BACKGROUND The coronavirus disease 2019(COVID-19) pandemic produced changes in intensive care units(ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychologi...BACKGROUND The coronavirus disease 2019(COVID-19) pandemic produced changes in intensive care units(ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff;this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.AIM To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.METHODS We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles,upon which we commented.RESULTS Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.CONCLUSION As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.展开更多
Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can...Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases,including diabetes;hypertension;atherosclerosis;coronary artery disease and stroke;obstructive sleep apnea;depression;weight-related arthropathies and endometrial and breast cancer.A body weight 20%above ideal for age,gender and height is a severe health risk.Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet,increased physical activity,behavioral changes and drugs have failed.The two most common procedures currently used are sleeve gastrectomy and gastric bypass.This procedure has gained popularity recently and is generally considered safe and effective.Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved,more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures.This review aims to synthesize and summarize the growing evidence on the long-term effectiveness,outcomes and complications of bariatric surgery.展开更多
Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires ...Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA Ⅰ-Ⅱ adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 m L(P100 group), 250 m L(P250 group), 500 m L(P500 group), 0.9% saline 500 m L(N500 group) or Gelofusine 500 m L(G500 group) was completed within 30 min, respectively, Propofol(0.5 mg/kg, 1%) was injected at a rate of 0.5 m L/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively(P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups(P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group(62.5%)(N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group(P<0.05) and G500 group(P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 m L before propofol injection is effective in alleviating propofol-induced pain.展开更多
Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a cont...Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a continuous Rb administration method based on effect-site concentrations calculated by a pharmacokinetic/pharmacodynamics model during propofol, sevoflurane, and desflurane anesthesia. Methods: The 36 enrolled patients were equally divided into three groups (P;propofol, S;sevoflurane, and D;desflurane groups). After induction and administration of Rb 0.6 mg/kg, we calculated the simulated effect-site concentration at the point which the first twitch (%T1) recovered to > 0% and defined this as the Rb recovery concentration (Rbr.c.) level appropriate for continuous rocuronium administration. The continuous administration doses of Rb were adjusted to maintain Rbr.c. during surgery. The Rbr.c. and the recovery time at %T1 > 25% were recorded for each type of anesthesia. Results: Rbr.c. (μg/mL) for the P, S, and D groups were 1.54 ± 0.2, 1.24 ± 0.2, and 1.09 ± 0.2, respectively. Continuous administration doses (μg/kg/min) in the P, S, and D group were 6.7 ± 0.9, 5.2 ± 1.0, and 4.5 ± 0.8, respectively. Rbr.c. and continuous doses in the S and D groups were lower than the P group. Neuromuscular relaxations during surgery in the S and D groups were more strongly maintained than for the P group. There was also a significantly prolonged recovery duration for the %T1 > 25% in the D versus the other two groups (P < 0.05). Conclusion: Results showed that our continuous administration method was effective for maintaining sufficient muscle relaxation without excessively prolonged recovery effects for both sevoflurane and desflurane as well as propofol anesthesia.展开更多
Background and Objectives: Propofol remains the most common drug for induction of general anaesthesia, although it causes considerable pain on injection. None of the commonly used methods completely attenuate this dis...Background and Objectives: Propofol remains the most common drug for induction of general anaesthesia, although it causes considerable pain on injection. None of the commonly used methods completely attenuate this discomfort. We aimed to investigate the effect of i.v. paracetamol pretreatment on the propofol injection pain. Materials and Methods: A prospective randomized double-blind study was conducted on 180 patients, ASA I or II status, scheduled to undergo elective surgery. They were randomly assigned to one of the three groups of 60 each. Groups I, II, III were pretreated with 40 mg of lidocaine in saline, 100 mg of paracetamol and 10 ml of saline, respectively. All patients had an 18-gauge catheter inserted into a superficial radial vein. After 2 min of venous occlusion, one-fourth of the total propofol dose was injected into the vein over a period of 20 seconds. During the injection of both pretreatment solution and propofol, a blinded researcher assessed the patient’s pain level using a four-point verbal rating scale (VRS) (none = 0, mild = 1, moderate = 2, and severe = 3). X2 test and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P < 0.05. Results: The three groups were comparable in respect to patient’s characteristics. The incidence of pain on injection of propofol in placebo, i.v. paracetamol and lidocaine groups were 85%, 36%, 21% respectively (p < 0.05). Intensity and severity of propofol induced pain were comparable between paracetamol and lidocaine groups. Conclusion: Pretreatment using i.v. paracetamol was found to be effective in reducing propofol injection-induced pain.展开更多
Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracorporeal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thir...Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracorporeal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thirty-four ASA I-III patients used PCS with propofol and alfentanil for ESWL in this interventional study. Strict safety limits were defined regarding respiratory rate (RR), heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation from pulse oximetry (SpO2), and transcutaneous partial pressures of oxygen (PtcO2) and carbon dioxide (PtcCO2). The patients' levels of consciousness was graded on a five-point scale and monitored with Bispectral Index (BIS). A nurse anaesthetist was supervising the procedure but was instructed to intervene only if safety limits were breached. No supplementary oxygen was given. Results: All patients responded to verbal stimuli during treatment. Cardiovascular stability was maintained, but respiratory variables were affected. Two patients with SpO2 2 ≥ 6.5 kPa). In 18 patients hypoxaemia was indicated as PtcO2 ≤ 8.0 kPa. All these 18 patients were given supplementary oxygen. There was no correlation between dose of drugs, age, weight or any vital variable. The 34 patients would use PCS again in the case of future treatment. Conclusions: During ESWL treatment PCS can be used with good patients’ satisfaction, and maintained cardiovascular stability, but PCS had an indisputable effect on pulmonary function with hypoxemia (resulting in need for supplementary oxygen) or hypercarbia. The person in charge of PCS must therefore be trained to perform according to the guidelines for sedation and/or analgesia by non-anaesthesiology doctors.展开更多
Blood glucose control in intensive care unit(ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate ...Blood glucose control in intensive care unit(ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate calories load and, when necessary, to continuously infuse insulin titrated to patients needs: intensive insulin therapy(IIT). Short acting insulin analogues(SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter onset and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a more limited risk of inducing episodes of iatrogenic hypoglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and researchers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients(i.e., sedation and treatment of arterial hypertension) and we also describe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia relatedto IIT. The pharmacodynamic and pharmachokinetic characteristics of SAIA will be also discussed.展开更多
Objective To investigate the effect of sevoflurane preconditioning and postconditioning on lung ischemia-reperfusion(IR) injury and apoptosis in rat.Methods Wistar rats were randomly assigned to four groups:sham group...Objective To investigate the effect of sevoflurane preconditioning and postconditioning on lung ischemia-reperfusion(IR) injury and apoptosis in rat.Methods Wistar rats were randomly assigned to four groups:sham group(n =6):no ischaemia-reperfusion;IR group(n =6):left lung ischemia was achieved by clamping the hilum for 90 min,followed by 120 min reperfusion;sev+pre group(n =6):1 minimum alveolar concentration(MAC) sevoflurane was admi-nistered for 30 min prior to ischemia;sev+post group(n =6):ischemia was followed by 1 MAC sevoflurane postconditioning at the first 30 min reperfusion.PaO2 was measured after reperfusion.The number of apoptotic cells was estimated using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling(TUNEL) technique.Results After ischemia-reperfusion,a significant deterioration of PaO2 was noticed and the number of apoptotic cells remarkably increased compared with that of sham group.In sev+pre group and sev+post group,PaO2 was(85.7±14.4) mmHg and(88.6±12.5) mmHg respectively,which was apparently increased compared with that in IR group [(63.9±11.3) mmHg,P <0.05].The number of apoptotic cells in sev+pre group [(6.94 ± 1.49)%] and sev+post group [(7.69 ± 1.61)%] was significantly lower than that in IR group [(12.12 ± 2.77)%,P <0.05].But all parameters showed no significant difference between sev+pre group and sev+post group.Conclusions Both sevoflurane preconditioning and postconditioning could prevent lung ischemia-reperfusion injury and attenuate apoptosis in rat.展开更多
BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyel...BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.展开更多
The existing researches in the field of regional anesthesia of the sciatic nerve show that if popliteal sciatic nerve blockade is performed, the time of the development of the sciatic nerve anesthesia is longer in com...The existing researches in the field of regional anesthesia of the sciatic nerve show that if popliteal sciatic nerve blockade is performed, the time of the development of the sciatic nerve anesthesia is longer in comparison with subgluteal sciatic nerve blockade. Background: The aim of the research is to compare the time of the development of the sciatic nerve blockade performed with 1% lidocaine with epinephrine (1:200,000) in subgluteal and popliteal areas under ultrasound guidance. Materials and Methods: Patients were divided into two groups. In Group A (20 patients), the subgluteal approach to block the sciatic nerve was taken;in Group B (20 patients), the popliteal approach was applied. All blockades of the sciatic nerve were performed with 1% lidocaine (30 ml of lidocaine with epinephrine (1:200,000)) and electrical stimulation of peripheral nerves under ultrasound guidance. We measured the time of the development of sensory and motor blocks. Results: In Group A, the sciatic nerve sensory block developed in 15 (14 - 16) minutes, a complete motor block developed in 15.5 (15 - 17) minutes. In Group B the sciatic nerve sensory block developed in 40 (38.5 - 42.5) minutes while a complete motor block did not develop in any patient. Conclusion: When the sciatic nerve is blocked in subgluteal area with 30 ml of 1% lidocaine with epinephrine (1:200,000) under ultrasound guidance, sensory blocks develop faster than during the popliteal blockade: 15 (14 - 16) minutes vs. 40 (38.5 - 42.5) minutes respectively. The opportunity to define the place of the introduction of local anesthetic in our research is limited.展开更多
Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endo...Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious Sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious Sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 < 90%), patient cooperation, patient comfort, hallucination, nausea and vomiting, nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea was not statistically significant. The anesthesiologist was satisfied by the quality of patient’s cooperation for laryngoscopy in both groups. Conclusion: Subcutaneous dissociative conscious sedation is comparable with general anesthesia to provide desirable situation for laryngoscopy and tracheal intubation.展开更多
<strong>Background:</strong> Hand hygiene (HH) is essential in preventing healthcare-associated infections, especially during the COVID-19 pandemic, where SARS-CoV2 has shown the ability to survive on surf...<strong>Background:</strong> Hand hygiene (HH) is essential in preventing healthcare-associated infections, especially during the COVID-19 pandemic, where SARS-CoV2 has shown the ability to survive on surfaces for days. In this study, we explore HH compliance rate and the factors associated with its increase during COVID-19 pandemic. <strong>Methods:</strong> HH compliance was assessed amongst doctors in Anesthesia and Surgical Intensive Care Unit by direct observation between 2018 and 2021. An anonymous survey was then sent to the doctors to understand factors influencing the observed improvement in HH compliance during the pandemic. <strong>Results:</strong> Compliance towards the five moments of HH has shown a statistically significant rising trend from a median HH compliance of 60% in 2018, to 70% in 2019 to 94% in 2020. However, HH compliance subsequently declined in the first quarter of 2021 to median of 87%. The follow-up survey had a response rate of 96% (n = 53). 90% of survey participants responded that their HH frequency had increased during the COVID-19 pandemic with 47% stating they were performing HH 11 - 20 times/day. 64% responded that this increased frequency had affected their skin condition. 62% responded that this increased frequency was sustainable even after the pandemic ends. Participants ranked considerations influencing HH compliance. “Prevent transmitting the infection to vulnerable patients” was ranked highest followed by “High infection rate”, “Fear of contracting COVID-19” and lastly, “Public health guidelines”. <strong>Conclusions:</strong> Despite the absence of new campaigns, HH compliance reached an all-time high. The pandemic has provided opportunity for behavioral change through “reflective” drivers of behavior such as emotions (“Fear”) and knowledge (“High infection rate”). Understanding the motivations behind current increased HH compliance and riding on the increased initial uptake of behavior may help convert HH into a habitual action and not just a reaction to the pandemic.展开更多
Controversy exists whether or not patient’s concerns regarding anesthetics can be reduced by face-to-face pre-assessment with an anesthetist. Thus we were looking at concerns patients had before and after such a cons...Controversy exists whether or not patient’s concerns regarding anesthetics can be reduced by face-to-face pre-assessment with an anesthetist. Thus we were looking at concerns patients had before and after such a consultation. Patient satisfaction was rated by a validated questionnaire. A four-staged Likert-scale was used to quantify the extent of patients concerns. The totaling 461 patients were overall highly satisfied. 448 patients had “nil” to “minimal” concerns. After the assessment, 106 patients stated their concerns had been lessened (p 0.001). Having gone through the anesthetic pre-assessment center, 99.1% of all patients reported no considerable concerns regarding anesthetics whatsoever. A high level of patient satisfaction does not constitute a low level of concerns patients may hold over anesthetics, although a pre-operative consultation mitigated these concerns by 23%, whilst for 9% of all patients this pre-assessment led to a higher level of concerns.展开更多
Background: Propofol inhibits fatty acid oxidation and induces mitochondrial deficiency, a possible mechanism involved in propofol infusion syndrome. This study investigated how propofol influences fatty acid, glucose...Background: Propofol inhibits fatty acid oxidation and induces mitochondrial deficiency, a possible mechanism involved in propofol infusion syndrome. This study investigated how propofol influences fatty acid, glucose, and amino acid metabolism, as well as whether L-carnitine may improve suppression of free fatty acid metabolism. Methods: Male Sprague-Dawley rats, fasted for 16 hours, were allocated to the following two groups: (Group P;continuous intravenous administration of 10 mg/kg/h propofol;n = 8) and (Group P + C;intravenous administration of 50 mg/kg and then 50 mg/kg/h L-carnitine continuously;n = 8). Concentrations of glucose, free fatty acid (FFA), amino acids, in-sulin, and β-hydroxybutyric acid were measured at the start and then one, two, and three hours after propofol administration. Intrahepatic triglyceride levels were measured at the end of experiments. In vitro experiments comprised measurement of oxygen consumption in human hepatocytes (Hepg2) and investigating dependency on palmitic acid, glucose, and glutamine as fuel during propofol administration, with or without L-carnitine. Results: FFA increased in Group P and gradually decreased in Group P + C. There were significant differences between the two groups (Group P;331.2 ± 64.5 μM vs. Group P + C;199 ± 73.6 μM). Glucose decreased in both groups (Group P;53.8 ±16.6 mg/dL vs. Group P + C;88 ± 11.3 mg/dL). Amino acid concentrations were higher in Group P + C after experiments;alanine and glutamine increased significantly. β-hydroxybutyric acid increased significantly in Group P + C, and intrahepatic triglyceride decreased in Group P + C. Dependency on fatty acid metabolism significantly decreased with propofol only;addition of L-carnitine prevented these effects. Conclusions: Propofol impaired mitochondrial fatty acid metabolism, which was compensated mainly by a switch to glucose metabolism and partially by amino acid metabolism. Addition of L-carnitine may improve this imbalance of energy metabolism.展开更多
Background: The aim of the study is to determine the effect of a reduction in dose of local anesthetic blockade on the development of the sciatic nerve. Methods: Forty blocks of sciatic nerve were used in a double-bli...Background: The aim of the study is to determine the effect of a reduction in dose of local anesthetic blockade on the development of the sciatic nerve. Methods: Forty blocks of sciatic nerve were used in a double-blind randomized research, under ultrasonic guidance, using an electric stimulator with the peripheral nerves. Forty patients were divided into 2 equal groups. In the first group, a sciatic nerve block was performed with 5 ml of 0.75% ropivacaine solution (37.5 mg);in the second group, 10 ml of 0.75% ropivacaine solution (75 mg) was used. The assessment of the time required for developing sensory and motor blocks was carried out from the beginning of local anesthetic solution injection in the fascial sheath of the sciatic nerve. Results: Demographic data of patients were identical in the two sample groups. The time required for achieving a complete sensory block in groups treated with 5 and 10 ml ropivacaine was 45 (40;48) and 30 (28;30) min, respectively, (р 0.05. Conclusions: Complete blockade of the sciatic nerve is developed using 5 ml of 0.75% ropivacaine. Reducing the dose of ropivacaine prolongs the latent period of the LA during the blockade of the sciatic nerve. Time of postoperative analgesia was not significantly changed.展开更多
AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fe...AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.展开更多
Pancreatic islet transplantation is a minimally invasive procedure aiming to reverse the effects of insulin deficiency in patients with type 1 diabetes(T1D)by transplanting pancreatic beta cells.Overall,pancreatic isl...Pancreatic islet transplantation is a minimally invasive procedure aiming to reverse the effects of insulin deficiency in patients with type 1 diabetes(T1D)by transplanting pancreatic beta cells.Overall,pancreatic islet transplantation has improved to a great extent,and cellular replacement will likely become the mainstay treatment.We review pancreatic islet transplantation as a treatment for T1D and the immunological challenges faced.Published data demonstrated that the time for islet cell transfusion varied between 2 and 10 h.Approximately 54%of the patients gained insulin independence at the end of the first year,while only 20%remained insulin-free at the end of the second year.Eventually,most transplanted patients return to using some form of exogenous insulin within a few years after the transplantation,which imposed the need to improve immunological factors before transplantation.We also discuss the immunosuppressive regimens,apoptotic donor lymphocytes,anti-TIM-1 antibodies,mixed chimerism-based tolerance induction,induction of antigen-specific tolerance utilizing ethylene carbodiimide-fixed splenocytes,pretransplant infusions of donor apoptotic cells,B cell depletion,preconditioning of isolated islets,inducing local immunotolerance,cell encapsulation and immunoisolation,using of biomaterials,immunomodulatory cells,etc.展开更多
<strong>Background:</strong> Multicentric prospective cohort investigation survey conducted between 1<sup>st</sup> of March and 1<sup>st</sup> of April 2021on SARS-CoV-2 occupationa...<strong>Background:</strong> Multicentric prospective cohort investigation survey conducted between 1<sup>st</sup> of March and 1<sup>st</sup> of April 2021on SARS-CoV-2 occupational risk for German Emergency Medical Services (EMS) personnel. <strong>Study Objectives: Primary:</strong> The objective is to take stock of the use and availability of Personal Protective Equipment (PPE) in German EMS, both at managerial and employee level, during the SARS-CoV-2 pandemic. <strong>Secondary:</strong> Generate additional data on individual perceptions of risk of infection and occurrence of infections at respective places of service. <strong>Methods:</strong> Multicentric prospective cohort investigation survey conducted online at two levels of German EMS personnel—EMS managers and EMS employees, both medical and paramedical—with questions adapted slightly to fit the respective study population. <strong>Results:</strong> A total of 34 responses were received in the managerial group;a total of 2389 responses were received in the group of employees. Self-reported PPE adherence of EMS employees for confirmed SARS-CoV-2 positive patients: use of gloves (99.8%), FFP2 or FFP3 masks (99.8%), gowns or coveralls (99.1%), goggles (89.7%), face shields (24.0%), surgical masks (0.0%). Self-reported PPE adherence of EMS employees for suspected SARS-CoV-2 positive patients: gloves (98.8%), FFP2 or FFP3 masks (total: 99.4%), gowns or coveralls (total: 95.9%), goggles (85.6%), face shields (19.2%), surgical masks (0.2%). <strong>Conclusions:</strong> Findings included an overall improved self-reported adherence to PPE compared to studies that were conducted before the pandemic. Self-reported general adherence to PPE recommendations when attending to confirmed SARS-CoV-2 positive patients was good, with the exception of goggles. Self-reported adherence to PPE recommendations dropped when attending to suspected SARS-CoV-2 positive patients.展开更多
During the past decades,populous expansion in mast cell scientific literature came forth with more,than forty-four thousand PubMed publications available to date.Such surge is due to the appreciation of the momentous ...During the past decades,populous expansion in mast cell scientific literature came forth with more,than forty-four thousand PubMed publications available to date.Such surge is due to the appreciation of the momentous role of mast cells in the evolution of species,in the development and maintenance of vital physiological functions,such as reproduction,homeostasis,and fluids,diverse immunological roles,and the potential of far-reaching effects despite minute numbers.While the emerging knowledge of the importance of mast cells in equilibrium comes of age when looking at the matter from an evolutionary perspective,the recognition of mast cells beyond detrimental performance in allergies and asthma,during protection against parasites,falters.Beyond wellknown classical functions,mast cells can process and present antigens,can serve as a viral reservoir,can respond to hormones and xenobiotics,initiate antiviral and antibacterial responses,phagocytosis,apoptosis,and participate in important developmental cornerstones.During evolution,upon the development of a sophisticated niche of innate and adaptive cell populations,certain mast cell functions became partially transmutable,yet the potency of mast cells remained considerable.Reviewing mast cells enables us to reflect on the certitude,that our sophisticated,complex physiology is rooted deeply in evolution,which we carry ancient remnants of,ones that may have decisive roles in our functioning.This communication sets out the goal of characterizing mast cells,particularly the aspects less in limelight yet of immense significance,without the aspiration exhaust it all.展开更多
文摘BACKGROUND The coronavirus disease 2019(COVID-19) pandemic produced changes in intensive care units(ICUs) in patient care and health organizations. The pandemic event increased patients’ risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff;this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties.AIM To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff.METHODS We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles,upon which we commented.RESULTS Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories.CONCLUSION As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.
基金Supported by the European Union-NextGenerationEU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No. BG-RRP-2.004-0008-C01。
文摘Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases,including diabetes;hypertension;atherosclerosis;coronary artery disease and stroke;obstructive sleep apnea;depression;weight-related arthropathies and endometrial and breast cancer.A body weight 20%above ideal for age,gender and height is a severe health risk.Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet,increased physical activity,behavioral changes and drugs have failed.The two most common procedures currently used are sleeve gastrectomy and gastric bypass.This procedure has gained popularity recently and is generally considered safe and effective.Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved,more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures.This review aims to synthesize and summarize the growing evidence on the long-term effectiveness,outcomes and complications of bariatric surgery.
文摘Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA Ⅰ-Ⅱ adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 m L(P100 group), 250 m L(P250 group), 500 m L(P500 group), 0.9% saline 500 m L(N500 group) or Gelofusine 500 m L(G500 group) was completed within 30 min, respectively, Propofol(0.5 mg/kg, 1%) was injected at a rate of 0.5 m L/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively(P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups(P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group(62.5%)(N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group(P<0.05) and G500 group(P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 m L before propofol injection is effective in alleviating propofol-induced pain.
文摘Purpose: Although rocuronium bromide (Rb) is suitable for continuous administration use, determination of optimal continuous doses is difficult due to individual differences. This study examines the efficacy of a continuous Rb administration method based on effect-site concentrations calculated by a pharmacokinetic/pharmacodynamics model during propofol, sevoflurane, and desflurane anesthesia. Methods: The 36 enrolled patients were equally divided into three groups (P;propofol, S;sevoflurane, and D;desflurane groups). After induction and administration of Rb 0.6 mg/kg, we calculated the simulated effect-site concentration at the point which the first twitch (%T1) recovered to > 0% and defined this as the Rb recovery concentration (Rbr.c.) level appropriate for continuous rocuronium administration. The continuous administration doses of Rb were adjusted to maintain Rbr.c. during surgery. The Rbr.c. and the recovery time at %T1 > 25% were recorded for each type of anesthesia. Results: Rbr.c. (μg/mL) for the P, S, and D groups were 1.54 ± 0.2, 1.24 ± 0.2, and 1.09 ± 0.2, respectively. Continuous administration doses (μg/kg/min) in the P, S, and D group were 6.7 ± 0.9, 5.2 ± 1.0, and 4.5 ± 0.8, respectively. Rbr.c. and continuous doses in the S and D groups were lower than the P group. Neuromuscular relaxations during surgery in the S and D groups were more strongly maintained than for the P group. There was also a significantly prolonged recovery duration for the %T1 > 25% in the D versus the other two groups (P < 0.05). Conclusion: Results showed that our continuous administration method was effective for maintaining sufficient muscle relaxation without excessively prolonged recovery effects for both sevoflurane and desflurane as well as propofol anesthesia.
文摘Background and Objectives: Propofol remains the most common drug for induction of general anaesthesia, although it causes considerable pain on injection. None of the commonly used methods completely attenuate this discomfort. We aimed to investigate the effect of i.v. paracetamol pretreatment on the propofol injection pain. Materials and Methods: A prospective randomized double-blind study was conducted on 180 patients, ASA I or II status, scheduled to undergo elective surgery. They were randomly assigned to one of the three groups of 60 each. Groups I, II, III were pretreated with 40 mg of lidocaine in saline, 100 mg of paracetamol and 10 ml of saline, respectively. All patients had an 18-gauge catheter inserted into a superficial radial vein. After 2 min of venous occlusion, one-fourth of the total propofol dose was injected into the vein over a period of 20 seconds. During the injection of both pretreatment solution and propofol, a blinded researcher assessed the patient’s pain level using a four-point verbal rating scale (VRS) (none = 0, mild = 1, moderate = 2, and severe = 3). X2 test and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P < 0.05. Results: The three groups were comparable in respect to patient’s characteristics. The incidence of pain on injection of propofol in placebo, i.v. paracetamol and lidocaine groups were 85%, 36%, 21% respectively (p < 0.05). Intensity and severity of propofol induced pain were comparable between paracetamol and lidocaine groups. Conclusion: Pretreatment using i.v. paracetamol was found to be effective in reducing propofol injection-induced pain.
文摘Background: The aim was to evaluate safety aspects of patient-controlled sedation and analgesia (PCS) for extracorporeal shockwave lithotripsy (ESWL) and PCS to be handled by non-anaesthesiology doctors. Methods: Thirty-four ASA I-III patients used PCS with propofol and alfentanil for ESWL in this interventional study. Strict safety limits were defined regarding respiratory rate (RR), heart rate (HR), mean arterial blood pressure (MAP), oxygen saturation from pulse oximetry (SpO2), and transcutaneous partial pressures of oxygen (PtcO2) and carbon dioxide (PtcCO2). The patients' levels of consciousness was graded on a five-point scale and monitored with Bispectral Index (BIS). A nurse anaesthetist was supervising the procedure but was instructed to intervene only if safety limits were breached. No supplementary oxygen was given. Results: All patients responded to verbal stimuli during treatment. Cardiovascular stability was maintained, but respiratory variables were affected. Two patients with SpO2 2 ≥ 6.5 kPa). In 18 patients hypoxaemia was indicated as PtcO2 ≤ 8.0 kPa. All these 18 patients were given supplementary oxygen. There was no correlation between dose of drugs, age, weight or any vital variable. The 34 patients would use PCS again in the case of future treatment. Conclusions: During ESWL treatment PCS can be used with good patients’ satisfaction, and maintained cardiovascular stability, but PCS had an indisputable effect on pulmonary function with hypoxemia (resulting in need for supplementary oxygen) or hypercarbia. The person in charge of PCS must therefore be trained to perform according to the guidelines for sedation and/or analgesia by non-anaesthesiology doctors.
文摘Blood glucose control in intensive care unit(ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate calories load and, when necessary, to continuously infuse insulin titrated to patients needs: intensive insulin therapy(IIT). Short acting insulin analogues(SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter onset and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a more limited risk of inducing episodes of iatrogenic hypoglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and researchers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients(i.e., sedation and treatment of arterial hypertension) and we also describe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia relatedto IIT. The pharmacodynamic and pharmachokinetic characteristics of SAIA will be also discussed.
文摘Objective To investigate the effect of sevoflurane preconditioning and postconditioning on lung ischemia-reperfusion(IR) injury and apoptosis in rat.Methods Wistar rats were randomly assigned to four groups:sham group(n =6):no ischaemia-reperfusion;IR group(n =6):left lung ischemia was achieved by clamping the hilum for 90 min,followed by 120 min reperfusion;sev+pre group(n =6):1 minimum alveolar concentration(MAC) sevoflurane was admi-nistered for 30 min prior to ischemia;sev+post group(n =6):ischemia was followed by 1 MAC sevoflurane postconditioning at the first 30 min reperfusion.PaO2 was measured after reperfusion.The number of apoptotic cells was estimated using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling(TUNEL) technique.Results After ischemia-reperfusion,a significant deterioration of PaO2 was noticed and the number of apoptotic cells remarkably increased compared with that of sham group.In sev+pre group and sev+post group,PaO2 was(85.7±14.4) mmHg and(88.6±12.5) mmHg respectively,which was apparently increased compared with that in IR group [(63.9±11.3) mmHg,P <0.05].The number of apoptotic cells in sev+pre group [(6.94 ± 1.49)%] and sev+post group [(7.69 ± 1.61)%] was significantly lower than that in IR group [(12.12 ± 2.77)%,P <0.05].But all parameters showed no significant difference between sev+pre group and sev+post group.Conclusions Both sevoflurane preconditioning and postconditioning could prevent lung ischemia-reperfusion injury and attenuate apoptosis in rat.
文摘BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.
文摘The existing researches in the field of regional anesthesia of the sciatic nerve show that if popliteal sciatic nerve blockade is performed, the time of the development of the sciatic nerve anesthesia is longer in comparison with subgluteal sciatic nerve blockade. Background: The aim of the research is to compare the time of the development of the sciatic nerve blockade performed with 1% lidocaine with epinephrine (1:200,000) in subgluteal and popliteal areas under ultrasound guidance. Materials and Methods: Patients were divided into two groups. In Group A (20 patients), the subgluteal approach to block the sciatic nerve was taken;in Group B (20 patients), the popliteal approach was applied. All blockades of the sciatic nerve were performed with 1% lidocaine (30 ml of lidocaine with epinephrine (1:200,000)) and electrical stimulation of peripheral nerves under ultrasound guidance. We measured the time of the development of sensory and motor blocks. Results: In Group A, the sciatic nerve sensory block developed in 15 (14 - 16) minutes, a complete motor block developed in 15.5 (15 - 17) minutes. In Group B the sciatic nerve sensory block developed in 40 (38.5 - 42.5) minutes while a complete motor block did not develop in any patient. Conclusion: When the sciatic nerve is blocked in subgluteal area with 30 ml of 1% lidocaine with epinephrine (1:200,000) under ultrasound guidance, sensory blocks develop faster than during the popliteal blockade: 15 (14 - 16) minutes vs. 40 (38.5 - 42.5) minutes respectively. The opportunity to define the place of the introduction of local anesthetic in our research is limited.
文摘Despite outstanding improvements in anesthesia techniques and anesthetics, difficult airway is still a dilemma and is accompanied by morbidity and mortality. The aim of this study is to compare the feasibility of endotracheal intubation with the traditional method of general anesthesia by using muscle relaxants, and “sDCS” (Subcutaneous Dissociative Conscious Sedation) which has been recently reported as an efficient method of anesthesia with the capability of maintaining spontaneous ventilation and providing an appropriate situation for larynxgoscopy and endotracheal intubation. Material and Methods: This randomized clinical trial was conducted on 100 patients who were scheduled for elective laparotomy. Patients were randomly divided into two groups: group A and group B. In group A, patients underwent general anesthesia with thiopental sodium and relaxant. In group B, patients underwent “subcutaneous Dissociative Conscious Sedation” and received low dose subcutaneous ketamine and intravenous narcotic with no relaxant. The feasibility of direct laryngoscopy and tracheal intubation, hemodynamic changes, desaturation (SpO2 < 90%), patient cooperation, patient comfort, hallucination, nausea and vomiting, nystagmus and salivation were evaluated in two groups. Adverse events including apnea and need for positive pressure mask ventilation, additional dose of fentanyl were recorded in group B. The anesthesiologist who performed the procedure was asked about the patient calmness and cooperation during the procedure and the feasibility of laryngoscopy and tracheal intubation. The incidence of nausea and vomiting in post-operative care unit was recorded too. Results: Hemodynamic variables were comparable in two groups. No event of irreversible respiratory depression, desaturation, need for positive pressure ventilation and hallucination was observed in group B. All patients were cooperative and obedient during the laryngoscopy and tracheal intubation. The incidence of nausea was not statistically significant. The anesthesiologist was satisfied by the quality of patient’s cooperation for laryngoscopy in both groups. Conclusion: Subcutaneous dissociative conscious sedation is comparable with general anesthesia to provide desirable situation for laryngoscopy and tracheal intubation.
文摘<strong>Background:</strong> Hand hygiene (HH) is essential in preventing healthcare-associated infections, especially during the COVID-19 pandemic, where SARS-CoV2 has shown the ability to survive on surfaces for days. In this study, we explore HH compliance rate and the factors associated with its increase during COVID-19 pandemic. <strong>Methods:</strong> HH compliance was assessed amongst doctors in Anesthesia and Surgical Intensive Care Unit by direct observation between 2018 and 2021. An anonymous survey was then sent to the doctors to understand factors influencing the observed improvement in HH compliance during the pandemic. <strong>Results:</strong> Compliance towards the five moments of HH has shown a statistically significant rising trend from a median HH compliance of 60% in 2018, to 70% in 2019 to 94% in 2020. However, HH compliance subsequently declined in the first quarter of 2021 to median of 87%. The follow-up survey had a response rate of 96% (n = 53). 90% of survey participants responded that their HH frequency had increased during the COVID-19 pandemic with 47% stating they were performing HH 11 - 20 times/day. 64% responded that this increased frequency had affected their skin condition. 62% responded that this increased frequency was sustainable even after the pandemic ends. Participants ranked considerations influencing HH compliance. “Prevent transmitting the infection to vulnerable patients” was ranked highest followed by “High infection rate”, “Fear of contracting COVID-19” and lastly, “Public health guidelines”. <strong>Conclusions:</strong> Despite the absence of new campaigns, HH compliance reached an all-time high. The pandemic has provided opportunity for behavioral change through “reflective” drivers of behavior such as emotions (“Fear”) and knowledge (“High infection rate”). Understanding the motivations behind current increased HH compliance and riding on the increased initial uptake of behavior may help convert HH into a habitual action and not just a reaction to the pandemic.
文摘Controversy exists whether or not patient’s concerns regarding anesthetics can be reduced by face-to-face pre-assessment with an anesthetist. Thus we were looking at concerns patients had before and after such a consultation. Patient satisfaction was rated by a validated questionnaire. A four-staged Likert-scale was used to quantify the extent of patients concerns. The totaling 461 patients were overall highly satisfied. 448 patients had “nil” to “minimal” concerns. After the assessment, 106 patients stated their concerns had been lessened (p 0.001). Having gone through the anesthetic pre-assessment center, 99.1% of all patients reported no considerable concerns regarding anesthetics whatsoever. A high level of patient satisfaction does not constitute a low level of concerns patients may hold over anesthetics, although a pre-operative consultation mitigated these concerns by 23%, whilst for 9% of all patients this pre-assessment led to a higher level of concerns.
文摘Background: Propofol inhibits fatty acid oxidation and induces mitochondrial deficiency, a possible mechanism involved in propofol infusion syndrome. This study investigated how propofol influences fatty acid, glucose, and amino acid metabolism, as well as whether L-carnitine may improve suppression of free fatty acid metabolism. Methods: Male Sprague-Dawley rats, fasted for 16 hours, were allocated to the following two groups: (Group P;continuous intravenous administration of 10 mg/kg/h propofol;n = 8) and (Group P + C;intravenous administration of 50 mg/kg and then 50 mg/kg/h L-carnitine continuously;n = 8). Concentrations of glucose, free fatty acid (FFA), amino acids, in-sulin, and β-hydroxybutyric acid were measured at the start and then one, two, and three hours after propofol administration. Intrahepatic triglyceride levels were measured at the end of experiments. In vitro experiments comprised measurement of oxygen consumption in human hepatocytes (Hepg2) and investigating dependency on palmitic acid, glucose, and glutamine as fuel during propofol administration, with or without L-carnitine. Results: FFA increased in Group P and gradually decreased in Group P + C. There were significant differences between the two groups (Group P;331.2 ± 64.5 μM vs. Group P + C;199 ± 73.6 μM). Glucose decreased in both groups (Group P;53.8 ±16.6 mg/dL vs. Group P + C;88 ± 11.3 mg/dL). Amino acid concentrations were higher in Group P + C after experiments;alanine and glutamine increased significantly. β-hydroxybutyric acid increased significantly in Group P + C, and intrahepatic triglyceride decreased in Group P + C. Dependency on fatty acid metabolism significantly decreased with propofol only;addition of L-carnitine prevented these effects. Conclusions: Propofol impaired mitochondrial fatty acid metabolism, which was compensated mainly by a switch to glucose metabolism and partially by amino acid metabolism. Addition of L-carnitine may improve this imbalance of energy metabolism.
文摘Background: The aim of the study is to determine the effect of a reduction in dose of local anesthetic blockade on the development of the sciatic nerve. Methods: Forty blocks of sciatic nerve were used in a double-blind randomized research, under ultrasonic guidance, using an electric stimulator with the peripheral nerves. Forty patients were divided into 2 equal groups. In the first group, a sciatic nerve block was performed with 5 ml of 0.75% ropivacaine solution (37.5 mg);in the second group, 10 ml of 0.75% ropivacaine solution (75 mg) was used. The assessment of the time required for developing sensory and motor blocks was carried out from the beginning of local anesthetic solution injection in the fascial sheath of the sciatic nerve. Results: Demographic data of patients were identical in the two sample groups. The time required for achieving a complete sensory block in groups treated with 5 and 10 ml ropivacaine was 45 (40;48) and 30 (28;30) min, respectively, (р 0.05. Conclusions: Complete blockade of the sciatic nerve is developed using 5 ml of 0.75% ropivacaine. Reducing the dose of ropivacaine prolongs the latent period of the LA during the blockade of the sciatic nerve. Time of postoperative analgesia was not significantly changed.
文摘AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.
基金Supported by European Union-NextGenerationEU,through The National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008-C01.
文摘Pancreatic islet transplantation is a minimally invasive procedure aiming to reverse the effects of insulin deficiency in patients with type 1 diabetes(T1D)by transplanting pancreatic beta cells.Overall,pancreatic islet transplantation has improved to a great extent,and cellular replacement will likely become the mainstay treatment.We review pancreatic islet transplantation as a treatment for T1D and the immunological challenges faced.Published data demonstrated that the time for islet cell transfusion varied between 2 and 10 h.Approximately 54%of the patients gained insulin independence at the end of the first year,while only 20%remained insulin-free at the end of the second year.Eventually,most transplanted patients return to using some form of exogenous insulin within a few years after the transplantation,which imposed the need to improve immunological factors before transplantation.We also discuss the immunosuppressive regimens,apoptotic donor lymphocytes,anti-TIM-1 antibodies,mixed chimerism-based tolerance induction,induction of antigen-specific tolerance utilizing ethylene carbodiimide-fixed splenocytes,pretransplant infusions of donor apoptotic cells,B cell depletion,preconditioning of isolated islets,inducing local immunotolerance,cell encapsulation and immunoisolation,using of biomaterials,immunomodulatory cells,etc.
文摘<strong>Background:</strong> Multicentric prospective cohort investigation survey conducted between 1<sup>st</sup> of March and 1<sup>st</sup> of April 2021on SARS-CoV-2 occupational risk for German Emergency Medical Services (EMS) personnel. <strong>Study Objectives: Primary:</strong> The objective is to take stock of the use and availability of Personal Protective Equipment (PPE) in German EMS, both at managerial and employee level, during the SARS-CoV-2 pandemic. <strong>Secondary:</strong> Generate additional data on individual perceptions of risk of infection and occurrence of infections at respective places of service. <strong>Methods:</strong> Multicentric prospective cohort investigation survey conducted online at two levels of German EMS personnel—EMS managers and EMS employees, both medical and paramedical—with questions adapted slightly to fit the respective study population. <strong>Results:</strong> A total of 34 responses were received in the managerial group;a total of 2389 responses were received in the group of employees. Self-reported PPE adherence of EMS employees for confirmed SARS-CoV-2 positive patients: use of gloves (99.8%), FFP2 or FFP3 masks (99.8%), gowns or coveralls (99.1%), goggles (89.7%), face shields (24.0%), surgical masks (0.0%). Self-reported PPE adherence of EMS employees for suspected SARS-CoV-2 positive patients: gloves (98.8%), FFP2 or FFP3 masks (total: 99.4%), gowns or coveralls (total: 95.9%), goggles (85.6%), face shields (19.2%), surgical masks (0.2%). <strong>Conclusions:</strong> Findings included an overall improved self-reported adherence to PPE compared to studies that were conducted before the pandemic. Self-reported general adherence to PPE recommendations when attending to confirmed SARS-CoV-2 positive patients was good, with the exception of goggles. Self-reported adherence to PPE recommendations dropped when attending to suspected SARS-CoV-2 positive patients.
文摘During the past decades,populous expansion in mast cell scientific literature came forth with more,than forty-four thousand PubMed publications available to date.Such surge is due to the appreciation of the momentous role of mast cells in the evolution of species,in the development and maintenance of vital physiological functions,such as reproduction,homeostasis,and fluids,diverse immunological roles,and the potential of far-reaching effects despite minute numbers.While the emerging knowledge of the importance of mast cells in equilibrium comes of age when looking at the matter from an evolutionary perspective,the recognition of mast cells beyond detrimental performance in allergies and asthma,during protection against parasites,falters.Beyond wellknown classical functions,mast cells can process and present antigens,can serve as a viral reservoir,can respond to hormones and xenobiotics,initiate antiviral and antibacterial responses,phagocytosis,apoptosis,and participate in important developmental cornerstones.During evolution,upon the development of a sophisticated niche of innate and adaptive cell populations,certain mast cell functions became partially transmutable,yet the potency of mast cells remained considerable.Reviewing mast cells enables us to reflect on the certitude,that our sophisticated,complex physiology is rooted deeply in evolution,which we carry ancient remnants of,ones that may have decisive roles in our functioning.This communication sets out the goal of characterizing mast cells,particularly the aspects less in limelight yet of immense significance,without the aspiration exhaust it all.
