CSF of breast cancer patients presenting with LM. Methods On the occasion of a randomized phase III study evaluating the role of the intrathecal treatment in LM from breast cancer (DEPOSEIN, EudraCT N°: 2010-023134-23, the CellSearch® technology was adapted to direct enrichment, enumeration and visualization of tumor cells in 5 mL CSF samples, collected on CellSave® Preservative Tubes and analyzed within 3 days after CSF sampling. Results Sixteen CSF of 8 patients with primary breast cancer presenting with LM were studied. EpCAM+/cytokeratin + cells with typical morphology could be observed and enumerated sequentially with reproducible results in low or elevated numbers in 8 patients. Conclusion This methodology, established on a limited volume of sample and allowing delayed processing, could prove of great interest in the diagnosis and follow-up of cancer patients with LM, especially to appreciate the efficacy of chemotherapy.

  17. [Hip fracture, antiplatelet drugs treatment and postoperative complications]. (United States)

    Reguant, F; Martínez, E; Gil, B; Prieto, J C; del Milagro Jiménez, L; Arnau, A; Bosch, J


    To assess the incidence of postoperative complications, blood transfusions and survival at one month, in the old patients operated for hip fracture undergoing chronic treatment with antiplatelet drugs. Two hundred twenty three patients operated for hip fracture were studied retrospectively, separated into 3 groups: patients who received acetylsalicylic acid (group I), patients who were given 100mg/day of acetylsalicylic acid or 300mg/day of triflusal (group II) and patients receiving>100mg/day of acetylsalicylic acid, or>300mg/day of triflusal or thienopyridines (group III). Surgery was delayed for 4 days in patients in group III. Demographic, biological, clinical and treatment characteristics, postoperative complications and survival at one month were recorded. Patients in group III were older and sustain worse general health status. Patients with a higher transfusion requirement were those of group II (73.8%) (P=0.192), who also showed a higher percentage of anaemia on admission. Severe cardiovascular complications were experienced by 5.4% of group III patients, 4.8% of group II patients and 2.1% of group I patients. Patients from group III presented a significant amount of respiratory complications (P=0.007). Our results suggest that delaying surgery for 4 days in patients treated with clopidogrel can be associated to an increase in postoperative respiratory complications and severe adverse cardiovascular events, without increasing the tranfusional index, hospital stay, mortality, and without complications related to neuraxial anaesthesia. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  18. Stiff person syndrome in South Asia. (United States)

    Chang, Thashi; Lang, Bethan; Vincent, Angela


    Stiff person syndrome is a highly disabling, progressive autoimmune disorder of the central nervous system characterized by muscle rigidity and spasms. Stiff person syndrome is rare, but is believed to be under diagnosed with only 14 cases been reported among a 1.7 billion population in South Asia. We report the first authenticated case from Sri Lanka. A 55-year-old Sri Lankan female presented with difficulty in walking and recurrent falls due to progressive muscular rigidity in her lower limbs and trunk with superimposed muscle spasms that occurred in response to unexpected noise, startle or emotional upset. She had anxiety and specific phobias to open spaces, walking unaided and being among crowds of people. She had insulin-dependent diabetes mellitus and was on thyroxine replacement. On examination, she had hyperlordosis combined with board-like rigidity of her anterior abdomen and rigidity of her lower limbs bilaterally. Upper limbs were normal. Magnetic resonance imaging of her neuraxis was normal. Electromyography showed continuous motor unit activity at rest. Glutamic acid decarboxylase antibodies were detected in her serum at a titre of 15,500 IU/ml (normal <5). She showed a remarkable and sustained improvement to treatment with intravenous immunoglobulins, immunosuppressive and muscle relaxant medications, regaining independent ambulation. Diagnosis of stiff person syndrome remains clinical, supported by electromyography and serology for glutamic acid decarboxylase antibodies, facilitated by a high index of clinical suspicion. An autoimmune basis lends stiff person syndrome amenable to treatment highlighting the importance of diagnosis. This case adds to map the worldwide distribution of stiff person syndrome.

  19. Alexander disease in a dog: case presentation of electrodiagnostic, magnetic resonance imaging and histopathologic findings with review of literature. (United States)

    Wrzosek, Marcin; Giza, Elżbieta; Płonek, Marta; Podgórski, Przemysław; Vandevelde, Marc


    Alexander disease is a rare neurodegenerative disorder that has not often been described in dogs. None of the existing descriptions include electrodiagnostic or magnetic resonance imaging workup. This is the first presentation of the results of an electrodiagnostic evaluation including electromyography, motor nerve conduction velocity, F-wave, the brainstem auditory evoked response and magnetic resonance imaging of a dog with Alexander disease. A six month old male entire Bernese mountain dog was presented with central nervous system symptoms of generalized tremor, general stiffness, decreased proprioceptive positioning, a reduced menace response, decreased physiological nystagmus, myotonic spasms and increased spinal reflexes which progressed to lateral recumbency. The electromyography revealed normal muscle activity and a decreased motor nerve conduction velocity, temporal dispersion of the compound muscle action potential, prolonged F-wave minimal latency, lowered F-ratio, decreased latency, and lowered amplitude of the brainstem auditory evoked potentials. The magnetic resonance imaging examination revealed ventriculomegaly and linear hyperintensity on the border of the cortical grey and white matter. The histopathological examination confirmed the presence of diffuse degenerative changes of the white matter throughout the neuraxis. A proliferation of abnormal astrocytes was found at the border between the white matter and cortex. There was also a massive accumulation of eosinophilic Rosenthal fibers as well as diffuse proliferation of abnormally large astrocytes and unaffected neurons. This is the first histopathologically confirmed case of Alexander disease in a dog with a full neurological workup. The results of the electrodiagnostic and magnetic resonance imaging examinations allow for a high-probability antemortem diagnosis of this neurodegenerative disorder in dogs.

  20. Regional and subcellular distribution of the receptor-targeting protein PIST in the rat central nervous system. (United States)

    Chen, Annie; Gössling, Enno K; Witkowski, Leora; Bhindi, Amar; Bauch, Carola; Roussy, Geneviève; Sarret, Philippe; Kreienkamp, Hans-Jürgen; Stroh, Thomas


    Protein interacting specifically with Tc10, PIST, is a Golgi-associated sorting protein involved in regulating cell-surface targeting of plasma membrane receptors. The present study provides the first comprehensive description of PIST distribution in the mammalian central nervous system and of its subcellular localization by immunocytochemistry. PIST is distributed widely throughout the neuraxis, predominantly associated with neuronal cell bodies and dendrites. In hippocampal neurons, in vitro and in situ, PIST displayed a patchy subcellular distribution in an area surrounding the nucleus and extending into one of the major dendrites. By colocalization with the trans-Golgi marker TGN38, we were able to show that PIST is associated largely but not exclusively with the trans-Golgi network in central neurons. High or moderate to high levels of PIST-like immunoreactivity were found in cortical areas, in particular in layer V of the neocortex. The motor cortex was most strongly labeled. Also, the piriform and insular cortices displayed strong PIST labeling. In the hippocampus, CA2 but not CA1 or CA3 pyramidal cells displayed strong PIST-labeling, extending into their apical dendrites. In the thalamus, ventrolateral and laterodorsal nuclei were most strongly stained, whereas in the hypothalamus the supraoptic nucleus stood out with strong immunoreactivity. Strikingly, in the brainstem all cranial nerve motor nuclei were PIST-positive at varying levels, which is in keeping with the prominent expression of PIST in forebrain motor areas. This selective distribution of PIST suggests that the protein serves distinctive roles in specific neuronal populations, establishing functionally distinct zones, for instance, in the hippocampus. Copyright © 2011 Wiley-Liss, Inc.

  1. Early Clinical Outcomes Demonstrate Preserved Cognitive Function in Children With Average-Risk Medulloblastoma When Treated With Hyperfractionated Radiation Therapy

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    Gupta, Tejpal, E-mail: [Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India); Jalali, Rakesh [Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India); Goswami, Savita [Department of Clinical Psychology and Psychiatry Unit, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India); Nair, Vimoj [Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India); Moiyadi, Aliasgar [Division of Neuro-Surgery, Department of Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India); Epari, Sridhar [Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India); Sarin, Rajiv [Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer and Tata Memorial Hospital, Mumbai (India)


    Purpose: To report on acute toxicity, longitudinal cognitive function, and early clinical outcomes in children with average-risk medulloblastoma. Methods and Materials: Twenty children {>=}5 years of age classified as having average-risk medulloblastoma were accrued on a prospective protocol of hyperfractionated radiation therapy (HFRT) alone. Radiotherapy was delivered with two daily fractions (1 Gy/fraction, 6 to 8 hours apart, 5 days/week), initially to the neuraxis (36 Gy/36 fractions), followed by conformal tumor bed boost (32 Gy/32 fractions) for a total tumor bed dose of 68 Gy/68 fractions over 6 to 7 weeks. Cognitive function was prospectively assessed longitudinally (pretreatment and at specified posttreatment follow-up visits) with the Wechsler Intelligence Scale for Children to give verbal quotient, performance quotient, and full-scale intelligence quotient (FSIQ). Results: The median age of the study cohort was 8 years (range, 5-14 years), representing a slightly older cohort. Acute hematologic toxicity was mild and self-limiting. Eight (40%) children had subnormal intelligence (FSIQ <85), including 3 (15%) with mild mental retardation (FSIQ 56-70) even before radiotherapy. Cognitive functioning for all tested domains was preserved in children evaluable at 3 months, 1 year, and 2 years after completion of HFRT, with no significant decline over time. Age at diagnosis or baseline FSIQ did not have a significant impact on longitudinal cognitive function. At a median follow-up time of 33 months (range, 16-58 months), 3 patients had died (2 of relapse and 1 of accidental burns), resulting in 3-year relapse-free survival and overall survival of 83.5% and 83.2%, respectively. Conclusion: HFRT without upfront chemotherapy has an acceptable acute toxicity profile, without an unduly increased risk of relapse, with preserved cognitive functioning in children with average-risk medulloblastoma.

  2. Anesthetic and Obstetric Management of Syringomyelia During Labor and Delivery: A Case Series and Systematic Review. (United States)

    Garvey, Gráinne Patricia; Wasade, Vibhangini S; Murphy, Kellie E; Balki, Mrinalini


    Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken. Hospital records and electronic databases were interrogated using International Classification of Diseases, 10th Revision codes and the keywords "syringomyelia," "syringobulbia," and "pregnancy." Data regarding demographics, diagnosis, radiology reports, neurological symptoms, mode of delivery, anesthetic management, and maternal-fetal outcomes were collected. We collected and analyzed data on a total of 43 pregnancies in 39 patients. The most common location for syrinx was in the cervicothoracic region (41.9%). The large majority of patients (n = 34; 87%) demonstrated signs and symptoms associated with syringomyelia before delivery. Syringomyelia associated with Arnold Chiari malformation was documented in 49% (n = 21) cases. General anesthesia was the most commonly used (n = 21/30, 70%) anesthetic technique for cesarean delivery. The majority (n = 9/13, 69%) of patients had an epidural sited for labor analgesia. There were no maternal or neonatal complications associated with neuraxial anesthesia; however, 3 cases (14%) raised concerns regarding general anesthesia including difficult intubation, transient worsening of neurological symptoms postpartum, and prolonged muscle paralysis after atracurium. Despite concerns regarding aggravation of the syrinx with vaginal delivery, this mode of delivery has never caused any documented long-term worsening of neurological

  3. Homeotic evolution in the mammalia: diversification of therian axial seriation and the morphogenetic basis of human origins.

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    Aaron G Filler


    Full Text Available Despite the rising interest in homeotic genes, little has been known about the course and pattern of evolution of homeotic traits across the mammalian radiation. An array of emerging and diversifying homeotic gradients revealed by this study appear to generate new body plans and drive evolution at a large scale.This study identifies and evaluates a set of homeotic gradients across 250 extant and fossil mammalian species and their antecedents over a period of 220 million years. These traits are generally expressed as co-linear gradients along the body axis rather than as distinct segmental identities. Relative position or occurrence sequence vary independently and are subject to polarity reversal and mirroring. Five major gradient modification sets are identified: (1--quantitative changes of primary segmental identity pattern that appeared at the origin of the tetrapods ; (2--frame shift relation of costal and vertebral identity which diversifies from the time of amniote origins; (3--duplication, mirroring, splitting and diversification of the neomorphic laminar process first commencing at the dawn of mammals; (4--emergence of homologically variable lumbar lateral processes upon commencement of the radiation of therian mammals and ; (5--inflexions and transpositions of the relative position of the horizontal septum of the body and the neuraxis at the emergence of various orders of therian mammals. Convergent functional changes under homeotic control include laminar articular engagement with septo-neural transposition and ventrally arrayed lumbar transverse process support systems.Clusters of homeotic transformations mark the emergence point of mammals in the Triassic and the radiation of therians in the Cretaceous. A cluster of homeotic changes in the Miocene hominoid Morotopithecus that are still seen in humans supports establishment of a new "hominiform" clade and suggests a homeotic origin for the human upright body plan.

  4. Peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type: a report of 2 cases. (United States)

    Patzkowski, Michael S


    Ehlers-Danlos syndrome is an inherited disorder of collagen production that results in multiorgan dysfunction. Patients with hypermobility type display skin hyperextensibility and joint laxity, which can result in chronic joint instability, dislocation, peripheral neuropathy, and severe musculoskeletal pain. A bleeding diathesis can be found in all subtypes of varying severity despite a normal coagulation profile. There have also been reports of resistance to local anesthetics in these patients. Several sources advise against the use of regional anesthesia in these patients citing the 2 previous features. There have been reports of successful neuraxial anesthesia, but few concerning peripheral nerve blocks, none of which describe nerves of the lower extremity. This report describes 2 cases of successful peripheral regional anesthesia in the lower extremity. In case 1, a 16-year-old adolescent girl with hypermobility type presented for osteochondral grafting of tibiotalar joint lesions. She underwent a popliteal sciatic (with continuous catheter) and femoral nerve block under ultrasound guidance. She proceeded to surgery and tolerated the procedure under regional block and intravenous sedation. She did not require any analgesics for the following 15 hours. In case 2, an 18-year-old woman with hypermobility type presented for medial patellofemoral ligament reconstruction for chronic patella instability. She underwent a saphenous nerve block above the knee with analgesia in the distribution of the saphenous nerve lasting for approximately 18 hours. There were no complications in either case. Prohibitions against peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type, appear unwarranted. Published by Elsevier Inc.

  5. Unintentional dural puncture with a Tuohy needle increases risk of chronic headache. (United States)

    Webb, Christopher Allen-John; Weyker, Paul David; Zhang, Li; Stanley, Susan; Coyle, D Tyler; Tang, Timothy; Smiley, Richard M; Flood, Pamela


    Neuraxial analgesia is chosen by almost half of women who give birth in the United States. Unintentional dural puncture is the most common complication of this pain management technique, occurring in 0.4% to 6% of parturients. Severe positional headaches develop acutely in 70% to 80% of these parturients. Acute postdural puncture headaches are well known, but few studies have investigated long-term sequelae. We investigated the incidence of and risk factors for chronic headache and chronic back pain in parturients who experienced unintentional dural puncture with a 17-gauge Tuohy needle compared with matched controls. In a case control design, 40 parturients who sustained unintentional dural puncture with a 17-gauge Tuohy needle over an 18-month period and 40 controls matched for age, weight, and time of delivery were recruited by telephone and 2 validated questionnaires were administered assessing headache and back pain symptoms 12 to 24 months after delivery. The incidence of chronic headaches in the study group (28%) was significantly higher than in the matched controls (5%) (OR = 7, P = 0.0129). Subjects who experienced dural punctures were more likely than controls to report chronic back pain (OR = 4, P = 0.0250), but treatment with an epidural blood patch was not a risk factor for chronic back pain. Patients who incur unintentional dural punctures with large-gauge needles are surprisingly likely to continue to suffer chronic headaches. Treatment with an epidural blood patch does not enhance the risk of chronic back pain. The pathophysiology underlying these symptoms and the best treatment for this syndrome are not known.

  6. Comparison of a GPS needle-tracking system, multiplanar imaging and 2D imaging for real-time ultrasound-guided epidural anaesthesia: A randomized, comparative, observer-blinded study on phantoms. (United States)

    Menacé, Cécilia; Choquet, Olivier; Abbal, Bertrand; Bringuier, Sophie; Capdevila, Xavier


    The real-time ultrasound-guided paramedian sagittal oblique approach for neuraxial blockade is technically demanding. Innovative technologies have been developed to improve nerve identification and the accuracy of needle placement. The aim of this study was to evaluate three types of ultrasound scans during ultrasound-guided epidural lumbar punctures in a spine phantom. Eleven sets of 20 ultrasound-guided epidural punctures were performed with 2D, GPS, and multiplanar ultrasound machines (660 punctures) on a spine phantom using an in-plane approach. For all punctures, execution time, number of attempts, bone contacts, and needle redirections were noted by an independent physician. Operator comfort and visibility of the needle (tip and shaft) were measured using a numerical scale. The use of GPS significantly decreased the number of punctures, needle repositionings, and bone contacts. Comfort of the physician was also significantly improved with the GPS system compared with the 2D and multiplanar systems. With the multiplanar system, the procedure was not facilitated and execution time was longer compared with 2D imaging after Bonferroni correction but interaction between the type of ultrasound system and mean execution time was not significant in a linear mixed model. There were no significant differences regarding needle tip and shaft visibility between the systems. Multiplanar and GPS needle-tracking systems do not reduce execution time compared with 2D imaging using a real-time ultrasound-guided paramedian sagittal oblique approach in spine phantoms. The GPS needle-tracking system can improve performance in terms of operator comfort, the number of attempts, needle redirections and bone contacts. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  7. Heterogeneity of histopathological presentation of pilocytic astrocytoma - diagnostic pitfalls. A review. (United States)

    Matyja, E; Grajkowska, W; Stępień, K; Naganska, E


    Pilocytic astrocytomas (PAs) are the most frequent primary astroglial tumours affecting children and adolescents. They occur sporadically or in association with a genetically determined syndrome - neurofibromatosis type 1. Classic PA usually manifests as a well-circumscribed, often cystic, slowly growing tumour, which corresponds to WHO grade I. The majority of pilocytic tumours arise along the neuraxis, predominantly in the cerebellum. They are associated with favourable long-term outcome or spontaneous regression, even after incomplete resection. However, the behaviour and prognosis might also be related to tumour histology and location. Pilomyxoid astrocytoma (PMA) represents a variant of classical PA with more invasive growth and increased risk of recurrences and dissemination. Typically, PAs exhibit distinct histology with biphasic architecture of loose, microcystic and compact, fibrillary areas. However, some tumours arise in an uncommon location and display heterogeneous histopathological appearance. The morphological pattern of PA can mimic some other glial neoplasms, including oligodendroglioma, pleomorphic xanthoastrocytoma, ependymoma or diffuse astrocytoma. Not infrequently, the advanced degenerative changes, including vascular fibrosis, and recent and old haemorrhages, may mimic vascular pathology. Sometimes, the neoplastic piloid tissue can resemble reactive gliosis, related to long-standing non neoplastic lesions. Not infrequently, PA exhibits histological features typical for anaplasia, including necrosis, mitoses and glomeruloid vascular proliferation that can suggest a diffuse high-grade glioma. However, even those PAs that lack distinct histological features of anaplasia can behave unpredictably, in a more aggressive manner, with leptomeningeal spreading. Genetic alterations resulting in aberrant signalling of the mitogen-activated protein kinase (MAPK) pathway have been considered to underlie the development of PAs. The most commonly identified

  8. Water as an Independent Taste Modality

    Directory of Open Access Journals (Sweden)

    Andrew M Rosen


    Full Text Available To qualify as a basic taste quality or modality, defined as a group of chemicals that taste alike, three empirical benchmarks have commonly been used. The first is that a candidate group of tastants must have a dedicated transduction mechanism in the peripheral nervous system. The second is that the tastants evoke physiological responses in dedicated afferent taste nerves innervating the oropharyngeal cavity. Last, the taste stimuli evoke activity in central gustatory neurons, some of which may respond only to that group of tastants. Here we argue that water may also be an independent taste modality. This argument is based on the identification of a water dedicated transduction mechanism in the peripheral nervous system, water responsive fibers of the peripheral taste nerves and the observation of water responsive neurons in all gustatory regions within the central nervous system. We have described electrophysiological responses from single neurons in nucleus of the solitary tract (NTS and parabrachial nucleus of the pons (PbN, respectively the first two central relay nuclei in the rodent brainstem, to water presented as a taste stimulus in anesthetized rats. Responses to water were in some cases as robust as responses to other taste qualities and sometimes occurred in the absence of responses to other tastants. Both excitatory and inhibitory responses were observed. Also, the temporal features of the water response resembled those of other taste responses. We argue that water may constitute an independent taste modality that is processed by dedicated neural channels at all levels of the gustatory neuraxis. Water-dedicated neurons in the brainstem may constitute key elements in the regulatory system for fluid in the body, i.e. thirst, and as part of the swallowing reflex circuitry.

  9. Spinal opioid bioavailability in postoperative pain. (United States)

    Bujedo, Borja Mugabure


    Opioids have been used for spinal analgesia for more than a century, and their injection epidurally and intrathecally has a key role in the control of postoperative pain. Since the discovery of the endogenous opioid system, 3 decades ago, their use has become more generalized in obstetric analgesia, the management of chronic pain, and acute postoperative pain. To use opioids effectively for this type of analgesia, it is important to understand the pharmacokinetics and clinical pharmacology of these drugs, specifically those that produce analgesia by an intrinsic spinal mechanism. Evidence from animal and human experiments indicates that hydrophilic opioids (such as hydromorphone and morphine) bind more strongly to specific receptors within the dorsal horn of the spinal cord than lipophilic opioids (such as alfentanil, fentanyl, and sufentanil). This can be understood by considering the spinal cord selectivity and bioavailability of these opioids. This difference is attributable to differences in the pharmacokinetic and pharmacodynamic properties of the 2 groups. It is more difficult for lipophilic opioids to reach and remain at sufficiently high concentrations at the site of action due to their sequestration in epidural fat and rapid plasma clearance from both epidural and intrathecal spaces, resulting in analgesia with a limited spread and duration, as well as the appearance of early supraspinal side effects. In contrast, morphine has very different properties, including greater spinal bioavailability and therefore administered neuraxially, it is suitable choice for the treatment of acute postoperative pain. However, when using morphine, a greater incidence of adverse effects can be expected, and it requires careful patient selection. © 2013 World Institute of Pain.

  10. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section

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    Tanmay H. Shah


    Full Text Available Patients with Klippel-Feil Syndrome (KFS have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-yearold female, G2P1A0 with KFS (fusion of cervical vertebrae who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiberoptic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus.

  11. Initial Experience of the American Society of Regional Anesthesia and Pain Medicine Coags Regional Smartphone Application: A Novel Report of Global Distribution and Clinical Usage of an Electronic Decision Support Tool to Enhance Guideline Use. (United States)

    Gupta, Rajnish K; McEvoy, Matthew D


    Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app. The app was created to be a user-friendly version of the guideline. Download statistics were collected from April 2014 to October 2015, and app usage data were collected from October 2014 to October 2015. Usage data were analyzed for number of devices, number of search sessions, medications searched, and types of procedures. There were 8381 downloads, with 83% from North America. Of users who allowed data tracking, 4504 unique devices were identified with 30,003 separate search events. The most searched-for medications were rivaroxaban (n = 4427; 11%), clopidogrel (n = 4042; 10%), and enoxaparin, prophylactic twice daily dosing (n = 3249; 8%). Neuraxial procedures (n = 22,477; 78%) were the most commonly searched-for procedures and over half (n = 22,773; 52%) the users were interested in how long to hold a medication before performing a procedure. This is the first publication of download and usage data concerning medical smartphone apps. It provides a template for future app uptake and use in clinical practice. The app platform provides a new mechanism of rapidly disseminating guidelines and facilitating distribution of frequent updates.

  12. Cell Proliferation in the Forebrain and Midbrain of the Adult Bullfrog, Rana catesbeiana (United States)

    Simmons, Andrea Megela; Horowitz, Seth S.; Brown, Rebecca A.


    The distribution of proliferating cells in the midbrain, thalamus, and telencephalon of adult bullfrogs (Rana catesbeiana) was examined using immunohistochemistry for the thymidine analog 5-bromo-2′-deoxyuridine (BrdU) and DNA dot-blotting. At all time points examined (2 to 28 days post-injection), BrdU-labeled cells were located in ventricular zones at all levels of the neuraxis, but with relatively more label around the telencephalic ventricles. Labeled cells, some showing profiles indicative of dividing and migrating cells, were present in brain parenchyma from 7 to 28 days post-injection. These labeled cells were particularly numerous in the dorsal and ventral hypothalamus, preoptic area, optic tectum, and laminar and principal nuclei of the torus semicircularis, with label also present, but at qualitatively reduced levels, in thalamic and telencephalic nuclei. Double-label immunohistochemistry using glial and early neural markers indicated that gliogenesis and neurogenesis both occurred, with new neurons observed particularly in the hypothalamus, optic tectum, and torus semicircularis. In all brain areas, many cells not labeled with BrdU were nonetheless labeled with the early neural marker TOAD-64, indicating that these cells were postmitotic. Incorporation of DNA measured by dot-blotting confirms the presence of DNA synthesis in the forebrain and brainstem at all time points measured. The pattern of BrdU label confirms previous experiments based on labeling with 3H-thymidine and proliferating cell nuclear antigen showing cell proliferation in the adult ranid brain, particularly in hypothalamic nuclei. The consistent appearance of new cells in the hypothalamus of adult frogs suggests that proliferative activity may be important in mediating reproductive behaviors in these animals. PMID:17878717

  13. Addition of intrathecal fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery. (United States)

    Farzi, Farnoush; Mirmansouri, Ali; Forghanparast, Kambiz; Heydarzadeh, Abtin; Abdollahzadeh, Mehrsima; Jahanyar Moghadam, Fatemeh


    A common and useful approach to pain management is administration of neuraxial opioids. Whether addition of fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery has any effects on duration of postoperative pain. This was a clinical trial, conducted on 195 pregnant women candidates for elective cesarean section. All patients were in ASA classes I, and II aged 17-45 years, and were randomly allocated to three groups named as meperidine (P), fentanyl (F), and placebo (S). In the three groups (P, F, and S), 25 mg meperidine, 25 µg fentanyl and 0.5 mL saline with lidocaine and epinephrine were injected into the subarachnoid space for spinal anesthesia, respectively. Perioperative complications and Apgar scores were recorded. Duration of analgesia was measured from the end of operation for 24 hours by using VAS. The first VAS≥4 was recorded as the end of the painless period. Characteristics of sensory and motor block were assessed. Statistical analysis was performed with SPSS software. The mean duration of analgesia with meperidine, fentanyl or placebo were 9.46 ± 0.6, 6.27 ± 0.45, 2.06 ± 0.13 hours, respectively (P < 0.0001). There was significant difference between the group P and the other groups. Patients on meperidine had faster, longer and higher sensory block (P < 0.0001) and faster and longer motor block (P < 0.0001). Frequency of sedation in the group F was more than the others (P < 0.026). There was no difference in Apgar scores between the three groups (P < 0.45). Addition of meperidine or fentanyl to lidocaine and epinephrine solution increases the duration of postoperative analgesia in cesarean section. Meperidine is a recommended adjuvant according to longer duration of analgesia and lower complications.

  14. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

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    Srivastava Pratima


    Full Text Available Abstract Background Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. Methods Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. Results Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. Conclusion Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod on bupivacaine (a local anesthetic in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

  15. Despite differences in cytosolic calcium regulation, lidocaine toxicity is similar in adult and neonatal rat dorsal root ganglia in vitro. (United States)

    Doan, Lisa V; Eydlin, Olga; Piskoun, Boris; Kline, Richard P; Recio-Pinto, Esperanza; Rosenberg, Andrew D; Blanck, Thomas J J; Xu, Fang


    Neuraxial local anesthetics may have neurological complications thought to be due to neurotoxicity. A primary site of action of local anesthetics is the dorsal root ganglia (DRG) neuron. Physiologic differences have been noted between young and adult DRG neurons; hence, the authors examined whether there were any differences in lidocaine-induced changes in calcium and lidocaine toxicity in neonatal and adult rat DRG neurons. DRG neurons were cultured from postnatal day 7 (P7) and adult rats. Lidocaine-induced changes in cytosolic calcium were examined with the calcium indicator Fluo-4. Cells were incubated with varying concentrations of lidocaine and examined for viability using calcein AM and ethidium homodimer-1 staining. Live imaging of caspase-3/7 activation was performed after incubation with lidocaine. The mean KCl-induced calcium transient was greater in P7 neurons (P lidocaine significantly inhibited KCl-induced calcium responses in both ages (P lidocaine, KCl-induced calcium transients in both ages became more homogeneous but remained different between the groups. Interestingly, cell viability was decreased by lidocaine in a dose-dependent manner similarly in both ages. Lidocaine treatment also activated caspase-3/7 in a dose- and time-dependent manner similarly in both ages. Despite physiological differences in P7 and adult DRG neurons, lidocaine cytotoxicity is similar in P7 and adult DRG neurons in vitro. Differences in lidocaine- and KCl-evoked calcium responses suggest the similarity in lidocaine cytotoxicity involves other actions in addition to lidocaine-evoked effects on cytosolic calcium responses.

  16. Peripartum management of patient with a rare combination of two bleeding diatheses: Recognizing active role of anesthesiologists during preparatory preemptive prepartum multi-disciplinary conference

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    Jeffrey Kangas


    Full Text Available To provide optimal medical care to our patients, it is crucial that all members of operating room team have clear understanding of patients′ medical needs and the risks associated with their upcoming surgeries. Multi-disciplinary meetings to establish the best treatment options regarding patient care are not new to medicine. We hereby present a case in which an obstetric patient with a rare combination of two bleeding diathesis was managed using a similar multi-disciplinary approach. A 21-year-old pregnant patient with known von Willebrand′s disease type I and platelet storage pool disorder (dense granule deficiency type: Decreased number of granules per platelet presented to her hematologist for counseling regarding her current pregnancy. Decision was made to convene a multi-disciplinary conference with the panel inclusive of personnel from anesthesiology, adult hematology, pediatric hematology, pediatrics, maternal fetal medicine, obstetrics, pathology and blood bank services along with the patient and her family. The primary concerns of anesthesiologists were whether the patient with rare bleeding diathesis combination can have neuraxial analgesia-anesthesia and how likely the patient may have severe bleeding complications requiring massive blood transfusion protocol. As patient′s von Willebrand factor activity was normal (>150% secondary to pregnancy but platelet function was impaired, the hematologist′s recommendations were that patient should receive transfusion of 5 units random donor platelets prior to labor epidural catheter insertion and 5 units random donor platelets prior to removal of epidural catheter left-in-situ for 24 h postdelivery. Anesthesiologists as perioperative physicians are in a unique position to actively participate in multi-disciplinary approach to perioperative patient care. Complex patient scenarios wherein multiple clinicians are concurrently managing these patients can benefit the most from this approach.

  17. Despite Differences in Cytosolic Calcium Regulation, Lidocaine Toxicity Is Similar in Adult and Neonatal Rat Dorsal Root Ganglia in Vitro (United States)

    Doan, Lisa V.; Eydlin, Olga; Piskoun, Boris; Kline, Richard P; Recio-Pinto, Esperanza; Rosenberg, Andrew D; Blanck, Thomas JJ; Xu, Fang


    Background Neuraxial local anesthetics may have neurological complications thought to be due to neurotoxicity. A primary site of action for local anesthetics is the dorsal root ganglia (DRG) neuron. Physiologic differences have been noted between young and adult DRG neurons; hence, we examined whether there were differences in lidocaine-induced changes in calcium and lidocaine toxicity in neonatal and adult rat DRG neurons. Methods DRG neurons were cultured from postnatal day 7 (P7) and adult rats. Lidocaine-induced changes in cytosolic calcium were examined with the calcium indicator Fluo-4. Cells were incubated with varying concentrations of lidocaine and examined for viability using calcein AM and ethidium homodimer-1 staining. Live imaging of caspase-3/7 activation was performed after incubation with lidocaine. Results The mean KCl-induced calcium transient was greater in P7 neurons (p lidocaine significantly inhibited KCl-induced calcium responses in both ages (p lidocaine, KCl-induced calcium transients in both ages became more homogeneous but remained different between the groups. Interestingly cell viability was decreased by lidocaine in a dose-dependent manner similarly in both ages. Lidocaine treatment also activated caspase-3/7 in a dose- and time-dependent manner similarly in both ages. Conclusions Despite physiological differences in P7 and adult DRG neurons, lidocaine cytotoxicity is similar in P7 and adult DRG neurons in vitro. Differences in lidocaine- and KCl-evoked calcium responses suggest the similarity in lidocaine cytotoxicity involves other actions in addition to lidocaine-evoked effects on cytosolic calcium responses. PMID:23851347

  18. Membrane–initiated estradiol signaling regulating sexual receptivity

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    Paul E Micevych


    Full Text Available Estradiol has profound actions on the structure and function of the nervous system. In addition to nuclear actions that directly modulate gene expression, the idea that estradiol can rapidly activate cell signaling by binding to membrane estrogen receptors (mERs has emerged. Even the regulation of sexual receptivity, an action previously thought to be completely regulated by nuclear ERs, has been shown to have a membrane-initiated estradiol signaling (MIES component. This highlighted the question of the nature of mERs. Several candidates have been proposed, ERα, ERβ, ER-X, GPR30 (G protein coupled estrogen receptor; GPER, and a receptor activated by a diphenylacrylamide compound, STX. Although each of these receptors has been shown to be active in specific assays, we present evidence for and against their participation in sexual receptivity by acting in the lordosis-regulating circuit. The initial MIES that activates the circuit is in the arcuate nucleus of the hypothalamus (ARH. Using both activation of μ-opioid receptors (MOR in the medial preoptic nucleus and lordosis behavior, we document that both ERα and the STX receptor participate in the required MIES. ERα and the STX receptor activation of cell signaling are dependent on the transactivation of type 1 metabotropic glutamate receptors (mGluR1a that augment progesterone synthesis in astrocytes and protein kinase C (PKC in ARH neurons. While estradiol-induced sexual receptivity does not depend on neuroprogesterone, proceptive behaviors do. Moreover, the ERα and the STX receptor activation of medial preoptic MORs and augmentation of lordosis were sensitive to mGluR1a blockade. These observations suggest a common mechanism through which mERs are coupled to intracellular signaling cascades, not just in regulating reproduction, but in actions throughout the neuraxis including the cortex, hippocampus, striatum and DRGs.

  19. Distribution of transplanted human mesenchymal stem cells from Wharton’s Jelly in the central nervous systems of the EAE rats

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    Kovalchuk M. V.


    Full Text Available Human Wharton’s Jelly MSCs (hWJ-MSCs have a considerable advantage and potential in treating the central nervous system diseases and can be a new alternative treatment of Multiple Sclerosis (MS. Aim. To study the persistence and distribution of hWJ-MSCs along the neuraxis following transplantation in central nervous system of rats with experimental autoimmune encephalomyelitis (EAE, the animal model of MS. Methods. Isolation and cultivation of hWJ-MSCs in vitro. Immunological phenotyping by flow cytometry. EAE induction. Intrathecal (suboccipital injection of MSCs into CNS of SCH-induced EAE rats. Persistence of hWJ-MSCs in the CNS of hWJ-MSCs -treated rats was detected through detection of the human alpha-satellite DNA in the tissue sections and the cerebrospinal fluid (CSF by PCR at days 2, 3, 4 and 5 Results. PCR-assays for alpha-satellite sequences revealed that Human DNA was detected during 5 days following intrathecal injection at the peak of disease in the treated rats. It has been demonstrated that the human DNA was traced in CSF and various segments of a spinal cord. Conclusions. The data obtained suggest that intrathecally delivered hWJ-MSCs, with time, can migrate through the CSF from the injection site to various segments of CNS and persist therein during the first week of post transplantation, which was performed at the EAE disease peak in the xenogeneic setting without immunosuppression. hWJ-MSCs may be considered as a delivery cell source of therapeutic molecules for CNS inflammatory diseases.

  20. Supraspinal gene transfer by intrathecal adeno-associated virus serotype 5

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    Daniel J. Schuster


    Full Text Available We report the pattern of transgene expression across brain regions after intrathecal delivery of adeno-associated virus serotype 5 (AAV5. Labeling in hindbrain appeared to be primarily neuronal, and was detected in sensory nuclei of medulla, pontine nuclei, and all layers of cerebellar cortex. Expression in midbrain was minimal, and generally limited to isolated neurons and astrocytes in the cerebral peduncles. GFP immunoreactivity (-ir in thalamus was most prominent in medial geniculate nucleus, and otherwise limited to posterior nuclei of the dorsal and lateral margins. Labeling was also observed in neurons and astrocytes of the hippocampal formation and amygdaloid complex. In the hippocampal formation, GFP-ir was found in neuronal cell bodies of the rostral ventral portion, but was largely restricted to fiber-like staining in the molecular layer of dentate gyrus and stratum lacunosum-moleculare of the rostral dorsal region. GFP-ir was seen in neurons and astroglia throughout caudal cortex, whereas in rostral regions of neocortex it was limited to isolated astrocytes and neurons. Labeling was also present in olfactory bulb. These results demonstrate that intrathecal delivery of AAV5 vector leads to transgene expression in discrete CNS regions throughout the rostro-caudal extent of the neuraxis. A caudal-to-rostral gradient of decreasing GFP-ir was present in choroid plexus and Purkinje cells, suggesting that spread of virus through cerebrospinal fluid plays a role in the resulting transduction pattern. Other factors contributing to the observed expression pattern likely include variations in cell-surface receptors and inter-parenchymal space.

  1. The sound source distance dependence of the acoustical cues to location and their encoding by neurons in the inferior colliculus: implications for the Duplex theory. (United States)

    Jones, Heath G; Koka, Kanthaiah; Thornton, Jennifer; Tollin, Daniel J


    For over a century, the Duplex theory has posited that low- and ­high-frequency sounds are localized using two different acoustical cues, interaural time (ITDs) and level (ILDs) differences, respectively. Psychophysical data have generally supported the theory for pure tones. Anatomically, ITDs and ILDs are separately encoded in two parallel brainstem pathways. Acoustically ILDs are a function of location and frequency such that lower and higher frequencies exhibit smaller and larger ILDs, respectively. It is well established that neurons throughout the auditory neuraxis encode high-frequency ILDs. Acoustically, low-frequency ILDs are negligible (∼1–2 dB); however, humans are still sensitive to them and physiological studies often report low-frequency ILD-sensitive neurons. These ­latter findings are at odds with the Duplex theory. We suggest that these discrepancies arise from an inadequate characterization of the acoustical environment. We hypothesize that low-frequency ILDs become large and useful when sources are located near the head. We tested this hypothesis by making measurements of the ILDs in chinchillas as a function of source distance and the sensitivity to ILDs in 103 neurons in the inferior colliculus (IC). The ILD sensitivity of IC neurons was found to be frequency independent even though far-field acoustical ILDs were frequency dependent. However, as source distance was decreased, the magnitudes of low-frequency ILDs increased. Using information theoretic methods, we ­demonstrate that a population of IC neurons can encode the full range of acoustic ILDs across frequency that would be experienced as a joint function of source location and distance.

  2. A Randomized Controlled Trial of Music Use During Epidural Catheter Placement on Laboring Parturient Anxiety, Pain, and Satisfaction. (United States)

    Drzymalski, Dan M; Tsen, Lawrence C; Palanisamy, Arvind; Zhou, Jie; Huang, Chuan-Chin; Kodali, Bhavani S


    Although music is frequently used to promote a relaxing environment during labor and delivery, the effect of its use during the placement of neuraxial techniques is unknown. Our study sought to determine the effects of music use on laboring parturients during epidural catheter placement, with the hypothesis that music use would result in lower anxiety, lower pain, and greater patient satisfaction. We conducted a prospective, randomized, controlled trial of laboring parturients undergoing epidural catheter placement with or without music. The music group listened to the patient's preferred music on a Pandora® station broadcast through an external amplified speaker; the control group listened to no music. All women received a standardized epidural technique and local anesthetic dose. The primary outcomes were 3 measures of anxiety. Secondary outcomes included pain, patient satisfaction, hemodynamic parameters, obstetric parameters, neonatal outcomes, and anesthesia provider anxiety. Intention-to-treat analysis with Bonferroni correction was used for the primary outcomes. For secondary outcomes, a P value of anxiety as measured by Numeric Rating Scale scores immediately after epidural catheter placement (2.9 ± 3.3 vs 1.4 ± 1.7, mean difference 1.5 [95% confidence interval {CI} 0.2-2.7], P = .02), and as measured by fewer parturients being "very much relaxed" 1 hour after epidural catheter placement (51% vs 78%, odds ratio {OR} 0.3 [95% CI 0.1-0.9], P = .02). No differences in mean pain scores immediately after placement or patient satisfaction with the overall epidural placement experience were observed; however, the desire for music use with future epidural catheter placements was higher in the music group (84% vs 45%, OR 6.4 [95% CI 2.5-16.5], P anxiety and no improvement in pain or satisfaction; however, a stronger desire for music with future epidural catheter placements was observed. Further investigation is needed to determine the effect of music use in

  3. DIPG in children - what can we learn from the past?

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    Magimairajan Issai eVanan


    Full Text Available Brainstem tumors represent 10-15% of pediatric central nervous system tumors and diffuse intrinsic pontine glioma (DIPG is the most common brainstem tumor of childhood. DIPG is almost uniformly fatal and is the leading cause of brain tumor-related death in children. To date, radiation therapy (RT is the only form of treatment that offers a transient benefit in DIPG. Chemotherapeutic strategies including multi-agent neoadjuvant chemotherapy, concurrent chemotherapy with RT, and adjuvant chemotherapy have not provided any survival advantage. To overcome the restrictive ability of the intact blood brain barrier (BBB in DIPG, several alternative drug delivery strategies have been proposed but have met with minimal success. Targeted therapies either alone or in combination with RT have also not improved survival. Five decades of unsuccessful therapies coupled with recent advances in the genetics and biology of DIPG have taught us several important lessons: (1 DIPG is a heterogeneous group of tumors that are biologically distinct from other pediatric and adult high grade gliomas (HGG. Adapting chemotherapy and targeted therapies that are used in pediatric or adult HGG for the treatment of DIPG should be abandoned. (2 Biopsy of DIPG is relatively safe and informative and should be considered in the context of multicenter clinical trials. (3 DIPG probably represents a whole brain disease so regular neuraxis imaging is important at diagnosis and during therapy. (4 BBB permeability is of major concern in DIPG and overcoming this barrier may ensure that drugs reach the tumor. (5 Recent development of DIPG tumor models should help us accurately identify and validate therapeutic targets and small molecule inhibitors in the treatment of this deadly tumor.

  4. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. (United States)

    Santana, Licia Santos; Gallo, Rubneide Barreto Silva; Ferreira, Cristine Homsi Jorge; Duarte, Geraldo; Quintana, Silvana Maria; Marcolin, Alessandra Cristina


    In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. NCT01600495. Copyright © 2015. Published by Elsevier B.V.

  5. Highly encephalitogenic aquaporin 4-specific T cells and NMO-IgG jointly orchestrate lesion location and tissue damage in the CNS. (United States)

    Zeka, Bleranda; Hastermann, Maria; Hochmeister, Sonja; Kögl, Nikolaus; Kaufmann, Nathalie; Schanda, Kathrin; Mader, Simone; Misu, Tatsuro; Rommer, Paulus; Fujihara, Kazuo; Illes, Zsolt; Leutmezer, Fritz; Sato, Douglas Kazutoshi; Nakashima, Ichiro; Reindl, Markus; Lassmann, Hans; Bradl, Monika


    In neuromyelitis optica (NMO), astrocytes become targets for pathogenic aquaporin 4 (AQP4)-specific antibodies which gain access to the central nervous system (CNS) in the course of inflammatory processes. Since these antibodies belong to a T cell-dependent subgroup of immunoglobulins, and since NMO lesions contain activated CD4(+) T cells, the question arose whether AQP4-specific T cells might not only provide T cell help for antibody production, but also play an important role in the induction of NMO lesions. We show here that highly pathogenic, AQP4-peptide-specific T cells exist in Lewis rats, which recognize AQP4268-285 as their specific antigen and cause severe panencephalitis. These T cells are re-activated behind the blood-brain barrier and deeply infiltrate the CNS parenchyma of the optic nerves, the brain, and the spinal cord, while T cells with other AQP4-peptide specificities are essentially confined to the meninges. Although AQP4268-285-specific T cells are found throughout the entire neuraxis, they have NMO-typical "hotspots" for infiltration, i.e. periventricular and periaqueductal regions, hypothalamus, medulla, the dorsal horns of spinal cord, and the optic nerves. Most remarkably, together with NMO-IgG, they initiate large astrocyte-destructive lesions which are located predominantly in spinal cord gray matter. We conclude that the processing of AQP4 by antigen presenting cells in Lewis rats produces a highly encephalitogenic AQP4 epitope (AQP4268-285), that T cells specific for this epitope are found in the immune repertoire of normal Lewis rats and can be readily expanded, and that AQP4268-285-specific T cells produce NMO-like lesions in the presence of NMO-IgG.

  6. Transcutaneous Electrical Nerve Stimulation on the PC-5 and PC-6 Points Alleviated Hypotension after Epidural Anaesthesia, Depending on the Stimulus Frequency

    Directory of Open Access Journals (Sweden)

    Young-Chang P. Arai


    Full Text Available Neuraxial blockade causes arterial hypotension. Transcutaneous electrical nerve stimulation (TENS at the Neiguan (PC-6 and Jianshi (PC-5 reduces the severity of hypotension after spinal anaesthesia, but did not clarify the optimal stimulus frequency. We hypothesized that the stimulus frequency of TENS at the PC-6 and PC-5 points would influence the severity of hypotension after epidural anaesthesia. 65 ASA I or II male patients presenting for inguinal hernia repair were randomized to five groups: the control group received no treatment; the 2 Hz, 10 Hz, 20 Hz, and 40 Hz groups received TENS at a frequency of 2 Hz, 10 Hz, 20 Hz, and 40 Hz, respectively. The lowest SBP was significantly higher in the 40 Hz group [the control, 84 (74–110 mmHg; the 2 Hz, 96 (62–116 mmHg; the 10 Hz, 100 (68–110 mmHg; the 20 Hz, 96 (64–115 mmHg; the 40 Hz, 104 (75–140 mmHg: P=0.004]. Significantly less patients experienced hypotension in the 40 Hz group [the control, 78%; the 2 Hz, 43%; the 10 Hz, 38%; the 20 Hz, 38%; the 40 Hz, 8%: P=0.008]. TENS on the PC-6 and PC-5 points reduced the severity and incidence of hypotension after epidural anaesthesia, depending on the stimulus frequency.

  7. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty (United States)

    Nakamura, Mashio; Kamei, Masataka; Bito, Seiji; Migita, Kiyoshi; Miyata, Shigeki; Kumagai, Kenji; Abe, Isao; Nakagawa, Yasuaki; Nakayama, Yuichiro; Saito, Masanobu; Tanaka, Takaaki; Motokawa, Satoru


    Abstract Clinical guidance on the choice of anesthetic modality vis-à-vis the risk of perioperative venous thromboembolism (VTE) is largely lacking because of a paucity of recent evidence. A comparative effect of general anesthesia and neuraxial blockade on the perioperative incidence of VTE has not been well-investigated. We compared the effects of different types of anesthetic modalities on the risk of VTE after total hip arthroplasty (THA) and total knee arthroplasty (TKA). This is a secondary analysis of the Japanese Study of Prevention and Actual Situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT). Data pertaining to a total of 2162 patients who underwent THA and TKA at 34 hospitals were included in this analysis. We compared the different anesthetic modalities with respect to the incidence of VTE. The composite end-point was asymptomatic/symptomatic deep vein thrombosis detected using scheduled bilateral ultrasonography up to postoperative day (POD) 10 and fatal/non-fatal pulmonary embolism up to POD 10. The study groups were as follows: general anesthesia (n = 646), combined epidural/general anesthesia (n = 1004), epidural anesthesia (n = 87), and spinal anesthesia (n = 425). On multivariate analysis, only spinal anesthesia was associated with a significant increase in the risk of VTE as compared with that associated with general anesthesia. Propensity score-matched analysis for “combined epidural/general anesthesia group” versus “spinal anesthesia group” demonstrated a 48% higher incidence of VTE (relative risk = 1.48, 95% confidence interval [CI] 1.18–1.85) in the latter. Spinal anesthesia was associated with a higher risk of postoperative VTE, as compared with that associated with combined epidural/general anesthesia, in patients undergoing total arthroplasty. PMID:28471968

  8. The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialty. (United States)

    Amaral, Cristina; Guimarães Pereira, Luís; Moreto, Ana; Sá, Ana Carolina; Azevedo, Ana


    Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Low-dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy: the suitability and impact of adding intrathecal fentanyl. (United States)

    Atallah, M M; Shorrab, A A; Abdel Mageed, Y M; Demian, A D


    Unilateral spinal anaesthesia has been used for lower limb surgery with a stable cardiovascular state and a short recovery unit stay. We sought to test the suitability of low-dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy, a procedure hitherto performed under general anaesthesia. Furthermore, we hypothesized that adding intrathecal fentanyl to bupivacaine may improve the quality of anaesthesia. We randomly allocated, through computer-generated randomization, 108 patients subjected to percutaneous nephrolithotomy to receive either 7.5 mg of hyperbaric bupivacaine 5 mg/ml alone or with the addition of 10 microg of fentanyl. Drugs were given at the L(2)-L(3) interspace with the patient in the lateral decubitus position. The patients remained in this position for 10 min, after which the sensory and motor blocks were assessed. Intra-operative analgesic supplementation, when deemed necessary, was achieved with intravenous fentanyl boluses (25 microg). The sensory and motor blocks after intrathecal bupivacaine and bupivacaine-fentanyl were similar. Sensory block, in both groups, reached the fifth and eighth thoracic dermatomes on the operative and non-operative sides, respectively. Deep motor block occurred on the operative side in all patients and in nearly 50% of patients on the non-operative side. The patients in the bupivacaine-fentanyl group required less intra-operative and post-operative analgesics, and both patients and endoscopists were better satisfied. This study demonstrated, for the first time, that intrathecal low-dose bupivacaine and fentanyl offers a reliable neuraxial block for patients subjected to percutaneous nephrolithotomy, with stable haemodynamics, good post-operative analgesia and acceptable patient and endoscopist satisfaction.

  10. Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial. (United States)

    Lee, Amy I; McCarthy, Robert J; Toledo, Paloma; Jones, Mary Jane; White, Nancy; Wong, Cynthia A


    Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured. A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, -58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum. Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.

  11. Diabetes insipidus in pediatric germinomas of the suprasellar region: characteristic features and significance of the pituitary bright spot. (United States)

    Kilday, John-Paul; Laughlin, Suzanne; Urbach, Stacey; Bouffet, Eric; Bartels, Ute


    The pituitary bright spot is acknowledged to indicate functional integrity of the posterior pituitary gland, whilst its absence supports a diagnosis of central diabetes insipidus (DI). This feature was evaluated, together with the incidence and clinical characteristics of DI in children with suprasellar/neurohypophyseal germinomas. We performed a review of all suprasellar (SS) or bifocal (BF) germinoma pediatric patients treated in Toronto since 2000. Demographics, symptomatology, treatment outcome and imaging were evaluated. Nineteen patients fulfilled inclusion criteria (10 SS, 9 BF; median age 12.5 years (6.2-16.8 years)). All remained alive at 6.4 years median follow-up (1.2-13.7 years) after receiving chemotherapy and radiotherapy (13 focal/ventricular, four whole brain, two neuraxis), with only one progression. All had symptoms of DI at presentation with a symptom interval above one year in eight cases (42 %). Desmopressin was commenced and maintained in 16 patients (84 %). The pituitary bright spot was lost in most diagnostic interpretable cases, but was appreciated in three patients (18 %) who had normal serum sodium values compared to 'absent' cases (p = 0.013). For two such cases, spots remained visible until last follow-up (range 0.4-3.3 years), with one still receiving desmopressin. No case of bright spot recovery was observed following therapy. Protracted symptom intervals for germinoma-induced central DI may reflect poor clinical awareness. Explanations for persistence of the pituitary bright spot in symptomatic patients remain elusive. Desmopressin seldom reverses the clinical features of germinoma-induced DI to allow discontinuation, nor does treatment cause bright spot recovery.

  12. Pronociceptive and Antinociceptive Effects of Buprenorphine in the Spinal Cord Dorsal Horn Cover a Dose Range of Four Orders of Magnitude (United States)

    Gerhold, Katharina J.; Drdla-Schutting, Ruth; Honsek, Silke D.; Forsthuber, Liesbeth


    Due to its distinct pharmacological profile and lower incidence of adverse events compared with other opioids, buprenorphine is considered a safe option for pain and substitution therapy. However, despite its wide clinical use, little is known about the synaptic effects of buprenorphine in nociceptive pathways. Here, we demonstrate dose-dependent, bimodal effects of buprenorphine on transmission at C-fiber synapses in rat spinal cord dorsal horn in vivo. At an analgesically active dose of 1500 μg·kg−1, buprenorphine reduced the strength of spinal C-fiber synapses. This depression required activation of spinal opioid receptors, putatively μ1-opioid receptors, as indicated by its sensitivity to spinal naloxone and to the selective μ1-opioid receptor antagonist naloxonazine. In contrast, a 15,000-fold lower dose of buprenorphine (0.1 μg·kg−1), which caused thermal and mechanical hyperalgesia in behaving animals, induced an enhancement of transmission at spinal C-fiber synapses. The ultra-low-dose buprenorphine-induced synaptic facilitation was mediated by supraspinal naloxonazine-insensitive, but CTOP-sensitive μ-opioid receptors, descending serotonergic pathways, and activation of spinal glial cells. Selective inhibition of spinal 5-hydroxytryptamine-2 receptors (5-HT2Rs), putatively located on spinal astrocytes, abolished both the induction of synaptic facilitation and the hyperalgesia elicited by ultra-low-dose buprenorphine. Our study revealed that buprenorphine mediates its modulatory effects on transmission at spinal C-fiber synapses by dose dependently acting on distinct μ-opioid receptor subtypes located at different levels of the neuraxis. PMID:26134641

  13. Choroid plexus papillomas: advances in molecular biology and understanding of tumorigenesis (United States)

    Safaee, Michael; Oh, Michael C.; Bloch, Orin; Sun, Matthew Z.; Kaur, Gurvinder; Auguste, Kurtis I.; Tihan, Tarik; Parsa, Andrew T.


    Choroid plexus papillomas are rare, benign tumors originating from the choroid plexus. Although generally found within the ventricular system, they can arise ectopically in the brain parenchyma or disseminate throughout the neuraxis. We sought to review recent advances in our understanding of the molecular biology and oncogenic pathways associated with this disease. A comprehensive PubMed literature review was conducted to identify manuscripts discussing the clinical, molecular, and genetic features of choroid plexus papillomas. Articles concerning diagnosis, treatment, and long-term patient outcomes were also reviewed. The introduction of atypical choroid plexus papilloma as a distinct entity has increased the need for accurate histopathologic diagnosis. Advances in immunohistochemical staining have improved our ability to differentiate choroid plexus papillomas from other intracranial tumors or metastatic lesions using combinations of key markers and mitotic indices. Recent findings have implicated Notch3 signaling, the transcription factor TWIST1, platelet-derived growth factor receptor, and the tumor necrosis factor–related apoptosis-inducing ligand pathway in choroid plexus papilloma tumorigenesis. A combination of commonly occurring chromosomal duplications and deletions has also been identified. Surgical resection remains the standard of care, although chemotherapy and radiotherapy may be considered for recurrent or metastatic lesions. While generally considered benign, these tumors possess a complex biology that sheds insight into other choroid plexus tumors, particularly malignant choroid plexus carcinomas. Improving our understanding of the molecular biology, genetics, and oncogenic pathways associated with this tumor will allow for the development of targeted therapies and improved outcomes for patients with this disease. PMID:23172371

  14. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia. (United States)

    Nakamura, Mashio; Kamei, Masataka; Bito, Seiji; Migita, Kiyoshi; Miyata, Shigeki; Kumagai, Kenji; Abe, Isao; Nakagawa, Yasuaki; Nakayama, Yuichiro; Saito, Masanobu; Tanaka, Takaaki; Motokawa, Satoru


    Clinical guidance on the choice of anesthetic modality vis-à-vis the risk of perioperative venous thromboembolism (VTE) is largely lacking because of a paucity of recent evidence. A comparative effect of general anesthesia and neuraxial blockade on the perioperative incidence of VTE has not been well-investigated.We compared the effects of different types of anesthetic modalities on the risk of VTE after total hip arthroplasty (THA) and total knee arthroplasty (TKA).This is a secondary analysis of the Japanese Study of Prevention and Actual Situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT). Data pertaining to a total of 2162 patients who underwent THA and TKA at 34 hospitals were included in this analysis. We compared the different anesthetic modalities with respect to the incidence of VTE. The composite end-point was asymptomatic/symptomatic deep vein thrombosis detected using scheduled bilateral ultrasonography up to postoperative day (POD) 10 and fatal/non-fatal pulmonary embolism up to POD 10.The study groups were as follows: general anesthesia (n = 646), combined epidural/general anesthesia (n = 1004), epidural anesthesia (n = 87), and spinal anesthesia (n = 425). On multivariate analysis, only spinal anesthesia was associated with a significant increase in the risk of VTE as compared with that associated with general anesthesia. Propensity score-matched analysis for "combined epidural/general anesthesia group" versus "spinal anesthesia group" demonstrated a 48% higher incidence of VTE (relative risk = 1.48, 95% confidence interval [CI] 1.18-1.85) in the latter.Spinal anesthesia was associated with a higher risk of postoperative VTE, as compared with that associated with combined epidural/general anesthesia, in patients undergoing total arthroplasty.

  15. Spinal ultrasound versus palpation for epidural catheter insertion in labour: A randomised controlled trial. (United States)

    Arzola, Cristian; Mikhael, Rafeek; Margarido, Clarita; Carvalho, Jose C A


    Ultrasound imaging of the spine is thought to reduce failed and traumatic neuraxial procedures. Most of the evidence supporting this assumption has been produced in the context of an expert sonographer performing the ultrasound assessment, and it remains unknown whether this technique is useful when used by multiple individual operators. To invesstigate the impact of preprocedural spinal ultrasound on the ease of insertion of labour epidurals by a group of trainees. We hypothesised that the ultrasound-assisted technique would improve the ease of insertion when compared with the conventional palpation technique. A randomised controlled trial. Academic hospital in Toronto, Canada. A group of 17 second-year anaesthesia residents and five anaesthesia fellows underwent a training programme in ultrasound assessment of the spine. Parturients with easily palpable lumbar spines were randomised to either ultrasound or palpation group. Residents and fellows performed both the assessment (ultrasound or palpation) and the epidural procedure. ease of insertion of epidural catheter composed of the time taken to insert the epidural catheter, number of interspace levels attempted and number of needle passes. total procedural time (assessment and insertion); first pass success rate; number of attempts required to thread the epidural catheter; failure of epidural analgesia; and patient satisfaction. We analysed 128 epidural catheter insertions (residents 84, fellows 44). There was no difference in median (interquartile range, IQR) epidural insertion time between the ultrasound and palpation groups [174 (120 to 241) versus 180 (130 to 322.5) s, respectively; P = 0.14]. The number of interspace levels attempted and needle passes were also similar in both groups. The total procedural time was longer in the ultrasound group. The use of preprocedural spinal ultrasound by a cohort of anaesthesia trainees did not improve the ease of insertion of labour epidural catheters in patients

  16. Accuracy of manual palpation vs ultrasound for identifying the L3-L4 intervertebral space level in children. (United States)

    Hayes, Jason; Borges, Bruno; Armstrong, Derek; Srinivasan, Ilavajady


    Insertion of needles into the spinal or epidural space is an important component of modern anesthetic practice. Needles are usually inserted at or below the L3-L4 intervertebral space to minimize the risk of spinal cord injury. Manual palpation is the most common method for identifying intervertebral spaces. However, anesthesiologists are increasingly using ultrasonography to guide the placement of regional, including neuraxial, anesthetic, and analgesic blocks. We undertook an observational study to compare the accuracy of manual palpation and ultrasound for determining the L3-L4 intervertebral space level. Thirty children 0-12 years of age undergoing lumbar puncture were enrolled. For each subject, an anesthesiologist, using the landmark palpation method, determined the point on a radio-opaque ruler that corresponded to the L3-L4 intervertebral space. A different anesthesiologist using the ultrasound method repeated this measurement. Fluoroscopy was then used to confirm the accuracy of each technique. The proportion of inaccurate measurements and the effects of anesthesiologists' experience, patient age, and size on the accuracy of each technique were compared. Thirty-seven percent of measurements by the landmark palpation method were inaccurate by ≥1 levels cephalad to the L3-L4 intervertebral space. However, less experienced anesthesiologists (residents and fellows) made a disproportionate number of inaccurate measurements compared to consultants. Twenty-three percent of measurements by the ultrasound method were inaccurate by ≥1 cephalad levels. The BMI-for-age percentile/weight-for-length percentile was higher in patients in whom either technique was inaccurate. This observational study found no difference in the accuracy of landmark palpation, when performed by a consultant anesthesiologist, and ultrasound for determining the L3-L4 intervertebral space in children. © 2014 John Wiley & Sons Ltd.

  17. Parasagittal meningiomas – literature review and a case report

    Directory of Open Access Journals (Sweden)

    Toma Papacocea


    Full Text Available Meningiomas are tumors that can develop anywhere along the neuraxis, but with increased concentration in some specific areas. Parasagittal meningiomas have the dural attachment on the external layer of the superior sagittal sinus (SSS and invade the parasagittal angle displacing brain away from its normal position. Among meningiomas, the parasagittal location is the most common (22%. Taking into account their anatomic insertion along SSS, parasagittal meningiomas can have their dural attachment in the anterior, the middle or the posterior third of the SSS. Most frequently parasagittal meningiomas are located in the middle third of the superior sagittal sinus (between coronal suture and lambdoid suture. The clinical picture of parasagittal meningiomas depends on the tumor location along the SSS and so is the attitude towards ligation and reconstruction of the sinus. Controversial issues regarding surgical management of parasagittal meningiomas concerning leaving a tumor remnant that invades the SSS instead attempting total resection, or the attitude in the case of totally occluded segment of a sinus are summarized in this paper. The special care for the venous system is emphasized. The recurrence matter is also approached underlining the importance of adjuvant radiosurgery for the management of residual tumors. Results described in the main papers of the literature are reviewed. Conclusions are referring to the historical evolution regarding the surgical management of parasagittal meningiomas: aggressiveness of resection, sinus reconstruction, importance of adjuvant techniques: radiosurgery, endovascular surgery and to the importance of microsurgery and careful and meticulous planning of the approach in order to avoid interference with venous collaterals. A suggestive clinical case from the authors experience is presented.

  18. Cerebrospinal fluid and spinal cord distribution of hyperbaric bupivacaine and baclofen during slow intrathecal infusion in pigs. (United States)

    Flack, Sean H; Bernards, Christopher M


    Despite the widespread use of implanted pumps for continuous intrathecal drug delivery, there have been no studies aimed at defining the effect of baricity and posture on drug distribution in the cerebrospinal fluid and spinal cord during the very slow infusion rates typically used for chronic intrathecal drug administration. Intrathecal microdialysis probes were placed at six points along the neuraxis in both the anterior and posterior intrathecal space of anesthetized pigs to permit cerebrospinal fluid sampling. Animals were then positioned either vertically or horizontally (prone), and a hyperbaric solution containing bupivacaine (7.5 mg/ml) and baclofen (2 mg/ml) was infused at 20 microl/h for 6 h, while the cerebrospinal fluid was collected for measurement of drug concentration. At the end of the experiment, the animals were killed, and the spinal cord was removed and divided into 1-cm sections that were further divided into anterior and posterior portions for measurement of drug concentration. Bupivacaine and baclofen distribution was biased caudally in the vertical group and cephalad in the horizontal group. Drug concentration decreased rapidly in the cerebrospinal fluid and spinal cord as a function of distance from the site of administration in both groups, resulting in most drugs being located in very close proximity to the site of infusion. Even at very slow infusion rates, drug distribution within the cerebral spinal fluid and spinal cord are affected by baricity/posture. These findings suggest that patient position and solution baricity may be important clinical factors determining the distribution and ultimate efficacy of chronic intrathecal drug infusions.

  19. Finer gauge of cutting but not pencil-point needles correlate with lower incidence of post-dural puncture headache: a meta-regression analysis. (United States)

    Zorrilla-Vaca, Andres; Healy, Ryan; Zorrilla-Vaca, Carolina


    Post-dural puncture headache (PDPH) is a well-known neurological outcome caused by leakage of cerebrospinal fluid during neuraxial anesthesia. Studies aimed at assessing the efficacy of finer gauged spinal needles to reduce the incidence of PDPH have produced conflicting results. We have therefore examined the effect of the gauge of cutting needles and pencil-point needles, separately, on the incidence of PDPH. The PubMed, EMBASE and Google Scholar databases were searched for randomized studies which compared PDPH incidence in a head-to-head analysis of individual needle gauges of similar needle designs (cutting and pencil-point). A meta-regression analysis was performed taking into account various covariates, such as needle gauge and design, mean age of patient population, surgery type, percentage of males and females in study population and year of publication. Of the 22 studies (n = 5631) included in the analysis, 12 (n = 3148) and ten (n = 2483) compared different gauges of cutting needles and pencil-point needles, respectively. After adjusting for covariates, meta-regression analysis was performed for all studies that randomly compared individual needle gauges of similar needle design. Whereas the incidence of PDPH inversely correlated with gauge in cutting needles (β = -1.36 % per gauge, P = 0.037), no relationship was noted in pencil-point needles (β = -0.32 % per gauge, P = 0.114). Female gender was the only covariate that reached a statistically significant correlation with the incidence of PDPH in both models. A significant relationship between needle gauge and subsequent rate of PDPH was noted in cutting needles, but not pencil-point needles.

  20. Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5%: a randomized double-blinded study.

    LENUS (Irish Health Repository)

    Mannion, S


    BACKGROUND: Tramadol has been administered peripherally to prolong analgesia after brachial plexus and neuraxial blocks. Our aim was to evaluate the systemic and perineural effects of tramadol as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. METHODS: In a randomized, prospective, double-blinded trial, 60 patients (ASA I-III), aged 49-88 yr, undergoing primary total hip or knee arthroplasty underwent PCB and subsequent bupivacaine spinal anaesthesia. Patients were randomized into three groups. Each patient received PCB with levobupivacaine 0.5%, 0.4 ml kg(-1). The control group (group L, n=21) received i.v. saline, the systemic tramadol group (group IT, n=19) received i.v. tramadol 1.5 mg kg(-1) and the perineural tramadol group (group T, n=20) received i.v. saline and PCB with tramadol 1.5 mg kg(-1). Postoperatively patients received regular paracetamol 6-hourly and diclofenac sodium 12-hourly. Time to first morphine analgesia, 24-hour morphine consumption, sensory block, pain and sedation scores and haemodynamic parameters were recorded. RESULTS: Time (h) to first morphine analgesia was similar in the three groups [mean (SD)]: group L, 11.2 (6.6); group T, 14.5 (8.0); group IT, 14.6 (6.8); P=0.35. Twenty-four-hour cumulative morphine (mg) consumption was also similar in the three groups [group L, 21.9 (10.1); group T, 19.8 (6.7), group IT, 16.5 (9.5)], as were durations of sensory and motor block. There were no differences in the incidence of adverse effects except that patients in group IT were more sedated at 14 h than group L (P=0.02). CONCLUSION: We conclude that our data do not support a clinically important local anaesthetic or peripheral analgesic effect of tramadol as adjunct to PCB with levobupivacaine 0.5%.


    Directory of Open Access Journals (Sweden)

    Hari Kishore


    Full Text Available INTRODUCTION: Various adjuvants have been used with local anesthetics in spinal anesthesia to improve the quality of block and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2 - agonist drug, is now being used as a neuraxial adju vant. AIM: The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. METHOD OLOGY: Fifty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were included in this prospective cohort study at Amala Institute of Medical Sciences. Patients received either 15 mg hyperba ric bupivacaine plus 25 μg fentanyl (group 1, n = 25 or 15 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group 2, n = 25 intrathecally . RESULTS : Patients in dexmedetomidine group (2 had a significantly longer duration of motor and sensory block t han patients in fentanyl group . (1 The mean time regression of motor block to reach Bromage 0 was 17 6 . 2± 5.71 min in d exmeditomid ine group and 16 6 . 36 ± 5.97 min in fentanyl group (P<0.05. Duration of analgesia was 2 39.52 ± 9.05 min in D exmed i tomidine gro up and 189.96 ± 5.35 min in fentanyl group ( p< 0.05. A significant decrease in heart rate was noted in dexmedetomidine group. CONCLUSION : Intrathecal dexmedetomidine is associated with prolonged duration of analgesia and motor block along with significant dec rease in heart rate.

  2. [Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina]. (United States)

    Erdmann, Thomas Rolf; Garcia, Jorge Hamilton Soares; Loureiro, Marcos Lázaro; Monteiro, Marcelo Petruccelli; Brunharo, Guilherme Muriano


    Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were: distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina. (United States)

    Erdmann, Thomas Rolf; Garcia, Jorge Hamilton Soares; Loureiro, Marcos Lázaro; Monteiro, Marcelo Petruccelli; Brunharo, Guilherme Muriano


    Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. First steps toward understanding the variability in acute pain service provision and the quality of pain relief in everyday practice across the United Kingdom. (United States)

    Duncan, Fiona; Day, Ruth; Haigh, Carol; Gill, Stuart; Nightingale, Jeremy; O'Neill, Olga; Counsell, David


    Pain management for patients in hospital is a major problem. There is significant variation in care provision. Evidence is needed about the ways in which acute pain services are organized in order to understand whether these are linked to important differences in patient outcomes. The National Inpatient Pain Study group is a voluntary collaborative venture of inpatient pain specialists in the United Kingdom who are working toward establishing a national prospective database of service provision and activity. The objectives of this article are (1) to describe current pain service provision and activity (2) to define and monitor the quality and side effects of the primary analgesic techniques, such as central neuraxial block or systemic analgesia, and identify variations in practice. Phase 1: Surveys were conducted in two phases during 2010-2011. Information about the organization of services was collected from 121 centers via a live Website. Phase 2: The pilot clinical dataset was collected from 13 hospitals in 2011. Results indicated that staffing varied widely from one to nine nurses per hospital site. Twelve percent of hospitals did not routinely collect data. The main workload was orthopedic and general surgery based on data from 13 hospitals and 29,080 patients in 2011. Thirty-seven percent of patients reported a pain score of moderate to severe pain on the first assessment by the specialist pain team, and 21% reported severe pain. Nausea and vomiting was the most frequent adverse event reported. Sixty-nine major adverse events were logged, of which 64 documented respiratory depression (N = 29,080, 0.22%). Prospective longitudinal data has the potential to improve our understanding of variation in process and outcome measures and establish future research priorities. Wiley Periodicals, Inc.

  5. Comparison between Epidural Ropivacaine versus Ropivacaine with Clonidine in Patients Undergoing Abdominal Hysterectomy: A Randomized Study. (United States)

    Rao, Keshav Govind; Misra, Shilpi; Shukla, Aparna


    Regional anesthesia has emerged as one of the preferred and convenient modes for intra- and post-operative management owing to its advantage of not interfering with the metabolic functions, better tolerability, and decrease in reflex activity. In recent years, ropivacaine has increasingly replaced bupivacaine as a preferred local anesthetic because of its similar analgesic properties, lesser motor blockade, and decreased propensity of cardiotoxicity. Neuraxial adjuvant such as clonidine used in epidural anesthesia offers advantage by augmenting the local anesthetic effect and reducing the anesthetic and analgesic requirement. Comparison of onset, duration of sensory and motor block, and any adverse effects between 0.5% ropivacaine with normal saline versus 0.5% ropivacaine with clonidine (75 μg/kg). This prospective randomized study was carried out in 50 patients (25 in each group) of American Society of Anesthesiologist Grade 1 and 2 scheduled for abdominal hysterectomy under epidural block. Group-1 (ropivacaine-clonidine [RC]): Epidural ropivacaine 20 ml (0.5%) with 0.75 μg/kg clonidine. Group-2 (ropivacaine [R]): Epidural ropivacaine 20 ml (0.5%) with normal saline. Onset, duration of sensory-motor block, heart rate, blood pressure, oxygen saturation, and respiratory rate were recorded. The statistical analysis was done using Statistical Package for Social Sciences version 15.0. Chi-square test, ANOVA, Student's t-test, and paired t-test were used. Groups were comparable with regard to demographic data and hemodynamic stability. Onset of sensory and motor blockade was faster in RC group as compared to R group. Duration of postoperative analgesia was significantly prolonged in RC group. No potential side effect was seen in either group. On account of faster onset, hemodynamic stability, and prolonged postoperative analgesia, ropivacaine with clonidine is a better option than ropivacaine alone.

  6. A retrospective effectiveness study of loss of resistance to air or saline for identification of the epidural space. (United States)

    Segal, Scott; Arendt, Katherine W


    Randomized trials comparing air to saline for loss of resistance (LOR) for identification of the epidural space have suggested the superiority of saline. We hypothesized that, in actual clinical practice, anesthesiologists using their preferred technique would produce similar analgesic outcomes with either air or saline. The labor analgesia records for 929 parturients requesting neuraxial analgesia were reviewed with respect to technique (epidural or combined spinal-epidural; air or saline for LOR), analgesic outcomes (initial comfort, asymmetry of the block, need for physician top-up during patient-controlled epidural analgesia, and catheter replacement), and complications (paresthesia, IV or intrathecal catheter placement, and unintentional dural puncture). Of 929 labor analgesics analyzed, 52.6% were performed with LOR to air and 47.4% to saline. Among anesthesiologists who performed at least 10 blocks, 82% used 1 medium at least 70% of the time. There were no differences between the air and saline groups in patient characteristics, analgesic technique, or block success. Among operators with a preference for 1 medium, use of the preferred technique was associated with fewer attempts (1.3 +/- 0.7 vs 1.6 +/- 0.8, P = 0.001), fewer paresthesias (8.7% vs 18.5%, odds ratio = 0.42, P = 0.007), and fewer unintentional dural punctures (1.0% vs 4.4%, odds ratio = 0.23, P = 0.03). When used at the anesthesiologist's discretion, there is no significant difference in block success between air and saline for localization of the epidural space by LOR.

  7. Diagnosis and management of pre-eclampsia: an update

    Directory of Open Access Journals (Sweden)

    Judi A Turner


    Full Text Available Judi A TurnerDepartment of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Pre-eclampsia is a significant, multifactorial, multiorgan disease affecting 5%–8% of all pregnancies in the US where it is the third leading cause of maternal mortality. Despite improvements in the diagnosis and management of pre-eclampsia, severe complications can occur in both the mother and the fetus, and there is no effective method of prevention. Early detection and identification of pregnant women most at risk of developing the disease have proven challenging, but recent efforts combining biochemical and biophysical markers are promising. Efforts at prevention of pre-eclampsia with aspirin and calcium have had limited success, but research on modifiable risk factors, such as obesity surgery, are encouraging. Obstetric management of severe pre-eclampsia focuses on medical management of blood pressure and prevention of seizures using magnesium sulfate, but the ultimate cure remains delivery of the fetus and placenta. Timing of delivery depends on several factors, including gestational age, fetal lung maturity, and most importantly, disease severity. Anesthetic management includes regional anesthesia with careful evaluation of the patient’s airway, volume status, and coagulation status to reduce morbidity and mortality. The potential complications of general anesthesia, including intracranial hemorrhage, in these patients make regional anesthesia the preferred choice in many cases. Nevertheless, it is important to be aware of the contraindications to neuraxial anesthesia and to prepare always for the possibility of encountering a difficult airway.Keywords: pre-eclampsia, diagnosis, risk factors, complications, management, anesthesia, prevention

  8. Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report Disseminação leptomeníngea de astrocitoma pilocítico ao diagnóstico: relato de dois casos

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    Eberval Gadelha Figueiredo


    Full Text Available Pilocytic astrocytoma (PA is a benign tumor that rarely spread along the neuraxis. At the moment there are no more than five cases of leptomeningeal dissemination (LD from PA at diagnosis described in the literature. Different patterns of presentation or recurrence may be noted: local recurrence, malignant transformation, multicentric disease or metastatic disease. LD and multicentric disease can be distinct pathological entities. We report two cases and analyse literature, emphasizing leptomeningeal spread at presentation. Hydrocephalus, biopsy and parcial ressection are likely to be favorable factors to the occurrence of LD. Otherwise, LD may be part of natural history of PA, as evidenced by its ocurrence in non-treated cases.Astrocitoma pilocítico (AP é tumor benigno que raramente se dissemina ao longo do neuroeixo. Até o momento não há mais que cinco casos de AP que se tenham apresentado com disseminação leptomeníngea (DL descritos na literatura. Diferentes padrões de apresentação ou recorrência podem ser observados: recorrência local, transformação maligna, doença multicêntrica ou doença metastática. DL e doença multicêntrica podem ser entidades diferentes. Relatamos dois casos e analisamos a literatura. Hidrocefalia, biópsia e ressecção parcial são provavelmente fatores predisponentes à DL. Por outro lado, DL pode ser parte da história natural de AP, como pode ser evidenciado pela sua ocorrência em casos não tratados.

  9. Replication of yellow fever virus in the mouse central nervous system: comparison of neuroadapted and non-neuroadapted virus and partial sequence analysis of the neuroadapted strain. (United States)

    Schlesinger, J J; Chapman, S; Nestorowicz, A; Rice, C M; Ginocchio, T E; Chambers, T J


    Serial passage of yellow fever virus (YF17D) in mouse brain enhances neurovirulence, causing a reduction in survival time after intracerebral inoculation of adult mice. To study the biological and genetic basis for this phenomenon, we compared neurovirulence properties of the neuroadapted Porterfield strain (PYF) to a YF17D strain generated from a full-length YF cDNA template (YF5.2iv). Adult mice were infected by olfactory bulb inoculation, which results in widespread distribution of virus throughout the central nervous system. Although PYF and YF5.2iv spread rapidly throughout the neuraxis, maximal titres of PYF in the brain and spinal cord were 1000- to 10,000-fold higher than those of YF5.2iv. Paralysis and death occurred earlier with the PYF strain. Several cDNA clones of the E/NS1 region of the PYF strain were sequenced. Three predicted amino acid changes were consistently observed in the envelope protein of the PYF strain compared to YF5.2iv. Common substitutions were also identified in NS1 and NS2A. The potential contribution of these genetic differences to neurovirulence was evaluated by generating recombinant, intertypic PYF/YF5.2iv viruses. Physical signs of disease and mean spinal cord titres after inoculation of one recombinant were not different from the YF5.2iv parent. Our data indicate that PYF and YF5.2iv differ significantly in their virulence properties, however, common amino acid substitutions in the E/NS1 region of the PYF strain do not determine its enhanced neurovirulence. Other regions of the viral genome may contribute dominant effects on the virulence properties of the PYF strain.

  10. Electrolyte changes: An indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: A prospective study

    Directory of Open Access Journals (Sweden)

    Gupta Kumkum


    Full Text Available Context: Fluid absorption is inevitable complication of transuretheral resection of prostate and serum electrolytes changes can indirectly assess the irrigation fluid absorption. Aims: To monitor the extent of 1.5% glycineirrigation fluid absorption during transurethral resection of prostate (TURP, by measuring the changes of serum sodium and potassium levels peri-operatively. Settings and Design: This is a randomized prospective cohort observational study. Materials and Methods: The 86 male patients of ASA grades I to III in the age group of 50 to 80 years, scheduled for elective TURP surgery under central neuraxial block, were studied. Their preoperative and post-operative serum sodium, potassium and calcium levels were measured. When duration of surgery exceeds 60 min, serum sodium and potassium levels were done intra-operatively with venous blood samples by using blood gas analyser. The height of irrigation fluid column was kept constant at 60 cm. These changes were correlated with the volume of irrigating fluid used, duration of procedure and the volume of prostate gland resected. Statistical Analysis Used: The values of pre and postoperative sodium, potassium and calcium serum levels were compared and statistical significance of the difference in values was assessed using Student′s paired t test. Results: Statistically significant reduction of serum sodium levels (hyponatremia and elevation of serum potassium levels (hyperkalemia were observed post-operatively, which was directly proportional to volume of irrigating fluid used, duration of procedure and volume of prostate gland resected. No significant changes in serum calcium level were observed. Conclusions: To measure serum electrolytes changes during TURP surgery, it is simple and economical method for indirect assessment of fluid absorption for early identification of TURP syndrome.

  11. Characterization of amorphous and nanocomposite Nb–Si–C thin films deposited by DC magnetron sputtering

    Energy Technology Data Exchange (ETDEWEB)

    Nedfors, Nils, E-mail: [Department of Chemistry, The Ångström Laboratory, Uppsala University, SE-751 21 Uppsala (Sweden); Tengstrand, Olof [Thin Film Physics Division, Department of Physics, Chemistry and Biology (IFM), Linköping University, SE-581 83 Linköping (Sweden); Flink, Axel [Thin Film Physics Division, Department of Physics, Chemistry and Biology (IFM), Linköping University, SE-581 83 Linköping (Sweden); Impact Coatings AB, Westmansgatan 29, SE-582-16 Linköping (Sweden); Eklund, Per; Hultman, Lars [Thin Film Physics Division, Department of Physics, Chemistry and Biology (IFM), Linköping University, SE-581 83 Linköping (Sweden); Jansson, Ulf [Department of Chemistry, The Ångström Laboratory, Uppsala University, SE-751 21 Uppsala (Sweden)


    Two series of Nb–Si–C thin films of different composition have been deposited using DC magnetron sputtering. In the first series the carbon content was kept at about 55 at.% while the Si/Nb ratio was varied and in the second series the C/Nb ratio was varied instead while the Si content was kept at about 45 at.%. The microstructure is strongly dependent on Si content and Nb–Si–C films containing more than 25 at.% Si exhibit an amorphous structure as determined by X-ray diffraction. Transmission electron microscopy, however, induces crystallisation during analysis, thus obstructing a more detailed analysis of the amorphous structure. X-ray photo-electron spectroscopy suggests that the amorphous films consist of a mixture of chemical bonds such as Nb–Si, Nb–C, and Si–C. The addition of Si results in a hardness decrease from 22 GPa for the binary Nb–C film to 18 – 19 GPa for the Si-containing films, while film resistivity increases from 211 μΩcm to 3215 μΩcm. Comparison with recently published results on DC magnetron sputtered Zr–Si–C films, deposited in the same system using the same Ar-plasma pressure, bias, and a slightly lower substrate temperature (300 °C instead of 350 °C), shows that hardness is primarily dependent on the amount of Si–C bonds rather than type of transition metal. The reduced elastic modulus on the other hand shows a dependency on the type of transition metal for the films. These trends for the mechanical properties suggest that high wear resistant (high H/E and H{sup 3}/E{sup 2} ratio) Me–Si–C films can be achieved by appropriate choice of film composition and transition metal. - Highlights: • Si reduces crystallinity, amorphous structure for films containing > 25 at.% Si. • Electron beam induced crystallization during transmission electron microscopy. • Hardness and resistivity are primarily dependent on the relative amount of C–Si bonds.

  12. Utility of Tru-Cut Biopsy of Breast Lesions - An Experience in a Regional Cancer Center of a Developing Country. (United States)

    Samantaray, Sagarika; Panda, Niharika; Besra, Kusumabati; Pattanayak, Lucy; Samantara, Subrat; Dash, Sashibhusan


    Tru-cut Needle Biopsy (TCB) is an integral part of triple assessment of breast cancer, which includes clinical assessment, mammography and TCB or Core Needle Biopsy (CNB). The technique is reliable, simple, and reproducible, and inexpensive, which can be adapted even for low-income group of patients and in developing countries. This study was done to establish the efficacy of TCB of palpable breast lesions in a developing country where mammography is not possible in all cases. A retrospective analysis of 892 TCBs was done in AH Regional Cancer Centre, Cuttack, Odisha, India where TCBs were performed in patients presenting to outpatient department with palpable breast lesions. The H&E stained sections were interpreted by pathologists of the same centre. Diagnosis was classified into different categories. Immunohistochemistry (IHC) for Estrogen Receptor (ER), Progesterone Receptor (PR) and Her-2/neu was done and interpreted by Allred scoring system. A total 892 TCBs were analysed with 23 repeat TCBs. There were 13 (1.4%) male patients. A total of 747 cases (83.6%) were diagnosed as malignant, including 735 carcinomas, nine malignant phyllodes tumour, two angiosarcoma and one case of Non-Hodgkin' Lymphoma (NHL). It was possible to diagnose special histological types such as lobular carcinoma, metaplastic carcinoma and mucinous carcinoma on TCB. A total of 21 cases were diagnosed as carcinoma on repeat biopsy. Eight of the 735 TCBs diagnosed as carcinoma were bilateral breast cancers, hence actual number of carcinoma cases were 727. IHC was done successfully on the paraffin blocks in 260 cases. In this series out of 727 patients of carcinomas 30% were in young, i.e., below 40 years of age, including four cases of carcinoma below 20 years. There were no false positive case in this study giving a specificity of 100% and sensitivity was 97%. TCBs are well tolerated by patients, can be done in OPDs and reduce cost. It is possible to give histological diagnosis of carcinoma

  13. A novel steroid-coenzyme A ligase from Novosphingobium sp. strain Chol11 is essential for an alternative degradation pathway for bile salts. (United States)

    Yücel, Onur; Holert, Johannes; Ludwig, Kevin Christopher; Thierbach, Sven; Philipp, Bodo


    Bile salts such as cholate are steroid compounds with a C5 carboxylic side chain and occur ubiquitously in vertebrates. Upon their excretion into soils and waters bile salts can serve as growth substrates for diverse bacteria. Novosphingobium sp. strain Chol11 degrades 7-hydroxy bile salts via 3-keto-7-deoxy-Δ(4,6) metabolites by dehydration of the 7-hydroxyl group catalyzed by the 7α-hydroxysteroid dehydratase Hsh2. This reaction has not been observed in the well-studied 9-10-seco degradation pathway used by other steroid-degrading bacteria indicating that strain Chol11 uses an alternative pathway. A reciprocal BLASTp analysis showed that known side chain degradation genes from other cholate-degrading bacteria (Pseudomonas stutzeri Chol1, Comamonas testosteroni CNB-2 and Rhodococcus jostii RHA1) were not found in the genome of strain Chol11. Characterization of a transposon mutant of strain Chol11 showing altered growth with cholate identified a novel steroid-24-oyl-coenzyme A ligase named Scl1. Unmarked deletion of scl1 resulted in a strong growth rate decrease with cholate, while growth with steroids with a C3-side chain or without a side chain was not affected. Intermediates with a 7-deoxy-3-keto-Δ(4,6) structure such as 3,12-dioxo-4,6-choldienoic acid (DOCDA) were shown to be likely physiological substrates of Scl1. Furthermore, a novel CoA-dependent DOCDA degradation metabolite with an additional double bond in the side chain was identified. These results support that Novosphingobium sp. strain Chol11 harbors an alternative pathway for cholate degradation, in which side chain degradation is initiated by the CoA-ligase Scl1 and proceeds via reaction steps catalyzed by so-far unknown enzymes different from other steroid degrading bacteria.IMPORTANCE This study provides further evidence of the diversity of metabolic pathways for the degradation of steroid compounds in environmental bacteria. The knowledge about these pathways contributes to the understanding

  14. PKA-mediated responses in females' estrous cycle affect cocaine-induced responses in dopamine-mediated intracellular cascades. (United States)

    Weiner, J; Sun, W Lun; Zhou, L; Kreiter, C M; Jenab, S; Quiñones-Jenab, V


    An extensive body of literature provides evidence for both sexual dimorphism and menstrual cycle effects in drug abuse patterns and behavioral responses. However, the cellular mechanisms underlying sexually dimorphic responses to and hormonal effects on cocaine use remain unclear. We hypothesized that endogenous hormonal fluctuations during the estrous cycle of rats modulate cocaine's effects on dopamine- and PKA-mediated intracellular responses. To test this hypothesis, intact female rats at different stages of their cycle received a single injection of saline or cocaine (20 mg/kg) and were sacrificed after 15 or 60 min. The nucleus accumbens (NAc) and caudate putamen (CPu) were dissected and analyzed via Western blot for total and phosphorylated (p-thr34) dopamine- and 3'-5'-cyclic AMP-regulated phosphoprotein with molecular weight 32 kDa (DARPP-32), PP1, PP2B (CNA1 and CNB1 subunits), PKA, CREB, cFOS, and Delta-FosB. Our results show that saline-treated rats had estrous cycle-related differences in protein levels of pCREB, DARPP-32, p-thr34-DARPP-32, PP1, and CNA1. Saline-treated female rats in the estrus stage had higher levels of pCREB in the NAc, but cocaine-treatment lowered pCREB levels. The estrous cycle also significantly affected the magnitude of change for p-thr34-DARPP-32 protein levels in both the NAc and CPu. Sixty minutes of cocaine administration increased p-thr34-DARPP-32 levels in the NAc of rats during estrus and proestrus and in the CPu of rats in diestrus. Furthermore, cocaine-induced changes in PP1 protein levels in the NAc were also affected by the stage of the cycle; 60 min of cocaine administration increased PP1 levels in the NAc of rats during diestrus, whereas PP-1 levels decreased in rats during estrus. Taken together, these novel findings suggest that hormonal fluctuations during the estrous cycle may contribute to the previously reported sex differences in the PKA pathway and in behavioral responses to cocaine.

  15. VizieR Online Data Catalog: Panchromatic observations of PTF11qcj (Corsi+, 2014) (United States)

    Corsi, A.; Ofek, E. O.; Gal-Yam, A.; Frail, D. A.; Kulkarni, S. R.; Fox, D. B.; Kasliwal, M. M.; Sullivan, M.; Horesh, A.; Carpenter, J.; Maguire, K.; Arcavi, I.; Cenko, S. B.; Cao, Y.; Mooley, K.; Pan, Y.-C.; Sesar, B.; Sternberg, A.; Xu, D.; Bersier, D.; James, P.; Bloom, J. S.; Nugent, P. E.


    On 2011 November 1, we discovered PTF11qcj in an R-band image from the 48 inch Samuel Oschin telescope at Palomar Observatory (P48), which is routinely used by the Palomar Transient Factory (PTF). Subsequent observations with the P48 were conducted with the Mould-R and Gunn-g filters. Photometry (Table2) was performed relative to the SDSS r-band and g-band magnitudes of stars in the field. Multi-color optical (gri) optical light curves were also obtained using the Palomar 60 inch telescope (P60) and the RATCAM optical imager on the robotic 2m Liverpool Telescope (LT) located at the Roque de Los Muchachos Observatory on La Palma. On 2011 November 15, we started a long-term monitoring campaign of PTF11qcj (along with calibrators J1327+4326 and 3C 286) with the Karl G. Jansky Very Large Array (VLA; in its D, DnC, C, CnB, and A configurations, under our Target of Opportunity programs (VLA/11A-227, VLA/11B-034, VLA/11B-247, VLA/12B-195; PI: A. Corsi). The light curves of PTF11qcj at frequencies of 2.5GHz, 3.5GHz, 5GHz, 7.4GHz, 13.5GHz, 16GHz are reported in Table3. We also observed the field of PTF11qcj (together with the test calibrator J1203+480) using the Combined Array for Research in Millimeter-wave Astronomy (CARMA;, at a frequency of 93GHz. The data collected on 2011 November 19 and 2011 November 26 (CARMA program no. c0857; PI: A. Horesh) both resulted in a detection of PTF11qcj (Table3). We have carried out an X-ray monitoring campaign of PTF11qcj with Chandra and Swift. All our Swift-XRT observations yielded non detections (see Table 4), while Chandra detected PTF11qcj in three epochs (DDT proposals nos. 501793, 501794, 501797; PI: A. Corsi). The results of our X-ray follow-up are reported in Table4. We observed the position of PTF11qcj with Spitzer on two epochs (on 2012 March 28.747 and 2012 June 25.643; Table5; DDT proposal no. 31731; PI: A. Corsi). On 2012 March 28 (Table5), we also observed

  16. NMF-mGPU: non-negative matrix factorization on multi-GPU systems. (United States)

    Mejía-Roa, Edgardo; Tabas-Madrid, Daniel; Setoain, Javier; García, Carlos; Tirado, Francisco; Pascual-Montano, Alberto


    daily work of bioinformaticians that are trying to extract biological meaning out of hundreds of gigabytes of experimental information. NMF-mGPU can be used "out of the box" by researchers with little or no expertise in GPU programming in a variety of platforms, such as PCs, laptops, or high-end GPU clusters. NMF-mGPU is freely available at .

  17. Currency hedging with help of derivatives

    Directory of Open Access Journals (Sweden)

    Sylvie Riederová


    Full Text Available The high volatility combined with unpredictable fluctuations of CZK had shown one more time to the Czech exporting companies the necessity of currency hedging. This article is focused on finding of suitable currency hedging instrument for exporting company, working with the currency pair of CZK/EUR. In the first part, the time series analysis is made for volatility, interest rates and exchange rate. Based on the real market data – gained from Thomson REUTERS and CNB for the time period starting in 2002 – the detailed analysis is made in graphical form. The main goal is to find out the future trends with help of liner regression analysis, based on the historical data. Several graphs are provided with the trend line end estimated interval (min and max for the each variable. The calculated values are clearly marked, to be separated from the real market data. Exchange rate curve shows the market behaviour in the last years and is to be used as most important indicator for the future trends. Interest rates curves are very important for the calculation of the BIPS (basis points, determining the price of the forwards. The difference between landing and deposit rates for the same period of time and different currencies are showing the market estimation of the future development of each currency. Forward price is to be seen as a benchmark for the all other financial instruments. And finally the volatility (quoted as middle is very important part in the pricing of currency options.The second part is closely connected with the first one. Based on the results of provided analyses, it recommends a suitable hedging product for the next period of time. All of the analyses are taken as an input in different ways. The volatility is important for the decision of selling or purchasing the specific part of currency option. The exchange rate outlook together with the interest rates is the indicator of the future development of the currency pair and is playing

  18. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials (United States)


    Introduction The ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions. Methods The PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. Results We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR) = 0.39; 95% confidence interval (CI) = 0.16 to 0.95). Both typical (three RCTs with 965 patients, RR = 0.71; 95% CI = 0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR = 0.36; 95% CI = 0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR = 0.71; 95% CI = 0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR = 0.99; 95% CI = 0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR = 0.93; 95% CI = 0.61 to 1

  19. Life cycle greenhouse gas emissions of anesthetic drugs. (United States)

    Sherman, Jodi; Le, Cathy; Lamers, Vanessa; Eckelman, Matthew


    unnecessarily high fresh gas flow rates for all inhaled drugs. There are waste anesthetic gas capturing systems, and even in advance of reprocessed gas applications, strong consideration should be given to their use. From our results it appears likely that techniques other than inhalation anesthetics, such as total i.v. anesthesia, neuraxial, or peripheral nerve blocks, would be least harmful to the environment.

  20. Optimising postoperative pain management in the ambulatory patient. (United States)

    Shang, Allan B; Gan, Tong J


    Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the

  1. Nitrous oxide and serious morbidity and mortality in the POISE trial. (United States)

    Leslie, Kate; Myles, Paul; Devereaux, Philip J; Forbes, Andrew; Rao-Melancini, Purnima; Williamson, Elizabeth; Xu, Shouchun; Foex, Pierre; Pogue, Janice; Arrieta, Maribel; Bryson, Gregory L; Paul, James; Paech, Michael J; Merchant, Richard N; Choi, Peter T; Badner, Neal; Peyton, Philip; Sear, John W; Yang, Homer


    In this post hoc subanalysis of the Perioperative Ischemic Evaluation (POISE) trial, we sought to determine whether nitrous oxide was associated with the primary composite outcome of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal cardiac arrest within 30 days of randomization. The POISE trial of perioperative β-blockade was undertaken in 8351 patients. Nitrous oxide anesthesia was defined as the coadministration of nitrous oxide in patients receiving general anesthesia, with or without additional neuraxial blockade or peripheral nerve blockade. Logistic regression, with inverse probability weighting using estimated propensity scores, was used to determine the association of nitrous oxide with the primary outcome, MI, stroke, death, and clinically significant hypotension. Nitrous oxide was administered to 1489 (29%) of the 5133 patients included in this analysis. Nitrous oxide had no significant effect on the risk of the primary outcome (112 [7.5%] vs 248 [6.9%]; odds ratio [OR], 1.08; 95% confidence interval [CI], 0.82-1.44; 99% CI, 0.75-1.57; P = 0.58), MI (89 [6.0] vs 204 [5.6]; OR, 0.99; 95% CI, 0.75-1.31; 99% CI, 0.69-1.42; P = 0.94), stroke (6 [0.4%] vs 28 [0.8%]; OR, 0.85; 95% CI, 0.26-2.82; 99% CI, 0.17-4.11; P = 0.79), death (40 [2.7%] vs 100 [2.8%]; OR, 1.04; 95% CI, 0.6-1.81; 99% CI, 0.51-2.15; P = 0.88) or clinically significant hypotension (219 [14.7%] vs 544 [15.0%]; OR, 0.92; 95% CI, 0.74-1.15; 99% CI, 0.70-1.23; P = 0.48). In this post hoc subanalysis, nitrous oxide was not associated with an increased risk of adverse outcomes in the POISE trial patients. This analysis was limited by the observational nature of the data and the lack of information on the concentration and duration of nitrous oxide administration. Further randomized controlled trial evidence is required.

  2. Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

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    Ashok Jadon


    Full Text Available Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB and intra- venous (IV fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB and Intravenous fentanyl group (FENT. In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000 was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 μg/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020. Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049. Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027. Patient acceptance was less in group FENT (P = 0.000031. Conclusion: Femoral nerve block provides better analgesia, patient

  3. The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary. (United States)

    Neal, Joseph M; Brull, Richard; Horn, Jean-Louis; Liu, Spencer S; McCartney, Colin J L; Perlas, Anahi; Salinas, Francis V; Tsui, Ban Chi-Ho


    In 2009 and again in 2012, the American Society of Regional Anesthesia and Pain Medicine assembled an expert panel to assess the evidence basis for ultrasound guidance as a nerve localization tool for regional anesthesia. The 2012 panel reviewed evidence from the first advisory but focused primarily on new information that had emerged since 2009. A new section was added regarding the accuracy and reliability of ultrasound for determining needle-to-nerve proximity. Jadad scores are used to rank study quality. Grades of recommendations consistent with their level of evidence are provided. The panel offers recommendations based on synthesis and analysis of literature related to (1) the technical capabilities of ultrasound equipment and its operators, (2) comparison of ultrasound to other methods of nerve localization with regard to block characteristics, (3) comparison of block techniques where ultrasound is the sole nerve localization modality, and (4) major complications. Assessment of evidence strength and recommendations are made for upper- and lower-extremity, truncal, neuraxial, and pediatric blocks. Scientific evidence from the past 5 years has clarified and strengthened our understanding of ultrasound-guided regional anesthesia as a nerve localization tool. High-level evidence supports ultrasound guidance contributing to superior characteristics with selected blocks, although absolute differences with the comparator technique are often relatively small (especially for upper-extremity blocks). The clinical meaningfulness of these differences is likely of variable importance to individual practitioners. The use of ultrasound significantly reduces the risk of local anesthetic systemic toxicity as well as the incidence and intensity of hemidiaphragmatic paresis, but has no significant effect on the incidence of postoperative neurologic symptoms. WHAT'S NEW IN THIS UPDATE?: This evidence-based assessment of ultrasound-guided regional anesthesia reviews findings

  4. Intravenous dexamethasone as an adjunct to improve labor analgesia: A randomized, double-blinded, placebo controlled clinical trial. (United States)

    Dube, Pratibha; Mitra, Sukanya; Singh, Jasveer; Saroa, Richa; Mehra, Reeti


    To study the role of intravenous (i.v.) dexamethasone as an analgesic adjunct in labor analgesia. Double-blinded randomized controlled trial. Labor analgesia in a tertiary-care teaching hospital. Eighty consenting ASA I-II parturients, age>18year, nulliparous, single gestation, cephalic presentation at ≥36 wk. of gestation, in early spontaneous labor (cervical dilatation≤5cm) requesting epidural analgesia. The patients were randomized to two groups. The Dexa group received 8mg of dexamethasone i.v. in 50ml normal saline approximately 45min before the procedure. Placebo group patients received 50ml normal saline only. All patients underwent epidural labor analgesia per hospital protocol. After an initial bolus, they received continuous background infusion of 5ml/h of 0.1% of levobupivacaine with 2μg/ml of fentanyl, with the provision of patient controlled boluses of 5ml of the same drug combination with a lockout interval of 12min if needed. Primary outcome measure: hourly average consumption of neuraxially administered levobupivacaine-fentanyl combination. Secondary outcomes and observations: pain score, maternal satisfaction, sensory and motor block characteristics, hemodynamic parameters of mother, fetal heart rate, duration of second stage of labor, mode of delivery, Apgar scores at 1 and 5min, and adverse effects. Average hourly drug consumption was significantly lower in Dexa group as compared to Placebo group (10.34±1.79ml/h vs. 11.34±1.83ml/h; mean difference 1.007, 95% CI 0.199-1.815; P=0.015). The median number of bolus doses was 4 (interquartile-range [IQR] 3-5.75) and 5 (IQR 3-6) in the Dexa and Placebo groups, respectively (P=0.162). There was no significant difference between groups with regard to pain scores, maternal satisfaction and hemodynamics, mode of delivery, and adverse effects. I.v. dexamethasone significantly decreased hourly average drug consumption of levobupivacaine-fentanyl combination through the epidural route, demonstrating the

  5. Minimally invasive approach for small ventrally located intradural lesions of the craniovertebral junction. (United States)

    Eicker, Sven O; Mende, Klaus Christian; Dührsen, Lasse; Schmidt, Nils Ole


    The surgical management of lesions ventral to the neuraxis at the level of the craniovertebral junction (CVJ) and upper cervical spine is challenging. Here, the authors describe a minimally invasive dorsal approach for small ventrally located intradural lesions at the CVJ as an alternative for the more extensive classic transoral approach or variants of suboccipital approaches. Between 2012 and 2014, 6 symptomatic patients with a small lesion of the ventral aspect at the CVJ level were treated using a minimally invasive dorsal approach at the University Medical Center in Hamburg-Eppendorf, Germany. The anatomical distance between the posterior atlantooccipital membrane and the posterior atlantoaxial ligament, as determined by CT images, was assessed in the treated patients and in 100 untreated persons. The authors treated 6 patients (mean age 54.7 years) who had a clinical presentation of mild neurological symptoms that disappeared after resection. Minimally invasive surgical dorsal access was achieved by using tubular systems and using the natural space between the occiput (C-0) and C-1, and in 1 case between C-1 and C-2, without having to remove bony structures. The postoperative course in each of the 6 patients was uneventful. The neuropatho-logical findings confirmed a meningotheliomatous meningioma (WHO Grade I) in 5 cases and an extramedullary cavernous hemangioma in 1 case. MRI confirmed complete resection of all the lesions. The atlantooccipital distances ranged from 3 to 17 mm (mean 8.98 mm) in the supine neutral position, and the atlantoaxial distances ranged from 5 to 17 mm (mean 10.56 mm). There were no significant differences between women and men (atlantooccipital p = 0.14; atlantoaxial p = 0.72). The results of this study demonstrate that the minimally invasive dorsal approach using the space between C-0 and C-1 or C-1 and C-2 provides direct and sufficient exposure for the safe surgical resection of small ventrally located intradural lesions at the

  6. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. (United States)

    Tan, Mingjuan; Law, Lawrence Siu-Chun; Gan, Tong Joo


    The optimal management of postoperative pain using multimodal analgesia is a key component of Enhanced Recovery After Surgery (ERAS). Pain has adverse clinical implications on postoperative recovery, including prolonging the time to recovery milestones and length of hospital stay. Moreover, the ubiquity of opioids in postoperative analgesic regimens results in adverse effects, such as sedation, postoperative nausea and vomiting, urinary retention, ileus, and respiratory depression, which can delay discharge. Thus, multimodal analgesia, i.e., the use of more than one analgesic modality to achieve effective pain control while reducing opioid-related side effects, has become the cornerstone of enhanced recovery. The purpose of this review is to address the analgesic techniques used as part of multimodal analgesic regimens to optimize postoperative pain control and to summarize the evidence for their use in reducing opioid requirements and side effects. There is a wide variety of analgesic techniques available for multimodal postoperative analgesia. These modalities are divided into pharmacological and non-pharmacological techniques. Systemic pharmacological modalities involve opioids and non-opioids such as acetaminophen, non-steroidal anti-inflammatory drugs, N-methyl-D-aspartate receptor antagonists, anticonvulsants (e.g., gamma-aminobutyric acid analogues), beta-blockers, alpha-2 agonists, transient receptor potential vanilloid receptor agonists (capsaicin), and glucocorticoids. Other pharmacological modalities include central neuraxial techniques, surgical-site infiltration, and regional anesthesia. Evidence supports the use of these pharmacological techniques as part of multimodal analgesia, but each has its own advantages and specific safety profile, which highlights the importance of selecting the appropriate analgesics for each patient. Adjunctive non-pharmacological techniques include acupuncture, music therapy, transcutaneous electrical nerve stimulation

  7. Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

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    Bhanu Prakash Zawar


    Full Text Available Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG. Thoracic epidural anesthesia (TEA, combined with general anesthesia (GA attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά, interleukin-6 and leucocyte count. Design: A prospective randomised non blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group or GA only (control group. Inclusion Criteria (for participants were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction. Serum concentration of Interlukin: - 6, TNF ά, cortisol, Troponin - I, CK-MB, and HsCRP (highly sensitive C reactive protein, was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result: Study group

  8. Transcutaneous electrical nerve stimulation (TENS reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial

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    Licia Santos Santana


    Full Text Available Questions: In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Design: Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Participants: Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4 cm, and without the use of any medications from hospital admission until randomisation. Intervention: The principal investigator applied TENS to the experimental group for 30 minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. Outcome measures: The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. Results: After the intervention, a significant mean difference in change in pain of 15 mm was observed favouring the experimental group (95% CI 2 to 27. The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0 hours (95% CI 4.1 to 5.9 longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. Conclusion: TENS produces a significant decrease in pain during labour and postpones the need for pharmacological

  9. Similar Clinical Outcomes with Preoperative and Postoperative Start of Thromboprophylaxis in THA: A Register-based Study. (United States)

    Borgen, Pål O; Pripp, Are H; Dybvik, Eva; Leistad, Lilian; Dahl, Ola E; Reikerås, Olav


    .84-1.27; p = 0.786), or other postoperative clinical complications; (OR, 0.86; 95% CI, 0.76-0.99; p = 0.034), with the two regimens. Six-month mortality was similar, (OR, 0.76; 95% CI, 0.56-1.05; p = 0.093), and the readmission rate was higher in the preoperative group; (OR, 0.92; 95% CI, 0.85-0.97; p = 0.016). The risk for postoperative complications seems to be comparable whether LMWH prophylaxis is initiated before or after THA. The postoperative approach reduces costs, decreases risks related to neuraxial anesthesia, and facilitates same-day admissions. Methods for individual risk assessment including laboratory tests would be feasible. Level III, therapeutic study.

  10. Maternal Pulse Pressure and the Risk of Postepidural Complications: A Randomized Controlled Trial. (United States)

    Lappen, Justin R; Myers, Stephen A; Bolen, Norman; Mercer, Brian M; Chien, Edward K S


    initiation of neuraxial labor analgesia., NCT02565485.

  11. Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration (United States)

    Baysinger, Curtis L.; Pujic, Borislava; Velickovic, Ivan; Owen, Medge D.; Serafin, Joanna; Shotwell, Matthew S.; Braveman, Ferne


    Many low- and middle-income countries (LMICs) report low rates of regional anesthesia (RA) use for cesarean delivery (CD), despite its association with lower maternal major morbidity and mortality. Also, the prevalence of neuraxial analgesia for labor (NAL) is often low in LMICs. We report on the results of a collaboration in clinical education over a multi-year period between Kybele Inc., an international non-profit organization, and Klinicki Centar Vojvodine (CCV), a teaching hospital in Novi Sad, Serbia, to increase RA use for CD and NAL at CCV. From late 2011 through 2015, teams from Kybele participated in annual to biannual didactic conferences and week-long bedside teaching efforts involving obstetric and anesthesia staff from CCV and surrounding hospitals. Ongoing contact occurred at least weekly between Kybele and the host to discuss progress. De-identified quality improvement data on total deliveries, numbers of elective and non-elective CDs, number of vaginal deliveries, type of anesthesia for CD, and the number of NALs were collected. RA use for CD increased to 25% in year 2015 versus 14% in base year 2011 [odds ratio (OR): 2.05; 95% confidence interval (CI): 1.73,2.42; p < 0.001]. NAL increased to 10.5% of laboring women in 2015 versus 1.2% in 2011 (OR: 9.6; 95% CI: 7.2, 12.8; p < 0.001). Greater increases for RA use during non-elective CD were observed between 2011 and 2015 (1.4 versus 7.5% of total CD; OR: 5.52; 95% CI: 2.63, 8.41; p < 0.001) relative to elective CD (12.5 versus 17.5% of total CD; OR: 1.48; 95% CI: 1.23, 1.77; p < 0.001). Overall, RA for CD increased during the 4 year collaboration but was not as great as reported in other countries with similar health-care demographics utilizing a similar program. Detailed descriptions of program interventions and barriers to change at CCV are presented. PMID:28649565

  12. Six3

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    Steinmetz Patrick RH


    lobes do not represent the tip of the neuraxis. These results support the hypothesis that the last common ancestor of annelids and arthropods already possessed neurosecretory centres in the most anterior region of the brain. In light of its broad evolutionary conservation in protostomes and, as previously shown, in deuterostomes, the six3-otx head patterning system may be universal to bilaterian animals.

  13. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. (United States)

    Zhang, Hao; Lu, Yan; Liu, Meng; Zou, Zui; Wang, Long; Xu, Feng-Ying; Shi, Xue-Yin


    The ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions. The PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR)=0.39; 95% confidence interval (CI)=0.16 to 0.95). Both typical (three RCTs with 965 patients, RR=0.71; 95% CI=0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR=0.36; 95% CI=0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR=0.71; 95% CI=0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR=0.99; 95% CI=0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR=0.93; 95% CI=0.61 to 1.43) or acetylcholinesterase inhibitors and placebo

  14. Nutrient and phytoplankton biomass in the Amazon River shelf waters

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    Maria L.S. Santos


    na área em estudo. Os resultados das simulações com o modelo bidimensional MAAC-2D confirmaram que as águas ricas em nutrientes são deslocadas para noroeste (dois núcleos em 2,5°N-50°W e 4°N-51°W, pela ação de uma CNB mais forte durante o período de decaimento da vazão dos rios. No período de vazão máxima, estas lentes de águas ricas de nutrientes distribuem-se próximo de 0,5°N-48,5°W, bem como ao longo da plataforma Amazônica rasa (20m-50m profundidade, 1°N-3,5°N, como resultado do espalhamento da água doce de origem continental.

  15. Comportamento ingestivo de cordeiros alimentados com torta de macaúba Ingestive behavior of lambs fed with macauba meal

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    R.A. Azevedo


    Full Text Available Avaliaram-se os efeitos de diferentes porcentagens (0, 10, 20 e 30% de inclusão da torta de macaúba (TM no comportamento ingestivo de 24 cordeiros Santa Inês, com média de cinco meses de idade e peso vivo de 23,9kg, distribuídos em delineamento em blocos ao acaso, com quatro tratamentos e seis repetições, durante 60 dias de confinamento. Foram avaliados os tempos médios despendidos com alimentação, ruminação (TR, ócio (TO, tempo de mastigação total (TMT, eficiência de alimentação (EA MS e EA FDN e eficiência de ruminação, além do número de bolos ruminados (NBR e número diário de mastigações merícicas (MMnd. A adição de TM à dieta aumentou linearmente o TR, TMT, NBR, MMnd e EA FDN e reduziu de forma linear o TO, em consequência do maior teor de fibra em detergente neutro das dietas com o coproduto. Mesmo com o aumento no TMT, não foi verificada diferença no consumo e na eficiência de ruminação e alimentação da matéria seca, possivelmente em razão da baixa efetividade de fibra da TM, demonstrando o potencial de utilização desse coproduto na dieta de ovinos em crescimento.The effects of different percentages (0, 10, 20 and 30% of inclusion of macauba meal (MM on the ingestive behavior of 24 Santa Inês male lambs, averaging five months of age and 23.9kg of initial body weight were studied. The animals were allotted to a completely randomized block design with four treatments and six replications during 60 days of confinement. The variables measured were time spent in rumination (TR, idle time (IT, total chewing (TC, power efficiency (PE DM and PE NDF and efficiency of rumination, as well as the number of ruminated bolus (NRB and daily number of chews (Cnd. The addition of MM to the diet increased TR, TC, NRB, Cnb and PE NDF linearly, and reduced IT linearly, as a result of higher content of neutral detergent fiber in the diet. Although there was an increase in TC, no difference was verified in the


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    Ricardo Bustamante, Dr.


    the most in the last 40 years. As a consequence, surgery has become possible in cases that should have been called “inoperable” before, and a strong reduction of the number of mortalities due to anesthetic causes has been observed.Anesthesiologists administer different types of anesthesia: from monitoring patient awake or with varying degrees of sedation, without anesthesia or just local anesthesia, to the performance of various types of peripheral blocks, neuraxial blocks or different types of general anesthesia (inhalation, total intravenous, or a mixture of both.The role of the anesthesiologist has extended to many activities outside the surgical ward, including radiological, hemodynamic, oncological, endoscopic and dental procedures.Over time, some subspecialties have been developed in anesthesiology: intensive care, chronic pain, pediatric anesthesia, cardiovascular anesthesia, obstetric anesthesia, palliative care and regional anesthesia. Anesthesiologists share some medical activities with other specialists, including intensive medicine, management of chronic pain and palliative care.Another multidisciplinary specialty that is emerging and setting in modern medicine is perioperative medicine. Most anesthesiologists practice perioperative medicine to some degree and it is probably what lies in the future for our specialty if it wants to move forward. Palabras clave: Historia anestesia, vigilancia anestésica, tipos de anestesia, anestesiólogo, Keywords: Anesthesia development, Anesthetic monitoring, types of anesthesia, anesthesiologist

  17. Anaesthesia for hip fracture surgery in adults. (United States)

    Guay, Joanne; Parker, Martyn J; Gajendragadkar, Pushpaj R; Kopp, Sandra


    state: RR 0.85, 95% CI 0.51 to 1.40; I(2) = 49%. Based on laboratory tests, the risk of deep vein thrombosis was decreased when no specific precautions or just early mobilization was used: RR 0.57, 95% CI 0.41 to 0.78; I(2) = 0%; (number needed to treat for an additional beneficial outcome (NNTB) = 3, 95% CI 2 to 7, based on a basal risk of 76%) but not when low molecular weight heparin was administered: RR 0.98, 95% CI 0.52 to 1.84; I(2) for heterogeneity between the two subgroups = 58%. For neuraxial blocks compared to general anaesthesia, we rated the quality of evidence as very low for mortality (at 0 to 30 days), pneumonia, myocardial infarction, cerebrovascular accident, acute confusional state, decreased rate of deep venous thrombosis in the absence of potent thromboprophylaxis, and return of patient to their own home. The number of studies comparing other anaesthetic techniques was limited. We did not find a difference between the two techniques, except for deep venous thrombosis in the absence of potent thromboprophylaxis. The studies included a wide variety of clinical practices. The number of participants included in the review is insufficient to eliminate a difference between the two techniques in the majority of outcomes studied. Therefore, large randomized trials reflecting actual clinical practice are required before drawing final conclusions.

  18. Preeclampsia: an update. (United States)

    Lambert, G; Brichant, J F; Hartstein, G; Bonhomme, V; Dewandre, P Y


    . Delivery is proposed for patients with preeclampsia without severe features after 37 weeks of gestation and in case of severe preeclampsia after 34 weeks of gestation. Between 24 and 34 weeks of gestation, conservative management of severe preeclampsia may be considered in selected patients. Antenatal corticosteroids should be administered to less than 34 gestation week preeclamptic women to promote fetal lung maturity. Termination of pregnancy should be discussed if severe preeclampsia occurs before 24 weeks of gestation. Maternal end organ dysfunction and non-reassuring tests of fetal well-being are indications for delivery at any gestational age. Neuraxial analgesia and anesthesia are, in the absence of thrombocytopenia, strongly considered as first line anesthetic techniques in preeclamptic patients. Airway edema and tracheal intubation-induced elevation in blood pressure are important issues of general anesthesia in those patients. The major adverse outcomes associated with preeclampsia are related to maternal central nervous system hemorrhage, hepatic rupture, and renal failure. Preeclampsia is also a risk factor for developing cardiovascular disease later in life, and therefore mandates long-term follow-up.

  19. I. The synthesis and coordination chemistry of novel 6pi-electron ligands. II. Improvement of student writing skills in general chemistry lab reports through the use of Calibrated Peer Review (United States)

    William, Wilson Ngambeki

    Abstract I. The goal of this study was to synthesize and characterize a set of coordination complexes containing 6pi-cationic ligands. These compounds could be extremely useful as catalysts for the polymerization of olefins that are widely used in the synthetic polymer industry. The original strategy was to synthesize the 6pi-cationic ligands using (Ph2P) 3CH (1) and (Me2P)3CH (10) as precursors; however, both precursors 1 and 10 were found to be highly reactive leading to the fragmentation products (Ph 2P)2CH2 and (Me2P)2CH 2 respectively. In trying to control the reactivity, precursor 1 was coordinated to the group 6B metal carbonyl in two modes, Mo(CO)3(C 2H5CN)(Ph2P)2CHPPh2 and W(CO) 3(C2H5CN)(Ph2P)2CHPPh 2. In these novel compounds, two of the three phosphorus atoms are chelated to the metal. These complexes were isolated and characterized by X-ray analysis, elemental analysis, NMR and infrared spectroscopy. When these metal complexes were reacted with B(C6F5)3, the complexes were stabilized, and no molecular fragmentation was observed. Instead, a second mode of coordination was observed by 31P{1H} NMR spectroscopy, where all three phosphorus atoms are bonded to the metal in a tridentate fashion, yielding the novel product EtCNB(C6F 5)3, which was characterized by X-ray analysis. However, because there was no hydride abstraction from the tertiary carbon in either compound, further studies will be required to develop a strategy for hydride abstraction to produce a cationic ligand. Another strategy for the synthesis of 6pi-cationic ligands was to directly synthesize the halogenated version of the tertiary carbon atom of compound 10. Fractional recrystallization of the crude product yielded two compounds of 2,4,6-trimethypyridinium bromide and (PMe2)3CBr. (PMe2)3CBr was determined to be pure as revealed by 31P{1H} NMR. It is expected that oxidation of the bromide should yield the 6pi-cationic ligand. In the next strategy, density function theory calculations (DFT

  20. Anestesia regional e trombocitopenia não pré-eclâmptica; hora de repensar o nível seguro de plaquetas Anestesia regional y trombocitopenia no preclámptica; es hora de pensar de nuevo sobre el nivel seguro de plaquetas Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count

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    Motoshi Tanaka


    Full Text Available JUSTIFICATIVA E OBJETIVOS: Apesar de a anestesia regional ser amplamente utilizada no controle da dor em obstetrícia, seu uso pode não ser apropriado nas pacientes com trombocitopenia por causa do risco de hematoma no neuroeixo. Não existem fortes evidências sugerindo número mínimo de plaquetas necessário para garantir a segurança na realização da anestesia regional. O objetivo deste estudo foi rever a segurança da anestesia regional em pacientes com trombocitopenia não pré-eclâmptica na instituição durante período de cinco anos. MÉTODO: Foi realizada revisão retrospectiva dos prontuários médicos de todas as pacientes obstétricas não pré-eclâmpticas cujo parto foi realizado na instituição entre abril de 2001 e março de 2006 e que apresentaram contagem de plaquetas JUSTIFICATIVA Y OBJETIVOS: A pesar de que la anestesia regional esté siendo muy utilizada en el control del dolor en obstetricia, su uso puede no ser muy apropiado en las pacientes con trombocitopenia, debido al riesgo de hematoma en el neuro eje. No existen fuertes evidencias que sugieran un número mínimo de plaquetas necesario para garantizar la seguridad en la realización de la anestesia regional. El objetivo de este estudio fue analizar la seguridad de la anestesia regional en pacientes con trombocitopenia no preeclámptica en la institución durante un período de cinco años. MÉTODO: Fue realizada revisión retrospectiva de las historias clínicas médicas de todas las pacientes obstétricas no preeclámpticas cuyo parto fue realizado en la institución entre abril de 2001 y marzo de 2006 y que presentaron BACKGROUND AND OBJECTIVES: Although regional anesthesia is widely used for pain control in obstetrics, it may not be appropriate for patients with thrombocytopenia due to the risk of neuraxial hematoma. There is no strong evidence to suggest the minimum platelet count that is necessary to ensure the safe practice of regional anesthesia. The

  1. Pesando riscos e benefícios: lições aprendidas com as intervenções terapêuticas de um caso com pré-eclâmpsia grave Balance entre beneficios y riesgos: lecciones aprendidas con las intervenciones terapéuticas de un caso con preclampsia grave Balancing the benefits and risks: lessons learned from the therapeutic interventions of a case with severe preeclampsia

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    Shiqin Xu


    para evitar las complicaciones cerebrales serias.BACKGROUND AND OBJECTIVE: Preeclampsia is a multiple organ dysfunction syndrome (MODS for its typical and atypical manifestations including hypertension, proteinuria, HELLP syndrome, hypertensive encephalopathy and coagulopathy. Optimal management for such patients is determined from an assessment of the balance between benefits and risks of anesthetic and obstetric therapeutic strategies. CASE REPORT: A 35-year-old pregnant woman, with one past uncomplicated pregnancy presented at 29 weeks to our medical institute as an emergency with dizziness, chest distress, palpitation, blurred vision and vaginal bleeding. After physical examination and laboratory tests, the patient was diagnosed with severe preeclampsia, HELLP syndrome, placental abruption, and MODS. The patient also presented spinal and pelvic deformity, fixation of articulus mandibularis, and tracheal displacement because of a traffic accident 11 years ago. Therefore, urgent cesarean section was performed under general anesthesia with nasal tracheal intubation using a guide wire. The patient was discharged directly home from the obstetric intensive care unit on the 7th postoperative day with normal blood pressure and full recovery of organic function. CONCLUSIONS: This case merits further discussion on the anesthesia considerations concerning how to make a clinical decision when treating such a patient. Neuraxial block is the first choice for preeclampsia patients undergoing cesarean section when a moderate but not progressive thrombocytopenia exists. When general anesthesia is decided, adequate sedation and analgesia is needed to better control the stress response to intubation especially in patients with neurological signs, and to prevent major cerebral complications.

  2. Efeitos antinociceptivos, analgésicos e histopatológicos de dexmedetomidina e bupivacaína intratecal em rato Efectos antinociceptivos, analgésicos e histopatológicos de dexmedetomidina y bupivacaína intratecal en ratones Anti-nociceptive, analgesic and pathohistological effects of intrathecal dexmedetomidine and bupivacaine in rats

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    Başar Erdivanli


    prolonga la duración del bloqueo.BACKGROUND AND OBJECTIVES: This study investigates analgesic and nociceptive effects of adding dexmedetomidine to bupivacaine neuraxial anesthesia through Tail-flick (TF and Hot-plate (HP tests and the pathohistological changes on spinal nerves and nerve roots through light microscopy. METHODS: Forty anesthetized, male Sprague-Dawley rats were intrathecally catheterized. Basal values of TF and HP tests were measured before and after catheterization. Thirty-six successfully catheterized rats were assigned to four groups. Group B received 10 µg bupivacaine, Group BD3 received 10 µg bupivacaine + 3 µg dexmedetomidine, Group BD10 received 10 µg bupivacaine + 10 µg dexmedetomidine and Control group received 10 µL volume of artificial cerebrospinal fluid. TF and HP tests were performed between the 5th and 300th minutes of drug administration. Twenty-four hours after administration of drugs, rats were sacrificed and spinal cord and nerve roots were removed for pathological investigation. RESULTS: Baseline values of the TF and HP tests were not statistically different among the groups (6.8 ± 0.15 s. TF and HP latencies in the Control group did not change significantly during the study. TF and HP test results showed that adding 3 and 10 µg dexmedetomidine caused a dosedependent increase in duration and amplitude of analgesic and nociceptive effect of bupivacaine (TF: 37.52 ± 1.08%, 57.86 ± 1.16% respectively, HP: 44.24 ± 1.15%, 68.43 ± 1.24% respectively. CONCLUSIONS: There were no apparent pathohistological changes at least 24 hours after the intrathecal administration of a single dose of dexmedetomidine 3 µg and 10 µg. Dexmedetomidine added to bupivacaine for spinal block improves analgesia and prolongs block duration.