Validating a blood donation awareness tool created using general practitioner and patient acceptability and preferences

BACKGROUND

There is a need to develop an awareness raising tool for GPs to reach out their patients in order to increase blood donation. The main objective was to create and validate a tool to raise awareness about blood donation that meets acceptability and preference criteria and is applicable in general practice.

MATERIAL AND METHODS

This cross-sectional study was conducted in three phases. 1. Tool creation: A stakeholder meeting co-developed three potential tools to raise awareness about blood donation: a consulting room poster, a waiting room poster and a lapel badge for the doctor. Three GPs pilot-tested each tool for one day during their regular consultations. Then, once the pilot was completed each GP assessed acceptability and preference using a semi-structured interview, and patients were also interviewed. 2. Consensual tool selection: An appropriate tool was selected based on pilot data using nominal group technique and expert review. 3. The tool was validated for its acceptability in practice via a quantitative questionnaire distributed electronically to GPs.

RESULTS

The consensual tool selected by the nominal group was a combination of elements from all three tools trialled in the pilot, reported to be non-intrusive and convenient for both GPs and patients. Patient responses indicated a high level of acceptability and indicated a strong preference for self-generated discussion of the topic with their GP. In the validation step, 217 responses to the quantitative questionnaire were received: 74.5% of responses fulfilled the acceptability criteria for using this combined tool in general practice. Furthermore, 93.1% of GPs indicated they would use the tool in the proposed format for the purpose of raising awareness.

DISCUSSION

The validation of our blood donation awareness tool for use in general practice justifies its evaluation on a larger scale as part of a wider blood donation awareness campaign.

Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat

OBJECTIVE

To report a surgical technique for pancreaticoduodenostomy and its outcomes in a cat.

ANIMALS

A 14-year-old domestic cat.

STUDY DESIGN

Case report.

METHODS

A cat was referred to our hospital with a large abdominal mass. On ultrasonographic examination, this mass was identified as a large fluid-filled cavity in place of the right pancreatic duct and involved the pancreatic and accessory pancreatic ducts. A small echoic cavity was observed in the left pancreatic lobe. Serous fluid was collected from the large cavity. On cytology, the small cavity was consistent with an abscess. A partial left pancreatectomy was performed to remove the abscess. The large cavity was excised with the remnant of the right pancreatic lobe and body. After ligation of the pancreatic ducts, the left pancreatic duct was isolated and an end-to-side pancreaticoduodenostomy was performed.

RESULTS

The cat recovered without complications. Histological examination was consistent with chronic pancreatitis and peripheral inflammation. No evidence of postoperative pancreatic insufficiency was detected on clinical examination or laboratory findings. A focal ampulla-like dilation of the pancreatic duct was noted on ultrasonography, with no other complications at the anastomosis. The cat presented 225 days postoperatively with respiratory distress. Multiple nodules were identified throughout the lung parenchyma on radiographs. Abnormalities on ultrasonographic examination included an enlarged liver infiltrated with nodules. Due to poor prognosis, the cat was euthanized. Final histopathological diagnosis was diffuse carcinoma.

CONCLUSION

Pancreaticoduodenostomy restored pancreaticointestinal continuity after extensive pancreatectomy involving the pancreatic ducts and resulted in long-term survival in the cat reported here.

Hydropulsion as Palliative, Long-Term, Last-Resort Treatment of Nasal Carcinoma in a Dog and a Cat

An 8 yr old spayed female domestic shorthair and an 8 yr old neutered male Polish Lowland sheepdog were evaluated for a 3 wk history of sneezing and a 5 day history of left epistaxis, respectively. In both cases, computed tomography revealed a voluminous nasal mass, which was later histologically identified as carcinoma, without cribriform plate involvement. Nasal hydropulsion was performed in both animals in sternal recumbency under general anesthesia. A Poole suction tip was inserted into the orad esophageal opening and adequacy of the endotracheal tube cuff inflation was checked. Sterile saline was forcefully infused into the obstructed nasal cavity to dislodge the tumor. Both patients had temporary resolution of clinical signs. Nasal hydropulsion was repeated as a palliative last-resort treatment at each clinical relapse (four times in both animals over ≥1 yr), allowing long-term survival. Minor complications included a self-limiting retrobulbar and oropharyngeal swelling in the cat and self-limiting epistaxis in both animals. Although this technique is not intended to represent an equivalent alternative to radiation or surgical therapies, nasal hydropulsion may represent an appropriate palliative, last-resort treatment in case of obstructive nasal tumors in dogs and cats, when radiation therapy or surgery is not affordable, available, or desired.

The multivariate predictive model to estimate ionized calcium concentration from serum biochemical results in dogs: External validation

BACKGROUND

Predicted ionized calcium (piCa) can be calculated from routine biochemistry variables using a recently developed predictive model in dogs. However, it has not been evaluated with variables measured from multiple laboratories.

OBJECTIVES

We aimed to (a) externally validate piCa in dogs where biochemistry results were obtained from different analyzers, and (b) compare the diagnostic performances of piCa and total calcium (tCa).

METHODS

A cross-sectional multicentric study on 138 dogs from three different hospitals was performed. The sensitivity (Sen), specificity (Spe), positive (PPV) and negative predictive values (NPV), and diagnostic discordance of piCa and tCa were calculated using logistic regression for ionized hypercalcemia and hypocalcemia. Diagnostic performance fluctuations across hospitals were also assessed.

RESULTS

For ionized hypercalcemia, the Sen (81.8%), Spe (96.1%), PPV (69.2%), NPV (97.7%), and diagnostic discordance (5.1%) of piCa were not significantly different among hospitals or from those of tCa. For ionized hypocalcemia, the Sen (range: 9.7%-53.8%) and Spe (range: 95.6%-99.6%) of piCa and tCa (Sen range: 16.2%-87.8%; Spe range: 58.3%-98.1%) varied across hospitals, although to a lesser extent for piCa. The diagnostic discordances of piCa (20.3%) and tCa (25.4%) were close. The prediction interval (PI) of piCa demonstrated high Sen to screen for ionized hypercalcemia (100%) and hypocalcemia (range: 75%-93.3%), and high Spe to diagnose ionized hypercalcemia and hypocalcemia (100% for both).

CONCLUSIONS

These results support the external validation of piCa in dogs. Its PI represents a notable advantage over tCa to help clinicians explore calcium-related disorders when ionized calcium cannot be readily measured.

A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials

CONTEXT

Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions.

EVIDENCE ACQUISITION

This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018.

EVIDENCE SYNTHESIS

Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%).

CONCLUSIONS

Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.

Bilateral Pyelonephritis in a Cat with Multiple Urinary Malformations Including Ureteral Pseudodiverticulosis

Ureteral pseudodiverticulosis is an unusual acquired abnormality in humans and dogs. This report describes the first feline case of ureteral pseudodiverticulosis, associated with right retrocaval ureter and malposition of the uretero-vesical junctions, in the context of pyelonephritis. The coexistence of pseudodiverticulosis with other urinary abnormalities suggested that this lesion should be considered in other patients with urinary pathology.

A systematic review and meta-analyses of the association between 4 mycoplasma species and lower respiratory tract disease in dogs

Background

The pathogenic role of mycoplasmas in the lower respiratory tract (LRT) of dogs is debated, because mycoplasmas can be isolated from both healthy and sick dogs.

Objectives

To critically assess available data from controlled observational studies on the role of 4 mycoplasma species in LRT disease of dogs.

Design

Systematic review and meta‐analyses.

Methods

Seven electronic databases were searched for relevant publications. Risk of bias was assessed by the Newcastle‐Ottawa Scale. Meta‐analyses, stratified by mycoplasmal species, were performed using a random effects Bayesian model with noninformative priors to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the association between Mycoplasma cynos, Mycoplasma canis, Mycoplasma spumans, and Mycoplasma edwardii and LRT disease in dogs.

Results

Five studies were included from 1201 references identified. All studies dealt with M. cynos, whereas 3 dealt with the other mycoplasma species. A significant association was found between M. cynos and LRT disease (Bayesian OR, 3.60; CI, 1.31‐10.29). Conversely, M. canis, M. spumans, and M. edwardii were not significantly associated with LRT signs (Bayesian OR, 1.06; CI, 0.10‐14.63; Bayesian OR, 3.40; CI, 0.16‐54.27; and Bayesian OR, 1.04; CI, 0.05‐23.54, respectively).

Conclusions and Clinical Importance

Results support a pathogenic role of M. cynos and a commensal role of M. canis and M. edwardii in LRT in dogs. Although the association was not significant based on the CI, the point estimate of the Bayesian OR was relatively high for M. spumans, making its role less clear. Mycoplasma cynos‐specific polymerase chain reaction should be considered on samples from dogs with LRT.

Probing the light hole/heavy hole switching with correlated magneto-optical spectroscopy and chemical analysis on a single quantum dot

A whole series of complementary studies have been performed on the same single nanowire containing a quantum dot: cathodoluminescence spectroscopy and imaging, micro-photoluminescence spectroscopy under magnetic field and as a function of temperature, and energy-dispersive x-ray spectrometry and imaging. The ZnTe nanowire was deposited on a Si₃N₄ membrane with Ti/Al patterns. The complete set of data shows that the CdTe quantum dot features the heavy-hole state as a ground state, although the compressive mismatch strain promotes a light-hole ground state as soon as the aspect ratio is larger than unity (elongated dot). A numerical calculation of the whole structure shows that the transition from the heavy-hole to the light-hole configuration is pushed toward values of the aspect ratio much larger than unity by the presence of a (Zn, Mg)Te shell, and that the effect is further enhanced by a small valence band offset between the semiconductors in the dot and around it.

Monolithic Axial and Radial Metal-Semiconductor Nanowire Heterostructures

The electrical and optical properties of low-dimensional nanostructures depend critically on size and geometry and may differ distinctly from those of their bulk counterparts. In particular, ultrathin semiconducting layers as well as nanowires have already proven the feasibility to realize and study quantum size effects enabling novel ultrascaled devices. Further, plasmonic metal nanostructures attracted recently a lot of attention because of appealing near-field-mediated enhancement effects. Thus, combining metal and semiconducting constituents in quasi one-dimensional heterostructures will pave the way for ultrascaled systems and high-performance devices with exceptional electrical, optical, and plasmonic functionality. This Letter reports on the sophisticated fabrication and structural properties of axial and radial Al-Ge and Al-Si nanowire heterostructures, synthesized by a thermally induced exchange reaction of single-crystalline Ge-Si core-shell nanowires and Al pads. This enables a self-aligned metallic contact formation to Ge segments beyond lithographic limitations as well as ultrathin semiconducting layers wrapped around monocrystalline Al core nanowires. High-resolution transmission electron microscopy, energy dispersive X-ray spectroscopy, and μ-Raman measurements proved the composition and perfect crystallinity of these metal-semiconductor nanowire heterostructures. This exemplary selective replacement of Ge by Al represents a general approach for the elaboration of radial and axial metal-semiconductor heterostructures in various Ge-semiconductor heterostructures.

Recurrent Obstructive Fibrinous Tracheal Pseudomembranes in a Young English Bulldog

Endotracheal intubation is a common procedure, rarely associated with life-threatening complications (e.g., tracheal rupture, necrosis, foreign body). A 1.5-year-old English Bulldog was presented for respiratory distress, with increased respiratory efforts and stridor, 2 days after endotracheal intubation. Cervical and thoracic radiographs disclosed a severe narrowing of the tracheal lumen associated with an intraluminal soft-tissue structure at the thoracic inlet. Tracheoscopy confirmed the presence of an obstructive fibrinous tracheal pseudomembrane (OFTP) creating a 1-way valve obstruction. Removal of the OFTP dramatically improved the dog's respiratory function, but the lesion reformed twice despite corticosteroid and antibiotic therapy PO, warranting repeated endoscopic removal of the OFTP. No additional recurrences were observed after treatment with inhaled heparin and N-acetylcysteine q4h. No respiratory signs were reported 9 months after discharge. Postintubation OFTP has been reported rarely in humans and never described in dogs. Unexplained signs of upper airway obstruction shortly after endotracheal intubation should prompt consideration of OFTP in dogs, even if intubation was uneventful. Unlike its counterpart in humans, OFTP in dogs can reoccur after endoscopic removal, warranting repeated endoscopic extraction. A combination of corticosteroid therapy PO and heparin and N-acetylcysteine inhalation q4h may be attempted if recurrence is observed.

Abstract OT3-04-01: BRE12-158: A phase II randomized controlled trial of genomically directed therapy after preoperative chemotherapy in patients with triple negative breast cancer (TNBC)

Background: About 1/3 of patients with TNBC who receive preoperative therapy will experience a pathological complete response (pCR). Patients with residual disease have a markedly inferior overall survival (OS) compared to those who experience pCR. Recently, the CREATE-X trial demonstrated an improvement in disease free survival (DFS) and OS for post-neoadjuvant capecitebine; although the addition of capecitebine to standard therapy has not previously improved outcome across other non-selected adjuvant or neo-adjuvant trials. Prior data have also demonstrated that the residual tumors are genomically diverse and that these genetic changes are reflected at time of relapse.

Trial Design: This trial is a randomized phase II trial to determine whether a genomically guided therapy in the setting of incomplete response to standard neoadjuvant therapy will improve outcomes compared to standard of care. DNA from archived tumor samples collected at the time of surgery will be extracted and sequenced. The sequencing data will be interrogated for known genomic drivers of sensitivity or resistance to existing FDA approved agents. A cancer genomic tumor board (CGTB) will consider the genomic data along with the patient's prior treatment history, toxicities, and comorbidities and select the optimal therapy. Participants with a CGTB recommendation will be randomized to Experimental Arm A (genomically directed monotherapy) or Control Arm B (standard of care). Participants may have no CGTB recommendation either because sequencing did not identify a matched drug or because the drug was contraindicated and will be assigned to Control Arm B.

Eligibility criteria: Patients must have histologically confirmed TNBC with completion of all definitive local therapy and no evidence of metastatic disease. There must be significant residual disease characterized by &gt;2cm primary tumor, or lymph node positivity or RCB classification II or III. An FFPE tumor block with tumor cellularity &gt;20% is required. All patients must have completed preoperative chemotherapy including a taxane or anthracycline or both.

Specific aims: The Primary Aim is to compare 2-year DFS with a genomically directed therapy vs. standard of care. Secondary Aims include 1-year DFS, 5-year OS, collection of archival specimens for correlative studies, and to describe toxicities. Exploratory Aims are to describe the evolution of genomically directed therapies during the course of the study and to evaluate the drug specific effect on efficacy and toxicity.

Statistical methods: In order to detect an improvement in the fraction of patients free from disease at 2-year from 40% in the control Arm B to 63.2% in the genomically directed Experimental Arm A (corresponding to an HR=0.5), 136 participants will have 80% power to detect a difference in DFS using a two-side log-rank test with 0.05 level of significance.

Present accrual/target accrual: 38 accrued of 136 to be randomized.

Citation Format: Schneider B, Miller KD, Badve S, O'Neil B, Helft P, Chitambar C, Falkson C, Nanda R, McCormick M, Danso M, Blaya M, Langdon R, Lippman M, Paplomata E, Walling R, Thompson M, Robin E, Aggarwal L, Shalaby I, Canfield V, Adesunloye B, Lee T, Daily K, Ma C, Erban J, Radhakrishnan N, Bruetman D, Graham M, Reddy NA, Lynce FC, Radovich M. BRE12-158: A phase II randomized controlled trial of genomically directed therapy after preoperative chemotherapy in patients with triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-04-01.

Uniform phosphorus doping of untapered germanium nanowires

One of the major challenges in the growth of vapor-liquid-solid (VLS) nanowires is the control of dopant incorporation in the structures. In this work, we study the n-type doping and morphology of nanowires grown by chemical vapor deposition when HCl is introduced. We obtain fully untapered nanowires with a growth temperature up to 410 °C and measure their resistivity using the 4-probe technique to be 2.0 mΩ cm. We perform energy dispersive x-ray measurements showing a concentration of dopants in the (5-7) × 10¹⁸ cm^-3 range, being radially and axially uniform. The combination of these two measurements shows that the mobility is the same as for bulk germanium, demonstrating that the VLS mechanism has no detrimental effect for the electron transport in these nanowires.

Quantitative Reconstructions of 3D Chemical Nanostructures in Nanowires

Energy dispersive X-ray spectrometry is used to extract a quantitative 3D composition profile of heterostructured nanowires. The analysis of hypermaps recorded along a limited number of projections, with a preliminary calibration of the signal associated with each element, is compared to the intensity profiles calculated for a model structure with successive shells of circular, elliptic, or faceted cross sections. This discrete tomographic technique is applied to II-VI nanowires grown by molecular beam epitaxy, incorporating ZnTe and CdTe and their alloys with Mn and Mg, with typical size down to a few nanometers and Mn or Mg content as low as 10%.

Abrupt Schottky Junctions in Al/Ge Nanowire Heterostructures

In this Letter we report on the exploration of axial metal/semiconductor (Al/Ge) nanowire heterostructures with abrupt interfaces. The formation process is enabled by a thermal induced exchange reaction between the vapor-liquid-solid grown Ge nanowire and Al contact pads due to the substantially different diffusion behavior of Ge in Al and vice versa. Temperature-dependent I-V measurements revealed the metallic properties of the crystalline Al nanowire segments with a maximum current carrying capacity of about 0.8 MA/cm(2). Transmission electron microscopy (TEM) characterization has confirmed both the composition and crystalline nature of the pure Al nanowire segments. A very sharp interface between the ⟨111⟩ oriented Ge nanowire and the reacted Al part was observed with a Schottky barrier height of 361 meV. To demonstrate the potential of this approach, a monolithic Al/Ge/Al heterostructure was used to fabricate a novel impact ionization device.

An original architectured NiTi silicone rubber structure for biomedical applications

This paper deals with composite structures for biomedical applications. For this purpose, an architectured tubular structure composed of Nickel Titanium (NiTi) Shape Memory Alloy (SMA) and silicone rubber was fabricated. One of the main interests of such structures is to ensure a good adhesion between its two constitutive materials. A previous study of the authors (Rey et al., 2014) has shown that the adhesion between NiTi and silicone rubber can be improved by an adhesion promoter or plasma treatment. However, adhesion promoters are often not biocompatible. Hence, plasma treatment is favored to be used in the present study. Three different gases were tested; air, argon and oxygen. The effects of these treatments on the maximum force required to pull-out a NiTi wire from the silicone rubber matrix were investigated by means of pull-out tests carried out with a self-developed device. Among the three gases, a higher maximum force was obtained for argon gas in the plasma treatment. A tube shaped architectured NiTi/silicone rubber structure was then produced using this treatment. The composite was tested by means of a bulge test. Results open a new way of investigations for architectured NiTi-silicone structures for biomechanical applications.

Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014

Since October 2013, French Polynesia has experienced the largest documented outbreak of Zika virus (ZIKAV) infection. To prevent transmission of ZIKAV by blood transfusion, specific nucleic acid testing of blood donors was implemented. From November 2013 to February 2014: 42 (3%) of 1,505 blood donors, although asymptomatic at the time of blood donation, were found positive for ZIKAV by PCR. Our results serve to alert blood safety authorities about the risk of post-transfusion Zika fever.

Structure and morphology in diffusion-driven growth of nanowires: the case of ZnTe

Gold-catalyzed ZnTe nanowires were grown at low temperature by molecular beam epitaxy on a ZnTe(111) B buffer layer, under different II/VI flux ratios, including with CdTe insertions. High-resolution electron microscopy and energy-dispersive X-ray spectroscopy (EDX) gave information about the crystal structure, polarity, and growth mechanisms. We observe, under stoichiometric conditions, the simultaneous presence of zinc-blende and wurtzite nanowires spread homogeneously on the same sample. Wurtzite nanowires are cylinder-shaped with a pyramidal-structured base. Zinc-blende nanowires are cone-shaped with a crater at their base. Both nanowires and substrate show a Te-ended polarity. Te-rich conditions favor zinc-blende nanowires, while Zn-rich suppress nanowire growth. Using a diffusion-driven growth model, we present a criterion for the existence of a crater or a pyramid at the base of the nanowires. The difference in nanowire morphology indicates lateral growth only for zinc-blende nanowires. The role of the direct impinging flux on the nanowire's sidewall is discussed.

Fate of arsenic-bearing phases during the suspended transport in a gold mining district (Isle river Basin, France)

Arsenic-rich (~140-1520 mg x kg(-1)) suspended particulate matter (SPM) was collected daily with an automatic sampler in the Upper Isle River (France) draining a former gold mining district in order to better understand the fate of arsenic during the suspended transport (particles smaller than 50 μm). Various techniques at a micrometric scale (EPMA, quantitative SEM-EDS with an automated particle counting including classification system and μXRD) were used to directly characterize As-bearing phases. The most frequent ones were aggregates of fine clay particles. Their mineralogy varied with particle sources involved. These aggregates were formed by chlorite-phlogopite-kaolinite assemblages during the high flow and chlorite-illite-montmorillonite during the low flow. Among all the observed As-carriers in SPM, these clay assemblages were the least As-rich (0.10 up to 1.58 wt.% As) and their median As concentrations suggested that they were less concentrated during the high flow than during the low flow. Iron oxyhydroxides were evidenced by μXRD in these clay aggregates, either as micro- to nano-sized particles and/or as coating. (Mn, Fe)oxyhydroxides were also present as discrete particles. Manganese oxides (0.14-1.26 wt.% As) transport significantly more arsenic during the low flow than during the high flow (0.16-0.79 wt.% As). The occurrence of Fe oxyhydroxide particles appeared more complex. During the low flow, observations on banks and in wetlands of freshly precipitated Fe hydroxides (ferrihydrite-type) presented the highest As concentrations (up to 6.5 wt.% As) but they were barely detected in SPM at a microscale. During the high flow, As-rich Fe-oxyhydroxides (0.10-2.80 wt.% As) were more frequent, reflecting mechanical erosion and transport when the surface water level increased. Arsenic transfers from SPM to corresponding aqueous fraction mostly depend on As-carrier stability. This study shows the temporal occurrence of each type of As-bearing phases in SPM, their As concentrations at a particle scale and abundance according to hydrological periods.

[Hydroxyethyl starch]

OBJECTIVE

The purpose of this review is to draw up a statement on current knowledge available on the more recent hydroxyethyl starch (HES).

DATA SOURCES

References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files.

STUDY SELECTION

All categories of articles on this topic have been selected.

DATA EXTRACTION

Articles have been analysed for biophysics, pharmacology, toxicity, side effects, clinical effects and using prospect of HES.

DATA SYNTHESIS

The first HES was made available in the United States in 1970. The development of a new generation of HES restarted the discussion on clinical interest and the limits in the use of these macromolecules. This interest is also strengthened today by the recent data attached to plasma substitution in intensive care or perioperative resuscitation. The interest for crystalloids and colloids is still widely debated, and among the latter, the relative interest of the HES last generation compared to older ones. Recent HES development is in line with a decrease molecular weight, change rate molar substitution and to amend the glucose to hydroxyethyl report. The ultimate goal is to reduce the side effects of these molecules preventing their use. Side effects are dominated by haemostasis and renal dysfunction. The latest developments are the so-called HES "balanced" solutions.

[Benefits and indications of xenon anaesthesia]

OBJECTIVE

To analyze the current knowledge related to xenon anaesthesia.

DATA SOURCES

References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service and personal files.

STUDY SELECTION

All categories of articles on this topic have been selected.

DATA EXTRACTION

Articles have been analyzed for biophysics, pharmacology, toxicity and environmental effects, clinical effects and using prospect.

DATA SYNTHESIS

The noble gas xenon has anaesthetic properties that have been recognized 50 years ago. Xenon is receiving renewed interest because it has many characteristics of an ideal anaesthetic. In addition to its lack of effects on cardiovascular system, xenon has a low solubility enabling faster induction of and emergence from anaesthesia than with other inhalational agents. Nevertheless, at present, the cost and rarity of xenon limits widespread use in clinical practice. The development of closed rebreathing system that allowed recycling of xenon and therefore reducing its waste has led to a recent interest in this gas.

CONCLUSION

Reducing its cost will help xenon to find its place among anaesthetic agents and extend its use to severe patients with specific pathologies.

[Contribution of central venous oxygen saturation in postoperative blood transfusion decision]

OBJECTIVE

The aim of this study was to assess the value of central venous oxygen saturation (ScvO(2)) for the decision of blood transfusion in comparison with the criteria of the French guidelines for blood transfusion (2003).

STUDY DESIGN

Prospective, observational.

PATIENTS AND METHODS

Sixty patients, haemodynamically stable, for whom a blood transfusion (BT) was discussed in the postoperative course of general surgery, were included. ScvO(2) (%) and haemoglobin (g/dl) were measured before and after BT. Patients were retrospectively divided into two groups according to ScvO(2) measured before BT (< or >or=70%). Results are expressed as median.

RESULTS

The ScvO(2) before transfusion was greater or equal to 70% in 25 (47.2%) patients. Following BT, the ScvO(2) increased significantly (from 57.8 to 68.5%) in the group with initial ScvO(2) less than 70% whereas it was unchanged in patients with initial ScvO(2) greater or equal 70% (from 76.8 to 76.5%). Twenty patients (37.7%) did not meet the French guidelines for BT criteria. Eighteen patients out of 33 that met the criteria had ScvO(2) greater or equal 70% before BT while 13 patients with ScvO(2) less than 70% were not detected by these same criteria.

CONCLUSION

ScvO(2) could be a relevant biological parameter to complete the current guidelines for BT in stable patient with a central venous catheter during the postoperative period.

Disruption of lipid rafts induces gonadotropin release in ovine pituitary and LbetaT2 gonadotroph cells

In order to better understand the cellular mechanisms underlying LH and FSH secretion, we have addressed the contribution of lipid rafts to the secretion of gonadotropins. We used methyl-beta-cyclodextrin (MbetaCD), a cholesterol-sequestering agent, on an LbetaT2 murine gonadotroph cell line and on primary cultures of ovine pituitary cells. We found that in both systems, cholesterol depletion by MbetaCD induced a fast and substantial release of LH in the absence of natural stimulation by GnRH. In ovine pituitary cells, MbetaCD-mediated LH release was shown to be independent of protein synthesis. Twenty-four hours after MbetaCD treatment, there was no loss of cell viability and full recovery of LH secretory capabilities, as determined by GnRH or MbetaCD treatment. In addition, our data suggest the existence of a pool of LH that is not released by GnRH treatment but that is released by MbetaCD treatment. Finally, in ovine pituitary cells, MbetaCD treatment induced FSH secretion. Importantly, these in vitro data are supported by in vivo studies, because MbetaCD injected into the pituitary glands of anaesthetized sheep reproducibly induced a peak of LH release.

Analgesic efficacy of bilateral superficial cervical plexus block administered before thyroid surgery under general anaesthesia

BACKGROUND

The use of regional anaesthesia in thyroid surgery remains controversial. This double-blind, randomized controlled study was conducted to evaluate the analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) performed under general anaesthesia in patients undergoing total thyroidectomy.

METHODS

Eighty-seven consecutive consenting patients were randomized to receive a BSCPB with saline (Group P, n = 29), ropivacaine 0.487% (Group R, n = 29), or ropivacaine 0.487% plus clonidine 5 microg ml(-1) (Group RC, n = 29). Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in a patient with a bispectral index between 40 and 60. All patients received 4 g of acetaminophen during the first 24 h after operation. The pain score was checked every 4 h and nefopam was given for pain score >4 on a numeric pain scale.

RESULTS

During surgery, the median sufentanil requirements were significantly reduced in Group RC compared with Groups R and P (0.32 vs 0.47 and 0.62 microg kg(-1); P < 0.0001). After surgery, the number of patients requiring nefopam within 24 h of surgery was significantly lower in Groups R and RC than in Group P (16 and 19 vs 25; P = 0.03). At post-anaesthetic care unit admission, median (range) pain scores were significantly lower in Groups R [3 (0-10)] and RC [3 (0-8)] than in Group P [5 (0-8), P = 0.03]. No major complications of BSCPB occurred during study.

CONCLUSIONS

BSCPB with ropivacaine and clonidine improved intraoperative analgesia. BSCPB with ropivacaine or ropivaciane and clonidine was effective in reducing analgesic requirements after thyroid surgery.

L'entropie: un moyen d'apprécier le défaut d'analgésie?

OBJECTIVE

Comparison between BIS (Bispectral Index) and state (SE) and response (RE) entropy during laparotomy for inflammatory bowel disease patients (IBD) and evaluation of the variations of RE and SE during nociceptive stimulation.

STUDY DESIGN

Prospective, observational study.

PATIENTS AND METHODS

Fourteen IBD's patients undergoing laparotomy were included. Anaesthesia aimed to maintain BIS between 40 and 60 by isoflurane and nitrous oxide. Analgesia was performed by sufentanil bolus administrated according to an increase of 20% of systolic blood pressure (SBP) and heart rate compared with the baseline values. BIS, RE and SE were measured at each nociceptive stimulation. A variance analysis (Anova) was used to assess BIS, RE and SE variations throughout surgery (p<0.05 as significant). Relationship between BIS, RE and SE was assessed by Pearson correlation (p<0.01 as significant). The ability for SE and RE to predict depth of anaesthesia and intraoperative analgesia was performed by calculating area under the receiver operated curves (AUC).

RESULTS

BIS and entropy parameters had strictly the same evolution during anaesthesia. SBP increased significantly during nociceptive stimulation while no variation of RE was observed. A significant correlation was shown between BIS, RE and SE. The evaluation of anaesthesia depth was good for RE (AUC: 0.932+/-0.26) and SE (AUC: 0.926+/-0.27). There was however no difference between RE and SE to predict analgesic requirement.

CONCLUSION

Because RE includes muscular frequency analysis, it does not allow analgesic requirement evaluation in paralyzed patients.

Predictive factors for rhabdomyolysis after bariatric surgery

BACKGROUND

Prevalence of obesity is increasing internationally. Obesity is also incriminated in the development of postoperative rhabdomyolysis (RML). Its major risk is the development of renal failure which is associated with high mortality. The aim of this study was to determine the risk factors for RML in patients undergoing bariatric surgery.

METHODS

Over a 12-month period, 49 consecutive patients were studied. They underwent gastric banding (n=32) or intestinal or gastric bypass (n=17) for morbid obesity (BMI >40 kg/m(2)). Surgery was performed in the supine position with a lumbar pad placed for intestinal shunt. The duration of surgery, persistent postoperative muscular pain, and pre- and postoperative creatine kinase (CK) were recorded. RML was defined as postoperative CK >1000 IU. L(-1) (5 times the normal value). Patients were retrospectively divided into 2 groups according to the presence or not of RML. In order to assess the role of BMI, it was decided to conduct an additional analysis in a group of consecutive non-obese patients who were matched for other risk characteristics.

RESULTS

In the 49 patients included in the study 13 developed RML (26.5%). Surgery >4 hours, presence of diabetes and patient ASA physical status III or IV were identified as factors associated with higher risk of RML. In the matched group (9 patients), no one developed postoperative RML.

CONCLUSIONS

After surgery for obesity, the risk of RML increases with prolonged surgery (>4 hours) and in diabetic obese patients with BMI >40 kg/m(2). In such patients, CK could be systematically measured to verify the presence of muscle injuries.

Non-invasive prediction of fluid responsiveness during major hepatic surgery

BACKGROUND

The aim of this study was to evaluate potential predictors of fluid responsiveness obtained during major hepatic surgery. The predictors studied were invasive monitoring of intravascular pressures (radial and pulmonary artery catheter), including direct measurement of respiratory variation in arterial pulse pressure (PPVart), transoesophageal echocardiography (TOE), and non-invasive estimates of PPVart from the infrared photoplethysmography waveform from the Finapres (PPVfina) and the pulse oximetry waveform (PPVsat).

METHODS

We conducted a prospective study of 54 fluid challenges (250 ml colloid) given for haemodynamic instability in eight patients undergoing hepatic resection. Fluid responsiveness was defined as an increase in stroke volume index (SVI) >or=10%. The following variables were recorded before each fluid challenge: right atrial pressure (RAP), pulmonary artery occlusion pressure (PAOP), PPVart, PPVfina, PPVsat, and the TOE-derived variables left ventricular end-diastolic area index (LVEDAI), early/late (E/A) diastolic filling wave ratio, deceleration time of the E wave (MDT) of mitral flow and the systolic fraction of the pulmonary venous flow (SF).

RESULTS

Only PPVfina, PPVart (both P<0.001), PPVsat (P=0.02), LVEDAI and MDT (both P=0.04) were different in responder vs non-responder fluid challenges. The areas under the receiver operating characteristic (ROC) curves were 0.81 (PPVfina), 0.79 (PPVart), 0.70 (LVEDAI), 0.68 (PPVsat and MDT), 0.63 (RAP), 0.62 (E/A), 0.55 (PAOP) and 0.42 (SF). The areas under the ROC curves for RAP, E/A, PAOP and SF were significantly less than that for PPVfina (P<0.05 in each case). Only PPVart (r=0.59, P=0.0001) and PPVfina (r=0.56, P=0.0001) correlated with the fluid challenge-induced changes in SVI.

CONCLUSIONS

PPVart and PPVfina predict fluid responsiveness during major hepatic surgery. This suggests that intraoperative monitoring of fluid responsiveness may be implemented simply and non-invasively.