Evaluation of Postoperative Warming Care Protocol for Thermal Comfort and Temperature Management Immediately After Surgery: Nonrandomized Controlled Trial.

PURPOSE: This study aimed to determine the effects of a warming care protocol (WCM) on temperature control and thermal comfort perception in hypothermia following major abdominal surgery. DESIGN: A prospective nonrandomized controlled trial. METHODS: A total of 54 patients undergoing major abdominal surgery were assigned to receive routine care (control group, 27 patients) or the WCM (intervention group, 27 patients). The body temperature (core and peripheral) was measured, and physical symptoms were monitored every hour for 4 hours after arriving at the ward and then every 4 hours for up to 12 hours. FINDINGS: The temperature gap, calculated as the difference between the core and skin temperatures, was similar between the control and intervention groups at the end of surgery. However, the temperature gap in the intervention group decreased within 3 hours after arrival at the ward and remained lower than that in the control group. The visual analog scale score for postoperative thermal discomfort was significantly lower in the intervention group than in the control group, indicating achievement of higher comfort with the warming intervention. CONCLUSIONS: Patients were warmed using active warming methods under the WCM, which in turn increased the thermal comfort perception with the body temperature. Postoperative patients often require warming care for thermal comfort, which may be improved by proper observation and management within 1 to 2 hours postoperatively. Our results indicate that nurses could effectively warm the patient to maintain normal body temperature following surgery not only to improve thermal comfort, but also to prevent shivering and possibly various postoperative complications.

Effects of postoperative active warming and early exercise on postoperative body temperature distribution: Non-blinded and randomized controlled trial.

AIM: We tested a hypothesis that postoperative active warming and/or arm leg stretches reduce the difference between core and skin temperatures (primary variable) improving the peripheral circulation immediately after major abdominal surgery. METHODS: Fifty-one patients undergoing major abdominal surgeries were randomly assigned to receive one of three interventions immediately after surgery; routine care (control group), mild intermittent exercise on the bed (exercise group), and forced-air warming (warming group). Core and skin temperatures and perfusion index were continuously measured from anesthesia induction to 12 h after arrival at the ward. RESULTS: Core body temperature was maintained over 37°C with a relatively greater gap between core and skin temperatures over 1°C and reduced perfusion index in the early postoperative period in the control group. In the warming group, the reduced skin temperature at arrival at the ward approximated to the core temperature leading to significant reduction of the temperature gap and increasing the perfusion index to the preoperative level. Although less evident, both the temperature gap and peripheral perfusion significantly improved in the exercise group after 6 and 8 h after arrival at the ward, respectively. CONCLUSIONS: Vasoconstriction in response to cessation after anesthesia and surgery serves to maintain core temperature, but impairs peripheral circulation. Active warming and intermittent mild exercise immediately after arrival at the ward reduces the temperature gap and improves peripheral circulation during the early postoperative period. While cost-effectiveness needs to be considered before clinical application of the intervention, the cost-free mild exercise may be a feasible option for improving postoperative patient care.

Effect of using portable alcohol-based handrub on nurses' hand hygiene compliance and nasal carriage of staphylococcus aureus in a low-income health setting.

BACKGROUND: Low hand-hygiene compliance (HHC) in low-income countries due to deficient hand hygiene resources may increase nasal carriage of S. aureus, a causative agent of health care-associated infections. The study aimed to assess the effect of using locally available portable alcohol-based handrub (ABHR) regarding nurses' HHC and nasal carriage of S. aureus. METHODS AND DESIGN: Nonrandomized interventional design. Seventy-two (72) of 86 nurses were provided with portable ABHR to use during patient care (intervention group). The remaining 14 nurses constituted the control group. Evaluation was done via HHC observation per WHO 5-moments of HH, determining S. aureus nasal carriage prevalence and HH guideline knowledge assessment via a self-response questionnaire. RESULTS: In the intervention group, HHC improved from 48.9% to 67.7% (P < .001) especially for hand-hygiene before and after patient contact. Hand-hygiene by handrubbing improved from 16 to 105 moments. There was positive feedback to portable ABHR use from nurses. S. aureus nasal carriage significantly decreased from 30.6% to 21% (P < .031). Negative carriage of S. aureus was significantly associated with increase in HHC (P < .001). Despite the low preintervention HHC, nurses showed considerably high levels of knowledge on relevance of hand hygiene. CONCLUSIONS: Portable ABHR use was associated with improved HHC and reduced S. aureus nasal carriage prevalence. As nurses' knowledge of HH guidelines was high, provision of portable ABHR compensated for deficient facility HH resources resulting in improved HHC, which effected reduction in nasal carriage of S. aureus among nurses.

Effect of edible sesame oil on growth of clinical isolates of Candida albicans.

Elderly individuals are at increased risk of oral thrush (oral candidiasis) due to decreased saliva secretion. Due to their antimicrobial properties, edible oils can be effective natural agents for oral care. The objective of the present study was to compare the effects of sesame oil, which is widely used for cooking in Asian countries, and two other edible oils on the growth of both mycelial and yeast forms of five clinical isolates of Candida albicans, a causative microorganism of oral thrush. We assessed the effect of each oil in concentrations of 0.078%, 0.156%, and 0.313% on growth of the mycelial forms of the clinical isolates over 24 hr using the crystal violet method. We also evaluated the effect of each oil on growth of the yeast forms by counting the number of viable yeast cells after culturing in the oils for 24 hr. Sesame oil inhibited the growth of both mycelial and yeast forms. Safflower and olive oil also inhibited the growth of both forms of C. albicans but to a lesser extent than sesame oil. The ability to inhibit the growth of the mycelial form correlated with sesame oil concentration. Roasting influenced growth inhibition ability and high-roasted sesame oil most effectively inhibited the yeast form. The growth inhibitory effect differed among the five isolates. We hypothesize that the sesamin and fatty acid components of sesame oil are involved in its antifungal activity.

Effect of acetylcholine on mitogen response of peripheral lymphocytes isolated from rats exposed to chronic stress.

The purpose of this study was to clarify the effects of acetylcholine (Ach) on lymphocyte function in rats under chronic stress. The authors isolated peripheral lymphocytes from rats 5 weeks after stress treatment and then measured interleukin-2 (IL-2) production after stimulation with concanavalin A or phytohemagglutinin-L. Although mitogen-induced IL-2 production of the stress group was lower than that of the control group, the addition of Ach significantly increased mitogen-induced IL-2 production in both groups. This effect of Ach was inhibited by atropine in the control group only. The changes (increasing rates) in mitogen-induced IL-2 production from basal condition showed a negative correlation with serum corticosterone concentrations. The authors observed no correlation between the effects of Ach (changes in mitogen-induced IL-2 production with Ach compared to those without Ach) and serum corticosterone concentration. These findings suggest that stimulation of the parasympathetic nervous system improves lymphocyte function during chronic stress.

Heat shock protein 90 inhibitor 17-allylamino-17-demethoxygeldanamycin potentiates the radiation response of tumor cells grown as monolayer cultures and spheroids by inducing apoptosis.

Activation of the PI3K-Akt pathway is known to induce tumor radioresistance. In the current study, we examined the ability of 17AAG, which decreases the levels of Hsp90 client proteins including components of the PI3K-Akt pathway, to sensitize radioresistant human squamous cell carcinoma cells to X-irradiation. Human squamous cell carcinoma cell lines (SQ20B, SCC61 and SCC13) were incubated for 16 h at 37 degrees C in medium containing 17AAG. Radiation sensitivity was determined by clonogenic assays, and protein levels were examined by western blotting. Apoptosis was determined in monolayer cells by AO/EB double staining and in spheroids using the TdT-mediated dUTP nick end labeling assay. 17AAG (0.2 microM) enhanced the radiosensitivity more effectively in radioresistant SQ20B and SCC13 cells than in radiosensitive SCC61 cells. However, in all three cell lines, 17AAG increased radiation-induced apoptosis by reducing the expression of EGFR and ErbB-2 and inhibiting the phosphorylation of Akt. Furthermore, 17AAG (1 microM) sensitized SQ20B spheroids to radiation, and inhibition of Akt activation by 17AAG increased radiation-induced apoptosis in spheroids. The findings suggest that 17AAG effectively sensitizes radioresistant cells to radiation by inhibiting the PI3K-Akt pathway. Targeting the PI3K-Akt pathway with 17AAG could be a useful strategy for radiosensitization of carcinomas.

Influence of experimental chronic hypertension on the cerebral and renal arteries of wild cats.

The influence of chronic hypertension (HT) on the cerebral and renal arteries was examined pathologically and morphometrically in wild cats without a specific genetic background. Chronic HT for 8-15 months was induced by uninephrectomy and salt-loading, and the blood pressure was monitored for a maximum of 5 months. The grade of systolic blood pressure elevation in each cat during the monitoring period was 21-51 mmHg. Histologically, the cerebral arachnoid and medullary arteries of all hypertensive cats showed a well-preserved medial layer, and neither loss of medial smooth muscle cells, adventitial fibrosis or fibrinoid exudation was detected. This experimental model of chronic HT in wild cats for 8-15 months induced segmental intimal elastofibrosis of the arachnoid and renal arteries, but spared the cerebral medullary artery. The parenchymal changes in the brain were negligible. Morphometrically, the arachnoid artery in control cats had a significantly thinner media than the renal artery, and the medial hypertrophy of the arachnoid artery resulting from HT occurred significantly less frequently than that of the renal artery. These findings suggest that the arachnoid and medullary arteries are relatively well protected from HT, and that this may be characteristic of cerebral arteries in general and ascribed to autoregulation.

Neuropathology of delayed encephalopathy in cats induced by heavy-ion irradiation.

AIM: The pathogenesis of delayed encephalopathy induced by heavy-ion irradiation was investigated experimentally in cats. The left cerebral hemispheres were irradiated with 15-40 Gy of heavy ions (carbon), and histologically and morphometrically examined 12 months later. RESULTS: In the irradiated cerebral white matter the following occurred as the dose increased: astrocytic swelling, then the dilatation of small blood vessels with a fibrous thickening of the wall, and then loosening of the white matter with cavity formation and diffuse albumin deposition. Pathological features of these cavities suggested that they are induced by long-standing edema. Although the dilated vessels were arteries, veins, and capillaries, arteriovenous shunt and damage of the smooth muscle cells of the arterial media were absent. Changes of the cerebral cortex were scarce. Morphometrically, the irradiated cerebral white matter was swollen, and the capillary density tended to be reduced in the deep cortex and subcortical white matter, but this effect was not dose dependent. CONCLUSION: Heavy-ion irradiation induces delayed encephalopathy in cats, preferentially involving the white matter. The cardinal pathogenesis was long-standing edema of the white matter due to vascular hyperpermeability, and the vascular dilatation seemed to be caused by a reduction in the vascular bed and/or hemoconcentration due to hyperpermeability.