Search for B

A search for the flavor-changing neutral-current decay B^{+}→K^{+}νν[over ¯] is performed at the Belle II experiment at the SuperKEKB asymmetric energy electron-positron collider. The data sample corresponds to an integrated luminosity of 63 fb^{-1} collected at the ϒ(4S) resonance and a sample of 9 fb^{-1} collected at an energy 60 MeV below the resonance. Because the measurable decay signature involves only a single charged kaon, a novel measurement approach is used that exploits not only the properties of the B^{+}→K^{+}νν[over ¯] decay, but also the inclusive properties of the other B meson in the ϒ(4S)→BB[over ¯] event, to suppress the background from other B meson decays and light-quark pair production. This inclusive tagging approach offers a higher signal efficiency compared to previous searches. No significant signal is observed. An upper limit on the branching fraction of B^{+}→K^{+}νν[over ¯] of 4.1×10^{-5} is set at the 90% confidence level.

Search for an Invisibly Decaying Z

Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→µ^{+}µ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}µ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{µ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6 GeV/c^{2}.

Virtual reality increases pressure pain threshold and lowers anxiety in children compared with control and non-immersive control-A randomized, crossover trial.

BACKGROUND: Virtual reality (VR) is a promising non-pharmacological pain intervention because it may not only distract but also modulate pain by immersing the user in a three-dimensional 360° alternate reality. In children, VR has been reported to reduce clinical pain and anxiety during medical procedures. However, the effect of immersive VR on pain and anxiety remains to be investigated in randomized controlled trials (RCT). The aim of the present crossover RCT was to assess the effect of VR on pressure pain threshold (PPT) and anxiety level measured with the modified Yale Preoperative Anxiety Scale (mYPAS) in children in a controlled experimental setting. METHODS: Seventy-two children (mean age 10.2 (6-14) years) were randomized to 24 sequences of four interventions (immersive VR Game, immersive VR video, tablet: 2D video and control: small talk). Outcome measures PPT, mYPAS and heart rate were assessed before and after each intervention. RESULTS: PPT increased significantly during VR game (PPTdiff): 136 kPa (CI 112; 161), p < 0.0001 and VR Video (PPTdiff): 122 kPa (CI 91; 153), p < 0.0001. Also, anxiety levels significantly decreased during both VR game (mYPASdiff: -7 points (-8 to -5), p < 0.0001) and VR video (mYPASdiff: -6 points (CI -7; -4), p < 0.0001). CONCLUSIONS: VR had a marked beneficial effect on PPT and anxiety compared with the control interventions: 2D video and small talk. Thus, immersive VR had a distinct modulatory effect on pain and anxiety in a well-controlled experimental setting. Immersive VR was effective and feasible in children and can act as a valid tool for non-pharmacological pain and anxiety management. SIGNIFICANCE: Paediatric immersive VR seems to be beneficial although well-controlled studies are pending. We investigated whether immersive VR can modulate children's threshold for pain and anxiety level in an experimental well-controlled setting. We document a modulatory pain threshold increase and anxiety level decrease compared with extensive control conditions. Paediatric immersive VR is effective, feasible and valid for non-pharmacological pain and anxiety management. All efforts to reach the goal that no child should experience pain or anxiety when exposed to medical procedures.

Chronic pain after inguinal hernia repair in children.

BACKGROUND: The prevalence of moderate-to-severe pain after inguinal hernia repair (IHR) in adults is ≈ 10%. Two studies with very long follow-up periods (16.8 and 49 yr, respectively) have, however, suggested that the risk of developing chronic pain is much lower in children. The purpose of the present study was to examine the prevalence of chronic pain 6-48 months after IHR in children. METHODS: Postal questionnaires were sent to 156 children who had undergone IHR between the age of 6 months and 12 yr. The children were asked to recall the duration of postoperative pain, if necessary with help from their parents, and to describe the intensity and character of their pain, if the pain was still present. Children with chronic pain were offered quantitative sensory testing (QST), and a surgical examination, including ultrasound, in order to exclude hernia recurrence. RESULTS: Ninety-eight children, mean (sd) age 7.8 (2.6) yr, answered the questionnaire. Their age at the time of surgery was mean (sd) 4.6 (2.4) yr, and the follow-up period was mean (sd) 3.2 (1.3) yr. Five children (5.1%, 95% confidence interval: 0.75-9.5) had pain located in the inguinal region, and three of these children underwent further examination. There was no hernia recurrence, but QST revealed pinprick hyperalgesia and decreased pressure pain thresholds on the operated side in all three children. CONCLUSIONS: The prevalence of chronic pain after IHR in children is 5.1%, which is lower than the prevalence reported after adult hernia repair.

Is day surgery safe? A Danish multicentre study of morbidity after 57,709 day surgery procedures.

BACKGROUND: Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort. METHODS: We prospectively recorded data from 57,709 day surgery procedures performed in eight day surgery centres over a 3-year period. We cross-checked with the National Patient Registry to identify complications 0-30 days post-operatively, and registrations from The Danish Register of Cause of Death were requested. We retrieved the records of 1174 patients to assign a relation between secondary contact and day surgery. RESULTS: The overall rate of return hospital visits was 1.21% [95% confidence interval (CI): 1.12-1.30%] caused by a wide range of diagnoses. No deaths were definitely related to day surgery. The return hospital visits were due to haemorrhage/haematoma 0.50% (95% CI: 0.44-0.56%), infection 0.44% (95% CI: 0.38-0 49%) and thromboembolic events 0.03%. Major morbidity was rare. The surgical procedures with the highest rate of complication were tonsillectomies 11.4%, surgically induced abortions 3.13% and inguinal hernia repairs 1.23%. CONCLUSION: This large-scale Danish national study confirmed that day surgery is associated with a very low rate of return hospital visits. Despite the rapid expansion of day surgery, safety has been maintained, major morbidity being very rare, and no deaths being definitely related to day surgery.

Oxycodone vs. fentanyl in the treatment of early post-operative pain after laparoscopic cholecystectomy: a randomised double-blind study.

BACKGROUND: It has been suggested that oxycodone is superior to other opioids in the treatment of visceral pain. We therefore compared the effect of intravenous (i.v.) oxycodone and i.v. fentanyl on post-operative abdominal (visceral) pain after outpatient laparoscopic cholecystectomy. METHODS: Seventy-eight patients were randomised to intra- and post-operative pain treatment with either oxycodone (n=39) or fentanyl (n=39). The patients received 10 mg oxycodone/100 microg fentanyl at the end of anaesthesia. In the post-anaesthetic care unit (PACU), 5 mg oxycodone/50 microg fentanyl was administered to patients with moderate pain [3-5 on a numeric rating scale (NRS)], and 10 mg oxycodone/100 microg fentanyl was administered to patients with severe pain (>5 on an NRS). The following measures were recorded: intensity of pain at arrival, after 30, 60 and 90 min and at discharge from the PACU; total consumption of oxycodone/fentanyl; nausea; vomiting; sedation and pressure tolerance thresholds. RESULTS: The median intra- and post-operative consumption of oxycodone was 15 mg (range: 10-40 mg) and the consumption of fentanyl was 200 microg (range: 100-500 microg). The intensity of abdominal pain was significantly lower in the oxycodone group at arrival (P<0.05), after 30, 60 and 90 min, and at discharge from the PACU (P<0.01). There was a strong tendency towards more side effects with oxycodone. CONCLUSIONS: Oxycodone provided better analgesia but also more side effects, suggesting that the doses used in the present study may not be equipotent.

Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia.

BACKGROUND: In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant. METHODS: Patients with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation [leukocytes, interleukin-6, -8 and -10, granulocyte macrophage colony-stimulating factor, and C-reactive protein (CRP)], and endocrine stress (cortisol) in blood collected before operation, 4 h postincision, and on postoperative day 2. RESULTS: Leukocyte counts and interleukin-6 and CRP levels increased in both groups, with the CRP increase being significantly greater in the OR group. The other markers did not increase significantly. CONCLUSION: The acute phase response was more pronounced after OR, even when this was done under local anesthesia. Both techniques seemed rather atraumatic.

Monitoring thrombin generation with prothrombin fragment 1.2 assay during cardiopulmonary bypass surgery.

UNLABELLED: Despite high plasma levels of heparin during cardiopulmonary bypass surgery, activation of the coagulation system has been reported. We hypothesize that the coagulation system activity most appropriately could be assessed by molecular markers of thrombin generation. The aim of the present study was to describe the changes in thrombin generation during CPB, using prothrombin fragment F1 + 2 (F1.2) as an indicator and evaluate different blood sampling regimens for interpretation of the F1.2 measurements. Twenty patients, operated under extracorporeal circulation with coronary artery bypass grafting (CABG), comprised the study material. The heparin levels were maintained above 2.5 IU/ml throughout the bypass procedure and the functional AT-III level was kept above 0.5 U/ml. Despite of this anticipated inactivation of the coagulation system, the concentrations of F1.2 and FpA increased throughout CPB, particularly after release of the aortic crossclamp. F1.2 and FpA correlated significantly (R = 0.69). No statistically significant correlation was found between F1.2 formation rate and age, bodyweight, baseline ACT, ACT after 200 IU heparin/kg, average heparin concentration during CPB or average AT-III level during CPB. CONCLUSIONS: Thrombin formation seems to be a continuous process during CPB despite adequate heparinization. The pattern of thrombin generation can be assessed most appropriately in terms of F1.2 generation rate. Extraordinary high levels of F1.2 were seen after release of the aortic crossclamp, indicating that the periods before and after aortic crossclamping should be evaluated separately.

Nutritional repletion in malnourished patients with emphysema.

We examined the effect of nutritional supplementation for 13 wk on anthropometric, pulmonary function, and immunological status in malnourished ambulant patients with pulmonary emphysema (EP). The study was placebo controlled, randomized and double blind. Twenty-eight patients were included. Thirteen patients in the fed group were provided with a nutritional formula providing 20% protein, 30% fat, and 50% carbohydrate, 1 Kcal/ml, 400 ml/day. The control group was provided with a reference product of the same consistency and taste containing 0.1 Kcal/ml, 400 ml/day for 13 wk. The fed group had a mean weight gain of 1.5 kg during the study period, the control group increased concomitantly 0.16 kg, the difference being significant (p less than 0.01). Sum of four skinfolds increased 2.7 mm in the fed group, and decreased 0.9 mm in the control group the difference being significant (p less than 0.01). No difference were observed regarding pulmonary function or immunological status. We also found a high habitual energy intake in our study group (204% Basal Energy Expenditure). We conclude that nutritional supplementation produce weight gain in malnourished patients with EP, but it does not change other indices of well-being.

Clinical evaluation of Duraflo II heparin treated extracorporeal circulation circuits (2nd version). The European Working Group on heparin coated extracorporeal circulation circuits.

OBJECTIVES: To evaluate whether the application of heparin treated circuits for elective coronary artery surgery improves postoperative recovery, a European multicenter randomised clinical trial was carried out. METHODS: In 11 European heart centers, 805 low-risk patients underwent cardiopulmonary bypass (CPB) with either an untreated circuit (n = 407) or an identical but heparin treated circuit (n = 398, Duraflo II). RESULTS: Significant differences were found among participating centers with respect to patient characteristics, blood handling procedures and postoperative care. The use of heparin treated circuits revealed no overall changes in blood loss, blood use, time on ventilator, occurrence of adverse events, morbidity, mortality, and intensive care stay. These results did not change after adjustment for centers and (other) prognostic factors as analysed with logistic regression. In both groups no clinical or technical (patient or device related) side effects were reported. Because female gender and aortic cross clamp time appeared as prognostic factors in the logistic regression analysis, a subgroup analysis with these variables was performed. In a subpopulation of females (n = 99), those receiving heparin treated circuits needed less blood products, had a lower incidence of rhythm disturbances and were extubated earlier than controls. In another subgroup of patients with aortic cross clamp time exceeding 60 min (n = 197), the amount of patients requiring prolonged intensive care treatment (> 24 h) was significantly lower when they received heparin treated circuits versus controls. CONCLUSION: These findings suggest that improved recovery can be expected with heparin treated circuits in specific higher risk patient populations (e.g. females) and when prolonged aortic cross clamp time is anticipated. Further investigations are recommended to analyses the clinical benefit of heparin treated circuits in studies with patients in different well defined risk categories and under better standardised circumstances.

[Treatment of interpleural pain]. / Interpleural smertebehandling.

Since then, a great deal of work on this topic has been published. The literature is reviewed and indications, contraindications, dosage, mechanism of action and side effects are discussed.

[Assessment of the diet of malnourished outpatients with chronic obstructive respiratory insufficiency]. / Vurdering af kosten hos ambulante underernaerede patienter med kronisk obstruktiv ventilatorisk insufficiens.

We investigated the daily diets of malnourished patients with chronic obstructive ventilatory insufficiency. A total of 28 patients with body weights of less than 80% of ideal body weight were included. The patients were all ambulatory and in a stable phase of their illness. Their diets were assessed by dietary registration covering seven days. Basal energy expenditure was calculated using the Harris-Benedict equation. On an average these patients had a daily energy intake of 205% of their total energy expenditure, which is significantly higher than the value of 150% of basal energy expenditure considered sufficient for normal daily activity (p less than 0.0001). We conclude that low energy intake is not the cause of low body weight in these patients. They seem to be in a hypermetabolic state which may be due to the increased energy demand of the exertion of breathing.

[Interpleural bupivacaine (Marcain) in the treatment of pain in a patient with chronic pancreatitis]. / Interpleural bupivakain (Marcain) som smertebehandling hos en patient med kronisk pancreatitis.

A case of long-term relief of pain after interpleural blockade with bupivacaine in a patient suffering from severe chronic pancreatitis is reported.

[Testing and comparison of the accuracy and precision of 5 pulse oximeters]. / En afprøvning og sammenligning af 5 pulsoxymetres nøjagtighed og praecision.

Determination of the oxygen saturation (SaO2) was carried out on 47 patients employing five pulse oxymeters. Measurements with Criticare CSI 501 (Simonsen & Weel), Criticare CSI 502 (Simonsen & Weel), Nellcor N 100 (Dräeger), Satlite (Datex) and Novametrix 500 (Vickers) were compared with arterial blood gas analyses with Radiometer ABL 3 (Radiometer, Copenhagen). Statistical calculation of the agreement with the pulse oxymetric and the invasive measurements were performed by the method recommended by Bland & Altman. The precision profiles for the pulse oxymeters varied from 1.84 to 2.25 (CV%) and the accuracy profiles from -0.90 to 1.44%. All of the apparatuses fulfilled the specifications made by the manufacturs. All were considered to be suitable and reliable for monitoring of decreases in oxygen saturation during and after operation.

[The dosage-effect-curves for propofol in young and elderly patients--and modification of these following fentanyl]. / Propofols dosis-effekt-kurver hos unge og aeldre--og deres modifkation efter fentanyl.

Forty-eight patients between 20 and 40 years and 48 patients between 60 and 80 years, none of whom had received premedication were subdivided at random for induction of anaesthesia with propofol (Diprivan) in four doses with or without prior administration of fentanyl. ED95 (effective dosage for 95%) for the young patients was 3.4 mg/kg and, for the elderly patients, 2.4 mg/kg. When 4 micrograms/kg fentanyl was administered five minutes prior to induction of anaesthesia, ED95 was reduced by 10% in the young patients and 20% in the elderly patients. In both the young patients and the elderly patients, the mean arterial blood pressure (MAP) three minutes after induction was found to be reduced by 2-26%. No further reduction was observed. The pulse did not alter significantly from the original value. When 4 micrograms/kg of fentanyl was administered five minutes prior to induction of anaesthesia, a significantly more pronounced decrease in MAP was found in young and also elderly patients during the entire period. This decrease in MAP was dependent on the dosage in the group of elderly patients. During the period of investigation, the pulse decreased 5-35%, except in the group of the young patients who received the smallest doses of propofol, where an increase of 15-20% was observed. It is concluded that induction of anaesthesia with propofol preceded by administration of fentanyl, may be followed by a considerable reduction in MAP.

[Comparison of propofol and thiopentone in young and elderly patients]. / Propofol versus tiopental til unge og aeldre patienter.

Forty patients between 20 and 40 years and 39 patients between 60 and 80 years, all unpremedicated, were allocated to induction with propofol or thiopentone. The induction dose of propofol in patients between 60 and 80 years was 65% of the dose in the patients between 20 and 40 years. Administration of the induction dose of propofol was followed by an even decrease in mean arterial blood pressure of approximately 16% in young and in elderly patients. Propofol caused a more pronounced decrease in mean arterial blood pressure than thiopentone, both in young and elderly patients.

[Continuous spinal analgesia. A review]. / Kontinuerlig spinal analgesi. En oversigt.

Continuous spinal analgesia is a recognized method of analgesia for surgical interventions which was originally described in 1907. A brief historical review is presented with a description of the current technique. Emphasis is laid on comparison with other regional techniques, particularly single-shot analgesia and epidural analgesia. A review is presented of the current knowledge about technique, particularly the equipment, analgesic agents, advantages and disadvantages and indications and contraindications. it is concluded that continuous spinal analgesia probably offers certain advantages, particularly cardiovascular stability. However, the lack of randomized comparisons of the various techniques make further clinically controlled investigations necessary to illustrate this.

Neurological sequelae after cryoanalgesia for thoracotomy pain relief.

Twenty-two patients treated with cryoanalgesia of the intercostal nerves in connection with thoracic surgery were re-examined with special attention to possible late neurological sequelae. Half of the patients had some degree of hypoaesthesia in the scar or the adjacent skin segment, but apart from one patient (a known morphine addict) none of the patients had any neurological complaints.