Sample records for prolonged hfov compared

  1. Effects of heliox as carrier gas on ventilation and oxygenation in an animal model of piston-type HFOV: a crossover experimental study

    Hiroma Takehiko


    Full Text Available Abstract Objective This study aimed to compare gas exchange with heliox and oxygen-enriched air during piston-type high-frequency oscillatory ventilation (HFOV. We hypothesized that helium gas would improve both carbon dioxide elimination and arterial oxygenation during piston-type HFOV. Method Five rabbits were prepared and ventilated by piston-type HFOV with carrier 50% helium/oxygen (heliox50 or 50% oxygen/nitrogen (nitrogen50 gas mixture in a crossover study. Changing the gas mixture from nitrogen50 to heliox50 and back was performed five times per animal with constant ventilation parameters. Arterial blood gas, vital function and respiratory test indices were recorded. Results Compared with nitrogen50, heliox50 did not change PaCO2 when stroke volume remained constant, but significantly reduced PaCO2 after alignment of amplitude pressure. No significant changes in PaO2 were seen despite significant decreases in mean airway pressure with heliox50 compared with nitrogen50. Conclusion This study demonstrated that heliox enhances CO2 elimination and maintains oxygenation at the same amplitude but with lower airway pressure compared to air/O2 mix gas during piston-type HFOV.

  2. Continuous distending pressure effects on variables contributing to oxygenation in healthy and ARDS model pigs during HFOV

    Laviola, Marianna; Hajny, Ondrej; Roubik, Karel


    High frequency oscillatory ventilation (HFOV) is an alternative mode of mechanical ventilation. HFOV has been shown to provide adequate ventilation and oxygenation in acute respiratory distress syndrome (ARDS) patients and may represent an effective lung-protective ventilation in patients where conventional ventilation is failing. The aim of this study is to evaluate effects of continuous distending pressure (CDP) on variables that contribute to the oxygenation in healthy and ARDS lung model pigs. Methods. In order to simulate a lung disease, lung injury was induced by lavage with normal saline with detergent in three pigs. HFOV ventilation was applied before and after the lung lavage. CDP was stepwise increased by 2 cmH2O, until the maximum CDP (before the lung lavage 32 cmH2O and after the lung lavage 42 cmH2O) and then it was stepwise decreased by 2 cmH2O to the initial value. In this paper we analyzed the following parameters acquired during our experiments: partial pressure of oxygen in arterial blood (PaO2), cardiac output (CO) and mixed venous blood oxygen saturation (SvO2). In order to find how both PaO2 and CO affected SvO2 during the increase of CDP before and after lavage, a nonlinear regression fitting of the response in SvO2 on the predictors (PaO2 and CO) was implemented. Results. Before the lavage, with increasing of CDP, PaO2 remained constant, CO strongly decreased and SvO2 slightly decreased. After the lavage, with increasing of CDP, PaO2 strongly increased, CO decreased and SvO2 increased. So, development of SvO2 followed the PaO2 and CO trends. Changes in PaO2 and CO occur at decisive CDP step and it was much higher after the lung lavage compared to the healthy lungs. The implemented nonlinear model gives a good goodness of fitting in all three pigs. The values of PaO2 and CO estimated coefficients changed at the same decisive step of CDP identified by the trends. Also the algorithm identified a CDP step much higher after the lung lavage

  3. Independent lung ventilation combined with HFOV for a patient suffering from tracheo-gastric roll fistula.

    Ichinose, Maki; Sakai, Hiroaki; Miyazaki, Ikuo; Muraoka, Akihiro; Aizawa, Miyuki; Igarashi, Kaigen; Okazaki, Atsushi


    This case report describes the difficult respiratory management of an esophageal cancer patient with acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) caused by a postoperative tracheogastric roll fistula. A single-lumen tracheal tube could not seal the fistula, and therefore a double-lumen tracheal tube (DLT) for the left side was used. Although the proximal cuff of the DLT failed to seal the fistula, independent lung ventilation (ILV) improved blood gas levels. During right thoracotomy, the left lung was ventilated conventionally with 5 cmH2O positive end-expiratory pressure (PEEP), and in addition, high-frequency oscillation ventilation (HFOV) to the right lung was employed. This combination allowed the maintenance of adequate oxygenation, and the HFOV to the right lung decreased the PaCO2 level during surgery without interruption of the surgical field. These techniques provided the opportunity to successfully remove a necrotic gastric roll and achieve closure of the fistula using an intercostal muscle flap. This report documents and discusses the difficulty of performing appropriate anesthetic management of a patient with these complex complications after esophageal surgery.

  4. 高频振荡通气在新生儿肺出血中的应用及护理分析%Application and nursing ofHFOV for pulmonary hemorrhage of newborn

    刘晓霞; 李怀营


    目的:探讨高频振荡通气治疗新生儿肺出血的疗效及最佳护理方法,寻求更好的护理措施。方法:选取2011年9月-2014年12月我科室收住的肺出血或其他疾病合并的肺出血患儿46例,按通气模式的不同随机分为两组,对比治疗前后血气改善情况、上机时间及并发症的发生率及成功率。结果:高频振荡通气组血气改善明显,上机时间缩短,并发症发生率降低,抢救成功率提高。结论:高频振荡通气是治疗新生儿肺出血最有效的手段,精心的专科护理是提高成功率的关键。%Objective: To explore efifcacy of HFOV on pulmonary hemorrhage of newborn. Methods: 46 cases were divided into two groups according to ventilation mode. Before and after treatment, improvement of blood and the efifcacy of incident and success of complications during treatment time were compared. Results: In the HFOV group, Xueqi was obviously improved; treatment time was shorter; the efifciency of complications was reduced; the successful cases were increased. Conclusion: HFOV was effective on pulmonary hemorrhage of newborn. Intensive nursing was the key to help the success.

  5. Prolonged-Release Oxycodone/Naloxone Improves Anal Sphincter Relaxation Compared to Oxycodone Plus Macrogol 3350.

    Poulsen, Jakob Lykke; Brock, Christina; Grønlund, Debbie; Liao, Donghua; Gregersen, Hans; Krogh, Klaus; Drewes, Asbjørn Mohr


    Opioid analgesics inhibit anal sphincter function and contribute to opioid-induced bowel dysfunction (OIBD). However, it is unknown whether the inhibition can be reduced by opioid antagonism with prolonged-release (PR) naloxone and how this compares to laxative treatment. To compare the effects of combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350 on anal sphincter function and gastrointestinal symptoms. A randomized, double-blind, crossover trial was conducted in 20 healthy men. Participants were treated for 5 days with combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350. Resting anal pressure, anal canal distensibility, and relaxation of the internal sphincter to rectal distension were evaluated before treatment (baseline) and on day 5. The Patient Assessment of Constipation Symptom (PAC-SYM) questionnaire, stool frequency, and stool consistency were assessed daily. Both PR oxycodone/naloxone and PR oxycodone plus macrogol treatment decreased sphincter relaxation compared to baseline (- 27.5%; P anal pressure and anal canal distensibility did not differ between treatments. PAC-SYM abdominal symptoms score was lower during PR naloxone compared to macrogol (0.2 vs. 3.2; P = 0.002). The number of bowel movements was lower during PR naloxone versus macrogol (4.2 vs. 5.4; P = 0.035). Relaxation of the internal anal sphincter was significantly better after PR oxycodone/naloxone treatment compared to PR oxycodone plus macrogol 3350. These findings highlight that OIBD may require specific therapy against the complex, pan-intestinal effects of opioids.

  6. Stimulated contractions delay and prolong central fatigue compared with voluntary contractions in men.

    Chaubet, Vincent; Cormery, Bruno; Maitre, Julien; Paillard, Thierry


    Voluntary and stimulated contractions are commonly used in sports training and rehabilitation, and it is well known that both these kinds of contractions generate central fatigue. However, to date, there is a lack of research on the comparison of the mechanisms by which these 2 exercises induce central disturbances. Central fatigue can be characterized by central activation failure during maximal voluntary contraction (MVC). Superimposition of an electrical stimulation onto MVC has been used to detect central activation failure. Completeness of activation has been quantified by the central activation ratio (CAR) = MVC/(MVC + stimulated force). The aim was not only to evaluate the CAR immediately after fatiguing voluntary (VOL) and stimulated (STIM) contractions but also to compare recovery duration over different time periods (prefatigue: PRE condition; immediate postfatigue: POST condition; after a 5-minute recovery: POST 5 condition; after a 30-minute recovery: POST 30 condition) (n = 18). Results showed that in the POST condition, the CAR is more affected for the VOL contractions than for the STIM contractions (p contractions only in the POST 5 condition (p contractions, whereas it was complete for the VOL contractions (p contractions alter the CAR more than the STIM contractions immediately after their completion. However, the effects of the STIM contractions on the CAR are delayed and prolonged.

  7. [A comparative study of antiarrhythmic and antihypoxic effects of magnesium sulfate, its prolonged form and blockers of calcium channels].

    Samsonia, M D; Kandelaki, M A


    The aim of the study is the comparative study of treatment of heart and brain damages during the hypoxia with magnesium sulfate, verapamil, diltiazem. As a result of the experiment carried out on rats it was proved that magnesium sulfate and its prolonged form are not less active than the blockers of calcium channels, such as verapamil and diltiazem. It is possible to avoid lethal fibrillations caused by calcium chloride with the help of 25% magnesium sulfate solution (after intraperitoneal administration with the dose of 1000 mg/kg) in case we make arrythmogenic injection 5 minutes after inputting magnesium sulfate solution. During the arrhythmia induced by calcium chloride prolonged form of magnesium sulfate is also effective only if we inject the drug subcutaneous 30 minutes before the arrythmogenic injection. If the interval is 5 minutes lethal fibrillations cant be avoided as the release of magnesium ions from the drug form is slowed down. The drugs containing magnesium ions also displayed cytoprotective activity on the model of normobaric hypoxia. This was resulted in the increase of protective index. Neuroprotective action of magnesium ions (in the condition of hypoxia) is caused by maintaining homeostasis of calcium ions and by inhibition of exocytosis of neuromediators in the synaptic cleft. Thus, magnesium sulfate and its prolonged form can be used with the purpose of pharmacocorrection of heart and brain injuries during hypoxic conditions.




    Full Text Available : BACKGROUND: The prolongation of spinal anaesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha-2 agonist, dexmedetomidine has been proved to prolong the spinal anaesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block also prolongs spinal analgesia. A placebo controlled randomized controlled trial study was done. METHODOLOGY: 50 Patients were randomly allocated into two equal groups group D and group C. Both group received spinal hyperbaric bupivacaine 15mg intrathecally. Patients in group D received intravenously a loading dose of 1mcg/kg dexmedetomidine over 10 min followed by C maintenance dose of 0.5mcg/kg/hr till the end of surgery. Patients in group C (The control group received normal saline. The regression times to reach S1 sensory level and bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (264.32+15.3 min vs 164.2+13.12 min, p 0.001. The duration of motor block was longer in dexmedetomidine group than control group (198.8+16.9 min vs 135.8+12.38 min, p 0.001 CONCLUSION: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability. The incidence of bradycardia is significantly high when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anaesthesia. Dexmedetomidine induced bradycardia and hypotension can be easily managed with atropine and mephentermine respectively. Dexmedetomidine provides excellent sedation and postoperative analgesia.

  9. Unique and shared responses of the gut microbiota to prolonged fasting: a comparative study across five classes of vertebrate hosts.

    Kohl, Kevin D; Amaya, James; Passement, Celeste A; Dearing, M Denise; McCue, Marshall D


    Many animals face unpredictable food sources and periods of prolonged fasting, which likely present significant challenges to gut microorganisms. While several studies have demonstrated that fasting impacts the gut microbiota, experiments have not been carried out in a comparative context. We used 16S rRNA gene sequencing to document changes in colonic and cecal microbiomes of animals representing five classes of vertebrates at four time points through prolonged fasting: tilapia, toads, geckos, quail, and mice. We found differences in the starvation-induced changes in the microbiome across host species and across gut regions. Microbial phylogenetic diversity increased as a result of fasting in the colons of fish, toads, and mice, while quail exhibited a decrease in diversity; geckos exhibited no change. Microbial diversity in the cecum decreased in fish and exhibited no change in mice. Alterations in relative abundances of microbial taxa varied across hosts. Fish exhibited the most significant changes due to fasting, while geckos maintained a stable community over 28 days of fasting. We uncovered several shared responses of the microbiota across hosts. For example, all tetrapods exhibited decreases in the abundances of Coprobacillus and Ruminococcus in response to fasting. We also discuss host-mediated physiological mechanisms that may underlie these community changes.

  10. The Combination of IV and Perineural Dexamethasone Prolongs the Analgesic Duration of Intercostal Nerve Blocks Compared with IV Dexamethasone Alone.

    Maher, Dermot P; Serna-Gallegos, Derek; Mardirosian, Rodney; Thomas, Otto J; Zhang, Xiao; McKenna, Robert; Yumul, Roya; Zhang, Vida


     The use of multiple-level, single-injection intercostal nerve blocks for pain control following video-assisted thorascopic surgery (VATS) is limited by the analgesic duration of local anesthetics. This study examines whether the combination of perineural and intravenous (IV) dexamethasone will prolong the duration of intraoperatively placed intercostal nerve blocks following VATS compared with IV dexamethasone and a perineural saline placebo.  Prospective, double-blind, randomized placebo-controlled trial.  Single level-1 academic trauma center.  Forty patients undergoing a unilateral VATS under the care of a single surgeon.  Patients were randomly assigned to two groups and received an intercostal nerve block containing 1) 0.5% bupivacaine with epinephrine and 1 ml of 0.9% saline or 2) 0.5% bupivacaine with epinephrine and 1 ml of a 4 mg/ml dexamethasone solution. All patients received 8 mg of IV dexamethasone.  Group 2 had lower NRS-11 scores at post-operative hours 8 (5.05, SD = 2.13 vs 3.50, SD = 2.50; p  = 0.04), 20 (4.30, SD = 2.96 vs 2.26, SD = 2.31; p  = 0.02), and 24 (4.53, SD = 1.95 vs 2.26, SD = 2.31; p  = 0.02). Equianalgesic opioid requirement was decreased in group 2 at 32 hours (5.78 mg, SD = 5.77 vs 1.67 mg, SD = 3.49; p  = 0.02). Group 2 also had greater FEV1 measured at 8, 12, 24, and 44 hours; greater FVC at 24 hours; greater PEF at 28 through 48 hours; and greater FEV1/FVC at 8 and 36 hours.  The combination of IV and perineural dexamethasone prolonged the duration of a single-injection bupivacaine intercostal nerve block as measured by NRS-11 compared with IV dexamethasone alone at 24 hours. Reduced NRS-11 at other times, reduced opioid requirements, and increased PFTs were observed in group 2.

  11. Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials

    Van Arendonk Kyle J


    Full Text Available Abstract Background The emergence of multi-drug resistant Gram-negatives (MDRGNs coupled with an alarming scarcity of new antibiotics has forced the optimization of the therapeutic potential of available antibiotics. To exploit the time above the minimum inhibitory concentration mechanism of β-lactams, prolonging their infusion may improve outcomes. The primary objective of this meta-analysis was to determine if prolonged β-lactam infusion resulted in decreased mortality and improved clinical cure compared to intermittent β-lactam infusion. Methods Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL. Heterogeneity was assessed qualitatively, in addition to I2 and Chi-square statistics. Pooled relative risks (RR and 95% confidence intervals (CI were calculated using Mantel-Haenszel random-effects models. Results Fourteen randomized controlled trials (RCTs were included. Prolonged infusion β-lactams were not associated with decreased mortality (n= 982; RR 0.92; 95% CI:0.61-1.37 or clinical cure (n = 1380; RR 1.00 95% CI:0.94-1.06 compared to intermittent infusions. Subgroup analysis for β-lactam subclasses and equivalent total daily β-lactam doses yielded similar results. Most studies had notable methodological flaws. Conclusions No clinical advantage was observed for prolonged infusion β-lactams. The limited number of studies with MDRGNs precluded evaluation of prolonged infusion of β-lactams for this subgroup. A large, multicenter RCT with critically ill patients infected with MDRGNs is needed.

  12. Clinical nursing of HFOV plus CMV on premature newborns with hyaline membrane disease%高频振荡通气加常频通气治疗早产儿肺透明膜病的临床和护理研究

    叶蕾; 杨小红; 孙小娟


    Objective To study the effect and nursing strategies of high frequency oscillatory ventilation (HFOV) plus conventional mandatory ventilation (CMV)on treating critical hyaline membrane disease(HMD). Methods A total of 18 infants with critical HMD in the NICU from January 2009 to December 2010 were enrolled and divided into treatment group(HFOV plus CMV) and control group(CMV). Clinical efficacy, ventilator parameters, blood gas analysis and complications (pneumothorax, intracranial hemorrhage) were compared between the two groups. Nursing strategies were summarized accordingly. Results After 24 h treatment, PO2, MAP, OI and outcome of the treatment group were better than those of the control group (P<0. 05). Compared with the control group, the incidence of pneumothorax in the treatment group was significantly low-er(P<0.05). But no statistical significance was found in incidence of intracranial hemorrhage between the two groups(P<0. 05). Conclusion HFOV plus CMV can improve lung oxygenation and clinical outcome, and reduce the incidence rate of pneumothorax without increasing the risk of intracranial hemorrhage. The effect is superior to conventional mandatory ventilation. During the treatment process, nursing cooperation related to high - quality mechanical ventilation is paramount to an successful treatment.%目的 研究高频振荡通气加常频通气治疗早产儿肺透明膜病的临床疗效和护理特点.方法 以2009年1月~2010年12月在本院新生儿重症监护室(NICU)住院采用机械通气治疗的18例早产儿肺透明膜病(HMD)患儿为研究对象,随机分为研究组10例和对照组8例,研究组通气模式为高频振荡通气加常频通气,对照组采用为常频通气模式,比较两组患儿上机后临床疗效、呼吸机参数、氧合指标以及气胸、颅内出血等并发症的发生率,同时总结高频振荡通气加常频通气的护理特点和体会.结果 研究组上机24 h后吸氧浓度(FiO2)、平均气道

  13. 西地那非联合高频振荡通气治疗新生儿持续肺动脉高压的疗效%Sildenafil combining HFOV in treating persistent pulmonary hypertension of newborn

    陈爱萍; 李志飞


    Objective To investigate the efficacy and adverse reactions of sildenafil combined with high-frequency oscillatory ventilation ( HFOV) on persistent pulmonary hypertension of newborn ( PPHN) .Methods From February 2014 to February 2015 60 neonates with PPHN hospitalized in pediatrics department of Affiliated Hospital of Medical College of Ningbo University were divided into control group and observation group randomly with 30 cases in each.Pulmonary arterial pressure (SPAP), systemic blood pressure (SBP), arterial oxygen partial pressure ( PaO2 ) , arterial blood oxidation carbon partial pressure ( PaCO2 ) , inhalation of oxygen ( FiO2 ) and arterial oxygen saturation ( SaO2 ) before and after treatment were monitored for all patients.The control group was treated with HFOV, while the observation group was treated with sildenafil combined with HFOV.Arterial blood gas and pulmonary artery pressure before and 3 days after treatment, and adverse reactions were monitored.Results After treatment, PaO2 and SaO2 of two groups were significantly higher than those before treatment ( t value of control group was 2.011 and 2.241, respectively, t value of observation group was 2.939 and 2.839, respectively, all P0.05).Total effective rate of the observation group (96.7%) was significantly higher than that (83.3%) in the control group (χ2 =4.403,P0.05). 观察组治疗总有效率为96.7%,对照组为83.3%,观察组显著高于对照组(χ2 =4.403,P<0.05). 结论 西地那非联合高频振荡通气可能是一种更为有效和安全的临床治疗方法,值得临床推广应用.

  14. Comparable Effects of High-Intensity Interval Training and Prolonged Continuous Exercise Training on Abdominal Visceral Fat Reduction in Obese Young Women

    Haifeng Zhang


    Full Text Available This study compared the effect of prolonged moderate-intensity continuous training (MICT on reducing abdominal visceral fat in obese young women with that of work-equivalent (300 kJ/training session high-intensity interval training (HIIT. Forty-three participants received either HIIT (n=15, MICT (n=15, or no training (CON, n=13 for 12 weeks. The abdominal visceral fat area (AVFA and abdominal subcutaneous fat area (ASFA of the participants were measured through computed tomography scans preintervention and postintervention. Total fat mass and the fat mass of the android, gynoid, and trunk regions were assessed through dual-energy X-ray absorptiometry. Following HIIT and MICT, comparable reductions in AVFA (−9.1, −9.2 cm2, ASFA (−35, −28.3 cm2, and combined AVFA and ASFA (−44.7, −37.5 cm2, p>0.05 were observed. Similarly, reductions in fat percentage (−2.5%, −2.4%, total fat mass (−2.8, −2.8 kg, and fat mass of the android (−0.3, −0.3 kg, gynoid (−0.5, −0.7 kg, and trunk (−1.6, −1.2 kg, p>0.05 regions did not differ between HIIT and MICT. No variable changed in CON. In conclusion, MICT consisting of prolonged sessions has no quantitative advantage, compared with that resulting from HIIT, in abdominal visceral fat reduction. HIIT appears to be the predominant strategy for controlling obesity because of its time efficiency.

  15. Comparable Effects of High-Intensity Interval Training and Prolonged Continuous Exercise Training on Abdominal Visceral Fat Reduction in Obese Young Women

    Zhang, Haifeng; Tong, Tom K.; Qiu, Weifeng; Zhang, Xu; Zhou, Shi


    This study compared the effect of prolonged moderate-intensity continuous training (MICT) on reducing abdominal visceral fat in obese young women with that of work-equivalent (300 kJ/training session) high-intensity interval training (HIIT). Forty-three participants received either HIIT (n = 15), MICT (n = 15), or no training (CON, n = 13) for 12 weeks. The abdominal visceral fat area (AVFA) and abdominal subcutaneous fat area (ASFA) of the participants were measured through computed tomography scans preintervention and postintervention. Total fat mass and the fat mass of the android, gynoid, and trunk regions were assessed through dual-energy X-ray absorptiometry. Following HIIT and MICT, comparable reductions in AVFA (−9.1, −9.2 cm2), ASFA (−35, −28.3 cm2), and combined AVFA and ASFA (−44.7, −37.5 cm2, p > 0.05) were observed. Similarly, reductions in fat percentage (−2.5%, −2.4%), total fat mass (−2.8, −2.8 kg), and fat mass of the android (−0.3, −0.3 kg), gynoid (−0.5, −0.7 kg), and trunk (−1.6, −1.2 kg, p > 0.05) regions did not differ between HIIT and MICT. No variable changed in CON. In conclusion, MICT consisting of prolonged sessions has no quantitative advantage, compared with that resulting from HIIT, in abdominal visceral fat reduction. HIIT appears to be the predominant strategy for controlling obesity because of its time efficiency. PMID:28116314

  16. An antithrombotic fucoidan, unlike heparin, does not prolong bleeding time in a murine arterial thrombosis model: a comparative study of Undaria pinnatifida sporophylls and Fucus vesiculosus.

    Min, Soon-Ki; Kwon, Oh-Choon; Lee, Sub; Park, Ki-Hyuk; Kim, Jong-Ki


    The antithrombotic activities and bleeding effects of selected fucoidans (source from either Undaria pinnatifida sporophylls or from Fucus vesiculosus) have been compared with heparin in the ferric chloride-induced arterial thrombus mouse model. Thrombosis was induced by applying 5% ferric chloride for 3 min on the carotid artery region of Balb/c mouse. Five minutes prior to thrombus induction, mice were infused through the tail vein with either saline (control) or polysaccharides. Either fucoidan or heparin was dosed at 0.1, 1.25, 2.5, 5.0, 10, 25, or 50 mg/kg intravenously (i.v.) The carotid blood flow was monitored until more than 60 min post-thrombus induction. Mouse tail transection bleeding time was measured up to 60 min after making a cut in the mouse tail. Both antithrombotic and bleeding effects were observed in a dose-dependent manner for both fucoidans and heparin. Thrombus formation was totally (reflected by Doppler flow meter) inhibited at either 5 or 50 mg/kg of unfractionated Undaria fucoidan or a low-molecular-weight Undaria fucoidan fraction, respectively, without prolonging the time-to-stop bleeding compared with the control (p Fucus fucoidan at 25 mg/kg where the time-to-stop bleeding was still significantly prolonged, by as much as 8 ± 1.7 min (p < 0.02). In contrast the heparin-treated group showed total inhibition of thrombus formation even at a small dose of 0.8 mg/kg (400 IU) at which bleeding continued until 60 min. In conclusion algal fucoidans are highly antithrombotic without potential haemorrhagic effects compared with heparin in the arterial thrombus model, but this property differs from algal species to species, and from the molecular structure of fucoidans.




    Full Text Available BACKGROUND : Addition of α2 adrenergic agonists with local anaesthetics in bupivacaine spinal anaesthesia prolongs the duration of sensory and motor blockade and postoperative analgesia with minimal haemod ynamic alterations. AIM AND OBJECTIVES: To compare and evaluate the efficacy of intravenous dexmedetomidine and clonidine as premedication on subarachnoid blockade duration, postoperative analgesia, and sedation score in patients undergoing lower limb orthopaedic surgeries in bupivacaine (0.5% heavy intrathecal block. MATERIALS AND METHOD S: We carried out a prospective, randomized, double blind study in which 60 patients of ASA status I or II, scheduled for orthopaedic lower limb surgery under spinal a naesthesia, were randomly allocated into two groups of 30 each group A and group B. Group A received dexmedetomidine 0.5μg/kg IV and group B received clonidine 1μg/kg in 10 ml of normal saline intravenously as premedication over 10 min., before subarachnoi d blockade with 3.0 ml. of 0.5% hyperbaric bupivacaine. Onset time and regression times of both sensory and motor blockade, haemodynamic parameters were recorded. Duration of postoperative analgesia and sedation score with adverse effects were also recorde d. RESULTS: The sensory block level was higher (T5 - T7 and earlier in onset (1.81±1.75min. in dexmedetomidine group than clonidine with level (T6 - T8 and onset (2.56±1.62min.. Dexmedetomidine also increased the onset (3.54±3.07min. and duration (265.45± 41.50min. of motor block achieved as compared to clonidine. The Ramsay sedation score was also greater in dexmedetomidine group than clonidine group (P<0.0001. CONCLUSION: Single dose of premedication with intravenous dexmedetomidine is better than intrav enous clonidine during bupivacaine spinal anaesthesia in orthopaedic lower limb surgeries for prolongation of sensory and motor blockade.

  18. Early and prolonged antiretroviral therapy is associated with an HIV-1-specific T-cell profile comparable to that of long-term non-progressors.

    Cristina Cellerai

    Full Text Available BACKGROUND: Intervention with antiretroviral treatment (ART and control of viral replication at the time of HIV-1 seroconversion may curtail cumulative immunological damage. We have therefore hypothesized that ART maintenance over a very prolonged period in HIV-1 seroconverters could induce an immuno-virological status similar to that of HIV-1 long-term non-progressors (LTNPs. METHODOLOGY/PRINCIPAL FINDINGS: We have investigated a cohort of 20 HIV-1 seroconverters on long-term ART (LTTS and compared it to one of 15 LTNPs. Residual viral replication and reservoirs in peripheral blood, as measured by cell-associated HIV-1 RNA and DNA, respectively, were demonstrated to be similarly low in both cohorts. These two virologically matched cohorts were then comprehensively analysed by polychromatic flow cytometry for HIV-1-specific CD4(+ and CD8(+ T-cell functional profile in terms of cytokine production and cytotoxic capacity using IFN-γ, IL-2, TNF-α production and perforin expression, respectively. Comparable levels of highly polyfunctional HIV-1-specific CD4(+ and CD8(+ T-cells were found in LTTS and LTNPs, with low perforin expression on HIV-1-specific CD8(+ T-cells, consistent with a polyfunctional/non-cytotoxic profile in a context of low viral burden. CONCLUSIONS: Our results indicate that prolonged ART initiated at the time of HIV-1 seroconversion is associated with immuno-virological features which resemble those of LTNPs, strengthening the recent emphasis on the positive impact of early treatment initiation and paving the way for further interventions to promote virological control after treatment interruption.

  19. Prolonged release oxycodone and naloxone treatment counteracts opioid-induced constipation in patients with severe pain compared to previous analgesic treatment.

    Koopmans-Klein, Gineke; Van Op den Bosch, Joeri; van Megen, Yvonne; Prenen, Hans; Huygen, Frank; Mancini, Isabelle


    Treatment with prolonged-release oxycodone/naloxone (PR OXN) has been shown to improve opioid induced constipation (OIC) in constipated patients. This publication reports on a real-life observational study investigating the efficacy of PR OXN with regard to bowel function in patients switching to PR OXN from WHO-step 1, step 2 and step 3 opioids. Patients with chronic pain experiencing insufficient pain relief and/or unacceptable side effects were switched to PR OXN and monitored in this observational study with respect to efficacy regarding bowel function and efficacy regarding pain relief in comparison with previous analgesic therapy. A patient was considered responder with respect to efficacy if this assessment was 'slightly better', 'better' or 'much better' compared with previous therapy. Bowel function index, pain intensity, quality of life, laxative medication use, and safety analgesic were also evaluated. 1,338 patients (mean (sd) age 64.3 (14.9), 63% female) were observed for 43 [3-166] days (median [range]) during treatment with PR OXN. Overall response rate regarding bowel function efficacy was 82.5%. Patients with symptoms of constipation at study entry obtained a clinically relevant improvement of the bowel function index (BFI) within the first 2 weeks of PR OXN treatment. Non-constipated patients at study entry maintained normal bowel function despite switching to treatment with the opioid PR OXN. In conclusion, treatment with PR OXN results in a significant and clinically relevant improvement of bowel function. During the observation of the treatment with PR OXN patients reported an improvement of QoL. More interestingly, non-constipated patients maintained a normal bowel function, showing prevention of constipation despite the use of an opioid.

  20. Treating Low-Income and Minority Women with Posttraumatic Stress Disorder: A Pilot Study Comparing Prolonged Exposure and Treatment as Usual Conducted by Community Therapists

    Feske, Ulrike


    Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominately low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community…

  1. [Dopplerometry at prolonged pregnancy].

    Salii-Prenichi, L; Milchev, N; Markova, D; Apiosjan, Zh


    Prolonged pregnancy, associated with low amniotic fluid is a reason for the increase of fetal mortality and morbidity. There is no a define test at prolonged pregnancy which can determine which pregnancy are at a risk for adverse outcome and complications. Dopplerometry as a noninvasive method for examination of blood circulation, and especially a. cerebri media and a. umbilicalis can be used for the prediction of the outcome of prolonged pregnancy.

  2. Prolonged QT interval in Rett syndrome


    Rett syndrome is a severe neurodevelopmental disorder of unknown aetiology. A prolonged QT interval has been described previously in patients with Rett syndrome. To investigate QT prolongation and the presence of cardiac tachyarrhythmias in Rett syndrome electrocardiography and 24 hour Holter monitoring were performed prospectively in a cohort of 34 girls with Rett syndrome. The corrected QT value was prolonged in nine patients. Compared with a group of healthy controls of a...

  3. Comparative Evaluation of Human Mesenchymal Stem Cells of Fetal (Wharton's Jelly and Adult (Adipose Tissue Origin during Prolonged In Vitro Expansion: Considerations for Cytotherapy

    I. Christodoulou


    Full Text Available Mesenchymal stem cells (MSCs are somatic cells with a dual capacity for self-renewal and differentiation, and diverse therapeutic applicability, both experimentally and in the clinic. These cells can be isolated from various human tissues that may differ anatomically or developmentally with relative ease. Heterogeneity due to biological origin or in vitro manipulation is, nevertheless, considerable and may equate to differences in qualitative and quantitative characteristics which can prove crucial for successful therapeutic use. With this in mind, in the present study we have evaluated the proliferation kinetics and phenotypic characteristics of MSCs derived from two abundant sources, that is, fetal umbilical cord matrix (Wharton's jelly and adult adipose tissue (termed WJSC and ADSC, resp. during prolonged in vitro expansion, a process necessary for obtaining cell numbers sufficient for clinical application. Our results show that WJSC are derived with relatively high efficiency and bear a substantially increased proliferation capacity whilst largely sustaining the expression of typical immunophenotypic markers, whereas ADSC exhibit a reduced proliferation potential showing typical signs of senescence at an early stage. By combining kinetic with phenotypic data we identify culture thresholds up to which both cell types maintain their stem properties, and we discuss the practical implications of their differences.

  4. A Comparative Effectiveness Study of Rescue Strategies in 1,000 Subjects With Severe Hypoxemic Respiratory Failure.

    Moreno Franco, Pablo; Enders, Felicity; Wilson, Gregory; Gajic, Ognjen; Pannu, Sonal R


    Subjects with severe hypoxemic respiratory failure have shown a high mortality in previous studies. All adult ICU patients requiring mechanical ventilation from 2005 to 2010 at Mayo Clinic were screened for severe hypoxemia (Murray lung injury score of ≥ 3). Extracorporeal membrane oxygenation, prone positioning, high-frequency oscillatory ventilation (HFOV), and inhaled vasodilators were considered as rescue strategies. A propensity-based scoring was created for the indication or predilection to use each strategy. A model was created to evaluate the association of each rescue strategy with hospital mortality. Among 1,032 subjects with severe hypoxemia, 239 subjects received some form of rescue strategy (59 received a combination of therapies, and 180 received individual therapies). Inhaled vasodilators were the most common, followed by HFOV. Rescue strategies were used in younger subjects with severe oxygenation deficits. Subjects receiving rescue strategies had higher mortality and longer ICU stays. None of the strategies individually or in combination showed a significant association with hospital mortality after adjusting covariates by propensity scoring. Adjusted Odds ratios and respective 95% CI were as follows: HFOV 0.67 (0.35-1.27), extracorporeal membrane oxygenation 0.63 (0.18-1.92), prone position 1.07 (0.49-2.28), and inhaled vasodilators 1.17 (0.78-1.77). In this retrospective comparative effectiveness study, there was no association of rescue strategies with hospital mortality in subjects with severe hypoxemia. Copyright © 2016 by Daedalus Enterprises.

  5. Exhaustion from prolonged gambling

    Fatimah Lateef


    Full Text Available Complaints of fatigue and physical exhaustion are frequently seen in the acute medical setting, especially amongst athletes, army recruits and persons involved in strenuous and exertional physical activities. Stress-induced exhaustion, on the other hand, is less often seen, but can present with very similar symptoms to physical exhaustion. Recently, three patients were seen at the Department of Emergency Medicine, presenting with exhaustion from prolonged involvement in gambling activities. The cases serve to highlight some of the physical consequences of prolonged gambling.

  6. Exhaustion from prolonged gambling

    Fatimah Lateef


    Complaints of fatigue and physical exhaustion are frequently seen in the acute medical setting, especially amongst athletes, army recruits and persons involved in strenuous and exertional physical activities.Stress-induced exhaustion, on the other hand, is less often seen, but can present with very similar symptoms to physical exhaustion.Recently, three patients were seen at theDepartment ofEmergencyMedicine, presenting with exhaustion from prolonged involvement in gambling activities.The cases serve to highlight some of the physical consequences of prolonged gambling.

  7. Cladribine prolongs progression-free survival and time to second treatment compared to fludarabine and high-dose chlorambucil in chronic lymphocytic leukemia.

    Mulligan, Stephen P; Karlsson, Karin; Strömberg, Mats; Jønsson, Viggo; Gill, Devinder; Hammerström, Jens; Hertzberg, Mark; McLennan, Roger; Uggla, Bertil; Norman, John; Wallvik, Jonas; Sundström, Gunnel; Johansson, Hemming; Brandberg, Yvonne; Liliemark, Jan; Juliusson, Gunnar


    We conducted a randomized phase III trial to compare the efficacy and safety of two purine analogs, cladribine and fludarabine, with high-dose chlorambucil, in patients with previously untreated chronic lymphocytic leukemia (CLL). Between 1997 and 2004, 223 patients with CLL were randomly assigned to cladribine, fludarabine or chlorambucil, for six cycles of therapy with frequent health-related quality of life assessments. There was no statistical difference for the primary endpoint of overall response with cladribine (70%), fludarabine (67%) and chlorambucil (59%), or complete remission (12%, 7% and 8%), respectively. However, the median progression-free survival (25, 10, 9 months) and median time to second treatment (40, 22, 21 months) were superior with cladribine. There was no significant difference in overall survival (96, 82 and 91 months), nor in toxicity or HRQoL assessments. Monotherapy with cladribine gives superior PFS and longer response duration than fludarabine and chlorambucil as first-line treatment of CLL.

  8. Deciding about treatments that prolong life

    Palliative care - treatments that prolong life; Palliative care - life support; End-of-life-treatments that prolong life; Ventilator - treatments that prolong life; Respirator - treatments that prolong life; ...

  9. [The comparative characteristics of the bone marrow cellular composition in rats after the prolonged continuous or interrupted action of a low geomagnetic field].

    Azarenko, V V; Smirnov, R V


    Bone marrow cell composition in male Wistar rats exposed to long-term continuous (Run 1) or interrupted (Run 2) hypo-geomagnetic field (HGMF) with an attenuation coefficient of 172.5 generating in a permalloic chamber has been studied. When comparing the rat myelograms of the two test runs, a significant increase of lymphoid cell content, less pronounced during an interrupted exposure to HGMF by 10.1 and 6.5%, respectively, was noted. Analysis of myeloid cell response indicated that on a continuous exposure to HGMF the percentage of neutrophilic promyelocytes and myelocytes is somewhat declined. The levels of mature relating to stab and nuclear-segmental neutrophils in bone marrow during both modes of HGMF exposures practically remained unchanged. A certain decrease in cell fractions of erythroblastic shoot (chiefly at the cost of polychromatophilic normocytes), to a lesser extent manifested during an interrupted exposure to HGMF (by 5.8 and 2.4%, respectively) was noted. Long-term exposure of the animals to a weak terrestrial magnetic field causes a particular eosinophilia of bone marrow due to an increased fraction of mature eosinophils approximately similar on both HGMF profiles (by 2.1 and 2.0% respectively). On an interrupted HGMF exposure there was a significant myelogram elevation of the mast cell counts by 1.4%.

  10. Prolonged labour : women's experiences

    Nystedt, Astrid


    Aim: The overall aim of this thesis was to illuminate, describe, and promote understanding of women’s experiences of prolonged labour. The thesis compromises four studies. Methods: Paper I describes a case-referent study that recruited women (n = 255) giving singleton live birth to their first child by spontaneous labour after more than 37 completed weeks’ pregnancy. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships, and childhood e...

  11. Comparative analysis of ECGs in navy personnel onboard large and small vessels during prolonged deployment at sea%海军护航不同舰艇官兵的心电图对比分析

    杨翅; 蒋建华; 柳兵; 陈文; 彭焕亭


    目的:观察海军大、小不同类型舰艇亚丁湾护航返回官兵心电图特点。方法对赴亚丁湾海域护航返回的某补给舰(简称大舰组)140名官兵、某护卫舰(简称小舰组)79名官兵,分别在2艘舰艇返回靠泊的当天,行常规体表12导联心电图检测,比较心电图异常及心率、各波间期的变化情况。结果小舰组官兵室性早搏发生率高于大舰组官兵,差异有统计学意义(P<0.05);心率、左心室高电压、ST-T改变、早期复极、间歇性Ⅰ度或Ⅱ度Ⅰ型房室传导阻滞及各波形的间期差异均无统计学意义(P>0.05)。结论小舰官兵心律失常发生率高于大舰官兵,可能与小舰官兵自主神经功能失衡程度高,造成交感神经兴奋性增高有关。%Objective To observe the change features of ECG in navy personnel onboard large and small vessels after they re -turn from prolonged deployment to the Gulf of Aden .Methods One hundred and forty navy personnel onboard the auxiliary ship ( sim-ply designated as the large vessel ) and 79 people onboard the escort ( simply called the small vessel ) respectively received routine body surface 12-lead ECG detection , on the day they returned to the homeport , following prolonged deployment at sea .Abnormality in ECG and changes in heart rate and wave intervals were compared between the 2 ship crews.Results The incidence of premature ventricular contraction for the afloat personnel onboard the small vessel was higher than that for those onboard the large vessel (P0.05).Conclusion The incidence of arrhythmia for the afloat personnel onboard small vessel was evidently higher than that for the afloat personnel onboard the large ves -sel, which might be related with autonomic nervous system dysfunction and increased sympathetic nerve excitability .

  12. Safety information on QT-interval prolongation

    Warnier, Miriam J; Holtkamp, Frank A; Rutten, Frans H;


    Prolongation of the QT interval can predispose to fatal ventricular arrhythmias. Differences in QT-labeling language can result in miscommunication and suboptimal risk mitigation. We systematically compared the phraseology used to communicate on QT-prolonging properties of 144 drugs newly approve......) was moderate (kappa 0.434). However, the agreement in expected clinical decisions based on the product labels was much higher (kappa 0.673). The US drug label tends to be more explicit, especially when it considers absence of QT effects....


    Suzanne Schneider


    Full Text Available Prolonged exercise may compromise immunity through a reduction of salivary antimicrobial proteins (AMPs. Salivary IgA (IgA has been extensively studied, but little is known about the effect of acute, prolonged exercise on AMPs including lysozyme (Lys and lactoferrin (Lac. Objective: To determine the effect of a 50-km trail race on salivary cortisol (Cort, IgA, Lys, and Lac. Methods: 14 subjects: (6 females, 8 males completed a 50km ultramarathon. Saliva was collected pre, immediately after (post and 1.5 hrs post race ( 1.5. Results: Lac concentration was higher at 1.5 hrs post race compared to post exercise (p0.05. IgA concentration, secretion rate, and IgA/Osm were lower 1.5 hrs post compared to pre race (p<0.05. Cort concentration was higher at post compared to 1.5 (p<0.05, but was unaltered from pre race levels. Subjects finished in 7.81 ± 1.2 hrs. Saliva flow rate did not differ between time points. Saliva Osm increased at post (p<0.05 compared to pre race. Conclusions: The intensity could have been too low to alter Lys and Lac secretion rates and thus, may not be as sensitive as IgA to changes in response to prolonged running. Results expand our understanding of the mucosal immune system and may have implications for predicting illness after prolonged running.

  14. Prolonged unexplained fatigue in paediatrics

    Bakker, R.J.


    Prolonged Unexplained Fatigue in Paediatrics. Fatigue, as the result of mental or physical exertion, will disappear after rest, drinks and food. Fatigue as a symptom of illness will recover with the recovering of the illness. But when fatigue is ongoing for a long time, and not the result of exertio

  15. Prolongation structures for supersymmetric equations

    Roelofs, G.H.M.; Hijligenberg, van den N.W.


    The well known prolongation technique of Wahlquist and Estabrook (1975) for nonlinear evolution equations is generalized for supersymmetric equations and applied to the supersymmetric extension of the KdV equation of Manin-Radul. Using the theory of Kac-Moody Lie superalgebras, the explicit form of

  16. [Prolonged pain in neonates: retrospective analysis].

    Lilla, Michèle; Stadelman-Diaw, Corinne; Ramelet, Anne-Sylvie


    Infants hospitalised in neonatology are inevitably exposed to pain repeatedly. Premature infants are particularly vulnerable, because they are hypersensitive to pain and demonstrate diminished behavioural responses to pain. They are therefore at risk of developing short and long-term complications if pain remains untreated. Compared to acute pain, there is limited evidence in the literature on prolonged pain in infants. However, the prevalence is reported between 20 and 40 %. This single case study aimed to identify the bio-contextual characteristics of neonates who experienced prolonged pain. This study was carried out in the neonatal unit of a tertiary referral centre in Western Switzerland. A retrospective data analysis of seven infants' profile, who experienced prolonged pain ,was performed using five different data sources. The mean gestational age of the seven infants was 32weeks. The main diagnosis included prematurity and respiratory distress syndrome. The total observations (N=55) showed that the participants had in average 21.8 (SD 6.9) painful procedures that were estimated to be of moderate to severe intensity each day. Out of the 164 recorded pain scores (2.9 pain assessment/day/infant), 14.6 % confirmed acute pain. Out of those experiencing acute pain, analgesia was given in 16.6 % of them and 79.1 % received no analgesia. This study highlighted the difficulty in managing pain in neonates who are exposed to numerous painful procedures. Pain in this population remains underevaluated and as a result undertreated.Results of this study showed that nursing documentation related to pain assessment is not systematic.Regular assessment and documentation of acute and prolonged pain are recommended. This could be achieved with clear guidelines on the Assessment Intervention Reassessment (AIR) cyclewith validated measures adapted to neonates. The adequacy of pain assessment is a pre-requisite for appropriate pain relief in neonates.

  17. Prolonged fever after Infliximab infusion

    Jennifer; Katz; Michael; Frank


    Pharmacologic management for ulcerative colitis (UC) has recently been expanded to include antitumor necrosis factor (TNF) therapy for severe disease. Infliximab, a chimeric monoclonal antibody directed again TNF α was first tested in patients with Crohn’s disease. In addition to serious infections, malignancy, drug induced lupus and other autoimmune diseases, serum sickness-like reactions, neurological disease, and infusion reactions further complicate the use of Infliximab. We report a case of prolonged fever after Infliximab infusion to treat steroid refractory UC.

  18. Patient preference with respect to QoL and reduction in opioid-induced constipation (OIC) after treatment with prolonged-release (PR) oxycodone/naloxone compared with previous analgesic therapy [PREFER study].

    van Dongen, V C P C; Vanelderen, P J L; Koopmans-Klein, G; van Megen, Y J B; Van Zundert, J; Huygen, F J P M


    The aim of this study was to assess patient preference in terms of quality of life (QoL), analgesia and bowel function for patients with moderate to severe chronic non-malignant pain, when treated with oxycodone PR/naloxone PR compared with the previous WHO-step I and/or WHO-step II analgesic treatment . This was a 3-week open-label phase 3b study conducted in Belgium and the Netherlands, after 3 weeks patients could enter an extension phase. Patient preference with respect to QoL for oxycodone PR/naloxone PR treatment compared with previous WHO-step I and/or WHO-step II analgesics was assessed. A patient was considered a responder with respect to QoL if this assessment was 'better' or 'much better' compared with previous WHO-step I or II analgesics at any time point. Response rate with respect to QoL was 59.2% (95% CI: 51.7-66.8%) for the Full Analysis (FA)-population, for the Per Protocol-population response rate was 71.7% (95% CI: 63.1-80.3%). Explorative analysis showed that response rate with respect to QoL was highest in constipated patients pretreated with WHO-step II analgesics (73.8%). Mean ± SD pain score in the FA-population at start was 74.7 ± 16.6 decreasing to 53.9 ± 24.3 after a median (range) treatment period of 173.5 (31-771) days. For constipated subjects the significant reduction in constipation [improvement of the Bowel Function Index (BFI)], was -24.8 points (95% CI: -17.1 to -32.5). BFI for non-constipated subjects remained well below 28.8. Adverse events with oxycodone PR/naloxone PR treatment were well-known opioid-related adverse events. This study shows that the studied patients previously treated with WHO-step I and/or WHO-step II analgesics prefer treatment with oxycodone PR/naloxone PR with respect to QoL. Moreover, the study shows that treatment with oxycodone PR/naloxone PR significantly reduces OIC in constipated patients and that non-constipated patients do not develop OIC during treatment with oxycodone PR/naloxone PR.

  19. Comparative study of the efficacy of transdermal buprenorphine patches and prolonged-release tramadol tablets for postoperative pain control after spinal fusion surgery: a prospective, randomized controlled non-inferiority trial.

    Kim, Ho-Joong; Ahn, Hyo Sae; Nam, Yunjin; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S


    To compare the efficacy of a transdermal buprenorphine patch (5, 10, 15, and 20 μg/h) with that of oral tramadol (150, 200, 250, and 300 mg) for postoperative pain control after single level spinal fusion surgery. The present study (, number NCT02416804) was a prospective, randomized controlled non-inferiority trial designed to determine the efficacy of buprenorphine TDS for alleviating postoperative pain following patient controlled analgesia (PCA) in persons underwent a single level posterior lumbar interbody fusion surgery through 1:1 allocation. The primary outcome was the Visual Analog Pain Scale (VAS) score for postoperative back pain at 7 days after surgery. The non-inferior margin of the VAS was set at δ = 1.5 points. The VAS score (primary outcome) for postoperative back pain at 7 days after surgery in the Buprenorphine group was not inferior compared to the Tramadol group. The overall changes in VAS scores for postoperative pain during follow-up assessments over a 2-week period did not differ between both groups. However, the VAS scores for postoperative pain significantly improved with time after surgery in both groups. The patterns of changes in the VAS scores for postoperative pain during the follow-up period were not significantly different between the both groups. The efficacy of buprenorphine TDS was not inferior to that of oral tramadol medication for alleviating postoperative pain in the subacute period from 72 h after surgery, following PCA administration. In addition, adverse events were similar between both groups.

  20. Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment

    Nystedt, Astrid; Hildingsson, Ingegerd


    Background: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. Method: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic an...

  1. Prolonged Pregnancy: Methods, Causal Determinants and Outcome

    Olesen, Annette Wind

    Summary Prolonged pregnancy, defined as a pregnancy with a gestational length of 294 days or more, is a frequent condition. It is associated with an increased risk of fetal and maternal complications. Little is known about the aetiology of prolonged pregnancy. The aims of the thesis were 1...

  2. Prenatal risk indicators of a prolonged pregnancy

    Olesen, Annette Wind; Westergaard, Jes Grabow; Olsen, Jørn


    BACKGROUND: Few prenatal risk factors of prolonged pregnancy, a pregnancy of 42 weeks or more, are known. The objective was to examine whether sociodemographic, reproductive, toxicologic, or medical health conditions were associated with the risk of prolonged pregnancy. METHODS: Data from the Dan...

  3. Risk factors for a prolonged operative time in a single-incision laparoscopic cholecystectomy

    Sato, Norihiro; Yabuki, Kei; Shibao, Kazunori; Mori, Yasuhisa; Tamura, Toshihisa; Higure, Aiichiro; Yamaguchi, Koji


    Background: A prolonged operative time is associated with adverse post-operative outcomes in laparoscopic surgery. Although a single-incision laparoscopic cholecystectomy (SILC) requires a longer operative time as compared with a conventional laparoscopic cholecystectomy, risk factors for a prolonged operative time in SILC remain unknown.

  4. QT Prolongation due to Graves’ Disease

    Zain Kulairi


    Full Text Available Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status.

  5. Hippocampal Abnormalities in Prolonged Febrile Seizures

    J Gordon Millichap


    Full Text Available Apparent diffusion coefficient (ADC measurements were used to characterize hippocampal edema within 5 days of a prolonged febrile seizure (PFS in a study at Great Ormond Street Hospital, London, UK.

  6. MRI Abnormalities After Prolonged Febrile Seizures

    J Gordon Millichap


    Full Text Available The clinical, radiologic, and laboratory findings of 17 Asian patients with encephalopathy following a prolonged febrile seizure were reviewed retrospectively at Kameda Medical Center, and other centers in Japan and San Francisco, USA.

  7. QT Prolongation due to Graves' Disease

    Deol, Nisha; Tolly, Renee; Manocha, Rohan; Naseer, Maliha


    Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status. PMID:28154763

  8. Fatigue associated with prolonged graded running.

    Giandolini, Marlene; Vernillo, Gianluca; Samozino, Pierre; Horvais, Nicolas; Edwards, W Brent; Morin, Jean-Benoît; Millet, Guillaume Y


    Scientific experiments on running mainly consider level running. However, the magnitude and etiology of fatigue depend on the exercise under consideration, particularly the predominant type of contraction, which differs between level, uphill, and downhill running. The purpose of this review is to comprehensively summarize the neurophysiological and biomechanical changes due to fatigue in graded running. When comparing prolonged hilly running (i.e., a combination of uphill and downhill running) to level running, it is found that (1) the general shape of the neuromuscular fatigue-exercise duration curve as well as the etiology of fatigue in knee extensor and plantar flexor muscles are similar and (2) the biomechanical consequences are also relatively comparable, suggesting that duration rather than elevation changes affects neuromuscular function and running patterns. However, 'pure' uphill or downhill running has several fatigue-related intrinsic features compared with the level running. Downhill running induces severe lower limb tissue damage, indirectly evidenced by massive increases in plasma creatine kinase/myoglobin concentration or inflammatory markers. In addition, low-frequency fatigue (i.e., excitation-contraction coupling failure) is systematically observed after downhill running, although it has also been found in high-intensity uphill running for different reasons. Indeed, low-frequency fatigue in downhill running is attributed to mechanical stress at the interface sarcoplasmic reticulum/T-tubule, while the inorganic phosphate accumulation probably plays a central role in intense uphill running. Other fatigue-related specificities of graded running such as strategies to minimize the deleterious effects of downhill running on muscle function, the difference of energy cost versus heat storage or muscle activity changes in downhill, level, and uphill running are also discussed.

  9. Differences in gene expression amplitude overlie a conserved transcriptomic program occurring between the rapid and potent localized resistant reaction at the syncytium of the Glycine max genotype Peking (PI 548402) as compared to the prolonged and potent resistant reaction of PI 88788.

    Klink, Vincent P; Hosseini, Parsa; Matsye, Prachi D; Alkharouf, Nadim W; Matthews, Benjamin F


    Glycine max L. Merr. (soybean) resistance to Heterodera glycines Ichinohe occurs at the site of infection, a nurse cell known as the syncytium. Resistance is classified into two cytologically-defined responses, the G. max ([Peking])- and G. max ([PI 88788])-types. Each type represents a cohort of G. max genotypes. Resistance in G. max ([Peking]) occurs by a potent and rapid localized response, affecting parasitic second stage juveniles (p-J2). In contrast, resistance occurs by a potent but more prolonged reaction in the genotype G. max ([PI 88788]) that affects nematode development at the J3 and J4 stages. Microarray analyses comparing these cytologically and developmentally distinct resistant reactions reveal differences in gene expression in pericycle and surrounding cells even before infection. The differences include higher relative levels of the differentially expressed in response to arachidonic acid 1 gene (DEA1 [Gm-DEA1]) (+224.19-fold) and a protease inhibitor (+68.28-fold) in G. max ([Peking/PI 548402]) as compared to G. max ([PI 88788]). Gene pathway analyses compare the two genotypes (1) before, (2) at various times during, (3) constitutively throughout the resistant reaction and (4) at all time points prior to and during the resistant reaction. The amplified levels of transcriptional activity of defense genes may explain the rapid and potent reaction in G. max ([Peking/PI 548402]) as compared to G. max ([PI 88788]). In contrast, the shared differential expression levels of genes in G. max ([Peking/PI 548402]) and G. max ([PI 88788]) may indicate a conserved genomic program underlying the G. max resistance on which the genotype-specific gene expression programs are built off.

  10. Quality of drug label information on QT interval prolongation

    Warnier, Miriam J; Holtkamp, Frank A; Rutten, Frans H;


    characteristics (SPC) of recently approved medicinal products. METHODS: Drug labels of products centrally approved in Europe between 2006 and 2012 were screened. Of drugs including the term 'QT' in the SPC, the message on QT-prolongation ('no prolongation'/'unclear drug-QT association'/'possibly QT......-prolongation'/'QT-prolongation') and the advice on cautionary measures pertaining to QT-prolongation in the label were examined, as well as their association. RESULTS: Of the 175 screened products, 44 contained information on QT in the SPC ('no QT-prolongation': 23%, 'unclear drug-QT association': 43%, 'possibly QT-prolongation': 16%, 'QT......-prolongation': 18%). 62% contained advices to act with caution in patients with additional risk factors for QT-prolongation. Products that more likely to have QT-prolonging properties according to the SPC provided more information on QT-prolongation in the SPC ('no prolongation': 10% and for the category 'QT...

  11. Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes

    Flethøj, M.; Schwarzwald, C. C.; Haugaard, M. M.;


    Background: Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown. Objectives :To investigate the effects of prolonged exercise on LV systolic...

  12. Prolonged hyperprolactinemia in preterm infants.

    Perlman, M; Schenker, J; Glassman, M; Ben-david, M


    Serum PRL levels were followed serially in full term (FT; 39-41 weeks) and preterm (PT; 30-32 weeks) infants, from birth to 12 and 20 postnatal weeks, respectively. Values were higher in FT infants than in PT infants on day 1 after birth (267 +/- 20 vs. 156 +/- 8 ng/ml) but were similar in both by the age of 2-4 weeks (69 +/- 8 vs. 69 +/- 6 ng/ml). Between the ages of 4-12 weeks, the serum PRL in FT infants fell to near adult levels (24 +/- 2 ng/ml), but this fall was seen much later in PT infants, between 12-20 weeks postnatally (23 +/- 2 ng/ml). When values in FT and PT infants were compared at parallel postmenstrual ages in contradistinction to postnatal ages, a similar course of PRL was discernable in both groups. These data may provide indirect evidence for the establishment and maturation of inhibition of PRL secretion (i.e. PRL-inhibitory factor production) postnatally, between 44-52 weeks postmenstrually.

  13. Prolonged acute hepatitis A mimicking autoimmune hepatitis

    Rintaro Mikata; Osamu Yokosuka; Fumio Imazeki; Kenichi Fukai; Tatsuo Kanda; Hiromitsu Saisho


    AIM: We report a case with a prolonged course of hepatitisA, with alanine aminotransferase (ALT) higher than 500 IU/Lfor more than 2 mo.METHODS: A middle-aged woman had an elevated IgG level of more than 2 000 mg/dL, positive arti-nudear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), but no evidence of persistent hepatitis A virus (HAV) infection. Liver biopsy findings were compatible with prolonged acute hepatitis, although acute onset of autoimmune hepatitis could not be ruled out.RESULTS: It was assumed that she developed a course of hepatitis similar to autoimmune hepatitis triggered by HAV infection. Ursodeoxycholic acid (UDCA) treatment was initiated and a favorable outcome was obtained. CONCLUSION: We describe a case of a middle-aged woman who showed a prolonged course of acute hepatitis A mimicking autoimmune hepatitis. Treatment with UDCAproved to be effective.

  14. Diagnostic and clinical considerations in prolonged grief disorder.

    Maercker, Andreas; Lalor, John


    This review focuses on the similarities and differences between prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD). It highlights how a PTSD-related understanding aids the investigation and clinical management of PGD. Grief has long been understood as a natural response to bereavement, as serious psychological and physiological stress has been regarded as a potential outcome of extreme or traumatic stress. PTSD was first included in DSM-III in 1980. In the mid-1980s, the first systematic investigation began into whether there is an extreme or pathological form of mourning. Meanwhile, there is much research literature on complicated, traumatic, or prolonged grief This literature is reviewed in this article, with the following questions: Is it possible to distinguish normal from non-normal grief? Which clinical presentation does PGD have-and how does this compare with PTSD? Finally, diagnostic, preventive, and therapeutic approaches and existing tools are presented.

  15. Effect of prolonged chemical challenges on selected properties of silorane

    de Jesus, Vivian CBR; Martinelli, Natan Luiz; Pascotto, Renata Corrêa

    Objectives: The purpose of this study was to investigate the effect of prolonged chemical challenges on water sorption, solubility, and roughness of a silorane-based material when compared to methacrylate-based composites. Methods: Initial roughness and mass were registered for specimens (n=24...... phosphoric acid, 75% ethanol or distilled water for 7, 14, 21, and 180 days, when new measurements were performed. Subsequently, specimens were dehydrated until a constant mass was obtained. Water sorption and solubility were calculated after 180 days of immersion in the different solutions. Data were...... differences in water sorption and solubility were detected amongst the investigated composites (pwater sorption (with similar values to Filtek Z250 and Filtek Z350XT) and low solubility (with similar values to Filtek Z250) after prolonged immersion...

  16. QTc-prolonging drugs and hospitalizations for cardiac arrhythmias

    De Bruin, Marie L; Hoes, Arno W; Leufkens, Hubert G M


    Cardiac arrhythmia as an adverse effect of noncardiac drugs has been an issue of growing importance during the past few years. In this population-based study, we evaluated the risk for serious cardiac arrhythmias during the use of several noncardiac QTc-prolonging drugs in day-to-day practice......, and subsequently focused on several specific groups of patients who could be extremely vulnerable for drug-induced arrhythmias. We performed a case-control study in which patients (cases), hospitalized for nonatrial cardiac arrhythmias from 1987 to 1998, were compared with their matched controls regarding current...... use of QTc-prolonging drugs. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariate conditional logistic regression, adjusting for potential confounding factors. Data were obtained from the PHARMO record linkage system. We identified 501 cases, 39 of whom used QTc...

  17. Smoking prolongs the infectivity of patients with tuberculosis.

    Siddiqui, U A


    We sought to establish if smokers on anti-tuberculosis treatment are more likely to have a prolonged period of infectivity, compared to non-smoking tuberculosis patients, in a low tuberculosis prevalence country. We conducted a cross-sectional, retrospective study in Ireland that recruited 53 microbiologically confirmed cases of pulmonary tuberculosis (PTB). The age-sex adjusted odds ratios (AOR) suggest that the infectivity status of PTB on treatment was four times more likely to be prolonged beyond 6-8 weeks, if the cases had a smoking history (AOR: 4.42; 95% CI: 1.23; 15.9). Smoking was associated with delayed sputum smear conversion in PTB patients on treatment.

  18. Carotid Baroreflex Function During Prolonged Exercise

    Raven, P. B.


    Astronauts are often required to work (exercise) at moderate to high intensities for extended periods while performing extra-vehicular activities (EVA). Although the physiologic responses associated with prolonged exercise have been documented, the mechanisms involved in blood pressure regulation under these conditions have not yet been fully elucidated. An understanding of this issue is pertinent to the ability of humans to perform work in microgravity and complies with the emphasis of NASA's Space Physiology and Countermeasures Program. Prolonged exercise at a constant workload is know to result in a progressive decrease in mean arterial pressure (MAP) concomitant with a decrease in stroke volume and a compensatory increase in heart rate. The continuous decrease in MAP during the exercise, which is related to the thermoregulatory redistribution of circulating blood volume to the cutaneous circulation, raises the question as to whether there is a loss of baroreflex regulation of arterial blood pressure. We propose that with prolongation of the exercise to 60 minutes, progressive increases on central command reflect a progressive upward resetting of the carotid baroreflex (CBR) such that the operating point of the CBR is shifted to a pressure below the threshold of the reflex rendering it ineffectual in correcting the downward drift in MAP. In order to test this hypothesis, experiments have been designed to uncouple the global hemodynamic response to prolonged exercise from the central command mediated response via: (1) continuous maintenance of cardiac filling volume by intravenous infusion of a dextran solution; and (2) whole body surface cooling to counteract thermoregulatory cutaneous vasodialation. As the type of work (exercise) performed by astronauts is inherently arm and upper body dependent, we will also examine the physiologic responses to prolonged leg cycling and arm ergometry exercise in the supine positions with and without level lower body negative

  19. Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

    Christina Bognet


    Full Text Available Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL solutions, with or without epinephrine 5 µg/mL (1:200,000 in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001 or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001. Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

  20. Prolonged storage of packed red blood cells for blood transfusion.

    Martí-Carvajal, Arturo J; Simancas-Racines, Daniel; Peña-González, Barbra S


    A blood transfusion is an acute intervention, used to address life- and health-threatening conditions on a short-term basis. Packed red blood cells are most often used for blood transfusion. Sometimes blood is transfused after prolonged storage but there is continuing debate as to whether transfusion of 'older' blood is as beneficial as transfusion of 'fresher' blood. To assess the clinical benefits and harms of prolonged storage of packed red blood cells, in comparison with fresh, on recipients of blood transfusion. We ran the search on 1st May 2014. We searched the Cochrane Injuries Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase (OvidSP), CINAHL (EBSCO Host) and two other databases. We also searched clinical trials registers and screened reference lists of the retrieved publications and reviews. We updated this search in June 2015 but these results have not yet been incorporated. Randomised clinical trials including participants assessed as requiring red blood cell transfusion were eligible for inclusion. Prolonged storage was defined as red blood cells stored for ≥ 21 days in a blood bank. We did not apply limits regarding the duration of follow-up, or country where the study took place. We excluded trials where patients received a combination of short- and long-stored blood products, and also trials without a clear definition of prolonged storage. We independently performed study selection, risk of bias assessment and data extraction by at least two review authors. The major outcomes were death from any cause, transfusion-related acute lung injury, and adverse events. We estimated relative risk for dichotomous outcomes. We measured statistical heterogeneity using I(2). We used a random-effects model to synthesise the findings. We identified three randomised clinical trials, involving a total of 120 participants, comparing packed red blood cells with ≥ 21 days storage

  1. Severe bradycardia and prolonged hypotension in ciguatera.

    Chan, Thomas Yan Keung


    Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.

  2. Napping and Human Functioning during Prolonged Work


    alternative to napping is prolonged wakefulness. Polyphasic sleep , with frequent naps rather than a single sleep period per 24 hours, is natural for both the...very young and for the aged. It is not practiced by most adults, perhaps because of societal demands. Possibly a polyphasic sleep schedule could be...Functioning 1.2 Scope of this Chapter 2. REVIEW OF LITERATURE 2.1 Partial Sleep Deprivation Studies 2.2 Nap Studies: Four Nap Factors Affecting Performance

  3. Prolonged grief: setting the research agenda

    Rita Rosner


    Full Text Available Background: Prolonged grief disorder is proposed for the International Classification of Diseases (ICD-11, though it was rejected as a diagnosis for DSM-5. Objective: This review outlines findings and defines important areas for future research viewed from a lifespan perspective. Results: The development and psychometric evaluation of measures for the new diagnosis is paramount, specifically for children and adolescents. Treatments need to be adapted for specific subgroups and research findings have to be disseminated into various professional settings.

  4. Prolonged ulcerative laryngitis: a new disease entity.

    Hsiao, Tzu-Yu


    Over the last decade, a new disease entity, prolonged ulcerative laryngitis (PUL), with unique clinical presentation and prolonged disease course, has been recognized. Until now, very few studies dealing with this disease have been reported in the literature. From 1999 to 2008, we analyzed clinical data from a series of 39 PUL patients who were treated with an observational approach without implementing specific treatments. This disease affects adults, predominantly females. The age of patients in our series ranged from 26 to 76 years with a median of 49.5 years. This disease is characterized by ulcers and signs of acute inflammation on the membranous portion of the vocal folds with a prolonged clinical course. The recovery times of patients ranged from 4 to 20 weeks with an average of 9.4 weeks. The data in this study may reflect a natural history of this disease. PUL seems to be a self-limited disease, but the etiology of this disease is unknown. Specific infections or systemic inflammatory processes involving the larynx must be ruled out before diagnosis, and conservative treatments are suggested.

  5. The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue.

    Ng, Deborah Hl; Wong, Joshua Gx; Thein, Tun-Linn; Leo, Yee-Sin; Lye, David C


    Dengue fever is gaining importance in Singapore with an increase in the number of cases and mortality in recent years. Although prolonged and saddleback fever have been reported in dengue fever, there are no specific studies on their significance in dengue. This study aims to examine the prevalence of prolonged and saddleback fever in dengue as well as their associations with dengue severity. A total of 2843 polymerase-chain reaction (PCR) confirmed dengue patients admitted to Tan Tock Seng Hospital from 2004 to 2008 were included in the study. Sixty-nine percent of them were male with a median age of 34 years. Prolonged fever (fever > 7 days duration) was present in 572 (20.1%) of patients. Dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) and severe dengue (SD) were significantly more likely to occur in patients with prolonged fever. Mucosal bleeding, anorexia, diarrhea, abdominal pain, nausea or vomiting, lethargy, rash, clinical fluid accumulation, hepatomegaly, nosocomial infection, leukopenia, higher neutrophil count, higher hematocrit, higher alanine transaminase (ALT) and aspartate transaminase (AST), higher creatinine, lower protein and prolonged activated partial thromboplastin time (APTT) were significantly associated with prolonged fever but not platelet count or prothrombin time (PT). Saddleback fever was present in 165 (5.8%). Although DHF and SD were more likely to occur in patients in those with saddleback fever, DSS was not. Compared with prolonged fever, saddleback fever did not show many significant associations except for diarrhea, abdominal pain, clinical fluid accumulation, hematocrit and platelet change, and lower systolic blood pressure. This study demonstrates that prolonged fever may be associated with various warning signs and more severe forms of dengue (SD, DSS, DHF), while saddleback fever showed associations with DHF and SD but not DSS. The presence of prolonged or saddleback fever in dengue patients should therefore prompt

  6. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

    Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem


    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

  7. Prolonged labour as indication for emergency caesarean section

    Maaløe, Nanna; Sorensen, B L; Onesmo, R


    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.......To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour....

  8. Prolonged fasting impairs neural reactivity to visual stimulation.

    Kohn, N; Wassenberg, A; Toygar, T; Kellermann, T; Weidenfeld, C; Berthold-Losleben, M; Chechko, N; Orfanos, S; Vocke, S; Laoutidis, Z G; Schneider, F; Karges, W; Habel, U


    Previous literature has shown that hypoglycemia influences the intensity of the BOLD signal. A similar but smaller effect may also be elicited by low normal blood glucose levels in healthy individuals. This may not only confound the BOLD signal measured in fMRI, but also more generally interact with cognitive processing, and thus indirectly influence fMRI results. Here we show in a placebo-controlled, crossover, double-blind study on 40 healthy subjects, that overnight fasting and low normal levels of glucose contrasted to an activated, elevated glucose condition have an impact on brain activation during basal visual stimulation. Additionally, functional connectivity of the visual cortex shows a strengthened association with higher-order attention-related brain areas in an elevated blood glucose condition compared to the fasting condition. In a fasting state visual brain areas show stronger coupling to the inferior temporal gyrus. Results demonstrate that prolonged overnight fasting leads to a diminished BOLD signal in higher-order occipital processing areas when compared to an elevated blood glucose condition. Additionally, functional connectivity patterns underscore the modulatory influence of fasting on visual brain networks. Patterns of brain activation and functional connectivity associated with a broad range of attentional processes are affected by maturation and aging and associated with psychiatric disease and intoxication. Thus, we conclude that prolonged fasting may decrease fMRI design sensitivity in any task involving attentional processes when fasting status or blood glucose is not controlled.

  9. Laryngotracheal Injury following Prolonged Endotracheal Intubation

    J. Mehdizadeh


    Full Text Available Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications; the most important is laryngo-tracheal injuries. Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia. Results: Fifty-seven patients (44 male; mean age, 23.014.7 years were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%. Head trauma was responsible for most cases of intubation (72.4%. The most common types of tracheal and laryngeal lesions were tracheal (56.9% and subglottic (55.2% stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001 but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS. Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%. No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS. Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS. Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation

  10. [Prolonged acute pancreatitis after bone marrow transplantation].

    De Singly, B; Simon, M; Bennani, J; Wittnebel, S; Zagadanski, A-M; Pacault, V; Gornet, J-M; Allez, M; Lémann, M


    Acute pancreatitis is not infrequent after allogenic marrow transplantation. Several causes can predispose to pancreatitis, including Graft-Versus-Host Disease (GVHD), a condition which is probably underestimated. In the literature, few description of pancreatic GVHD can be found. Pancreatic GVHD diagnosis can be difficult if pancreatic involvement occurs without other typical manifestations of GVHD. We report the case of a woman, 54 years old, suffering from prolonged, painful pancreatitis two months after allogenic bone marrow transplantation for acute myeloid leucemia. Pancreatic GVHD diagnosis was performed after five weeks on duodenal biopsies despite the absence of diarrheoa. The patient dramatically improved within few days on corticosteroids.

  11. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    Estmann, Anne; Qvist, Niels; Husby, Steffen


    INTRODUCTION: Long-term treatment with parenteral nutrition (PN) may be essential for survival in infants after neonatal gastrointestinal surgery. It seemed well indicated in a population-based study to estimate the need for long-term PN and to characterize the infants that received TPN with regard...... to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...

  12. Survival of soil bacteria during prolonged desiccation.

    Chen, M.; Alexander, M.


    A determination was made of the kinds and numbers of bacteria surviving when two soils were maintained in the laboratory under dry conditions for more than half a year. Certain non-spore-forming bacteria were found to survive in the dry condition for long periods. A higher percentage of drought-tolerant than drought-sensitive bacteria was able to grow at low water activities. When they were grown in media with high salt concentrations, bacteria generally became more tolerant of prolonged drought and they persisted longer. The percent of cells in a bacterial population that remained viable when exposed to drought stress varied with the stage of growth.

  13. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    Estmann, Anne; Qvist, Niels; Husby, Steffen


    INTRODUCTION: Long-term treatment with parenteral nutrition (PN) may be essential for survival in infants after neonatal gastrointestinal surgery. It seemed well indicated in a population-based study to estimate the need for long-term PN and to characterize the infants that received TPN with regard...... to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...

  14. The impact of obesity on physiological responses during prolonged exercise.

    Eijsvogels, T M H; Veltmeijer, M T W; Schreuder, T H A; Poelkens, F; Thijssen, D H J; Hopman, M T E


    Prolonged, moderate-intensity exercise training is routinely prescribed to subjects with obesity. In the general population, this type of exercise can lead to fluid and sodium imbalance. However, little is known whether obesity alters the risk of fluid and sodium imbalances. This study examined physiological responses, such as core body temperature, fluid and sodium balance, in lean (BMIobese (BMI>30) subjects during prolonged moderate-intensity exercise. A total of 93 volunteers (24-80 years), stratified for BMI, participated in the Nijmegen Marches and walked 30-50 km at a self-selected pace. Heart rate and core body temperature were recorded every 5 km. Subjects reported fluid intake, while urine output was measured and sweat rate was calculated. Baseline and post-exercise plasma sodium levels were determined, and urinary specific gravity levels were assessed before and after exercise. BMI groups did not differ in training status preceding the experiment. Exercise duration (8 h 41 ± 1 h 36 min) and intensity (72 ± 9% HR(max)) were comparable across groups, whereas obese subjects tended to have a higher maximum core body temperature than lean controls (P=0.06). Obese subjects demonstrated a significantly higher fluid intake (Pobese versus lean subjects after exercise (Pexercise, whereas plasma-sodium levels increased significantly (Pobese subjects. Also, overweight and obese subjects demonstrated a significantly larger decrease in body mass after exercise than lean controls (PObese subjects demonstrate a larger deviation in markers of fluid and sodium balance than their lean counterparts during prolonged moderate-intensity exercise. These findings suggest that overweight and obese subjects, especially under strenuous environmental conditions, have an increased risk to develop fluid and sodium imbalances.

  15. Prevention of neutropenia during chemotherapy by prolonged myelostimulatory preparations

    V. V. Ptushkin


    Full Text Available Neutropenia and associated infection, resulting in hospitalization and use of antibiotics, has a negative effect on chemotherapy. The need to reduce the dose of cytotoxic drugs during neutropenia leads to lower survival rates in patients with hematological malignancies and solid tumors. Since 1990s myelocytokines – proteins that accelerate neutrophil recovery after cytostatic chemotherapy and reduce the risk of infection – is widely used in the clinical practice. The use of these drugs can support the planned dose intensity of chemotherapy and improves the treatment efficacy. The disadvantages of these drugs include the need for their daily parenteral administration for 7–10 days. The development of long-acting forms (pegfilgrastim and lipegfilgrastim has solved this problem. Self-regulating clearance of prolonged forms allowed to use them only once on a chemotherapy course. Results of pegfilgrastim administration in 25 patients with hematological malignancies (8 patients and solid tumors (17 patients included in our analysis. Prolonged preparation showed high efficacy in secondary prophylaxis of neutropenia and infection decreasing the risk by 82 %. The single administration of pegfilgrastim allowed safe dose intensity chemotherapy with shorter intervals between courses (AC-14 in 8 patients with breast cancer. Tolerability was good; cases of hyperleukocytosis have notbeen reported. Recently in Europe and the Russian Federation a new drug from prolonged myelocytokine group – lipegfilgrastim – has been registered. The results of two controlled trials in patients with breast cancer (n = 410 receiving doxorubicin/docetaxel showed high efficacy of the drug as the pegfilgrastim with comparable tolerability.

  16. Lifetime Prolonging Algorithms for Underwater Sensor Networks

    GUO Zhong-wen; LI Zhi-wei; YU Lei


    Underwater acoustic modem technology has attained a level of maturity to support underwater acoustic sensor networks (UASNs) which are generally formed by acoustically connected sensor nodes and a surface station providing a link to an on-shore control center. While many applications require long-term monitoring of the deployment area, the battery-powered network nodes limit the lifetime of UASNs. Therefore, designing a UASN that minimizes the power consumption while maximizing lifetime becomes a very difficult task. In this paper, a method is proposed to determine the optimum number of clusters through combining an application-specific protocol architecture and underwater acoustic communication model so as to reduce the energy dissipation of UASNs. Deploying more sensor nodes which work alternately is another way to prolong the lifetime of UASNs. An algorithm is presented for selecting sensor nodes and putting them into operation in each round, ensuring the monitoring to the whole given area. The present results show that the algorithm can help prolong system lifetime remarkably when it is applied to other conventional approaches for sensor networks under the condition that the sensor node density is high.

  17. Prolonged energy harvesting for ingestible devices.

    Nadeau, Phillip; El-Damak, Dina; Glettig, Dean; Kong, Yong Lin; Mo, Stacy; Cleveland, Cody; Booth, Lucas; Roxhed, Niclas; Langer, Robert; Chandrakasan, Anantha P; Traverso, Giovanni


    Ingestible electronics have revolutionized the standard of care for a variety of health conditions. Extending the capacity and safety of these devices, and reducing the costs of powering them, could enable broad deployment of prolonged monitoring systems for patients. Although prior biocompatible power harvesting systems for in vivo use have demonstrated short minute-long bursts of power from the stomach, not much is known about the capacity to power electronics in the longer term and throughout the gastrointestinal tract. Here, we report the design and operation of an energy-harvesting galvanic cell for continuous in vivo temperature sensing and wireless communication. The device delivered an average power of 0.23 μW per mm(2) of electrode area for an average of 6.1 days of temperature measurements in the gastrointestinal tract of pigs. This power-harvesting cell has the capacity to provide power for prolonged periods of time to the next generation of ingestible electronic devices located in the gastrointestinal tract.

  18. Moderate superficial hypothermia prolongs bleeding time in humans.

    Romlin, B; Petruson, K; Nilsson, K


    In vitro and in vivo studies have shown that mild systemic hypothermia influences platelet adhesion and aggregation and coagulation reactions. We wanted to test the hypothesis that mild local hypothermia in healthy volunteers with preserved core temperature increased bleeding time. A secondary aim was to evaluate if local cooling influenced whole blood coagulation measured by thrombelastograph (TEG) in the same setting. Bleeding time was measured at the left volar forearm at a baseline skin temperature of 32 degrees C and after cooling to 30 degrees C and 28 degrees C in a water bath. Skin temperature was continuously measured by contact thermistors. Measurements of coagulation by TEG were performed at baseline skin temperature before cooling and after cooling to 28 degrees C skin temperature. Tympanic membrane temperature was continuously measured. Compared with baseline, bleeding time was significantly prolonged at 30 degrees C skin temperature and further prolonged at 28 degrees C skin temperature. No significant differences were measured in any of the TEG parameters. During the procedure, tympanic membrane temperature did not change. Lowering the skin temperature from 32 degrees C to 30 degrees C and 28 degrees C with a preserved core temperature more than doubled the bleeding time. Whole blood coagulation measured by TEG was not influenced by the local cooling. In addition to core temperature, local temperature may offer information in understanding the surgical site of bleeding.

  19. High efficiency holographic Bragg grating with optically prolonged memory

    Khoo, Iam Choon; Chen, Chun-Wei; Ho, Tsung-Jui


    In this paper, we show that photosensitive azo-dye doped Blue-phase liquid crystals (BPLC) formed by natural molecular self-assembly are capable of high diffraction efficiency holographic recording with memory that can be prolonged from few seconds to several minutes by uniform illumination with the reference beam. Operating in the Bragg regime, we have observed 50 times improvement in the grating diffraction efficiency and shorter recording time compared to previous investigations. The enabling mechanism is BPLC’s lattice distortion and index modulation caused by the action of light on the azo-dopant; upon photo-excitation, the azo-molecules undergo transformation from the oblong-shaped Trans-state to the bent-shaped Cis-state, imparting disorder and also cause the surrounding BPLC molecules to undergo coupled flow & reorientation leading to lattice distortion and index modulation. We also showed that the same mechanism at work here that facilitates lattice distortion can be used to frustrate free relaxation of the lattice distortion, thereby prolonging the lifetime of the written grating, provided the reference beam is kept on after recording. Due to the ease in BPLC fabrication and the availability of azo-dopants with photosensitivity throughout the entire visible spectrum, one can optimize the controlling material and optical parameters to obtain even better performance.

  20. Influence of a Prolonged Tennis Match Play on Serve Biomechanics.

    Martin, Caroline; Bideau, Benoit; Delamarche, Paul; Kulpa, Richard


    The aim of this study was to quantify kinematic, kinetic and performance changes that occur in the serve throughout a prolonged tennis match play. Serves of eight male advanced tennis players were recorded with a motion capture system before, at mid-match, and after a 3-hour tennis match. Before and after each match, electromyographic data of 8 upper limb muscles obtained during isometric maximal voluntary contraction were compared to determine the presence of muscular fatigue. Vertical ground reaction forces, rating of perceived exertion, ball speed, and ball impact height were measured. Kinematic and upper limb kinetic variables were computed. The results show decrease in mean power frequency values for several upper limb muscles that is an indicator of local muscular fatigue. Decreases in serve ball speed, ball impact height, maximal angular velocities and an increase in rating of perceived exertion were also observed between the beginning and the end of the match. With fatigue, the majority of the upper limb joint kinetics decreases at the end of the match. No change in timing of maximal angular velocities was observed between the beginning and the end of the match. A prolonged tennis match play may induce fatigue in upper limb muscles, which decrease performance and cause changes in serve maximal angular velocities and joint kinetics. The consistency in timing of maximal angular velocities suggests that advanced tennis players are able to maintain the temporal pattern of their serve technique, in spite of the muscular fatigue development.

  1. [Sideroblastic anemia after prolonged linezolid therapy].

    Kakimoto, Tsunayuki; Nakazato, Tomonori; Miura, Reiko; Kurai, Hanako; Yamashita, Daisuke; Sagara, Yuko; Ishida, Akaru


    Linezolid is an effective and well-tolerated antibiotic for the treatment of infections caused by Gram-positive pathogens. Some reports have shown that linezolid treatment for more than 2 weeks has been associated with reversible bone marrow suppression, especially thrombocytopenia and anemia. We encountered a case of sideroblastic anemia following prolonged linezolid therapy in a laryngeal cancer patient. He received linezolid therapy for multiple abscesses due to MRSA. Before treatment, the Hb level was 12.5 g/dl and then slowly decreased to 5.9 g/dl for 2 months during treatment. Ringed sideroblasts were detected in the bone marrow. Linezolid was discontinued and the Hb level was slowly increased. This case was considered to reflect a rare complication of linezolid therapy.

  2. Multifactorial QT Interval Prolongation and Takotsubo Cardiomyopathy

    Michael Gysel


    Full Text Available A 71-year-old woman collapsed while working as a grocery store cashier. CPR was performed and an AED revealed torsades de pointes (TdP. She was subsequently defibrillated resulting in restoration of sinus rhythm with a QTc interval of 544 msec. Further evaluation revealed a diagnosis of Takotsubo Cardiomyopathy (TCM contributing to the development of a multifactorial acquired long QT syndrome (LQTS. The case highlights the role of TCM as a cause of LQTS in the setting of multiple risk factors including old age, female gender, hypokalemia, and treatment with QT prolonging medications. It also highlights the multifactorial nature of acquired LQTS and lends support to growing evidence of an association with TCM.

  3. Neurohumoral responses during prolonged exercise in humans

    Nybo, Lars; Nielsen, Bodil; Blomstrand, Eva


    in the hyperthermic trial, with a concomitant increase in perceived exertion (P brain had a small release of tryptophan (arteriovenous difference of -1.2 +/- 0.3 micromol/l), whereas a net balance was obtained during the two exercise trials. Both the arterial and jugular venous dopamine levels...... became elevated during the hyperthermic trial, but the net release from the brain was unchanged. During exercise, the O2/CHO was similar across trials, but, during recovery from the hyperthermic trial, the ratio decreased to 3.8 +/- 0.3 (P ...This study examined neurohumoral alterations during prolonged exercise with and without hyperthermia. The cerebral oxygen-to-carbohydrate uptake ratio (O2/CHO = arteriovenous oxygen difference divided by arteriovenous glucose difference plus one-half lactate), the cerebral balances of dopamine...

  4. A randomized controlled trial of vaginal misoprostol tablet and intracervical dinoprostone gel in labor induction of women with prolonged pregnancies

    Apurba Mandal


    Conclusions: Vaginal misoprostol tablet is a safe and more effective method of induction of labour when compared with intracervical dinoprostone gel in prolonged pregnancies. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 343-348

  5. In-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs

    De Bruin, Marie L; Langendijk, Pim N J; Koopmans, Richard P


    AIMS: QTc interval-prolonging drugs have been linked to cardiac arrhythmias, cardiac arrest and sudden death. In this study we aimed to quantify the risk of cardiac arrest associated with the use of non-antiarrhythmic QTc-prolonging drugs in an academic hospital setting. METHODS: We performed...... a case-control study in which patients, for whom intervention of the advanced life support resuscitation team was requested for cardiac arrest between 1995 and 2003 in the Academic Medical Centre, Amsterdam, were compared with controls regarding current use of non-antiarrhythmic QTc-prolonging drugs......-prolonging drugs (42/140). The risk was more pronounced in patients receiving doses > 1 defined daily dose (OR 2.5, 95% CI 1.1, 5.9), patients taking > 1 QTc-prolonging drug simultaneously (OR 4.8, 95% CI 1.6, 14) and patients taking pharmacokinetic interacting drugs concomitantly (OR 4.0, 95% CI 1.2, 13...

  6. Multivariate analysis of risk factors for QT prolongation following subarachnoid hemorrhage

    Fukui, Shinji; Katoh, Hiroshi; Tsuzuki, Nobusuke; Ishihara, Shoichiro; Otani, Naoki; Ooigawa, Hidetoshi; Toyooka, Terushige; Ohnuki, Akira; Miyazawa, Takahito; Nawashiro, Hiroshi; Shima, Katsuji


    Background Subarachnoid hemorrhage (SAH) often causes a prolongation of the corrected QT (QTc) interval during the acute phase. The aim of the present study was to examine independent risk factors for QTc prolongation in patients with SAH by means of multivariate analysis. Method We studied 100 patients who were admitted within 24 hours after onset of SAH. Standard 12-lead electrocardiography (ECG) was performed immediately after admission. QT intervals were measured from the ECG and were corrected for heart rate using the Bazett formula. We measured serum levels of sodium, potassium, calcium, adrenaline (epinephrine), noradrenaline (norepinephrine), dopamine, antidiuretic hormone, and glucose. Results The average QTc interval was 466 ± 46 ms. Patients were categorized into two groups based on the QTc interval, with a cutoff line of 470 ms. Univariate analyses showed significant relations between categories of QTc interval, and sex and serum concentrations of potassium, calcium, or glucose. Multivariate analyses showed that female sex and hypokalemia were independent risk factors for severe QTc prolongation. Hypokalemia (<3.5 mmol/l) was associated with a relative risk of 4.53 for severe QTc prolongation as compared with normokalemia, while the relative risk associated with female sex was 4.45 as compared with male sex. There was a significant inverse correlation between serum potassium levels and QTc intervals among female patients. Conclusion These findings suggest that female sex and hypokalemia are independent risk factors for severe QTc prolongation in patients with SAH. PMID:12793884

  7. Prolonged pain and disability are common after rib fractures.

    Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John


    The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis. One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Prolonged Temozolomide Maintenance Therapy in Newly Diagnosed Glioblastoma.

    Skardelly, Marco; Dangel, Elena; Gohde, Julia; Noell, Susan; Behling, Felix; Lepski, Guilherme; Borchers, Christian; Koch, Marilin; Schittenhelm, Jens; Bisdas, Sotirios; Naumann, Aline; Paulsen, Frank; Zips, Daniel; von Hehn, Ulrike; Ritz, Rainer; Tatagiba, Marcos Soares; Tabatabai, Ghazaleh


    The impact of prolonging temozolomide (TMZ) maintenance beyond six cycles in newly diagnosed glioblastoma (GBM) remains a topic of discussion. We investigated the effects of prolonged TMZ maintenance on progression-free survival (PFS) and overall survival (OS). In this retrospective single-center cohort study, we included patients with GBM who were treated with radiation therapy with concomitant and adjuvant TMZ. For analysis, patients were considered who either completed six TMZ maintenance cycles (group B), continued with TMZ therapy beyond six cycles (group C), or stopped TMZ maintenance therapy within the first six cycles (group A). Patients with progression during the first six TMZ maintenance cycles were excluded. Clinical data from 107 patients were included for Kaplan-Meier analyses and 102 for Cox regressions. Median PFS times were 8.1 months (95% confidence interval [CI] 6.1-12.4) in group A, 13.7 months (95% CI 10.6-17.5) in group B, and 20.9 months (95% CI 15.2-43.5) in group C. At first progression, response rates of TMZ/lomustine rechallenge were 47% in group B and 13% in group C. Median OS times were 12.7 months (95% CI 10.3-16.8) in group A, 25.2 months (95% CI 17.7-55.5) in group B, and 28.6 months (95% CI 24.4-open) in group C. Nevertheless, multivariate Cox regression for patients in group C compared with group B that accounted for imbalances of other risk factors showed no different relative risk (RR) for OS (RR 0.77, p = .46). Our data do not support a general extension of TMZ maintenance therapy beyond six cycles. The Oncologist 2017;22:570-575 IMPLICATIONS FOR PRACTICE: Radiation therapy with concomitant and adjuvant temozolomide (TMZ) maintenance therapy is still the standard of care in patients below the age of 65 years in newly diagnosed glioblastoma. However, in clinical practice, many centers continue TMZ maintenance therapy beyond six cycles. The impact of this continuation is controversial and has not yet been addressed in

  9. Media Impacts on Women's Fertility Desires: A Prolonged Exposure Experiment.

    Knobloch-Westerwick, Silvia; Willis, Laura E; Kennard, Ashley R


    Media exposure may have implications for family planning, a public health issue of key importance. Drawing on social comparison theory and social identity theory, a prolonged exposure experiment examined whether media portrayals of women's social roles affect fertility desires among 166 American, nonstudent, never married, childless women ages 21-35 years old. After sign-up and baseline sessions, participants viewed magazine pages five days in a row. Stimuli presented women in either mother/homemaker roles, beauty ideal roles, or professional roles. Three days later, participants again indicated their number of desired children and time planned until first birth. Exposure to mother/homemaker and beauty ideal portrayals increased the number of desired children across time. Exposure to professional portrayals increased the time planned until 1st birth compared to beauty ideal portrayals-this impact was partially mediated by a shift toward more progressive gender norms (per social identity theory) and assimilation (per social comparison theory).

  10. Prolonged cholestasis and ductopenia associated with tenoxicam.

    Trak-Smayra, Viviane; Cazals-Hatem, Dominique; Asselah, Tarik; Duchatelle, Veronique; Degott, Claude


    Cholestatic liver diseases leading to progressive destruction of intra-hepatic bile ducts and ductopenia encompass multiple etiologies. Pathophysiology and natural history of drug-induced cholangiopathies remain unclear. We report a case of prolonged ductopenia attributed to Tenoxicam (Tilcotil o--a non-steroidal anti-inflammatory drug of the oxicam family) ingested at therapeutic dose. A 36 year-old male patient was admitted for jaundice and Lyell syndrome starting 1 week after the ingestion of Tenoxicam. Liver biopsy showed cholestasis, non-suppurative cholangitis and polymorphous inflammatory infiltrate of the portal tracts (round cells, macrophages an eosinophils). Treatment with ursodesoxycholic acid and cholestyramine was instituted and the patient was asymptomatic 1 year after. Three years later mild biological cholestasis persisted and ductopenia was evidenced on liver biopsy. In this report we found that: (1) The toxicity of tenoxicam was probably mediated by an immunoallergic mechanism (Lyell syndrome and eosinophils on histology); (2) ductopenia was secondary to inflammatory cholangitis. Factors responsible for this chronic evolution are still unknown (genetic predisposition, vascular factors, etc.); and (3) the presence of ductopenia contrasted with the "clinical recovery" of the disease suggesting accessory bile drainage by cholangioles or partial reconstruction of the biliary tree.

  11. Prolonging sensor networks lifetime using convex clusters

    Payam Salehi


    Full Text Available Reducing the energy consumption of nodes in sensor networks and prolonging the network life time has been proposed as one of the most important challenges facing researchers in the field of sensor networks. Therefore, designing an energy-aware protocol to gather data from network level and transmitting it to sink is placed on the agenda at this paper. After presenting an analysis of the processes of clustering in sensory networks and investigating the effect of sending interval on the amount of energy consumption, We have shown that if the use of convex static casters be done such as all the communications within the cluster with the sending distance less than the optimal threshold, it Will help to increase the lifetime of nodes. also have shown that if we create a virtual backbone between cluster heads to transfer far cluster heads data from sink to sink , will has a significant impact on increasing the network lifetime. For this reason, a detailed discussion on how to determine the size of clusters and partitioning of the network environment to them is presented in Chapter 4.Simulation results show considerable improvement of the proposed algorithm.

  12. Persistent telomere cohesion triggers a prolonged anaphase.

    Kim, Mi Kyung; Smith, Susan


    Telomeres use distinct mechanisms (not used by arms or centromeres) to mediate cohesion between sister chromatids. However, the motivation for a specialized mechanism at telomeres is not well understood. Here we show, using fluorescence in situ hybridization and live-cell imaging, that persistent sister chromatid cohesion at telomeres triggers a prolonged anaphase in normal human cells and cancer cells. Excess cohesion at telomeres can be induced by inhibition of tankyrase 1, a poly(ADP-ribose) polymerase that is required for resolution of telomere cohesion, or by overexpression of proteins required to establish telomere cohesion, the shelterin subunit TIN2 and the cohesin subunit SA1. Regardless of the method of induction, excess cohesion at telomeres in mitosis prevents a robust and efficient anaphase. SA1- or TIN2-induced excess cohesion and anaphase delay can be rescued by overexpression of tankyrase 1. Moreover, we show that primary fibroblasts, which accumulate excess telomere cohesion at mitosis naturally during replicative aging, undergo a similar delay in anaphase progression that can also be rescued by overexpression of tankyrase 1. Our study demonstrates that there are opposing forces that regulate telomere cohesion. The observation that cells respond to unresolved telomere cohesion by delaying (but not completely disrupting) anaphase progression suggests a mechanism for tolerating excess cohesion and maintaining telomere integrity. This attempt to deal with telomere damage may be ultimately futile for aging fibroblasts but useful for cancer cells.

  13. [Prospective study of patients with prolonged fever].

    Calderón, E; Legorreta, J; Sztabinski, G; Hernández, M; Wilkins, A; Gómez, D; Dávila, A


    A prospective study was made in 283 patients who attended IMAN's Children's Hospital, with fever the main symptom. A clinical and paraclinical procedure was designed for the study of each patient. 112 patients were eliminated because they did not follow the established criteria. All patients had acute infectious diseases considered trivial; 85% were 3 weeks to 2 years of age. They all had an antibacterial treatment without precise diagnosis. It was considered that on admission the patients showed a normal course in the natural history of the basic disease. The study group included 171 patients 2 months to 13 years of age; 62.5% had fever due to infection, 12.2% to collagenopathies, 7% to neoplasias 5.2% to miscellaneous causes and 12.8% were not diagnosed. The most common infectious causes for prolonged fever were tuberculosis, upper respiratory infections, amoebic liver abscess, typhoid fever and malaria. Careful questioning and clinical examination were enough to enlighten diagnosis in more than 80% of the patients.


    Ah. Yusuf


    Full Text Available Introduction: Decision for cesarean section may lead to the stress for women in delivery. Stress response requires longer recovery time in post cesarean section patients. Most of patients who experience stress before and after surgical is associated with wound healing delay. When this condition continues, the wound will have a higher risk of infection. The objective of this study was to analyze correlation between stress and wound healing phase in post cesarean section patients. Method: A cross sectional design was used in this study. The population were women with cesarean section, both elective or emergency, in Delivery Room I RSU Dr. Soetomo Surabaya. Samples were recruited by using purposive sampling, with 28 samples who met to the inclusion criterias. The observed variables were stress and wound healing phase in post cesarean section patient. Stress data were collected by interview and wound healing measurement done by observation on the 3rd day post cesarean section. Result: The result showed that women with stress experience wound healing delay. The characteristic of wound healing delay was prolonged on inflammation phase, nevertheless there was presence of granulation tissue. Spearman’s rho correlation showed that correlation value r=0.675 with p=0.000. Discussion: It can be concluded that there was strong significant correlation between stress and wound healing phase in post cesarean section patients. It is important to give this information to the patients with cesarean section in order to prevent stress and delay in wound healing phase.

  15. Gluteal Compartment Syndrome After Prolonged Immobilisation

    H.L. Liu


    Full Text Available Muscles in the gluteal region are confined by distinct fascial attachments which can potentially result in compartment syndrome. A 74-year-old chronic drinker was admitted to the medical ward after being found drunk on the street. He noticed acute painful swelling of the right side of his buttock the following morning and recalled a slip and fall prior to his blackout. The whole right half of the buttock was tense with erythematous overlying skin. Examination revealed sciatic nerve palsy and myoglobinuria. Emergency fasciotomy and debridement were performed. Intra-operative pressure measurement confirmed a grossly elevated intra-compartmental pressure. Gluteal compartment syndrome is an extremely rare condition and has only been scantily documented previously in case reports. Early diagnosis is crucial but delay recognition is common from lack of knowledge of the condition and readily results in permanent sciatic nerve injury and acute renal shutdown from myoglobinuria. Awareness of the condition, early diagnosis and prompt exploration provide the only chance of avoiding these devastating consequences. Acute swelling diffusely affecting the whole or one side of the buttock, a history of trauma and prolonged local pressure impingement associated with pain out of proportion to the clinical signs should raise a suspicion of this rare condition.

  16. Effectiveness of a prolonged incarceration and rehabilitation measure for high-frequency offenders

    Tollenaar, N.; van der Laan, A. M.; van der Heijden, P. G M


    Objectives: To estimate the incapacitation effect and the impact on post-release recidivism of a measure combining prolonged incarceration and rehabilitation, the ISD measure for high frequency offenders (HFOs) was compared to the standard practice of short-term imprisonment. Methods: We applied a q

  17. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study

    M.C. de Bruyne (Martine); A.W. Hoes (Arno); J.A. Kors (Jan); J.H. van Bemmel (Jan); D.E. Grobbee (Diederick); A. Hofman (Albert)


    textabstractAIMS: To examine the association between heart-rate corrected QT prolongation and cardiac and all-cause mortality in the population-based Rotterdam Study among men and women aged 55 years or older and to compare the prognostic value of the QT interval, using

  18. Rat pancreatic islet function during prolonged glucose stimulation in vitro : Effect of sex and reproductive state

    Moes, H; Koiter, TR


    Prolonged stimulation with glucose may induce desensitisation of pancreatic beta-cell function in male rats. The effects of such a treatment on pancreatic islets of pregnant (P) rats, in which beta-cell function is enhanced, were studied in a perifusion design and compared with the effects on islets

  19. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der


    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different

  20. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der


    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different pos

  1. Tolerability to prolonged lifting tasks. A validation of the recommended limits.

    Capodaglio, P; Bazzini, G


    Prolonged physical exertion is subjectively regulated by the perception of effort. This preliminary study was conducted to validate the use of subjective perceptions of effort in assessing objectively tolerable workloads for prolonged lifting tasks. Ten healthy male subjects tested their maximal lifting capacity (MLC) on a lift dynamometer (LidoLift, Loredan Biomed., West Sacramento, CA) and underwent incremental and 30-minute endurance lifting tests. Cardiorespiratory parameters were monitored with an oxygen uptake analyzer, mechanical parameters were calculated using a computerized dynamometer. Ratings of perceived exertion were given on Borg's 10-point scale. Physiological responses to repetitive lifting were matched with subjective perceptions. A single-variable statistical regression for power functions was performed to obtain the individual "iso-perception" curves as functions of the mechanical work exerted. We found that the "iso-perception" curve corresponding to a "moderate" perception of effort may represent the individual "tolerance threshold" for prolonged lifting tasks, since physiological responses at this level of intensity did not change significantly and the respiratory exchange ratio was less than one. The individually tolerable weight for lifting tasks lasting 30 min has been expressed as a percentage of the isoinertial MLC value and compared with the currently recommended limits for prolonged lifting tasks (Italian legislation D.L. 626/94). On the basis of our preliminary results a "tolerance threshold" of 20% MLC has been proposed for prolonged lifting tasks.

  2. A detailed description and assessment of outcomes of patients with hospital recorded QTc prolongation.

    Laksman, Zachary; Momciu, Bogdan; Seong, You Won; Burrows, Patricia; Conacher, Susan; Manlucu, Jaimie; Leong-Sit, Peter; Gula, Lorne J; Skanes, Allan C; Yee, Raymond; Klein, George J; Krahn, Andrew D


    Corrected QT (QTc) interval prolongation has been shown to be an independent predictor of mortality in many clinical settings and is a common finding in hospitalized patients. The causes and outcomes of patients with extreme QTc interval prolongation during a hospital admission are poorly described. The aim of this study was to prospectively identify patients with automated readings of QTc intervals >550 ms at 1 academic tertiary hospital. One hundred seventy-two patients with dramatic QTc interval prolongation (574 ± 53 ms) were identified (mean age 67.6 ± 15.1 years, 48% women). Most patients had underlying heart disease (60%), predominantly ischemic cardiomyopathy (43%). At lease 1 credible and presumed reversible cause associated with QTc interval prolongation was identified in 98% of patients. The most common culprits were QTc interval-prolonging medications, which were deemed most responsible in 48% of patients, with 25% of these patients taking ≥2 offending drugs. Two patients were diagnosed with congenital long-QT syndrome. Patients with electrocardiograms available before and after hospital admission demonstrated significantly lower preadmission and postdischarge QTc intervals compared with the QTc intervals recorded in the hospital. In conclusion, in-hospital mortality was high in the study population (29%), with only 4% of patients experiencing arrhythmic deaths, all of which were attributed to secondary causes.

  3. An Automatic Prolongation Detection Approach in Continuous Speech With Robustness Against Speaking Rate Variations

    Esmaili, Iman; Dabanloo, Nader Jafarnia; Vali, Mansour


    In recent years, many methods have been introduced for supporting the diagnosis of stuttering for automatic detection of prolongation in the speech of people who stutter. However, less attention has been paid to treatment processes in which clients learn to speak more slowly. The aim of this study was to develop a method to help speech-language pathologists (SLPs) during diagnosis and treatment sessions. To this end, speech signals were initially parameterized to perceptual linear predictive (PLP) features. To detect the prolonged segments, the similarities between successive frames of speech signals were calculated based on correlation similarity measures. The segments were labeled as prolongation when the duration of highly similar successive frames exceeded a threshold specified by the speaking rate. The proposed method was evaluated by UCLASS and self-recorded Persian speech databases. The results were also compared with three high-performance studies in automatic prolongation detection. The best accuracies of prolongation detection were 99 and 97.1% for UCLASS and Persian databases, respectively. The proposed method also indicated promising robustness against artificial variation of speaking rate from 70 to 130% of normal speaking rate. PMID:28487827

  4. Office workers' objectively assessed total and prolonged sitting time: Individual-level correlates and worksite variations

    Nyssa T. Hadgraft


    Full Text Available Sedentary behavior is highly prevalent in office-based workplaces; however, few studies have assessed the attributes associated with this health risk factor in the workplace setting. This study aimed to identify the correlates of office workers' objectively-assessed total and prolonged (≥30 min bouts workplace sitting time. Participants were 231 Australian office workers recruited from 14 sites of a single government employer in 2012–13. Potential socio-demographic, work-related, health-related and cognitive-social correlates were measured through a self-administered survey and anthropometric measurements. Associations with total and prolonged workplace sitting time (measured with the activPAL3 were tested using linear mixed models. Worksites varied significantly in total workplace sitting time (overall mean [SD]: 79% [10%] of work hours and prolonged workplace sitting time (42% [19%], after adjusting for socio-demographic and work-related characteristics. Organisational tenure of 3–5 years (compared to tenure >5 years was associated with more time spent in total and prolonged workplace sitting time, while having a BMI categorised as obese (compared to a healthy BMI was associated with less time spent in total and prolonged workplace sitting time. Significant variations in sitting time were observed across different worksites of the same employer and the variation remained after adjusting for individual-level factors. Only BMI and organisational tenure were identified as correlates of total and prolonged workplace sitting time. Additional studies are needed to confirm the present findings across diverse organisations and occupations.

  5. Efficacy of the "baby-sitter" procedure after prolonged denervation.

    Mersa, B; Tiangco, D A; Terzis, J K


    This study was undertaken to evaluate whether 40 percent of the hypoglossal nerve, which showed optimal efficacy in restoring orbicularis oculi muscle (OOM) function after different percentages of partial neurectomy in a previous study would be effective after prolonged denervation time. Twenty Sprague-Dawley rats were divided into four groups. In first-stage surgery the left facial nerve of all animals was transected at the level of the stylomastoid foramen and main zygomatic branch. Group A (controls) consisted of animals with only left facial nerves transected (no repair). In Groups B, C, and D the facial nerve was transected and the facial musculature was denervated for a period of 4, 8, and 12 weeks respectively. During a second-stage procedure, a 40 percent neurectomy was performed on the hypoglossal nerve. Subsequently, a nerve transfer was performed by coaptations of a saphenous nerve graft to the neurectomized hypoglossal nerve and the main zygomatic branch of the facial nerve that innervated the OOM. Behavioral analysis of blink reflex, electrophysiology, and axon and motor end-plate counts in Groups B, C, and D showed superior results compared to Group A. There was no statistically significant difference observed among Groups B, C, and D (p > 0.05). Despite the diminished number of axons in the zygomatic branch and motor end-plates in the orbicularis oculi muscle after 12 weeks of denervation, there was still sufficient muscle target recovery to effect some eye closure in all groups except the controls. This study demonstrated in this model that the 40 percent partial neurectomy of the XII to VII component of the "baby-sitter" procedure was effective even after prolonged denervation.

  6. Late-responding normal tissue cells benefit from high-precision radiotherapy with prolonged fraction delivery times via enhanced autophagy

    Yao, Qiwei; Zheng, Rong; Xie, Guozhu; Liao, Guixiang; Du, Shasha; Ren, Chen; Li, Rong; Lin, Xiaoshan; Hu, Daokun; Yuan, Yawei


    High-precision radiotherapy (HPR) has established its important role in the treatment of tumors due to its precise dose distribution. Given its more complicated delivery process, HPR commonly requires more fraction delivery time (FDT). However, it is unknown whether it has an identical response of prolonged FDT on different normal tissues. Our results showed that fractionated irradiation with prolonged FDTs (15, 36, and 50 minutes) enhanced cell surviving fractions for normal tissue cells compared with irradiation with an FDT of 2 minutes. However, the late-responding normal cell line HEI-OC1 was more responsive to prolonged FDTs and demonstrated higher surviving fractions and significantly decreased apoptosis and DNA damage compared to the acute-responding normal cell line HaCaT. Increased autophagy mediated via the ATM-AMPK pathway was observed in HEI-OC1 cells compared with HaCaT cells when irradiated with prolonged FDTs. Furthermore, treatment with the autophagy inhibitor 3-MA or ATM inhibitor KU55933 resulted in enhanced ROS accumulation and attenuation of the effect of prolonged FDT-mediated protection on irradiated HEI-OC1 cells. Our results indicated that late-responding normal tissue cells benefitted more from prolonged FDTs compared with acute-responding tissue cells, which was mainly attributed to enhanced cytoprotective autophagy mediated via the ATM/AMPK signaling pathway. PMID:25766900

  7. Encephalitis with Prolonged but Reversible Splenial Lesion

    Alena Meleková


    Full Text Available Introduction: The splenium of the corpus callosum has a specific structure of blood supply with a tendency towards blood-brain barrier breakdown, intramyelinic edema, and damage due to hypoxia or toxins. Signs and symptoms of reversible syndrome of the splenium of the corpus callosum typically include disorientation, confusion, impaired consciousness, and epileptic seizures. Case report: A previously healthy 32-year-old man suffered from weakness, headache, and fever. Subsequently, he developed apathy, ataxia, and inability to walk, and therefore was admitted to the hospital. Cerebrospinal fluid showed protein elevation (0.9 g/l and pleocytosis (232/1 ul. A brain MRI showed hyperintense lesions in the middle of the corpus callosum. The patient was treated with antibiotics, and subsequently, in combination with steroids. Two months later, the hyperintense lesions in the splenium and the basal ganglia had disappeared. Almost seven months since his hospitalization in the Department of Neurology, the patient has returned to his previous employment. He now does not exhibit any mental changes, an optic edema and urological problems have improved. In addition, he is now actively engaged in sports. Conclusion: We have described a case of a 32-year-old man with confusion, ataxia, and inability to stand and walk. The man developed a febrile meningeal syndrome and a hyperintense lesion of the splenium, which lasted for two months. Neurological changes, optic nerve edema, and urinary retention have resolved over the course of seven months. We think that the prolonged but transient lesion of the splenium may have been caused by encephalitis of viral origin.

  8. Diaphragmatic energetics during prolonged exhaustive exercise.

    Manohar, M; Hassan, A S


    The present study was carried out to examine diaphragmatic O2 extraction and lactate and ammonia production during prolonged exhaustive exercise. Experiments were performed on nine healthy exercise-conditioned ponies in which catheters had been implanted in the phrenic vein previously. Blood-gas variables and lactate and ammonia concentrations were determined on simultaneously obtained arterial and phrenic-venous blood samples at rest and during 30 min of exertion at 15 mph + 7% grade (heart rate, 200 beats/min; approximately 90% of maximum). Arterial O2 tension and saturation were maintained near resting value but CO2 tension decreased markedly with exercise, and because of increased hemoglobin concentration, arterial O2 content rose. Concomitantly, phrenic venous O2 tension, saturation and content decreased markedly (23.6 +/- 1 mm Hg, 24.5 +/- 2%, 5.2 +/- 0.3 ml/dl at 3 min of exertion) and significant fluctuations did not occur as exercise duration progressed to 30 min. Diaphragmatic arteriovenous O2 content difference and O2 extraction rose from 4 +/- 0.3 to 16 +/- 0.5 ml/dl and from 30 +/- 3 to 75 +/- 1% at 3 min of exercise, and significant deviations did not occur as exercise duration progressed. Arterial lactate and ammonia levels increased during exercise, indicating their release from working limb muscles. Phrenic-venous values of lactate and ammonia did not exceed arterial values. Ponies sweated profusely and were unable to keep up with the belt speed in the last 4 to 5 min of exercise. Constancy of phrenic arteriovenous O2 content difference in exercise indicated ability to adjust perfusion in diaphragm so as to adequately meet its O2 needs.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Exceptionally prolonged tooth formation in elasmosaurid plesiosaurians

    Kear, Benjamin P.; Larsson, Dennis; Lindgren, Johan; Kundrát, Martin


    Elasmosaurid plesiosaurians were globally prolific marine reptiles that dominated the Mesozoic seas for over 70 million years. Their iconic body-plan incorporated an exceedingly long neck and small skull equipped with prominent intermeshing ‘fangs’. How this bizarre dental apparatus was employed in feeding is uncertain, but fossilized gut contents indicate a diverse diet of small pelagic vertebrates, cephalopods and epifaunal benthos. Here we report the first plesiosaurian tooth formation rates as a mechanism for servicing the functional dentition. Multiple dentine thin sections were taken through isolated elasmosaurid teeth from the Upper Cretaceous of Sweden. These specimens revealed an average of 950 daily incremental lines of von Ebner, and infer a remarkably protracted tooth formation cycle of about 2–3 years–other polyphyodont amniotes normally take ~1–2 years to form their teeth. Such delayed odontogenesis might reflect differences in crown length and function within an originally uneven tooth array. Indeed, slower replacement periodicity has been found to distinguish larger caniniform teeth in macrophagous pliosaurid plesiosaurians. However, the archetypal sauropterygian dental replacement system likely also imposed constraints via segregation of the developing tooth germs within discrete bony crypts; these partly resorbed to allow maturation of the replacement teeth within the primary alveoli after displacement of the functional crowns. Prolonged dental formation has otherwise been linked to tooth robustness and adaption for vigorous food processing. Conversely, elasmosaurids possessed narrow crowns with an elongate profile that denotes structural fragility. Their apparent predilection for easily subdued prey could thus have minimized this potential for damage, and was perhaps coupled with selective feeding strategies that ecologically optimized elasmosaurids towards more delicate middle trophic level aquatic predation. PMID:28241059

  10. QT interval prolongation after Premature Ventricular Contractions (PVCs

    Mohammed Haroon Rashid


    Full Text Available Long QT syndrome (LQTS is an inherited ion channelopathy resulting in abnormal ventricular repolarization and abnormal prolongation of QT interval on the ECG. Syncope, fainting, cardiac arrest, and sudden death are common manifestations of LQTS. We present a case report that describes a patient with prolonged QT interval after extrasystoles and a family history of sudden cardiac deaths.

  11. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

    Dihmis Walid C


    Full Text Available Abstract Objective Patients who have prolonged stay in intensive care unit (ICU are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG. Methods 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004. The area under the receiver operating characteristic (ROC curve was calculated to assess the performance of the prediction tool. Results 475(9.2% patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively. Conclusion A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.

  12. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade.

    Parrington, Simon J; O'Donnell, Dermot; Chan, Vincent W S; Brown-Shreves, Danielle; Subramanyam, Rajeev; Qu, Melody; Brull, Richard


    Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications. Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively. The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.

  13. Prolonged treatment with ursodeoxycholic acid for primary biliary cirrhosis.

    Crippa, G; Cagnoni, C; Castelli, A; Concesi, C; Girometta, S; Pancotti, D; Sverzellati, E; Tacchini, G; Pierfranceschi, M G; Carrara, G C


    Eighteen patients affected with biopsy-proved primary biliary cirrhosis (PBC) (histological stage III and IV) received ursodeoxicholic acid (UDCA) 600 mg for 1 year. Signs and symptoms and biochemical tests (glutamic and oxalcetic transaminase, glutamic and pyruvic transaminase, bilirubine, gamma-glutamyl transpeptidase, alkaline phosphatase, leucine aminopeptidase, bile acids, plasma proteins electrophoresis, immunoglubulins A, G and M) and antimitochondrial antibodies were evaluated before the treatment and every four months during the treatment. The results were compared with those obtained in 8 untreated patients affected PBC. The control group of patients were comparable (as far as age, histological stage, biochemical tests are concerned) to the group who received UDCA. Bilirubine, ALP, gamma-GT and LAP decreased during the treatment with UDCA and remained lower than baseline values until the end of the observation (12 months), while no changes occurred in the untreated patients. Both in the treated and untreated group plasma protein electrophoresis, serum immunoglubulins A, G and M remained unchanged, as well as anti-mitochondrial antibody. A moderate reduction of transaminases and bile acids was observed in the group of patients receiving UDCA but it did not reach statistical significance. In 16 out of the 18 treated patients pruritus disappeared and resulted diminished in the remaining 2 patients. No significant amelioration of pruritus was observed in the patients who did not receive UDCA. In conclusion, our data show that prolonged treatment with UDCA drastically reduces pruritus and improves cholestasis biochemical tests in patients affected with symptomatic PBC.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Effect of prolonged chemical challenges on selected properties of silorane

    de Jesus, Vivian CBR; Martinelli, Natan Luiz; Pascotto, Renata Corrêa;

    Objectives: The purpose of this study was to investigate the effect of prolonged chemical challenges on water sorption, solubility, and roughness of a silorane-based material when compared to methacrylate-based composites. Methods: Initial roughness and mass were registered for specimens (n=24......) fabricated from methacrylate (Filtek Z250, 3M ESPE; Filtek Z350XT, 3M ESPE; Master Fill, Biodinâmica) or silorane-based (Filtek P90, 3M ESPE) composites. The volume of all specimens was also calculated. Specimens were divided in four groups (n=6) and individually stored at 37°C in 0.02N citric acid, 0.02N...... submitted to two-way analysis of variance or analysis of variance for repeated measures, and Tukey’s multiple comparison test (a=0.05). Results: The silorane-based composite was the roughest (pcomposite (Ra=0.06±0.01) when compared to the other investigated materials (Ra=0.05±0.01). Significant...

  15. Quality assessment of palm products upon prolonged heat treatment.

    Tarmizi, Azmil Haizam Ahmad; Lin, Siew Wai


    Extending the frying-life of oils is of commercial and economic importance. Due to this fact, assessment on the thermal stability of frying oils could provide considerable savings to the food processors. In this study, the physico-chemical properties of five palm products mainly palm oil, single-fractionated palm olein, double-fractionated palm olein, red palm olein and palm-based shortening during 80 hours of heating at 180 degrees C were investigated. Heating properties of these products were then compared with that of high oleic sunflower oil, which was used as reference oil. The indices applied in evaluating the quality changes of oils were free fatty acid, smoke point, p-anisidine value, tocols, polar and polymer compounds. Three palm products i.e. palm oil, single-fractionated palm olein and double-fractionated palm olein were identified to be the most stable in terms of lower formation of free fatty acid, polar and polymer compounds as well as preserving higher smoke point and tocols content compared to the other three oils. The low intensity of hydrolytic and oxidative changes due to prolonged heating, suggests that these palm products are inherently suitable for frying purposes.

  16. Prolonged chewing at lunch decreases later snack intake.

    Higgs, Suzanne; Jones, Alison


    Prolonged chewing of food can reduce meal intake. However, whether prolonged chewing influences intake at a subsequent eating occasion is unknown. We hypothesised that chewing each mouthful for 30s would reduce afternoon snack intake more than (a) an habitual chewing control condition, and (b) an habitual chewing condition with a pauses in between each mouthful to equate the meal durations. We further hypothesised that this effect may be related to effects of prolonged chewing on lunch memory. Forty three participants ate a fixed lunch of sandwiches in the laboratory. They were randomly allocated to one of the three experimental groups according to a between-subjects design. Appetite, mood and lunch enjoyment ratings were taken before and after lunch and before snacking. Snack intake of candies at a taste test 2h after lunch was measured as well as rated vividness of lunch memory. Participants in the prolonged chewing group ate significantly fewer candies than participants in the habitual chewing group. Snack intake by the pauses group did not differ from either the prolonged or habitual chewing groups. Participants in the prolonged chewing group were less happy and enjoyed their lunch significantly less than participants in other conditions. Appetite ratings were not different across groups. Rated vividness of lunch memory was negatively correlated with intake but there was no correlation with rated lunch enjoyment. Prolonged chewing of a meal can reduce later snack intake and further investigation of this technique for appetite control is warranted.

  17. Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychoses.

    Vohs, J L; Lysaker, P H; Francis, M M; Hamm, J; Buck, K D; Olesek, K; Outcalt, J; Dimaggio, G; Leonhardt, B; Liffick, E; Mehdiyoun, N; Breier, A


    While it has been documented that persons with prolonged schizophrenia have deficits in metacognition and social cognition, it is less clear whether these difficulties are already present during a first episode. To explore this issue we assessed and compared metacognition using the Metacognition Assessment Scale-Abbreviated (MAS-A) and social cognition using the Eyes, Hinting and Bell-Lysaker Emotional Recognition Tests (BLERT) in participants with first episode psychosis (FEP; n=26), participants with a prolonged psychosis (n=72), and a psychiatric control group consisting of persons with a substance use disorder and no history of psychosis (n=14). Analyses revealed that both psychosis cohorts scored lower than controls on the MAS-A total and all subscales except metacognitive mastery. Compared to the FEP group, the persons with prolonged psychosis demonstrated greater metacognitive capacities only in those MAS-A domains reflective of the ability to understand the mental state of others and to see that others may have motivations and desires separate from their own. Other domains of metacognition did not differ between psychosis groups. The Eyes, Hinting and BLERT scores of the two psychosis groups did not differ but were poorer than those produced by the control group. Exploratory correlations in the FEP group showed a pattern similar to that previously observed in prolonged psychosis. Taken together, these findings suggest that while certain domains of metacognition could improve with prolonged psychosis, difficulties with global metacognition and social cognition may be stable features of the disorder and perhaps unique to psychosis. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Supplementation of Ascorbic Acid in Weanling Horses Following Prolonged Transportation

    Michelle Stives


    Full Text Available Though horses synthesize ascorbic acid in their liver in amounts that meet their needs under normal circumstances, prolonged stress results in low plasma concentrations due to enhanced utilization and renal excretion and can reduce immune function. It was hypothesized that plasma ascorbic acid could be maintained in weanling horses by oral supplementation following prolonged transportation. Weanlings were supplemented with no ascorbic acid (Tx 0: n = 4, 5 grams ascorbic acid twice daily for 5 days (Tx 1: n = 4 or for 10 days (Tx 2: n = 4 following >50 hours of transportation. Supplementation caused slight (P < 0.2 increases in plasma ascorbic acid concentrations. Both supplemented groups had decreased (P < 0.05 plasma concentrations for 1 to 3 weeks following cessation of supplementation, possibly due to increased renal excretion or suppressed hepatic synthesis. Supplementation of ascorbic acid following prolonged stress will increase plasma concentrations, but prolonged supplementation should be avoided.

  19. Paroxysmal events during prolonged video-video electroencephalography monitoring in refractory epilepsy.

    Sanabria-Castro, A; Henríquez-Varela, F; Monge-Bonilla, C; Lara-Maier, S; Sittenfeld-Appel, M


    Given that epileptic seizures and non-epileptic paroxysmal events have similar clinical manifestations, using specific diagnostic methods is crucial, especially in patients with drug-resistant epilepsy. Prolonged video electroencephalography monitoring during epileptic seizures reveals epileptiform discharges and has become an essential procedure for epilepsy diagnosis. The main purpose of this study is to characterise paroxysmal events and compare patterns in patients with refractory epilepsy. We conducted a retrospective analysis of medical records from 91 patients diagnosed with refractory epilepsy who underwent prolonged video electroencephalography monitoring during hospitalisation. During prolonged video electroencephalography monitoring, 76.9% of the patients (n=70) had paroxysmal events. The mean number of events was 3.4±2.7; the duration of these events was highly variable. Most patients (80%) experienced seizures during wakefulness. The most common events were focal seizures with altered levels of consciousness, progressive bilateral generalized seizures and psychogenic non-epileptic seizures. Regarding all paroxysmal events, no differences were observed in the number or type of events by sex, in duration by sex or age at onset, or in the number of events by type of event. Psychogenic nonepileptic seizures were predominantly registered during wakefulness, lasted longer, started at older ages, and were more frequent in women. Paroxysmal events recorded during prolonged video electroencephalography monitoring in patients with refractory epilepsy show similar patterns and characteristics to those reported in other latitudes. Copyright © 2017 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Epileptogenesis provoked by prolonged experimental febrile seizures: mechanisms and biomarkers

    Dubé, Celiné M.; Ravizza, Teresa; Hamamura, Mark; Zha, Qinqin; Keebaugh, Andrew; Fok, Kimberly; Andres, Adrienne M.; Nalcioglu, Orhan; Obenaus, Andre; Vezzani, Annamaria; Baram, Tallie Z.


    Whether long febrile seizures (FS) can cause epilepsy in the absence of genetic or acquired predisposing factors is unclear. Having established causality between long FS and limbic epilepsy in an animal model, we studied here if the duration of the inciting FS influenced the probability of developing subsequent epilepsy and the severity of the spontaneous seizures. We evaluated if interictal epileptifom activity and/or elevation of hippocampal T2 signal on MRI provided predictive biomarkers for epileptogenesis, and if the inflammatory mediator interleukin-1β (IL-1β), an intrinsic element of FS generation, contributed also to subsequent epileptogenesis. We found that febrile status epilepticus, lasting an average of 64 minutes, increased the severity and duration of subsequent spontaneous seizures compared with FS averaging 24 minutes. Interictal activity in rats sustaining febrile status epilepticus was also significantly longer and more robust, and correlated with the presence of hippocampal T2 changes in individual rats. Neither T2 changes nor interictal activity predicted epileptogenesis. Hippocampal levels of IL-1β were significantly higher for over 24 hours after prolonged FS. Chronically, IL-1β levels were elevated only in rats developing spontaneous limbic seizures after febrile status epilepticus, consistent with a role for this inflammatory mediator in epileptogenesis. Establishing seizure duration as an important determinant in epileptogenesis, and defining the predictive roles of interictal activity, MRI, and inflammatory processes are of paramount importance to the clinical understanding of the outcome of FS, the most common neurological insult in infants and children. PMID:20519523

  1. Color stability and staining of silorane after prolonged chemical challenges

    de Jesus, Vivian CBR; Martinelli, Nata Luiz; Poli-Frederico, Regina Célia;

    Objectives: The purpose of this study was to investigate the effect of prolonged chemical challenges on color stability and staining susceptibility of a silorane-based composite material when compared to methacrylate-based composites. Methods: Cylindrical specimens (n=24) were fabricated from...... methacrylate (Filtek Z250, 3M ESPE; Filtek Z350XT, 3M ESPE; Master Fill, Biodinâmica) or silorane-based (Filtek P90, 3M ESPE) composite materials. Initial color was registered in a spectrophotometer. Specimens were divided in four groups and individually stored at 37°C in 0.02N citric acid, 0.02N phosphoric...... acid, 75% ethanol or distilled water (control) for 7, 14, 21, and 180 days, when new measurements were performed. A staining test was performed (n=12) after 21 days of chemical challenge by immersion in coffee during 3 weeks at 37°C. Color changes (¿E) were characterized using the CIEL*a*b* color...

  2. Adhesive polydopamine coated avermectin microcapsules for prolonging foliar pesticide retention.

    Jia, Xin; Sheng, Wen-bo; Li, Wei; Tong, Yan-bin; Liu, Zhi-yong; Zhou, Feng


    In this work, we report a conceptual strategy for prolonging foliar pesticide retention by using an adhesive polydopamine (PDA) microcapsule to encapsulate avermectin, thereby minimizing its volatilization and improving its residence time on crop surfaces. Polydopamine coated avermectin (Av@PDA) microcapsules were prepared by emulsion interfacial-polymerization and characterized by Fourier transform infrared spectroscopy, energy dispersive X-ray spectroscopy, field-emission scanning electron microscope, and transmission electron microscopy. The in situ synthesis route confers Av@PDA microcapsules with remarkable avermectin loading ability of up to 66.5% (w/w). Kinetic study of avermectin release demonstrated that Av@PDA microcapsules exhibit sustained- and controlled-release properties. The adhesive property of Av@PDA microcapsules on different surfaces was verified by a comparative study between Av@PDA and passivated Av@SiO2 and Av@PDA@SiO2 capsules with silica shell. Moreover, PDA shell could effectively shield UV irradiation and so protect avermectin from photodegradation, making it more applicable for foliar spraying. Meanwhile, it is determinated that Av@PDA microcapsules have good mechanical stability property.

  3. Prolongation structure of the Landau–Lifshitz equation

    Roelofs, G.H.M.; Martini, R.


    The prolongation method of Wahlquist and Estabrook is applied to the Landau–Lifshitz equation. The resulting prolongation algebra is shown to be isomorphic to a subalgebra of the tensor product of the Lie algebra so(3) with the elliptic curve v α 2−v β 2=j β−j α (α,β=1,2,3), which is essentially a s

  4. Outcome of Induction of Labour in Prolonged Pregnancy.

    Nasrin, S; Islam, S; Shahida, S M; Begum, R A; Haque, N


    This was a hospital based prospective clinical study conducted among women having prolonged pregnancy to assess the outcome of induction of labour in prolonged pregnancy cases. One hundred and thirty nine women having uncomplicated prolonged pregnancy were studied. The study was carried out in Sir Salimullah Medical College & Mitford Hospital, Dhaka from 01 July 2010 to 30 March 2011. In this study 66% of the respondents had vaginal delivery on routine induction of labour and in 34% cases induction failed. Ninety three percent (93%) of the multigravida had vaginal delivery and in primigravida their vaginal delivery rate was 47.5%. Regarding cervical condition for delivery, 75% of the respondents having favourable cervix had vaginal delivery and in case of unfavourable cervix respondents, they had 55% cases of vaginal delivery. About the foetal outcome it was evidenced from this study that the perinatal adverse outcome increases with the increasing age of gestation beyond 40 completed weeks of gestation. This study showed that the use of prostaglandins for cervical ripening and by confirming the diagnosis of prolonged pregnancy, the delivery outcome in prolonged pregnancy can be improved. The study also showed that induction of labour is not associated with any major complications and the routine induction of labour in prolonged pregnancy is beneficial for both mother and the baby.

  5. Diagnosis, antenatal surveillance and management of prolonged pregnancy: current perspectives.

    Vitale, S G; Marilli, I; Rapisarda, A M; Iapichino, V; Stancanelli, F; Cianci, A


    Prolonged pregnancy is defined as a pregnancy that extends beyond 42 weeks of gestation (294 days) from the first day of the last normal menstrual period. An accurate estimation of the 'natural' incidence of prolonged pregnancy would require meticulous early pregnancy dating. The use of ultrasound to establish gestational age reduces the number of pregnancies that are classified as prolonged. Prolonged pregnancy is associated with an increased perinatal mortality and morbidity in pregnancies which appear to be otherwise low risk. Postterm births are easily preventable by intervening to deliver with the use of induction of labor. Thus, this potentially problematic condition deserves further attention and careful consideration. The focus of this article is to review and challenge some current concepts surrounding the diagnosis and management of prolonged pregnancy. We outline how to identify those women with prolonged pregnancy and which is the appropriate moment to start monitoring the fetal wellbeing. Finally we address the question of benefits and hazards of induction of labor strategies.

  6. Psidium guajava and Piper betle Leaf Extracts Prolong Vase Life of Cut Carnation (Dianthus caryophyllus Flowers

    M. M. Rahman


    Full Text Available The effect of leaf extracts of Psidium guajava and Piper betle on prolonging vase life of cut carnation flowers was studied. “Carola” and “Pallas Orange” carnation flowers, at bud stage, were pulsed 24 hours with a floral preservative. Then, flowers were placed in a vase solution containing sprite and a “germicide” (leaf extracts of P. guajava and P. betle, 8-HQC, or a copper coin. Flowers treated with 8-HQC, copper coin, and leaf extracts had longer vase life, larger flower diameter, and higher rate of water uptake compared to control (tap water. The leaf extracts of P. guajava and P. betle showed highest antibacterial and antifungal activities compared to the other treatments. Both showed similar effects on flower quality as the synthetic germicide, 8-HQC. Therefore, these extracts are likely natural germicides to prolong vase life of cut flowers.

  7. Psidium guajava and Piper betle leaf extracts prolong vase life of cut carnation (Dianthus caryophyllus) flowers.

    Rahman, M M; Ahmad, S H; Lgu, K S


    The effect of leaf extracts of Psidium guajava and Piper betle on prolonging vase life of cut carnation flowers was studied. "Carola" and "Pallas Orange" carnation flowers, at bud stage, were pulsed 24 hours with a floral preservative. Then, flowers were placed in a vase solution containing sprite and a "germicide" (leaf extracts of P. guajava and P. betle, 8-HQC, or a copper coin). Flowers treated with 8-HQC, copper coin, and leaf extracts had longer vase life, larger flower diameter, and higher rate of water uptake compared to control (tap water). The leaf extracts of P. guajava and P. betle showed highest antibacterial and antifungal activities compared to the other treatments. Both showed similar effects on flower quality as the synthetic germicide, 8-HQC. Therefore, these extracts are likely natural germicides to prolong vase life of cut flowers.

  8. Sulphasalazine: a safe, effective agent for prolonged control of rheumatoid arthritis. A comparison with sodium aurothiomalate.

    Bax, D E; Amos, R S


    The place of sulphasalazine in the management of rheumatoid arthritis over prolonged periods of time has been compared and contrasted with that of sodium aurothiomalate. One hundred and forty-three patients (59 on sulphasalazine, 84 on sodium aurothiomalate) have been treated for periods of up to 42 months. Sulphasalazine is highly effective for some patients, though probably less frequently than sodium aurothiomalate. However, its safety profile is far superior, and very long-term treatment ...

  9. Sulphasalazine: a safe, effective agent for prolonged control of rheumatoid arthritis. A comparison with sodium aurothiomalate.

    Bax, D E; Amos, R S


    The place of sulphasalazine in the management of rheumatoid arthritis over prolonged periods of time has been compared and contrasted with that of sodium aurothiomalate. One hundred and forty-three patients (59 on sulphasalazine, 84 on sodium aurothiomalate) have been treated for periods of up to 42 months. Sulphasalazine is highly effective for some patients, though probably less frequently than sodium aurothiomalate. However, its safety profile is far superior, and very long-term treatment ...

  10. Prevention of Pazopanib-Induced Prolonged Cardiac Repolarization and Proarrhythmic Effects

    Tulay Akman


    Full Text Available Background: Pazopanib (PZP may induce prolonged cardiac repolarization and proarrhythmic effects, similarly to other tyrosine kinase inhibitors. Objectives: To demonstrate PZP-induced prolonged cardiac repolarization and proarrhythmic electrophysiological effects and to investigate possible preventive effects of metoprolol and diltiazem on ECG changes (prolonged QT in an experimental rat model. Methods: Twenty-four Sprague-Dawley adult male rats were randomly assigned to 4 groups (n = 6. The first group (normal group received 4 mL of tap water and the other groups received 100 mg/kg of PZP (Votrient® tablet perorally, via orogastric tubes. After 3 hours, the following solutions were intraperitoneally administered to the animals: physiological saline solution (SP, to the normal group and to the second group (control-PZP+SP group; 1 mg/kg metoprolol (Beloc, Ampule, AstraZeneca, to the third group (PZP+metoprolol group; and 1mg/kg diltiazem (Diltiazem, Mustafa Nevzat, to the fourth group (PZP+diltiazem group. One hour after, and under anesthesia, QTc was calculated by recording ECG on lead I. Results: The mean QTc interval values were as follows: normal group, 99.93 ± 3.62 ms; control-PZP+SP group, 131.23 ± 12.21 ms; PZP+metoprolol group, 89.36 ± 3.61 ms; and PZP+diltiazem group, 88.86 ± 4.04 ms. Both PZP+metoprolol and PZP+diltiazem groups had significantly shorter QTc intervals compared to the control-PZP+SP group (p < 0.001. Conclusion: Both metoprolol and diltiazem prevented PZP-induced QT interval prolongation. These drugs may provide a promising prophylactic strategy for the prolonged QTc interval associated with tyrosine kinase inhibitor use.

  11. The impact of prolonged violent video-gaming on adolescent sleep: an experimental study.

    King, Daniel L; Gradisar, Michael; Drummond, Aaron; Lovato, Nicole; Wessel, Jason; Micic, Gorica; Douglas, Paul; Delfabbro, Paul


    Video-gaming is an increasingly prevalent activity among children and adolescents that is known to influence several areas of emotional, cognitive and behavioural functioning. Currently there is insufficient experimental evidence about how extended video-game play may affect adolescents' sleep. The aim of this study was to investigate the short-term impact of adolescents' prolonged exposure to violent video-gaming on sleep. Seventeen male adolescents (mean age = 16 ± 1 years) with no current sleep difficulties played a novel, fast-paced, violent video-game (50 or 150 min) before their usual bedtime on two different testing nights in a sleep laboratory. Objective (polysomnography-measured sleep and heart rate) and subjective (single-night sleep diary) measures were obtained to assess the arousing effects of prolonged gaming. Compared with regular gaming, prolonged gaming produced decreases in objective sleep efficiency (by 7 ± 2%, falling below 85%) and total sleep time (by 27 ± 12 min) that was contributed by a near-moderate reduction in rapid eye movement sleep (Cohen's d = 0.48). Subjective sleep-onset latency significantly increased by 17 ± 8 min, and there was a moderate reduction in self-reported sleep quality after prolonged gaming (Cohen's d = 0.53). Heart rate did not differ significantly between video-gaming conditions during pre-sleep game-play or the sleep-onset phase. Results provide evidence that prolonged video-gaming may cause clinically significant disruption to adolescent sleep, even when sleep after video-gaming is initiated at normal bedtime. However, physiological arousal may not necessarily be the mechanism by which technology use affects sleep.

  12. Predictors for Prolonged Intensive Care Unit Stay After Adult Orthotopic Liver Transplantation

    Aycan Kundakcı


    Full Text Available Objective: Intensive care unit (ICU stay consumes physical and financial resources and may increase the risk of complications and possibly mortality. The purpose of this study was to evaluate the factors predicting prolonged ICU length of stay (LOS after orthotopic liver transplantation (OLT. Materials and Methods: We reviewed the data of 112 adult patients who underwent OLT between January 2000 and February 2009. The data included the demographic and clinical features, preoperative laboratory values, intraoperative hemodynamic parameters and transfusions, and mortalities. Prolonged ICU LOS was defined as more than 3 days stay in the ICU after OLT. Results: Out of 112 patients 59 (53% of them required prolonged ICU LOS. Patients who required prolonged ICU LOS compared to those who did not had higher model for end stage liver disease (MELD and Child-Pugh scores (p<0.001, had a lower mean preoperative hemoglobin level (p=0.04, had a higher mean preoperative blood urea nitrogen level (p=0.013, less frequently had coronary artery disease (p=0.046, required higher amounts of blood products transfusions intraoperatively (p=0.004, and had a longer duration of anesthesia (p=0.010. Multivariate logistic regression revealed that only higher MELD scores (odds ratio: 1.4, CI%95:1.2-1.7, p=0.010 was an independent risk factor for prolonged ICU stay after liver transplantation Patients who had developed renal failure in the early postoperative period according to the RIFLE criteria had stayed in the ICU longer [74% (23 vs 44%(36, p=0.006]. Patients who had stayed in the ICU for more than 3 days had higher rates of mortalities [41% (24 vs 9% (5, p<0.001]. Conclusion: In conclusion, 53% of our liver transplant recipients required prolonged ICU stay postoperatively and a higher MELD score was an independent risk factor for prolonged ICU requirement. (Journal of the Turkish Society of Intensive Care 2011; 9: 14-8

  13. Does obesity prolong anesthesia in children undergoing common ENT surgery?

    Lee, Jennifer J; Sun, Lena S; Gu, Brian; Kim, Minjae; Wang, Shuang; Han, Sena


    To report the epidemiology of obesity in a pediatric surgical population and determine whether obesity is a risk factor for longer anesthesia duration. Childhood obesity is a significant public health problem in the United States. Epidemiologic studies on pediatric surgical populations have been limited to states with very high prevalence of adult obesity (Michigan, Texas). Data from other states and more recent data since 2006 are unavailable. We examined anesthesia records for surgical patients age 2-18 years at Columbia University Medical Center from January 2009 to December 2010. Patients undergoing bariatric surgery or those with records missing preoperative height or weight data were excluded. Body mass index (BMI) was calculated as weight (kg)/height (m(2) ). BMI ≥95th percentile according to national growth charts were considered obese. We reviewed 9522 patients of which 1639 were obese (17.2%). The sex-age category interaction on obesity was not significant using logistic regression (P = 0.11). Among surgical groups, the otolaryngology (ENT) cohort had the highest obesity rate (21.7%, 360/1656). Obese children who had tonsillectomy, adenoidectomy, or both did not have a prolonged anesthetic (P = 0.33) or surgical duration (P = 0.61) compared with nonobese children, adjusting for surgeon, season, surgical procedure code, and ASA status. Children presenting for surgery, particularly the ENT cohort, have a high prevalence of obesity. Obese and nonobese children who had tonsillectomy, adenoidectomy, or both had comparable durations of anesthesia. Therefore, obesity did not lead to longer anesthetic duration. © 2014 John Wiley & Sons Ltd.

  14. Prolonged myelination in human neocortical evolution.

    Miller, Daniel J; Duka, Tetyana; Stimpson, Cheryl D; Schapiro, Steven J; Baze, Wallace B; McArthur, Mark J; Fobbs, Archibald J; Sousa, André M M; Sestan, Nenad; Wildman, Derek E; Lipovich, Leonard; Kuzawa, Christopher W; Hof, Patrick R; Sherwood, Chet C


    Nerve myelination facilitates saltatory action potential conduction and exhibits spatiotemporal variation during development associated with the acquisition of behavioral and cognitive maturity. Although human cognitive development is unique, it is not known whether the ontogenetic progression of myelination in the human neocortex is evolutionarily exceptional. In this study, we quantified myelinated axon fiber length density and the expression of myelin-related proteins throughout postnatal life in the somatosensory (areas 3b/3a/1/2), motor (area 4), frontopolar (prefrontal area 10), and visual (areas 17/18) neocortex of chimpanzees (N = 20) and humans (N = 33). Our examination revealed that neocortical myelination is developmentally protracted in humans compared with chimpanzees. In chimpanzees, the density of myelinated axons increased steadily until adult-like levels were achieved at approximately the time of sexual maturity. In contrast, humans displayed slower myelination during childhood, characterized by a delayed period of maturation that extended beyond late adolescence. This comparative research contributes evidence crucial to understanding the evolution of human cognition and behavior, which arises from the unfolding of nervous system development within the context of an enriched cultural environment. Perturbations of normal developmental processes and the decreased expression of myelin-related molecules have been related to psychiatric disorders such as schizophrenia. Thus, these species differences suggest that the human-specific shift in the timing of cortical maturation during adolescence may have implications for vulnerability to certain psychiatric disorders.

  15. Prolonged remission maintenance in acute myeloid leukaemia.

    Spiers, A S; Goldman, J M; Catovsky, D; Costello, C; Galton, D A; Pitcher, C S


    Twenty-five patients with acute myeloid leukaemia were treated with three quadruple drug combinations in predetermined rotation: TRAP (thioguanine, daunorubicin, cytarabine, prednisolone); COAP (cyclophosphamide, vincristine, cytarabine, prednisolone); and POMP (prednisolone, vincristine, methotrexate, mercaptopurine). Fifteen patients (60%) achieved complete remission and five (20%) partial remission. For maintenance, five-day courses of drugs were administered every 14 to 21 days and doses were increased to tolerance. The median length of complete remission was 66 weeks. In eight patients remission maintenance treatment was discontinued and some remained in complete remission for over two years. In this series the remission induction rate was comparable with that reported for other regimens and complete remission lasted longer with this intensive maintenance regimen than with others. Nevertheless, the TRAP programme must still be regarded as only palliative treatment for acute myeloid leukaemia.

  16. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: Rationale and design of a randomized trial [ISRCT 26872154

    W.C. Peul (Wilco); H.C. van Houwelingen (Hans); W.B. van den Hout (Wilbert); R. Brand (René); J.A.H. Eekhof (Just); J.T.J. Tans (Th); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)


    textabstractBackground: The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design: Patients presenting themselves to

  17. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation : cost utility analysis alongside a randomised controlled trial

    Hout, van den W.B.; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.W.M.


    Objective: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. Design: Cost utility analysis alongside a randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with sciati

  18. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial.

    Hout, W.B. van den; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.


    OBJECTIVE: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. DESIGN: Cost utility analysis alongside a randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with sciati

  19. Constrained spheroids for prolonged hepatocyte culture.

    Tong, Wen Hao; Fang, Yu; Yan, Jie; Hong, Xin; Hari Singh, Nisha; Wang, Shu Rui; Nugraha, Bramasta; Xia, Lei; Fong, Eliza Li Shan; Iliescu, Ciprian; Yu, Hanry


    Liver-specific functions in primary hepatocytes can be maintained over extended duration in vitro using spheroid culture. However, the undesired loss of cells over time is still a major unaddressed problem, which consequently generates large variations in downstream assays such as drug screening. In static culture, the turbulence generated by medium change can cause spheroids to detach from the culture substrate. Under perfusion, the momentum generated by Stokes force similarly results in spheroid detachment. To overcome this problem, we developed a Constrained Spheroids (CS) culture system that immobilizes spheroids between a glass coverslip and an ultra-thin porous Parylene C membrane, both surface-modified with poly(ethylene glycol) and galactose ligands for optimum spheroid formation and maintenance. In this configuration, cell loss was minimized even when perfusion was introduced. When compared to the standard collagen sandwich model, hepatocytes cultured as CS under perfusion exhibited significantly enhanced hepatocyte functions such as urea secretion, and CYP1A1 and CYP3A2 metabolic activity. We propose the use of the CS culture as an improved culture platform to current hepatocyte spheroid-based culture systems.

  20. Correcting magnesium deficiencies may prolong life

    Rowe WJ


    Full Text Available William J RoweFormer Assistant Clinical Professor of Medicine, Medical University of Ohio at Toledo, Ohio, USAAbstract: The International Space Station provides an extraordinary facility to study the accelerated aging process in microgravity, which could be triggered by significant reductions in magnesium (Mg ion levels with, in turn, elevations of catecholamines and vicious cycles between the two. With space flight there are significant reductions of serum Mg (P < 0.0001 that have been shown in large studies of astronauts and cosmonauts. The loss of the functional capacity of the cardiovascular system with space flight is over ten times faster than the course of aging on Earth. Mg is an antioxidant and calcium blocker and in space there is oxidative stress, insulin resistance, and inflammatory conditions with evidence in experimental animals of significant endothelial injuries and damage to mitochondria. The aging process is associated with progressive shortening of telomeres, repetitive DNA sequences, and proteins that cap and protect the ends of chromosomes. Telomerase can elongate pre-existing telomeres to maintain length and chromosome stability. Low telomerase triggers increased catecholamines while the sensitivity of telomere synthesis to Mg ions is primarily seen for the longer elongation products. Mg stabilizes DNA and promotes DNA replication and transcription, whereas low Mg might accelerate cellular senescence by reducing DNA stability, protein synthesis, and function of mitochondria. Telomerase, in binding to short DNAs, is Mg dependent. On Earth, in humans, a year might be required to detect changes in telomeres, but in space there is a predictably much shorter duration required for detection, which is therefore more reasonable in time and cost. Before and after a space mission, telomere lengths and telomerase enzyme activity can be determined and compared with age-matched control rats on Earth. The effect of Mg supplementation

  1. Central and regional hemodynamics in prolonged space flights

    Gazenko, O. G.; Shulzhenko, E. B.; Turchaninova, V. F.; Egorov, A. D.

    This paper presents the results of measuring central and regional (head, forearm, calf) hemodynamics at rest and during provocative tests by the method of tetrapolar rheography in the course of Salyut-6-Soyuz and Salyut-7-Soyuz missions. The measurements were carried out during short-term (19 man-flights of 7 days in duration) and long-term (21 man-flights of 65-237 days in duration) manned missions. At rest, stroke volume (SV) and cardiac output (CO) as well as heart rate (HR) decreased insignificantly (in short-term flights) or remained essentially unchanged (in long-term flights). In prolonged flights CO increased significantly in response to exercise tests due to an increase in HR and the lack of changes in SV. After exercise tests SV and CO decreased as compared to the preflight level. During lower body negative pressure (LBNP) tests HR and CO were slightly higher than preflight. Changes in regional hemodynamics included a distinct decrease of pulse blood filling (PBF) of the calf, a reduction of the tone of large vessels of the calf and small vessels of the forearm. Head examination (in the region of the internal carotid artery) showed a decrease of PBF of the left hemisphere (during flight months 2-8) and a distinct decline of the tone of small vessels, mainly, in the right hemisphere. During LBNP tests the tone of pre- and postcapillary vessels of the brain returned to normal while PBF of the right and left hemisphere vessels declined. It has been shown that regional circulation variations depend on the area examined and are induced by a rearrangement of total hemodynamics of the human body in microgravity. This paper reviews the data concerning changes in central and regional circulation of men in space flights of different duration.

  2. Intrasplenic transplantation of allogeneic hepatocytes prolongs survival in anhepatic rats.

    Arkadopoulos, N; Lilja, H; Suh, K S; Demetriou, A A; Rozga, J


    To examine whether hepatocytes transplanted in the spleen can function as an ectopic liver, we performed hepatocyte transplantation in rats that were rendered anhepatic. Total hepatectomy was performed by using a novel single-stage technique. Following hepatectomy, Group 1 rats (n = 16) were monitored until death to determine survival time without prior intervention. Group 2 anhepatic rats (n = 20) were sacrificed at various times to measure blood hepatocyte growth factor (HGF) and transforming growth factor beta1 (TGF-beta1) levels. Group 3 (n = 16) rats received intrasplenic injection of isolated hepatocytes (2.5 x 10(7) cells/rat) followed by total hepatectomy after 3 days. Group 4 (n = 12) sham-transplanted rats received intrasplenic saline infusion, and after 3 days they were rendered anhepatic. Group 2, 3, and 4 rats were maintained on daily Cyclosporine A (10 mg/kg; intramuscularly). Group 1 anhepatic rats survived for 22.4 +/- 5.2 hours (standard deviation). The anhepatic state was associated with a progressive and statistically significant rise in blood HGF and TGF-beta1 levels. Rats that received hepatocyte transplantation before total hepatectomy had a significantly longer survival time than sham-transplanted anhepatic controls (34.1 +/- 8.5 vs. 15.5 +/- 4.8 hrs, P ammonia, prothrombin time, international normalized ratio, and TGF-beta1 levels when compared with sham-transplanted controls. In conclusion, intrasplenic transplantation of allogeneic hepatocytes prolonged survival, improved blood chemistry, and lowered blood TGF-beta1 levels in rats rendered anhepatic.

  3. Nucleic acid therapy for lifespan prolongation: Present and future

    Wing-Fu Lai


    Lifespan prolongation is a common desire of the human race. With advances in biotechnology, the mechanism of aging has been gradually unraveled, laying the theoretical basis of nucleic acid therapy for lifespan prolongation. Regretfully, clinically applicable interventions do not exist without the efforts of converting theory into action, and it is the latter that has been far from adequately addressed at the moment. This was demonstrated by a database search on PubMed and Web of Science, from which only seven studies published between 2000 and 2010 were found to directly touch on the development of nucleic acid therapy for anti-aging and/or longevity enhancing purposes. In light of this, the objective of this article is to overview the current understanding of the intimate association between genes and longevity, and to bring the prospect of nucleic acid therapy for lifespan prolongation to light.

  4. Severe postpartum sepsis with prolonged myocardial dysfunction: a case report

    Chen Katherine T


    Full Text Available Abstract Introduction Severe sepsis during pregnancy or in the postpartum period is a rare clinical event. In non obstetric surviving patients, the cardiovascular changes seen in sepsis and septic shock are fully reversible five to ten days after their onset. We report a case of septic myocardial dysfunction lasting longer than ten days. To the best of our knowledge, this is the first report of prolonged septic myocardial dysfunction in a parturient. Case presentation A 24 year old Hispanic woman with no previous medical history developed pyelonephritis and severe sepsis with prolonged myocardial dysfunction after a normal spontaneous vaginal delivery. Conclusions Septic myocardial dysfunction may be prolonged in parturients requiring longer term follow up and pharmacologic treatment.

  5. QT prolongation in a child with thyroid storm

    Albert, Benjamin B; Eckersley, Luke Gerard; Skinner, Jonathan Robert; Jefferies, Craig


    Summary A 12-year-old girl presented with an acute confusional state and a 2-year history of weight loss, anxiety, agitation and recurrent fever. Thyroid function tests confirmed severe hyperthyroidism, and a diagnosis of thyroid storm was made (Burch and Wartofsky score=75). ECG showed a prolonged QTc interval of 506 ms. Acute treatment for thyroid storm consisted of Lugol's iodine, prednisolone, carbimazole and propranolol. She made a steady recovery and by 3 months her thyroid function had normalised; a repeat ECG showed a QTc within the normal range (430 ms). There was no relevant family history. This is a case of QTc prolongation with hyperthyroidism and normalisation with euthyroidism. It is not commonly recognised that hyperthyroidism in children may be associated with QTc prolongation. QTc measurement should be incorporated into management protocols for hyperthyroidism. PMID:24729112

  6. Invariant NKT cells promote skin wound healing by preventing a prolonged neutrophilic inflammatory response.

    Tanno, Hiromasa; Kawakami, Kazuyoshi; Kanno, Emi; Suzuki, Aiko; Takagi, Naoyuki; Yamamoto, Hideki; Ishii, Keiko; Imai, Yoshimichi; Maruyama, Ryoko; Tachi, Masahiro


    The wound-healing process consists of the inflammation, proliferation, and remodeling phases. In chronic wounds, the inflammation phase is prolonged with persistent neutrophil infiltration. The inflammatory response is critically regulated by cytokines and chemokines that are secreted from various immune cells. Recently, we showed that skin wound healing was delayed and the healing process was impaired under conditions lacking invariant natural killer T (iNKT) cells, an innate immune lymphocyte with potent immuno-regulatory activity. In the present study, we investigated the effect of iNKT cell deficiency on the neutrophilic inflammatory response during the wound healing process. Neutrophil infiltration was prolonged in wound tissue in mice genetically lacking iNKT cells (Jα18KO mice) compared with wild-type (WT) control mice on days 1 and 3 after wounding. MIP-2, KC, and IL-17A were produced at a significantly higher level in Jα18KO mice than in WT mice. In addition, neutrophil apoptosis was significantly reduced in the wound tissue in Jα18KO mice compared with WT mice. Treatment with either anti-IL-17A mAb, anti-Gr-1 mAb, or neutrophil elastase inhibitor reversed the impaired wound healing in Jα18KO mice. These results suggest that iNKT cells may promote the wound healing process through preventing the prolonged inflammatory response mediated by neutrophils. This article is protected by copyright. All rights reserved. © 2017 by the Wound Healing Society.

  7. Glycoinsulins: dendritic sialyloligosaccharide-displaying insulins showing a prolonged blood-sugar-lowering activity.

    Sato, Masaaki; Furuike, Tetsuya; Sadamoto, Reiko; Fujitani, Naoki; Nakahara, Taku; Niikura, Kenichi; Monde, Kenji; Kondo, Hirosato; Nishimura, Shin-Ichiro


    Mono-, di-, and trisialyloligosaccharides were introduced to mutant insulins through enzymatic reactions. Sugar chains were sialylated by alpha2,6-sialyltransferase (alpha2,6-SiaT) via an accessible glutamine residue at the N-terminus of the B-chain attached by transglutaminase (TGase). Sia2,6-di-LacNAc-Ins(B-F1Q) and Sia2,6-tri-LacNAc-Ins(B-F1Q), displaying two and three sialyl-N-acetyllactosamines, respectively, were administered to hyperglycemic mice. Both branched glycoinsulins showed prolonged glucose-lowering effects compared to native or lactose-carrying insulins, showing that sialic acid is important in obtaining a prolonged effect. Sia2,6-tri-LacNAc-Ins(B-F1Q), in particular, induced a significant delay in the recovery of glucose levels.

  8. Bartonella henselae Infective Endocarditis Detected by a Prolonged Blood Culture

    Mito, Tsutomu; Hirota, Yusuke; Suzuki, Shingo; Noda, Kazutaka; Uehara, Takanori; Ohira, Yoshiyuki; Ikusaka, Masatomi


    A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient's history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis. This case demonstrates that B. henselae may be detected by prolonged incubation of blood cultures. PMID:27746451

  9. Sponsored parachute jumps--can they cause prolonged pain?

    Straiton, N; Sterland, J


    A survey of parachute injuries sustained in 1984 at a local parachute club was made using hospital notes and a questionnaire. The overall injury rate was 0.2%. The injury rate in first time jumpers was 1.1%. The injuries often resulted in a prolonged hospital stay, time off work and residual pain and disability. Injury rates may be reduced by more prolonged and intensive training preceding the first jumps. Those people not interested in parachuting as a regular sport and who jump once only in...

  10. Sponsored parachute jumps--can they cause prolonged pain?

    Straiton, N; Sterland, J


    A survey of parachute injuries sustained in 1984 at a local parachute club was made using hospital notes and a questionnaire. The overall injury rate was 0.2%. The injury rate in first time jumpers was 1.1%. The injuries often resulted in a prolonged hospital stay, time off work and residual pain and disability. Injury rates may be reduced by more prolonged and intensive training preceding the first jumps. Those people not interested in parachuting as a regular sport and who jump once only in order to raise money for charity are at risk of serious injury and perhaps should consider less dangerous alternatives.

  11. Prolonged nerve blockade in a patient treated with lithium

    Lehavi A


    Full Text Available Amit Lehavi, Boris Shenderey, Yeshayahu (Shai KatzDepartment of Anesthesiology, Rambam Health Care Campus, Haifa, IsraelAbstract: We report a case of a patient, chronically treated with oral lithium, who presented with an extremely prolonged (42-hour duration of sensory and motor paralysis following an uneventful infraclavicular block for hand surgery that was performed under ultrasound guidance using bupivacaine and lidocaine. Due to its direct effect on nerve conduction of action potential, we propose that lithium may have had a role in the unusually prolonged duration of a peripheral nerve block.Keywords: nerve blockade, lithium, duration, anesthesia

  12. Changes in the human blood coagulating system during prolonged hypokinesia

    Filatova, L. M.; Anashkin, O. D.


    Changes in the coagulating system of the blood were studied in six subjects during prolonged hypokinesia. Thrombogenic properties of the blood rose in all cases on the 8th day. These changes are explained by stress reaction due to unusual conditions for a healthy person. Changes in the blood coagulating system in the group subjected to physical exercise and without it ran a practically parallel course. Apparently physical exercise is insufficient to prevent such changes that appear in the coagulating system of the blood during prolonged hypokinesia.

  13. Hypoglycaemia and QT interval prolongation in type 1 diabetes

    Christensen, Toke Folke; Cichosz, Simon Lebech; Tarnow, L.


    hypoglycaemia varies greatly between studies. METHODS: We studied ten adults with type 1 diabetes (age 41±15years) without cardiovascular disease or neuropathy. Single-blinded hypoglycaemia was induced by a subcutaneous insulin bolus followed by a control episode on two occasions separated by 4weeks. QT....... CONCLUSIONS: Hypoglycaemia as experienced after a subcutaneous injection of insulin may cause QTc prolongation in type 1 diabetes. However, the magnitude of prolongation is less than typically reported during glucose clamp studies, possible because of the study design with focus on minimizing unwanted study...

  14. Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial.

    Nachum, Zohar; Garmi, Gali; Kadan, Yfat; Zafran, Noah; Shalev, Eliezer; Salim, Raed


    A prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities. We aimed to compare between oxytocin augmentation, amniotomy and a combination of both on the duration of labor among women with a prolonged latent phase. Women with a singleton fetus in cephalic presentation who have a prolonged latent phase, were randomly allocated to amniotomy (group 1), oxytocin (group 2) or both (group 3). A group of women who progressed spontaneously without intervention composed the control group (group 4). The primary outcome was the duration of time from initiation of augmentation until delivery. A total of 213 women were consented and randomized to group 1 (70 women), group 2 (72 women) and group 3 (71 women). Group 4 was composed from additional 70 women. A mean reduction of 120 minutes in labor duration was observed among group 3 compared to group 1 (p = 0.08) and 180 minutes compared to group 2 and 4 (p = 0.001). Women in group 3 had a shorter length of time from augmentation until the beginning of the active phase and a shorter first stage of labor than group 1 (p = 0.03), group 2 (p = 0.001) and group 4 (p = 0.001). Satisfaction was greater among group 3 and 4. Mode of delivery and neonatal outcome were comparable between the groups. Labor augmentation by combined amniotomy and oxytocin among women with a prolonged latent phase at term seems superior compared to either of them alone.

  15. Prolonged corrected QT interval is predictive of future stroke events even in subjects without ECG-diagnosed left ventricular hypertrophy.

    Ishikawa, Joji; Ishikawa, Shizukiyo; Kario, Kazuomi


    We attempted to evaluate whether subjects who exhibit prolonged corrected QT (QTc) interval (≥440 ms in men and ≥460 ms in women) on ECG, with and without ECG-diagnosed left ventricular hypertrophy (ECG-LVH; Cornell product, ≥244 mV×ms), are at increased risk of stroke. Among the 10 643 subjects, there were a total of 375 stroke events during the follow-up period (128.7±28.1 months; 114 142 person-years). The subjects with prolonged QTc interval (hazard ratio, 2.13; 95% confidence interval, 1.22-3.73) had an increased risk of stroke even after adjustment for ECG-LVH (hazard ratio, 1.71; 95% confidence interval, 1.22-2.40). When we stratified the subjects into those with neither a prolonged QTc interval nor ECG-LVH, those with a prolonged QTc interval but without ECG-LVH, and those with ECG-LVH, multivariate-adjusted Cox proportional hazards analysis demonstrated that the subjects with prolonged QTc intervals but not ECG-LVH (1.2% of all subjects; incidence, 10.7%; hazard ratio, 2.70, 95% confidence interval, 1.48-4.94) and those with ECG-LVH (incidence, 7.9%; hazard ratio, 1.83; 95% confidence interval, 1.31-2.57) had an increased risk of stroke events, compared with those with neither a prolonged QTc interval nor ECG-LVH. In conclusion, prolonged QTc interval was associated with stroke risk even among patients without ECG-LVH in the general population.

  16. Detecting drug-induced prolongation of the QRS complex: New insights for cardiac safety assessment

    Cros, C., E-mail: [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Skinner, M., E-mail: [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Moors, J. [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Lainee, P. [Sanofi-Aventis R and D, 371, rue du Pr Joseph Blayac, 34184 Montpellier Cedex 04 (France); Valentin, J.P. [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom)


    Background: Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I{sub Na}) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I{sub Na}, this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. Methods: Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau of each acute increase in HR (3 beats averaged at steady state), and averaged over 1 h period from 1 h pre-dose to 5 h post-dose. Results: Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E{sub max} 13% and 20% respectively, P < 0.01–0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of + 0.7 ± 0.5 ms (quinidine, NS), + 1.8 ± 0.8 ms (mexiletine, P < 0.05) and + 2.8 ± 0.8 ms (flecainide, P < 0.01) (calculated as QRS at basal HR-QRS at high HR). Conclusion: Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function. -- Highlights: ► We aimed to improve detection of drug-induced QRS prolongation in safety screening. ► We used telemetered dogs to test class I antiarrhythmics at low and high heart rate. ► At low heart rate only quinidine and flecainide induced an increase in QRS duration. ► At high heart rate the effects of two

  17. Repeated Prolonged Exercise Decreases Maximal Fat Oxidation in Older Men

    Morville, Thomas; Rosenkilde, Mads; Munch-Andersen, Thor


    INTRODUCTION/PURPOSE: Fat metabolism and muscle adaptation was investigated in 6 older trained men (age: 61 ± 4 years; VO2max: 48 ± 2 mL kg min) following repeated prolonged exercise). METHODS: 2706 km (1,681 miles) cycling was performed over 14 days and a blood sample and a muscle biopsy were...

  18. Prolonged unassisted survival in an infant with anencephaly.

    Dickman, Holly; Fletke, Kyle; Redfern, Roberta E


    Anencephaly is one of the most lethal congenital defects. This case report is of an anencephalic infant who lived to 28 months of life and defies current literature. She is the longest surviving anencephalic infant who did not require life-sustaining interventions. This case presents the obstacles that arose from this infant's prolonged life and recommendations based on these findings.

  19. Single Prolonged Stress Disrupts Retention of Extinguished Fear in Rats

    Knox, Dayan; George, Sophie A.; Fitzpatrick, Christopher J.; Rabinak, Christine A.; Maren, Stephen; Liberzon, Israel


    Clinical research has linked post-traumatic stress disorder (PTSD) with deficits in fear extinction. However, it is not clear whether these deficits result from stress-related changes in the acquisition or retention of extinction or in the regulation of extinction memories by context, for example. In this study, we used the single prolonged stress…

  20. Intrinsic motivation and amotivation in first episode and prolonged psychosis.

    Luther, Lauren; Lysaker, Paul H; Firmin, Ruth L; Breier, Alan; Vohs, Jenifer L


    The deleterious functional implications of motivation deficits in psychosis have generated interest in examining dimensions of the construct. However, there remains a paucity of data regarding whether dimensions of motivation differ over the course of psychosis. Therefore, this study examined two motivation dimensions, trait-like intrinsic motivation, and the negative symptom of amotivation, and tested the impact of illness phase on the 1) levels of these dimensions and 2) relationship between these dimensions. Participants with first episode psychosis (FEP; n=40) and prolonged psychosis (n=66) completed clinician-rated measures of intrinsic motivation and amotivation. Analyses revealed that when controlling for group differences in gender and education, the FEP group had significantly more intrinsic motivation and lower amotivation than the prolonged psychosis group. Moreover, intrinsic motivation was negatively correlated with amotivation in both FEP and prolonged psychosis, but the magnitude of the relationship did not statistically differ between groups. These findings suggest that motivation deficits are more severe later in the course of psychosis and that low intrinsic motivation may be partially independent of amotivation in both first episode and prolonged psychosis. Clinically, these results highlight the importance of targeting motivation in early intervention services.

  1. Single Prolonged Stress Disrupts Retention of Extinguished Fear in Rats

    Knox, Dayan; George, Sophie A.; Fitzpatrick, Christopher J.; Rabinak, Christine A.; Maren, Stephen; Liberzon, Israel


    Clinical research has linked post-traumatic stress disorder (PTSD) with deficits in fear extinction. However, it is not clear whether these deficits result from stress-related changes in the acquisition or retention of extinction or in the regulation of extinction memories by context, for example. In this study, we used the single prolonged stress…

  2. The impact of obesity on physiological responses during prolonged exercise

    Eijsvogels, T.M.H.; Veltmeijer, M.T.; Schreuder, T.H.A.; Poelkens, F.; Thijssen, D.H.J.; Hopman, M.T.E.


    Background:Prolonged, moderate-intensity exercise training is routinely prescribed to subjects with obesity. In the general population, this type of exercise can lead to fluid and sodium imbalance. However, little is known whether obesity alters the risk of fluid and sodium imbalances.Objective:This

  3. Examining potential contraindications for prolonged exposure therapy for PTSD

    Minnen, A. van; Harned, M.S.; Zöllner, L.; Mills, K.


    Although prolonged exposure (PE) has received the most empirical support of any treatment for posttraumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid p

  4. Cerebral ammonia uptake and accumulation during prolonged exercise in humans

    Nybo, Lars; Dalsgaard, Mads K.; Steensberg, Adam


    We evaluated whether peripheral ammonia production during prolonged exercise enhances the uptake and subsequent accumulation of ammonia within the brain. Two studies determined the cerebral uptake of ammonia (arterial and jugular venous blood sampling combined with Kety-Schmidt-determined cerebra...

  5. Prolonged drought results in starvation of African elephant (Loxodonta africana)

    Wato, Yussuf A.; Heitkonig, Ignas; Wieren, van Sipke E.; Wahungu, Geoffrey; Prins, Herbert H.T.; Langevelde, van Frank


    Elephant inhabiting arid and semi-arid savannas often experience periods of drought, which, if prolonged, may cause mortality. During dry periods, elephant aggregate around water sources and deplete local forage availability. However, the relationships between adult elephant mortality and both hi

  6. The carotid baroreflex is reset following prolonged exercise in humans

    Hart, E. C.; Rasmussen, P.; Secher, N. H.


    Alterations in the carotid baroreflex (CBR) control of arterial pressure may explain the reduction in arterial pressure and left ventricular (LV) function after prolonged exercise. We examined the CBR control of heart rate (HR) and mean arterial pressure (MAP), in addition to changes in LV function......, pre- to post-exercise....

  7. Economic viability of beef cattle grazing systems under prolonged drought

    Prolonged drought in the Southern Great Plains of the USA in recent years has raised concerns about vulnerability of beef cattle grazing systems under adverse climate change. To help address the economic viability of beef grazing operations in the Southern Great Plains, this paper provides an econom...

  8. Recognition Memory Is Impaired in Children after Prolonged Febrile Seizures

    Martinos, Marina M.; Yoong, Michael; Patil, Shekhar; Chin, Richard F. M.; Neville, Brian G.; Scott, Rod C.; de Haan, Michelle


    Children with a history of a prolonged febrile seizure show signs of acute hippocampal injury on magnetic resonance imaging. In addition, animal studies have shown that adult rats who suffered febrile seizures during development reveal memory impairments. Together, these lines of evidence suggest that memory impairments related to hippocampal…

  9. The Prolonged Neonatal Admission: Implications for our National Children's Hospital

    McGlacken-Byrne, SM


    A significant number of neonates are admitted to tertiary paediatric units for prolonged stays annually, despite limited availability of neonatal beds. As the three Dublin paediatric hospitals merge, this pressure will be transferred to our new National Children’s Hospital.\\r\

  10. Prolongation Structure of Semi-discrete Nonlinear Evolution Equations


    Based on noncommutative differential calculus, we present a theory of prolongation structure for semi-discrete nonlinear evolution equations. As an illustrative example, a semi-discrete model of the nonlinear Schr(o)dinger equation is discussed in terms of this theory and the corresponding Lax pairs are also given.

  11. Prolonged drought results in starvation of African elephant (Loxodonta africana)

    Wato, Yussuf A.; Heitkonig, Ignas; Wieren, van Sipke E.; Wahungu, Geoffrey; Prins, Herbert H.T.; Langevelde, van Frank


    Elephant inhabiting arid and semi-arid savannas often experience periods of drought, which, if prolonged, may cause mortality. During dry periods, elephant aggregate around water sources and deplete local forage availability. However, the relationships between adult elephant mortality and both

  12. Assessing QT Interval Prolongation and its Associated Risks with Antipsychotics

    Nielsen, Jimmi; Graff, Claus; Kanters, Jørgen K.


    markers for TdP have been developed but none of them is clinically implemented yet and QT interval prolongation is still considered the most valid surrogate marker. Although automated QT interval determination may offer some assistance, QT interval determination is best performed by a cardiologist skilled...

  13. Assessing QT interval prolongation and its associated risks with antipsychotics

    Nielsen, Jimmi; Graff, Claus; Kanters, Jørgen K.


    markers for TdP have been developed but none of them is clinically implemented yet and QT interval prolongation is still considered the most valid surrogate marker. Although automated QT interval determination may offer some assistance, QT interval determination is best performed by a cardiologist skilled...

  14. Effect of prolonged bed rest on the anterior hip muscles.

    Dilani Mendis, M; Hides, Julie A; Wilson, Stephen J; Grimaldi, Alison; Belavý, Daniel L; Stanton, Warren; Felsenberg, Dieter; Rittweger, Joern; Richardson, Carolyn


    Prolonged bed rest and inactivity is known to cause muscular atrophy with previous research indicating that muscles involved in joint stabilisation are more susceptible. The anterior hip muscles are important for hip joint function and stability but little is known about the effects of prolonged inactivity on their function. This study investigated the effect of prolonged bed rest on the size of the anterior hip muscles and their pattern of recovery. The effect of resistive vibration exercise (RVE) as a countermeasure to muscle atrophy was also investigated. 12 male participants, randomly assigned to either a control or an exercise group, underwent 8 weeks of bed rest with 6 months follow-up. Changes in muscle cross-sectional area (CSA) of the iliacus, psoas, iliopsoas, sartorius and rectus femoris muscles were measured by magnetic resonance imaging at regular intervals during bed rest and recovery phases. CSAs of iliopsoas and sartorius decreased at the hip joint (piliacus, psoas, and rectus femoris CSAs were unchanged (p>0.05). No significant difference was found between the two groups for all muscles (all p>0.1), suggesting inefficacy of the countermeasure in this sample. These findings suggest that prolonged bed rest can result in the atrophy of specific muscles across the hip joint which may affect its stability and function.

  15. Prolonged idiopathic gastric dilatation following revascularization for chronic mesenteric ischemia.

    Gauci, Julia L; Stoven, Samantha; Szarka, Lawrence; Papadakis, Konstantinos A


    A 71-year-old female presented with nausea, emesis, early satiety, and abdominal distension following revascularization for chronic mesenteric ischemia. Computed tomography angiogram showed gastric dilatation. Esophagogastroduodenoscopy, small bowel follow through, and paraneoplastic panel were negative. Gastric emptying was delayed. Despite conservative management, she required a percutaneous endoscopic jejunostomy. The development of a prolonged gastroparetic state has not been previously described.

  16. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    Vahedian Azimi


    Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.

  17. Comparison of QT dispersion during atrial fibrillation and sinus rhythm in the same patients, at normal and prolonged ventricular repolarization

    Houltz, B; Darpo, B; Swedberg, K; Blomstrom, P; Crijns, HJGM; Jensen, SM; Svernhage, E; Edvardsson, N

    Aims Drug-induced increase in QT dispersion has been associated with increased risk of ventricular proarrhythmia. The aim of the present study was to compare QT dispersion during atrial fibrillation and sinus rhythm in the same patients at normal and prolonged ventricular repolarization. Methods and

  18. QTc interval prolongation in HIV-infected patients: a case–control study by 24-hour Holter ECG recording

    Fiorentini Alessandra


    Full Text Available Abstract Background Aim of the study was to assess QTc interval by a 24-hour ECG recording in a group of HIV-infected individuals with a basal prolonged QTc. The risk factors associated with QTc prolongation and the indices of cardiovascular autonomic control were also evaluated. Methods A case–control study was performed using as cases 32 HIV-infected patients with prolonged (>440 msec QTc interval as assessed by Holter ECG, and as controls 64 HIV-infected subjects with normal QTc interval. Autonomic function was evaluated by heart rate variability analysis during 24-hour recording. Results Duration of HIV disease was significantly longer among cases than among controls (p=0.04. Waist/hip ratio was also higher among cases than among controls (p=0.05. Frequency domain analysis showed the absence of physiologic decrease of low frequency (LF in the night period in both cases and controls. The LF night in cases showed a statistically significant reduction when compared with controls (p=0.007. Conclusions In our study group, QTc interval prolongation was associated with a longer duration of HIV infection and with a greater waist/hip ratio. HIV patients with QTc interval prolongation and with a longer duration of HIV infection were more likely to have an impairment of parasympathetic and sympathetic cardiac component.

  19. Dissolution of Intact, Divided and Crushed Circadin Tablets: Prolonged vs. Immediate Release of Melatonin

    Hui Ming Chua


    Full Text Available Circadin 2 mg prolonged-release tablet is the only licensed melatonin product available in the UK. Circadin is indicated for patients with primary insomnia aged 55 and over, but is more widely used “off-label” to treat sleep disorders especially in the paediatric population. Children and older people often have difficulty swallowing tablets and dividing the tablet is sometimes required to ease administration. The aim of this study was to measure the release profile of melatonin from Circadin tablets when divided or crushed, and compare this with release from intact tablets. Dissolution testing was also performed for unlicensed melatonin products for comparison. Dissolution tests were performed using the pharmacopoeial paddle apparatus, with melatonin release analyzed by high performance liquid chromatography. Melatonin content, hardness, friability, and disintegration of the products were also evaluated. The prolonged release of melatonin from Circadin tablets was unlike that of any other product tested. When divided into halves, Circadin preserved most of the prolonged-release characteristic (f2 = 58, whereas quarter-cut and crushed tablet had a more immediate melatonin release profile. Circadin is significantly less expensive and should be preferred to unlicensed medicines which are not pharmaceutically equivalent and offer less quality assurance.

  20. Ageing is associated with a prolonged fever response in human endotoxemia

    Krabbe, Karen S.; Kemp, Helle Bruunsgaard; Hansen, Christian Muff


    The purpose of this study was to investigate whether an age-associated impaired acute-phase response exists. Nine healthy elderly volunteers (median, 66 years; range, 61 to 69 years) and eight young controls (median, 24 years; range, 20 to 27 years) were given an intravenous bolus of endotoxin (2...... levels than did the young group. In conclusion, ageing is associated with an altered acute-phase response including initial hyperreactivity, prolonged inflammatory activity, and prolonged fever response.......The purpose of this study was to investigate whether an age-associated impaired acute-phase response exists. Nine healthy elderly volunteers (median, 66 years; range, 61 to 69 years) and eight young controls (median, 24 years; range, 20 to 27 years) were given an intravenous bolus of endotoxin (2...... ng/kg). The rectal temperature was monitored continuously, and blood samples for cytokine measurements were obtained before endotoxin administration as well as 0.5, 1, 1.5, 2, 3, 4, 8, 12, and 24 h after the injection. The elderly subjects showed a more prolonged fever response compared to the young...

  1. Stress analysis in human temporomandibular joint affected by anterior disc displacement during prolonged clenching.

    Abe, S; Kawano, F; Kohge, K; Kawaoka, T; Ueda, K; Hattori-Hara, E; Mori, H; Kuroda, S; Tanaka, E


    Parafunctional habits, such as prolonged clenching and bruxism, have been associated with dysfunctional overloading in the temporomandibular joint (TMJ). In this study, stress distributions in the TMJ were analysed during prolonged clenching, using three-dimensional finite element (FE) models of the TMJ with and without disc displacement. The aim of this study was to investigate stress distribution of the cartilaginous tissues in the TMJ with and without disc displacement. Finite element models were developed on the basis of magnetic resonance images from two subjects with and without anterior disc displacement. Condylar movements recorded during a 5-min clenching were used as the loading condition for stress analysis. In the asymptomatic model, the highest von Mises stresses were located in the lateral area (4·91 MPa) of the disc surfaces, and after 5-min clenching, the higher stresses were still located at the lateral area (3·65 MPa). In all the cartilaginous tissues, 30-50% of stress reduction occurred during 5-min clenching. In contrast, the von Mises stress in the cartilaginous tissues of the symptomatic model with disc displacement was markedly lower, compared with the asymptomatic model. However, in the condylar cartilage, stress relaxation during clenching was not recognised. Furthermore, relatively high stresses were observed in the retrodiscal tissues throughout clenching. The present results indicate that disc position could be involved in the stress distribution of the TMJ components during prolonged clenching.

  2. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children.

    Ashrafi, Mahmoud Reza; Khosroshahi, Nahid; Karimi, Parviz; Malamiri, Reza Azizi; Bavarian, Behrouz; Zarch, Anoushiravan Vakili; Mirzaei, Mehdi; Kompani, Farshid


    A Prolonged convulsive seizure is the most common neurological medical emergency with poor outcome. An ideal anticonvulsant should be easy-to-use, effective, and safe, and it should also have a long-lasting effect. Benzodiazepines, give via the intravenous or rectal route have generally been used as first-line drugs. In small children, IV access can be difficult and time consuming. Midazolam is a potent anticonvulsant and is rapidly absorbed from the rectal, nasal, and buccal mucosa. Our aim was to evaluate the efficacy and usability of buccal midazolam in controlling seizures in children with acute prolonged seizures, by comparing it with rectal diazepam. Ninety-eight patients were enrolled, with 49 patients in each treatment group. In the buccal midazolam group, 42 (88%) patients were controlled in less than 4 min of drug administration, and all of the patients were controlled within 5 min of drug administration. In the rectal diazepam group, 24 (49%) patients were controlled in less than 4 min and 40 (82%) patients were controlled within 5 min of drug administration. The time for drug administration and drug effect was significantly less with buccal midazolam than with rectal diazepam (p valuediazepam group, 7 (14%) parents were satisfied. Buccal midazolam was significantly more acceptable than rectal diazepam (p valuediazepam but more convenient to use in the controlling acute prolonged seizures in children, especially in situations in which there is a difficulty in gaining IV access, for example, in infants.

  3. Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

    Knapik Piotr


    Full Text Available Abstract Background Few available models aim to identify patients at risk of prolonged ventilation after cardiac surgery. We compared prediction models developed in ICU in two adjacent periods of time, when significant changes were observed both in population characteristics and the perioperative management. Methods We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n = 2165; January 2009 - July 2010, n = 2192. The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate logistic regression analysis was performed separately for each cohort. Results Most recent patients were older, with more co-morbidities, more frequently undergoing off-pump surgery. At the beginning of 2009 we also changed the technique of postoperative ventilation. Percentage of patients with prolonged ventilation decreased from 5.7% to 2.4% (p Conclusions Prediction models for postoperative ventilation should be regularly updated, particularly when major changes are noted in patients' demographics and surgical or anaesthetic technique.

  4. Benefits of rice seed priming are offset permanently by prolonged storage and the storage conditions

    Hussain, Saddam; Zheng, Manman; Khan, Fahad; Khaliq, Abdul; Fahad, Shah; Peng, Shaobing; Huang, Jianliang; Cui, Kehui; Nie, Lixiao


    Seed priming is a commercially successful practice, but reduced longevity of primed seeds during storage may limit its application. We established a series of experiments on rice to test: (1) whether prolonged storage of primed and non-primed rice seeds for 210 days at 25°C or −4°C would alter their viability, (2) how long primed rice seed would potentially remain viable at 25°C storage, and (3) whether or not post-storage treatments (re-priming or heating) would reinstate the viability of stored primed seeds. Two different rice cultivars and three priming agents were used in all experiments. Prolonged storage of primed seeds at 25°C significantly reduced the germination (>90%) and growth attributes (>80%) of rice compared with un-stored primed seeds. However, such negative effects were not observed in primed seeds stored at −4°C. Beneficial effects of seed priming were maintained only for 15 days of storage at 25°C, beyond which the performance of primed seeds was worse even than non-primed seeds. The deteriorative effects of 25°C storage were related with hampered starch metabolism in primed rice seeds. None of the post-storage treatments could reinstate the lost viability of primed seeds suggesting that seeds become unviable by prolonged post-priming storage at 25°C. PMID:25631923

  5. Prolonged spontaneous emission and dephasing of localized excitons in air-bridged carbon nanotubes

    Sarpkaya, Ibrahim; Zhang, Zhengyi; Walden-Newman, William; Wang, Xuesi; Hone, James; Wong, Chee W.; Strauf, Stefan


    The bright exciton emission of carbon nanotubes is appealing for optoelectronic devices and fundamental studies of light-matter interaction in one-dimensional nanostructures. However, to date, the photophysics of excitons in carbon nanotubes is largely affected by extrinsic effects. Here we perform time-resolved photoluminescence measurements over 14 orders of magnitude for ultra-clean carbon nanotubes bridging an air gap over pillar posts. Our measurements demonstrate a new regime of intrinsic exciton photophysics with prolonged spontaneous emission times up to T1=18 ns, about two orders of magnitude better than prior measurements and in agreement with values hypothesized by theorists about a decade ago. Furthermore, we establish for the first time exciton decoherence times of individual nanotubes in the time domain and find fourfold prolonged values up to T2=2.1 ps compared with ensemble measurements. These first observations motivate new discussions about the magnitude of the intrinsic dephasing mechanism while the prolonged exciton dynamics is promising for applications.

  6. [Beta lactam antibiotics and the question of dose regimen for severe infection. Prolonged infusion theoretically appealing--yet no evidence of clinical benefit].

    Leander, Gunilla; Eliasson, Erik; Hanberger, Håkan; Giske, Christian


    Patients with severe sepsis/septic shock have a high mortality. Beta-lactam antibiotics are normally first line treatment. This antimicrobial class has been associated with time-dependent efficacy. It is therefore plausible that administration as prolonged infusion will increase the therapeutic effect, as compared to short term bolus injections, which is the most common practice today. We have reviewed 14 randomized controlled studies to investigate whether prolonged infusion provides lower mortality and/or increased clinical cure. In summary, convincing advantages with prolonged infusion could not be found, however randomized studies are heterogeneous, and it cannot be excluded that some subgroups of critically ill patients could benefit from such treatment.

  7. Very prolonged stay in the intensive care unit after cardiac operations: early results and late survival.

    Silberman, Shuli; Bitran, Daniel; Fink, Daniel; Tauber, Rachel; Merin, Ofer


    Prolonged intensive care unit (ICU) stay is a surrogate for advanced morbidity or perioperative complications, and resource utilization may become an issue. It is our policy to continue full life support in the ICU, even for patients with a seemingly grim outlook. We examined the effect of duration of ICU stay on early outcomes and late survival. Between 1993 and 2011, 6,385 patients were admitted to the ICU after cardiac surgery. Patients were grouped according to length of stay in the ICU: group 1, 2 days or less (n = 4,631; 73%); group 2, 3 to 14 days (n = 1,423; 22%); group 3, more than 14 days (n = 331; 5%). Length of stay in ICU for group 3 patients was 38 ± 24 days (range, 15 to 160; median 31). Clinical profile and outcomes were compared between groups. Patients requiring prolonged ICU stay were older, underwent more complex surgery, had greater comorbidity, and a higher predicted operative mortality (p < 0.0001). They had a higher incidence of adverse events and increased mortality (p < 0.0001). Of the 331 group 3 patients, 60% were discharged: survival of these patients at 1, 3, and 5 years was 78%, 65%, and 52%, respectively. Operative mortality as well as late survival of discharged patients was proportional to duration of ICU stay. Current technology enables keeping sick patients alive for extended periods of time. Nearly two thirds of patients requiring prolonged ICU leave hospital, and of these, 50% attain 5-year survival. These data support offering full and continued support even for patients requiring very prolonged ICU stay. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Effect of prolonging radiation delivery time on retention of gammaH2AX

    Duzenli Cheryl


    Full Text Available Abstract Background and purpose Compared to conventional external beam radiotherapy, IMRT requires significantly more time to deliver the dose. Prolonging dose delivery potentially increases DNA repair which would reduce the biological effect. We questioned whether retention of γH2AX, a measure of lack of repair of DNA damage, would decrease when dose delivery was protracted. Materials and methods Exponentially growing SiHa cervical carinoma cells were irradiated with 6 MV photons in a water tank using a VarianEX linear accelerator. Cells held at 37°C received 2 Gy in 0.5 min and 4 Gy in 1 min. To evaluate effect of dose delivery prolongation, 2 and 4 Gy were delivered in 30 and 60 min. After 24 h recovery, cells were analyzed for clonogenic survival and for residual γH2AX as measured using flow cytometry. Results Increasing the dose delivery time from 0.5 or 1 min to 30 or 60 min produced a signficant increase in cell survival from 0.45 to 0.48 after 2 Gy, and from 0.17 to 0.20 after 4 Gy. Expression of residual γH2AX decreased from 1.27 to 1.22 relative to background after 2 Gy and 1.46 to 1.39 relative to background after 4 Gy, but differences were not statistically significant. The relative differences in the slopes of residual γH2AX versus dose for acute versus prolonged irradiation bordered on significant (p = 0.055, and the magnitude of the change was consistent with the observed increase in surviving fraction. Conclusion These results support the concept that DNA repair underlies the increase in survival observed when dose delivery is prolonged. They also help to establish the limits of sensitivity of residual γH2AX, as measured using flow cytometry, for detecting differences in response to irradiation.

  9. The effect of arsenic trioxide on QT interval prolongation during APL therapy

    周晋; 孟然; 李晓霞; 吕成芳; 范圣瑾; 杨宝峰


    Objective To investigate the cardiac effect of QT interval prolongation in the treatment of acute promyelocytic leukemia (APL) with arsenic trioxide (As2O3), and the relationship between QT and serum arsenic concentration.Methods Blood serum arsenic concentrations of thirty APL patients were determined at 2 hours, 4 hours, 8 hours, and 24 hours after As2O3 injection using atomic fluorophotometry. Cardiac functions were measured simultaneously using a 12-lead body-surface electrocardiogram (ECG). Q-T intervals were manually measured, and then corrected using Bazett ' s formula (QTc). QT dispersion (QTd) was also calculated. In order to assess the effects of arsenic on the symptoms of anemia, twenty-four anemia patients were divided into two groups on the basis hemoglobin concentration: Group1 (Hb≥90 g/L), and Group 2 (60 g/L≤Hb<90 g/L). QTc and QTd of these patients were also manually measured.Results All QT intervals of APL patients treated with As2O3 injection were prolonged [32.2 ms (27, 41 ms); P 0.05]. There was a delay of 2 hours in maximum QTc following peaks in serum arsenic concentration. Changes in QTc and QTd of the two anemic groups were not prominent.Conclusions As2O3 can prolong QTc intervals in APL patients, but the effects are delayed compared to peak serum arsenic concentrations. As2O3 has no prolongation effect on QTd. Mild and moderate anemia do not effect QTc and QTd.

  10. QT interval prolongation related to psychoactive drug treatment: a comparison of monotherapy versus polytherapy

    Piccinelli Marco


    Full Text Available Abstract Background Several antipsychotic agents are known to prolong the QT interval in a dose dependent manner. Corrected QT interval (QTc exceeding a threshold value of 450 ms may be associated with an increased risk of life threatening arrhythmias. Antipsychotic agents are often given in combination with other psychotropic drugs, such as antidepressants, that may also contribute to QT prolongation. This observational study compares the effects observed on QT interval between antipsychotic monotherapy and psychoactive polytherapy, which included an additional antidepressant or lithium treatment. Method We examined two groups of hospitalized women with Schizophrenia, Bipolar Disorder and Schizoaffective Disorder in a naturalistic setting. Group 1 was composed of nineteen hospitalized women treated with antipsychotic monotherapy (either haloperidol, olanzapine, risperidone or clozapine and Group 2 was composed of nineteen hospitalized women treated with an antipsychotic (either haloperidol, olanzapine, risperidone or quetiapine with an additional antidepressant (citalopram, escitalopram, sertraline, paroxetine, fluvoxamine, mirtazapine, venlafaxine or clomipramine or lithium. An Electrocardiogram (ECG was carried out before the beginning of the treatment for both groups and at a second time after four days of therapy at full dosage, when blood was also drawn for determination of serum levels of the antipsychotic. Statistical analysis included repeated measures ANOVA, Fisher Exact Test and Indipendent T Test. Results Mean QTc intervals significantly increased in Group 2 (24 ± 21 ms however this was not the case in Group 1 (-1 ± 30 ms (Repeated measures ANOVA p Conclusions No significant prolongation of the QT interval was found following monotherapy with an antipsychotic agent, while combination of these drugs with antidepressants caused a significant QT prolongation. Careful monitoring of the QT interval is suggested in patients taking a

  11. Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD


    Hodges LF: The use of virtual reality exposure in the treatment of anxiety disorders . Behav Modif 1999; 23(4):507-25 4. Difede J, Cukor J, Ivy P, Giosan C...RD: Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder . J Clin Psychiatry 2001; 62(8):617-22 3. Rothbaum BO...Hoffman H: The Application of Virtual Reality to the Treatment of PTSD Following the WTC Attack, in Psychobiology of Posttraumatic Stress Disorders

  12. The effects of prolonged oral administration of the disinfectant calcium hypochlorite in Nigerian commercial cockerels

    Temitayo O. Iji


    Full Text Available This study was designed to investigate the effects of prolonged oral administration of calcium hypochlorite in the drinking water of commercial cockerels. It was carried out in order to ascertain probable toxicity associated with prolonged exposure to calcium hypochlorite. Thirty-two healthy birds were used; they were grouped into four groups of eight. Group 1, which served as the control, received 10 mL/kg body weight of physiological saline. Groups 2, 3 and 4 received 0.0375 g, 0.375 g and 0.75 g of calcium hypochlorite per 10 litres of drinking water for six weeks respectively. Six weeks after the administration of calcium hypochlorite, blood was collected from the jugular vein to assess liver function, lipid profiles and for markers of oxidative stress. The results revealed a significant (p < 0.05 increase in alanine aminotransferase activity in a dose-dependent manner when compared with the control. Also, there was a significant (p < 0.05 increase in aspartate aminotransferase and alkaline phosphatase activity. Similarly, there was a significant (p < 0.05 increase in total cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein levels compared with the control. There was a significant increase in malondialdehyde and hydrogen peroxide generation with a concomitant significant (p < 0.05 decrease in serum glutathione level in a dose-dependent manner when compared with the control. In this study, calcium hypochloriteinduced hepatic damage via oxidative stress and decrease in antioxidant defense system was found. Therefore, prolonged exposure of chickens to calcium hypochlorite is potentially harmful.

  13. Design of novel injectable cationic microspheres based on aminated gelatin for prolonged insulin action.

    Morimoto, Kazuhiro; Chono, Sumio; Kosai, Tadashi; Seki, Toshinobu; Tabata, Yasuhiko


    The aim of this study was to prepare two types of injectable cationized microspheres based on a native gelatin (NGMS) and aminated gelatin with ethylenediamine (CGMS) to prolong the action of insulin. Release of rhodamin B isothiocyanate insulin from CGMS was compared with that from NGMS under in-vitro and in-vivo conditions. Lower release of insulin from CGMS compared with that from NGMS was caused by the suppression of initial release. The disappearance of 125I-insulin from the injection site after intramuscular administration by NGMS and CGMS had a biphasic profile in mice. Almost all the 125I-insulin had disappeared from the injection site one day after administration by NGMS. The remaining insulin at the injection site after administration by CGMS was prolonged, with approximately 59% remaining after one day and 16% after 14 days. The disappearance of CGMS from the injection site was lower than that of NGMS. However, the difference in these disappearance rates was not great compared with those of 125I-insulin from the injection site by NGMS and CGMS. The time course of disappearance of 125I-CGMS from the injection site was similar to that of 125I-insulin by CGMS. The initial hypoglycaemic effect was observed 1 h after administration of insulin by NGMS, thereafter its effect rapidly disappeared. The hypoglycaemic effect was observed 2-4 h after administration by CGMS and continued to be exhibited for 7 days. The prolonged hypoglycaemic action by CGMS depended on the time profiles of the disappearance of insulin from muscular tissues, which occurs due to the enzymatic degradation of CGMS.

  14. Deep, prolonged torpor by pregnant, free-ranging bats

    Willis, Craig K. R.; Brigham, R. Mark; Geiser, Fritz


    Many mammals save energy during food shortage or harsh weather using controlled reductions in body temperature and metabolism called torpor. However, torpor slows offspring growth, and reproductive individuals are thought to avoid using it because of reduced fitness resulting from delayed offspring development. We tested this hypothesis by investigating torpor during reproduction in hoary bats ( Lasiurus cinereus, Vespertilionidae) in southern Canada. We recorded deep, prolonged torpor bouts, which meet the definition for hibernation, by pregnant females. Prolonged torpor occurred during spring storms. When conditions improved females aroused and gave birth within several days. Our observations imply a fitness advantage of torpor in addition to energy conservation because reduced foetal growth rate could delay parturition until conditions are more favourable for lactation and neonatal survival.

  15. Infection prevention and control during prolonged human space travel.

    Mermel, Leonard A


    Prolonged human spaceflight to another planet or an asteroid will introduce unique challenges of mitigating the risk of infection. During space travel, exposure to microgravity, radiation, and stress alter human immunoregulatory responses, which can in turn impact an astronaut's ability to prevent acquisition of infectious agents or reactivation of latent infection. In addition, microgravity affects virulence, growth kinetics, and biofilm formation of potential microbial pathogens. These interactions occur in a confined space in microgravity, providing ample opportunity for heavy microbial contamination of the environment. In addition, there is the persistence of aerosolized, microbe-containing particles. Any mission involving prolonged human spaceflight must be carefully planned to minimize vulnerabilities and maximize the likelihood of success.

  16. Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment.

    Weinfurtner, Kelley; Graves, Jennifer; Ness, Jayne; Krupp, Lauren; Milazzo, Maria; Waubant, Emmanuelle


    Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.

  17. Reversal of prolonged isoniazid-induced coma by pyridoxine.

    Brent, J; Vo, N; Kulig, K; Rumack, B H


    Isoniazid overdose is known to result in the rapid onset of seizures, metabolic acidosis, and prolonged obtundation. Pyridoxine has been reported to be effective in treating isoniazid-induced seizures. We report three cases of obtundation secondary to isoniazid overdose that was immediately reversed by intravenous pyridoxine. In two of these cases, status seizures were stopped by intravenous pyridoxine administration, but the patients remained comatose for prolonged periods. The comas were immediately reversed by the administration of additional pyridoxine. In the third case, the patient's lethargy was treated by intravenous pyridoxine on presentation and was followed by immediate awakening. Pyridoxine is effective in treating not only isoniazid-induced seizures, but also the mental status changes associated with this overdose. The dose required to induce awakening may be higher than that required to control seizures.

  18. Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

    Dhammapal Sahebrao Bhamare


    Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

  19. Prolonged apnea following modified electroconvulsive therapy with suxamethonium

    T M Omprakash


    Full Text Available A 36-year-old male from an urban middleclass family with strained relationship among family members was referred from a corporate hospital for further management of psychological problem. As he was attempting suicide repeatedly, Electroconvulsive Therapy (ECT was planned. After preoperative assessment and preparation, modified ECT was done with thiopentone and 0.5 mg/kg of suxamethonium. Apnea following suxamethonium was prolonged for 2 hours. Subsequent enquiry revealed that patient was treated for organophosphate poisoning and was on ventilator support for 15 days. This was concealed by the relatives. On searching patient previous records, Butyrylcholinesterase levels were very low, i.e., 350 u/l (normal reference range is 5 500 - 12 500 u/l. Prolonged suxamethonium apnea should be anticipated in patients with recent history of organophosphate poisoning; it is advisable to estimate the levels of butyrylcholinesterase and avoid suxamethonium in patients with low enzyme levels.

  20. MRI findings of prolonged post-traumatic sternal pain

    Grosse, Alexandra; Grosse, Claudia; Anderson, Suzanne [University Hospital of Berne, Department of Diagnostic, Pediatric and Interventional Radiology, Berne (Switzerland); Steinbach, Lynne [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)


    The objective of this study was to characterize the different causes of prolonged sternal pain following thoracic trauma with involvement of the sternum and to define criteria for sternal nonunion diagnosis using MRI. Five patients with abnormalities of the sternum were evaluated for prolonged sternal pain following thoracic trauma using MRI. MR images were evaluated by two radiologists in consensus. The patients were selected from the radiology database, which included 8 patients with post-traumatic prolonged sternal pain. Two patients (n = 2) revealed a sternal nonunion after sternal fracture. One patient had a sternal fracture with delayed union and minor displacement of the sternal halves. Abnormal signal intensity alterations adjacent to and within the manubrio-sternal joint were evident in 2 patients and considered due to trauma-related changes in the manubrio-sternal joint. The 3 patients who were not included in the study had no abnormalities of the sternum: 1 of them proved to have a well-healed sternal fracture and nonunion of a rib fracture, 1 had subtle Tietze's syndrome, and 1 patient revealed no pathological findings on imaging. Various factors may be responsible for prolonged sternal pain following thoracic trauma, and these can be viewed with MRI. In cases of sternal nonunion there was common fluid-like signal in the fracture interspace between the bony edges, and the bone marrow adjacent to the nonunion showed altered signal intensity. MRI identified sternal nonunion and other trauma-related abnormalities of the sternum following chest trauma. (orig.)

  1. Disseminated Mycobacterium celatum disease with prolonged pulmonary involvement

    Patsche, Cecilie Blenstrup; Svensson, Erik; Wejse, Christian


    Mycobacterium celatum is a rare cause of human infection, causing disseminated disease in immunosuppressed individuals. Infections localized to the lungs and the lymph nodes have also been reported in immunocompetent individuals. The existing literature on the subject is limited as are experience....... The treatment regimen was changed to azithromycin, ciprofloxacin, and pyrazinamide and the treatment duration was prolonged to a total of 24 months, with good effect....

  2. Prolonged morphine administration alters protein expression in the rat myocardium

    Drastichova Zdenka; Skrabalova Jitka; Neckar Jan; Kolar Frantisek; Novotny Jiri


    Abstract Background Morphine is used in clinical practice as a highly effective painkiller as well as the drug of choice for treatment of certain heart diseases. However, there is lack of information about its effect on protein expression in the heart. Therefore, here we aimed to identify the presumed alterations in rat myocardial protein levels after prolonged morphine treatment. Methods Morphine was administered to adult male Wistar rats in high doses (10 mg/kg per day) for 10 days. Protein...

  3. Amphiphilic vinyl polymers effectively prolong liposome circulation time in vivo.

    Torchilin, V P; Shtilman, M I; Trubetskoy, V S; Whiteman, K; Milstein, A M


    Newly synthesized amphiphilic polyacrylamide and poly(vinyl pyrrolidone), single terminus-modified with long-chain fatty acyl groups, are able to incorporate into the liposomal membrane, and similar to poly(ethylene glycol) prolong liposome circulation in vivo and decrease liposome accumulation in the liver. Protective efficacy of modified polymers increases with the increase in the length of acyl moiety and decreases for higher molecular weight polymers. The data on amphiphilic polymer-modified liposome biodistribution are presented.

  4. Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

    Hasan Onur Topcu


    Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs. [Cukurova Med J 2015; 40(1.000: 113-118

  5. Neural compensation within the human triceps surae during prolonged walking.

    Cronin, Neil J; Peltonen, Jussi; Sinkjaer, Thomas; Avela, Janne


    During human walking, muscle activation strategies are approximately constant across consecutive steps over a short time, but it is unknown whether they are maintained over a longer duration. Prolonged walking may increase tendinous tissue (TT) compliance, which can influence neural activation, but the neural responses of individual muscles have not been investigated. This study investigated the hypothesis that muscle activity is up- or down-regulated in individual triceps surae muscles during prolonged walking. Thirteen healthy subjects walked on a treadmill for 60 min at 4.5 km/h, while triceps surae muscle activity, maximal muscle compound action potentials, and kinematics were recorded every 5 min, and fascicle lengths were estimated at the beginning and end of the protocol using ultrasound. After 1 h of walking, soleus activity increased by 9.3 ± 0.2% (P triceps surae muscles and that changes in muscle activation are generally mirrored by changes in muscle fascicle length. These findings also support the notion of muscle-specific changes in TT compliance after prolonged walking and highlight the ability of the CNS to maintain relatively constant movement patterns in spite of neuromechanical changes in individual muscles.

  6. Prolonged Exposure Therapy For Post Traumatic Stress Disorder

    Levent SÜTÇİGİL


    Full Text Available Post-traumatic Stress Disorder (PTSD is a psychiatric illness that usually develops after an event that threatens one’s life and body integrity and it affects quality of life and impairs social functioning significantly. Many studies have shown therapeutic effect of cognitive behavioral therapies on posttraumatic stress disorder, so that these therapies take part in the first step of treatment guides. Exposure is a practice that is generally used to reduce pathological fear and related emotions common in posttraumatic stress disorder (PTSD and other anxiety disorders. During exposure, patients intentionally confront with feared objects, situations, thoughts and similar stimuli in order to reduce anxiety level. Exposure can be divided into two main techniques as in vivo exposure and imaginal exposure. Prolonged exposure therapy is a specialized treatment program configured for the treatment of posttraumatic stress disorder and it is based on emotional processing theory. Program is comprised of four main components: (a Psycho-education about trauma and posttraumatic disorders, (b Training for breathing exercises, (c repeated facing with objects, persons, situations and thoughts which causes re-experience about trauma, (d Patient are instructed for telling repeatedly and loudly about traumatic experiences . Prolonged exposure usually involves 9 to 12 sessions, each lasting about 60-90 minutes, administered once or twice a week. Prolonged exposure therapy was started to be implemented since the 1980s, during this period the effectiveness of the therapy has been shown in various empirical studies.

  7. Prolonged symptoms in sporadic hemiplegic migraine: aura or migrainous infarction?

    Lai, Tzu-Hsien; Hong, Chien-Tai


    Sporadic hemiplegic migraine is a rare form of migraine associated with motor weakness during the aura phase. While the aura usually lasts less than 1 hour, patients with sporadic hemiplegic migraine frequently have prolonged weakness. A 60-year-old male had sporadic hemiplegic migraine after a head injury at the age of 14. He presented to our emergency department with a typical migraine attack except prolonged right limbs weakness and numbness (>1 day). Brain magnetic resonance imaging showed an acute infarction in the left posterior medial pons. He recovered completely from motor weakness but still complained of residual numbness in his right limbs three months later. We report the first adult case of sporadic hemiplegic migraine with migrainous infarction located in the pons. Since patients with hemiplegic migraine often have prolonged aura, it is easy to be confused with a migrainous infarction. The case report highlights that migrainous infarction is a complication difficult to diagnose and treat early, especially in patients with hemiplegic migraine.

  8. Secondary bacteraemia in adult patients with prolonged dengue fever.

    Premaratna, R; Dissanayake, D; Silva, F H D S; Dassanayake, M; de Silva, H J


    Although dengue management guidelines do not advice on use of antibiotics in dengue shock syndrome, unrecognised bactraemia is likely to contribute to morbidity and mortality. To assess the occurance of secondary bacteraemia in adult patients with prolonged dengue fever. A prospective study was conducted recruiting patients with confirmed acute dengue infection who had prolonged fever (>5 days). Two sets of blood cultures were taken in such patients prior to institution of antibiotic therapy. Demographic, clinical, haematological and biochemical parameters were recorded. Development of ascites and pleural effusions were detected using ultrasonography. Fourty patients (52.5% males) with a mean age of 29.8 years (SD 13.6) were studied. The average duration of fever was 7.9 days (SD 1.8). Ten patients (25%) had bacterial isolates in their blood cultures; Staphylococcus aureus (n=2), coliforms (n=3), pseudomonas (n=1) and 4 had mixed growths. The culture positive group had severe body aches at admission and higher fever, third space fluid accumulation, a significant drop in platelets and a higher CRP. A quarter of dengue patients with prolonged fever had a bacterial isolate. Culture positive patients appeared more ill with body aches and had higher degrees of fever during the latter part of the illness. Increased vascular permeability may predispose to bacterial seepage into blood. Although white cell count is not helpful in detecting bacteraemia, low platelet count and elevation of CRP seem to be helpful.

  9. A centrally mediated prolonged hypotension produced by oxotremorine or pilocarpine

    Dage, R.C.


    1 Oxotremorine, methyloxotremorine, pilocarpine or arecoline were given intravenously to anaesthetized cats, dogs or rats, and intraperitoneally to conscious normotensive and spontaneously hypertensive rats, pretreated with doses of methylatropine that completely blocked peripheral muscarinic receptors, to ascertain their effects on blood pressure and heart rate. 2 Oxotremorine but not methyloxotremorine produced a prolonged hypotension in cats and dogs but not in rats. Heart rate was not changed. Pilocarpine, although less potent, produced an identical effect, whereas the effect of arecoline was short by comparison. The hypotensive effect of these drugs was reversed by atropine. 3 In dogs, oxotremorine produced a prolonged hypotension with no change in heart rate or cardiac output. 4 A decrease in spontaneous sympathetic nerve activity accompanied the hypotension in cats. Both effects were reversed by atropine but could be reinvoked by large doses of oxotremorine. 5 The oxotremorine-induced hypotension in cats was not altered by decerebration but was abolished by high cervical spinal section. 6 The results indicate that the prolonged hypotension elicited by oxotremorine is mediated by an action at muscarinic receptors in the brain stem resulting in a decrease in sympathetic nerve activity and peripheral resistance but not heart rate or cardiac output. PMID:760887

  10. Prolonged job strain and subsequent risk of cancer in women

    Vesterlund, Gitte K.; Høeg, Beverley L.; Johansen, Christoffer


    Background: The role of psychological stress in cancer risk is continuously debated. Stress at work is the most common form of stress and previous studies have shown inconsistent results regarding cancer risk. In this longitudinal study, we examined the association between prolonged job strain ac....... Since a large proportion of cancer patients perceive psychological stress as a possible cause of their cancer disease, it is of importance to communicate these findings to the public.......Background: The role of psychological stress in cancer risk is continuously debated. Stress at work is the most common form of stress and previous studies have shown inconsistent results regarding cancer risk. In this longitudinal study, we examined the association between prolonged job strain...... across six years and subsequent cancer risk. Methods and materials: We used data from 6571 cancer-free women from the Danish Nurse Cohort aged 45–70 years at inclusion, and self-reported questionnaires on job strain at baseline in 1993 and again in 1999. Prolonged job strain was defined as high job...

  11. Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging

    ZHOU Tao; LIU Zhen-jiang; ZHOU Sheng-hua; SHEN Xiang-qian; LIU Qi-ming; FANG Zhen-fei; HU Xin-qun; LI Jiang; L(U) Xiao-lin


    Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF-s) - simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome.Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization.Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4-46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6-24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed.Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.

  12. Opioid/naloxone prolonged release combinations for opioid induced constipation

    Shailendra Kapoor


    I read with great interest the recent article by Chen et a/in a recent issue of your esteemed journal.The article is highly thought provoking.One emerging therapeutic alternative for opioid induced constipation is the emergence of opioid/naloxone prolonged release combinations.For instance,naloxone when administered in a 1∶2 ratio with oxycodone reverses the inhibitory effect of oxycodone on the gastrointestinal tract.The advantage of oxycodone/naloxone prolonged release (OXN) is that while its anti-nociceptive efficacy is equivalent to that of oxycodone prolonged release (OXC),it significantly decreases the "Bowel Function Index" thereby ameliorating symptoms of opioid induced constipation to a large extent.Schutter et al in a recent study have reported a decrease in the bowel function index from 38.2 to 15.1.Similarly,L(o)wenstein et al in another recent study have reported that following a month of therapy,complete spontaneous bowel movements per week is increased from one in OXC therapy to three in OXN therapy.

  13. Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape victims.

    Rothbaum, Barbara Olasov; Astin, Millie C; Marsteller, Fred


    This controlled study evaluated the relative efficacy of Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) compared to a no-treatment wait-list control (WAIT) in the treatment of PTSD in adult female rape victims (n = 74). Improvement in PTSD as assessed by blind independent assessors, depression, dissociation, and state anxiety was significantly greater in both the PE and EMDR group than the WAIT group (n = 20 completers per group). PE and EMDR did not differ significantly for change from baseline to either posttreatment or 6-month follow-up measurement for any quantitative scale.




    Full Text Available This study was designed to find possible relationship between QTc prolongation and erythrocyte or plasma lithium concentrations. Fifty-six patients with bipolar disorder entered this case- control study. Subjects were between 17 to 63 years of age and were receiving lithium alone, or lithium plus haloperidol or lithium plus thioridazine. The exclusion criteria were past history of cardiovascular, hepatic, renal or metabolic disorders or using other medications known to cause rhythm disturbances. The case group included males with QTc 450ms and females with QTc470ms while the control group included males and females with QTc<450 and QTc< 470ms, respectively. Serum sodium and potassium levels, erythrocyte and plasma lithium concentrations as well as lithium ratio were determined for all subjects and compared between the case and control groups by independent sample t-test. The mean of these levels were not different between the case and control groups. Additionally, no correlations were found between QTc and erythrocyte or plasma lithium concentration, lithium ratio, serum sodium or potassium levels. Analyzing the data for patients treated with lithium alone showed no significant correlations between QTc prolongation and erythrocyte or plasma lithium concentration, lithium ratio or serum potassium level. However, a significant correlation was found between serum sodium concentration and QTc prolongation. It should be noted that QTc prolongation occurred six times more in patients who were taking thioridazine and lithium concomitantly. This study noted no influence of sex or co-administration of haloperidol with lithium on QTc prolongation. It is concluded that plasma or erythrocyte lithium levels may not be able to predict QTc prolongation and its consequences.


    SHI Guo-chao; HUANG Shao-guang; LI Min; DENG Wei-wu; WAN Huan-ying


    Objective To compare effect of high-frequency oscillation ventilation (HFOV) and conventional mandatory ventilation (CMV) on lung injury development in rabbit with acute respiratory distress syndrome (ARDS). Methods Animals that underwent saline lung lavage to produce lung injury were randomized to one of the two treatment groups (HFOV or CMV, n=6). PaCO2 was maintained between 35-45mmHg and arterial oxygen saturation (SaO2) was maintain >88% by adjusting corresponding ventilator parameters. Ventilation period was 6h. Lung fluids were aspirated before and at the end of ventilation for cell analysis. Then the animals were euthanized, lung tissue was removed for wet/dry weight measurement, light and electron microscopic examination.Results The difference of artery blood gas analyses(pH, PaO2, PaCO2) between HFOV and CMV was insignificant. The difference between HFOV and CMV in cytological examination of lung fluids, wet/dry weight measurement was also insignificant. But compared with CMV,HFOV not only reduced the area of lung injury, but also reduced lung injury score in light and electron microscopic examination. Conclusion When same artery blood gas analysis was obtained, HFOV significantly reduced lung injury development in ARDS animal than CMV. As a lung protection strategy, HFOV can be used in the treatment of ARDS.

  16. Interleukin-10 modified dendritic cells induce allo-hyporesponsiveness and prolong small intestine allograft survival

    Min Zhu; Ming-Fa Wei; Fang Liu; Hui-Fen Shi; Guo Wang


    AIM: To investigate whether TL-10-transduced dendritic cells (DCs) could induce tolerogenicity and prolong allograft survival in rat intestinal transplantation.METHODS: Spleen-derived DCs were prepared and genetically modified by hTL-10 gene. The level of IL-10 expression was quantitated by ELTSA. DC function was assessed by MTT in mixed leukocyte reaction. Allogeneic T-cell apoptosis was examined by flow cytometric analysis. Seven days before heterotopic intestinal transplantation, 2x106 donor-derived IL-10-DC were injected intravenously, then transplantation was performed between SD donor and Wistar recipient.RESULTS: Compared with untransduced DC, IL-10-DC could suppress allogeneic mixed leukocyte reaction (MLR). The inhibitory effect was the most striking with the stimulator/effector (S/F) ratio of 1:10. The inhibition rate was 33.25 %,41.19 % (P<0.01) and 22.92 % with the S/E ratio of 1:1,1:10 and 1:50 respectively. At 48 hours and 72 hours by flow cytometry counting, apoptotic T cells responded to IL-10-DC in MLR were 13.8 % and 30.1%, while untransduced group did not undergo significant apoptosis (P<0.05). IL-10-DC pretreated recipients had a moderate survival prolongation with a mean allograft survival of 19.8 days (P<0.01),compared with 7.3±2.4 days in control group and 8.3±2.9days in untransduced DC group. Rejection occurred in the control group within three days. The difference between untreated DC group and control group was not significant.CONCLUSION: IL-10-DC can induce allogenic T-cell hyporesponsiveness in vitro and apoptosis may be involved in it. IL-10-DC pretreatment can prolong intestinal allograft survival in the recipient.

  17. Efficacy and safety of prolonged-release melatonin in insomnia patients with diabetes: a randomized, double-blind, crossover study

    Garfinkel D


    Full Text Available Doron Garfinkel1, Mariana Zorin2, Julio Wainstein2, Zipora Matas3, Moshe Laudon4, Nava Zisapel4,51Geriatric Palliative Department, Shoham Geriatric Medical Center, Pardes Hana, Israel; 2Diabetes Unit, 3Biochemistry Laboratory, The E Wolfson Medical Center, Holon, Israel; 4Neurim Pharmaceuticals Ltd, 5Department of Neurobiology, Tel Aviv University, Tel Aviv, IsraelBackground: Diabetes is a major comorbidity in insomnia patients. The efficacy and safety of prolonged-release melatonin 2 mg in the treatment of glucose, lipid metabolism, and sleep was studied in 36 type 2 diabetic patients with insomnia (11 men, 25 women, age 46–77 years.Methods: In a randomized, double-blind, crossover study, the subjects were treated for 3 weeks (period 1 with prolonged-release melatonin or placebo, followed by a one-week washout period, and then crossed over for another 3 weeks (period 2 of treatment with the other preparation. All tablets were taken 2 hours before bedtime for a period of 3 weeks. In an extension period of 5 months, prolonged-release melatonin was given nightly to all patients in an open-label design. Sleep was objectively monitored in a subgroup of 22 patients using wrist actigraphy. Fasting glucose, fructosamine, insulin, C-peptide, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and some antioxidants, as well as glycosylated hemoglobin (HbA1c levels were measured at baseline and at the end of the study. All concomitant medications were continued throughout the study.Results: No significant changes in serum glucose, fructosamine, insulin, C-peptide, antioxidant levels or blood chemistry were observed after 3 weeks of prolonged-release melatonin treatment. Sleep efficiency, wake time after sleep onset, and number of awakenings improved significantly with prolonged-release melatonin as compared with placebo. Following 5 months of prolonged-release melatonin treatment, mean HbA1c (±standard deviation was

  18. Incidence and risk of QTc interval prolongation among cancer patients treated with vandetanib: a systematic review and meta-analysis.

    Jiajie Zang

    Full Text Available BACKGROUND: Vandetanib is a multikinase inhibitor that is under assessment for the treatment of various cancers. QTc interval prolongation is one of the major adverse effects of this drug, but the reported incidence varies substantially among clinical trials. We performed a systematic review and meta-analysis to obtain a better understanding in the risk of QTc interval prolongation among cancer patients administered vandetanib. METHODOLOGY AND PRINCIPAL FINDINGS: Eligible studies were phase II and III prospective clinical trials that involved cancer patients who were prescribed vandetanib 300 mg/d and that included data on QTc interval prolongation. The overall incidence and risk of QTc interval prolongation were calculated using random-effects or fixed-effects models, depending on the heterogeneity of the included studies. Nine trials with 2,188 patients were included for the meta-analysis. The overall incidence of all-grade and high-grade QTc interval prolongation was 16.4% (95% CI, 8.1-30.4% and 3.7% (8.1-30.4%, respectively, among non-thyroid cancer patients, and 18.0% (10.7-28.6% and 12.0% (4.5-28.0%, respectively, among thyroid cancer patients. Patients with thyroid cancer who had longer treatment duration also had a higher incidence of high-grade events, with a relative risk of 3.24 (1.57-6.71, than patients who had non-thyroid cancer. Vandetanib was associated with a significantly increased risk of all-grade QTc interval prolongation with overall Peto odds ratios of 7.26 (4.36-12.09 and 5.70 (3.09-10.53 among patients with non-thyroid cancer and thyroid cancer, respectively, compared to the controls. CONCLUSIONS/SIGNIFICANCE: Treatment with vandetanib is associated with a significant increase in the overall incidence and risk of QTc interval prolongation. Different cancer types and treatment durations may affect the risk of developing high-grade QTc interval prolongation.

  19. Impact of Azithromycin on Pregnancy Prolongation in Women at Risk of Preterm Labor: A Time-to-Event Analysis.

    Goyer, Isabelle; Ferland, Gabrielle; Ruo, Ni; Morin, Caroline; Brochet, Marie-Sophie; Morin, Lucie; Ferreira, Ema


    Since 2006, the empiric use of azithromycin in women at risk of premature birth has become prevalent in our institution without any evidence of its efficacy. Although antibiotics can prolong pregnancy in preterm prolonged rupture of membranes, no published data are available for women with intact membranes. To describe the purpose of adding azithromycin to the usual treatments (cerclage, tocolysis, rest, etc.) to prolong pregnancy in women with intact membranes who are at risk of or already in preterm labour. A retrospective observational cohort study was done at a Mother-Child University Hospital Centre. Patients admitted to obstetric ward who received azithromycin between January 1(st), 2006 and August 1(st), 2010 were included. A total of 127 exposed women were matched to 127 controls through medical records and pharmacy software. A time-to-event analysis was done to compare gestational age at the time of the recorded composite event (delivery, or rupture of membranes, or second intervention to prolong pregnancy). To compare proportions of composite event at different time points, χ(2) tests were used. Patients who received azithromycin had a more severe condition at presentation. Once adjusted for confounding factors, prolongation of pregnancy (HR =1.049; CI 95%: 0.774-1.421 [p=0.758]) and gestational age at the event (HR=1.200; CI 95%: 0.894-1.609 [p=0.225]) did not differ between the groups. The proportions of women with an event ≥7 days post-diagnosis or ≥37 gestational weeks were similar. Azithromycin was added to medical therapy in a more at-risk population and no clear benefit was measured.

  20. Prolonged particulate chromate exposure does not inhibit homologous recombination repair in North Atlantic right whale (Eubalaena glacialis) lung cells.

    Browning, Cynthia L; Wise, Catherine F; Wise, John Pierce


    Chromosome instability is a common feature of cancers that forms due to the misrepair of DNA double strand breaks. Homologous recombination (HR) repair is a high fidelity DNA repair pathway that utilizes a homologous DNA sequence to accurately repair such damage and protect the genome. Prolonged exposure (>72h) to the human lung carcinogen, particulate hexavalent chromium (Cr(VI)), inhibits HR repair, resulting in increased chromosome instability in human cells. Comparative studies have shown acute Cr(VI) exposure induces less chromosome damage in whale cells than human cells, suggesting investigating the effect of this carcinogen in other species may inform efforts to prevent Cr(VI)-induced chromosome instability. Thus, the goal of this study was to determine the effect of prolonged Cr(VI) exposure on HR repair and clastogenesis in North Atlantic right whale (Eubalaena glacialis) lung cells. We show particulate Cr(VI) induces HR repair activity after both acute (24h) and prolonged (120h) exposure in North Atlantic right whale cells. Although the RAD51 response was lower following prolonged Cr(VI) exposure compared to acute exposure, the response was sufficient for HR repair to occur. In accordance with active HR repair, no increase in Cr(VI)-induced clastogenesis was observed with increased exposure time. These results suggest prolonged Cr(VI) exposure affects HR repair and genomic stability differently in whale and human lung cells. Future investigation of the differences in how human and whale cells respond to chemical carcinogens may provide valuable insight into mechanisms of preventing chemical carcinogenesis. Copyright © 2017. Published by Elsevier Inc.

  1. Effects of cadence on aerobic capacity following a prolonged, varied intensity cycling trial.

    Stebbins, Charles L; Moore, Jesse L; Casazza, Gretchen A


    We determined if high cadences, during a prolonged cycling protocol with varying intensities (similar to race situations) decrease performance compared to cycling at a lower, more energetically optimal, cadence. Eight healthy, competitive male road cyclists (35 ± 2 yr) cycled for 180 min at either 80 or 100 rpm (randomized) with varying intensities of power outputs corresponding to 50, 65 and 80% of VO2max. At the end of this cycling period, participants completed a ramped exercise test to exhaustion at their preferred cadence (90 ± 7 rpm). There were no cadence differences in blood glucose, respiratory exchange ratio or rate of perceived exertion. Heart Rate, VO2 and blood lactate were higher at 100 rpm vs. 80 rpm. The total energy cost while cycling during the 65% and 80% VO2max intervals at 100 rpm (15.2 ± 2.7 and 19.1 ± 2.5 kcal∙min(-1), respectively) were higher than at 80 rpm (14.3 ± 2.7 and 18.3± 2.2 kcal∙min(-1), respectively) (p < 0.05). Gross efficiency was higher at 80 rpm vs. 100 rpm during both the 65% (22.8 ± 1.0 vs. 21.3 ± 4.5%) and the 80% (23.1 vs. 22.1 ± 0.9%) exercise intensities (P< 0.05). Maximal power during the performance test (362 ± 38 watts) was greater at 80 rpm than 100 rpm (327 ± 27 watts) (p < 0.05). Findings suggest that in conditions simulating those seen during prolonged competitive cycling, higher cadences (i.e., 100 vs. 80 rpm) are less efficient, resulting in greater energy expenditure and reduced peak power output during maximal performance. Key PointsWhen competitive cyclists perform prolonged exercise that simulates racing conditions (i.e., variable, low-moderate submaximal cycling), a higher cadence results in excess energy expenditure and lower gross efficiency compared to a lower cadence at the same power output.Consequently, maximal power output is reduced during a subsequent exercise bout to exhaustion after using a higher cadence.Selection of a lower, more energetically optimal cadence during prolonged


    Susanna Kinnunen


    Full Text Available Increased oxidative stress during prolonged endurance exercise may end up with muscle damage, fatigue and decreased physical performance. We have recently shown that acute exercise at moderate intensity induced lipid peroxidation, protein oxidation and oxygen radical absorbance capacity (ORAC in trained trotters. The aim of this study was to measure the changes in oxidative stress and antioxidant defense following an 80-km ride in the blood of endurance horses. Blood samples were collected before and immediately after the ride. Unlike to our previous studies performed on trotters, in endurance horses there were no measurable changes in antioxidants or oxidative stress marker lipid hydroperoxides (LPO after prolonged exercise. ORAC, vitamin E and lipid hydroperoxide (LPO concentration or glutathione related enzyme activities were not altered due to the 80-km ride. However, the base line levels of oxidative stress marker were higher in endurance horses compared to trotters. A positive correlation between the pre-ride LPO concentration and erythrocyte glutathione peroxidase (GPx activity after the ride was observed, which may indicate a protective response of glutathione peroxidase against exercise-induced oxidative stress. Our results suggest that endurance horses have higher oxidative stress levels compared to trotters and a single 80-km ride probably did not suffice to induce oxidative stress and to activate antioxidant defense mechanisms.

  3. A Parallelized Pumpless Artificial Placenta System Significantly Prolonged Survival Time in a Preterm Lamb Model.

    Miura, Yuichiro; Matsuda, Tadashi; Usuda, Haruo; Watanabe, Shimpei; Kitanishi, Ryuta; Saito, Masatoshi; Hanita, Takushi; Kobayashi, Yoshiyasu


    An artificial placenta (AP) is an arterio-venous extracorporeal life support system that is connected to the fetal circulation via the umbilical vasculature. Previously, we published an article describing a pumpless AP system with a small priming volume. We subsequently developed a parallelized system, hypothesizing that the reduced circuit resistance conveyed by this modification would enable healthy fetal survival time to be prolonged. We conducted experiments using a premature lamb model to test this hypothesis. As a result, the fetal survival period was significantly prolonged (60.4 ± 3.8 vs. 18.2 ± 3.2 h, P < 0.01), and circuit resistance and minimal blood lactate levels were significantly lower in the parallel circuit group, compared with our previous single circuit group. Fetal physiological parameters remained stable until the conclusion of the experiments. In summary, parallelization of the AP system was associated with reduced circuit resistance and lactate levels and allowed preterm lamb fetuses to survive for a significantly longer period when compared with previous studies.

  4. Fetal brain hypometabolism during prolonged hypoxaemia in the llama.

    Ebensperger, Germán; Ebensperger, Renato; Herrera, Emilio A; Riquelme, Raquel A; Sanhueza, Emilia M; Lesage, Florian; Marengo, Juan J; Tejo, Rodrigo I; Llanos, Aníbal J; Reyes, Roberto V


    In this study we looked for additional evidence to support the hypothesis that fetal llama reacts to hypoxaemia with adaptive brain hypometabolism. We determined fetal llama brain temperature, Na(+) and K(+) channel density and Na(+)-K(+)-ATPase activity. Additionally, we looked to see whether there were signs of cell death in the brain cortex of llama fetuses submitted to prolonged hypoxaemia. Ten fetal llamas were instrumented under general anaesthesia to measure pH, arterial blood gases, mean arterial pressure, heart rate, and brain and core temperatures. Measurements were made 1 h before and every hour during 24 h of hypoxaemia (n = 5), which was imposed by reducing maternal inspired oxygen fraction to reach a fetal arterial partial pressure of oxygen (P(a,O(2))) of about 12 mmHg. A normoxaemic group was the control (n = 5). After 24 h of hypoxaemia, we determined brain cortex Na(+)-K(+)-ATPase activity, ouabain binding, and the expression of NaV1.1, NaV1.2, NaV1.3, NaV1.6, TREK1, TRAAK and K(ATP) channels. The lack of brain cortex damage was assessed as poly ADP-ribose polymerase (PARP) proteolysis. We found a mean decrease of 0.56 degrees C in brain cortex temperature during prolonged hypoxaemia, which was accompanied by a 51% decrease in brain cortex Na(+)-K(+)-ATPase activity, and by a 44% decrease in protein content of NaV1.1, a voltage-gated Na(+) channel. These changes occurred in absence of changes in PARP protein degradation, suggesting that the cell death of the brain was not enhanced in the fetal llama during hypoxaemia. Taken together, these results provide further evidence to support the hypothesis that the fetal llama responds to prolonged hypoxaemia with adaptive brain hypometabolism, partly mediated by decreases in Na(+)-K(+)-ATPase activity and expression of NaV channels.

  5. Abnormal vascular function in PR-interval prolongation.

    Chan, Yap-Hang; Siu, Chung-Wah; Yiu, Kai-Hang; Li, Sheung-Wai; Lau, Kui-Kai; Lam, Tai-Hing; Lau, Chu-Pak; Tse, Hung-Fat


    Underlying mechanisms of PR-interval prolongation leading to increased risk of adverse cardiovascular outcomes, including atrial fibrillation, are unclear. This study aims to investigate the relation between PR interval and changes in vascular function. We hypothesize that there exists an intermediate pathological stage between electrocardiographic PR prolongation and adverse cardiovascular outcomes, which could be reflected by changes in surrogate measurements of vascular function. We recruited 88 healthy subjects (mean age 57.5 ± 9.8 y, 46% male) from a community-based health screening program who had no history of cardiovascular disease or diabetes mellitus. PR interval was determined from a resting 12-lead electrocardiogram. Vascular function was noninvasively assessed by flow-mediated dilation (FMD) using high-resolution ultrasound and brachial-ankle pulse wave velocity (PWV) using a vascular profiling system. Only 3 subjects had a PR-interval length longer than the conventional cutoff of 200 ms. The PR-interval length was associated inversely with FMD (Pearson r = -0.30, P = 0.004) and positively with PWV (r = 0.40, P PR-interval length by each 25 ms was independently associated with reduced FMD by -1 unit (absolute %, B = -0.04 [95% confidence interval: -0.080 to -0.002, P = 0.040)] and increased PWV by +103 cm/second (B = +4.1 [95% confidence interval: 0.6-7.6, P = 0.023]). This study shows that PR-interval length, even in the conventionally normal range, is independently associated with endothelial dysfunction and increased arterial stiffness in healthy subjects free of atherosclerotic disease. This suggests the presence of a systemic, intermediate pathologic stage of the vasculature in PR prolongation before clinically manifest cardiovascular events, and could represent a mediating mechanism. © 2011 Wiley Periodicals, Inc.

  6. Interleukin-6 release from the human brain during prolonged exercise

    Nybo, Lars; Nielsen, Bodil; Pedersen, Bente Klarlund


    Interleukin (IL)-6 is a pleiotropic cytokine, which has a variety of physiological roles including functions within the central nervous system. Circulating IL-6 increases markedly during exercise, partly due to the release of IL-6 from the contracting skeletal muscles, and exercise-induced IL-6 may...... influence of hyperthermia. In conclusion, IL-6 is released from the brain during prolonged exercise in humans and it appears that the duration of the exercise rather than the increase in body temperature dictates the cerebral IL-6 response....

  7. Nanomodified natural zeolite as a fertilizer of prolonged activity

    G. Tsintskaladze


    Full Text Available Natural zeolites of sedimentary origin are widely used in agriculture both as individual fertilizer and a mix of mineral and organic fertilizers. Natural zeolites are crystalline nanoporous hydrated aluminosilicates. Fertilizer of prolonged activity enriched with macro- and microelements is obtained by fusing zeolite with dehydrated ammonium using nanotechnological method of modification. The structure and some physical and chemical properties of a novel nanomaterial were studied by the methods of X-ray diffraction, IR-spectroscopy, absorption and thermal analysis. It was shown that the obtained fertilizer may be used in both protected and open grounds.

  8. Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report.

    Saleh, Christian; Pierquin, Geneviève; Beyenburg, Stefan


    Hemiplegic migraine is a rare and complex disease, characterized by migraine with a reversible motor aura. Hemiplegic migraine can be easily misdiagnosed at its first presentation with an atypical severe form of migraine, a stroke, multiple sclerosis, metabolic disorders, conversion disorder or an epilepsy. We present the case of a young 24-year-old male patient, who since the age of 4 years had been having multiple episodes of migraine associated with hemiparesis, paraesthesia, prolonged somnolence, aphasia and confusion. We review the literature and discuss important diagnostic findings in hemiplegic migraine to help establishing a prompt diagnosis.

  9. Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report

    Christian Saleh


    Full Text Available Hemiplegic migraine is a rare and complex disease, characterized by migraine with a reversible motor aura. Hemiplegic migraine can be easily misdiagnosed at its first presentation with an atypical severe form of migraine, a stroke, multiple sclerosis, metabolic disorders, conversion disorder or an epilepsy. We present the case of a young 24-year-old male patient, who since the age of 4 years had been having multiple episodes of migraine associated with hemiparesis, paraesthesia, prolonged somnolence, aphasia and confusion. We review the literature and discuss important diagnostic findings in hemiplegic migraine to help establishing a prompt diagnosis.

  10. Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report

    Saleh, Christian; Pierquin, Geneviève; Beyenburg, Stefan


    Hemiplegic migraine is a rare and complex disease, characterized by migraine with a reversible motor aura. Hemiplegic migraine can be easily misdiagnosed at its first presentation with an atypical severe form of migraine, a stroke, multiple sclerosis, metabolic disorders, conversion disorder or an epilepsy. We present the case of a young 24-year-old male patient, who since the age of 4 years had been having multiple episodes of migraine associated with hemiparesis, paraesthesia, prolonged somnolence, aphasia and confusion. We review the literature and discuss important diagnostic findings in hemiplegic migraine to help establishing a prompt diagnosis. PMID:27790126

  11. How long would SDH/SONET be prolonged?

    Tao, Zhiyong; Mao, Qian


    As we all know, the increasing speed of data traffic is exceeding gradually from voice in today"s communication network. The main reason is the explosive of Internet. The controversy with IP over ATM/SDH/Optical becomes hotter and hotter, Many people in the telecommunication field are doubt: HOW LONG WOULD SDH/SONET BE PROLONGED? WHAT KIND OF SDH EQUIPMENTS COULD BE USED IN THE NETWORK? With the analysis from several aspects: services in the network, new development with SDH technology, market in transport equipment, This paper is considered that the SDH with some new features would be predominant transport technology in the recent years.

  12. Response of grassland ecosystems to prolonged soil moisture deficit

    Ross, Morgan A.; Ponce-Campos, Guillermo E.; Barnes, Mallory L.; Hottenstein, John D.; Moran, M. Susan


    Soil moisture is commonly used for predictions of plant response and productivity. Climate change is predicted to cause an increase in the frequency and duration of droughts over the next century, which will result in prolonged periods of below-normal soil moisture. This, in turn, is expected to impact regional plant production, erosion and air quality. In fact, the number of consecutive months of soil moisture content below the drought-period mean has recently been linked to regional tree and shrub mortality in the southwest United States. This study investigated the effects of extended periods of below average soil moisture on the response of grassland ANPP to precipitation. Grassland ecosystems were selected for this study because of their ecological sensitivity to precipitation patterns. It has been postulated that the quick ecological response of grasslands to droughts can provide insight to large scale functional responses of regions to predicted climate change. The study sites included 21 grassland biomes throughout arid-to-humid climates in the United States with continuous surface soil moisture records for 2-13 years during the drought period from 2000-2013. Annual net primary production (ANPP) was estimated from the 13-year record of NASA MODIS Enhanced Vegetation Index extracted for each site. Prolonged soil moisture deficit was defined as a period of at least 10 consecutive months during which soil moisture was below the drought-period mean. ANPP was monitored before, during and after prolonged soil moisture deficit to quantify shifts in the functional response of grasslands to precipitation, and in some cases, new species assemblages that included invasive species. Preliminary results indicated that when altered climatic conditions on grasslands led to an increase in the duration of soil water deficit, then the precipitation-to-ANPP relation became non-linear. Non-linearity was associated with extreme grassland dieback and changes in the historic

  13. Extracorporeal Free Flap Perfusion in Case of Prolonged Ischemia Time

    Taeger, C. D.; Präbst, K; Beier, J P; Meyer, A; Horch, R E


    Summary: In free flap surgery, a clinically established concept still has to be found for the reduction of ischemia-related cell damage in the case of prolonged ischemia. Although promising results using extracorporeal free flap perfusion in the laboratory have been published in the past, until now this concept has not yet paved its way into clinical routine. This might be due to the complexity of perfusion systems and a lack of standardized tools. Here, we want to present the results of the ...


    Bronfenbrenner, J; Favour, C B


    (1) Restriction of fluid intake to 1,500 cc and the salt intake to 3 gm a day doubles the penicillin blood level following interrupted intramuscular [See Figure in the PDF file] injections of penicillin. (2) The administration of benzoic acid to a patient on an unrestricted diet Ilay double the penicillin blood level during similar treatment. (3) The combination of these two procedures results in a four- to eight-fold increase in penicillin blood level with a prolonged effective blood concentration.

  15. Transient impairments in single muscle fibre contractile function after prolonged cycling in elite endurance athletes

    Hvid, L G; Gejl, Kasper Degn; Bech, R D


    Prolonged muscle activity impairs whole-muscle performance and function. However, little is known about the effects of prolonged muscle activity on the contractile function of human single muscle fibres. The purpose of this study was to investigate the effects of prolonged exercise and subsequent...... recovery on the contractile function of single muscle fibres obtained from elite athletes....

  16. Effect of prolonged free-walking fatigue on gait and physiological rhythm.

    Yoshino, Kohzoh; Motoshige, Tomoko; Araki, Tsutomu; Matsuoka, Katsunori


    This study examined the ways in which gait patterns and physiological rhythms such as those of muscle activity (tibialis anterior (TA) and biceps femoris (BF)) and cardiac activity are affected by the fatigue induced by prolonged free walking. Twelve normal subjects who walked for 3 h at their preferred pace were divided into two groups according to whether their mean gait cycle time (reciprocal of stride rate) during the second 90 min was higher (Group A: n=8) or lower (Group B: n=4) than that during the first 90 min. For Group A, the level of subjective fatigue during the walking task was significantly higher and the heart rate at rest was significantly lower than Group B. In Group A, prolonged walking significantly decreased the mean power frequency of the electromyography from TA, increased the variability of gait rhythm, decreased the largest Lyapunov exponent of the vertical component of back-waist acceleration, and decreased the amplitude of the vertical component of back-waist acceleration. Taking the onset timings of these changes into account, we propose that subjects who tire easily during prolonged walking first show local muscle fatigue at TA followed by instability of gait rhythm and then they slow their gait rhythm to enhance local dynamic stability. For both groups we constructed a physical fatigue index described by linear regression of gait and physiological variables. When we compared the subjective fatigue level with the fatigue level predicted using the index, we obtained a relatively high correlation coefficient for both groups (r=0.77).

  17. The GOAT-ghrelin system is not essential for hypoglycemia prevention during prolonged calorie restriction.

    Chun-Xia Yi

    Full Text Available OBJECTIVE: Ghrelin acylation by ghrelin O-acyltransferase (GOAT has recently been reported to be essential for the prevention of hypoglycemia during prolonged negative energy balance. Using a unique set of four different genetic loss-of-function models for the GOAT/ghrelin/growth hormone secretagogue receptor (GHSR system, we thoroughly tested the hypothesis that lack-of-ghrelin activation or signaling would lead to hypoglycemia during caloric deprivation. METHODOLOGY: Male and female knockout (KO mice for GOAT, ghrelin, GHSR, or both ghrelin and GHSR (dKO were subjected to prolonged calorie restriction (40% of ad libitum chow intake. Body weight, fat mass, and glucose levels were recorded daily and compared to wildtype (WT controls. Forty-eight hour blood glucose profiles were generated for each individual mouse when 2% or less body fat mass was reached. Blood samples were obtained for analysis of circulating levels of acyl- and desacyl-ghrelin, IGF-1, and insulin. PRINCIPAL FINDINGS: Chronic calorie restriction progressively decreased body weight and body fat mass in all mice regardless of genotype. When fat mass was depleted to 2% or less of body weight for 2 consecutive days, random hypoglycemic events occurred in some mice across all genotypes. There was no increase in the incidence of hypoglycemia in any of the four loss-of-function models for ghrelin signaling including GOAT KO mice. Furthermore, no differences in insulin or IGF-1 levels were observed between genotypes. CONCLUSION: The endogenous GOAT-ghrelin-GHSR system is not essential for the maintenance of euglycemia during prolonged calorie restriction.


    Anil Kumar


    Full Text Available INTRODUCTION Generally, in dengue shock syndrome antibiotics are not advised. But unrecognised bacterial infection is likely to contribute to morbidity and mortality, probably because of increased vascular permeability. OBJECTIVES To assess the incidence of secondary bacterial infection in adult patients with prolonged and severe dengue fever. METHODS A prospective study was conducted recruiting patients with confirmed acute dengue infection who had prolonged fever (>5 days. Prior to institution of antibiotic therapy, two sets of blood cultures were taken from patients. Demographic, clinical, haematological and biochemical parameters were recorded. Severity of fever & associated symptoms assessed. Ultrasonography done to find out development of ascites and pleural effusions. RESULTS Sixty patients (60.0% males with a mean age of 33.5 years (SD 12.1 were studied. The average duration of fever was 6.9 days (SD 1.6. Fifteen patients (25% had bacterial isolates in their blood cultures; Staphylococcus aureus (n=3, coliforms (n=7, pseudomonas (n=2 and 3 had mixed growths. The culture positive group had severe body aches and joints paint at admission and high grade fever, third space fluid accumulation and significant drop in platelets compared to culture-negative group. CONCLUSIONS A quarter of dengue patients with prolonged fever had a bacterial isolate. Culture-positive patients appeared more ill with body aches and had higher degrees of fever during the course of the illness. Increased vascular permeability may predispose to bacterial seepage into blood. Although white cell count is not helpful in detecting bacteraemia in dengue fever, low platelet count and severe symptoms at presentation may be helpful.

  19. Toxicity after prolonged (more than four weeks administration of intravenous colistin

    Bliziotis Ioannis A


    Full Text Available Abstract Background The intravenous use of polymyxins has been considered to be associated with considerable nephrotoxicity and neurotoxicity. For this reason, the systemic administration of polymyxins had been abandoned for about 20 years in most areas of the world. However, the problem of infections due to multidrug-resistant (MDR Gram-negative bacteria such us Pseudomonas aeruginosa and Acinetobacter baumanniii has led to the re-use of polymyxins. Our objective was to study the toxicity of prolonged intravenous administration of colistin (polymyxin E. Methods An observational study of a retrospective cohort at "Henry Dunant" Hospital, a 450-bed tertiary care center in Athens, Greece, was undertaken. Patients who received intravenous colistin for more than 4 weeks for the treatment of multidrug resistant Gram-negative infections were included in the study. Serum creatinine, blood urea, liver function tests, symptoms and signs of neurotoxicity were the main outcomes studied. Results We analyzed data for 19 courses of prolonged intravenous colistin [mean duration of administration (± SD 43.4 (± 14.6 days, mean daily dosage (± SD 4.4 (± 2.1 million IU, mean cumulative dosage (± SD 190.4 (± 91.0 million IU] in 17 patients. The median creatinine value increased by 0.25 mg/dl during the treatment compared to the baseline (p Conclusions No serious toxicity was observed in this group of patients who received prolonged intravenous colistin. Colistin should be considered as a therapeutic option in patients with infections due to multidrug resistant Gram-negative bacteria.

  20. Influence of a prolonged fasting and mild activity on routine laboratory tests.

    Šupak-Smolčić, Vesna; Antončić, Dragana; Ožanić, Doris; Vladilo, Ivana; Bilić-Zulle, Lidija


    Despite the standardization of the phlebotomy procedure, blood analysis is occasionally requested after recommended hours with the excuse that the patient is still fasting. We aimed to examine the influence of prolonged fasting and mild physical activity on routine laboratory tests. The study was conducted on 30 volunteers (27 female) median age 40y (20-59). Blood samples were taken in the morning (7:00-8:00a.m.) and early afternoon (1:00-2:00p.m.) after prolonged fasting and usual daily activities. Serum glucose (GLU), urea, creatinine, triglyceride, uric acid (UA), iron and electrolytes were analyzed on Roche cobas 6000 c501 and complete blood count on Siemens ADVIA 2120i. Statistical significance between the two measurements was tested using paired t-test or Wilcoxon test according to data distribution. Clinical significance was judged against calculated reference change values (RCV). A statistically significant decrease was found for red blood cell count, hemoglobin, hematocrit, mean corpuscular volume (MCV), GLU, urea, creatinine, triglycerides and electrolytes, whereas white blood cell count and iron were significantly increased. Judging against desirable bias derived from biological variation, a significant change was found for all the analytes except MCV, platelet count, UA and triglycerides. A clinically significant change was not found for any of the tested analytes when compared to RCV. Prolonged fasting and mild activity will not influence the medical decision for healthy subjects with normal results. Despite the present statistically significant change, the clinically significant change was not shown. However, the study did not include pathological results which have to be interpreted more carefully. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  1. First steps in membrane oxygenation and prolonged extracorporeal perfusion in Duesseldorf using the Bramson membrane lung.

    Schulte, Hagen D


    After a shortened history of conventional closed and open heart surgery, including hypothermia by surface cooling and extracorporeal circulation, the first application of a new membrane oxygenator developed by ML Bramson with an integrated temperature exchange system and a heart-lung machine (HLM) was reported in 1972. The aim was to have an efficient oxygenating and gas exchange artificial lung that allowed prolonged perfusions in patients with cardiogenic shock or acute respiratory insufficiency. After in vitro closed recirculation studies comparing different bubble, vertical screen, and the new membrane oxygenators, the Bramson HLM was used in dog experiments before starting clinical cardiac surgery with routine interventions (closure of an atrial septal defect). The first clinically prolonged support for more than three hours after a double valve replacement in a NYHA class IV patient failed. A partial venoarterial prolonged perfusion for 42 hours and 43 minutes in a 10-year-old girl after surgical correction of a partial av canal defect and postoperative development of consistent lung edema caused by myocardial failure after an ischemic time of 43 minutes was the first successful long-term perfusion case in Europe. These first experiences with the Bramson membrane lung formed the basis, in our group, for further investigations of different perfusion routes and cannulations in animal experiments. Also, scanning electron microscopy studies could be performed with experimentally and clinically used membranes. The development of disposable membrane lung devices, for instance, Lande-Edwards, Kolobow Scimed, and General Electric Peirce membrane lungs, ameliorated and improved the use of these devices considerably. Also, BRAMSON had developed a disposable membrane lung device that had proved to be very effective in animal experiments by 1972, but, unfortunately, this device did not become commercially available.

  2. Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial

    Shalev Eliezer


    Full Text Available Abstract Background A prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities. We aimed to compare between oxytocin augmentation, amniotomy and a combination of both on the duration of labor among women with a prolonged latent phase. Methods Women with a singleton fetus in cephalic presentation who have a prolonged latent phase, were randomly allocated to amniotomy (group 1, oxytocin (group 2 or both (group 3. A group of women who progressed spontaneously without intervention composed the control group (group 4. The primary outcome was the duration of time from initiation of augmentation until delivery. Results A total of 213 women were consented and randomized to group 1 (70 women, group 2 (72 women and group 3 (71 women. Group 4 was composed from additional 70 women. A mean reduction of 120 minutes in labor duration was observed among group 3 compared to group 1 (p = 0.08 and 180 minutes compared to group 2 and 4 (p = 0.001. Women in group 3 had a shorter length of time from augmentation until the beginning of the active phase and a shorter first stage of labor than group 1 (p = 0.03, group 2 (p = 0.001 and group 4 (p = 0.001. Satisfaction was greater among group 3 and 4. Mode of delivery and neonatal outcome were comparable between the groups. Conclusion Labor augmentation by combined amniotomy and oxytocin among women with a prolonged latent phase at term seems superior compared to either of them alone.


    Galimberti R


    Full Text Available SUMMARYSecondary hyperparathyroidism is one of the main deragements caused by chronic renal failure, and parathyroid hormone is considered one of the toxins of the uremic syndrome. Prolonged fever due to primary hyperparathyroidism have already been described in the literature but not yet as induced by secondary hyperparathyroidism. In this case report a patient suffering from an erythema nodosum and prolonged fever associated to secondary hyperparathyroidism that disappeared through subtotal parathyroidectomy is presented.RESUMENEl hiperparatiroidismo secundario es uno de los principales disturbios causados por la insuficiencia renal crónica, y la paratohormona es considerada una de las toxinas del sindrome urémico. El sindrome febril prolongado secundario a hiperparatiroidismo primario ya ha sido descripto en la literatura, aunque no lo ha sido aun el inducido por hiperparatiroidismo secundario. En el presente reporte se presenta un caso de eritema nodoso y sindrome febril prolongado asociado a hiperparatiroidismo secundario y que resolvió luego de efectuada una paratiroidectomía subtotal.

  4. Cellular mechanism of the QT prolongation induced by sulpiride.

    Lee, Hyang-Ae; Kim, Ki-Suk; Park, Sang-Joon; Kim, Eun-Joo


    In this study, the authors investigated the electrophysiological effect of sulpiride on cardiac repolarization using conventional microelectrode recording techniques in isolated canine Purkinje fibers and a whole-cell patch clamp technique in transiently transfected cells with the hERG, KCNQ1/KCNE1, KCNJ2, and SCN5A cDNA and in rat cardiac myocytes for I(Ca). In studies of action potential duration, 10 microM, 100 microM, 300 microM, and 1 mM sulpiride prolonged action potential duration in a concentration-dependent manner. In studies of cardiac ion channels, sulpiride did not significantly affect I(Na), I(Ca), I(Ks), I(K1), except for I(Kr). Sulpiride dose-dependently decreased the hERG tail current. It is considered that the prolonged action potential duration by sulpiride was mainly the result of inhibition of the hERG channel. The data suggest that the clinical use of sulpiride is reasonable within therapeutic plasma concentrations, but all patients taking this drug should be cautiously monitored for clinical signs of long-QT syndrome and severe arrhythmia.

  5. Effect of Multiparity and Prolonged Lactation on Bone Mineral Density

    Natung, Tanie; Barooah, Rituparna; Ahanthem, Santa Singh


    Objectives This study was done to determine the effect of multiparity and prolonged lactation on bone mineral density (BMD). Methods This cross-sectional study included 196 perimenopausal and postmenopausal women aged 40 to 60 years old. Age, body mass index (BMI), menopausal status, duration of menopause, parity and total duration of lactation, nutritional history were recorded. Lumbar spine (LS; L2-L4) and femur neck (FN) BMD were measured using dual energy X-ray absorptiometry. Correlation of parity and lactation with BMD were investigated using multiple regression analysis. Results Parity was inversely correlated to BMD for LS (β = −0.266, P = 0.001) and FN (β = −0.380, P = 0.000). This relation remained significant even after adjusting for age, BMI and duration of menopause. Duration of lactation was inversely correlated with BMD for LS (β = −0.271, P = 0.001) but no for FN (β = −0.124, P = 0.130). Conclusions Multiparity and prolonged lactation have negative impact on BMD especially with in a socioeconomic group whose nutritional intake is borderline. Our data support that parity and duration of lactation can be associated with future osteoporosis. PMID:28119896

  6. Prolongation Structure Analysis of a Coupled Dispersionless System

    Souleymanou Abbagari; Bouetou Bouetou Thomas; Kuetche Kamgang Victor; Mouna Ferdinand; Timoleon Crepin Kofane


    We address the problem of integrability of a coupled dispersionless system recently introduced by Zhaqilao, Zhao and Li [Chin. Phys. B 18 (2009) 1780] which physically describes the propagation of electromagnetic fields within an optical nonlinear medium, but also arrives in the physical description of a charged object dynamics in an external magnetic field. Following the prolongation structure analysis developed by Wahlquist and Estabrook, we derive a more general form of Lax pairs of the previous coupled dispersionless system and its concrete nonAbelian Lie algebra resorting to a hidden symmetry. Also, we construct the B(a)cklund transformation of the system using the Riccati form of the linear eigenvalue problem.%@@ We address the problem of integrability of a coupled dispersionless system recently introduced by Zhaqilao, Zhao and Li [Chin.Phys.B 18(2009) 1780] which physically describes the propagation of electromagnetic fields within an optical nonlinear medium, but also arrives in the physical description of a charged object dynamics in an external magnetic field.Following the prolongation structure analysis developed by Wahlquist and Estabrook, we derive a more general form of Lax pairs of the previous coupled dispersionless system and its concrete non-Abelian Lie algebra resorting to a hidden symmetry.Also, we construct the Backlund transformation of the system using the Riccati form of the linear eigenvalue problem.

  7. The effects of a prolonged running exercise on strength characteristics.

    Lepers, R; Pousson, M L; Maffiuletti, N A; Martin, A; Van Hoecke, J


    The aim of this study was to examine concentric, isometric, and eccentric strength reductions in the quadriceps muscle following a prolonged running exercise. Before and after a 2 h run (28.4+/-1.4 km) peak torque (PT) of the knee extensors at angular velocities of -120, -90, -60, 0, 60, 120, 180, 240 degrees x s(-1) using an isokinetic dynamometer, electromyographic (EMG) activity of the vastus lateralis (VL) and vastus medialis (VM) muscles and height of a counter movement jump were recorded in twelve well-trained triathletes. Counter movement jump performances decreased by 10% and PT values were all significantly lower (p run. The torque loss was significantly (p activity (RMS) was lower in both VL and VM muscles after the 2 h run but no difference existed in RMS losses between concentric and eccentric contractions. The present results demonstrate that 1) a prolonged running exercise more greatly affects eccentric force production in the quadriceps muscle, and 2) this specificity seems to be due to an impairment of the muscular contractile mechanism rather than a modification to the neural input.

  8. Prolonged Paroxysmal Sympathetic Storming Associated with Spontaneous Subarachnoid Hemorrhage

    Yan Liu


    Full Text Available Paroxysmal sympathetic storming (PSS is a rare disorder characterized by acute onset of nonstimulated tachycardia, hypertension, tachypnea, hyperthermia, external posturing, and diaphoresis. It is most frequently associated with severe traumatic brain injuries and has been reported in intracranial tumors, hydrocephalous, severe hypoxic brain injury, and intracerebral hemorrhage. Although excessive release of catecholamine and therefore increased sympathetic activities have been reported in subarachnoid hemorrhage (SAH, there is no descriptive report of PSS primarily caused by spontaneous SAH up to date. Here, we report a case of prolonged PSS in a patient with spontaneous subarachnoid hemorrhage and consequent vasospasm. The sympathetic storming started shortly after patient was rewarmed from hypothermia protocol and symptoms responded to Labetalol, but intermittent recurrence did not resolve until 3 weeks later with treatment involving Midazolam, Fentanyl, Dexmedetomidine, Propofol, Bromocriptine, and minimizing frequency of neurological and vital checks. In conclusion, prolonged sympathetic storming can also be caused by spontaneous SAH. In this case, vasospasm might be a precipitating factor. Paralytics and hypothermia could mask the manifestations of PSS. The treatment of the refractory case will need both timely adjustment of medications and minimization of exogenous stressors or stimuli.

  9. Risk Factors for Prolonged Treatment of Whiplash-Associated Disorders.

    Hiroyuki Oka

    Full Text Available Whiplash-associated disorders (WAD are the most common injuries that are associated with car collisions in Japan and many Western countries. However, there is no clear evidence regarding the potential risk factors for poor recovery from WAD. Therefore, we used an online survey of the Japanese population to examine the association between potential risk factors and the persistence of symptoms in individuals with WAD.An online survey was completed by 127,956 participants, including 4,164 participants who had been involved in a traffic collision. A random sample of the collision participants (n = 1,698 were provided with a secondary questionnaire. From among the 974 (57.4% respondents to the secondary questionnaire, we selected 183 cases (intractable neck pain that was treated over a period of 6 months and 333 controls (minor neck pain that was treated within 3 months. Multivariable logistic regression analysis was used to evaluate the potential risk factors for prolonged treatment of WAD.Female sex, the severity of the collision, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain were associated with a poor recovery from WAD.In the present study, the baseline symptoms (dizziness, numbness or pain in the arms, and lower back pain had the strongest associations with prolonged treatment for WAD, although the psychological and behavioral factors were also important. These risk factors should be considered when evaluating patients who may have the potential for poor outcomes.

  10. Prolonged morphine administration alters protein expression in the rat myocardium

    Drastichova Zdenka


    Full Text Available Abstract Background Morphine is used in clinical practice as a highly effective painkiller as well as the drug of choice for treatment of certain heart diseases. However, there is lack of information about its effect on protein expression in the heart. Therefore, here we aimed to identify the presumed alterations in rat myocardial protein levels after prolonged morphine treatment. Methods Morphine was administered to adult male Wistar rats in high doses (10 mg/kg per day for 10 days. Proteins from the plasma membrane- and mitochondria-enriched fractions or cytosolic proteins isolated from left ventricles were run on 2D gel electrophoresis, scanned and quantified with specific software to reveal differentially expressed proteins. Results Nine proteins were found to show markedly altered expression levels in samples from morphine-treaded rats and these proteins were identified by mass spectrometric analysis. They belong to different cell pathways including signaling, cytoprotective, and structural elements. Conclusions The present identification of several important myocardial proteins altered by prolonged morphine treatment points to global effects of this drug on heart tissue. These findings represent an initial step toward a more complex view on the action of morphine on the heart.

  11. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

    Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed


    "Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

  12. Cyclodextrin modified PLLA parietal reinforcement implant with prolonged antibacterial activity.

    Vermet, G; Degoutin, S; Chai, F; Maton, M; Flores, C; Neut, C; Danjou, P E; Martel, B; Blanchemain, N


    The use of textile meshes in hernia repair is widespread in visceral surgery. Though, mesh infection is a complication that may prolong the patient recovery period and consequently presents an impact on public health economy. Such concern can be avoided thanks to a local and extended antibiotic release on the operative site. In recent developments, poly-l-lactic acid (PLLA) has been used in complement of polyethyleneterephthalate (Dacron®) (PET) or polypropylene (PP) yarns in the manufacture of semi-resorbable parietal implants. The goal of the present study consisted in assigning drug reservoir properties and prolonged antibacterial effect to a 100% PLLA knit through its functionalization with a cyclodextrin polymer (polyCD) and activation with ciprofloxacin. The study focused i) on the control of degree of polyCD functionalization of the PLLA support and on its physical and biological characterization by Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC) and cell viability, ii) on the understanding of drug/meshes interaction using mathematic model and iii) on the correlation between drug release studies in phosphate buffer saline (PBS) and microbiological evaluation of meshes and release medium against E. coli and S. aureus. All above mentioned tests highlighted the contribution of polyCD on the improved performances of the resulting antibacterial implantable material.

  13. Effect of renal sympathetic denervation on atrial substrate remodeling in ambulatory canines with prolonged atrial pacing.

    Xule Wang

    Full Text Available We have previously demonstrated that catheter-based renal sympathetic denervation (RSD could suppress atrial fibrillation (AF in canines with short-time rapid right atrial pacing (RAP. However, the role of renal denervation on atrial remodeling is unclear. The aim of the present study was to explore the long-term effect of RSD on the atrial remodeling during prolonged RAP. Twenty mongrel dogs were implanted with a high-frequency cardiac pacemaker with a transvenous lead inserted into the right atrial appendage. The dogs were divided into three groups: a sham-operated group (n = 6, the chronic RAP (CRAP group (n = 7, and the CRAP+RSD group (n = 7. In the CRAP+RSD group, a pacemaker was implanted 6 weeks after RSD was performed bilaterally for recovery. RAP was maintained for 5 weeks in CRAP group and CRAP+RSD group. The plasma levels of Angiotensin II and aldosterone were significantly increased in CRAP group compared with sham-operated group, but the increasing trend was inhibited in CRAP+RSD group compared with CRAP group (P<0.05. Similarly, RSD suppressed the increasing trend that prolonged RAP produced in the left atrial levels of ANP, TNF-α and IL-6. Compared with the sham-operated group, the CRAP group had significantly increased levels of caspase-3, bax and Cx40 whereas the level of Bcl-2 decreased (P<0.05. RSD markedly reduced the upregulation of caspase-3, bax and Cx40 and the downregulation of Bcl-2 expression compared with the CRAP group (P<0.05. Picric acid-sirius red staining study suggested that RSD could markedly alleviate the lesion degree of cardic fibrosis induced by CRAP (P<0.05. Immunohistochemistry results showed that the densities of TH- and GAP43- positive nerves were significantly elevated in the CRAP group compared with the sham-operated group, while RSD operation signicantly inhibited the these changes produced by CRAP. These findings suggest that renal denervation could suppress the atrial remodeling after

  14. The in vivo study on the radiobiologic effect of prolonged delivery time to tumor control in C57BL mice implanted with Lewis lung cancer.

    Wang, Xin; Xiong, Xiao-Peng; Lu, Jiade; Zhu, Guo-Pei; He, Shao-Qin; Hu, Chao-Su; Ying, Hong-Mei


    High-precision radiation therapy techniques such as IMRT or sterotactic radiosurgery, delivers more complex treatment fields than conventional techniques. The increased complexity causes longer dose delivery times for each fraction. The purpose of this work is to explore the radiobiologic effect of prolonged fraction delivery time on tumor response and survival in vivo. 1-cm-diameter Lewis lung cancer tumors growing in the legs of C57BL mice were used. To evaluate effect of dose delivery prolongation, 18 Gy was divided into different subfractions. 48 mice were randomized into 6 groups: the normal control group, the single fraction with 18 Gy group, the two subfractions with 30 min interval group, the seven subfractions with 5 min interval group, the two subfractions with 60 min interval group and the seven subfractions with 10 min interval group. The tumor growth tendency, the tumor growth delay and the mice survival time were analyzed. The tumor growth delay of groups with prolonged delivery time was shorter than the group with single fraction of 18 Gy (P delivery time 30 min was longer than that of groups with prolonged delivery time 60 min P delivery time (P > 0.05). Compared to the group with single fraction of 18 Gy, the groups with prolonged delivery time shorten the mice survival time while there was no significant difference between the groups with prolonged delivery time 30 min and the groups with prolonged delivery time 60 min. The prolonged delivery time with same radiation dose shorten the tumor growth delay and survival time in the mice implanted with Lewis lung cancer. The anti-tumor effect decreased with elongation of the total interfractional time.

  15. [The treatment of recent myocardial infarction by prolonged infusion of trinitrin (author's transl)].

    Chiche, P; Derrida, J P; Baligadoo, S; Sal, R


    Seventy four clinically comparable cases of myocardial infarction, admitted on average at the 10th hour were divided at random in two groups: thirty nine were treated with a prolonged intravenous infusion of trinitrin lasting for 24 hours in 12 cases and during 5 at 7 days in 27 cases: 35 served as controls. The results showed the following: a) the good tolerance of the drug used in this way; b) on the basis of precordial cartography, a reduction of 56.2 +/- 14.5% to 30 +/- 7.3% in the index of secondary extension of necrosis; c) clinical signs of left ventricular failure developed in 60% of the controls as compared with 45.8% of the treated group; d) the prevalence of rhythm disturbances was also lower in those treated; e) overall mortality during the first 4 weeks was 8 amongst the 35 controls and 2 of the treated patients (p less than 0.05).

  16. Hypoxic ventilatory sensitivity in men is not reduced by prolonged hyperoxia (Predictive Studies V and VI)

    Gelfand, R.; Lambertsen, C. J.; Clark, J. M.; Hopkin, E.


    Potential adverse effects on the O2-sensing function of the carotid body when its cells are exposed to toxic O2 pressures were assessed during investigations of human organ tolerance to prolonged continuous and intermittent hyperoxia (Predictive Studies V and VI). Isocapnic hypoxic ventilatory responses (HVR) were determined at 1.0 ATA before and after severe hyperoxic exposures: 1) continuous O2 breathing at 1.5, 2.0, and 2.5 ATA for 17.7, 9.0, and 5.7 h and 2) intermittent O2 breathing at 2.0 ATA (30 min O2-30 min normoxia) for 14.3 O2 h within 30-h total time. Postexposure curvature of HVR hyperbolas was not reduced compared with preexposure controls. The hyperbolas were temporarily elevated to higher ventilations than controls due to increments in respiratory frequency that were proportional to O2 exposure time, not O2 pressure. In humans, prolonged hyperoxia does not attenuate the hypoxia-sensing function of the peripheral chemoreceptors, even after exposures that approach limits of human pulmonary and central nervous system O2 tolerance. Current applications of hyperoxia in hyperbaric O2 therapy and in subsea- and aerospace-related operations are guided by and are well within these exposure limits.

  17. Catanionic aggregates formed from drugs and lauric or capric acids enable prolonged release from gels.

    Dew, Noel; Bramer, Tobias; Edsman, Katarina


    The aim of this study was to add to the range of charged surfactants that can be used to form catanionic aggregates with oppositely charged surface active drug substances; and to apply these aggregates to prolong drug release from gels. The surfactants used in this study, lauric and capric acids are of natural origin-unlike traditionally used, synthetic, surfactants. The mixtures of drug substances and oppositely charged surfactants were studied visually and with cryogenic transmission electron microscopy. Drug release from gels was studied with a modified USP paddle method. This study shows that lauric and capric acids are as, or even more, active in forming catanionic aggregates than traditionally used surfactants such as sodium dodecyl sulfate. It is shown that the length of the hydrophobic part of the surfactant plays an important role in the formation of pharmaceutically interesting catanionic aggregates. As seen in previous studies, using catanionic vesicles prolongs the drug release from gels and decreases the apparent diffusion coefficient by a factor of 10-50, compared to a gel containing only drug substance.

  18. Effect of different carboxylic acids in cyclodextrin functionalization of cellulose nanocrystals for prolonged release of carvacrol.

    Castro, D O; Tabary, N; Martel, B; Gandini, A; Belgacem, N; Bras, J


    Current investigations deal with new surface functionalization strategy of nanocrystalline cellulose-based substrates to impart active molecule release properties. In this study, cellulose nanocrystals (CNC) were surface-functionalized with β-cyclodextrin (β-CD) using succinic acid (SA) and fumaric acid (FA) as bridging agents. The main objective of this surface modification performed only in aqueous media was to obtain new active materials able to release antibacterial molecules over a prolonged period of time. The reactions were conducted by immersing the CNC film into a solution composed of β-CD, SA and FA, leading to CNC grafting. The materials were characterized by infrared spectroscopy (FT-IR), Quartz crystal microbalance-dissipation (QCM-D), AFM and phenolphthalein (PhP) was used to determine the efficiency of CNC grafting with β-CD. The results indicated that β-CD was successfully attached to the CNC backbone through the formation of ester bonds. Furthermore, carvacrol was entrapped by the attached β-CD and a prolonged release was confirmed. In particular, CNC grafted to β-CD in the presence of FA was selected as the best solution. The antibacterial activity and the controlled release were studied for this sample. Considerably longer bacterial activity against B. subtilis was observed for CNC grafted to β-CD compared to CNC and CNC-FA, confirming the promising impact of the present strategy.

  19. Rapamycin Prolongs Cardiac Allograft Survival in a Mouse Model by Inducing Myeloid-Derived Suppressor Cells.

    Nakamura, T; Nakao, T; Yoshimura, N; Ashihara, E


    Mammalian target of rapamycin (mTOR) inhibitors are the main immunosuppressive drugs for organ transplant recipients. Nevertheless, the mechanisms by which mTOR inhibitors induce immunosuppression is not fully understood. Myeloid-derived suppressor cells (MDSCs) maintain host immunity; however, the relationship between mTOR inhibitors and MDSCs is unclear. Here, the results from a murine cardiac transplantation model revealed that rapamycin treatment (3 mg/kg, intraperitoneally on postoperative days 0, 2, 4, and 6) led to the recruitment of MDSCs and increased their expression of inducible nitric oxide synthase (iNOS). Immunohistochemical analysis revealed that rapamycin induced the migration of iNOS-expressing MDSCs into the subintimal space within the allograft vessels, resulting in a significant prolongation of graft survival compared with that in the untreated group (67 days vs. 7 days, respectively). These effects were counterbalanced by the administration of an anti-Gr-1, which reduced allograft survival to 21 days. Moreover, adoptive transcoronary arterial transfer of MDSCs from rapamycin-treated recipients prolonged allograft survival; this increase was reversed by the anti-Gr-1 antibody. Finally, co-administration of rapamycin and a mitogen-activated protein kinase kinase (MEK) inhibitor trametinib reversed rapamycin-mediated MDSC recruitment. Thus, the mTOR and Raf/MEK/extracellular signal regulated kinase (ERK) signaling pathways appear to play an important role in MDSC expansion.

  20. Correlations between edema and the immediate and prolonged painful consequences of inflammation: therapeutic implications?

    Chesler, Elissa J [ORNL; Lariviere, William R [University of Pittsburgh; Zhen, Li [Institute for Biomedical Sciences of Pain, Beijing, China; Shang, G [Institute for Biomedical Sciences of Pain, Beijing, China; Chen, Ya [Institute for Biomedical Sciences of Pain, Beijing, China; Yu, Yao [Institute for Biomedical Sciences of Pain, Beijing, China; Lu, Zhuo [Institute for Biomedical Sciences of Pain, Beijing, China; Chang, Ying [Institute for Biomedical Sciences of Pain, Beijing, China; Luo, Ceng [Institute for Biomedical Sciences of Pain, Beijing, China; Li, KaiCheng [Institute for Biomedical Sciences of Pain, Beijing, China; Chen, Jun [Institute for Biomedical Sciences of Pain, Beijing, China


    The precise relationship between the degree of pan and the degree of inflammation in the individual remains debated. A quantitative analysis simultaneously applied to the immediate and prolonged painful consequences of inflammation has not yet been done. Thus, the correlations between edema, nociception and hypersensitivity following an inflammatory insult were assessed in rodents. To better understand the therapeutic value of modifying specific aspects of inflammation, the effects of anti-inflammatory drug were compared to the results. Inbred strains of mice and outbred rats received an intraplantar injection of honeybee venom and the between group and within-group correlations were calculated for spontaneous nociceptive measures, thermal and mechanical hypersensitivity, and edema and temperature. The effect of indomethacin on the pain and the inflammation measures was examined. Edema correlated with spontaneous flinching, licking and lifting of the inject paw, and not with thermal or mechanical hypersensitivity. Indomethacin affected edema and spontaneous nociception dose-dependently, and affected hypersensitivity only at the highest dose test (P <0.005). These results suggest that edema may contribute only to immediate spontaneous nociceptive responses to an inflammatory insult, and not to the more clinically relevant prolonged hypersensitivity. This analysis represents a method for determine which inflammatory processes are the most promising therapeutic targets against the multiple painful consequences of inflammation.

  1. Mental fatigue caused by prolonged cognitive load associated with sympathetic hyperactivity

    Kuratsune Hirohiko


    Full Text Available Abstract Background It is known that chronic fatigue is associated with sympathetic hyperactivity. However, the relationship between autonomic function and mental fatigue caused by a prolonged mental load in healthy humans is still unclear. Thus, in order to clarify the mechanisms underlying mental fatigue, we examined the association between mental fatigue and autonomic functions. Methods The study group comprised 10 healthy participants. To induce mental fatigue, participants performed mental tasks, which consisted of the advanced trail making test, kana pick-out test and mirror drawing test, for 8 hr, corresponding to a normal work day. Autonomic functions were measured by accelerated plethysmography before and after the fatigue-inducing mental tasks. As a control, the same participants completed an 8-hr relaxation session 4 weeks before the fatigue session. Results After the 8-hr relaxation session, low-frequency component power (LF, high-frequency component power (HF and low-frequency component power/high-frequency component power ratio (LF/HF ratio were not changed from baseline. In contrast, after the fatigue session, the HF and LF/HF ratio were significantly changed from baseline; specifically, the HF was lower and LF/HF ratio was higher as compared to those after the relaxation session. Conclusions Sympathetic hyperactivity based on decreased parasympathetic activity is associated with mental fatigue induced by prolonged cognitive load.

  2. [Prolonged bone marrow aplasia in patients with acute leukemia after chemotherapy].

    Gaĭdamaka, N V; Parovichnikova, E N; Zavalishina, L E; Garmaeva, T Ts; Gaponova, T V; Troitskaia, V V; Pokrovskaia, O S; Tikhomirov, D S; Khodunova, E E; Mar'in, D S; Kaplanskaia, I B; Ustinova, E N; Mikhaĭlova, E A; Isaev, V G; Gribanova, E O; Savchenko, V G


    To analyze the causes of prolonged hematopoietic tissue aplasias in patients with acute leukemias (AL) after chemotherapy courses. Data on 7 patients with acute myeloid leukemia, followed up at the Hematology Departments, Hematology Research Center, Russian Academy of Medical Sciences, over the period 2003 to 2007, who had developed deep bone marrow aplasia (BMA) inadequate to cytostatic drug exposure during chemotherapy, were analyzed. The authors compared in all the patients the values of peripheral blood and bone marrow (BM) puncture specimens and the results of blood tests using the polymerase chain reaction at different AL development stages with the results of an immunohistochemical study using the markers of viruses of hepatitis C and B, a herpes group (EBV, CMV, HSV-1, HSV-2) and parvovirus B19. The marker of hepatitis C was detected in 6 of the 7 patients with prolonged BMA; 3 of these 6 patients showed a simultaneous infection with hepatitis B. Six of the 7 patients were found to have concomitant BM lesion with various herpes group viruses. Two patients had a resistant form of AL. Hepatitis C virus infection in patients and the resistant form of the disease were the principal causes of the development of BMA inadequate to cytostatic drug exposure. Affliction of abundant bone marrow cells with herpes group viruses was not a direct cause, but might substantially aggravate BMA.

  3. Prolonged acid rain facilitates soil organic carbon accumulation in a mature forest in Southern China.

    Wu, Jianping; Liang, Guohua; Hui, Dafeng; Deng, Qi; Xiong, Xin; Qiu, Qingyan; Liu, Juxiu; Chu, Guowei; Zhou, Guoyi; Zhang, Deqiang


    With the continuing increase in anthropogenic activities, acid rain remains a serious environmental threat, especially in the fast developing areas such as southern China. To detect how prolonged deposition of acid rain would influence soil organic carbon accumulation in mature subtropical forests, we conducted a field experiment with simulated acid rain (SAR) treatments in a monsoon evergreen broadleaf forest at Dinghushan National Nature Reserve in southern China. Four levels of SAR treatments were set by irrigating plants with water of different pH values: CK (the control, local lake water, pH ≈ 4.5), T1 (water pH=4.0), T2 (water pH=3.5), and T3 (water pH=3.0). Results showed reduced pH measurements in the topsoil exposed to simulated acid rains due to soil acidification. Soil respiration, soil microbial biomass and litter decomposition rates were significantly decreased by the SAR treatments. As a result, T3 treatment significantly increased the total organic carbon by 24.5% in the topsoil compared to the control. Furthermore, surface soil became more stable as more recalcitrant organic matter was generated under the SAR treatments. Our results suggest that prolonged acid rain exposure may have the potential to facilitate soil organic carbon accumulation in the subtropical forest in southern China.

  4. Effectiveness of carbohydrate feeding in delaying fatigue during prolonged exercise.

    Coyle, E F; Coggan, A R


    Prolonged exercise in the fasted state frequently results in a lowering of blood glucose concentration, and when the intensity is moderate (i.e. 60-80% of VO2 max), muscle often becomes depleted of glycogen. The extent to which carbohydrate feedings contribute to energy production, and their effectiveness for improving endurance during prolonged exercise, are reviewed in this article. Prolonged exercise (i.e. greater than 2 hours) results in a failure of hepatic glucose output to keep pace with muscle glucose uptake. As a result, blood glucose concentration frequently declines below 2.5 mmol/L. Despite this hypoglycaemia, fewer than 25% of subjects display symptoms suggestive of central nervous system dysfunction. Since fatigue rarely results from hypoglycaemia alone, the effectiveness of carbohydrate feeding should be judged by its potential for muscle glycogen sparing. Carbohydrate feeding during moderate intensity exercise postpones the development of fatigue by approximately 15 to 30 minutes, yet it does not prevent fatigue. This observation agrees with data suggesting that carbohydrate supplementation reduces muscle glycogen depletion. It is not certain whether carbohydrate feeding increases muscle glucose uptake throughout moderate exercise or if glucose uptake is higher only during the latter stages of exercise. In contrast to moderate intensity exercise, carbohydrate feeding during low intensity exercise (i.e. less than 45% of VO2 max) results in hyperinsulinaemia. Consequently, muscle glucose uptake and total carbohydrate oxidation are increased by approximately the same amount. The amount of ingested glucose which is oxidised is greater than the increase in total carbohydrate oxidation and therefore endogenous carbohydrate is spared. The majority of sparing appears to occur in the liver, which is reasonable since muscle glycogen is not utilised to a large extent during mild exercise. Although carbohydrate feedings prevent hypoglycaemia and are readily

  5. Mast cell leukemia with prolonged survival on PKC412/midostaurin.

    Xu, Xiangdong; Kreisel, Friederike H; Frater, John L; Hassan, Anjum


    Mast cell leukemia (MCL) is a rare and aggressive form of systemic mastocytosis. There are approximately 50 reported cases since 1950s. MCL is refractory to cytoreduction chemotherapy and the average survival is only six months. We report a MCL case in a 71 year-old woman with high tumor load at the initial presentation in 2005, who did not respond to either interleukin-2 or dasatinib therapy. After enrolled in a clinical trial of PKC412 (or Midostaurin) with a daily dose of 100 mg, the patient responded well to PKC412 and became transfusion independent in three months. Since then, her disease had been stably controlled. This is the first report of a high-tumor-load MCL case which achieved prolonged survival (101 months) by PKC 412. The 101-month overall survival is the longest among reported MCL cases in the English literature.

  6. Prolonged treatment of refractory status epilepticus in a child.

    Sahin, M; Riviello, J J


    Barbiturate anesthesia, which is commonly used for refractory status epilepticus, is an effective treatment, but with many significant complications. The relationship between the duration of this extreme therapy and the ultimate outcome of refractory status epilepticus has not been well studied. We report a 7-year-old girl who presented with refractory status epilepticus secondary to presumed encephalitis with a focal lesion on cranial magnetic resonance imaging. She was treated for 70 days with high-dose antiepileptic drugs and recovered with a residual seizure disorder. This case suggests that, if the status epilepticus is due to a reversible cause such as encephalitis, neurologic recovery may occur despite this very prolonged course of extreme therapy.

  7. Prolonged QT interval in a man with anorexia nervosa

    Macías-Robles, María Dolores; Perez-Clemente, Ana María; Maciá-Bobes, Carmen; Alvarez-Rueda, María Asunción; Pozo-Nuevo, Sergio


    Anorexia nervosa is an eating disorder characterized by the avoidance of food intake, which usually leads to a weight loss. Cardiac co-morbility is common and we can find sometimes a mass loss from the left ventricle, which can be seen by echocardiography. But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk. We present the case of a male who was diagnosed with anorexia nervosa and developed asthenia, a long QT interval and also a severe both hypokalaemia and hypomagnesaemia. We intend to discuss the pathogenic paths as well as prophylactic and therapeutic measures to this potentially-lethal pathology. PMID:19646241

  8. Prolonged intensive dominance behavior between gray wolves, Canis lupus

    Mech, L. David; Cluff, H. Dean


    Dominance is one of the most pervasive and important behaviors among wolves in a pack, yet its significance in free-ranging packs has been little studied. Insights into a behavior can often be gained by examining unusual examples of it. In the High Arctic near Eureka, Nunavut, Canada, we videotaped and described an unusually prolonged and intensive behavioral bout between an adult male Gray Wolf (Canis lupus) and a male member of his pack, thought to be a maturing son. With tail raised, the adult approached a male pack mate about 50 m from us and pinned and straddled this packmate repeatedly over 6.5 minutes, longer than we had ever seen in over 50 years of studying wolves. We interpreted this behavior as an extreme example of an adult wolf harassing a maturing offspring, perhaps in prelude to the offspring?s dispersal.

  9. Near wins prolong gambling on a video lottery terminal.

    Côté, Denis; Caron, Anne; Aubert, Jonathan; Desrochers, Véronique; Ladouceur, Robert


    The purpose of the present study was to evaluate whether near wins can prolong gambling activity on a video lottery terminal. In a three-reel game, near wins were operationally defined as two identical symbols followed by a third different symbol. Players in an experimental condition were exposed to 27% near wins in a series of continuous losses, whereas players in a control group were exposed to none. Participants played as long as they wished, and received real money for their wins. The results showed that players in the near win condition played 33% more games than did the control group. The results of this study suggest that near wins can be added to the list of factors that may motivate people to gamble despite the probability of monetary loss.

  10. Rat liver pathomorphology during prolonged sodium valproate administration.

    Sobaniec-Lotowska, M; Sobaniec, W; Kułak, W


    Prolonged administration (1, 3, 6, 9 and 12 months) to rats of an antiepileptic drug--sodium valproate (Vupral--"Polfa") in the dose of 200 mg/kg/day produced the first hepatic morphological lesions after 3 months of the experiment. These structural abnormalities progressively increased to achieve their peak within 12 months. The most prominent microscopic changes consisted of extensive microvesicular fatty change and vacuolar degeneration of periportal hepatocytes. Intralobular focal necrosis, infiltrations of lymphocytes, plasma cells, and phagocytes in the portal tracts, and centrilobular congestion were also present. The connective tissue did not proliferate either in periportal lobular zone or around the central veins. The described lesions seem thus to be reversible.

  11. Brain activity and fatigue during prolonged exercise in the heat

    Hyldig, Tino Hoffmann


    reflects suppressed arousal. In H, subjects fatigued after 34.4-1.4 min coinciding with an oesophageal temperature (Toes) of 39.8-0.1°C, an almost maximal heart rate (HR 192-3 beats·min-1), a rating of perceived exertion (RPE) of 19.0-0.8 and significantly elevated !/# index (188-71% of the value after 2...... min of exercise; PIncreases in the !/# index were strongly correlated to increases in Toes (r2=0.98; P=0.0001).......We hypothesized that fatigue due to hyperthermia during prolonged exercise in the heat is in part related to alterations in frontal cortical brain activity. The electroencephalographic activity (EEG) of the frontal cortex of the brain was measured in seven cyclists [maximal O2 uptake (VO2max) 4...

  12. New Heterogeneous Clustering Protocol for Prolonging Wireless Sensor Networks Lifetime

    Md. Golam Rashed


    Full Text Available Clustering in wireless sensor networks is one of the crucial methods for increasing of network lifetime. The network characteristics of existing classical clustering protocols for wireless sensor network are homogeneous. Clustering protocols fail to maintain the stability of the system, especially when nodes are heterogeneous. We have seen that the behavior of Heterogeneous-Hierarchical Energy Aware Routing Protocol (H-HEARP becomes very unstable once the first node dies, especially in the presence of node heterogeneity. In this paper we assume a new clustering protocol whose network characteristics is heterogeneous for prolonging of network lifetime. The computer simulation results demonstrate that the proposed clustering algorithm outperforms than other clustering algorithms in terms of the time interval before the death of the first node (we refer to as stability period. The simulation results also show the high performance of the proposed clustering algorithm for higher values of extra energy brought by more powerful nodes.

  13. CNS fatigue provoked by prolonged exercise in the heat

    Nybo, Lars


    to the brain. However, exercise with superimposed hyperthermia is not only a challenge to the brain it also provides an excellent model for studying factors of importance for central fatigue. Excessive heat storage within the brain appears to be the primary cause for the central fatigue during exercise...... to aggravate central fatigue and degrade exercise performance. Hyperthermia mediated central fatigue may include other cerebral perturbations such as reduced perfusion of the brain, accumulation of ammonia or depletion of neuronal energy stores, but further research is needed to elucidate their possible......Exercise-induced hyperthermia is associated with central fatigue as indicated by an impaired ability to sustain maximal motor activation during prolonged voluntary efforts. Therefore, exercise in hot environments challenges not only to the cardiorespiratory and locomotive systems but also...

  14. Prolonged remission of leukemia associated with polycythemia vera.

    Hazani, A; Tatarsky, I; Barzilai, D


    A patient with polycythemia vera (PV) received successive treatment by phlebotomies, radioactive phosphorus, myleran and cyclophosphamide. Sixteen years after the diagnosis, he developed acute myeloblastic leukemia. A complete remission was achieved following two courses of COAP (cyclophosphamide, vincristine, Cytosine Arabinoside, and prednisone) therapy. Four months later, while still in leukemic remission, he became mildly polycythemic again and the treatment with phlebotomies and cyclophosphamide was resume. The patient has subsequently been in complete remission of leukemia for over three years and his polycythemia is controlled by small doses of cyclophosphamide. This appears to be a unique case of such a prolonged remission of leukemia in the course of PV, with a return to a mild polycythemia state.

  15. Prolonging the postcomplex spike pause speeds eyeblink conditioning.

    Maiz, Jaione; Karakossian, Movses H; Pakaprot, Narawut; Robleto, Karla; Thompson, Richard F; Otis, Thomas S


    Climbing fiber input to the cerebellum is believed to serve as a teaching signal during associative, cerebellum-dependent forms of motor learning. However, it is not understood how this neural pathway coordinates changes in cerebellar circuitry during learning. Here, we use pharmacological manipulations to prolong the postcomplex spike pause, a component of the climbing fiber signal in Purkinje neurons, and show that these manipulations enhance the rate of learning in classical eyelid conditioning. Our findings elucidate an unappreciated aspect of the climbing fiber teaching signal, and are consistent with a model in which convergent postcomplex spike pauses drive learning-related plasticity in the deep cerebellar nucleus. They also suggest a physiological mechanism that could modulate motor learning rates.

  16. Prolonged weightlessness, reference frames and visual symmetry detection.

    Leone, G; de Schonen, S; Lipshits, M


    We evaluated the influence of prolonged weightlessness on the performance of three cosmonauts to bilateral symmetry detection in the course of a 15-day-long Russian-French mission CASSIOPEE 96 aboard the MIR station. We tested the influence of weightlessness on subjects' performance as a function of the retinal orientation of axis of symmetry. as a function of type of stimuli (closed versus multi-elements shapes) and as a function of visual field presentation (at fixation, left visual field. right visual field). The results indicate firstly a difference between presentation at fixation versus away of fixation. Away of fixation, no effect of microgravity on performance was shown. A hypothesis of hemispheric specialization for symmetry detection was not supported as well. At fixation, an effect of micro-gravity was shown and more interestingly, the effect was quite different as a function of type of shapes used. suggesting that symmetry detection is a multiple-stage process.

  17. Prolonged cholestasis and ductopenia following gold salt therapy.

    Basset, Céline; Vadrot, Jacqueline; Denis, Jacques; Poupon, Joël; Zafrani, Elie Serge


    Hepatotoxicity, predominantly cholestatic, is a rare adverse effect of gold salt therapy, which usually completely resolves within a few months. We report the case of a female patient treated for rheumatoid arthritis, who had gold salt overdose, and in whom acute cholestatic hepatitis occurred three weeks after beginning of therapy. Evolution of gold concentration was followed in plasma and urine, as well as in cutaneous and liver dry tissue. Liver biopsy showed marked inflammatory changes of interlobular bile ducts that evolved towards ductopenia, which was responsible for prolonged cholestasis still present 15 months later. In addition, sialadenitis with sicca syndrome was noted six months after onset of the disease. The mechanism of hepatotoxicity was probably immunoallergic since liver lesions were associated with hypersensitivity syndrome including dermatitis and blood and tissue eosinophilia. This is the first report of gold salt hepatotoxicity with histological demonstration of cholangitis followed by ductopenia.

  18. Tracheoesophageal fistula--a complication of prolonged tracheal intubation.

    Paraschiv, M


    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results.

  19. Prolonged reorganization of thiol-capped Au nanoparticles layered structures

    Sarathi Kundu


    Full Text Available Prolonged reorganization behaviour of mono-, di-, tri- and multi-layer films of Au nanoparticles prepared by Langmuir-Blodgett method on hydrophobic Si(001 substrates have been studied by using X-ray scattering techniques. Out-of-plane study shows that although at the initial stage the reorganization occurs through the compaction of the films keeping the layered structure unchanged but finally all layered structures modify to monolayer structure. Due to this reorganization the Au density increases within the nanometer thick films. In-plane study shows that inside the reorganized films Au nanoparticles are distributed randomly and the particle size modifies as the metallic core of Au nanoparticles coalesces.

  20. Joint contracture following prolonged stay in the intensive care unit

    Clavet, Heidi; Hébert, Paul C.; Fergusson, Dean; Doucette, Steve; Trudel, Guy


    Background Prolonged immobility during a critical illness may predispose patients to the development of joint contracture. We sought to document the incidence of, the risk factors for and the reversibility of joint contractures among patients who stayed in a tertiary intensive care unit (ICU) for 2 weeks or longer. Methods We conducted a chart review to collect data on the presence of and risk factors for joint contractures in the shoulders, elbows, hips, knees and ankles among patients admitted to the ICU between January 2003 and March 2005. Results At the time of transfer out of the ICU, at least 1 joint contracture was recorded in 61 (39%) of 155 patients; 52 (34%) of the patients had joint contractures of an extent documented to impair function. Time spent in the ICU was a significant risk factor for contracture: a stay of 8 weeks or longer was associated with a significantly greater risk of any joint contracture than a stay of 2 to 3 weeks (adjusted odds ratio [OR] 7.09, 95% confidence interval (CI) 1.29–38.9; p = 0.02). Among the variables tested, only the use of steroids conferred a protective effect against joint contractures (adjusted OR 0.35, 95% CI 0.14–0.83; p = 0.02). At the time of discharge to home, which occurred a median of 6.6 weeks after transfer out of intensive care, 50 (34%) of the 147 patients not lost to follow-up still had 1 or more joint contractures, and 34 (23%) of the patients had at least 1 functionally significant joint contracture. Interpretation Following a prolonged stay in the ICU, a functionally significant contracture of a major joint occurred in more than one-third of patients, and most of these contractures persisted until the time of discharge to home. PMID:18332384

  1. Candidemia in patients with prolonged fever in Kashan, Iran.

    Razzaghi, R; Momen-Heravi, M; Erami, M; Nazeri, M


    Candida species are considered a common cause of fungal blood stream infections, which are associated with considerable mortality and morbidity rates, especially in the admitted and immunocompromised patients. Despite the increase in new and available antifungal agents, the emergence of resistant strains is growing. Regarding this, the aim of the present study was to assess the fungal epide-miology of candidemia and the antifungal susceptibility patterns against five current antifungal agents among the patients with prolonged fever, who were admitted to Beheshti Educational Hospital, Kashan, Iran. This cross-sectional study was conducted on 253 hospitalized patients with prolonged fever despite receiving broad-spectrum antibiotic therapy. Blood samples were collected aseptically, and then cultured using an automated blood culture system and conventional broth culture bottle. Candida isolates were identified at species level using morphological and physiological properties and produced color on the CHROMagar Candida. Furthermore, the antifungal susceptibility testing was performed using (CLSI M27-A3 and CLSI M27-S4) broth microdilution methods. The most positive cultures were detected by the automated blood culture system. C.albicans (%50) was the most prevalent species, followed by C. glabrata (%40), and C. parapsilosis, (%10) respectively .The mortality rate was high (%60) and most patients with candidemia were admitted to the Intensive Care Unit and Neonatal Intensive Care Unit. All isolates were susceptible to amphotericin B, while the highest resistance belonged to caspofungin. In this study, high resistance was reported, especially for caspofungin, which can be regarded as the emergence of caspofungin-resistant strains. Regarding this, the establishment of a surveillance and prevention program for the reduction of the emergence of resistant species is necessary.

  2. [Prolonged pregnancy--prostaglandins as the cause of labor onset].

    Rath, W


    The causes of prolonged pregnancy are still largely unknown and their investigation requires a detailed observation of potential birth-initiating stimuli on the endocrine and biomolecular level. A large number of clinical and biochemical studies point to the central importance of prostaglandins for the beginning of human birth. The main places of origin of the intensified prostaglandin formation and release are the amnion and the decidua which has "macrophage-like" properties and functions. The superordinate regulation and trigger mechanisms for intensified uterine prostaglandin production has not been sufficiently investigated either. Possible factors currently being debated include local changes in estrogen and progesterone biosynthesis in fetal membranes and decidua, subclinical inflammatory reactions with the activation of macrophages and the consecutive release of cytokines, and a loss of maternal immune tolerance with a time-determined rejection reaction. In addition, the substances inhibiting and stimulating prostaglandin synthesis have been detected in the amniotic fluid, fetal membranes and decidua. The fetus itself also plays an important part in the initiation of labor. Prolongation may be due to anatomic functional disturbances of the one hand which prevent the activation of the fetal hypothalamic-hypophyseal-adrenal axis and the release of the birth-initiating stimuli originating in the fetus; on the other hand, an elevated immune tolerance with a delayed rejection reaction or the lack of "bacterial stimulus" may inhibit the activation of the macrophages and hence the formation of cytokines. The consequences would be the development and release of a quantity of prostaglandins from the fetal membranes and decidua insufficient to overcome the pregnancy-maintaining safety systems.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Knee abduction angular impulses during prolonged running with wedged insoles.

    Lewinson, Ryan T; Worobets, Jay T; Stefanyshyn, Darren J


    Wedged insoles may produce immediate effects on knee abduction angular impulses during running; however, it is currently not known whether these knee abduction angular impulse magnitudes are maintained throughout a run when fatigue sets in. If changes occur, this could affect the clinical utility of wedged insoles in treating conditions such as patellofemoral pain. Thus, the purpose of this study was to determine whether knee abduction angular impulses are altered during a prolonged run with wedged insoles. It was hypothesized that knee abduction angular impulses would be reduced following a prolonged run with wedged insoles. Nine healthy runners participated. Runners were randomly assigned to either a 6-mm medial wedge condition or a 6-mm lateral wedge condition and then ran continuously overground for 30 min. Knee abduction angular impulses were quantified at 0 and 30 min using a gait analysis procedure. After 2 days, participants returned to perform the same test but with the other wedge type. Two-way repeated-measures analysis of variance was used to evaluate main effects of wedge condition and time and interactions between wedge condition and time (α = 0.05). Paired t-tests were used for post hoc analysis (α = 0.01). No interaction effects (p = 0.958) were found, and knee abduction angular impulses were not significantly different over time (p = 0.384). Lateral wedge conditions produced lesser knee abduction angular impulses than medial conditions at 0 min (difference of 2.79 N m s, p = 0.006) and at 30 min (difference of 2.76 N m s, p < 0.001). It is concluded that significant knee abduction angular impulse changes within wedge conditions do not occur during a 30-min run. Additionally, knee abduction angular impulse differences between wedge conditions are maintained during a 30-min run.

  4. Cesium-induced QT-interval prolongation in an adolescent.

    O'Brien, Catherine E; Harik, Nada; James, Laura P; Seib, Paul M; Stowe, Cindy D


    Alternative medicine is becoming increasingly popular, especially with terminally ill patients. Most alternative remedies have not been adequately studied or proven effective for the diseases for which they are promoted. In the worst cases, these therapies are harmful. We describe a 16-year-old girl with metastatic hepatocellular carcinoma who experienced cesium-induced QT-interval prolongation after the start of a cesium chloride-based alternative treatment regimen. She had received seven courses of chemotherapy, with a cumulative doxorubicin dose of 500 mg/m(2) over 5 months, resulting in minimal tumor regression. Against the advice of her oncologist, she abandoned traditional therapy and started an alternative regimen that included cesium chloride supplements. Two weeks later, the patient went to a local emergency department after experiencing two brief syncopal episodes. An electrocardiogram revealed occasional premature ventricular contractions, a QTc interval of 683 msec (normal range for females 450-460 msec), and R on T phenomenon. She was admitted to the hospital and later experienced monomorphic ventricular tachycardia, which resolved spontaneously. Lidocaine therapy was started, and the patient was transferred to a cardiac intensive care unit at our hospital. Her plasma cesium level was 2400 microg/dl (normal cesium level was 1800 microg/dl, and her QTc interval was 494 msec. According to the Naranjo adverse drug reaction probability scale, cesium was the probable cause of the patient's arrhythmia. In animal models, cesium chloride has induced cardiac arrhythmias, including torsade de pointes. It inhibits delayed rectifier potassium channels in the myocardium, causing delayed repolarization and QT-interval prolongation. Patients with cancer should be aware that alternative remedies may be harmful and ineffective. Because patients may be unlikely to self-report alternative remedies, health care providers should specifically ask their patients about any

  5. QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings.

    Isbister, Geoffrey K; Brown, Amanda L; Gill, Anthony; Scott, Alexander J; Calver, Leonie; Dunlop, Adrian J


    Methadone is a widely used opioid agonist treatment associated with QT prolongation and torsades de pointes. We investigated the QT interval in patients treated with methadone or buprenorphine using continuous 12-lead Holter recordings. We prospectively made 24-h Holter recordings in patients prescribed methadone or buprenorphine, compared to controls. After their normal dose a continuous 12-lead Holter recorder was attached for 24 h. Digital electrocardiograms were extracted hourly from the Holter recordings. The QT interval was measured automatically (H-scribe software, Mortara Pty Ltd) and checked manually. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine abnormality. Demographics, dosing, medical history and laboratory investigations were recorded. There were 58 patients (19 methadone, 20 buprenorphine and 19 control); median age 35 years (20-56 years); 33 males. Baseline characteristics were similar. Median dose of methadone was 110 mg day(-1) (70-170 mg day(-1) ) and buprenorphine was 16 mg day(-1) (12-32 mg day(-1) ). Seven participants had abnormal QT intervals. There was a significant difference in the proportion of prescribed methadone with abnormal QT intervals, 7/19 (37%; 95% confidence interval: 17-61%), compared to controls 0/19 (0%; 95% confidence interval: 0-21%; P = 0.008), but no difference between buprenorphine and controls (0/20). QT vs. HR plots showed patients prescribed methadone had higher QT-HR pairs over 24 h compared to controls. There was no difference in dose for patients prescribed methadone with abnormal QT intervals and those without. Methadone is associated with prolonged QT intervals, but there was no association with dose. Buprenorphine did not prolong the QT interval. Twenty four-hour Holter recordings using the QT nomogram is a feasible method to assess the QT interval in patients prescribed methadone. © 2017 The Authors. British Journal of Clinical Pharmacology published by John

  6. Sublingual fast dissolving niosomal films for enhanced bioavailability and prolonged effect of metoprolol tartrate

    Allam, Ayat; Fetih, Gihan


    The aim of the present work was to prepare and evaluate sublingual fast dissolving films containing metoprolol tartrate-loaded niosomes. Niosomes were utilized to allow for prolonged release of the drug, whereas the films were used to increase the drug’s bioavailability via the sublingual route. Niosomes were prepared using span 60 and cholesterol at different drug to surfactant ratios. The niosomes were characterized for size, zeta-potential, and entrapment efficiency. The selected niosomal formulation was incorporated into polymeric films using hydroxypropyl methyl cellulose E15 and methyl cellulose as film-forming polymers and Avicel as superdisintegrant. The physical characteristics (appearance, texture, pH, uniformity of weight and thickness, disintegration time, and palatability) of the prepared films were studied, in addition to evaluating the in vitro drug release, stability, and in vivo pharmacokinetics in rabbits. The release of the drug from the medicated film was fast (99.9% of the drug was released within 30 minutes), while the drug loaded into the niosomes, either incorporated into the film or not, showed only 22.85% drug release within the same time. The selected sublingual film showed significantly higher rate of drug absorption and higher drug plasma levels compared with that of commercial oral tablet. The plasma levels remained detectable for 24 hours following sublingual administration, compared with only 12 hours after administration of the oral tablet. In addition, the absolute bioavailability of the drug (ie, relative to intravenous administration) following sublingual administration was found to be significantly higher (91.06%±13.28%), as compared with that after oral tablet administration (39.37%±11.4%). These results indicate that the fast dissolving niosomal film could be a promising delivery system to enhance the bioavailability and prolong the therapeutic effect of metoprolol tartrate. PMID:27536063

  7. Is lumbar lordosis related to low back pain development during prolonged standing?

    Sorensen, Christopher J; Norton, Barbara J; Callaghan, Jack P; Hwang, Ching-Ting; Van Dillen, Linda R


    An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain during prolonged standing. The purposes of this study were to (1) compare baseline lumbar lordosis in back-healthy participants who do (Pain Developers) and do not (Non-Pain Developers) develop low back pain during 2 h of standing, and (2) examine the relationship between lumbar lordosis and low back pain intensity. Cross-sectional. First, participants stood while positions of markers placed superficial to the lumbar vertebrae were recorded using a motion capture system. Following collection of marker positions, participants stood for 2 h while performing light work tasks. At baseline and every 15 min during standing, participants rated their low back pain intensity on a visual analog scale. Lumbar lordosis was calculated using marker positions collected prior to the 2 h standing period. Lumbar lordosis was compared between pain developers and non-pain developers. In pain developers, the relationship between lumbar lordosis and maximum pain was examined. There were 24 (42%) pain developers and 33 (58%) non-pain developers. Lumbar lordosis was significantly larger in pain developers compared to non-pain developers (Mean difference = 4.4°; 95% Confidence Interval = 0.9° to 7.8°, Cohen's d = 0.7). The correlation coefficient between lumbar lordosis and maximum pain was 0.46 (P = 0.02). The results suggest that standing in more lumbar lordosis may be a risk factor for low back pain development during prolonged periods of standing. Identifying risk factors for low back pain development can inform preventative and early intervention strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Sublingual fast dissolving niosomal films for enhanced bioavailability and prolonged effect of metoprolol tartrate

    Allam A


    Full Text Available Ayat Allam, Gihan Fetih Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt Abstract: The aim of the present work was to prepare and evaluate sublingual fast dissolving films containing metoprolol tartrate-loaded niosomes. Niosomes were utilized to allow for prolonged release of the drug, whereas the films were used to increase the drug’s bioavailability via the sublingual route. Niosomes were prepared using span 60 and cholesterol at different drug to surfactant ratios. The niosomes were characterized for size, zeta-potential, and entrapment efficiency. The selected niosomal formulation was incorporated into polymeric films using hydroxypropyl methyl cellulose E15 and methyl cellulose as film-forming polymers and Avicel as superdisintegrant. The physical characteristics (appearance, texture, pH, uniformity of weight and thickness, disintegration time, and palatability of the prepared films were studied, in addition to evaluating the in vitro drug release, stability, and in vivo pharmacokinetics in rabbits. The release of the drug from the medicated film was fast (99.9% of the drug was released within 30 minutes, while the drug loaded into the niosomes, either incorporated into the film or not, showed only 22.85% drug release within the same time. The selected sublingual film showed significantly higher rate of drug absorption and higher drug plasma levels compared with that of commercial oral tablet. The plasma levels remained detectable for 24 hours following sublingual administration, compared with only 12 hours after administration of the oral tablet. In addition, the absolute bioavailability of the drug (ie, relative to intravenous administration following sublingual administration was found to be significantly higher (91.06%±13.28%, as compared with that after oral tablet administration (39.37%±11.4%. These results indicate that the fast dissolving niosomal film could be a promising delivery system to

  9. Quantification of 16 QT-prolonging Drugs and Metabolites in Human Postmortem Blood and Cardiac Tissue Using UPLC–MS-MS

    Mikkelsen, Christian Reuss; Jornil, Jakob; Vukelic Andersen, Ljubica;


    QT-prolonging compounds present a treatment risk in mentally ill patients. Knowledge of the concentration in the heart compared with blood is necessary to assess the cardiac toxicity of QT-prolonging compounds. To address this issue, this article presents a validated analytical method for the qua......QT-prolonging compounds present a treatment risk in mentally ill patients. Knowledge of the concentration in the heart compared with blood is necessary to assess the cardiac toxicity of QT-prolonging compounds. To address this issue, this article presents a validated analytical method...... for the quantification of 16 QT-prolonging drugs (QTD) and metabolites in postmortem whole blood and postmortem cardiac tissue. Samples were prepared by protein precipitation and quantified using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Deuterated internal standards were used...... concentrations of the prescription drugs. No noteworthy degradation during storage of the extracts was detected. The method was applied in five authentic cases of mentally ill patients. In conclusion, an analytical method was successfully developed and validated for the quantification of QTD in postmortem whole...

  10. [Prolonged molecular response induced by imatinib in Philadelphia positive acute lymphoblastic leukemia A case report and brief review].

    Raissi, Abderrahim; Bouaouad, Majdouline; Drideb, Noufissa Alami; Jennane, Selim; Mahtat, El Mahdi; Doghmi, Kamal; Mikdame, Mohammed


    Philadelphia or BCR-ABL positive acute lymphoblastic leukemia (PH+ ALL) is the most common and severe of adult ALL. The only potentially curator treatment remains allogeneic hematopoietic stem cells transplantation (SCT) in first complete remission. The use of imatinib has revolutionized the treatment of chronic myeloid leukemia. Its incorporation into PH + ALL protocols also improved the prognosis of this disease giving better complete remission rates compared to chemotherapy alone. The treatment of patients not eligible for SCT remains controversial. Prolonged use of high dose tyrosine kinase inhibitors (TKI) (ie: imatinib at 600 or 800 mg/j) as maintenance therapy seems to be a reasonable approach. We present a case of prolonged molecular remission of PH+ ALL under TKI alone as maintenance therapy.

  11. Comparison of guar gum from different sources for the preparation of prolonged-release or colon-specific dosage forms.

    Acartürk, Füsun; Celkan, Armağan


    The aim of the present study was to compare some physicochemical properties of guar gum samples from different sources and thus to investigate the suitability of these samples for the formulation of either prolonged-release or colon-specific dosage forms. Twelve different guar gum samples from India, Pakistan and the USA were used. Theophylline was chosen as a model drug. The flow type of the guar gum samples was determined as pseudoplastic. The viscosity and the particle size of the guar gum samples were found to be the main parameters which could affect the drug release from matrix tablets. All of the guar gum samples are suitable for use in the preparation of prolonged-release matrix tablets. But, three of them, obtained from India and the USA, may be potentially the most suitable guar gum samples for the preparation of colon-specific dosage forms.

  12. Evaluation of Sphingolipids in Wistar Rats Treated to Prolonged and Single Oral Doses of Fumonisin B1

    Direito, Glória M.; Almeida, Adriana P.; Aquino, Simone; dos Reis, Tatiana Alves; Pozzi, Claudia Rodrigues; Corrêa, Benedito


    The objective of the present study was to evaluate sphingolipid levels (sphingosine-So and sphinganine-Sa) and to compare the Sa/So ratio in liver, serum and urine of Wistar rats after prolonged administration (21 days) of fumonisin B1 (FB1). In parallel, the kinetics of sphingolipid elimination in urine was studied in animals receiving a single dose of FB1. Prolonged exposure to FB1 caused an increase in Sa levels in urine, serum and liver. The most marked effect on sphingolipid biosynthesis was observed in animals treated with the highest dose of FB1. Animals receiving a single dose of FB1 presented variations in Sa and So levels and in the Sa/So ratio. PMID:19333435

  13. Effect of prolonged inactivity on skeletal motor nerve terminals during aestivation in the burrowing frog, Cyclorana alboguttata.

    Hudson, Nicholas J; Lavidis, Nickolas A; Choy, Peng T; Franklin, Craig E


    This study examined the effect of prolonged inactivity, associated with aestivation, on neuromuscular transmission in the green-striped burrowing frog, Cyclorana alboguttata. We compared the structure and function of the neuromuscular junctions on the iliofibularis muscle from active C. alboguttata and from C. alboguttata that had been aestivating for 6 months. Despite the prolonged period of immobility, there was no significant difference in the shape of the terminals (primary, secondary or tertiary branches) or the length of primary terminal branches between aestivators and non-aestivators. Furthermore, there was no significant difference in the membrane potentials of muscle fibres or in miniature end plate potential (EPP) frequency and amplitude. However, there was a significant decrease in evoked transmitter release characterised by a 56% decrease in mean EPP amplitude, and a 29% increase in the failure rate of nerve terminal action potentials to evoke transmitter release. The impact of this suite of neuromuscular characteristics on the locomotor performance of emergent frogs is discussed.

  14. Randomised clinical trial of the effects of prolonged-release melatonin, temazepam and zolpidem on slow-wave activity during sleep in healthy people.

    Arbon, Emma L; Knurowska, Malgorzata; Dijk, Derk-Jan


    Current pharmacological treatments for insomnia include benzodiazepine and non-benzodiazepine hypnotics targeting γ-aminobutyric acid (GABA)A receptors, as well as agonists of the melatonin receptors MT1 and MT2. Melatonin, temazepam and zolpidem are thought to exert their effect through different mechanisms of action, but whether this leads to differential effects on electroencephalogram (EEG) power spectra during sleep in middle-aged people is currently not known. To establish whether the effects of prolonged-release melatonin (2 mg) on the nocturnal sleep EEG are different to those of temazepam (20 mg) and zolpidem (10 mg). Sixteen healthy men and women aged 55-64 years participated in a double-blind, placebo-controlled, four-way cross-over trial. Nocturnal sleep was assessed with polysomnography and spectral analysis of the EEG. The effects of single oral doses of prolonged-release melatonin, temazepam and zolpidem on EEG slow-wave activity (SWA, 0.75-4.5 Hz) and other frequencies during nocturnal non-rapid eye movement (NREM) sleep were compared. In an entire night analysis prolonged-release melatonin did not affect SWA, whereas temazepam and zolpidem significantly reduced SWA compared with placebo. Temazepam significantly reduced SWA compared with prolonged-release melatonin. Prolonged-release melatonin only reduced SWA during the first third of the night compared with placebo. These data show that the effects of prolonged-release melatonin on the nocturnal sleep EEG are minor and are different from those of temazepam and zolpidem; this is likely due to the different mechanisms of action of the medications.

  15. Levo-α-acetylmethadol (LAAM induced QTc-prolongation - results from a controlled clinical trial

    Wieneke H


    Full Text Available Abstract Background Due to potential proarrhythmic side-effects levo-α-Acetylmethadol (LAAM is currently not available in EU countries as maintenance drug in the treatment of opiate addiction. However, recent studies and meta-analyses underline the clinical advantages of LAAM with respect to the reduction of heroin use. Thus a reappraisal of LAAM has been demanded. The aim of the present study was to evaluate the relative impact of LAAM on QTc-interval, as a measure of pro-arrhythmic risk, in comparison to methadone, the current standard in substitution therapy. Methods ECG recordings were analysed within a randomized, controlled clinical trial evaluating the efficacy and tolerability of maintenance treatment with LAAM compared with racemic methadone. Recordings were done at two points: 1 during a run-in period with all patients on methadone and 2 24 weeks after randomisation into methadone or LAAM treatment group. These ECG recordings were analysed with respect to QTc-values and QTc-dispersion. Mean values as well as individual changes compared to baseline parameters were evaluated. QTc-intervals were classified according to CPMP-guidelines. Results Complete ECG data sets could be obtained in 53 patients (31 LAAM-group, 22 methadone-group. No clinical cardiac complications were observed in either group. After 24 weeks, patients receiving LAAM showed a significant increase in QTc-interval (0.409 s ± 0.022 s versus 0.418 s ± 0.028 s, p = 0.046, whereas no significant changes could be observed in patients remaining on methadone. There was no statistically significant change in QTc-dispersion in either group. More patients with borderline prolonged and prolonged QTc-intervals were observed in the LAAM than in the methadone treatment group (n = 7 vs. n = 1; p = 0.1. Conclusions In this controlled trial LAAM induced QTc-prolongation in a higher degree than methadone. Given reports of severe arrhythmic events, careful ECG-monitoring is recommended

  16. Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis.

    Teo, Jocelyn; Liew, Yixin; Lee, Winnie; Kwa, Andrea Lay-Hoon


    The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53-0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03-1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43-0.76; clinical success, RR = 1.34, 95% CI 1.02-1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57-1.21; clinical success, RR = 1.05, 95% CI 0.99-1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit.

  17. Prolonging the duration of preventing bacterial adhesion of nanosilver-containing polymer films through hydrophobicity.

    Yin, Bing; Liu, Tao; Yin, Yansheng


    A superhydrophobic coating composed of silver nanoparticles was developed on copper from fluorinated multilayered polyelectrolyte films to examine its performance in preventing microbial adhesion. Antibacterial and antibiofouling experiments for this novel coating were conducted with SRB. From the disk diffusion tests (for 48 h), it was found that, compared to the traditional coating composed of nanosilver, this novel coating significantly improved antibacterial performance and long-term effectiveness. The oxidation states of the immobilized silver in polyelectrolyte multilayer films were investigated with X-ray photoelectron spectroscopy (XPS), and the stability of the immobilized silver was evaluated through a leaching test. It was found that if silver was exposed to aqueous environments some ionic silver species would be produced and released. The ion release kinetics showed that the duration of sustained release of antibacterial Ag ions from the novel coatings was prolonged, which was why they had more long-term antibacterial performance.

  18. Kinematic effects of inertia and friction added by a robotic knee exoskeleton after prolonged walking.

    Shirota, C; Tucker, M R; Lambercy, O; Gassert, R


    The capabilities of robotic gait assistive devices are ever increasing; however, their adoption outside of the lab is still limited. A critical barrier for the functionality of these devices are the still unknown mechanical properties of the human leg during dynamic conditions such as walking. We built a robotic knee exoskeleton to address this problem. Here, we present the effects of our device on the walking pattern of four subjects. We assessed the effects after a short period of acclimation as well as after a 1.5h walking protocol. We found that the knee exoskeleton decreased (towards extension) the peak hip extension and peak knee flexion of the leg with the exoskeleton, while minimally affecting the non-exoskeleton leg. Comparatively smaller changes occurred after prolonged walking. These results suggest that walking patterns attained after a few minutes of acclimation with a knee exoskeleton are stable for at least a couple of hours.

  19. Nanocomposite polymeric electrolytes to record electrophysiological brain signals in prolonged, unconventional or extreme conditions.

    Licoccia, Silvia; Luisa Di Vona, M; Romagnoli, Paola; Narici, Livio; Acquaviva, Massimo; Carozzo, Simone; Marco, Stefano Di; Saturno, Moreno; Sannita, Walter G; Traversa, Enrico


    Chemically stable nanocomposite iono-conducting polymeric membranes (based on lithium salts and nanocrystalline oxide powders dispersed in a polymethyl methacrylate matrix) performed successfully in the recording of human brain responses to visual stimulation. Impedance was higher than that of conventional electrodes. However, the electrophysiological signals recorded by acid Al(2)O(3) and neutral Al(2)O(3) 5 wt.% and 10 wt.% nanocomposite gel electrolytes were comparable to those obtained with standard electrodes, even without preliminary skin cleaning and in the absence of gel electrolytes allowing better contact with and skin-electrode ionic conductance. The electrochemical and mechanical characteristics of these membranes make them fit for human and animal research, for clinical application (specifically in emergencies, prolonged electrophysiological recordings), or in unconventional or extreme conditions when fluid electrolytes are unsuitable (e.g., biomedical space research).

  20. Are ECG monitoring recommendations before prescription of QT-prolonging drugs applied in daily practice?

    Warnier, Miriam Jacoba; Rutten, Frans Hendrik; Souverein, Patrick Cyriel


    PURPOSE: Monitoring of the QT duration by electrocardiography (ECG) prior to treatment is frequently recommended in the label of QT-prolonging drugs. It is, however, unknown how often general practitioners in daily clinical practice are adhering to these risk-minimization measures. We assessed...... the frequency of ECG measurements in patients where haloperidol was initiated in primary care. METHODS: Patients (≥18 years) with a first prescription of haloperidol in the UK Clinical Practice Research Datalink (2009-2013) were included. The proportion of ECGs made was determined in two blocks of 4 weeks......: during the exposure period when haloperidol was initiated, and during the control period, 1 year before. Conditional logistic regression analysis was applied to calculate the relative risk of having an ECG in the exposure period compared with the control period. Subgroup analyses were performed to assess...

  1. Intravenous bicarbonate and sodium chloride both prolong endurance during intense cycle ergometer exercise.

    Mitchell, T H; Abraham, G; Wing, S; Magder, S A; Cosio, M G; Deschamps, A; Marliss, E B


    To determine the effects of neutralizing exercise systemic acidosis via the intravenous route upon endurance and metabolic responses, eight lean, normal, postabsorptive men exercised to exhaustion at about 80% of their VO2 max (69 +/- 3%, mean +/- SEM, of maximum power output) on a cycle ergometer. Exercise studies were performed either with no infusion (control) or with a total infusion volume of about 1.5 L, mainly as 1.3% sodium bicarbonate or as 0.9% sodium chloride (NaCl), infused (double-blind) throughout exercise. The sodium bicarbonate was to prevent acid-base change, the sodium chloride was as a control for the volume infused. Arterialized venous blood and breath-by-breath analysis of expired gases were obtained. [H+] (nmol.L-1) and [HCO3-] (mmol.L-1) at exhaustion were similar in control and NaCl (46.5 +/- 1.8, 19.9 +/- 0.9), but remained unchanged from rest values with bicarbonate (38.4 +/- 0.9, 24.8 +/- 1.5, p less than 0.005 vs control and NaCl). At exhaustion, VO2, VCO2, RER, heart rate, and systolic BP as well as FFA, glycerol, alanine, insulin, norepinephrine, and epinephrine did not differ among protocols. Endurance was markedly prolonged (p less than 0.01) with bicarbonate (31.9 +/- 5.8 min) and NaCl (31.8 +/- 4.1 min) compared with the control (19.0 +/- 2.9 min) condition. Plasma glucose at exhaustion was higher (p less than 0.025) in the control compared to bicarbonate and NaCl experiments, while lactate was higher (p less than 0.025) in the bicarbonate than in the control and NaCl experiments. Thus, the prolonged endurance with sodium bicarbonate infusion could not be explained either by its effect of maintaining blood acid-base equilibrium or concomitant metabolic changes.

  2. The in vivo study on the radiobiologic effect of prolonged delivery time to tumor control in C57BL mice implanted with Lewis lung cancer

    Zhu Guo-Pei


    Full Text Available Abstract Background High-precision radiation therapy techniques such as IMRT or sterotactic radiosurgery, delivers more complex treatment fields than conventional techniques. The increased complexity causes longer dose delivery times for each fraction. The purpose of this work is to explore the radiobiologic effect of prolonged fraction delivery time on tumor response and survival in vivo. Methods 1-cm-diameter Lewis lung cancer tumors growing in the legs of C57BL mice were used. To evaluate effect of dose delivery prolongation, 18 Gy was divided into different subfractions. 48 mice were randomized into 6 groups: the normal control group, the single fraction with 18 Gy group, the two subfractions with 30 min interval group, the seven subfractions with 5 min interval group, the two subfractions with 60 min interval group and the seven subfractions with 10 min interval group. The tumor growth tendency, the tumor growth delay and the mice survival time were analyzed. Results The tumor growth delay of groups with prolonged delivery time was shorter than the group with single fraction of 18 Gy (P 0.05. Compared to the group with single fraction of 18 Gy, the groups with prolonged delivery time shorten the mice survival time while there was no significant difference between the groups with prolonged delivery time 30 min and the groups with prolonged delivery time 60 min. Conclusions The prolonged delivery time with same radiation dose shorten the tumor growth delay and survival time in the mice implanted with Lewis lung cancer. The anti-tumor effect decreased with elongation of the total interfractional time.

  3. The Effect of Ethanol on the Release of Opioids from Oral Prolonged-Release Preparations

    Walden, Malcolm; Nicholls, Fiona A.; Smith, Kevin J.; Tucker, Geoffrey T


    Recent experience has prompted the US FDA to consider whether ethanol ingestion may modify the release characteristics of prolonged-release formulations, where dose dumping may be an issue for patient safety. The influence of ethanol on the in vitro release of opioid drugs from some prolonged-release formulations utilizing different release technologies was examined. Results indicated that the prolonged-release mechanisms remained intact under the testing conditions, although one product show...

  4. Features of History, Anthropometric Data and Individual Functions of the Liver in Children with Prolonged Jaundice

    O.V. Tyajka


    Full Text Available Background. Neonatal jaundice is one of the urgent problems in neonatology. There is a tendency to increase the incidence of prolonged jaundice. The aim of our study was to explore the features of history, anthropometric data and some liver functions in children with prolonged jaundice. Materials and methods. The study involved 111 children with prolonged jaundice aged from 3 weeks to 3 months. In all children with prolonged jaundice, we have examined complete blood count, urinalysis, blood chemistry (determination of total bilirubin and fractions, total protein, albumin, glucose and used instrumental methods of examination — ultrasound of the abdominal cavity and cranial ultrasonography, electrocardiography. Most children with prolonged jaundice were breastfed and were term infants. Results. Indicators of physical development at birth (body weight, body length, head circumference, chest circumference in children with prolonged jaundice and in healthy children had not statistically significant differences. Neonatal jaundice was prolonged in children, who were born from the first pregnancy, — 60 children (54.1 %. A high level of total and indirect bilirubin was accompanied by a low level of albumin in the blood serum of children with prolonged jaundice. Protein-synthesis function of the liver was reduced in children with prolonged jaundice.

  5. Supporting prolonged COPD monitoring using an application for mobile devices.

    Haller, Andreas; Schuerg, Sebastian; Schudt, Florian; Koczulla, Andreas Rembert; Mursina, Ljudmila; Gross, Volker; Sohrabi, Keywan


    COPD (chronic obstructive pulmonary disease) is the most frequent form of chronic respiratory disease. During the progress of this disease, phases of aggravation of pulmonary function (exacerbations) can occur, which reduce the quality of life. Clinical experience shows that single investigations are insufficient. Therefore a prolonged monitoring is required to recognize an exacerbation early. This home monitoring will involve a quick respiratory test and a related application for Android, iOS and Windows phones. This rapid test transmits the relevant pulmonary parameters, converted in an Extensible Markup Language file to the smartphone. The application will analyze the incoming data to evaluate the current health status of the patient. Additionally the data will be transferred to the virtual control point (server) and stored in a database. If critical values are detected, the server will send a notification to prior defined relatives and doctors. A connection to a Hospital Information System will be possible through an included Health Level 7 interface. This offers an improved site-independent patient care. The project is planned to be in development until 2016.

  6. Mean arterial pressure following prolonged exercise in the heat

    Gagnon, D; Lynn, A G; Binder, K


    Prolonged exercise in the heat without fluid replacement represents a significant challenge to the regulation of mean arterial pressure (MAP). It is unknown, however, if MAP is equally challenged during the post-exercise period, and whether regular endurance exercise training can provide any...... benefit to its regulation. We examined MAP (Finometer) in eight trained (T) and eight untrained (UT) individuals prior to, and following, 120 min of cycling at 42 °C with (HYD) and without (DEHY) fluid replacement. Exercise during DEHY induced significant hyperthermia (T: 39.20 ± 0.52 °C vs UT: 38.70 ± 0.......36 °C, P = 0.941) and body weight losses (T: 3.4 ± 1.2% vs UT: 2.7 ± 0.9%, P = 0.332), which did not differ between groups. Although MAP was equally reduced 5 min into the post-exercise period of DEHY (T: -20 ± 11 mmHg vs UT: -22 ± 13 mmHg, P = 0.800), its subsequent recovery was significantly different...

  7. Examining potential contraindications for prolonged exposure therapy for PTSD

    Agnes van Minnen


    Full Text Available Although prolonged exposure (PE has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD, clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.

  8. Recovery in skeletal muscle contractile function after prolonged hindlimb immobilization

    Fitts, R. H.; Brimmer, C. J.


    The effect of three-month hindlimb immobilization (IM) in rats on contractile properties of slow-twitch soleus (SOL), fast-twitch extensor digitorum longus, and fast-twitch superficial region of the vastus lateralis were measured after 0, 14, 28, 60, and 90 days of recovery on excized, horizontally suspended muscles stimulated electrically to maximal twitch tension. IM caused decreases in muscle-to-body weight ratios for all muscles, with no complete recovery even after 90 days. The contractile properties of the fast-twitch muscles were less affected by IM than those of the slow-twitch SOL. The SOL isometric twitch duration was shortened, due to reduced contraction and half-relaxation time, both of which returned to control levels after 14 days of recovery. The peak tetanic tension, P(O), g/sq cm,, decreased with IM by 46 percent in the SOL, but recovered by the 28th day. The maximum shortening velocity was not altered by IM in any of the muscles. Thus, normal contractile function could recover after prolonged limb IM.

  9. Rosuvastatin blocks hERG current and prolongs cardiac repolarization.

    Plante, Isabelle; Vigneault, Patrick; Drolet, Benoît; Turgeon, Jacques


    Blocking of the potassium current I(Kr) [human ether-a-go-go related gene (hERG)] is generally associated with an increased risk of long QT syndrome (LQTS). The 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor, rosuvastatin, is a methanesulfonamide derivative, which shows structural similarities with several I(Kr) blockers. Hence, we assessed the effects of rosuvastatin on cardiac repolarization by using in vitro, ex vivo, and in vivo models. Patch clamp experiments on hERG-transfected human embryonic kidney (HEK) 293 cells established the potency of rosuvastatin to block hERG [half maximal inhibitory concentration (IC(50) ) = 195 nM]. We showed in isolated guinea pig hearts that 195 nM rosuvastatin prolonged (basic cycle length of 250 ms; p cancer resistance protein (BCRP), multidrug resistance gene (MDR1)] and influx [organic anion transporting polypeptide (OATP) 2B1] transporters involved in the disposition and cardiac distribution of the drug. Genetic polymorphisms observed for BCRP, MDR1, and OATP2B1, and IC(50) determined for hERG blocking lead us to propose that some patients may be at risk of rosuvastatin-induced LQTS.

  10. Characterization of renal response to prolonged immersion in normal man

    Epstein, M.; Denunzio, A. G.; Ramachandran, M.


    ?jDuring the initial phase of space flight, there is a translocation of fluid from the lower parts of the body to the central vascular compartment with a resultant natriuresis, diuresis, and weight loss. Because water immersion is regarded as an appropriate model for studying the redistribution of fluid that occurs in weightlessness, an immersion study of relatively prolonged duration was carried out in order to characterize the temporal profile of the renal adaptation to central hypervolemia. Twelve normal male subjects underwent an immersion study of 8-h duration in the sodium-replete state. Immersion resulted in marked natriuresis and diuresis which were sustained throughout the immersion period. The failure of that natriuresis and diuresis of immersion to abate or cease despite marked extracellular fluid volume contraction as evidenced by a mean weight loss of -2.2 + or - 0.3 kg suggests that central blood volume was not restored to normal and that some degree of central hypervolemia probably persisted.

  11. Prolonged sleep fragmentation of mice exacerbates febrile responses to lipopolysaccharide

    Ringgold, Kristyn M.; Barf, R. Paulien; George, Amrita; Sutton, Blair C.; Opp, Mark R.


    Background Sleep disruption is a frequent occurrence in modern society. Whereas many studies have focused on the consequences of total sleep deprivation, few have investigated the condition of sleep disruption. New Method We disrupted sleep of mice during the light period for 9 consecutive days using an intermittently-rotating disc. Results Electroencephalogram (EEG) data demonstrated that non-rapid eye movement (NREM) sleep was severely fragmented and REM sleep was essentially abolished during the 12 h light period. During the dark period, when sleep was not disrupted, neither NREM sleep nor REM sleep times differed from control values. Analysis of the EEG revealed a trend for increased power in the peak frequency of the NREM EEG spectra during the dark period. The fragmentation protocol was not overly stressful as body weights and water consumption remained unchanged, and plasma corticosterone did not differ between mice subjected to 3 or 9 days of sleep disruption and home cage controls. However, mice subjected to 9 days of sleep disruption by this method responded to lipopolysaccharide with an exacerbated febrile response. Comparison with existing methods Existing methods to disrupt sleep of laboratory rodents often subject the animal to excessive locomotion, vibration, or sudden movements. This method does not suffer from any of these confounds. Conclusions This study demonstrates that prolonged sleep disruption of mice exacerbates febrile responses to lipopolysaccharide. This device provides a method to determine mechanisms by which chronic insufficient sleep contributes to the etiology of many pathologies, particularly those with an inflammatory component. PMID:23872243

  12. Glucocorticoid augmentation of prolonged exposure therapy: rationale and case report

    Laura Pratchett


    Full Text Available Rationale: Prolonged exposure (PE therapy has been found to reduce symptoms of posttraumatic stress disorder (PTSD; however, it is difficult for many patients to engage fully in the obligatory retelling of their traumatic experiences. This problem is compounded by the fact that habituation and cognitive restructuring – the main mechanisms through which PE is hypothesized to work – are not instantaneous processes, and often require several weeks before the distress associated with imaginal exposure abates. Case reports: Two cases are described that respectively illustrate the use of hydrocortisone and placebo, in combination with PE, for the treatment of combat-related PTSD. Based on known effects of glucocorticoids on learning and memory performance, we hypothesized that augmentation with hydrocortisone would improve the therapeutic effects of PE by hastening “new” learning and facilitating decreases in the emotional impact of fear memories during the course of treatment. The veteran receiving hydrocortisone augmentation of PE displayed an accelerated and ultimately greater decline in PTSD symptoms than the veteran receiving placebo. Conclusions: While no general conclusion can be derived from comparison of two patients, the findings are consistent with the rationale for augmentation. These case reports support the potential for an appropriately designed and powered clinical trial to examine the efficacy of glucocorticoids in augmenting the effects of psychotherapy for PTSD.

  13. Depth perception after prolonged usage of night vision goggles.

    Sheehy, J B; Wilkinson, M


    The present study was initiated following a report that a few helicopter pilots had failed a test of stereoscopic depth perception after a prolonged training flight employing night vision goggles (NVGs). In order to determine the cause of the loss, 12 helicopter pilots/copilots were assessed for depth perception, lateral and vertical phoria, and contrast sensitivity before and after training flights requiring the pilots to wear night vision goggles for the duration of the flight. Pilots flew one to three missions while wearing either PVS-5A or AN/AVS-6 goggles. Mission duration ranged from 1 to 4 h. The results indicate that contrast sensitivity and depth perception when monocular cues are present did not degrade over the course of the mission. Lateral phoria, however, did demonstrate an average exophoric shift of 1.5 prism diopters for 12 out of the 24 missions. The results indicate that the original report of a loss of depth perception based on a test of depth requiring stereopsis might have been caused by a shift in lateral phoria. It would be expected that as additional fusional effort is required, the minimum resolvable disparity degrades due to the increase in accommodation brought about through vergence accommodation. Possible causes for the phoria shift and future testing are discussed.

  14. Axial elongation following prolonged near work in myopes and emmetropes.

    Woodman, Emily C; Read, Scott A; Collins, Michael J; Hegarty, Katherine J; Priddle, Scott B; Smith, Josephine M; Perro, Judd V


    To investigate the influence of a period of sustained near work upon axial length in groups of emmetropes (EMM) and myopes. Forty young adult subjects (20 myopes and 20 emmetropes) were recruited for the study. Myopes were further classified as early onset (EOM), late onset (LOM), stable (SM) or progressing (PM) subgroups. Axial length was measured with the IOLMaster instrument before, immediately after and then again 10 min after a continuous 30 min near task of 5 D accommodation demand. Measures of distance objective refraction were also collected. Significant changes in axial length were observed immediately following the near task. EOM axial length elongated on average by 0.027±0.021 mm, LOM by 0.014±0.020 mm, EMM by 0.010±0.015 mm, PM by 0.031±0.022 mm and SM by 0.014±0.018 mm. At the conclusion of the 10 min regression period, axial length measures were not significantly different from baseline values. Axial elongation was observed following a prolonged near task. Both EOM and PM groups showed increases in axial length that were significantly greater than emmetropes.

  15. Extraordinarily Prolonged Disease Recurrence in a Granulosa Cell Tumor Patient

    Lisa N. Abaid


    Full Text Available Background: Granulosa cell tumors are rare sex cord stromal lesions that comprise approximately 3% of all ovarian neoplasms. The vast majority of granulosa cell tumors are considered indolent but in spite of aggressive management, delayed recurrence is of significant concern. Case Report: We describe a case involving a 67-year-old woman who presented with abdominal pain, bloody stools, and mild nausea. Following a CT scan of the abdomen and pelvis, a 19-cm pelvic mass was identified. Her prior medical history included a hysterectomy for uterine fibroids 40 years ago and a bilateral salpingo-oophorectomy for a presumed granulosa cell tumor 20 years ago. Final pathology revealed granulosa cell tumor with small bowel mesentery involvement. The patient underwent surgical resection and adjuvant chemotherapy; she is currently doing well. Conclusion: Granulosa cell tumors are considered to be of low malignant potential but they have the capacity to recur, even several years following initial patient management. This case exemplifies the disease’s capacity for prolonged recurrence and further accentuates the significance of long-term follow-up in these patients.

  16. Can the rat donor liver tolerate prolonged warm ischemia ?

    Ji Qi Yan; Hong Wei Li; Wei Yao Cai; Ming Jun Zhang; Wei Ping Yang


    The last two decades of the twentieth century have witnessed increasingly successful rates of liver transplantation. The number of liver transplantations has increased steadily while the number of organ donors has remained relatively constant. Thus a great disparity has developed between the demand and supply of donor organs and remains a major limiting factor for further expansion of liver transplantation. Although many procedures, such as split liver[1] , living-related transplantation[2] , and xenotransplantation[3], have been attempted clinically to overcome the shortage, it is hoped that livers harvested from non-heart-beating donors (NHBDs) would alleviatethe problem of organ shortage, which again becomes the focus of attention[4-9]. However, sensitivity of the liver to warm ischemia remains a major worry for use of theNHBDs. The aim of this animal study was to assess if murine liver could tolerate prolonged period of warm ischemia and to determine the optimum timing of intervention in the cadaver donor in order to preserve liver viability.

  17. Heart rate variability analysis for newborn infants prolonged pain assessment.

    De Jonckheere, J; Rakza, T; Logier, R; Jeanne, M; Jounwaz, R; Storme, L


    Pain management is a general concern for healthcare quality. In the particular context of neonatal care, it's well known that an efficient pain management will decrease mortality and morbidity of newborn infants. Furthermore, the plasticity of developing brain is vulnerable to pain and/or stress, that in turn may cause long term neurodevelopmental changes, including altered pain sensitivity and neuroanatomic and behavioural abnormalities. During neonatal intensive care stay, large number of painful procedures are performed, the majority of which are not accompanied by adequate analgesia. Optimal management requires competent pain assessment which can be especially difficult to perform in this non verbal population. We have developed an instantaneous heart rate variability (HRV) analysis method, non intrusive and user-friendly, based on the ECG signal acquisition. This analysis method enabled us to design parameters related to the influence of pain on the Autonomic Nervous System (ANS) activity. This paper presents the application of this method, previously validated for adults under general anesthesia, to the domain of newborn infants prolonged pain assessment.

  18. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation : two year results of a randomised controlled trial

    Peul, W.C.; Hout, van den W.B.; Brand, R.; Thomeer, R.T.W.M.; Koes, B.W.


    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions

  19. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: Two year results of a randomised controlled trial

    W.C. Peul (Wilco); W.B. van den Hout (Wilbert); R. Brand (René); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)


    textabstractObjectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. I

  20. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

    Peul, W.C.; Hout, W.B. van den; Brand, R.; Thomeer, R.T.; Koes, B.W.; Eekhof, J.A.H.; Tans, J.T.; Houwelingen, H.C. van; Nuyten, M.; Bergman, P.; Holtkamp, G.; Dukker, S.; Mast, A.; Smakman, L.; Waanders, C.; Polak, P.; Nieborg, A.; Walchenbach, R.; Rossum, J. van; Schutte, P.J.; Verheul, G.A.; Dalman, J.A.; Wurzer, J.A.; Sven, J.W.; Kloet, A.; Merkies, I.S.; Dulken, H. van; Lambrechts, P.C.; Keunen, R.W.; Hoffmann, C.; Haan, J.; Groen, R.; Kuiters, R.R.; Roos, R.A.C.; Voormolen, J.H.


    OBJECTIVES: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. DESIGN: Randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with 6-12 weeks of sciatica. INTERVENTIONS

  1. Effects of prolonged head-down bed rest on working memory

    Liu Q


    Full Text Available Qing Liu,1,2 Renlai Zhou,1–4 Xin Zhao,5 Tian Po S Oei6 1Beijing Key Lab of Applied Experimental Psychology, School of Psychology, 2Research Center of Emotion Regulation, 3State Key Laboratory of Cognitive Neuroscience and Learning, International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People’s Republic of China; 4Department of Psychology, School of Social and Behavioral Science, Nanjing University, Nanjing, People’s Republic of China; 5Behavior Rehabilitation Training Research Institution, School of Psychology, Northwest Normal University, Lanzhou, People’s Republic of China; 6School of Psychology, University of Queensland, Brisbane, QLD, Australia Background: The weightlessness caused by prolonged bed rest results in changes in cerebral circulation and thus, brain functions, which is of interest. Methods: We investigated the effects of 45-day, -6° head-down bed rest, which stimulated microgravity, on working memory in 16 healthy male participants. The 2-back task was used to test the working memory variations on the 2nd day before bed rest (R-2; on the 11th (R11, 20th (R20, 32nd (R32, and 40th (R40 days of bed rest; and on the eighth day after bed rest (R+8. The cognitive response and the physiological reactivity (such as galvanic skin response, heart rate, and heart rate variability under the 2-back task were recorded simultaneously. Results: The results showed that compared with R-2, on the R+8, the participants’ galvanic skin response increased significantly, and the high frequency of heart rate variability (HF, low frequency of heart rate variability (LF, and reaction time in the 2-back task decreased significantly. There were positive correlations between the participants’ reaction time of working memory and the LF/HF under head-down bed rest (at R11, R20, and R32. Conclusion: The results suggested that the prolonged head-down bed rest may have a detrimental effect on individual

  2. Branched-chain amino acid supplementation reduces oxidative stress and prolongs survival in rats with advanced liver cirrhosis.

    Motoh Iwasa

    Full Text Available Long-term supplementation with branched-chain amino acids (BCAA is associated with prolonged survival and decreased frequency of development of hepatocellular carcinoma (HCC in patients with liver cirrhosis. However, the pharmaceutical mechanism underlying this association is still unclear. We investigated whether continuous BCAA supplementation increases survival rate of rats exposed to a fibrogenic agent and influences the iron accumulation, oxidative stress, fibrosis, and gluconeogenesis in the liver. Further, the effects of BCAA on gluconeogenesis in cultured cells were also investigated. A significant improvement in cumulative survival was observed in BCAA-supplemented rats with advanced cirrhosis compared to untreated rats with cirrhosis (P<0.05. The prolonged survival due to BCAA supplementation was associated with reduction of iron contents, reactive oxygen species production and attenuated fibrosis in the liver. In addition, BCAA ameliorated glucose metabolism by forkhead box protein O1 pathway in the liver. BCAA prolongs survival in cirrhotic rats and this was likely the consequences of reduced iron accumulation, oxidative stress and fibrosis and improved glucose metabolism in the liver.

  3. The synthesis and characterization of fatty acid salts of chitosan as novel matrices for prolonged intragastric drug delivery.

    Bani-Jaber, Ahmad; Hamdan, Imad; Alkawareek, Mahmoud


    The aim of this study was to prepare fatty acid salts of chitosan (CS) and to evaluate the salts as matrices for sustained drug release and prolonged gastric retention. CS-laurate and CS-palmitate were formed by mixing saturated CS solution and aqueous solutions of sodium laurate and sodium palmitate, respectively, and collected by centrifugation. They were characterized using Fourier-transform infrared spectroscopy and differential scanning calorimetry. Different matrices as effervescent tablets were prepared using each of these CS-salts, CS and the corresponding physical mixtures of CS and the fatty acids. Sodium bicarbonate as an effervescent agent and ranitidine HCl as a model drug were incorporated into these matrices. In vitro buoyancy and drug dissolution were studied for the matrices in 0.1 M HCl. Tablets with fatty acid salts of CS showed both rapid and prolonged buoyancy (> 8 h). Comparatively, CS tablets exhibited a short floatation period (tablets were completely disintegrated within 1 h of soaking. In addition, slow and prolonged drug release was achieved from tablets of fatty acid salts of CS with average drug release of 80.1 and 71.8% for CS-laurate and CS-palmitate, respectively. Rapid drug release (> 80% at 1 h) was exhibited by tablets with CS or the physical mixtures.

  4. An alcohol hand rub containing a synergistic combination of an emollient and preservatives: prolonged activity against transient pathogens.

    Gaonkar, T A; Geraldo, I; Caraos, L; Modak, S M


    A new alcohol-based hand antiseptic (Octoxy hand rub) containing a synergistic combination of an emollient (Octoxyglycerine) and preservatives was developed and evaluated for immediate and prolonged activity against transient bacteria. The in vitro and in vivo antimicrobial efficacy was compared with other alcohol hand rubs containing preservative/antimicrobial (Prevacare and Avagard). In vitro evaluation was carried out using a tube-dilution method and a pig-skin model. Rapid and prolonged efficacy in vivo was evaluated against Staphylococcus epidermidis on the hands of volunteers. Octoxy hand rub was 100% effective in rapidly killing pathogens including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium in vitro. In volunteers, all three hand rubs gave a significant reduction in microbial count within 15s. Octoxy hand rub showed significantly higher efficacy against S. aureus and Escherichia coli than Avagard and Prevacare 15 min after application to the pig-skin model, and against S. epidermidis in both the pig-skin model and in volunteers. Use of Octoxy hand rub with broad-spectrum immediate and prolonged antimicrobial activity may be a very effective way of improving hand hygiene without exposing the hands to higher concentrations of antimicrobials.

  5. Perioperative risk factors for prolonged mechanical ventilation and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass

    Zahra S Faritous


    Full Text Available Background: Prolonged mechanical ventilation is an important recognized complication occurring during cardiovascular surgery procedures. This study was done to assess the perioperative risk factors related to postoperative pulmonary complications and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass. Methods: It was a retrospective study on 5,497 patients, including 31 patients with prolonged ventilatory support and 5,466 patients without it; from the latter group, 350 patients with normal condition (extubated in 6-8 hours without any complication were selected randomly. Possible perioperative risk factors were compared between the two groups using a binary logistic regression model. Results: Among the 5,497 women undergoing coronary artery bypass graft (CABG, 31 women needed prolonged mechanical ventilation (PMV, and 15 underwent tracheostomy. After logistic regression, 7 factors were determined as being independent perioperative risk factors for PMV. Discussion: Age ≥70 years old, left ventricular ejection fraction (LVEF ≤30%, preexisting respiratory or renal disease, emergency or re-do operation and use of preoperative inotropic agents are the main risk factors determined in this study on women undergoing CABG.

  6. Prolonged Action Potential and After depolarizations Are Not due to Changes in Potassium Currents in NOS3 Knockout Ventricular Myocytes.

    Wang, Honglan; Bonilla, Ingrid M; Huang, Xin; He, Quanhua; Kohr, Mark J; Carnes, Cynthia A; Ziolo, Mark T


    Ventricular myocytes deficient in endothelial nitric oxide synthase (NOS3(-/-)) exhibit prolonged action potential (AP) duration and enhanced spontaneous activity (early and delayed afterdepolarizations) during β-adrenergic (β-AR) stimulation. Studies have shown that nitric oxide is able to regulate various K(+) channels. Our objective was to examine if NOS3(-/-) myocytes had altered K(+) currents. APs, transient outward (I(to)), sustained (I(Ksus)), and inward rectifier (I(K1)) K(+) currents were measured in NOS3(-/-) and wild-type (WT) myocytes. During β-AR stimulation, AP duration (measured as 90% repolarization-APD(90)) was prolonged in NOS3(-/-) compared to WT myocytes. Nevertheless, we did not observe differences in I(to), I(Ksus), or I(K1) between WT and NOS3(-/-) myocytes. Our previous work showed that NOS3(-/-) myocytes had a greater Ca(2+) influx via L-type Ca(2+) channels with β-AR stimulation. Thus, we measured β-AR-stimulated SR Ca(2+) load and found a greater increase in NOS3(-/-) versus WT myocytes. Hence, our data suggest that the prolonged AP in NOS3(-/-) myocytes is not due to changes in I(to), I(Ksus), or I(K1). Furthermore, the increase in spontaneous activity in NOS3(-/-) myocytes may be due to a greater increase in SR Ca(2+) load. This may have important implications for heart failure patients, where arrhythmias are increased and NOS3 expression is decreased.


    M. Y. Shagidulin


    Full Text Available Aim is to develop a method for a prolonged support of recovery processes in damaged liver. Materials and me- thods. It was carried out 3 groups of experiments on Wistar rats with the modeling of chronic fibrotic liver injury (n = 70: I group control (n = 20; in the II group (n = 20 a suspension of liver cells was transplanted into liver; in the III group (n = 30 cell-engineering designs (CED, which contained liver cells and BM MMSC, enclosed in a heterogeneous biodegradable gel “Sphero®GEL-long” were transplanted into damaged liver. The activity of recovery processes was evaluated by using biochemical and morphological methods in dynamics on 30, 60, 90 and 180 days. Results. It was shown that in the II and III gr. significantly accelerated the recovery processes in damaged livers compared with the I gr. The normalization of biochemical parameters took place in II and III du- ring 30 days instead of 90 days in the I group. However, the normalization of morphological signs of hepatocytes theirs viability and a degree of defibrotic changes in liver were more pronounced and prolonged in the III group. A study showed integration of CED by liver structures with formation of new bile ducts after 90 and 180 days. Conclusion. Higher levels and prolonged periods of recovery processes in damaged liver after CED transplanta- tion were due to the creation of biologically appropriate conditions for prolonged cell activity, included in their structure (donor liver cells and BM MMSC. 

  8. Unsatisfactory outcomes of prolonged ischemic priapism without early surgical shunts: our clinical experience and a review of the literature

    Da-Chao Zheng; Hai-Jun Yao; Ke Zhang; Ming-Xi Xu; Qi Chen; Yan-Bo Chen; Zhi-Kang Cai; Mu-Jun Lu; Zhong Wang


    Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction (ED) without timely treatment.This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations.In this paper,a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts,including nine Winter shunts,two AI-Ghorab shunts and one Grayhack shunt.During the follow-up visit (after a mean of 21.11 months),all patients' postoperative characters were recorded,except one patient lost for death.Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate.The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire (IIEF-5),which were later compared with their premorbid scores.All patients had complete resolutions,and none relapsed.The resolution rate was 100%.Seven patients were resolved with Winter shunts,one with an Al-Ghorab shunt and one with a Grayhack shunt.The mean hospital stay was 8.22 days.There was only one urethral fistula,and the incidence of postoperative ED was 66.67%.Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 (PDE-5) inhibitor treatment.These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism.However,the severe ED caused by prolonged duration is irreversible,and long-term PDE-5 inhibitor treatments are ineffective.Thus,we recommend early penile prosthesis surgeries for these patients.

  9. Efficacy and safety of intravenous sodium valproate versus phenobarbital in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children: a randomised trial.

    Malamiri, Reza Azizi; Ghaempanah, Mahdieh; Khosroshahi, Nahid; Nikkhah, Ali; Bavarian, Behrouz; Ashrafi, Mahmoud Reza


    Status epilepticus and acute prolonged seizures are the most commonly occurring neurological emergencies in children. Such events have high morbidity and mortality rates along with poor long-term outcomes, depending on their duration and causes. Therefore, such seizures warrant urgent treatment using appropriate doses of anticonvulsants. Benzodiazepines, phenobarbital, and phenytoin are the most commonly used anticonvulsants for controlling status epilepticus and acute prolonged seizures. However, these medications have several well-known adverse effects. Previous studies on both adults and children have shown the efficacy and safety of rapid infusion of valproate in controlling status epilepticus. However, few well-designed randomised trials have been carried out in children, and there remains a paucity of data regarding intravenous sodium valproate use in children. Therefore, our aim was to compare the efficacy and safety of rapid loading of valproate with those of intravenous phenobarbital in children with status epilepticus and acute prolonged seizures. Sixty children (30 in each group) with convulsive status epilepticus and acute prolonged seizures were enrolled and randomly assigned to receive either valproate or phenobarbital. The main outcome variable was termination of all convulsive activity within 20 min of starting anticonvulsant infusion. Intravenous rapid loading of valproate was successful in seizure termination in (27/30, 90%) of patients compared to phenobarbital (23/30, 77%) (p = 0.189). Clinically significant adverse effects occurred in 74% patients of the phenobarbital group and 24% patients of the valproate group (p < 0.001). In conclusion, rapid loading of valproate is effective and safe in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children. Intravenous valproate should be considered as a suitable choice for terminating status epilepticus and acute prolonged seizures in children. Copyright

  10. Activation of lymphocytes induced by bronchial epithelial cells with prolonged RSV infection.

    Ling Qin

    Full Text Available Respiratory syncytial virus (RSV preferentially infects airway epithelial cells,which might be responsible for susceptibility to asthma; however, the underlying mechanism is not clear. This study determined the activation of lymphocytes and drift of helper T (Th subsets induced by RSV-infected human bronchial epithelial cells (HBECs in vitro. HBECs had prolonged infection with RSV, and lymphocytes isolated from human peripheral blood were co-cultured with RSV-infected HBECs. Four groups were established, as follows: lymphocytes (group L; lymphocytes infected with RSV (group RL; co-culture of lymphocytes with non-infected HBECs (group HL; and co-culture of lymphocytes with infected HBECs (group HRL. After co-culture with HBECs for 24 hours, lymphocytes were collected and the following were determined in the 4 groups: cell cycle status; apoptosis rate; and concentrations of IL-4, IFN-γ, and IL-17 in the supernatants. Cell cycle analysis for lymphocytes showed a significant increase in S phase cells, a decrease in G1 phase cells, and a higher apoptosis rate in group HRL compared with the other three groups. In group HRL, the levels of IL-4, IFN-γ, and IL-17 in supernatants were also higher than the other three groups. For further study, lymphocytes were individually treated with supernatants from non-infected and RSV-infected HBECs for 24 h. We showed that supernatants from RSV-infected HBECs induced the differentiation of Th2 and Th17 subsets, and suppressed the differentiation of Treg subsets. Our results showed that HBECs with prolonged RSV infection can induce lymphocyte proliferation and apoptosis, and enhance the release of cytokines by lymphocytes. Moreover, subset drift might be caused by RSV-infected HBECs.

  11. Effects Of Cadence on Aerobic Capacity Following a Prolonged, Varied Intensity Cycling Trial

    Charles L. Stebbins


    Full Text Available We determined if high cadences, during a prolonged cycling protocol with varying intensities (similar to race situations decrease performance compared to cycling at a lower, more energetically optimal, cadence. Eight healthy, competitive male road cyclists (35 ± 2 yr cycled for 180 min at either 80 or 100 rpm (randomized with varying intensities of power outputs corresponding to 50, 65 and 80% of VO2max. At the end of this cycling period, participants completed a ramped exercise test to exhaustion at their preferred cadence (90 ± 7 rpm. There were no cadence differences in blood glucose, respiratory exchange ratio or rate of perceived exertion. Heart Rate, VO2 and blood lactate were higher at 100 rpm vs. 80 rpm. The total energy cost while cycling during the 65% and 80% VO2max intervals at 100 rpm (15.2 ± 2.7 and 19.1 ± 2.5 kcal∙min-1, respectively were higher than at 80 rpm (14.3 ± 2.7 and 18.3± 2.2 kcal∙min-1, respectively (p < 0.05. Gross efficiency was higher at 80 rpm vs. 100 rpm during both the 65% (22.8 ± 1.0 vs. 21.3 ± 4.5% and the 80% (23.1 vs. 22.1 ± 0.9% exercise intensities (P< 0.05. Maximal power during the performance test (362 ± 38 watts was greater at 80 rpm than 100 rpm (327 ± 27 watts (p < 0.05. Findings suggest that in conditions simulating those seen during prolonged competitive cycling, higher cadences (i.e., 100 vs. 80 rpm are less efficient, resulting in greater energy expenditure and reduced peak power output during maximal performance.

  12. Dissociated grey matter changes with prolonged addiction and extended abstinence in cocaine users.

    Connolly, Colm G; Bell, Ryan P; Foxe, John J; Garavan, Hugh


    Extensive evidence indicates that current and recently abstinent cocaine abusers compared to drug-naïve controls have decreased grey matter in regions such as the anterior cingulate, lateral prefrontal and insular cortex. Relatively little is known, however, about the persistence of these deficits in long-term abstinence despite the implications this has for recovery and relapse. Optimized voxel based morphometry was used to assess how local grey matter volume varies with years of drug use and length of abstinence in a cross-sectional study of cocaine users with various durations of abstinence (1-102 weeks) and years of use (0.3-24 years). Lower grey matter volume associated with years of use was observed for several regions including anterior cingulate, inferior frontal gyrus and insular cortex. Conversely, higher grey matter volumes associated with abstinence duration were seen in non-overlapping regions that included the anterior and posterior cingulate, insular, right ventral and left dorsal prefrontal cortex. Grey matter volumes in cocaine dependent individuals crossed those of drug-naïve controls after 35 weeks of abstinence, with greater than normal volumes in users with longer abstinence. The brains of abstinent users are characterized by regional grey matter volumes, which on average, exceed drug-naïve volumes in those users who have maintained abstinence for more than 35 weeks. The asymmetry between the regions showing alterations with extended years of use and prolonged abstinence suggest that recovery involves distinct neurobiological processes rather than being a reversal of disease-related changes. Specifically, the results suggest that regions critical to behavioral control may be important to prolonged, successful, abstinence.

  13. Intestinal temperature does not reflect rectal temperature during prolonged, intense running with cold fluid ingestion.

    Savoie, Félix A; Dion, Tommy; Asselin, Audrey; Gariepy, Carolanne; Boucher, Pierre M; Berrigan, Félix; Goulet, Eric D B


    It is generally assumed that intestinal temperature (Tint), as measured with a telemetric pill, agrees relatively well with rectal temperature (Trec) during exercise. However, whether Tint reflects Trec during prolonged, intense and continuous exercise when cold fluids are consumed is unknown. Therefore, we compared Trec and Tint during a half-marathon during which cold water was ingested to prevent bodyweight (BW) losses >2%. Nine endurance athletes (age 30  ±  5 years) underwent a 21.1 km running time-trial (TT) in the heat (~30 °C and 44% RH) while BW losses were maintained to ~1% with continuous cold (4 °C) water provision. Tint and Trec were monitored throughout the TT. Hypohydration level, TT time and fluid intake were 1.2  ±  0.4% BW, 93.2  ±  9.9 min and 2143  ±  264 ml, respectively. Trec was systematically higher than Tint by 0.25 °C (95% CI: 0.14-0.37 °C). Tint and Trec showed an excellent relative (r = 0.90, p < 0.01), but poor absolute agreement as reflected by a 95% limit of agreement of ±1.07 °C and a standard error of measurement of ±0.39 °C. In conclusion, Tint does not mirror Trec during prolonged, intense running with cold fluid ingestion and, therefore, these measures should not be used interchangeably under this scenario.

  14. Prolonged signaling at the parathyroid hormone receptor by peptide ligands targeted to a specific receptor conformation.

    Okazaki, Makoto; Ferrandon, Sebastien; Vilardaga, Jean-Pierre; Bouxsein, Mary L; Potts, John T; Gardella, Thomas J


    The parathyroid hormone receptor (PTHR) is a class B G protein-coupled receptor that plays critical roles in bone and mineral ion metabolism. Ligand binding to the PTHR involves interactions to both the amino-terminal extracellular (N) domain, and transmembrane/extracellular loop, or juxtamembrane (J) regions of the receptor. Recently, we found that PTH(1-34), but not PTH-related protein, PTHrP(1-36), or M-PTH(1-14) (M = Ala/Aib(1),Aib(3),Gln(10),Har(11),Ala(12),Trp(14),Arg(19)), binds to the PTHR in a largely GTPgammaS-resistant fashion, suggesting selective binding to a novel, high-affinity conformation (R(0)), distinct from the GTPgammaS-sensitive conformation (RG). We examined the effects in vitro and in vivo of introducing the M substitutions, which enhance interaction to the J domain, into PTH analogs extended C-terminally to incorporate residues involved in the N domain interaction. As compared with PTH(1-34), M-PTH(1-28) and M-PTH(1-34) bound to R(0) with higher affinity, produced more sustained cAMP responses in cells, formed more stable complexes with the PTHR in FRET and subcellular localization assays, and induced more prolonged calcemic and phosphate responses in mice. Moreover, after 2 weeks of daily injection in mice, M-PTH(1-34) induced larger increases in trabecular bone volume and greater increases in cortical bone turnover, than did PTH(1-34). Thus, the putative R(0) PTHR conformation can form highly stable complexes with certain PTH ligand analogs and thereby mediate surprisingly prolonged signaling responses in bone and/or kidney PTH target cells. Controlling, via ligand analog design, the selectivity with which a PTH ligand binds to R(0), versus RG, may be a strategy for optimizing signaling duration time, and hence therapeutic efficacy, of PTHR agonist ligands.

  15. Salivary stimulation by prolonged release of pilocarpine using films in diabetic rats.

    Jesús Rodríguez


    Full Text Available Introduction: The local use of prolonged drug delivery in the oral cavity provides many advantages, i.e., it increases pharmacologic actions in the desired local site, allows smaller doses and reduces adverse effects. Pilocarpine is a cholinergic drug approved by the FDA for treating glandular hypofunction; however, the adverse effects associated with it limit its use. Objective: To evaluate cytotoxicity of films in adherent fibroblasts and their ability to release pilocarpine in vivo for a prolonged time in the oral cavity of diabetic rats and its effect on salivary flow.Methods: Chitosan and Hydroxypropylmethylcellulose (Methocel K4MCR films were prepared in 1% acetic acid and pilocarpine was added under magnetic stirring. Cytotoxicity of films was evaluated in adherent fibroblasts HS27 and assessed by neutral red technique. The sialogogue effect of films was evaluated on the floor of the mouth of diabetic rats. Later, histopathological analysis was performed using hematoxylin and eosin and Masson’s trichrome stains. Results: Films were biocompatible and had 96% cell viability. It was possible to increase stimulation of salivary flow in diabetic rats (6.36±0.987mg/hr compared to the control group (0.5±0.06mg/hr. The histopathological analysis did not show inflammatory infiltrate in the area where films were placed. Conclusion: Films were biocompatible and had high cell viability. Also, they considerably increased salivary flow in diabetic rats, without triggering an inflammatory infiltrate in the area which indicates that it is a biocompatible product for sustained release and safe for pilocarpine administration.

  16. Influence of prolonged endurance cycling and recovery diet on intramuscular triglyceride content in trained males.

    van Loon, Luc J C; Schrauwen-Hinderling, Vera B; Koopman, René; Wagenmakers, Anton J M; Hesselink, Matthijs K C; Schaart, Gert; Kooi, M Eline; Saris, Wim H M


    Intramuscular triglycerides (IMTG) are assumed to form an important substrate source during prolonged endurance exercise in trained males. This study investigated the effects of endurance exercise and recovery diet on IMTG content in vastus lateralis muscle. Nine male cyclists were provided with a standardized diet for 3 days, after which they performed a 3-h exercise trial at a 55% maximum workload. Before and immediately after exercise and after 24 and 48 h of recovery, magnetic resonance spectroscopy (MRS) was performed to quantitate IMTG content. Muscle biopsies were taken after 48 h of recovery to determine IMTG content by using quantitative fluorescence microscopy. The entire procedure was performed two times; in one trial, a normal diet containing 39% energy (En%) as fat was provided (NF) and in the other a typical carbohydrate-rich athlete's diet (LF: 24 En% fat) was provided. During exercise, IMTG content decreased by 21.4 +/- 3.1%. During recovery, IMTG content increased significantly in the NF trial only, reaching preexercise levels within 48 h. In accord with MRS, fluorescence microscopy showed significantly higher IMTG content in the NF compared with the LF trial, with differences restricted to the type I muscle fibers (2.1 +/- 0.2 vs. 1.4 +/- 0.2% area lipid staining, respectively). In conclusion, IMTG content in the vastus lateralis muscle declines significantly during prolonged endurance exercise in male cyclists. When a normal diet is used, IMTG contents are subsequently repleted within 48 h of postexercise recovery. In contrast, IMTG repletion is impaired substantially when a typical, carbohydrate-rich athlete's diet is used. Data obtained by quantitative fluorescence microscopy correspond well with MRS results, implying that both are valid methods to quantify IMTG content.

  17. FTY720 treatment prolongs skin graft survival in a completely incompatible strain combination.

    Lima, R S M; Nogueira-Martins, M F; Silva, H T; Pestana, J O M; Bueno, V


    FTY720 has shown potent immunomodulatory activity in a variety of animal organ transplant models. However, the in vivo immunosuppressive mechanism of FTY720 is still not fully understood. It has been suggested that the marked decrease in the number of peripheral blood lymphocytes during FTY720 administration could be responsible for its immunosuppressive effects. Our aims were: (1) to study the effects of FTY720 treatment on skin graft survival using a fully mismatched strain combination and (2) to evaluate lymphocyte numbers in different sites at 5 days after skin transplant. C57BL/6 mice and BALB/c mice were the donors and recipients respectively. BALB/c mice received FTY720 (1 mg/kg/d) orally for 4 consecutive days. Drug administration started 1 day before skin transplants. A small segment of tail skin was affixed on the right dorsal side of the mouse via sutures. The administration of FTY720 (4 mg/kg) prolonged skin graft survival from 12.6 +/- 2.2 days (no treatment) to 16.6 +/- 4.2 days. The histologic findings of rejection were similar for all groups. Five days after transplant, lymphocyte numbers were significantly increased in lymph nodes compared with nontransplanted or isogenic graft mice. FTY720 decreased lymphocyte numbers only in the spleen. In conclusion, FTY720 prolonged skin graft survival in a fully mismatched strain combination when administered for 4 days (day -1 to day +2) at a dose of 1 mg/kg/d. The decreased number of lymphocytes in the spleen suggests that the spleen may be a target of FTY720 activity, during the early posttransplant period.

  18. Prolonged stays in hospital acute geriatric care units: identification and analysis of causes.

    Parent, Vivien; Ludwig-Béal, Stéphanie; Sordet-Guépet, Hélène; Popitéan, Laura; Camus, Agnès; Da Silva, Sofia; Lubrano, Anne; Laissus, Frederick; Vaillard, Laurence; Manckoundia, Patrick


    In France, the population of very old frail patients, who require appropriate high-quality care, is increasing. Given the current economic climate, the mean duration of hospitalization (MDH) needs to be optimized. This prospective study analyzed the causes of prolonged hospitalization in an acute geriatric care unit. Over 6 months, all patients admitted to the target acute geriatric care unit were included and distributed into two groups according to a threshold stay of 14 days: long MDH group (LMDHG) and short MDH group (SMDHG). These two groups were compared. 757 patients were included. The LMDHG comprised 442 with a mean age of 86.7 years, of whom 67.65% were women and the SMDHG comprised 315 with a mean age of 86.6 years, of whom 63.2% were women. The two groups were statistically similar for age, sex, living conditions at home (alone or not, help), medical history and number of drugs. Patients in the LMDHG were more dependent (p=0.005), and were more likely to be hospitalized for social reasons (p=0.024) and to have come from their homes (p=0.011) than those in the SMDHG. The reasons for the prolonged stay, more frequent in the LMDHG than the SMDHG (p<0.05), were principally: waiting for imaging examinations, medical complications, and waiting for discharge solutions, assistance from social workers and/or specialist consultations. In order to reduce the MDH in acute geriatric care unit, it is necessary to consider the particularities of the patients who are admitted, their medico-socio-psychological management, access to technical facilities/consultations and post-discharge accommodation.

  19. Rapid upregulation and clearance of distinct circulating microRNAs after prolonged aerobic exercise

    Park, Joseph; Min, Pil-Ki; Isaacs, Stephanie; Parker, Beth A.; Thompson, Paul D.; Troyanos, Chris; D'Hemecourt, Pierre; Dyer, Sophia; Thiel, Marissa; Hale, Andrew; Chan, Stephen Y.


    Short nonprotein coding RNA molecules, known as microRNAs (miRNAs), are intracellular mediators of adaptive processes, including muscle hypertrophy, contractile force generation, and inflammation. During basal conditions and tissue injury, miRNAs are released into the bloodstream as “circulating” miRNAs (c-miRNAs). To date, the impact of extended-duration, submaximal aerobic exercise on plasma concentrations of c-miRNAs remains incompletely characterized. We hypothesized that specific c-miRNAs are differentially upregulated following prolonged aerobic exercise. To test this hypothesis, we measured concentrations of c-miRNAs enriched in muscle (miR-1, miR-133a, miR-499–5p), cardiac tissue (miR-208a), and the vascular endothelium (miR-126), as well as those important in inflammation (miR-146a) in healthy male marathon runners (N = 21) at rest, immediately after a marathon (42-km foot race), and 24 h after the race. In addition, we compared c-miRNA profiles to those of conventional protein biomarkers reflective of skeletal muscle damage, cardiac stress and necrosis, and systemic inflammation. Candidate c-miRNAs increased immediately after the marathon and declined to prerace levels or lower after 24 h of race completion. However, the magnitude of change for each c-miRNA differed, even when originating from the same tissue type. In contrast, traditional biomarkers increased after exercise but remained elevated 24 h postexercise. Thus c-miRNAs respond differentially to prolonged exercise, suggesting the existence of specific mechanisms of c-miRNA release and clearance not fully explained by generalized cellular injury. Furthermore, c-miRNA expression patterns differ in a temporal fashion from corollary conventional tissue-specific biomarkers, emphasizing the potential of c-miRNAs as unique, real-time markers of exercise-induced tissue adaptation. PMID:24436293

  20. Does Modafinil improve the level of consciousness for people with a prolonged disorder of consciousness? a retrospective pilot study.

    Dhamapurkar, Samira Kashinath; Wilson, Barbara A; Rose, Anita; Watson, Peter; Shiel, Agnes


    Modafinil is best known as a sleep regulator among healthy individuals, but studies suggest that it reduces excessive daytime sleepiness in patients with brain injury. This retrospective pilot study evaluated the effectiveness of Modafinil for people with a prolonged disorder of consciousness and whether those with a traumatic brain injury did better than those with a non-traumatic brain injury. Twenty four prolonged disorder of consciousness patients who were prescribed Modafinil, were assessed at least four times both before and during treatment. The Coma Recovery Scale-Revised was used to determine if patients had a disorder of consciousness and the Wessex Head Injury Matrix was used to monitor behavior during baseline and treatment periods. Patients with a traumatic brain injury (N = 12) were compared with those with non-traumatic brain injury (N = 12). A chi-square test with significance at 0.05 was used and when frequencies were below 5 a Fisher's Exact Test was used. Cognitive improvements were noted in domains of wakefulness, awareness, concentration, tracking and following commands. Significant differences were found for the whole group between baseline and Modafinil (x(2 )=( )9.80; p = 0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head Injury Matrix scores when on Modafinil (x(2 )=( )8.33, p < 0.004). Six non-traumatic brain injury patients had higher scores with Modafinil, two had lower scores and four showed no change. There was no significant difference in the number of patients showing an increase compared to those showing a decrease (Fisher's exact test p = 0.29). Modafinil appears to be beneficial for enhancing cognition in prolonged disorder of consciousness patients. Traumatic brain injury patients benefited more than non-traumatic brain injury patients. Implications for Rehabilitation People with prolonged disorders of consciousness are those in coma, a vegetative state or a minimally

  1. Neural effects of prolonged mental fatigue: a magnetoencephalography study.

    Ishii, Akira; Tanaka, Masaaki; Shigihara, Yoshihito; Kanai, Etsuko; Funakura, Masami; Watanabe, Yasuyoshi


    Mental fatigue, manifest as a reduced efficiency for mental work load, is prevalent in modern society. It is important to understand the neural mechanisms of mental fatigue and to develop appropriate methods for evaluating mental fatigue. In this study we quantified the effect of a long-duration mental fatigue-inducing task on neural activity. We used magnetoencephalography (MEG) to examine the time course change of neural activity over the long duration of the task trials. Nine healthy male volunteers participated in this study. They performed two mental fatigue-inducing tasks on separate days. The order of task presentation was randomized in a single-blinded, crossover fashion. Each task consisted of 25-min mental fatigue-inducing 0- or 2-back task session for three times. Subjective rating of mental fatigue sensation and electrocardiogram, and resting state MEG measurements were performed just before and after each task session. MEG data were analyzed using narrow-band adaptive spatial filtering methods. Alpha band (8-13 Hz) power in the visual cortex decreased after performing the mental fatigue-inducing tasks, and the decrease of alpha power was greater when they performed 2-back task trials. The decrease in alpha power was positively associated with the self-reported level of mental fatigue sensation and sympathetic nerve activity level. These results demonstrate that performing the prolonged mental fatigue-inducing task causes overactivation of the visual cortex, manifest as decreased alpha power in this brain region. Our results increase understanding of the neural mechanisms of mental fatigue and can be used to develop new quantitative methods to assess mental fatigue.

  2. Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness.

    Schuster, Randi Melissa; Fontaine, Madeleine; Nip, Emily; Zhang, Haiyue; Hanly, Ailish; Eden Evins, A


    Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD- groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD- had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=-2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46)=-4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Risk Factors of Prolonged Postoperative Pleural Effusion After Repair of Tetralogy of Fallot

    Chi-Ming Liang


    Conclusion: Prolonged PE is a significant morbidity after TOF repair. The risk factors for prolonged PE are gender, age at repair, body weight, bypass time, low oxygen saturation before surgery, wound infection after surgery, duration of endotracheal intubation, length of hospital stay, and Nakata index. Oxygen saturation before surgery and wound infection were major risk factors while age at repair was a confounder.

  4. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism

    Suadicani, Poul; Hannerz, Harald; Bach, Elsa


    There is mounting evidence that prolonged cramped sitting in connection with long-lasting air travel increases the risk of deep vein thrombosis of the legs and pulmonary embolism, i.e. venous thromboembolism (VTE). Prolonged cramped sitting may occur even in various jobs unrelated to air travel...

  5. Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children.

    Sahin, Mustafa; Menache, Caroline C; Holmes, Gregory L; Riviello, James J


    High-dose suppressive therapy (HDST) is used to treat refractory status epilepticus (RSE). Prolonged therapy is required in some cases, and prognosis is important in making therapeutic decisions. The authors therefore studied the long-term outcome in previously normal children who survived prolonged HDST for acute symptomatic RSE. All have intractable epilepsy, and none returned to baseline.

  6. Hepatic scar in a case of healed candidiasis showing prolonged enhancement on CT

    Itai, Yuji; Yashiro, Naobumi


    A patient with acute myelocytic leukemia recovering from hepatic candidiasis after long-term administration of amphotericin B had large scar in the liver which showed prominent prolonged enhancement on postcontrast CT. Prolonged enhancement can occur in regions other than hepatic masses.

  7. Invariant prolongation of overdetermined PDE's in projective, conformal and Grassmannian geometry

    Hammerl, Matthias; Souček, Vladimír; Šilhan, Josef


    This is the second in a series of papers on natural modification of the normal tractor connection in a parabolic geometry, which naturally prolongs an underlying overdetermined system of invariant differential equations. We give a short review of the general procedure developed in [5] and then compute the prolongation covariant derivatives for a number of interesting examples in projective, conformal and Grassmannian geometries.

  8. Clinically relevant QTc prolongation due to overridden drug-drug interaction alerts: A retrospective cohort study

    I.H. van der Sijs (Heleen); R. Kowlesar (Ravi); A.P.J. Klootwijk (Peter); S.P. Nelwan (Stefan); A.G. Vulto (Arnold); T. van Gelder (Teun)


    textabstractAIMS: To investigate whether, in patients in whom drug-drug interaction (DDI) alerts on QTc prolongation were overridden, the physician had requested an electrocardiogram (ECG), and if these ECGs showed clinically relevant QTc prolongation. METHODS: For all patients with overridden DDI a

  9. Generalized lymphadenopathy as a marker of ongoing inflammation in prolonged cholestatic hepatitis A.

    Mukhopadhya, Ashis; Chandy, George M


    Extrahepatic manifestations of hepatitis A are very unusual. We describe a case of prolonged cholestatic hepatitis A in a patient with generalized lymphadenopathy. With normalization of transaminases, there was an accompanying reduction in size of these lymph nodes. Lymphadenopathy reflects ongoing hepatic inflammation in prolonged cholestatic hepatitis A.

  10. Prolonged Grief in Palliative Family Caregivers: A Pilot Study in a Portuguese Sample.

    Coelho, Alexandra; Delalibera, Mayra; Barbosa, António; Lawlor, Peter


    Caregivers are particularly vulnerable to experience intense levels of distress following the loss. The aim of this prospective pilot study is to determine the incidence of prolonged grief disorder symptoms among caregivers. A total of 73 bereaved families responded to the Prolonged Grief Disorder Evaluation Instrument (PG-13) at 6 and 12 months following their loss. The incidence of prolonged grief disorder at the first assessment was 28.8%, and it decreased to 15.1% at the second assessment. The prevalence of prolonged grief disorder declined significantly over time (p = .041). In the second evaluation, six bereaved individuals continued to meet criteria for a diagnosis of prolonged grief disorder, 15 remitted, and 4 new (incident) cases emerged. The important differences in values that occur after 12 months suggest time is important in distinguishing between those at risk for persistent distress and those whose grief symptomatology will decrease with time.

  11. [Drug-induced QT interval prolongation: do we know the risks?].

    Villamañán, Elena; Armada, Eduardo; Ruano, Margarita


    Sudden cardiac death is an important cause of mortality in developed countries, most of them being consequence of acute ventricular arrhythmias. These arrhythmias, in some cases, owe to QT interval prolongation. A major risk factor for this condition is the use of drugs that prolong the QT interval. In fact, in recent years, one of the most common reasons for drug withdrawal or usage restrictions has been drug induced QT interval prolongation that involves both cardiovascular and non-cardiovascular drugs. Taking into account the severity that the occurrence of such an event may have, it is important for clinicians to know the risks of these drugs in certain patients. In this review we analyze the drugs that prolong the QT interval, the risk factors that can enhance QT prolongation and the drug interactions that can increase these risks. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  12. Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery


    Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery (combined surgery) from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identify risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent (50 %)were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age,weight, and preoperative hospital stay (days) were not found to be associated with prolonged mechanical ventilation. It was concluded that, for age and weight, this might be due to the lower number of old age patients (70 years and above) included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

  13. Management and outcome of prolonged pregnancies in Shariati university hospital

    Eslamian L.


    Full Text Available Background: There is dearth of reports from Iran regarding the prevalence of postterm pregnancy and its complications. The present study was conducted to evaluate the prevalence, management and outcome of prolonged pregnancies.Methods: This cross-sectional study included data from the hospital records of all women referred to Shariati Hospital, Tehran, from 2001 to 2002 with pregnancies of more than 40 weeks in duration. Pregnancies ≥40-42 weeks were considered postdate and those more than 42 weeks postterm pregnancy. The data compiled from the hospital records were subjected to t, χ2 and Mann-Whitney U tests.Results: Of the 1500 deliveries in this hospital, 98 patients were included in this study, 66.3% of whom were nullipara and 33.7% multipara. The prevalence of postterm pregnancy was estimated to be 3.3%. Cervix dilation of 2 cm or less on admission occurred in 65 women (73.3%. The mean Bishop score was 4.31. Of the 62 fetuses that underwent assessment tests, 54 (87.1% were normal. The median time between the last test and induction of labor was 2.1 days, and 2.6 days for cesarean deliveries, which was not a significant difference (P=0.6. Cervical ripening with misoprostrol was performed in 36 cases (36.7% and was successful in 18 cases. In this group, the median time for cervical ripening in multiparas was significantly less than nulliparas (4 vs. 7 hrs, P=0.004. Women not subjected to cervical ripening had a higher cesarean rate than those who did undergo cervical ripening (74.7% vs. 66.1%, although this difference was not significant (P=0.9. Vaginal and cesarean delivery rates showed no significant difference between cases that underwent induction with oxytocin and those subjected to cervical ripening with misoprostol (P=0.9. The mean Apgar score was 9.5, with all scores above 6. There were no cases of neonatal hypoglycemia, hypocalcemia, NICU admission or prenatal death. The mean nursery stay was 1.84 days with a range of 1-8 days

  14. Engineered stealth porous silicon nanoparticles via surface encapsulation of bovine serum albumin for prolonging blood circulation in vivo.

    Xia, Bing; Zhang, Wenyi; Shi, Jisen; Xiao, Shou-jun


    Luminescent porous silicon nanoparticles (PSiNPs) have been widely used as drug delivery. However, fast biodegradation and short blood circulation have been major challenges for their biomedical applications. Herein, bovine serum albumin was readily encapsulated onto alkyl-terminated PSiNPs surfaces via hydrophobic interaction, which could significantly improve their water-dispersibility and long-term stability under physiological conditions. Furthermore, compared with PSiNPs alone, PSiNPs coated with bovine serum albumin remarkably reduced nonspecific cellular uptake in vitro and prolonged blood circulation in vivo.

  15. Does prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the live-birth rate in in vitro fertilization treatment?

    Ren, Jianzhi; Sha, Aiguo; Han, Dongmei; Li, Ping; Geng, Jie; Ma, Chaihui


    To evaluate the effects of a prolonged duration of gonadotropin-releasing hormone agonist (GnRH-a) in pituitary down-regulation for controlled ovarian hyperstimulation (COH) on the live-birth rate in nonendometriotic women undergoing in vitro fertilization and embryo transfer (IVF-ET). Retrospective cohort study. University-affiliated hospital. Normogonadotropic women undergoing IVF. Three hundred seventy-eight patients receiving a prolonged pituitary down-regulation with GnRH-a before ovarian stimulation and 422 patients receiving a GnRH-a long protocol. Live-birth rate per fresh ET. In comparison with the long protocol, the prolonged down-regulation protocol required a higher total dose of gonadotropins. A lower serum luteinizing hormone (LH) level on the starting day of gonadotropin and the day of human chorionic gonadotropin (hCG) and a fewer number of oocytes and embryos were observed in the prolonged down-regulation protocol. However, the duration of stimulation and number of high-quality embryos were comparable between the two groups. A statistically significantly higher implantation rate (50.27% vs. 39.69%), clinical pregnancy rate (64.02% vs. 56.87%) and live-birth rate per fresh transfer cycle (55.56% vs. 45.73%) were observed in the prolonged protocol. Prolonged down-regulation in a GnRH-a protocol might increase the live-birth rates in normogonadotropic women. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Prolongation of PR interval is associated with endothelial dysfunction and activation of vascular repair in high-risk cardiovascular patients.

    Chan, Yap-Hang; Siu, Chung-Wah; Yiu, Kai-Hang; Yiu, Yuen-Fung; Lau, Kui-Kai; Lam, Tai-Hing; Lau, Chu-Pak; Tse, Hung-Fat


    Epidemiological studies showed that PR prolongation is associated with increased risk of adverse cardiovascular outcomes. We investigated the relations of PR interval with indices of vascular function and endothelial repair as the underlying mechanisms. The study comprised 348 high-risk patients with prior coronary artery disease, ischemic stroke, and/or diabetes mellitus recruited from medical outpatient clinics and 150 healthy subjects without such a history. PR interval was considered prolonged if >200 ms, as determined from resting 12-lead electrocardiogram. Vascular function was assessed by brachial flow-meditated dilatation (FMD) using high-resolution ultrasound. Circulating CD133(+)/KDR(+) endothelial progenitor cell (EPC) levels were measured by flow cytometry. Among healthy subjects, PR interval was inversely associated with FMD (R = -0.20, P = 0.015), but not with the level of circulating CD133(+)/KDR(+) EPC (R = 0.05, P = 0.58). Among high-risk cardiovascular patients, PR prolongation >200 ms was more common compared with healthy subjects (45/348 (13 %) versus 4/150 (3 %), P PR interval was associated inversely with FMD (R = -0.14, P = 0.01) and positively with circulating CD133(+)/KDR(+) EPC level (R = +0.14, P = 0.009). Circulating CD133(+)/KDR(+) EPC level was significantly increased in patients with PR prolongation >200 ms (0.87 ± 0.37 versus 0.68 ± 0.42 (log, ×10(-3)/ml), P = 0.005). Adjusted for potential confounders, increased PR interval remained independently associated with increased CD133(+)/KDR(+) EPC by +0.002 (95 % confidence interval (CI) 0.000 to 0.004 (log, ×10(-3)/ml), P = 0.011) and depressed FMD (B = -0.014 %, 95 % CI -0.027 to -0.002, P = 0.026). PR prolongation is associated with endothelial dysfunction and evidence of endothelial repair activation in patients with high cardiovascular risk.

  17. Quantification of 16 QT-prolonging Drugs and Metabolites in Human Postmortem Blood and Cardiac Tissue Using UPLC-MS-MS

    Mikkelsen, Christian R; Jornil, Jakob; Andersen, Ljubica V;


    QT-prolonging compounds present a treatment risk in mentally ill patients. Knowledge of the concentration in the heart compared with blood is necessary to assess the cardiac toxicity of QT-prolonging compounds. To address this issue, this article presents a validated analytical method for the qua......QT-prolonging compounds present a treatment risk in mentally ill patients. Knowledge of the concentration in the heart compared with blood is necessary to assess the cardiac toxicity of QT-prolonging compounds. To address this issue, this article presents a validated analytical method....... Validation results showed that the bias was ±15% and precision was ≤15% for all compounds in both matrices. The recovery ranged from 78.8 to 127.4%, and the matrix effect ranged from 61.0 to 128.7% across both matrices. The limit of detection and the lower limit of quantification were below the therapeutic...... concentrations of the prescription drugs. No noteworthy degradation during storage of the extracts was detected. The method was applied in five authentic cases of mentally ill patients. In conclusion, an analytical method was successfully developed and validated for the quantification of QTD in postmortem whole...

  18. Prolonged Preoperative Opioid Therapy Associated With Poor Return to Work Rates After Single-Level Cervical Fusion for Radiculopathy for Patients Receiving Workers' Compensation Benefits.

    Faour, Mhamad; Anderson, Joshua T; Haas, Arnold R; Percy, Rick; Woods, Stephen T; Ahn, Uri M; Ahn, Nicholas U


    Retrospective comparative cohort study. Examine the effect of prolonged preoperative opioid use on return to work (RTW) status after single-level cervical fusion for radiculopathy. The use of opioids has a dramatic effect in a workers' compensation population. The costs of claims that involved opioids in the management plan are catastrophic particularly for those undergoing spinal surgical procedure. Data of patients who underwent single-level cervical fusion for radiculopathy and had received opioid prescriptions before surgery were retrospectively collected from Ohio Bureau of Workers' Compensation between 1993 and 2011 after work-related injury. Then, based on opioid use duration, short-term use (STO) group (6 mo) were constructed. A multivariate logistic regression analysis was used to determine whether successful RTW status was achieved. Chi-square and analysis of variance tests were used to compare other secondary outcomes after surgery. Prolonged preoperative opioid use was a negative predictor of successful RTW status (odds ratio = 0.73; 95% confidence interval: 0.55-0.98; P value: 0.04). Prolonged preoperative opioid use was associated with increasingly lower rates of achieving stable RTW status (P benefits awarded after surgery (P < 0.01). Prolonged preoperative opioid use was associated with poor functional outcomes after cervical fusion. STO and earlier inclusion of the surgical approach in the management plan may offer better surgical and functional outcomes after cervical fusion. 3.

  19. Study of the prolonged release of theopylline from polymeric matrices based on grafted chitosan with acrylamide.

    Tapia, C; Costa, E; Terraza, C; Munita, A M; Yazdani-Pedram, M


    The aim of this work was to study the performance of chitosan (CB) grafted with acrylamide (CB-g-A) as prolonged drug release matrix as compared with unmodified chitosan. A non-pH dependent swelling behaviour for the matrix tablets based on grafted chitosan was observed. The overlaping between degree of swelling measured by weighing (DSw) and measured by increase of diameter (DSd) up to 240 minutes showed that the swelling process could be isotropic. The non-pH dependent swelling behaviour of these matrices could be explained by the partial substitution of amine groups of the chitosan chain by acrylamide. The grafting reaction provides an ionizable amine group by a neutral amide group which make the matrix non pH-dependent. On the contrary, the matrix tablet based on chitosan showed a pH dependent swelling behaviour where the swelling process could be anisotropic. The higher degree of erosion and swelling of the formulation based on CB-g-A600 (%G = 600) compared with the formulation based on chitosan and CB-g-A418 (%G = 418) could explain the higher fraction of theopylline released. For all formulations studied in this work, the amount of theopylline released from the matrix tablets was found to be controlled by a combination of the diffusion process and relaxation of the polymeric structure. These results match with the controlled swelling behaviour and low degree of erosion observed for these systems.

  20. Effects of short and prolonged transcutaneous vagus nerve stimulation on heart rate variability in healthy subjects.

    De Couck, M; Cserjesi, R; Caers, R; Zijlstra, W P; Widjaja, D; Wolf, N; Luminet, O; Ellrich, J; Gidron, Y


    The vagus nerve is strategically located in the body, and has multiple homeostatic and health-promoting effects. Low vagal activity predicts onset and progression of diseases. These are the reasons to activate this nerve. This study examined the effects of transcutaneous vagus nerve stimulation (t-VNS) on a main index of vagal activity, namely heart rate variability (HRV). In Study 1, we compared short (10min) left versus right ear t-VNS versus sham (no stimulation) in a within-subjects experimental design. Results revealed significant increases in only one HRV parameter (standard deviation of the RR intervals (SDNN)) following right-ear t-VNS. Study 2 examined the prolonged effects of t-VNS (1h) in the right ear. Compared to baseline, right-t-VNS significantly increased the LF and LF/HF components of HRV, and SDNN in women, but not in men. These results show limited effects of t-VNS on HRV, and are discussed in light of neuroanatomical and statistical considerations and future directions are proposed.

  1. Prolonged Benefit from Ipilimumab Correlates with Improved Outcomes from Subsequent Pembrolizumab.

    Shreders, Amanda; Joseph, Richard; Peng, Chengwei; Ye, Fei; Zhao, Shilin; Puzanov, Igor; Sosman, Jeffrey A; Johnson, Douglas B


    Patients with metastatic melanoma whose disease progresses on ipilimumab can clearly derive benefit from subsequent anti-programmed death-1 (PD-1). However, patients experience heterogeneous outcomes with ipilimumab, including rapid or delayed progression, and it is unclear whether patterns of ipilimumab progression influence subsequent clinical responses to anti-PD-1. We retrospectively reviewed data from 116 patients with metastatic melanoma who progressed on ipilimumab and were subsequently treated with pembrolizumab. The study objectives were to determine whether progression-free survival (PFS) with ipilimumab was associated with PFS, objective response rate (ORR), and clinical benefit rate (CBR; ORR + stable disease) with pembrolizumab. Patients with PFS ≥90 days after treatment with ipilimumab generally had superior outcomes with subsequent pembrolizumab treatment compared with patients with PFS pembrolizumab compared with rapid progressors (PFS pembrolizumab (odds ratio, 1.22; 95% CI, 1.02-1.51). This study shows that prolonged PFS with ipilimumab predicts excellent outcomes with subsequent pembrolizumab treatment, offering valuable prognostic information for clinicians. Cancer Immunol Res; 4(7); 569-73. ©2016 AACR.

  2. Prolonged contraction-relaxation cycle of fast-twitch muscles in parvalbumin knockout mice.

    Schwaller, B; Dick, J; Dhoot, G; Carroll, S; Vrbova, G; Nicotera, P; Pette, D; Wyss, A; Bluethmann, H; Hunziker, W; Celio, M R


    The calcium-binding protein parvalbumin (PV) occurs at high concentrations in fast-contracting vertebrate muscle fibers. Its putative role in facilitating the rapid relaxation of mammalian fast-twitch muscle fibers by acting as a temporary buffer for Ca2+ is still controversial. We generated knockout mice for PV (PV -/-) and compared the Ca2+ transients and the dynamics of contraction of their muscles with those from heterozygous (PV +/-) and wild-type (WT) mice. In the muscles of PV-deficient mice, the decay of intracellular Ca2+ concentration ([Ca2+]i) after 20-ms stimulation was slower compared with WT mice and led to a prolongation of the time required to attain peak twitch tension and to an extension of the half-relaxation time. The integral [Ca2+]i in muscle fibers of PV -/- mice was higher and consequently the force generated during a single twitch was approximately 40% greater than in PV +/- and WT animals. Acceleration of the contraction-relaxation cycle of fast-twitch muscle fibers by PV may confer an advantage in the performance of rapid, phasic movements.

  3. Metoprolol and diltiazem ameliorate ziprasidone-induced prolonged corrected QT interval in rats.

    Erbas, Oytun; Yilmaz, Mustafa


    Ziprasidone, an atypical antipsychotic agent, has been shown to increase the corrected QT (QTc) interval in some patients. The aim of this study was to reveal the effects of metoprolol and diltiazem on ziprasidone drug-induced prolonged QTc interval. A total of 24 rats were equally divided into the following four groups: the first group was used as the control and received 1 mL/kg saline; 3 mg/kg ziprasidone and saline were administered to the second group; 3 mg/kg ziprasidone and 1 mg/kg metoprolol were administered to the third group and 3 mg/kg ziprasidone and 2 mg/kg diltiazem were administered to the fourth group. Two hours following application of the drugs, the QTc was calculated by performing electrocardiography in derivation (D)I. The duration of QTc interval was compared among the four groups. The mean QTc intervals were significantly increased in the third and fourth groups compared with the second group (p metoprolol and diltiazem in the prevention of ziprasidone-induced elongation in the QTc interval. Both metoprolol and diltiazem may be considered in the prophylactic therapy of high-risk patients who are using ziprasidone.

  4. Polyclonal neural cell adhesion molecule antibody prolongs the effective duration time of botulinum toxin in decreasing muscle strength.

    Guo, Yan; Pan, Lizhen; Liu, Wuchao; Pan, Yougui; Nie, Zhiyu; Jin, Lingjing


    This study aimed to investigate if the effective duration time of botulinum toxin A (Btx-A) could be prolonged by polyclonal neural cell adhesion molecule antibody (P-NCAM-Ab). 175 male SD rats were randomly divided into three major groups: control group (n = 25), Btx-A group (n = 25), and P-NCAM-Ab groups. P-NCAM-Ab groups were composed of five sub-groups, with 25 rats each in the dose-response study. Muscle strength of rat lower limbs was determined using a survey system. The expressions of muscle-specific receptor tyrosine kinase (MuSK) and neural cell adhesion molecule (NCAM) were determined by real-time polymerase chain reactions (RT-PCR) and western blotting (WB). The muscle strength was significantly decreased by Btx-A in Btx-A/P-NCAM-Ab groups compared with normal control group. Besides, the muscle strength of P-NCAM-Ab group was significantly decreased compared with the Btx-A group. The recovery time of muscle strength in P-NCAM-Ab group was significantly longer compared with Btx-A group. RT-PCR and WB assay showed that PNCAM-Ab delayed the increase of MuSK and NCAM after Btx-A injection. P-NCAM-Ab prolongs the effective duration time of Btx-A in decreasing muscle strength, which could provide a novel enhancement in clinical application.

  5. Congenital and prolonged adult-onset deafness cause distinct degradations in neural ITD coding with bilateral cochlear implants.

    Hancock, Kenneth E; Chung, Yoojin; Delgutte, Bertrand


    Bilateral cochlear implant (CI) users perform poorly on tasks involving interaural time differences (ITD), which are critical for sound localization and speech reception in noise by normal-hearing listeners. ITD perception with bilateral CI is influenced by age at onset of deafness and duration of deafness. We previously showed that ITD coding in the auditory midbrain is degraded in congenitally deaf white cats (DWC) compared to acutely deafened cats (ADC) with normal auditory development (Hancock et al., J. Neurosci, 30:14068). To determine the relative importance of early onset of deafness and prolonged duration of deafness for abnormal ITD coding in DWC, we recorded from single units in the inferior colliculus of cats deafened as adults 6 months prior to experimentation (long-term deafened cats, LTDC) and compared neural ITD coding between the three deafness models. The incidence of ITD-sensitive neurons was similar in both groups with normal auditory development (LTDC and ADC), but significantly diminished in DWC. In contrast, both groups that experienced prolonged deafness (LTDC and DWC) had broad distributions of best ITDs around the midline, unlike the more focused distributions biased toward contralateral-leading ITDs present in both ADC and normal-hearing animals. The lack of contralateral bias in LTDC and DWC results in reduced sensitivity to changes in ITD within the natural range. The finding that early onset of deafness more severely degrades neural ITD coding than prolonged duration of deafness argues for the importance of fitting deaf children with sound processors that provide reliable ITD cues at an early age.

  6. In vitro and in vivo studies on radiobiological effects of prolonged fraction delivery time in A549 cells.

    Jiang, Ling; Xiong, Xiao-Peng; Hu, Chao-Su; Ou, Zhou-Luo; Zhu, Guo-Pei; Ying, Hong-Mei


    Intensity-modulated radiation therapy, when used in the clinic, prolongs fraction delivery time. Here we investigated both the in vivoand in vitroradiobiological effects on the A549 cell line, including the effect of different delivery times with the same dose on A549 tumor growth in nude mice. The in vitroeffects were studied with clonogenic assays, using linear-quadratic and incomplete repair models to fit the dose-survival curves. Fractionated irradiation of different doses was given at one fraction per day, simulating a clinical dose-time-fractionation pattern. The longer the interval between the exposures, the more cells survived. To investigate the in vivoeffect, we used sixty-four nude mice implanted with A549 cells in the back legs, randomly assigned into eight groups. A 15 Gy radiation dose was divided into different subfractions. The maximum and minimum tumor diameters were recorded to determine tumor growth. Tumor growth was delayed for groups with prolonged delivery time (40 min) compared to the group receiving a single dose of 15 Gy (Pdelivery time had delayed growth compared to those with a 40 min delivery time [20' (7.5 Gy × 2 F) vs 40' (7.5 Gy × 2 F), P= 0.035; 20' (3 Gy × 5 F) vs 40' (3 Gy × 5 F); P= 0.054; 20' (1.67 Gy × 9 F) vs 40' (1.67 Gy × 9 F), P= 0.028]. A prolonged delivery time decreased the radiobiological effects, so we strongly recommend keeping the delivery time as short as possible.

  7. To Study the Efficacy of Intravenous Dexamethasone in Prolonging the Duration of Spinal Anesthesia in Elective Cesarean Section

    Shalu, Priyanka Sunil; Ghodki, Poonam Sachin


    Background and Aims: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. This randomized, double-blind study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia. Methods: A total of sixty patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, group SD and group SN, including thirty patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg through spinal anesthesia. Group SD received injection dexamethasone 8 mg intravenously, and group SN received injection normal saline (NS) 2 cc immediately after spinal anesthesia. Duration of sensory block, motor block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Whenever demanded rescue analgesia was given in the form of injection tramadol 100 mg. Results: The mean duration of sensory block (min) in group SD and group SN was 162.50 and 106.17, respectively which was highly significant. Similarly, time to the requirement of first rescue analgesia was prolonged in group SD (8.67 h) as compared to group SN (4.40 h). Significant changes were also seen in VAS score in postoperative period after 1 h of surgery in group SD and group SN. Duration of motor block, intra- and post-operative hemodynamic parameters were comparable in both the groups. No side effects were recorded in both the groups. Conclusion: We concluded that administration of dexamethasone 8 mg intravenously prolongs the duration of postoperative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia. PMID:28663614

  8. Ventricular Cycle Length Characteristics Estimative of Prolonged RR Interval during Atrial Fibrillation



    Background When atrial fibrillation (AF) is incessant, imaging during a prolonged ventricular RR interval may improve image quality. It was hypothesized that long RR intervals could be predicted from preceding RR values. Methods From the PhysioNet database, electrocardiogram RR intervals were obtained from 74 persistent AF patients. An RR interval lengthened by at least 250 ms beyond the immediately preceding RR interval (termed T0 and T1, respectively) was considered prolonged. A two-parameter scatterplot was used to predict the occurrence of a prolonged interval T0. The scatterplot parameters were: (1) RR variability (RRv) estimated as the average second derivative from 10 previous pairs of RR differences, T13–T2, and (2) Tm–T1, the difference between Tm, the mean from T13 to T2, and T1. For each patient, scatterplots were constructed using preliminary data from the first hour. The ranges of parameters 1 and 2 were adjusted to maximize the proportion of prolonged RR intervals within range. These constraints were used for prediction of prolonged RR in test data collected during the second hour. Results The mean prolonged event was 1.0 seconds in duration. Actual prolonged events were identified with a mean positive predictive value (PPV) of 80% in the test set. PPV was >80% in 36 of 74 patients. An average of 10.8 prolonged RR intervals per 60 minutes was correctly identified. Conclusions A method was developed to predict prolonged RR intervals using two parameters and prior statistical sampling for each patient. This or similar methodology may help improve cardiac imaging in many longstanding persistent AF patients. PMID:23998759


    Ilkka Väänänen


    Full Text Available The purpose of this study was to describe the physiological responses to daily repeated acute but non-competitive prolonged exercise during a 4-day march and a 2-day cross-country ski event to the cardiorespiratory, autonomic nervous, musculoskeletal and endocrine systems. Mood states were also evaluated after these repeated exercises. The data of these short-term follow-up (reversal field trials was collected from healthy, 23 to 48 year old Finnish male soldiers in 1993 (n=6 and 1994 (n=15 during the "International Four-Day Long-Distance March" in Nijmegen, The Netherlands, and from ten healthy, 22 to 48 year old Finnish male participants in 1995 during a 2-day Finlandia Ski Race in Lahti, Finland. Acute cardiovascular responses were estimated by measuring the heart rate during exercise. The responses of the autonomic nervous system were estimated by measuring the heart rates during the orthostatic test. The musculoskeletal responses were estimated by measuring the perceived pains, flexibility, functional strength, use of elastic energy and oedemic changes of the lower extremities. Hormonal responses were estimated from the urinary excretion of catecholamines, and the concentrations of serum cortisol, testosterone, luteinizing (LH and follicle stimulating hormone (FSH. Mood states were assessed with the Profile of Mood States (POMS questionnaire. Daily walking time was 7-10 hours while the skiing time was 3 hours. Average heart rate during walking was 59% and skiing 87% of maximum heart rate. Morning heart rate in the supine position increased progressively through the marching period but not through the skiing experiment. After the first day, perceived pain increased significantly and remained at a similarly increased level until the end of the exercise period. Leg measurements showed no signs of oedema, decreases in flexibility, or functional strength. Catecholamine excretion rates during marches indicated cumulatively increased

  10. Sequential thrombosis and bleeding in a woman with a prolonged activated partial thromboplastin time

    Pearce Michael I


    Full Text Available Abstract Simultaneous or sequential haemorrhage and thrombosis in the presence of a prolonged activated partial thromboplastin time (aPTT is a rare occurrence: we describe the case a 37 year old lady who developed post-delivery deep vein thrombosis treated with low molecular heparin and warfarin followed a week later by extensive bruising over legs and forearms, a significant drop in haemoglobin and a very prolonged aPTT. Further tests revealed an acquired factor VIII inhibitor at 35 Bethesda Units. We discuss the clinical and laboratory implications and provide a literature review of simultaneous thrombophilia and haemophilia in the presence of a prolonged aPTT.

  11. Sleep-prolonging effect of Coriandrum sativum hydro-alcoholic extract in mice.

    Rakhshandeh, Hassan; Sadeghnia, Hamid Reza; Ghorbani, Ahmad


    The present study was planned to investigate sleep-prolonging effect of C. sativum. The hydro-alcoholic extract (HAE) and its three fractions namely water (WF), ethyl acetate (EAF) and N-butanol (NBF) were prepared from C. sativum aerial parts and administrated to mice. Also, the possible cytotoxicity of the extracts was tested using cultured PC12 cells. The HAE, EAF and NBF significantly prolonged sleep duration. Only the NBF could significantly decrease sleep latency. No decrease in the neuronal surviving was observed either by HAE or by its fractions. The present data indicate that C. sativum exert sleep-prolonging action without major neurotoxic effect.

  12. Use of neuromuscular monitoring to detect prolonged effect of succinylcholine or mivacurium

    Cassel, J; Staehr-Rye, A K; Nielsen, C V


    effect of the neuromuscular blocking agent was not discovered until after extubation. In the third patient, the lack of response to nerve stimulation was interpreted as a technical failure and the prolonged effect of succinylcholine was discovered when general anaesthesia was terminated. Both patients...... allowed a prolonged neuromuscular blockade to be discovered prior to tracheal extubation of the patient. The patient was extubated after successful reversal of the neuromuscular blockade. On the contrary, neuromuscular monitoring was not used during anaesthesia in the second patient; hence, the prolonged...

  13. [Actinomycosis of the minor pelvis associated with prolonged use of intrauterine contraceptive devices (IUD)].

    Durdević, S; Vejnović, T; Novakov, A


    Pelvic actinomycosis is a rare disorder caused by Gram-positive anaerobic bacteria Actinomyces Israeli, and it is commonly associated with the prolonged use of IUD. The authors present two cases of pelvic actinomycosis in patients who used IUD for prolonged periods of time (eight and fourteen years). The diagnostic procedure in both cases lasted long and the definite diagnosis was made only after the pathohistological examination of the material taken during the surgical treatment. Actinomyces Israeli should be considered as one of the causes of the diagnosed pelvic inflammation especially when it is associated with the prolonged use of IUD.

  14. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

    Elham M. El-Feky


    Conclusion: Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

  15. Effects of prolonged intensive training on the resting levels of salivary immunoglobulin A and cortisol in adolescent volleyball players.

    Li, T L; Lin, H C; Ko, M H; Chang, C K; Fang, S H


    Concerns have been raised regarding the effects of prolonged intensive training on adolescent athletes. This study investigated the differences in mucosal immune functions and stress responses between intensively trained male adolescent volleyball players and age-matched sedentary controls. Twelve male volleyball players (16.5 [0.7] years of age) and sixteen healthy sedentary male volunteers (17.1 [0.6] years of age) participated in this study. Volleyball players were engaged in regular and year-round training. Unstimulated saliva samples were collected from volleyball players during the high-intensity training period and from the counterparts at the same timepoints after at least 18 hours of rest. Concentrations of salivary total protein, secretory immunoglobulin A (SIgA), cortisol, and lactoferrin were measured. Results of this study revealed that the SIgA concentrations and the ratio of SIgA/total protein in volleyball players were significantly lower compared with those in sedentary controls. However, the salivary cortisol concentrations and the ratio of cortisol/total protein in volleyball players were markedly higher compared with those in sedentary controls. No significant difference was observed in lactoferrin levels between volleyball players and sedentary controls. The findings of this study suggest that the prolonged intensive training may elicit a sustained stress and induce a suppressive effect on mucosal immunity in regularly and intensively trained adolescent athletes.

  16. Análise comparativa da complacência do sistema respiratório em três diferentes posições no leito (lateral, sentada e dorsal em pacientes submetidos à ventilação mecânica invasiva prolongada Comparative analysis of respiratory systems compliance in three different positioning (lateral, dorsal and sitting in patients in prolonged invasive mechanical ventilation

    Elias Ferreira Porto


    . After an alveolar recruitment maneuver, patients were placed to a position throughout two hours, and in the last five minutes the data was collected from the mechanical ventilator display. RESULTS: twenty eight patients were prospectively assessed. Values of respiratory system compliance in the lateral position were 37,07 ± 12,9 in the dorsal were 39,2 ± 10,5 and in the sitting 43,4 ± 9,6 mL/cmH2O. There were a statistical difference when we compared to the sitting and dorsal with lateral positioning for respiratory system compliance (p = 0.0052 and tidal volume (p < 0.001. There was a negative correlation between mean values of positive end expiratory pressure a respiratory system compliance (r = 0.59, p = 0.002. The FIO2 administered was 0.6 for the lateral positioning and 0.5 for the dorsal and sitting positioning (p = 0.049. CONCLUSIONS: That body positioning in patients restrained to a bed and submitted to invasive mechanical ventilation leads to pulmonary compliance, tidal volume and SpO2 oscillations. In the sitting position the pulmonary compliance is higher than in others positions.


    Nitheanandan, T; Brown, M.J


    .... The efficacy of available backup and ultimate heat sinks, available in a CANDU 6 reactor, in mitigating the consequences of a prolonged station blackout scenario was analysed using the MAAP4-CANDU code...



    The curing process of chemical reacton between flexible unsaturated polymer resin and diphenylmethane bismaleimides which have been chain-prolonged by diaminodiphenylmethane is presented, also the kinetics parameters and curing technology are investigated.

  19. Diagnostic utility of fractional exhaled nitric oxide in prolonged and chronic cough according to atopic status

    Takamitsu Asano


    Conclusions: Although high FeNO levels suggested the existence of AC, lower FeNO levels had limited diagnostic significance. Atopic status affects the utility of FeNO levels in the differential diagnosis of prolonged and chronic cough.

  20. The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

    Hagenaars, M.A.; Minnen, A. van; Hoogduin, C.A.L.


    This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dis

  1. Patient Characteristics and Outcomes of a Provincial Prolonged-Ventilation Weaning Centre: A Retrospective Cohort Study

    Louise Rose


    Full Text Available BACKGROUND: Growing numbers of critically ill patients require prolonged mechanical ventilation and experience difficulty with weaning. Specialized centres may facilitate weaning through focused interprofessional expertise with an emphasis on rehabilitation.

  2. The effect of ethanol on the release of opioids from oral prolonged-release preparations.

    Walden, Malcolm; Nicholls, Fiona A; Smith, Kevin J; Tucker, Geoffrey T


    Recent experience has prompted the US FDA to consider whether ethanol ingestion may modify the release characteristics of prolonged-release formulations, where dose dumping may be an issue for patient safety. The influence of ethanol on the in vitro release of opioid drugs from some prolonged-release formulations utilizing different release technologies was examined. Results indicated that the prolonged-release mechanisms remained intact under the testing conditions, although one product showed initial sensitivity to ethanol in its release characteristics. Nevertheless, in this case, extrapolation of the findings to likely outcome in vivo indicated no risk of dose-dumping. It is proposed that prolonged-release medicinal products should be tested during development to ensure robustness to the effects of ethanol on drug release.

  3. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals.

    Maaløe, N; Sorensen, B L; Onesmo, R; Secher, N J; Bygbjerg, I C


    To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Two Tanzanian rural mission hospitals. Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  4. Prolongation of heart rate-corrected QT interval is a predictor of cardiac autonomic dysfunction in patients with systemic lupus erythematosus.

    Nomura, Atsushi; Kishimoto, Mitsumasa; Takahashi, Osamu; Deshpande, Gautam A; Yamaguchi, Kenichi; Okada, Masato


    Heart rate-corrected QT interval duration (QTc) has been shown to be related to cardiac autonomic dysfunction in patients with diabetes mellitus, although this association has not been previously described in patients with systemic lupus erythematosus (SLE). We retrospectively reviewed the medical records of 91 SLE patients and 144 non-SLE connective tissue disease patients visiting our clinic from November 2010 to April 2011. We compared ambulatory heart rate identified by pulse measured by automated machine in an outpatient waiting area versus resting heart rate identified on prior screening electrocardiogram. Heart rate differences were analyzed in relation to QTc interval and other characteristics. Ambulatory and resting heart rate differences were larger among SLE patients with QTc prolongation (QTc > 430 ms) than those without QTc prolongation (mean difference, 15.9 vs. 9.6, p = 0.001). In multivariate analysis, differences in heart rate were associated with QTc prolongation (OR 1.10, 95 % CI 1.01-1.21; p = 0.038), independent of age, duration of disease, immunosuppressant use, hydroxychloroquine use, diabetes mellitus, cardiac abnormality, anti-Ro/SS-A antibody positivity, or resting heart rate. Cardiac autonomic dysfunction is a common manifestation of SLE and may be related to QTc prolongation.

  5. Prolonged manganese exposure induces severe deficits in lifespan,development and reproduction possibly by altering oxidative stress response in Caenorhabditis elegans

    XIAO Jing; RUI Qi; GUO Yuling; CHANG Xingya; WANG Dayong


    We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese (Mn) solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our data suggest that acute exposure (6 h) to Mn did not cause severe defects of life span,development,and reproduction.Similarly,no significant defects could be found for the life span,development,and reproduction in animals exposed to a low concentration of Mn (2.5 μmol/L) for 48 h.In contrast,prolonged exposure (48-h) to high concentrations of Mn (75 and 200 μmol/L) resulted in significant defects of life span,development,and reproduction,as well as the increase of the percentage of population with hsp-16.2::gfp expression indicating the obvious induction of stress responses in exposed animals.Moreover,prolonged exposure (48-h) to high concentrations (75 and 200 μmol/L) of Mn decreased the expression levels of antioxidant genes of sod-1,sod-2,sod-3,and sod-4 compared to control.Therefore,prolonged exposure to high concentrations of Mn will induce the severe defects of life span,development,and reproduction in nematodes possibly by affecting the stress response and expression of antioxidant genes in Caenorhabditis elegans.

  6. Locus coeruleus response to single-prolonged stress and early intervention with intranasal neuropeptide Y.

    Sabban, Esther L; Laukova, Marcela; Alaluf, Lishay G; Olsson, Emelie; Serova, Lidia I


    Dysregulation of the central noradrenergic system is a core feature of post-traumatic stress disorder (PTSD). Here, we examined molecular changes in locus coeruleus (LC) triggered by single-prolonged stress (SPS) PTSD model at a time when behavioral symptoms are manifested, and the effect of early intervention with intranasal neuropeptide Y (NPY). Immediately following SPS stressors, male SD rats were administered intranasal NPY (SPS/NPY) or vehicle (SPS/V). Seven days later, TH protein, but not mRNA, was elevated in LC only of the SPS/V group. Although 90% of TH positive cells expressed GR, its levels were unaltered. Compared to unstressed controls, LC of SPS/V, but not SPS/NPY, expressed less Y2 receptor mRNA with more CRHR1 mRNA in subset of animals, and elevated corticotropin-releasing hormone (CRH) in central nucleus of amygdala. Following testing for anxiety on elevated plus maze (EPM), there were significantly increased TH, DBH and NPY mRNAs in LC of SPS-treated, but not previously unstressed animals. Their levels highly correlated with each other but not with behavioral features on EPM. Thus, SPS triggers long-term noradrenergic activation and higher sensitivity to mild stressors, perhaps mediated by the up-regulation influence of amygdalar CRH input and down-regulation of Y2R presynaptic inhibition in LC. Results also demonstrate the therapeutic potential of early intervention with intranasal NPY for traumatic stress-elicited noradrenergic impairments. Single-prolonged stress (SPS)-triggered long-term changes in the locus coeruleus/norepinephrine (LC/NE) system with increased tyrosine hydroxylase (TH) protein and CRH receptor 1(CRHR1) mRNA and lower neuropeptide Y receptor 2 (Y2R) mRNA levels as well as elevated corticotropin-releasing hormone (CRH) in the central nucleus of amygdala (CeA) that were prevented by early intervention with intranasal neuropeptide Y (NPY). SPS treatment led to increased sensitivity of LC to mild stress of elevated plus maze

  7. A study of microemulsions as prolonged-release injectables through in-situ phase transition.

    Wu, Zimei; Alany, Raid G; Tawfeek, Noor; Falconer, James; Zhang, Wenli; Hassan, Ibrahim M; Rutland, Michael; Svirskis, Darren


    Microemulsions (MEs) have been studied extensively as colloidal carriers for the delivery of both water-soluble and lipid-soluble drugs. Our previous study showed that addition of water to ME formulations resulted in phase transition to either liquid crystal (LC) or coarse emulsion (CE). The aim of this study was to investigate whether these MEs could be used as drug delivery vehicles for prolonged release through in-situ phase transition following extravascular injection. Three ME formulations from the same pseudo-ternary phase diagram were investigated with respect to their phase transition behavior, and in-vivo drug release; a coarse emulsion-forming ME (CE-ME), an oil rich LC-forming ME (LC-ME1), and an oil poor LC-forming ME (LC-ME2). CE-ME was a W/O ME and both LC-MEs were O/W type. The release profiles of (99m)Tc labeled MEs following subcutaneous (SC) injection in rabbits were investigated with gamma-scintigraphy. The CE-ME dispersed readily in water, forming a CE, whereas the LC-forming MEs formed 'depots' in water. Polarized microscopy revealed a LC boundary spontaneously formed at the water/ME interface for the LC-MEs with the LC-ME2 forming a substantially thicker LC layer. The CE resulting from the water-induced transition of the CE-forming ME had a higher viscosity than the MEs, but lower than the LCs resulted from LC-MEs. Compared to LC-ME1, LC-ME2 underwent more rapid phase transition and the resultant LC had significant higher viscosity. The LCs formed from both ME formulations exhibited pseudoplastic properties; increasing the shear rate decreased the apparent viscosity exponentially. Following SC injection into the animal thigh, the LC-MEs had more prolonged release of (99m)Tc in a first-order manner, than CE-ME. The oil poor LC-ME2 had the slowest release with a t1/2 of 77min, 2.3 times longer than the oil rich LC-ME1; consistent with the thickness of LC layer formation observed in-vitro and their relative viscosities. In conclusion, the present

  8. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis.

    Oh, Eun Jo; Oh, Se Heang; Lee, In Soo; Kwon, Oh Soo; Lee, Jin Ho


    Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin (F68-VAcements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement (VAcement). TheF68 (7 wt%)-VAcement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth ofS. aureus(zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that theF68 (7 wt%)-VAcement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis.

  9. Graphical illustration and functional neuroimaging of visual hallucinations during prolonged blindfolding: a comparison to visual imagery.

    Sireteanu, Ruxandra; Oertel, Viola; Mohr, Harald; Linden, David; Singer, Wolf


    Visual hallucinations can occur in healthy subjects during prolonged visual deprivation. We investigated the visual percepts and the associated brain activity in a 37-year-old healthy female subject who developed visual hallucinations during three weeks of blindfolding, and then compared this activity with the cortical activity associated with mental imagery of the same patterns. We acquired fMRI data with a Siemens 3T Magnetom Allegra towards the end of the deprivation period to assess hallucination-related activity, and again after recovery from blindfolding to measure imagery-related activity. Detailed subjective descriptions and graphical illustrations were provided by the subject after blindfolding was completed. The subject reported the occurrence of simple and elementary hallucinations, consisting of flashes and coloured and moving patterns during the period of blindfolding. Neural activity related to hallucinations was found in extrastriate occipital, posterior parietal, and several prefrontal regions. In contrast, mental imagery of the same percepts led to activation in prefrontal, but not in posterior, parietal, and occipital regions. These results suggest that deprivation-induced hallucinations result from increased excitability of extrastriate visual areas, while mentally induced imagery involves active read-out under the volitional control of prefrontal structures. This agrees with the subject's report that visual hallucinations were more vivid than mental imagery.

  10. The expression of tin gene in prolongated tomato fruit ripening - Lycopersicom esculentum Mill.

    Zdravković Jasmina


    Full Text Available Tomato selection programme, aiming to create a tomato hybrid with better fruit firmness, has been based on adding rin gene in perspective selection material. The fruit firmness has been based on decelerated ripening which prolongs the shelf life. Heterozygote genotypes (rin/+ have considerably longer shelf life that genotypes with uniform ripening (+/+. The effects of rin gene on shelf life have been examined on four experimental hybrids (K 56S K - 18, K - 64 and K -15 - rin/+ genetic configuration compared with Atina Fl genotype (uniform ripening +/+ K - 91 selected, line (rin/rin and Fino F1 (DRS unknown genetic construction and very good fruit firmness. The parameter for shelf life has been the fruit weight loss during the preservation - from harvest till the fading. The weight loss has been recorded every 7th day during two months. The experimental hybrids showed good agro technical characteristics of mid early tomato intended for production in the open field. During the shelf life, the genotype K - 15 faded the most slowly, both in the group of green and mature fruits.

  11. A crossover comparison of extended release felodipine with prolonged action nifedipine in hypertension.

    Moncica, I; Oh, P I; ul Qamar, I; Scolnik, D; Arbus, G S; Hebert, D; Balfe, J W; Koren, G


    In a crossover design, control of blood pressure by extended release felodipine was compared with control by prolonged action nifedipine in 21 children with renal hypertension. Compliance with once daily felodipine was higher than with nifedipine, at 95.6 (SEM 2.7)% v 78.9 (6.0)% (p = 0.02). Mean diastolic blood pressure was lower during the day with felodipine than with nifedipine, at 77.6 (2.4) v 84.4 (2.8) mm Hg (p = 0.05). Similarly, blood pressure load (the percentage of the day during which the child had blood pressure exceeding the upper limits of normal for age) was lower for felodipine than for nifedipine: 43.5 (5.5)% v 61.3 (6.3)%. There was an opposite trend during the night, though this did not reach statistical significance. These data suggest that once a day felodipine is effective in children with hypertension. This may be because of improved compliance. PMID:7574861


    O. V. Kostyria


    Full Text Available The article describes the use for the production of food products with prolonged shelf-life food additives - dihydroquercetin. Dihydroquercetin is a bioflavonoid natural origin, which has the highest antioxidant activity compared with all known exogenous antioxidants, including vitamins E, A, B, C, D, K, beta-carotene. This connection is included in the list of food additives, do not have harmful effects on health when used for cooking food. Dihydroquercetin is non-toxic, physiologically harmless to human health, not give them a foreign tastes and odors, does not change their color when using it.Additive stable with respect to temperature (from minus 50 to plus 1800 с, mechanical stress , and the processes taking place in the manufacture of products, i.e., meets all the requirements applicable generally to all food additives, and in particular, to the antioxidants. Dihydroquercetin has antibacterial properties against some types of bacteria, and has a positive impact on the development and growth of the lactic microflora. Dihydroquercetin has antibacterial properties against some types of bacteria, and has a positive impact on the development and growth of the lactic microflora. Bioflavonoid is not synthesized in the human body, so you need to eat foods in which it is contained ..In addition, the use of dihydroquercetin will produce food therapeutic orientation that the positive effect of bioflavonoids on human health has been proven through years of experimental and clinical research medical institutions of Russia.

  13. Single Prolonged Stress Decreases Glutamate, Glutamine, and Creatine Concentrations In The Rat Medial Prefrontal Cortex

    Knox, Dayan; Perrine, Shane A.; George, Sophie A.; Galloway, Matthew P.; Liberzon, Israel


    Application of Single Prolonged Stress (SPS) in rats induces changes in neuroendocrine function and arousal that are characteristic of Post Traumatic Stress Disorder (PTSD). PTSD, in humans, is associated with decreased neural activity in the prefrontal cortex, increased neural activity in the amygdala complex, and reduced neuronal integrity in the hippocampus. However, the extent to which SPS models these aspects of PTSD has not been established. In order to address this, we used high-resolution magic angle spinning proton magnetic resonance spectroscopy (HR-MAS 1H MRS) ex vivo to assay levels of neurochemicals critical for energy metabolism (creatine and lactate), excitatory (glutamate and glutamine) and inhibitory (gamma amino butyric acid (GABA)) neurotransmission, and neuronal integrity (N-acetyl aspartate (NAA)) in the medial prefrontal cortex (mPFC), amygdala complex, and hippocampus of SPS and control rats. Glutamate, glutamine, and creatine levels were decreased in the mPFC of SPS rats when compared to controls, which suggests decreased excitatory tone in this region. SPS did not alter the neurochemical profiles of either the hippocampus or amygdala. These data suggest that SPS selectively attenuates excitatory tone, without a disruption of neuronal integrity, in the mPFC. PMID:20546834

  14. Phenolic and Aroma Composition of White Wines Produced by Prolonged Maceration and Maturation in Wooden Barrels

    Nikolina Jedrejčić


    Full Text Available To investigate the phenolic and aroma composition of Malvazija istarska (Vitis vinifera L. white wines produced by an unconventional technology comprising prolonged maceration followed by maturation in wooden barrels, representative samples were subjected to analysis by UV/Vis spectrometry, high-performance liquid chromatography, and gas chromatography-mass spectrometry. When compared to standard wines, the investigated samples contained higher levels of dry extract, volatile acidity, lactic acid, phenols, colour intensity, antioxidant activity, majority of monoterpenes, C13-norisoprenoids, methanol, higher alcohols, ethyl acetate, branched-chain esters and esters of hydroxy and dicarboxylic acids, ethylphenols, furans, and acetals, as well as lower levels of malic acid, β-damascenone, straight-chain fatty acids, ethyl and acetate esters. It was estimated that maceration had a stronger influence on phenols, and maturation on volatile aromas. Despite different vintages and technological details, the investigated wines showed a relative homogeneity in the composition, representing a clear and distinctive type.

  15. Neural and behavioural changes in male periadolescent mice after prolonged nicotine-MDMA treatment.

    Adeniyi, Philip A; Ishola, Azeez O; Laoye, Babafemi J; Olatunji, Babawale P; Bankole, Oluwamolakun O; Shallie, Philemon D; Ogundele, Olalekan M


    The interaction between MDMA and Nicotine affects multiple brain centres and neurotransmitter systems (serotonin, dopamine and glutamate) involved in motor coordination and cognition. In this study, we have elucidated the effect of prolonged (10 days) MDMA, Nicotine and a combined Nicotine-MDMA treatment on motor-cognitive neural functions. In addition, we have shown the correlation between the observed behavioural change and neural structural changes induced by these treatments in BALB/c mice. We observed that MDMA (2 mg/Kg body weight; subcutaneous) induced a decline in motor function, while Nicotine (2 mg/Kg body weight; subcutaneous) improved motor function in male periadolescent mice. In combined treatment, Nicotine reduced the motor function decline observed in MDMA treatment, thus no significant change in motor function for the combined treatment versus the control. Nicotine or MDMA treatment reduced memory function and altered hippocampal structure. Similarly, a combined Nicotine-MDMA treatment reduced memory function when compared with the control. Ultimately, the metabolic and structural changes in these neural systems were seen to vary for the various forms of treatment. It is noteworthy to mention that a combined treatment increased the rate of lipid peroxidation in brain tissue.

  16. A special type of scald caused by prolonged exposure to slowly heated water.

    Pircher, R; Pollak, S; Vogt, S; Epting, T; Kramer, L; Geisenberger, D


    When skin is subjected to water temperatures gradually rising from moderate to critical ranges for a prolonged period of time, the resulting scalds will initially present as reddening, followed by blistering and at last by full-thickness burns. On changing from second- to third-degree burn, the blisters stop to become enlarged and solidify due to heat-induced coagulation necrosis. Such gradually intensifying tissue damage results in multiple firm skin blisters together with third-degree burn of the affected area. The initially serous blister fluid assumes a jelly-like consistency as the proteins undergo denaturation. Scalds of this special type may occur in persons taking a bath and becoming incapable to act so that the warm water tap remains turned on or a hairdryer continues to work after having been dropped into the bath water. On the basis of two relevant fatalities (suicidal electrocutions in bathtubs by means of hairdryers), the macroscopic and histological appearance of blisters which only secondarily turned into a full-thickness scald is compared with blisters in genuine second-degree scalds. The blister fluid of the latter ones was also investigated as to their protein composition and hemoglobin concentration. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. A novel oromucosal prolonged release mucoadhesive suspension by one step spray coagulation method.

    Cilurzo, Francesco; Gennari, Chiara G M; Selmin, Francesca; Musazzi, Umberto M; Rumio, Cristiano; Minghetti, Paola


    An oromucosal mucoadhesive suspension (OMS) able to combine the peculiarities of prolonged release mucoadhesive microparticles with those of an immediate release oromucosal solution is described. Microparticles were obtained by ionotropic gelation of alginate blended with another mucoadhesive material in a one step process where the cross-linking bath constituted the suspension vehicle. The effects of formulation and processing conditions on OMS performances were measured in-vitro determining the enhancement of drug penetration in buccal porcine mucosa and inhibition of tooth plaque formation using flurbiprofen and delmopinol as model drugs, respectively. Well-formed and spherical microparticles were obtained combining alginate with carbomer; linear dependence of particle size from the feed composition, viscosity and atomization pressure was found. As demonstrated by using FITC-labelled microparticles, the system remained onto the buccal mucosa at least for a six hour period. As a consequence, 0.1% flurbiprofen OMS guaranteed a concentration of flurbiprofen into buccal porcine mucosa over 6 hours comparable to 0.25% flurbiprofen reference solution, allowing a potential reduction of the 60% administered dose. The use of in-house made artificial mouth revealed that the once-a-day administration of 0.1% delmopinol OMS was as effective in plaque inhibition as the 0.2% delmopinol reference solution product given twice-a-day. These results suggested that the development of bioadhesive oromucosal suspensions, localizing the drug into buccal cavity, can reduce regimen and administrated dose.

  18. Development of buccal adhesive tablet with prolonged antifungal activity: Optimization and ex vivo deposition studies

    Madgulkar A


    Full Text Available The purpose of the present work was to prepare buccal adhesive tablets of miconazole nitrate. The simplex centroid experimental design was used to arrive at optimum ratio of carbopol 934P, hydroxypropylmethylcellulose K4M and polyvinylpyrollidone, which will provide desired drug release and mucoadhesion. Swelling index, mucoadhesive strength and in vitro drug release of the prepared tablet was determined. The drug release and bioadhesion was dependent on type and relative amounts of the polymers. The optimized combination was subjected to in vitro antifungal activity, transmucosal permeation, drug deposition in mucosa, residence time and bioadhesion studies. IR spectroscopy was used to investigate any interaction between drug and excipients. Dissolution of miconazole from tablets was sustained for 6 h. based on the results obtained, it can be concluded that the prepared slow release buccoadhesive tablets of miconazole would markedly prolong the duration of antifungal activity. Comparison of in vitro antifungal activity of tablet with marketed gel showed that drug concentrations above the minimum inhibitory concentration were achieved immediately from both formulations but release from tablet was sustained up to 6 h, while the gel showed initially fast drug release, which did not sustain later. Drug permeation across buccal mucosa was minimum from the tablet as well as marketed gel; the deposition of drug in mucosa was higher in case of tablet. In vitro residence time and bioadhesive strength of tablet was higher than gel. Thus the buccoadhesive tablet of miconazole nitrate may offer better control of antifungal activity as compared to the gel formulation.

  19. Prolonged water immersion. Effects on blood pressure maturation in normotensive rats.

    Magrini, F; Reggiani, P; Ciulla, M; Meazza, R; Branzi, G


    The purpose of this experiment was to study the impact of simulated microgravity and of chronic removal of hydrostatic pressure gradients on blood pressure maturation and body growth in rats. A special device was developed in our laboratory to transfer prolonged "dry" water immersion (a technique that has been used for training astronauts under hypogravic conditions) to six Sprague-Dawley test rats (immersion-G group). The time course of heart rate, systolic blood pressure, urinary output, and body weight was monitored from weaning to maturity and then compared with those responses from six sex- and age-matched Sprague-Dawley rats grown in a gravity environment (group G). A downward shift in systolic blood pressure and body weight maturation curves was observed in immersion-G rats from the age of 60 days. Cessation of dry water immersion produced a gradual, significant rise in systolic blood pressure but not in body weight to control values. No marked changes in heart rate and urinary output between G and immersion-G rats were noticed throughout the investigation. Our results provide indirect evidence that an interference in the natural history of blood pressure maturation was introduced by immersion, which dissociated the effects of body weight increase during growth from the effects of ageing per se. It is concluded that the physiological increase in systolic blood pressure during growth is partly gravity-dependent.

  20. Effect of prolonged standardized bed rest on cystatin C and other markers of cardiovascular risk

    Arinell Karin


    Full Text Available Abstract Background Sedentary lifestyle is associated with coronary artery disease but even shorter periods of physical inactivity may increase cardiovascular risk. Cystatin C is independently associated with cardiovascular disease and our objective was to investigate the relation between this novel biomarker and standardized bed rest. Research of immobilization physiology in humans is challenging because good biological models are in short supply. From the Women International Space simulation for Exploration study (WISE we studied markers of atherosclerosis and kidney function, including cystatin C, in a standardized bed rest study on healthy volunteers. Fifteen healthy female volunteers participated in a 20-day ambulatory control period followed by 60 days of bed rest in head-down tilt position (-6° 24 h a day, finalized by 20 days of recovery. The subjects were randomized into two groups during bed rest: a control group (n = 8 that remained physically inactive and an exercise group (n = 7 that participated in both supine resistance and aerobic exercise training. Results Compared to baseline values there was a statistically significant increase in cystatin C in both groups after bed rest (P Conclusion During and following prolonged standardized bed rest the concentrations of several clinically relevant cardiovascular risk markers change.

  1. Upper limb muscle fatigue during prolonged Boccia games with underarm throwing technique.

    Fong, Daniel Tik-Pui; Yam, Kit-Yee; Chu, Vikki Wing-Shan; Cheung, Roy Tsz-Hei; Chan, Kai-Ming


    This study investigated the acute fatigue pattern in neuromuscular activity after a simulated Boccia game and the effect of fatigue pattern on sport performance. Nine elite Boccia athletes were tested before, during, and after a simulated game. Maximum ball speed was captured with video, and the target hitting rate and rating of perceived exertion (RPE) score were collected and analyzed. Electromyography signals from the upper trapezius, anterior deltoid, posterior deltoid, biceps brachii, triceps brachii, and wrist extensor muscles were collected by surface electrode and were evaluated with mean power frequency (MPF). Only the upper trapezius muscle showed fatigue as demonstrated by a reduction of MPF of 8% (p = 0.027) when comparing the first and last throws in a simulated game. Subjective RPE score increased during the game (118%, p = 0.004), and sports performance in terms of maximum ball speed (-12%, p = 0.004) and target hitting rate (-25%, p = 0.004) also deteriorated. In conclusion, fatigue on the upper trapezius muscle was demonstrated in elite Boccia athletes following a prolonged Boccia game and may have affected Boccia performance. Preventative measures against upper trapezius muscle fatigue and endurance training for synergists of the upper trapezius muscle may be considered in future studies.

  2. Can Tracheostomy Improve Outcome and Lower Resource Utilization for Patients with Prolonged Mechanical Ventilation?

    Ciou-Rong Yuan; Tzuo-Yun Lan; Gau-Jun Tang


    Background:It is not clear whether the benefits oftracheostomy remain the same in the population.This study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator patients.Methods:Data were from the medical claims data in Taiwan.A total of 3880 patients with ventilator use for more than 14 days between 2005 and 2009 were identified.Among them,645 patients with tracheostomy conducted within 30 days of ventilator use were compared to 2715 patients without tracheostomy on death during hospitalization and study period,and successful weaning and medical utilization during hospitalization.Cox proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main outcomes.Results:The tracheostomy rate was 30%,and 55% of tracheostomies were performed within 30 days of mechanical ventilation.After adjustments,patients with tracheostomy were at a lower risk of death during hospitalization (hazard ratio [HR] =0.51;95% confidence interval [CI] =0.43-0.61) and 5-year observation (HR =0.73;95% CI =0.66-0.81),and a lower probability of successful weaning (HR =0.88;95% CI =0.79-0.99).Higher medical use was also observed in patients with tracheostomy.Conclusions:The beneficial effect for tracheostomy observed in our data was the reduction of death.However,patients with tracheostomy were less likely to wean and more likely to consume medical resources.

  3. Mortality, fecundity and development among bed bugs (Cimex lectularius) exposed to prolonged, intermediate cold stress.

    Rukke, Bjørn A; Hage, Morten; Aak, Anders


    Bed bugs (Cimex lectularius L.) have returned as a nuisance pest worldwide. Their ability to withstand different types of environmental stress should be explored in order potentially to increase the efficiency of control methods. Immediate and long-term effects of exposure to temperatures from 0 to -10 °C for 1, 2 and 3 weeks are reported. Fifth-instar nymphs and adults were exposed to constant or fluctuating temperatures. Increased cold and extended time yielded higher mortality; nymphs were more resilient than adults at the shorter durations of exposure. At intermediate temperatures, mortality was higher at constant compared with fluctuating temperatures, whereas all individuals died after 3 weeks of exposure to -7 °C. The success among survivors after cold treatment was also affected in terms of reduced egg production, hatching success and the ability of fifth-instar nymphs to advance into the adult stage; however, nymphs produced after cold treatment developed normally. Detrimental effects of prolonged exposure to low temperatures were seen in bed bugs both during and after cold treatment. The results suggest that temperatures below -7 °C can be applied by laymen to control this pest in small items if available treatment time is of less concern. © 2016 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. © 2016 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

  4. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review.

    Cheng, Hang; Chen, Brian Po-Han; Soleas, Ireena M; Ferko, Nicole C; Cameron, Chris G; Hinoul, Piet

    The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time.

  5. Prolonging warm ischemia reduces the cold preservation limits of liver grafts in swine

    De-Ke Qing


    BACKGROUND:The critical shortage of transplantable organs necessitates utilization of unconventional donors. But the safe time limits of cold preservation of liver grafts subjected to warm ischemia (WI) for up to 30 minutes from non-heart-beating-donors (NHBDs) has not been delineated. In this study, we investigated how the limits of cold ischemia (CI) in University of Wisconsin (UW) solution are changed in liver grafts subjected to WI from 10 to 30 minutes. METHODS:A simple porcine NHBD liver transplantation (LT) model was developed. In donors, livers were subjected to 10, 20 or 30 minutes of WI and subsequent different times of CI in UW solution. Animals were divided into three groups (WI 10 min, WI 20 min, WI 30 min, n=13 in each group) and nine subgroups (from CI 6 h to CI 28 h). One-week survival rates of recipients, hepatic function, liver energy metabolism, grafted liver microcirculation and pathological observations of the liver were compared. RESULTS:In the WI 10 min group, the one-week survival rate of the CI 20 h subgroup was signiifcantly higher than in the other two subgroups (CI 24 h and CI 28 h) (P CONCLUSIONS: The cold preservation limits of the liver grafts shortened from 20 to 12 to 6 hours when WI time was prolonged from 10 to 20 to 30 minutes. Only the liver grafts within these time limits could be safely transplanted.

  6. Acid-Responsive Therapeutic Polymer for Prolonging Nanoparticle Circulation Lifetime and Destroying Drug-Resistant Tumors.

    Piao, Ji-Gang; Gao, Feng; Yang, Lihua


    How to destroy drug-resistant tumor cells remains an ongoing challenge for cancer treatment. We herein report on a therapeutic nanoparticle, aHLP-PDA, which has an acid-activated hemolytic polymer (aHLP) grafted onto photothermal polydopamine (PDA) nanosphere via boronate ester bond, in efforts to ablate drug-resistant tumors. Upon exposure to oxidative stress and/or near-infrared laser irradiation, aHLP-PDA nanoparticle responsively releases aHLP, likely via responsive cleavage of boronate ester bond, and thus responsively exhibits acid-facilitated mammalian-membrane-disruptive activity. In vitro cell studies with drug-resistant and/or thermo-tolerant cancer cells show that the aHLP-PDA nanoparticle demonstrates preferential cytotoxicity at acidic pH over physiological pH. When administered intravenously, the aHLP-PDA nanoparticle exhibits significantly prolonged blood circulation lifetime and enhanced tumor uptake compared to bare PDA nanosphere, likely owing to aHLP's stealth effects conferred by its zwitterionic nature at blood pH. As a result, the aHLP-PDA nanoparticle effectively ablates drug-resistant tumors, leading to 100% mouse survival even on the 32nd day after suspension of photothermal treatment, as demonstrated with the mouse model. This work suggests that a combination of nanotechnology with lessons learned in bacterial antibiotic resistance may offer a feasible and effective strategy for treating drug-resistant cancers often found in relapsing patients.

  7. Butyrylcholinesterase gene mutations in patients with prolonged apnea after succinylcholine for electroconvulsive therapy

    Mollerup, Hannah Malthe; Gätke, M R


    patients undergoing electroconvulsive therapy (ECT) often receive succinylcholine as part of the anesthetic procedure. The duration of action may be prolonged in patients with genetic variants of the butyrylcholinesterase enzyme (BChE), the most common being the K- and the A-variants. The aim...... of the study was to assess the clinical significance of genetic variants in butyrylcholinesterase gene (BCHE) in patients with a suspected prolonged duration of action of succinylcholine after ECT....

  8. Subtleties in practical application of prolonged infusion of β-lactam antibiotics.

    De Waele, Jan J; Lipman, Jeffrey; Carlier, Mieke; Roberts, Jason A


    Prolonged infusion (PI) of β-lactam antibiotics is increasingly used in order to optimise antibiotic exposure in critically ill patients. Physicians are often not aware of a number of subtleties that may jeopardise the treatment. In this clinically based paper, we stress pragmatic issues, such as the importance of a loading dose before PI, and discuss a number of important practicalities that are mandatory to benefit from the pharmacokinetic advantages of prolonged β-lactam antibiotic administration.

  9. Butyrylcholinesterase gene mutations in patients with prolonged apnea after succinylcholine for electroconvulsive therapy

    Mollerup, Hannah Malthe; Gätke, M R


    patients undergoing electroconvulsive therapy (ECT) often receive succinylcholine as part of the anesthetic procedure. The duration of action may be prolonged in patients with genetic variants of the butyrylcholinesterase enzyme (BChE), the most common being the K- and the A-variants. The aim...... of the study was to assess the clinical significance of genetic variants in butyrylcholinesterase gene (BCHE) in patients with a suspected prolonged duration of action of succinylcholine after ECT....

  10. Seizures following hippocampal kindling induce QT interval prolongation and increased susceptibility to arrhythmias in rats.

    Bealer, Steven L; Little, Jason G


    The prolonged seizures of status epilepticus produce chronic arrhythmogenic changes in cardiac function. This study was designed to determine if repeated, self-limiting seizures administered to kindled rats induce similar cardiac dysfunction. Multiple seizures administered to rats following hippocampal kindling resulted in cardiac QT interval prolongation and increased susceptibility to experimental arrhythmias. These data suggest that multiple, self-limiting seizures of intractable epilepsy may have cardiac effects that can contribute to sudden unexpected death in epilepsy (SUDEP).

  11. Development and Optimization of a Novel Prolonged Release Formulation to Resist Alcohol-Induced Dose Dumping

    Gujjar, Chaitanya Yogananda; Rallabandi, Balaramesha Chary; Gannu, Ramesh; Deulkar, Vallabh Subashrao


    Alcohol-induced dose dumping is a serious concern for the orally administered prolonged release dosage forms. The study was designed to optimize the independent variables, propylene glycol alginate (PGA), Eudragit RS PO (ERS) and coating in mucoadhesive quetiapine prolonged release tablets 200 mg required for preventing the alcohol-induced dose dumping. Optimal design based on response surface methodology was employed for the optimization of the composition. The formulations are evaluated for...

  12. Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management


    Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospi...

  13. Using a modified nasotracheal tube to prevent nasal ala pressure sore during prolonged nasotracheal intubation.

    Cherng, Chen-Hwan; Chen, Yuan-Wu


    Nasotracheal tube induced nasal ala pressure sores or necrosis during prolonged nasotracheal intubation have been reported, and it is a serious but preventable complication. Here we introduce a modified nasotracheal tube to prevent this complication. This modified nasotracheal tube is composed of two parts, an oral endotracheal tube and a proximal part of a preformed nasotracheal tube, which are linked by a connector. The use of this modified nasotracheal tube can prevent nasal ala pressure sores during prolonged nasotracheal intubation.

  14. Prolonged exercise following diuretic-induced hypohydration: effects on cardiovascular and thermal strain.

    Roy, B D; Green, H J; Burnett, M E


    To examine the role of a reduction in plasma volume (PV) on the cardiovascular and thermoregulatory responses to submaximal exercise, ten untrained males (VO2 peak = 3.96 +/- 0.14 L x min(-1); mean +/- SE) performed 60 min of cycle exercise at -61% of VO2 peak while on a diuretic (DIU) and under control (CON) conditions. Participants consumed either Novotriamazide (100 mg triameterene + 50 mg hydrochlorothiazide, a diuretic) or a placebo, in random order, for 4 days prior to the exercise. Diuretic resulted in a calculated 14.6% reduction (P DIU compared with CON. No differences were observed for cardiac output (Qc) and stroke volume (SV) at rest for the two conditions, but during exercise both Qc and SV were lower (P DIU. Exercise VO2 (L x min(-1)) for CON and DIU at 30 min (2.39 +/- 0.09 vs 2.43 +/- 0.08) and 60 min (2.56 +/- 0.08 vs 2.53 +/- 0.12) were similar between conditions. Whole body a-vO2 difference was significantly greater (P DIU both at rest and during exercise as compared with CON. Rectal temperature (Tre) was significantly higher (P DIU from 15 min to the end of exercise. Blood concentrations of norepinephrine were higher (P DIU compared to CON at 15 min of exercise and beyond. For blood epinephrine, no differences were observed between DIU and CON. These results suggest that reductions in PV led to greater circulating concentrations of norepinephrine which likely resulted from increased cardiac and thermoregulatory stresses. In addition, reductions in PV do not appear to increase cardiovascular instability during prolonged dynamic exercise.

  15. Prolonged effect of allergen sublingual immunotherapy for house dust mites in elderly patients.

    Bozek, Andrzej; Starczewska-Dymek, Liwia; Jarzab, Jerzy


    The prolonged effect of allergen immunotherapy is unknown, especially in older patients. To analyze the 3-year effect of sublingual allergen-specific immunotherapy (SLIT) to house dust mites in elderly patients with allergic rhinitis. Forty-seven elderly patients (65.78 ± 4.89 years old) underwent SLIT to house dust mites and were monitored for 3 years and compared with a placebo group. SLIT was performed with the use of oral Staloral 300 SR Der p and Der f 50/50% extract (Stallergens Greer, London, United Kingdom) or placebo. Symptoms and medication score, represented by the average adjusted symptom score (AAdSS), serum level of immunoglobulin (Ig) G4 to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Der p 1, and Der p 2, and quality of life, were assessed immediately after SLIT and 3 years later. The AAdSS was significantly decreased after SLIT, and the level remained low during the 3 years after SLIT compared with placebo. Serum-specific IgG4 against D pteronyssinus, D farinae, Der p 1, and Der p 2 increased during the SLIT trial in the study group. For the 3 years of observation after SLIT, there were no significant changes of specific IgG4 levels against the analyzed allergens compared with results just after SLIT. Quality of life based on the Rhinoconjunctivitis Quality of Life Questionnaire score was significantly decreased in patients who received SLIT, from 1.48 (95% confidence interval 1.33-1.79) to 0.98 (95% confidence interval 0.67-1.07; P mites was observed in elderly patients with allergic rhinitis. Further trials are needed to confirm this effect. Identifier: NCT01605760. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  16. Sequential intrarectal diazepam and intravenous levetiracetam in treating acute repetitive and prolonged seizures.

    Modur, Pradeep N; Milteer, Warren E; Zhang, Song


    In this retrospective study of institutionalized patients with mental retardation, we present the efficacy and safety of sequential treatment with intrarectal diazepam (IRD) gel (Diastat) and intravenous levetiracetam (IVL) in comparison with either treatment alone for acute repetitive or prolonged seizures (ARPS). We defined ARPS as >or=3 seizures of any type within 1 h or a single seizure of any type lasting >or=3 min. Eighty-eight ARPS episodes were treated in 25 patients (14 female, age 21-72 years), with mainly symptomatic generalized epilepsy. There were no adverse events directly attributable to the administration of IRD or IVL. Seizure recurrence within 4 h of treatment, the primary outcome measure, was significantly lower after combined sequential IRD + IVL treatment (3 of 36) compared to IRD alone (6 of 24, p = 0.048) or IVL alone (10 of 28, p = 0.039). There was no statistically significant difference between the individual IRD and IVL treatments (p = 0.604). The estimated odds ratio (OR) indicated that the risk of seizure recurrence was higher after IRD or IVL monotherapy compared to combined IRD + IVL treatment. Subsequent emergency room (ER) transfers following seizure recurrence were least likely after IVL treatment (10%) compared to combined IRD + IVL (67%) or IRD (83%) treatment. These findings suggest that although IRD or IVL monotherapy is efficacious, the combination is superior in controlling ARPS in this special group of institutionalized patients. In addition, we speculate that a more reliable onset of action after IVL treatment results in rapid seizure control and fewer ER transfers, despite seizure recurrence.

  17. Hippocampal Malrotation (HIMAL) is Associated with Prolonged Febrile Seizures: Results of the FEBSTAT Study

    Chan, Stephen; Bello, Jacqueline A.; Shinnar, Shlomo; Hesdorffer, Dale C.; Lewis, Darrell V.; MacFall, James; Shinnar, Ruth C.; Gomes, William; Litherland, Claire; Xu, Yuan; Nordli, Douglas R.; Pellock, John M.; Frank, Matthew L.; Moshé, Solomon L.; Sun, Shumei


    Objective HIMAL (hippocampal malrotation) is characterized by incomplete hippocampal inversion with rounded shape and blurred internal architecture. There is still debate whether or not HIMAL has pathological significance. We present findings from the FEBSTAT study on the frequency and risk factors for HIMAL. Materials and Methods FEBSTAT is a prospective multicenter study investigating consequences of febrile status epilepticus (FSE) in childhood. MR imaging studies of 226 FSE subjects were analyzed visually by two board-certified neuroradiologists blinded to clinical details and compared to MR imaging studies of 96 subjects with first simple febrile seizure (FS). Quantitative analysis of hippocampal volume was performed by two independent observers. Results HIMAL was present in 20 (8.8%), of FSE cases compared with 2 (2.1%) of controls (odds ratio 4.56; 95% CI=1.05, 19.9). HIMAL was exclusively left-sided in 18 (81.8%), and bilateral in the remaining 4 (18.2%). There was no case of exclusively right-sided HIMAL. HIMAL was more common in boys than in girls (OR 6.1, 95%CI = (1.7, 21.5) On quantitative volumetric MR imaging analysis, the left hippocampal volume in HIMAL cases was smaller than in simple FS controls (p=0.004), and the R/L hippocampal volume ratio was higher in the HIMAL group compared to the simple FS group (p<0.001). Conclusion HIMAL is a developmental malformation that predominantly affects the left hippocampus in males, and is more frequently found in children with prolonged FSE than in controls. These data provide further evidence that HIMAL represents a pathological error in brain development rather than a normal variant. PMID:26496555

  18. Hospital Compare

    U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...

  19. Energy Cost during Prolonged Walking vs Jogging Exercise.

    Thomas, Tom R.; Londeree, Ben R.


    This study of nine young men compared the energy expended, substrates used, and perception of effort from brisk walking and jogging at the same target heart rates. Jogging utilized more total energy and fat energy than walking and was perceived as less strenuous. Oxygen pulse was higher during jogging. (Author/SM)

  20. Exemestane Following Tamoxifen Reduces Breast Cancer Recurrences and Prolongs Survival

    Postmenopausal women with early-stage hormone receptor-positive breast cancer had delayed disease recurrence and longer survival after taking 2-3 years of tamoxifen followed by exemestane for a total of 5 years compared to taking tamoxifen for 5 years.

  1. Role of Magnesium Sulfate in Prolonging the Analgesic Effect of ...

    Journal of Basic and Clinical Reproductive Sciences · January - June 2015 · Vol 4 · Issue 1. 24 ... rescue analgesic requirement in Group BM 2.5 (0.4) compared to Group B 3.6 (0.4). Incidence of postpartum .... nursing personnel. Data were ...

  2. Liposomal formulations of prilocaine, lidocaine and mepivacaine prolong analgesic duration.

    Cereda, Cíntia Maria Saia; Brunetto, Giovana Bruschini; de Araújo, Daniele Ribeiro; de Paula, Eneida


    A laboratory investigation was undertaken to compare the in vivo antinociceptive effects of 2% liposomal formulations of prilocaine (PLC), lidocaine (LDC) and mepivacaine (MVC) compared to plain solutions of each of these three local anesthetics. Large unilamellar vesicles were prepared by extrusion (400 nm), at pH 7.4. The membrane/water partition coefficients were obtained from encapsulation efficiency values, after incorporation of each local anesthetic to the vesicles. The anesthetic effect of each liposomal formulation was compared to the respective local anesthetic solution in water, using the infraorbital nerve-blockade test, in rats. The partition coefficients were: 57 for PLC, 114 for LDC and 93 for MVC. In vivo results showed that local anesthetic-free liposomes, used as control, had no analgesic effect. In contrast, the encapsulated formulations induced increased intensities of total anesthetic effect (35.3%, 26.1% and 57.1%) and time for recovery (percentage increases of 30%, 23.1% and 56%), respectively, for PLC, LDC and MVC when compared to the plain solutions (P Mepivacaine was affected to the greatest extent, while LDC benefited least from liposome encapsulation, possibly due to greater vasodilatory properties of LDC.

  3. Oxidative stress in patients with type 1 diabetes mellitus: is it affected by a single bout of prolonged exercise?

    Francescato, Maria Pia; Stel, Giuliana; Geat, Mario; Cauci, Sabina


    Presently, no clear-cut guidelines are available to suggest the more appropriate physical activity for patients with type 1 diabetes mellitus due to paucity of experimental data obtained under patients' usual life conditions. Accordingly, we explored the oxidative stress levels associated with a prolonged moderate intensity, but fatiguing, exercise performed under usual therapy in patients with type 1 diabetes mellitus and matched healthy controls. Eight patients (4 men, 4 women; 49±11 years; Body Mass Index 25.0±3.2 kg·m(-2); HbA1c 57±10 mmol·mol(-1)) and 14 controls (8 men, 6 women; 47±11 years; Body Mass Index 24.3±3.3 kg·m(-2)) performed a 3-h walk at 30% of their heart rate reserve. Venous blood samples were obtained before and at the end of the exercise for clinical chemistry analysis and antioxidant capacity. Capillary blood samples were taken at the start and thereafter every 30 min to determine lipid peroxidation. Patients showed higher oxidative stress values as compared to controls (95.9±9.7 vs. 74.1±12.2 mg·L(-1) H2O2; pexercise (p = NS), while oxidative defence increased significantly at the end of exercise (ptype 1 diabetes exercising under their usual life conditions (i.e. usual therapy and diet). Specifically, we found that the oxidative stress was not exacerbated due to a single bout of prolonged moderate intensity aerobic exercise, a condition simulating several outdoor leisure time physical activities. Oxidative defence increased in both patients and controls, suggesting beneficial effects of prolonged aerobic fatiguing exercise.

  4. RNOP-09: Pegylated liposomal doxorubicine and prolonged temozolomide in addition to radiotherapy in newly diagnosed glioblastoma - a phase II study

    Proescholdt Martin


    Full Text Available Abstract Background Although Temozolomide is effective against glioblastoma, the prognosis remains dismal and new regimens with synergistic activity are sought for. Methods In this phase-I/II trial, pegylated liposomal doxorubicin (Caelyx™, PEG-Dox and prolonged administration of Temozolomide in addition to radiotherapy was investigated in 63 patients with newly diagnosed glioblastoma. In phase-I, PEG-Dox was administered in a 3-by-3 dose-escalation regimen. In phase-II, 20 mg/m2 PEG-Dox was given once prior to radiotherapy and on days 1 and 15 of each 28-day cycle starting 4 weeks after radiotherapy. Temozolomide was given in a dose of 75 mg/m2 daily during radiotherapy (60 Gy and 150-200 mg/m2 on days 1-5 of each 28-day cycle for 12 cycles or until disease progression. Results The toxicity of the combination of PEG-Dox, prolonged administration of Temozolomide, and radiotherapy was tolerable. The progression free survival after 12 months (PFS-12 was 30.2%, the median overall survival was 17.6 months in all patients including the ones from Phase-I. None of the endpoints differed significantly from the EORTC26981/NCIC-CE.3 data in a post-hoc statistical comparison. Conclusion Together, the investigated combination is tolerable and feasible. Neither the addition of PEG-Dox nor the prolonged administration of Temozolomide resulted in a meaningful improvement of the patient's outcome as compared to the EORTC26981/NCIC-CE.3 data Trial registration NCT00944801.

  5. Prolonged Action Potential and After depolarizations Are Not due to Changes in Potassium Currents in NOS3 Knockout Ventricular Myocytes

    Honglan Wang


    Full Text Available Ventricular myocytes deficient in endothelial nitric oxide synthase (NOS3−/− exhibit prolonged action potential (AP duration and enhanced spontaneous activity (early and delayed afterdepolarizations during β-adrenergic (β-AR stimulation. Studies have shown that nitric oxide is able to regulate various K+ channels. Our objective was to examine if NOS3-/- myocytes had altered K+ currents. APs, transient outward (to, sustained (Ksus, and inward rectifier (K1 K+ currents were measured in NOS3-/- and wild-type (WT myocytes. During β-AR stimulation, AP duration (measured as 90% repolarization-APD90 was prolonged in NOS3−/− compared to WT myocytes. Nevertheless, we did not observe differences in to, Ksus, or K1 between WT and NOS3−/− myocytes. Our previous work showed that NOS3−/− myocytes had a greater Ca2+ influx via L-type Ca2+ channels with β-AR stimulation. Thus, we measured β-AR-stimulated SR Ca2+ load and found a greater increase in NOS3−/− versus WT myocytes. Hence, our data suggest that the prolonged AP in NOS3−/− myocytes is not due to changes in to, Ksus, or K1. Furthermore, the increase in spontaneous activity in NOS3−/− myocytes may be due to a greater increase in SR Ca2+ load. This may have important implications for heart failure patients, where arrhythmias are increased and NOS3 expression is decreased.

  6. Prolonged Culture of Aligned Skeletal Myotubes on Micromolded Gelatin Hydrogels

    Bettadapur, Archana; Suh, Gio C.; Geisse, Nicholas A.; Wang, Evelyn R.; Hua, Clara; Huber, Holly A.; Viscio, Alyssa A.; Kim, Joon Young; Strickland, Julie B.; McCain, Megan L.


    In vitro models of skeletal muscle are critically needed to elucidate disease mechanisms, identify therapeutic targets, and test drugs pre-clinically. However, culturing skeletal muscle has been challenging due to myotube delamination from synthetic culture substrates approximately one week after initiating differentiation from myoblasts. In this study, we successfully maintained aligned skeletal myotubes differentiated from C2C12 mouse skeletal myoblasts for three weeks by utilizing micromolded (μmolded) gelatin hydrogels as culture substrates, which we thoroughly characterized using atomic force microscopy (AFM). Compared to polydimethylsiloxane (PDMS) microcontact printed (μprinted) with fibronectin (FN), cell adhesion on gelatin hydrogel constructs was significantly higher one week and three weeks after initiating differentiation. Delamination from FN-μprinted PDMS precluded robust detection of myotubes. Compared to a softer blend of PDMS μprinted with FN, myogenic index, myotube width, and myotube length on μmolded gelatin hydrogels was similar one week after initiating differentiation. However, three weeks after initiating differentiation, these parameters were significantly higher on μmolded gelatin hydrogels compared to FN-μprinted soft PDMS constructs. Similar results were observed on isotropic versions of each substrate, suggesting that these findings are independent of substrate patterning. Our platform enables novel studies into skeletal muscle development and disease and chronic drug testing in vitro.

  7. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

    Tans Joseph; Eekhof Just AH; Brand Ronald; van der Hout Wilbert B; van Houwelingen Hans C; Peul Wilco C; Thomeer Ralph TWM; Koes Bart W


    Abstract Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the di...

  8. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial

    Peul, Wilco; Hout, Wilbert; Brand, René; Thomeer, Raph; Koes, Bart


    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions: Early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed. Main outcome measures: Scores from Roland disability questionnaire for sciatica, visua...

  9. Respiratory dynamics and dead space to tidal volume ratio of volume-controlled versus pressure-controlled ventilation during prolonged gynecological laparoscopic surgery.

    Lian, Ming; Zhao, Xiao; Wang, Hong; Chen, Lianhua; Li, Shitong


    Laparoscopic operations have become longer and more complex and applied to a broader patient population in the last decades. Prolonged gynecological laparoscopic surgeries require prolonged pneumoperitoneum and Trendelenburg position, which can influence respiratory dynamics and other measurements of pulmonary function. We investigated the differences between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) and tried to determine the more efficient ventilation mode during prolonged pneumoperitoneum in gynecological laparoscopy. Twenty-six patients scheduled for laparoscopic radical hysterectomy combined with or without laparoscopic pelvic lymphadenectomy were randomly allocated to be ventilated by either VCV or PCV. Standard anesthesic management and laparoscopic procedures were performed. Measurements of respiratory and hemodynamic dynamics were obtained after induction of anesthesia, at 10, 30, 60, and 120 min after establishing pneumoperitoneum, and at 10 min after return to supine lithotomy position and removal of carbon dioxide. The logistic regression model was applied to predict the corresponding critical value of duration of pneumoperitoneum when the Ppeak was higher than 40 cmH2O. Prolonged pneumoperitoneum and Trendelenburg position produced significant and clinically relevant changes in dynamic compliance and respiratory mechanics in anesthetized patients under PCV and VCV ventilation. Patients under PCV ventilation had a similar increase of dead space/tidal volume ratio, but had a lower Ppeak increase compared with those under VCV ventilation. The critical value of duration of pneumoperitoneum was predicted to be 355 min under VCV ventilation, corresponding to the risk of Ppeak higher than 40 cmH2O. Both VCV and PCV can be safely applied to prolonged gynecological laparoscopic surgery. However, PCV may become the better choice of ventilation after ruling out of other reasons for Ppeak increasing.

  10. Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm.

    Stahrenberg, Raoul; Weber-Krüger, Mark; Seegers, Joachim; Edelmann, Frank; Lahno, Rosine; Haase, Beatrice; Mende, Meinhard; Wohlfahrt, Janin; Kermer, Pawel; Vollmann, Dirk; Hasenfuss, Gerd; Gröschel, Klaus; Wachter, Rolf


    Diagnosis of paroxysmal atrial fibrillation is difficult but highly relevant in patients presenting with cerebral ischemia yet free from atrial fibrillation on admission. Early initiation and prolongation of continuous Holter monitoring may improve diagnostic yield compared with the standard of care including a 24-hour Holter recording. In the observational Find-AF trial (ISRCTN 46104198), consecutive patients presenting with symptoms of cerebral ischemia were included. Patients free from atrial fibrillation at presentation received 7-day Holter monitoring. Two hundred eighty-one patients were prospectively included. Forty-four (15.7%) had atrial fibrillation documented by routine electrocardiogram on admission. All remaining patients received Holter monitors at a median of 5.5 hours after presentation. In those 224 patients who received Holter monitors but had no previously known paroxysmal atrial fibrillation, the detection rate with early and prolonged (7 days) Holter monitoring (12.5%) was significantly higher than for any 24-hour (mean of 7 intervals: 4.8%, P = 0.015) or any 48-hour monitoring interval (mean of 6 intervals: 6.4%, P = 0.023). Of those 28 patients with new atrial fibrillation on Holter monitoring, 15 (6.7%) had been discharged without therapeutic anticoagulation after routine clinical care (ie, with data from 24-hour Holter monitoring only). Detection rates were 43.8% or 6.3% for short supraventricular runs of ≥ 10 beats or prolonged episodes (> 5 hours) of atrial fibrillation, respectively. Diagnostic yield appeared to be only slightly and not significantly increased during the first 3 days after the index event. Prolongation of Holter monitoring in patients with symptoms of cerebral ischemic events increases the rate of detection of paroxysmal atrial fibrillation up to Day 7, leading to a relevant change in therapy in a substantial number of patients. Early initiation of monitoring does not appear to be crucial. Hence, prolonged Holter

  11. Blood pressure and plasma catecholamines in acute and prolonged hypoxia

    Kanstrup, I L; Poulsen, T D; Hansen, J M


    and 5 days after rapid, passive transport to high altitude (4,559 m). Acute mountain sickness scores ranged from 5 to 16 (maximal attainable score: 20) on the first day but were reduced to 0-8 by the fifth day. Systolic blood pressure, heart rate, and plasma epinephrine increased on day 1 at altitude...... compared with sea level but declined again on day 5, whereas diastolic and mean blood pressures continued to rise in parallel with plasma norepinephrine. With local cooling, an increased vasoactive response was seen on the fifth day at altitude. Very high pressures were obtained, and the pressure elevation...

  12. Peculiar features of ionospheric F3 layer during prolonged solar minimum (2007-2009)

    Nayak, C. K.; Yadav, V.; Kakad, B.; Sripathi, S.; Emperumal, K.; Pant, T. K.; Bhattacharyya, A.; Jin, Shuanggen


    We present the seasonal and local time occurrence of ionospheric F3 layer over Tirunelveli (geographic longitude 77.8°E, geographic latitude 8.7°N, dip 0.7°) during extremely low and prolonged solar activity period (2007-2009). Canadian Advanced Digital Ionosonde observations from this station are used in the present study. We find that the occurrence of F3 layer is nearly 3 times higher during 2009 (˜ 48%) as compared to that during 2007 (˜16%). The increase of this order just within the low solar activity period is unusual. In earlier studies similar increase in F3 occurrence has been reported when solar activity changes from high (F10.7=182) to low (F10.7=72). The other important feature is the presence of postnoon F3 layers which are observed dominantly during summer solstice of 2009. Such occurrence of postnoon F3 layers was nearly absent during summer solstice of the previous solar minimum (1996) over nearby dip equatorial station Trivandrum. We take equatorial electrojet (EEJ) as a proxy for eastward electric field. It is noticed that the EEJ strength and the maximum rate of change of EEJ are higher for F3 days as compared to those on non-F3 days. We find that the peak occurrence of prenoon F3 layer closely coincides with the time of maximum rate of change of EEJ. It is in general accordance with the theory proposed by Balan et al. (1998) that suggests the formation of F3 through vertically upward E × B drift in presence of equatorward neutral wind. The present study reveals that the rate of change of eastward electric field (dE/dt) as well plays an important role in the formation of F3 layer.

  13. Entacapone prolongs the reduction of PLM by levodopa/carbidopa in restless legs syndrome.

    Polo, Olli; Ylä-Sahra, Riitta; Hirvonen, Kari; Karvinen, Johanna; Vahteristo, Mikko; Ellmén, Juha


    Levodopa is effective in the treatment of restless legs syndrome (RLS). However, due to the short duration of action of conventional levodopa/decarboxylase inhibitor formulations, multiple dosing may be required in individual patients with persisting symptoms. We assessed whether a new levodopa formulation containing levodopa, carbidopa, and entacapone (LCE) improves levodopa action in RLS. Twenty-eight RLS patients with periodic limb movement (PLM) received single doses of Stalevo 50 (LCE50; 50/12.5/200 mg), Stalevo 100 (LCE100; 100/25/200 mg), Stalevo 150 (LCE150; 150/37.5/200 mg), Sinemet 100 (LC100; 100/25 mg), or placebo in a randomized, double-blind, crossover study with polysomnography. Periodic limb movements per hour (PLM/h) during total sleep time and PLM during total time in bed were the primary and secondary variables, respectively. Mean PLM/h during total sleep time after Stalevo 50 (12.6/h, P PLM/h during total time in bed for all treatments (P < 0.01) and a significant dose response observed between LCE doses (P < 0.05). Compared with LC100, LCE100 and LCE150 reduced PLMs during the second half (P = 0.06 and P < 0.001, respectively) or during the last 3 early morning hours (hours 5-7 from the start of recording) of the night (P < 0.05 and P < 0.01, respectively). All formulations were well tolerated. Single doses of LCE tablets decreased PLMs in a dose-related manner in RLS patients. Prolonged effects of levodopa on PLMs suggest that, compared with standard levodopa, this new levodopa formulation provides longer symptom control throughout the night in patients with previously untreated RLS.

  14. Delirium in advanced age and dementia: A prolonged refractory course of delirium and lower functional status



    Objective The factors associated with persistent delirium, in contrast to resolved delirium, have not been studied well. The aim of our present study was to identify the factors associated with delirium resolution as measured by the Memorial Delirium Assessment Scale (MDAS) and functional improvement as measured by the Karnofsky Performance Status (KPS) scale. Method All subjects were recruited from psychiatric referrals at the Memorial Sloan Kettering Cancer Center (MSKCC). The two study instruments were performed at baseline (T1), at 2–3 days (T2), and at 4–7 days (T3). Subjects with persistent delirium were compared to those with resolved delirium in respect to sociodemographic and medical variables. Results Overall, 26 out of 111 patients had persistent delirium. These patients were older, predominantly male, and had more frequently preexisting comorbid dementia. Among cancer diagnoses and stage of illness, brain cancer and terminal illness contributed to persistent delirium or late response, whereas gastrointestinal cancer was associated with resolved delirium. Among etiologies, infection responded late to delirium management, usually at one week. Furthermore, delirium was more severe in patients with persistent delirium from baseline through one week. At baseline, MDAS scores were 20.1 in persistent delirium compared to 17 to 18.8 in resolved delirium (T2 and T3), and at one week of management (T3), MDAS scores were 15.2 and 4.7 to 7.4, respectively. At one week of management, persistent delirium manifested in more severe impairment in the domains of consciousness, cognition, organization, perception, psychomotor behavior, and sleep–wake cycle. In addition, persistent delirium caused more severe functional impairment. Significance of results In this delirium sample, advanced age and preexisting dementia, as well as brain cancer, terminal illness, infection, and delirium severity contributed to persistent delirium or late response, indicating a prolonged

  15. [Oleanolic acid synergizes with cyclosporine A to prolong renal allograft survival in rats].

    Qian, Kun; Liao, Wenting; Li, Jianjun; Jiang, Hongtao; Zhou, Hao; Long, Jianhua; Qin, Guoqing; Wang, Yi


    To investigate the synergistic effect of oleanolic acid (OA) and cyclosporine A (CsA) on the survival of renal allografts in rats. Renal allograft transplantation was performed using BN rats as donors and LEW rats as recipients. Forty male LEW rats were randomized into 4 equal groups for interventions with DMSO-PBS (control), OA, CsA, or CsA+OA, starting from 1 day before transplantation. Serum creatinine levels were regularly examined, and the survival of rats were recorded. On day 5 after transplantation, CD4(+) and CD8(+) T-cell infiltration in the renal grafts was analyzed by immunohistochemistry; the concentrations of the proinflammatory cytokines (IL-1β, IFN-γ, IL-2, IL-4, and IL-17), anti-inflammatory cytokine IL-10 and chemokines (IP-10, MCP-1, MIP, and Mig) were analyzed with Luminex; the T-cell phenotypes (IFN-γ, IL-10, IL-4, and IL-17) were analyzed using ELISpot. In OA+CsA group, renal allograft survival was markedly prolonged and CD4(+) and CD8(+) T cell infiltration in the graft significantly decreased as compared to other groups. A significant decrease in IL-2 was observed in OA group and OA+CsA group, especially the latter. Compared with the control group, all the 3 treated groups showed significantly decreased IL-1β, IP-10 and MCP-1, increased IL-10 levels, decreased percentages of T cells secreting IFN-γ, IL-4 and IL-17, and increased percentage of T cells secreting IL-10. The increments of serum IL-10 level and T cell percentage were more prominent in OA+CsA group than in the other two intervention groups. OA and CsA synergistically ameliorate renal graft rejection and inflammation and promote allograft survival and function in rats.

  16. P wave dispersion is prolonged in patients with Wilson's disease


    AIM: To investigate the P wave dispersion as a noninvasive marker of intra-atrial conduction disturbances in patients with Wilson's disease. METHODS: We compared Wilson's disease patients (n=18) with age matched healthy subjects (n=15) as controls. The diagnosis was based on clinical symptoms, laboratory tests (ceruloplasmin, urinary and hepatic copper concentrations). P wave dispersion, a measurement of the heterogeneity of atrial depolarization, was measured as the difference between the duration of the longest and the shortest P-waves in 12 lead electrocardiography. RESULTS: All the patients were asymptomatic on cardiological examination and have sinusal rhythm in electrocardiography. Left ventricular and left atrial diameters, left ventricular ejection fraction and left ventricular mass index were similar in both groups. The Wilson's disease patients had a significantly higher P wave dispersion compared with the controls (44.7+5.8vs 25.7±2.5,P<0.01=. CONCLUSION: There was an increase in P wave dispersion in cardiologically asymptomatic Wilson's disease patients which probably represents an early stage of cardiac involvement.

  17. Inhibition of spontaneous recovery of fear by mGluR5 after prolonged extinction training.

    Sheng-Chun Mao

    Full Text Available Fear behavior is vital for survival and involves learning contingent associations of non-threatening cues with aversive stimuli. In contrast, excessive levels of fear can be maladaptive and lead to anxiety disorders. Generally, extensive sessions of extinction training correlates with reduced spontaneous recovery. The molecular mechanisms underlying the long-term inhibition of fear recovery following repeated extinction training are not fully understood. Here we show that in rats, prolonged extinction training causes greater reduction in both fear-potentiated startle and spontaneous recovery. This effect was specifically blocked by metabotropic glutamate receptor 5 (mGluR5, but not by mGluR1 antagonists and by a protein synthesis inhibitor. Similar inhibition of memory recovery following prolonged extinction training was also observed in mice. In agreement with the instrumental role of mGluR5 in the prolonged inhibition of fear recovery, we found that FMR1-/- mice which exhibit enhanced mGluR5-mediated signaling exhibit lower spontaneous recovery of fear after extinction training than wild-type littermates. At the molecular level, we discovered that prolonged extinction training reversed the fear conditioning-induced increase in surface expression of GluR1, AMPA/NMDA ratio, postsynaptic density-95 (PSD-95 and synapse-associated protein-97 (SAP97. Accordingly, delivery of Tat-GluR2(3Y, a synthetic peptide that blocks AMPA receptor endocytosis, inhibited prolonged extinction training-induced inhibition of fear recovery. Together, our results demonstrate that prolonged extinction training results in the mGluR5-dependent long-term inhibition of fear recovery. This effect may involve the degradation of original memory and may explain the beneficial effects of prolonged exposure therapy for the treatment of phobias.

  18. Inhibition of spontaneous recovery of fear by mGluR5 after prolonged extinction training.

    Mao, Sheng-Chun; Chang, Chih-Hua; Wu, Chia-Chen; Orejarena, M Juliana; Orejanera, Maria Juliana; Manzoni, Olivier J; Gean, Po-Wu


    Fear behavior is vital for survival and involves learning contingent associations of non-threatening cues with aversive stimuli. In contrast, excessive levels of fear can be maladaptive and lead to anxiety disorders. Generally, extensive sessions of extinction training correlates with reduced spontaneous recovery. The molecular mechanisms underlying the long-term inhibition of fear recovery following repeated extinction training are not fully understood. Here we show that in rats, prolonged extinction training causes greater reduction in both fear-potentiated startle and spontaneous recovery. This effect was specifically blocked by metabotropic glutamate receptor 5 (mGluR5), but not by mGluR1 antagonists and by a protein synthesis inhibitor. Similar inhibition of memory recovery following prolonged extinction training was also observed in mice. In agreement with the instrumental role of mGluR5 in the prolonged inhibition of fear recovery, we found that FMR1-/- mice which exhibit enhanced mGluR5-mediated signaling exhibit lower spontaneous recovery of fear after extinction training than wild-type littermates. At the molecular level, we discovered that prolonged extinction training reversed the fear conditioning-induced increase in surface expression of GluR1, AMPA/NMDA ratio, postsynaptic density-95 (PSD-95) and synapse-associated protein-97 (SAP97). Accordingly, delivery of Tat-GluR2(3Y), a synthetic peptide that blocks AMPA receptor endocytosis, inhibited prolonged extinction training-induced inhibition of fear recovery. Together, our results demonstrate that prolonged extinction training results in the mGluR5-dependent long-term inhibition of fear recovery. This effect may involve the degradation of original memory and may explain the beneficial effects of prolonged exposure therapy for the treatment of phobias.

  19. Quetiapine, QTc interval prolongation, and torsade de pointes: a review of case reports.

    Hasnain, Mehrul; Vieweg, W Victor R; Howland, Robert H; Kogut, Christopher; Breden Crouse, Ericka L; Koneru, Jayanthi N; Hancox, Jules C; Digby, Geneviève C; Baranchuk, Adrian; Deshmukh, Anand; Pandurangi, Ananda K


    Recently, both the manufacturer of quetiapine and the US Food and Drug Administration warned healthcare providers and patients about quetiapine-induced QTc interval prolongation and torsade de pointes (TdP) when using this drug within the approved labeling.  We reviewed the case-report literature and found 12 case reports of QTc interval prolongation in the setting of quetiapine administration. There were no cases of quetiapine-induced TdP or sudden cardiac death (SCD) among patients using quetiapine appropriately and free of additional risk factors for QTc interval prolongation and TdP. Among the 12 case reports risk factors included female sex (nine cases), coadministration of a drug associated with QTc interval prolongation (eight cases), hypokalemia or hypomagnesemia (six cases) quetiapine overdose (five cases), cardiac problems (four cases), and coadministration of cytochrome P450 3A4 inhibitors (two cases). There were four cases of TdP. As drug-induced TdP is a rare event, prospective studies to evaluate the risk factors associated with QTc prolongation and TdP are difficult to design, would be very costly, and would require very large samples to capture TdP rather than its surrogate markers. Furthermore, conventional statistical methods may not apply to studies of TdP, which is rare and an 'outlier' manifestation of QTc prolongation. We urge drug manufacturers and regulatory agencies to periodically publish full case reports of psychotropic drug-induced QTc interval prolongation, TdP, and SCD so that clinicians and investigators may better understand the clinical implications of prescribing such drugs as quetiapine.

  20. Evaluating acellular versus cellular perfusate composition during prolonged ex vivo lung perfusion after initial cold ischaemia for 24 hours.

    Becker, Simon; Steinmeyer, Jasmin; Avsar, Murat; Höffler, Klaus; Salman, Jawad; Haverich, Axel; Warnecke, Gregor; Ochs, Matthias; Schnapper, Anke


    Normothermic ex vivo lung perfusion (EVLP) has developed as a powerful technique to evaluate particularly marginal donor lungs prior to transplantation. In this study, acellular and cellular perfusate compositions were compared in an identical experimental setting as no consensus has been reached on a preferred technique yet. Porcine lungs underwent EVLP for 12 h on the basis of an acellular or a cellular perfusate composition after 24 h of cold ischaemia as defined organ stress. During perfusion, haemodynamic and respiratory parameters were monitored. After EVLP, the lung condition was assessed by light and transmission electron microscopy. Aerodynamic parameters did not show significant differences between groups and remained within the in vivo range during EVLP. Mean oxygenation indices were 491 ± 39 in the acellular group and 513 ± 53 in the cellular group. Groups only differed significantly in terms of higher pulmonary artery pressure and vascular resistance in the cellular group. Lung histology and ultrastructure were largely well preserved after prolonged EVLP and showed only minor structural alterations which were similarly present in both groups. Prolonged acellular and cellular EVLP for 12 h are both feasible with lungs prechallenged by ischaemic organ stress. Physiological and ultrastructural analysis showed no superiority of either acellular or cellular perfusate composition.

  1. Do Prolonged Prophylactic Antibiotics Reduce the Incidence of Surgical-Site Infections in Immediate Prosthetic Breast Reconstruction?

    Wang, Frederick; Chin, Robin; Piper, Merisa; Esserman, Laura; Sbitany, Hani


    Approximately 50,000 women in the United States undergo mastectomy and immediate prosthetic breast reconstruction annually, and most receive postoperative prophylactic antibiotics. The effect of these antibiotics on the risk of surgical-site infections remains unclear. The authors searched the Medline, Embase, and Cochrane Library databases for studies that compared less than 24 hours and greater than 24 hours of antibiotics following immediate prosthetic breast reconstruction. Primary outcomes were surgical-site infections and implant loss. Conservative random effects models were used to obtain pooled relative risk estimates. The authors identified 927 studies, but only four cohort studies and one randomized controlled trial met their inclusion criteria. Unadjusted incidences of surgical-site infections were 14 percent with more than 24 hours of antibiotics, 19 percent with less than 24 hours of antibiotics, and 16 percent overall. Unadjusted incidences of implant loss were 8 percent with more than 24 hours of antibiotics, 10 percent with less than 24 hours of antibiotics, and 9 percent overall. The pooled relative risk of implant loss was 1.17 (95 percent CI, 0.39 to 3.6) with less than 24 hours of antibiotics, which was not statistically significant. Prolonged antibiotic use did not have a statistically significant effect on reducing surgical-site infections or implant loss. There was significant heterogeneity between studies, and prolonged antibiotics may have increased the risk of implant loss in the randomized controlled trial. Definitive evidence may only be obtained with data from more prospective randomized controlled trials.

  2. The Analysis of the Causes of Prolonged Hospitalization after Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma

    Chang, Nam Kyu; Jeong, Yong Yeon [Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Park, Seo Yeon; Kim, Jae Kyu [Chonnam National University Medical School, Chonnam National University Hospital, Gwangju (Korea, Republic of)


    We wanted to analyze the causes of prolonged hospitalization (over 7 days) after transarterial chemoembolization (TACE) in patients with unresectable Hepatocellular Carcinoma and its related factors. We analyzed the total hospital days after patients with unresectable Hepatocellular Carcinoma received transarterial chemoembolization, and these patients were treated during the recent 6 month at our hospital. Two hundred twenty three sessions showed a short term hospital stay (less than 7 days) and 57 sessions showed a prolonged hospital stay (more than 7 days), so a total of 280 sessions were analyzed. The hospital stay less than seven days was set for the control group and this was correlated with the patient's age, gender, the level of bilirubin and albumin, the platelet counts, the AST/ALT ratio, the a-FT, the presence of portal vein thrombosis and ascites, several scoring systems (Child-Pugh, CLIP, and OKUDA score) and the need for additional embolization at the time of the procedure. Compared with that of the control group, ascites (p=0.004), portal vein thrombosis (p=0.000), a platelet count below the hundred thousand (p=0.012), a Child-Pugh score more than B (p=0.023), a CLIP score more than 2 (p=0.000) and a OKUDA score more than II (p=0.000) showed significant differences. The evaluation of patients' factors would be useful to predict extended post-procedural hospitalization after hepatic chemoembolisation

  3. Prolonged exposure of mixed aerobic cultures to low temperature and benzalkonium chloride affect the rate and extent of nitrification.

    Yang, Jeongwoo; Tezel, Ulas; Li, Kexun; Pavlostathis, Spyros G


    The combined effect of benzalkonium chloride (BAC) and prolonged exposure to low temperature on nitrification was investigated. Ammonia oxidation at 22-24°C by an enriched nitrifying culture was inhibited at increasing BAC concentrations and ceased at 15 mg BAC/L. The non-competitive inhibition coefficient was 1.5±0.9 mg BAC/L. Nitrification tests were conducted without and with BAC at 5mg/L using an aerobic, mixed heterotrophic/nitrifying culture maintained at a temperature range of 24-10°C. Maintaining this culture at 10°C for over one month in the absence of BAC, resulted in slower nitrification kinetics compared to those measured when the culture was first exposed to 10°C. BAC was degraded by the heterotrophic population, but its degradation rate decreased significantly as the culture temperature decreased to 10°C. These results confirm the negative impact of quaternary ammonium compounds on the nitrification process, which is further exacerbated by prolonged, low temperature conditions.

  4. New approaches in the management of insomnia: weighing the advantages of prolonged-release melatonin and synthetic melatoninergic agonists

    Rüdiger Hardeland


    Full Text Available Rüdiger HardelandJohann Friedrich Blumenbach Institute of Zoology and Anthropology, University of Göttingen, GermanyAbstract: Hypnotic effects of melatonin and melatoninergic drugs are mediated via MT1 and MT2 receptors, especially those in the circadian pacemaker, the suprachiasmatic nucleus, which acts on the hypothalamic sleep switch. Therefore, they differ fundamentally from GABAergic hypnotics. Melatoninergic agonists primarily favor sleep initiation and reset the circadian clock to phases allowing persistent sleep, as required in circadian rhythm sleep disorders. A major obstacle for the use of melatonin to support sleep maintenance in primary insomnia results from its short half-life in the circulation. Solutions to this problem have been sought by developing prolonged-release formulations of the natural hormone, or melatoninergic drugs of longer half-life, such as ramelteon, tasimelteon and agomelatine. With all these drugs, improvements of sleep are statistically demonstrable, but remain limited, especially in primary chronic insomnia, so that GABAergic drugs may be indicated. Melatoninergic agonists do not cause next-day hangover and withdrawal effects, or dependence. They do not induce behavioral changes, as sometimes observed with z-drugs. Despite otherwise good tolerability, the use of melatoninergic drugs in children, adolescents, and during pregnancy has been a matter of concern, and should be avoided in autoimmune diseases and Parkinsonism. Problems and limits of melatoninergic hypnotics are compared.Keywords: agomelatine, hypnotics, melatonin, prolonged-release, ramelteon, tasimelteon

  5. Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

    Steffie H A Brouns

    Full Text Available To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS in elderly ED patients (226565 years old and in younger patients (1 consultation during the emergency department visit (odds ratio (OR 3.2, 95% confidence interval (CI 2.3-4.3, a higher number of diagnostic tests (OR 1.2, 95% CI 1.16-1.33 and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0-8.8 and OR 2.3, 95% CI 1.4-3.9. In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4-4.6. Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.Organisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.

  6. Prolonged Starvation Causes Up-Regulation of AQP1 in Adipose Tissue Capillaries of AQP7 Knock-Out Mice

    Mariusz T. Skowronski


    Full Text Available Aquaporins (AQPs are membrane proteins involved in the regulation of cellular transport and the balance of water and glycerol and cell volume in the white adipose tissue (WAT. In our previous study, we found the co-expression of the AQP1 water channel and AQP7 in the mouse WAT. In our present study, we aimed to find out whether prolonged starvation influences the AQP1 expression of AQP7 knock-out mice (AQP7 KO in the WAT. To resolve this hypothesis, immunoperoxidase, immunoblot and immunogold microscopy were used. AQP1 expression was found with the use of immunohistochemistry and was confirmed by immunogold microscopy in the vessels of mouse WAT of all studied groups. Semi-quantitative immunoblot and quantitative immunogold microscopy showed a significant increase (by 2.5- to 3-fold in the abundance of AQP1 protein expression in WAT in the 72 h starved AQP7 KO mice as compared to AQP7+/+ (p < 0.05 and AQP7−/− (p < 0.01 controls, respectively. In conclusion, the AQP1 water channel located in the vessels of WAT is up-regulated in response to prolonged starvation in the WAT of AQP7 KO mice. The present data suggest that an interaction of different AQP isoforms is required for maintaining proper water homeostasis within the mice WAT.

  7. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy

    Eggermont, Alexander M M; Chiarion-Sileni, Vanna; Grob, Jean-Jacques;


    Background On the basis of data from a phase 2 trial that compared the checkpoint inhibitor ipilimumab at doses of 0.3 mg, 3 mg, and 10 mg per kilogram of body weight in patients with advanced melanoma, this phase 3 trial evaluated ipilimumab at a dose of 10 mg per kilogram in patients who had...... undergone complete resection of stage III melanoma. Methods After patients had undergone complete resection of stage III cutaneous melanoma, we randomly assigned them to receive ipilimumab at a dose of 10 mg per kilogram (475 patients) or placebo (476) every 3 weeks for four doses, then every 3 months...... patients (1.1%) died owing to immune-related adverse events. Conclusions As adjuvant therapy for high-risk stage III melanoma, ipilimumab at a dose of 10 mg per kilogram resulted in significantly higher rates of recurrence-free survival, overall survival, and distant metastasis-free survival than placebo...

  8. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy

    Eggermont, Alexander M M; Chiarion-Sileni, Vanna; Grob, Jean-Jacques


    Background On the basis of data from a phase 2 trial that compared the checkpoint inhibitor ipilimumab at doses of 0.3 mg, 3 mg, and 10 mg per kilogram of body weight in patients with advanced melanoma, this phase 3 trial evaluated ipilimumab at a dose of 10 mg per kilogram in patients who had...... undergone complete resection of stage III melanoma. Methods After patients had undergone complete resection of stage III cutaneous melanoma, we randomly assigned them to receive ipilimumab at a dose of 10 mg per kilogram (475 patients) or placebo (476) every 3 weeks for four doses, then every 3 months...... patients (1.1%) died owing to immune-related adverse events. Conclusions As adjuvant therapy for high-risk stage III melanoma, ipilimumab at a dose of 10 mg per kilogram resulted in significantly higher rates of recurrence-free survival, overall survival, and distant metastasis-free survival than placebo...

  9. Prolonged suction drainage prevents serous wound discharge after cardiac surgery.

    Kockelbergh, R C; Harris, A M; John, R M; Bailey, J S; Firmin, R K


    A series of 180 patients was randomised to two groups after median sternotomy performed for cardiac surgery in order to evaluate the effect of suction drainage on serous wound discharge. In group A all wounds were drained using two conventional mediastinal drains, while in group B one suction drain and one conventional mediastinal drain were employed. Five patients developed serous wound discharge in group B compared with 14 in group A (chi 2, P < 0.02). There were no significant differences between the rates of major wound infection (group A, n = 1; group B, n = 1) or the incidence of postoperative pericardial effusion assessed by echocardiography (group A, n = 10; group B, n = 5).

  10. Thermoregulation during prolonged actual and laboratory-simulated bicycling.

    Brown, S L; Banister, E W


    Thermoregulatory and cardiorespiratory responses to bicycling 55 km (mean speed 9.7 m X s-1) outdoors (15 degrees C DB) were compared to equivalent cycle ergometry (90 min at 65% VO2max) in the laboratory (20-23 degrees C DB, 50% RH) in 7 trained cyclists. Outdoor environmental conditions were simulated with fans and lamps, and were contrasted with standard no-wind, no-sun laboratory conditions. Sweating rate was similar during outdoor and laboratory simulated outdoor cycling (0.90 and 0.87 to 0.94 1 X h-1 respectively). During outdoor bicycling, mean heart rate (161 bt X min-1) was 7-13% higher (p less than .05) than under laboratory conditions, suggesting a greater strain for a similar external work rate. The increase in rectal temperature (0.8 degrees C) was 33-50% less (p less than 0.05) at the cooler outdoor ambient temperature than in the laboratory. Thermoregulatory stress was greater under the no-fan, no-lamp laboratory condition than during simulated outdoor conditions (36-38% greater (p less than 0.05) sweating rate, 15-18% greater (p less than 0.01) mean skin temperature, 6.4 to 7.8 fold greater (p less than 0.01) amount of clothing-retrained sweat). The cooling wind encountered in actual road bicycling apparently reduces thermoregulatory and circulatory demands compared with stationary cycle ergometry indoors. Failure to account for this enhanced cooling may result in overestimation of the physiological stress of actual road cycling.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Pulsed flows observed during an interval of prolonged northward IMF

    G. Provan


    Full Text Available On the 22 December 2002 the interplanetary magnetic field (IMF was directed northwards for more than 12h. The Northern and Southern Hemisphere SuperDARN radars were used to study global high-latitude convection during this interval, complemented by data from the ACE and DMSP F13 spacecraft. The relative magnitudes of the IMF By and Bz components varied during this period. When the magnitude of the By component was comparable with or dominated the Bz component, signatures of simultaneous low-latitude and lobe reconnection were observed. Specifically two "standard" merging cells were observed in both hemispheres. In the Northern Hemisphere a high-latitude lobe cell was observed within the dusk merging cell, and there was also evidence of a narrow viscous cell located equatorward of this lobe cell. We observed the ionospheric signatures of flux transfer events (FTEs in both the Northern and Southern Hemispheres, occurring with a periodicity of ~15min. In the Northern Hemisphere the FTEs were associated with a stepwise equatorward progression of the equatorward boundary of radar backscatter on the dayside. When the IMF Bz component was predominantly greater than the IMF By component, we observed a four-cell convection pattern in the Northern Hemisphere, with pulses of reverse reconnection and an associated stepwise poleward retraction of the equatorward boundary of radar backscatter occurring every ~25min. These observations are consistent with pulsed lobe reconnection occurring in both hemispheres, closing open flux and adding closed flux to the dayside magnetopause. So, during this northward IMF interval the location of the sites of reconnection between the IMF and the Earth's magnetosphere, and thus the form of reconnection process, varied with changing IMF conditions. However, the reconnection remained pulsed, with lobe-only reconnection having a significantly longer

  12. Prolonged labour associated with lower expression of syndecan 3 and connexin 43 in human uterine tissue

    Malmström Anders


    Full Text Available Abstract Background Prolonged labour is associated with greater morbidity and mortality for mother and child. Connexin 43 is a major myometrial gap junction protein found in human myometrium. Syndecan 3 seems to prevail in the human uterus among heparan sulphate proteoglycans, showing the most significant increase during labour. The aims of the present study were to investigate syndecan 3 and connexin 43 mRNA expressions and protein distributions in human uterine tissue during normal and prolonged labour. Methods Uterine isthmic biopsies were collected from non-pregnant (n = 7, term pregnant women not in labour (n = 14, in normal labour (n = 7 and in prolonged labour (n = 7. mRNA levels of syndecan 3 and connexin 43 were determined by real time RT-PCR. The localization and expression were demonstrated by immunohistochemistry and confocal microscopy. Results In women with prolonged labour, the mRNA expressions of syndecan 3 and Connexin 43 were considerably lower than the expression level at normal labour (p Conclusion The high expression of syndecan 3 and connexin 43 and their co-localization to the smooth muscle bundles during normal labour, together with the significant reduction in prolonged labour, may indicate a role for these proteins in the co-ordination of myometrial contractility.

  13. Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs.

    Rutt, Benjamin T; Oehlert, Mary E; Krieshok, Thomas S; Lichtenberg, James W


    Objective This study evaluated the effectiveness of cognitive processing therapy and prolonged exposure in conditions reflective of current clinical practice within the Veterans Health Administration. Method This study involved a retrospective review of 2030 charts. A total of 750 veterans from 10 U.S. states who received cognitive processing therapy or prolonged exposure in individual psychotherapy were included in the study (participants in cognitive processing therapy, N = 376; participants in prolonged exposure, N = 374). The main dependent variable was self-reported posttraumatic stress disorder symptoms as measured by total scores on the Posttraumatic Stress Disorder Checklist. The study used multilevel modeling to evaluate the absolute and relative effectiveness of both treatments and determine the relationship between patient-level variables and total Posttraumatic Stress Disorder Checklist scores during treatment. Results Cognitive processing therapy and prolonged exposure were equally effective at reducing total Posttraumatic Stress Disorder Checklist scores. Veterans who completed therapy reported significantly larger reductions in the Posttraumatic Stress Disorder Checklist than patients who did not complete therapy. There were no significant differences in the improvement of posttraumatic stress disorder symptoms with respect to age and three racial/ethnic groups (Caucasian, African American, and Hispanic). Conclusions Cognitive processing therapy and prolonged exposure were shown to be effective in conditions highly reflective of clinical practice and with a highly diverse sample of veterans. Challenges related to dropout from trauma focused therapy should continue to be researched.

  14. Heart block and prolonged Q-Tc interval following muscle relaxant reversal: a case report.

    Shields, John A


    Heart block and Q-Tc interval prolongation have been reported with several agents used in anesthesia, and the US Food and Drug Administration mandates evaluation of the Q-T interval with new drugs. Drug-induced Q-T interval prolongation may precipitate life-threatening arrhythmias, is considered a precursor for torsades de pointes, and may predict cardiovascular complications. In the patient described in this article, heart block occurred and the Q-Tc interval became prolonged after muscle relaxant reversal with neostigmine; both were considered to be related to the combination of agents used in the case, as well as to other predisposing factors such as morbid obesity. The agents used that affected cardiac conduction were neostigmine, desflurane, droperidol, dolasetron, and dexmedetomidine. Although the heart block was resolved after 2 doses of atropine, prolonged P-R and Q-Tc intervals persisted into the immediate postoperative period but returned to baseline within 4 hours. Clinical implications of this report include increasing awareness of the multitude of factors affecting Q-T interval prolongation during anesthesia.

  15. Prolonging β-lactam infusion: a review of the rationale and evidence, and guidance for implementation.

    MacVane, Shawn H; Kuti, Joseph L; Nicolau, David P


    Given the sparse antibiotic pipeline and the increasing prevalence of resistant organisms, efforts should be made to optimise the pharmacodynamic exposure of currently available agents. Prolonging the infusion duration is a strategy used to increase the percentage of the dosing interval that free drug concentrations remain above the minimum inhibitory concentration (fT>MIC), the pharmacodynamic efficacy driver for time-dependent antibiotics such as β-lactams. β-Lactams, the most commonly prescribed class of antibiotics owing to their efficacy and safety profile, have been the mainstay of therapy since the discovery of penicillin over 60 years ago. Mounting evidence, including the use of population pharmacokinetic modelling and Monte Carlo simulation, suggests that prolonging the infusion time of β-lactam antibiotics may have advantages over standard infusion techniques, including an enhanced probability of achieving requisite fT>MIC exposures, lower mortality and potentially reductions in infection/antibiotic-related costs. As a result of these favourable attributes, clinical practice guidelines support the use of prolonged-infusion β-lactams in the treatment of many severe infections. This article discusses the rationale and evidence for prolonging the infusion of β-lactam antibiotics and provides guidance for the implementation of a prolonged-infusion programme.

  16. Prolongation Structure of a Generalised Inhomogeneous Gardner Equation in Plasmas and Fluids

    Xie, Xi-Yang; Tian, Bo; Sun, Wen-Rong; Wang, Yun-Po


    In this article, the prolongation structure technique is applied to a generalised inhomogeneous Gardner equation, which can be used to describe certain physical situations, such as the stratified shear flows in ocean and atmosphere, ion acoustic waves in plasmas with a negative ion, interfacial solitary waves over slowly varying topographies, and wave motion in a non-linear elastic structural element with large deflection. The Lax pairs, which are derived via the prolongation structure, are more general than the Lax pairs published before. Under the Painlevé conditions, the linear-damping coefficient equals to zero, the quadratic non-linear coefficient is proportional to the dispersive coefficient c(t), the cubic non-linear coefficient is proportional to c(t), leaving no constraints on c(t) and the dissipative coefficient d(t). We establish the prolongation structure through constructing the exterior differential system. We introduce two methods to obtain the Lax pairs: (a) based on the prolongation structure, the Lax pairs are obtained, and (b) via the Lie algebra, we can derive the Pfaffian forms and Lax pairs when certain parameters are chosen. We set d(t) as a constant to discuss the influence of c(t) on the Pfaffian forms and Lax pairs, and to discuss the influence of d(t) on the Pfaffian forms and Lax pairs, we set c(t) as another constant. Then, we get different prolongation structure, Pfaffian forms and Lax pairs.

  17. Factors causing prolonged hypoperfusion after transient ischemic attack

    Isaka, Yoshinari; Ashida, Keiichi; Iiji, Osamu; Imaizumi, Masatoshi (Osaka National Hospital (Japan))


    Even during the symptom-free stages, patients with a transient ischemic attack (TIA) often experience cerebral blood flow disturbances. In order to evaluate the factors which cause this abnormality, we studied the cerebral blood flow disturbance, anatomy and clinical status in 21 patients after TIAs. The results of [sup 99m]Tc-hexamethyl-propylene-amine oxime SPECT were compared with CT, cerebral angiogram, cerebrovascular risk factors and clinical findings to determine which factor is most responsible for the hypoperfusion of brain after TIA. The overall sensitivity rates in detecting a lesion were 67% in SPECT and 19% in CT. The hypoperfused area tended to be large in patients who had intracranial, severe stenotic, multiple, or hemodynamically significant arterial lesions on the ipsilateral side. No such relationships were found between other examinations. We conclude that hypoperfusion after TIA essentially reflects a continuous cerebral blood flow disturbance that can be attributed to atherosclerosis of the cerebral arteries, with subsequent embolic and/or hemodynamic cerebral ischemia, although there may be a variety of processes. (author).

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  19. Prolonged renal allograft survival by donor interleukin-6 deficiency: association with decreased alloantibodies and increased intragraft T regulatory cells.

    Wang, Hao; Guan, Qiunong; Lan, Zhu; Li, Shuyuan; Ge, Wei; Chen, Huifang; Nguan, Christopher Y C; Du, Caigan


    Both humoral and cellular immune responses are involved in renal allograft rejection. Interleukin (IL)-6 is a regulatory cytokine for both B and Foxp3 (forkhead box P3)-expressing regulatory T (Treg) cells. This study was designed to investigate the impact of donor IL-6 production on renal allograft survival. Donor kidneys from IL-6 knockout (KO) vs. wild-type (WT) C57BL/6 mice (H-2(b)) were orthotopically transplanted to nephrotomized BALB/c mice (H-2(d)). Alloantibodies and Treg cells were examined by fluorescence-activated cell sorting analysis. Graft survival was determined by the time to graft failure. Here, we showed that a deficiency in IL-6 expression in donor kidneys significantly prolonged renal allograft survival compared with WT controls. IL-6 protein was upregulated in renal tubules and endothelium of renal allografts following rejection, which correlated with an increase in serum IL-6 compared with that in those receiving KO grafts or naive controls. The absence of graft-producing IL-6 or lower levels of serum IL-6 in the recipients receiving IL-6 KO allografts was associated with decreased circulating anti-graft alloantibodies and increased the percentage of intragraft CD4(+)CD25(+)Foxp3(+) Treg cells compared with those with WT allografts. In conclusion, the lack of graft-producing IL-6 significantly prolongs renal allograft survival, which is associated with reduced alloantibody production and/or increased intragraft Treg cell population, implying that targeting donor IL-6 may effectively prevent both humoral and cellular rejection of kidney transplants.

  20. Neostigmine does not prolong the duration of analgesia produced by caudal bupivacaine in children undergoing urethroplasty

    Bhardwaj N


    Full Text Available Context : Neostigmine extends the duration of analgesia produced by caudal bupivacaine in children. Aims : To study the effect of different doses of caudal neostigmine on the duration of postoperative analgesia. Settings and Design : A randomized, double-blind study was conducted in 120 boys aged 1-12 years undergoing urethroplasty under combined general and caudal anesthesia. Materials and Methods : Children were administered 1.875 mg/kg bupivacaine alone (Group B, or with 2, 3 or 4 µg/kg of neostigmine (groups BN 2 , BN 3 or BN 4 respectively as caudal drug (0.75 ml/kg. Children with a pain score of 4 or more (OPS and NRS postoperatively were administered rescue analgesic. Time to first analgesic and the number of analgesic doses administered in the 24h were recorded. Statistical Analysis : Parametric data were analyzed using ANOVA. Kaplan-Meier survival curves for the time to first analgesic administration were plotted and compared using log rank analysis. Chi-square test was used to analyze the incidence data. Results : The median [IQR] time to first analgesic in Group B (540 [240-1441] min was similar to that in Groups BN 2 (450 [240-720], BN 3 (600 [360-1020] and BN 4 (990 [420-1441]. Significantly more patients in Groups B (9 [34.6%] and BN 4 (13 [44.8%] required no supplemental analgesic for 24h than those in Groups BN 2 and BN 3 (4 [13.8%] and 4 [13.3%]. The number of analgesic doses required in 24h in the four groups was similar. Conclusion : Addition of neostigmine to 1.875 mg/kg of caudal bupivacaine did not prolong the analgesia following urethroplasty in children.

  1. Consequences of prolonged total body immersion in cold water on muscle performance and EMG activity.

    Coulange, Mathieu; Hug, François; Kipson, Nathalie; Robinet, Claude; Desruelle, Anne Virginie; Melin, Bruno; Jimenez, Chantal; Galland, François; Jammes, Yves


    The consequences of a prolonged total body immersion in cold water on the muscle function have not been documented yet, and they are the object of this French Navy research program. Ten elite divers were totally immerged and stayed immobile during 6 h in cold (18 and 10 degrees C) water. We measured the maximal voluntary leg extension (maximal voluntary contraction, MVC) and evoked compound muscle potential (M wave) in vastus lateralis and soleus muscles at rest, after a submaximal (60% MVC) isometric extension allowing the measurement of the endurance time (Tlim). The power spectrum of surface electromyograms (EMG) was computed during 60% MVCs. MVCs and 60% MVC maneuvers were repeated four times during the immersion. Data were compared with those obtained in a control group studied in dry air condition during a 6-h session. Total body cooling did not affect MVC nor Tlim. The M wave duration increased in the coolest muscle (soleus), but only at 10 degrees C at rest. There were no further fatigue-induced M wave alterations in both muscles. During 60% the MVCs, a time-dependant increase in the leftward shift of the EMG spectrum occurred at the two temperatures. These EMG changes were absent in the control group of subjects studied in dry air. The plasma lactate concentration was elevated throughout the 18 and mostly the 10 degrees C immersion conditions. Throughout the 18 degrees C immersion study, the resting potassium level did not significantly vary, whereas at 10 degrees C, a significant potassium increase occurred soon and persisted throughout the study. Thus, total body immersion in cold water did not affect the global contractile properties of leg muscles during static efforts but elicited significant alterations in electromyographic events which may be related to the variations of interstitial fluid composition.

  2. Nifekalant hydrochloride terminating sustained ventricular tachycardia accompanied with QT dispersion prolongation

    WANG Jing; HUA Wei; ZHU Jun; YANG Yan-min; WANG Fang-zheng; PU Jie-lin; CHEN Ke-ping; ZHANG Shu


    Background Ventricular tachycardia (VT) and ventricular fibrillation are the main reasons causing sudden cardiac death.This study aimed to investigate the effects of nifekalant hydrochloride (NIF) on QT dispersion (QTd) in treating VT.Methods A total of 16 consecutive patients suffered sustained VT was included and then randomly divided into two groups according to the administration duration of NIF.In long-time group (group L), patients were injected with NIF continuously for at least 12 hours after a bolus dose.The patients in short-time group (group S) were injected with NIF just for 1 hour.Results There were 7 of all 10 episodes of VT which were terminated by NIF, including 4 episodes in group L were stopped over 1 hour after continuous infusion of NIF.One patient suffered from torsade de pointes.Electrocardiography analysis indicated that QTd was significantly decreased 12 hours after stopping of infusing NIF compared with that when VT stopped ((45.4±22.1) ms vs.(73.4±33.2) ms, P <0.01), and the corrected QTd (QTcd) decreased too ((47.8±22.9) ms vs.(78.3±36.5) ms, P <0.01 ).There was a positive correlation between the increase in QTd and dose of administrating NIF (P <0.01), so was QTcd (P <0.01).Conclusions More administration of NIF indicates higher terminating rate of VT and more QTd prolongation.However,the safety is acceptable if several important issues were noticed in using NIF, such as serum potassium concentration,stopping side-effect related agents, and carefully observing clinical responses.

  3. The impact of obesity on cardiac troponin levels after prolonged exercise in humans.

    Eijsvogels, Thijs M H; Veltmeijer, Matthijs T W; George, Keith; Hopman, Maria T E; Thijssen, Dick H J


    Elevated cardiac troponin I (cTnI), a marker for cardiac damage, has been reported after high-intensity exercise in healthy subjects. Currently, little is known about the impact of prolonged moderate-intensity exercise on cTnI release, but also the impact of obesity on this response. 97 volunteers (55 men and 42 women), stratified for BMI, performed a single bout of walking exercise (30-50 km). We examined cTnI-levels before and immediately after the exercise bout in lean (BMI obese subjects (BMI ≥ 30 kg/m(2), n = 28, 53 ± 9 years). Walking was performed at a self-selected pace. cTnI was assessed using a high-sensitive cTnI-assay (Centaur; clinical cut-off value ≥ 0.04 μg/L). We recorded subject characteristics (body weight, blood pressure, presence of cardiovascular risk) and examined exercise intensity by recording heart rate. Mean cTnI-levels increased significantly from 0.010 ± 0.006 to 0.024 ± 0.046 μg/L (P exercise-induced increase in cTnI was not different between lean, overweight and obese subjects (two-way ANOVA interaction; P = 0.27). In 11 participants, cTnI was elevated above the clinical cut-off value for myocardial infarction. Logistic regression analysis identified exercise intensity (P exercise results in a comparable increase in cTnI-levels in lean, overweight and obese subjects. Therefore, measures of obesity unlikely relate to the magnitude of the post-exercise elevation in cTnI.

  4. Morphine induces μ opioid receptor endocytosis in guinea pig enteric neurons following prolonged receptor activation

    Patierno, Simona; Anselmi, Laura; Jaramillo, Ingrid; Scott, David; Garcia, Rachel; Sternini, Catia


    Background & Aims The μ opioid receptor (μOR) undergoes rapid endocytosis following acute stimulation with opioids and most opiates, but not with morphine. We investigated whether prolonged activation of μOR affects morphine’s ability to induce receptor endocytosis in enteric neurons. Methods We compared the effects of morphine, a poor μOR-internalizing opiate, and [D-Ala2, MePhe4,Gly-ol5] enkephalin (DAMGO), a potent μOR-internalizing agonist, on μOR trafficking in enteric neurons and on the expression of dynamin and β-arrestin immunoreactivity in the ileum of guinea pigs rendered tolerant by chronic administration of morphine. Results Morphine (100 µM) strongly induced endocytosis of μOR in tolerant but not naïve neurons (55.7%±9.3% vs. 24.2%±7.3%, P<0.001) whereas DAMGO (10 µM) strongly induced internalization of μOR in neurons from tolerant and naïve animals (63.6%±8.4% and 66.5%±3.6%). Morphine- or DAMGO-induced μOR endocytosis resulted from direct interactions between the ligand and the μOR, because endocytosis was not affected by tetrodotoxin, a blocker of endogenous neurotransmitter release. Ligand-induced μOR internalization was inhibited by pretreatment with the dynamin inhibitor, dynasore. Chronic morphine administration resulted in a significant increase in dynamin and translocation of dynamin immunoreactivity from the intracellular pool to the plasma membrane, but did not affect β arrestin immunoreactivity. Conclusion Chronic activation of μORs increases the ability of morphine to induce μOR endocytosis in enteric neurons, which depends on the level and cellular localization of dynamin, a regulatory protein that has an important role in receptor-mediated signal transduction in cells. PMID:21070774

  5. Different adaptations of Chinese winter-over expeditioners during prolonged Antarctic and sub-Antarctic residence

    Chen, Nan; Wu, Quan; Li, Hao; Zhang, Tao; Xu, Chengli


    Prolonged residence in Antarctica is characterized by exposure to isolated, confined, and extreme (ICE) environment. Winter-over expeditioners at research stations often exhibit a complex of psychophysiological symptoms, which varied by stations and sociocultural backgrounds. To understand the different patterns of psychophysiological responses provoked by environmental stress, we conducted a longitudinal assessment of mood and endocrine function in two groups of Chinese expeditioners who were deployed to sub-Antarctic (Great Wall Station, 62°S, N = 12) and Antarctic (Zhongshan Station, 66°S, N = 16) from December 2003 to 2005. Measures of mood, thyroid function, the levels of plasma catecholamine, and circulating interleukins were obtained at departure from China, mid-winter (Antarctica), end of winter (Antarctica), and return to China, respectively. The Zhongshan Station crew experienced significant increases in fatigue, anger, tension, confusion, and decrease in free thyroxine (FT4), norepinephrine (NE), and epinephrine (E) during the winter, increase in thyrotropin (TSH) and total triiodothyronine (TT3) when returning, whereas their counterparts at Great Wall Station only experienced increased TT3 after deployment. Moreover, compared with the Great Wall Station crew, the Zhongshan Station crew exhibited greater increase in anger, greater decrease in FT4, total thyroxine (TT4), NE and E over the winter, and greater increase in TSH when returning. Chinese expeditioners who lived and worked at the Antarctic station and the sub-Antarctic station for over a year showed different change patterns in mood and endocrine hormones. Negative mood and endocrine dysfunction were positively associated with the severity of environment. The study is a supplement to scientific knowledge on psychophysiological variation under ICE environment, which has certain applied value for the development of preventive countermeasures or interventions.

  6. Coscinaraea marshae corals that have survived prolonged bleaching exhibit signs of increased heterotrophic feeding

    Bessell-Browne, Pia; Stat, Michael; Thomson, Damian; Clode, Peta L.


    Colonies of Coscinaraea marshae corals from Rottnest Island, Western Australia have survived for more than 11 months in various bleached states following a severe heating event in the austral summer of 2011. These colonies are situated in a high-latitude, mesophotic environment, which has made their long-term survival of particular interest as such environments typically suffer from minimal thermal pressures. We have investigated corals that remain unbleached, moderately bleached, or severely bleached to better understand potential survival mechanisms utilised in response to thermal stress. Specifically, Symbiodinium (algal symbiont) density and genotype, chlorophyll- a concentrations, and δ13C and δ15N levels were compared between colonies in the three bleaching categories. Severely bleached colonies housed significantly fewer Symbiodinium cells ( p coral in both severely and moderately bleached colonies, with clade C and a mixed clade population detected. In unbleached colonies, only clade B was observed. Levels of δ15N indicate that severely bleached colonies are utilising heterotrophic feeding mechanisms to aid survival whilst bleached. Collectively, these results suggest that these C. marshae colonies can survive with low symbiont and chlorophyll densities, in response to prolonged thermal stress and extended bleaching, and increase heterotrophic feeding levels sufficiently to meet energy demands, thus enabling some colonies to survive and recover over long time frames. This is significant as it suggests that corals in mesophotic and high-latitude environments may possess considerable plasticity and an ability to tolerate and adapt to large environmental fluctuations, thereby improving their chances of survival as climate change impacts coral ecosystems worldwide.

  7. Chitosan Hydrogel as siRNA vector for prolonged gene silencing


    Background The periodontitis is one of the most prevalent diseases with alveolar resorption in adult people and is the main cause of the tooth loss. To investigate the possibility for protecting the loss of alveolar bone in periodontal diseases, a RNAi-based therapeutic strategy is applied for silencing RANK signaling using thermosensitive chitosan hydrogel as siRNA reservoir and vector. Results The thermosensitive chitosan hydrogel was formed from solution (PH = 7.2, at 4°C) at 37°C within 8 minutes. The degradation rates of hydrogel were ~50% and 5% (W remaining/W beginning) in the presence and absence of lysozyme, respectively, over a period of 20 days. The concurrent cumulative in vitro release of Cy3-labeled siRNA from the hydrogel was 50% and 17% over 14 days, with or without lysozyme digestion, respectively. High cell viability (>88%) was maintained for cells treated with hydrogel loaded with RANK specific siRNA and RANK knockdown was prolonged for up to 9 days when cells were incubated with siRNA/hydrogel complex. In vivo release of siRNA was investigated in a subcutaneous delivery setup in mice. The fluorescent signal from siRNA within hydrogel was remained for up to 14 days compared to less than one day for siRNA alone. Conclusions Chitosan hydrogel can potentially serve as a suitable reservoir and vector for local sustained delivery of siRNA in potential therapy. PMID:24946934

  8. Seminal vesicles and diabetic neuropathy: ultrasound evaluation after prolonged treatment with a selective phosphodiesterase-5 inhibitor.

    La Vignera, S; Condorelli, R A; Vicari, E; Lotti, F; Favilla, V; Morgia, G; Maggi, M; Calogero, A E


    We have previously reported that infertile patients with diabetes mellitus (DM) have a particular ultrasound features of the seminal vesicles (SV) characterized by higher fundus-to-body ratio and lower pre- and post-ejaculatory difference in body antero-posterior diameter (APD). Based on these premises the aim of the present study was to investigate possible ultrasound SV changes in infertile patients with DM and diabetic neuropathy (DN), after prolonged administration of tadalafil (TAD) (a specific phosphodiesterase-5 inhibitor). To accomplish this, 20 infertile patients with symptomatic DN and erectile dysfunction were selected and arbitrarily divided into two groups which were assigned to: daily administration of 5 mg TAD for 3 months (Group A) (n = 10) and administration of placebo (Group B) (n = 10). All patients underwent to scrotal and prostate-vesicular transrectal ultrasound evaluation and semen analysis (Laboratory Manual for the Examination and Processing of Human Semen, WHO, 2010) before and after treatment. The following SV US parameters were recorded: (i) body APD; (ii) fundus APD; (iii) parietal thickness of the right and left SVs; and (iv) number of polycyclic areas within both SVs. We then calculated the following parameters: (i) fundus/body (F/B) ratio; (ii) difference of the parietal thickness between the right and the left SV and (iii) pre- and post-ejaculatory APD difference. In addition, we also evaluated the SV ejection fraction. Group A patients showed a significant reduction in F/B ratio and higher pre- and post-ejaculatory body SV APD difference compared with baseline or Group B after 3 months. These patients showed also a significant increase in SV ejection fraction and a significant improvement of the total sperm count, progressive motility, seminal levels of fructose, leucocytes and ejaculate volume. In conclusion, these results suggest that infertile DM patients with DN and erectile dysfunction had an improvement of ultrasound features

  9. Microdomain Ca{sup 2+} dynamics in mammalian muscle following prolonged high pressure treatments

    Schnee, S; Schuermann, S; Fink, R [Medical Biophysics, Institute of Physiology and Pathophysiology, University of Heidelberg, INF326, 69120 Heidelberg (Germany); Ludwig, H [Physical Chemistry, Institute of Molecular Biotechnology and Biopharmacy, University of Heidelberg, INF 366 (Germany); Wegner, F von; Friedrich, O, E-mail:


    High pressure (HP) applications are an important thermodynamic tool to influence cellular processes. Especially processes that undergo large volume changes, e.g. opening or closing of ion channels, are in particular susceptible to HP treatments. Such volume changes are extremely difficult to assess for intracellular ion channels, like ryanodine receptors (RyR) residing in the membrane of organelles. In skeletal muscle, RyR act as Ca{sup 2+} release channels. We previously showed that plasmalemmal Na{sup +} and Ca{sup 2+} ion channels were irreversibly altered after prolonged 20 MPa treatments. Here, changes in microdomain Ca{sup 2+} levels due to elementary Ca{sup 2+} release events (ECRE) were monitored using confocal fluorescence microscopy. We studied ECRE in mammalian skeletal muscle following 3 h HP treatments up to 30 MPa to clarify whether RyR induced intracellular microdomain Ca{sup 2+} dynamics was more susceptible to HP treatment compared to surface membrane ion currents. ECRE frequencies exponentially declined with pressure. ECRE amplitudes and rise times (RT) were quite robust towards HP treatments. In contrast, spatial and temporal ECRE extension showed a tendency towards larger values up to 20 MPa but declined for higher pressures. Activation volumes for pressure-induced persistent ECRE alterations were zero for RT but showed a bimodal behavior for event duration. It seems that although ECRE frequencies are markedly reduced, ECRE morphology is less affected by HP. In particular, RyR opening time is practically unaltered and the observed morphological ECRE changes might reflect alterations in local Ca{sup 2+} buffers and Ca{sup 2+} concentration profiles rather than involvement of RyR in mammalian skeletal muscle.

  10. Single prolonged stress effects on sensitization to cocaine and cocaine self-administration in rats

    Eagle, Andrew L.; Singh, Robby; Kohler, Robert J.; Friedman, Amy L.; Liebowitz, Chelsea P.; Galloway, Matthew P.; Enman, Nicole M.; Jutkiewicz, Emily M.; Perrine, Shane A.


    Posttraumatic stress disorder (PTSD) is often comorbid with substance use disorders (SUD). Single prolonged stress (SPS) is a well-validated rat model of PTSD that provides a framework to investigate drug-induced behaviors as a preclinical model of the comorbidity. We hypothesized that cocaine sensitization and self-administration would be increased following exposure to SPS. Male Sprague–Dawley rats were exposed to SPS or control treatment. After SPS, cocaine (0,10 or 20mg/kg, i.p.) was administered for 5 consecutive days and locomotor activity was measured. Another cohort was assessed for cocaine self-administration (0.1 or 0.32 mg/kg/i.v.) after SPS. Rats were tested for acquisition, extinction and cue-induced reinstatement behaviors. Control animals showed a dose-dependent increase in cocaine-induced locomotor activity after acute cocaine whereas SPS rats did not. Using a sub-threshold sensitization paradigm, control rats did not exhibit enhanced locomotor activity at Day 5 and therefore did not develop behavioral sensitization, asexpected. However, compared to control ratson Day 5 the locomotor response to 20mg/kg repeated cocaine was greatly enhanced in SPS-treated rats, which exhibited enhanced cocaine locomotor sensitization. The effect of SPS on locomotor activity was unique in that SPS did not modify cocaine self-administration behaviors under a simple schedule of reinforcement. These data show that SPS differentially affects cocaine-mediated behaviors causing no effect to cocaine self-administration, under a simple schedule of reinforcement, but significantly augmenting cocaine locomotor sensitization. These results suggest that SPS shares common neurocircuitry with stimulant-induced plasticity, but dissociable from that underlying psychostimulant-induced reinforcement. PMID:25712697

  11. Intractable restless legs syndrome: role of prolonged-release oxycodone–naloxone

    de Biase, Stefano; Valente, Mariarosaria; Gigli, Gian Luigi


    Restless legs syndrome (RLS) is a common neurological disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur at night or at time of rest. Pharmacological therapy should be limited to patients who suffer from clinically relevant symptoms. Chronic RLS is usually treated with either a dopamine agonist (pramipexole, ropinirole, rotigotine) or an α2δ calcium-channel ligand (gabapentin, gabapentin enacarbil, pregabalin). Augmentation is the main complication of long-term dopaminergic treatment, and frequently requires a reduction of current dopaminergic dose or a switch to non-dopaminergic medications. Opioids as monotherapy or add-on treatment should be considered when alternative satisfactory regimens are unavailable and the severity of symptoms warrants it. In a recent Phase III trial, oxycodone–naloxone prolonged release (PR) demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments. The adverse-event profile was consistent with the safety profile of opioids. The most frequent adverse events were fatigue, constipation, nausea, headache, hyperhidrosis, somnolence, dry mouth, and pruritus. Adverse events were usually mild or moderate in intensity. No cases of augmentation were reported. Oxycodone–naloxone PR is approved for the second-line symptomatic treatment of adults with severe to very severe idiopathic RLS after failure of dopaminergic treatment. Further studies are needed to evaluate if oxycodone–naloxone PR is equally efficacious as a first-line treatment. Moreover, long-term comparative studies between opioids, dopaminergic drugs and α2δ ligands are needed. PMID:26966363

  12. Intractable restless legs syndrome: role of prolonged-release oxycodone–naloxone

    de Biase S


    Full Text Available Stefano de Biase,1 Mariarosaria Valente,1,2 Gian Luigi Gigli1,21Neurology Unit, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, 2Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, ItalyAbstract: Restless legs syndrome (RLS is a common neurological disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur at night or at time of rest. Pharmacological therapy should be limited to patients who suffer from clinically relevant symptoms. Chronic RLS is usually treated with either a dopamine agonist (pramipexole, ropinirole, rotigotine or an α2δ calcium-channel ligand (gabapentin, gabapentin enacarbil, pregabalin. Augmentation is the main complication of long-term dopaminergic treatment, and frequently requires a reduction of current dopaminergic dose or a switch to nondopaminergic medications. Opioids as monotherapy or add-on treatment should be considered when alternative satisfactory regimens are unavailable and the severity of symptoms warrants it. In a recent Phase III trial, oxycodone–naloxone prolonged release (PR demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments. The adverse-event profile was consistent with the safety profile of opioids. The most frequent adverse events were fatigue, constipation, nausea, headache, hyperhidrosis, somnolence, dry mouth, and pruritus. Adverse events were usually mild or moderate in intensity. No cases of augmentation were reported. Oxycodone–naloxone PR is approved for the second-line symptomatic treatment of adults with severe to very severe idiopathic RLS after failure of dopaminergic treatment. Further studies are needed to evaluate if oxycodone–naloxone PR is equally efficacious as a first-line treatment. Moreover, long-term comparative studies between opioids, dopaminergic drugs and α2

  13. Intractable restless legs syndrome: role of prolonged-release oxycodone-naloxone.

    de Biase, Stefano; Valente, Mariarosaria; Gigli, Gian Luigi


    Restless legs syndrome (RLS) is a common neurological disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur at night or at time of rest. Pharmacological therapy should be limited to patients who suffer from clinically relevant symptoms. Chronic RLS is usually treated with either a dopamine agonist (pramipexole, ropinirole, rotigotine) or an α2δ calcium-channel ligand (gabapentin, gabapentin enacarbil, pregabalin). Augmentation is the main complication of long-term dopaminergic treatment, and frequently requires a reduction of current dopaminergic dose or a switch to non-dopaminergic medications. Opioids as monotherapy or add-on treatment should be considered when alternative satisfactory regimens are unavailable and the severity of symptoms warrants it. In a recent Phase III trial, oxycodone-naloxone prolonged release (PR) demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments. The adverse-event profile was consistent with the safety profile of opioids. The most frequent adverse events were fatigue, constipation, nausea, headache, hyperhidrosis, somnolence, dry mouth, and pruritus. Adverse events were usually mild or moderate in intensity. No cases of augmentation were reported. Oxycodone-naloxone PR is approved for the second-line symptomatic treatment of adults with severe to very severe idiopathic RLS after failure of dopaminergic treatment. Further studies are needed to evaluate if oxycodone-naloxone PR is equally efficacious as a first-line treatment. Moreover, long-term comparative studies between opioids, dopaminergic drugs and α2δ ligands are needed.

  14. Site-specific PEGylation of human thyroid stimulating hormone to prolong duration of action.

    Qiu, Huawei; Boudanova, Ekaterina; Park, Anna; Bird, Julie J; Honey, Denise M; Zarazinski, Christine; Greene, Ben; Kingsbury, Jonathan S; Boucher, Susan; Pollock, Julie; McPherson, John M; Pan, Clark Q


    Recombinant human thyroid stimulating hormone (rhTSH or Thyrogen) has been approved for thyroid cancer diagnostics and treatment under a multidose regimen due to its short circulating half-life. To reduce dosing frequency, PEGylation strategies were explored to increase the duration of action of rhTSH. Lysine and N-terminal PEGylation resulted in heterogeneous product profiles with 40% or lower reaction yields of monoPEGylated products. Eleven cysteine mutants were designed based on a structure model of the TSH-TSH receptor (TSHR) complex to create unique conjugation sites on both α and β subunits for site-specific conjugation. Sequential screening of mutant expression level, oligomerization tendency, and conjugation efficiency resulted in the identification of the αG22C rhTSH mutant for stable expression and scale-up PEGylation. The introduced cysteine in the αG22C rhTSH mutant was partially blocked when isolated from conditioned media and could only be effectively PEGylated after mild reduction with cysteine. This produced a higher reaction yield, ~85%, for the monoPEGylated product. Although the mutation had no effect on receptor binding, PEGylation of αG22C rhTSH led to a PEG size-dependent decrease in receptor binding. Nevertheless, the 40 kDa PEG αG22C rhTSH showed a prolonged duration of action compared to rhTSH in a rat pharmacodynamics model. Reverse-phase HPLC and N-terminal sequencing experiments confirmed site-specific modification at the engineered Cys 22 position on the α-subunit. This work is another demonstration of successful PEGylation of a cysteine-knot protein by an engineered cysteine mutation.

  15. Effects of prolonged drought stress on Scots pine seedling carbon allocation.

    Aaltonen, Heidi; Lindén, Aki; Heinonsalo, Jussi; Biasi, Christina; Pumpanen, Jukka


    As the number of drought occurrences has been predicted to increase with increasing temperatures, it is believed that boreal forests will become particularly vulnerable to decreased growth and increased tree mortality caused by the hydraulic failure, carbon starvation and vulnerability to pests following these. Although drought-affected trees are known to have stunted growth, as well as increased allocation of carbon to roots, still not enough is known about the ways in which trees can acclimate to drought. We studied how drought stress affects belowground and aboveground carbon dynamics, as well as nitrogen uptake, in Scots pine (Pinus sylvestris L.) seedlings exposed to prolonged drought. Overall 40 Scots pine seedlings were divided into control and drought treatments over two growing seasons. Seedlings were pulse-labelled with (13)CO2 and litter bags containing (15)N-labelled root biomass, and these were used to follow nutrient uptake of trees. We determined photosynthesis, biomass distribution, root and rhizosphere respiration, water potential, leaf osmolalities and carbon and nitrogen assimilation patterns in both treatments. The photosynthetic rate of the drought-induced seedlings did not decrease compared to the control group, the maximum leaf specific photosynthetic rate being 0.058 and 0.045 µmol g(-1) s(-1) for the drought and control treatments, respectively. The effects of drought were, however, observed as lower water potentials, increased osmolalities as well as decreased growth and greater fine root-to-shoot ratio in the drought-treated seedlings. We also observed improved uptake of labelled nitrogen from soil to needles in the drought-treated seedlings. The results indicate acclimation of seedlings to long-term drought by aiming to retain sufficient water uptake with adequate allocation to roots and root-associated mycorrhizal fungi. The plants seem to control water potential with osmolysis, for which sufficient photosynthetic capability is needed.

  16. Isolated fatty liver from prolonged propofol use in a pediatric patient with refractory status epilepticus.

    Rison, Richard A; Ko, David Y


    Propofol is a widely used rapidly acting sedating or hypnotic agent in the intensive care setting. It is generally considered safe in both pediatric and adult patients and has been used frequently in cases of refractory status epilepticus. The formulation of propofol is highly lipophilic to facilitate central nervous system penetration and has a high fat content, and prolonged infusions have been known to cause both extrahepatic complications and hepatomegaly secondary to fatty liver. Whereas extrahepatic manifestations of prolonged propofol infusions have been well reported in non-neurologic intensive care patients, cases of pathologically confirmed fatty liver in patients with status epilepticus are relatively few. Furthermore, these cases of hepatomegaly and fatty liver have been also in the context of concomitant extrahepatic side effects. We report on a pediatric patient with refractory status epilepticus treated with a prolonged propofol infusion who developed isolated pathologically confirmed fatty liver without the usually reported extrahepatic manifestations.

  17. Development of a Decision Support System for Analysis and Solutions of Prolonged Standing in the Workplace

    Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan


    Background Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. Methods The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Results Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. Conclusion The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially. PMID:25180141

  18. Analysis of Relationship between Levofloxacin and Corrected QT Prolongation Using a Clinical Data Warehouse.

    Park, Man Young; Kim, Eun Yeob; Lee, Young Ho; Kim, Woojae; Kim, Ku Sang; Sheen, Seung Soo; Lim, Hong Seok; Park, Rae Woong


    The aim of this study was to examine whether or not levofloxacin has any relationship with QT prolongation in a real clinical setting by analyzing a clinical data warehouse of data collected from different hospital information systems. Electronic prescription data and medical charts from 3 different hospitals spanning the past 9 years were reviewed, and a clinical data warehouse was constructed. Patients who were both administrated levofloxacin and given electrocardiograms (ECG) were selected. The correlations between various patient characteristics, concomitant drugs, corrected QT (QTc) prolongation, and the interval difference in QTc before and after levofloxacin administration were analyzed. A total of 2,176 patients from 3 different hospitals were included in the study. QTc prolongation was found in 364 patients (16.7%). The study revealed that age (OR 1.026, p data seem to be essential to adverse drug reaction surveillance in future.

  19. Mesenteric venous thrombosis after prolonged air travel-a case report

    Joaqun Salas-Coronas; Jos L Serrano-Carrillo; Ana B Lozano-Serrano; Jos C Snchez-Snchez; Leticia Miras-Lucas; Rosario Prez-Moyano


    We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome). Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother) with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.

  20. Effect of prolonged hypokinesia on resistance of resistive vessels in rats

    Saltykova, V. A.


    Under the effect of prolonged hypokinesia, the perfusion pressure in resistive vessels, measured under conditions of deep anesthesia and complete denervation, increased by approximately the same degree as arterial pressure in non-anesthetized animals. The increase in arterial, perfusion pressure and the resistance of resistive vessels in animals subjected to prolonged hypokinesia was accompanied by an increase in adrenoreactivity. During prolonged hypokinesia, partial obliteration of the vascular bed of the skeletal muscles plays a significant role in the observed increase in resistance of vessels of the extremities. The increase in adrenoreactivity of the vessels during hypokinesia may be realized as a partial case of an increase in the adrenoreactivity of structures whose innervation is disturbed.

  1. Multiphasic growth models and the evolution of prolonged growth exemplified by human brain evolution.

    Vrba, E S


    New models for multiphasic growth are presented. They are illustrated by analysis of brain growth in humans and chimpanzees, and the results are used to test the hypothesis of evolution by proportional growth prolongation: that all descendant growth phases are extended by the same factor while each remains at the ancestral growth rate. The results are consistent with the hypothesis and imply that gross brain weight increase towards humans required change in only one growth parameter: prolongation of the nonlinear ancestral growth phases. The restricted and orderly nature of the developmental changes hints at a basis in few genetic changes. Proportional growth prolongation is of general evolutionary importance because it can reorganize body proportions.

  2. Mesenteric venous thrombosis after prolonged air travel-a case report

    Joaquín Salas-Coronas


    Full Text Available We present a case of acute mesenteric venous thrombosis after a long distance flight in a traveller presenting with abdominal pain, diarrhoea and vomiting within 48 h of prolonged immobility situation. Venous thrombosis in the lower limbs and venous thromboembolism has been clearly associated with prolonged air travel (economy class syndrome. Thrombosis was diagnosed by computed tomography of the abdomen, and after starting anticoagulant therapy with acenocumarol, symptoms yielded completely in a few weeks. The study of thrombophilia was negative, although the existence of two first-degree relatives (mother and grandmother with a history of venous thrombosis with a history of venous thrombosis makes it likely a situation of inherited thrombophilia. Although exceptional, mesenteric venous thrombosis should be considered in travellers with acute abdominal pain after prolonged air travel when there are thrombophilic conditions.

  3. Prolonged Paralysis Following Emergent Cesarean Section with Succinylcholine Despite Normal Dibucaine Number.

    Ellison, Matthew; Grose, Brian; Howell, Stephen; Wilson, Colin; Lenz, Jackson; Driver, Richard


    Prolonged paralysis due to a quantitative or qualitative deficiency of pseudocholinesterase activity is an uncommon but known side effect of succinylcholine. We describe a patient who experienced prolonged paralysis following administration of succinylcholine for general anesthesia and endotracheal intubation for an emergent cesarean section despite laboratory evidence of normal enzyme function. The patient required mechanical ventilation in the intensive care unit for several hours following surgery. The patient was extubated following return of full muscle strength and had a good outcome. The enzyme responsible for the metabolism of succinylcholine, pseudocholinesterase, was determined to be low in quantity in this patient but was functionally normal. This low level, by itself, was unlikely to be solely responsible for the prolonged paralysis. The patient likely had an abnormal pseudocholinesterase enzyme variant that is undetectable by standard laboratory tests.

  4. Overview of clinical efficacy and risk data of benzodiazepines for prolonged seizures.

    Lagae, Lieven


    An historical overview is provided regarding the use of benzodiazepines for the treatment of acute prolonged convulsive seizures. It is clear that intravenous benzodiazepines remain a first step for the in-hospital treatment of prolonged seizures or status epilepticus. However, in the community, in a pre-hospital situation, intravenous administration is not possible. In recent years, it was shown that rectal, buccal, intranasal, and intramuscular administration of benzodiazepines is very effective as a first and safe treatment step. In many cases, rectal diazepam is not socially acceptable anymore, and therefore more emphasis is now put on buccal, intranasal, and intramuscular administration. At present, based on the available data, midazolam is the product of choice for the acute treatment of prolonged convulsive seizures.

  5. Prolonged clonal spreading and dynamic changes in antimicrobial resistance of Escherichia coli ST68 among patients who stayed in a respiratory care ward.

    Chen, Chih-Ming; Ke, Se-Chin; Li, Chia-Ru; Chiou, Chien-Shun; Chang, Chao-Chin


    From 2007 to 2009, we collected a total of 83 bacteraemic isolates of Escherichia coli with reduced susceptibility or resistance to third-generation cephalosporins (TGCs). Isolates were genotyped by PFGE and multilocus sequence typing (MLST). The PFGE patterns revealed two highly correlated clusters (cluster E: nine isolates; cluster G: 22 isolates) associated with this prolonged clonal spreading. Compared with cluster E isolates, cluster G isolates were significantly more likely to harbour aac(6')-Ib-cr (Pcoli cases caused by cluster E and G isolates were significantly associated with having stayed in our hospital's respiratory care ward (Pcoli ST68 associated with a stay in a long-term care facility. Using epidemiological investigations and PFGE and MLST analyses, we have identified long-term clonal spreading caused by E. coli ST68, with extra antimicrobial-resistance genes possibly acquired during the prolonged spreading period.

  6. Late recovery of awareness in prolonged disorders of consciousness -a cross-sectional cohort study.

    Yelden, Kudret; Duport, Sophie; James, Leon M; Kempny, Agnieszka; Farmer, Simon F; Leff, Alex P; Playford, E Diane


    To detect any improvement of awareness in prolonged disorders of consciousness in the long term. A total of 34 patients with prolonged disorders of consciousness (27 vegetative state and seven minimally conscious state; 16 males; aged 21-73) were included in the study. All patients were initially diagnosed with vegetative/minimally conscious state on admission to our specialist neurological rehabilitation unit. Re-assessment was performed 2-16 years later using Coma Recovery Scale-Revised. Although remaining severely disabled, 32% of the patients showed late improvement of awareness evidenced with development of non-reflexive responses such as reproducible command following and localization behaviors. Most of the late recoveries occurred in patients with subarachnoid hemorrhage (5/11, 45.5%). The ages of patients within the late recovery group (Mean = 45, SD = 11.4) and non-recovery group (Mean = 43, SD = 15.5) were not statistically different (p = 0.76). This study shows that late improvements in awareness are not exceptional in non-traumatic prolonged disorders of consciousness cases. It highlights the importance of long-term follow up of patients with prolonged disorders of consciousness, regardless of the etiology, age, and time passed since the brain injury. Long-term follow up will help clinicians to identify patients who may benefit from further assessment and rehabilitation. Although only one patient achieved recovery of function, recovery of awareness may have important ethical implications especially where withdrawal of artificial nutrition and hydration is considered. Implications for rehabilitation Long-term regular follow-up of people with prolonged disorders of consciousness is important. Albeit with poor functional outcomes late recovery of awareness is possible in both traumatic and non-traumatic prolonged disorders of consciousness cases. Recovery of awareness has significant clinical and ethical implications especially where

  7. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis.

    Drassinower, Daphnie; Friedman, Alexander M; Običan, Sarah G; Levin, Heather; Gyamfi-Bannerman, Cynthia


    Preterm premature rupture of membranes (PPROM) is associated with inflammation and infection, and it may involve the loss of a barrier to ascending infection from the vagina, and it is possible that prolonged PPROM could be an independent risk factor for neonatal sepsis. The objective of the study was to determine whether prolonged latency after PPROM is associated with an increased risk of neonatal sepsis. This secondary analysis of the randomized controlled trial of magnesium sulfate for the prevention of cerebral palsy evaluated whether the time interval between diagnosis of PPROM and delivery was associated with an increased risk of neonatal sepsis. Latency time was categorized by weeks of latency (0 weeks to ≥ 4 weeks). The primary outcome was confirmed neonatal sepsis. Logistic regression was used to control for confounders. A total of 1596 patients with PPROM were analyzed, of whom 1390 had a neonatal sepsis occurred in 15.5% of patients in the cohort. In the univariate analysis, patients in the prolonged PPROM group were less likely to have neonatal sepsis (6.8% vs 17.2%, relative risk, 0.40 95% confidence interval, 0.24-0.66). This relationship was retained in the multivariable model; patients with prolonged PPROM ≥ 4 weeks had an adjusted odds ratio of 0.21 (95% confidence interval, 0.10-0.41) for neonatal sepsis. Neonatal sepsis was also significantly associated with earlier gestational age at rupture of membranes. Prolonged exposure to an intrauterine environment of PPROM does not increase the risk of neonatal sepsis; prolonged PPROM ≥ 4 weeks was associated with decreased risk of neonatal sepsis. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Genomewide Mutational Diversity in Escherichia coli Population Evolving in Prolonged Stationary Phase.

    Chib, Savita; Ali, Farhan; Seshasayee, Aswin Sai Narain


    Prolonged stationary phase is an approximation of natural environments presenting a range of stresses. Survival in prolonged stationary phase requires alternative metabolic pathways for survival. This study describes the repertoire of mutations accumulating in starving Escherichia coli populations in lysogeny broth. A wide range of mutations accumulates over the course of 1 month in stationary phase. Single nucleotide polymorphisms (SNPs) constitute 64% of all mutations. A majority of these mutations are nonsynonymous and are located at conserved loci. There is an increase in genetic diversity in the evolving populations over time. Computer simulations of evolution in stationary phase suggest that the maximum frequency of mutations observed in our experimental populations cannot be explained by neutral drift. Moreover, there is frequent genetic parallelism across populations, suggesting that these mutations are under positive selection. Finally, functional analysis of mutations suggests that regulatory mutations are frequent targets of selection. IMPORTANCE Prolonged stationary phase in bacteria, contrary to its name, is highly dynamic, with extreme nutrient limitation as a predominant stress. Stationary-phase cultures adapt by rapidly selecting a mutation(s) that confers a growth advantage in stationary phase (GASP). The phenotypic diversity of starving E. coli populations has been studied in detail; however, only a few mutations that accumulate in prolonged stationary phase have been described. This study documented the spectrum of mutations appearing in Escherichia coli during 28 days of prolonged starvation. The genetic diversity of the population increases over time in stationary phase to an extent that cannot be explained by random, neutral drift. This suggests that prolonged stationary phase offers a great model system to study adaptive evolution by natural selection.

  9. Drug induced QT prolongation: the measurement and assessment of the QT interval in clinical practice.

    Isbister, Geoffrey K; Page, Colin B


    There has been an increasing focus on drug induced QT prolongation including research on drug development and QT prolongation, following the removal of drugs due to torsades de pointes (TdP). Although this has improved our understanding of drug-induced QT prolongation there has been much less research aimed at helping clinicians assess risk in individual patients with drug induced QT prolongation. This review will focus on assessment of drug-induced QT prolongation in clinical practice using a simple risk assessment approach. Accurate measurement of the QT interval is best done manually, and not using the measurement of standard ECG machines. Correction for heart rate (HR) using correction formulae such as Bazett's is often inaccurate. These formulae underestimate and overestimate the duration of cardiac repolarization at low and high heart rates, respectively. Numerous cut-offs have been suggested as an indicator of an abnormal QT, but are problematic in clinical practice. An alternative approach is the QT nomogram which is a plot of QT vs. HR. The nomogram has an 'at risk' line and QT-HR pairs above this line have been shown in a systematic study to be associated with TdP and the line is more sensitive and specific than Bazett's QTc of 440 ms or 500 ms. Plotting the QT-HR pair for patients on drugs suspected or known to cause QT prolongation allows assessment of the QT interval based on normal population QT variability. This risk assessment then allows the safer commencement of drugs therapeutically or management of drug induced effects in overdose. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  10. Training and muscle ammonia and amino acid metabolism in humans during prolonged exercise

    Graham, T E; Turcotte, L P; Kiens, Bente


    We studied the responses of NH3 and amino acids (AA) to prolonged exercise (3 h) in trained (Tr; n = 6) and untrained (Utr; n = 6) men. Each subject exercised the knee extensor muscles of one leg at 60% of maximum capacity. Thigh blood flow and femoral arteriovenous differences (0, 30, 60, 120, 150....... Under these conditions, prolonged dynamic knee extensor exercise is associated with a large release of alpha-amino moieties both as NH3 and as Gln as well as a net protein catabolism; these responses are similar in Tr and Utr....

  11. The Impact of Prolonged Economic Downturns and Economic Crises on the Nursing Profession.

    Phua, Kai-Lit; Hue, Jia-Wern


    Prolonged economic downturns and economic crises are affecting nations around the world, including developed countries such as Portugal, Spain, and Greece. In the United States, recovery from the latest economic crisis has been accompanied by a persistently high rate of unemployment. To a large extent, the impacts on the nursing profession may depend on the severity of economic downturns and their duration in the country of employment of nurses. Nurses in certain areas of patient care (such as mental health) may also be more strongly affected because of the impact of economic crises and high unemployment on morbidity patterns. Emigration of nurses may also increase as a result of prolonged economic crisis.

  12. Prevalence and Risk Factors Associated with Use of QT-Prolonging Drugs in Hospitalized Older People.

    Franchi, C; Ardoino, I; Rossio, R; Nobili, A; Biganzoli, E M; Marengoni, A; Marcucci, M; Pasina, L; Tettamanti, M; Corrao, S; Mannucci, P M


    The objective of this study was to evaluate the prevalence of the prescription of QT-prolonging drugs at hospital admission and discharge and the risk factors associated with their use in older people (aged 65 years and older). Data were obtained from the REPOSI (REgistro POliterapie SIMI [Società Italiana di Medicina Interna]) registry, which enrolled 4035 patients in 2008 (n = 1332), 2010 (n = 1380), and 2012 (n = 1323). Multivariable logistic regression was performed to determine the risk factors independently associated with QT-prolonging drug use. QT-prolonging drugs were classified by the risk of Torsades de Pointes (TdP) (definite, possible, or conditional) according to the Arizona Center for Education and Research on Therapeutics (AzCERT) classification. Specific drug combinations were also assessed. Among 3906 patients prescribed at least one drug at admission, 2156 (55.2%) were taking at least one QT-prolonging drug. Risk factors independently associated with the use of any QT-prolonging drugs were increasing age (odds ratio [OR] 1.02, 95% CI 1.01-1.03), multimorbidity (OR 2.69, 95% CI 2.33-3.10), hypokalemia (OR 2.79, 95% CI 1.32-5.89), atrial fibrillation (OR 1.66, 95% CI 1.40-1.98), and heart failure (OR 3.17, 95% CI 2.49-4.05). Furosemide, alone or in combination, was the most prescribed drug. Amiodarone was the most prescribed drug with a definite risk of TdP. Both the absolute number of QT-prolonging drugs (2890 vs. 3549) and the number of patients treated with them (2456 vs. 2156) increased at discharge. Among 1808 patients not prescribed QT-prolonging drugs at admission, 35.8% were prescribed them at discharge. Despite their risk, QT-prolonging drugs are widely prescribed to hospitalized older persons. The curriculum for both practicing physicians and medical students should be strengthened to provide more education on the appropriate use of drugs in order to improve the management of hospitalized older people.

  13. Prolonged sinoatrial block in an infant with respiratory syncytial viral bronchiolitis.

    Haddad, Wajed; Agoudemous, Melissa; Basnet, Sangita


    Complete heart block in children admitted to the pediatric intensive care unit with respiratory syncytial viral (RSV) infections has been described. This report describes a prolonged sinoatrial block exceeding 4 s in an infant with RSV, which, to the authors' knowledge, is the longest such event described in the published literature. This block was followed by shorter episodes within the next 24 h. An extensive workup showed no other known cause of bradycardia or sinoatrial block. The infant was discharged home with 48 h Holter monitoring, which was normal. At this writing, the infant has remained asymptomatic since discharge. Respiratory syncytial viral infections may cause prolonged sinoatrial block in an otherwise healthy child.

  14. Case of a woman with acromegaly whose presenting complaint was prolonged post-partum amenorrhea.

    Hara, Tomomi; Kanasaki, Haruhiko; Oride, Aki; Moriyama, Masayuki; Kyo, Satoru


    We report a case of a woman who was incidentally diagnosed with acromegaly after referral for prolonged post-partum amenorrhea. A 25-year-old woman, gravida 2 para 1, had a normal transvaginal delivery and breastfeeding had been discontinued more than a year after delivery. Thereafter, spontaneous menstruation did not restart and she underwent hormonal therapy. Subsequently, she was referred to our university hospital for prolonged amenorrhea. Hormonal examination revealed severe hypogonadotropic hypogonadism (luteinizing hormone 0.5 mIU/mL, follicle-stimulating hormone acromegaly. © 2016 Japan Society of Obstetrics and Gynecology.

  15. Symptôme, sublimation, sexuation: les prolongements du symptôme

    Geneviève More


    Full Text Available à partir du commentaire de Lacan sur Joyce, j'ai développé une thèse lacanienne fondamentale pour penser la transmission entre les générations avec un autre concept que celui de l'identification : le prolongement du symptôme. De plus, l'accent mis sur le sinthome par Lacan, n'empêche pas de situer la sublimation comme l'un des autres prolongements possibles du symptôme initial de Joyce.

  16. Prolonged asthma after smoke inhalation: A report of three cases and a review of previous reports

    Moisan, T.C. (Department of Preventive Medicine, Loyola University-Stritch School of Medicine, Maywood, IL (USA))


    The development of prolonged obstructive airways disease after smoke inhalation is of concern to fire victims and fire fighters. Three cases of asthma that developed following the inhalation of pyrolysis products are presented along with a review of previous reports of airway injury from smoke inhalation. Polyvinyl chloride pyrolysis products seem to pose a high risk, but other toxic inhalants are also implicated. There is substantial evidence that prolonged airway hyper-responsiveness and asthma may follow numerous inflammatory insults including smoke inhalation. Studies to identify specific individual risk factors and asthmagenic pyrolysis products are needed. Early, postexposure anti-inflammatory treatment may modify the outcome. 42 refs.

  17. Green teeth are a late complication of prolonged conjugated hyperbilirubinemia in extremely low birth weight infants.

    Battineni, Sireesha; Clarke, Paul


    Eruption of green, discolored teeth affecting the primary dentition has been described in association with congenital viral infection, sepsis, hemolytic jaundice, and cholestasis. The purpose of this paper was to present the cases of 3 extremely low birth weight preterm infants who were noted to have green teeth at the corrected ages of 10 to 12 months. All had a history of prolonged conjugated hyperbilirubinemia during their time in neonatal intensive care. For infants with prolonged conjugated hyperbilirubinemia, extreme preterm birth and/or extremely low birth weight may be additional risk factors predisposing to the eruption of green teeth in later infancy.

  18. The effect of prolonged duration of untreated depression on antidepressant treatment outcome

    Bukh, Jens Otto Drachmann; Bock, Camilla; Vinberg, Maj;


    The duration of untreated illness has been considered a likely predictor of the course of psychotic disorders. However, there is only sparse data concerning the influence of treatment delay on the outcome of mood disorders. The present study aimed to assess the effect of prolonged untreated depre...... depression on the outcome of antidepressant treatment.......The duration of untreated illness has been considered a likely predictor of the course of psychotic disorders. However, there is only sparse data concerning the influence of treatment delay on the outcome of mood disorders. The present study aimed to assess the effect of prolonged untreated...

  19. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block

    Sandhya Agarwal


    Full Text Available Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints. Materials and Methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25, 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25, 30 ml of 0.325% bupivacaine + 1 ml (100 μg dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR, systolic arterial blood pressure (SBP, and diastolic arterial blood pressure (DBP were also monitored. Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001, while the duration of blocks was significantly longer (P < 0.001 in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min, heart rate levels in group SD were significantly lower (P < 0.001. SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001. In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001 in group SD. The duration of analgesia (DOA was significantly longer in SD group than S group (P < 0.001. Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups. Conclusion

  20. Influences of prolonged apnea and oxygen inhalation on pulmonary hemodynamics during breath holding: Quantitative assessment by velocity-encoded MR imaging with SENSE technique

    Nogami, Munenobu [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan)], E-mail:; Ohno, Yoshiharu [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Higashino, Takanori [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Department of Radiology, Tenri Hospital, Tenri, Nara (Japan); Takenaka, Daisuke [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Yoshikawa, Takeshi [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Department of Radiology, Konan Hospital, Kobe, Hyogo (Japan); Koyama, Hisanobu [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Kawamitsu, Hideaki [Division of Radiology, Kobe University Hospital, Kobe, Hyogo (Japan); Fujii, Masahiko [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan); Division of Radiology, Kobe University Hospital, Kobe, Hyogo (Japan); Sugimura, Kazuro [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017 (Japan)


    Purpose: The purpose of our study was to assess the influence of prolonged apnea and administration of oxygen on pulmonary hemodynamics during breath holding (BH) by using velocity-encoded MR imaging combined with the SENSE technique (velocity MRI). Materials and methods: Ten healthy male volunteers underwent velocity MRI during BH with and without O{sub 2} inhalation. All velocity MRI data sets were obtained continuously with the 2D cine phase-contrast method during a single BH period. The data were then divided into three BH time phases as follows: first, second and third. To evaluate the influence of prolonged apnea on hemodynamics, stroke volume (SV) and maximal change in flow rate during ejection (MCFR) of second and third phases were statistically compared with those of first phase by using the ANOVA followed by Turkey's HSD multiple comparison test. To assess the influence of O{sub 2} on hemodynamics, SV and MCFR with or without O{sub 2} were compared by the paired t-test. To assess the measuring agreement of hemodynamic indices during prolonged breath holding, Bland-Altman's analysis was performed. Results: Prolonged apnea had no significant influence on SV and MCFR regardless of administration of O{sub 2} (p > 0.05). Mean MCFR for all phases was significantly lower with administration of O{sub 2} than without (p < 0.05). The limits of agreement for MCFR with O{sub 2} were smaller than without. Conclusion: O{sub 2} inhalation modulated maximal change in flow rate during ejection, and did not influence stroke volume during breath holding. Influence of O{sub 2} inhalation should be considered for MR measurements of pulmonary hemodynamics during breath holding.