Randomised trial comparing forced-air warming to the upper or lower body to prevent hypothermia during thoracoscopic surgery in the lateral decubitus position.

BACKGROUND: In the supine position, forced-air warming is more effective on the lower body than on the upper body to prevent intraoperative hypothermia. However, it is unknown in the lateral decubitus position. We thus compared forced-air warming on the upper and lower bodies in the lateral position. METHODS: Patients (n=123) were randomised to receive forced-air warming on the upper body or lower body during thoracoscopic surgery in the lateral position. We measured the nasopharyngeal temperature at 0, 30, 60, 90, and 120 min after lateral positioning during surgery and the infrared tympanic membrane temperature at 0, 30, 60, 90, and 120 min after surgery. Patients received both upper and lower body warming at a temperature of <35.5°C. The primary outcome was the incidence of intraoperative hypothermia with a temperature of <36.0°C. RESULTS: Intraoperative hypothermia was less frequent with the upper body warming than with the lower body warming {21/62 vs 35/61, risk ratio [95% confidence interval (CI)] 0.6 (0.4-0.9), P=0.011}. The intraoperative temperature was higher with the upper body warming than with the lower body warming at 30 (P=0.002), 60 (P<0.001), and 90 (P<0.001) min after lateral positioning, and the postoperative temperature was higher at 0 (P<0.001) and 30 (P=0.001) min after surgery. Fewer patients received both upper and lower body warming in the upper body warming group than in the lower body warming group during surgery (1 vs 7, P=0.032). CONCLUSIONS: Forced-air warming was more effective on the upper body than on the lower body to prevent hypothermia during thoracoscopic surgery in the lateral decubitus position. CLINICAL TRIAL REGISTRATION: NCT02993666.

Calling the patient's own name facilitates recovery from general anaesthesia: a randomised double-blind trial.

People can hear and pay attention to familiar terms such as their own name better than general terms, referred to as the cocktail party effect. We performed a prospective, randomised, double-blind trial to investigate whether calling the patient's name compared with a general term facilitated a patient's response and recovery from general anaesthesia. We enrolled women having breast cancer surgery with general anaesthesia using propofol and remifentanil. Patients were randomly allocated into two groups depending on whether the patient's name or a general term was called, followed by the verbal command - 'open your eyes!' - during emergence from anaesthesia; this pre-recorded sentence was played to the patient using headphones. Fifty patients were allocated to the name group and 51 to the control group. Our primary outcome was the time from discontinuation of anaesthesia until eye opening. The mean (SD) time was 337 (154) s in the name group and 404 (170) s in the control group (p = 0.041). The time to i-gel® removal was 385 (152) vs. 454 (173) s (p = 0.036), the time until achieving a bispectral index of 60 was 174 (133) vs. 205 (160) s (p = 0.3), and the length of stay in the postanaesthesia care unit was 43.8 (3.4) vs. 47.3 (7.1) min (p = 0.005), respectively. In conclusion, using the patient's name may be an easy and effective method to facilitate recovery from general anaesthesia.

Automated nonlinear feature generation and classification of foot pressure lesions.

Plantar lesions induced by biomechanical dysfunction pose a considerable socioeconomic health care challenge, and failure to detect lesions early can have significant effects on patient prognoses. Most of the previous works on plantar lesion identification employed the analysis of biomechanical microenvironment variables like pressure and thermal fields. This paper focuses on foot kinematics and applies kernel principal component analysis (KPCA) for nonlinear dimensionality reduction of features, followed by Fisher's linear discriminant analysis for the classification of patients with different types of foot lesions, in order to establish an association between foot motion and lesion formation. Performance comparisons are made using leave-one-out cross-validation. Results show that the proposed method can lead to approximately 94% correct classification rates, with a reduction of feature dimensionality from 2100 to 46, without any manual preprocessing or elaborate feature extraction methods. The results imply that foot kinematics contain information that is highly relevant to pathology classification and also that the nonlinear KPCA approach has considerable power in unraveling abstract biomechanical features into a relatively low-dimensional pathology-relevant space.

New p53 target, phosphatase of regenerating liver 1 (PRL-1) downregulates p53.

Most of the p53 target genes, all except MDM2, COP1 and PIRH2, perform functions in apoptosis, differentiation and cell cycle arrest. The aforementioned oncogenes downregulate p53 through a negative feedback mechanism, and thus contribute to tumor development. In this study, we report a new p53 target, PRL-1, which is believed to be a significant regulator in the development and metastasis of a variety of cancer types. Phosphatase of regenerating liver 1 (PRL-1) overexpression reduced the levels of endogenous and exogenous p53 proteins, and inhibited p53-mediated apoptosis. On the other hand, the ablation of PRL-1 by small interfering RNA (siRNA) increased p53 protein levels. The p53 downregulation was mediated by p53 ubiquitination and subsequent proteasomal degradation. Furthermore, p53 ubiquitination by PRL-1 was achieved through two independent pathways, by inducing PIRH2 transcription and by inducing MDM2 phosphorylation through Akt signaling. In addition, we showed that the PRL-1 gene harbors a p53 response element in the first intron, and its transcription is regulated by the p53 protein. These findings imply that the new oncogenic p53 target, PRL-1, may contribute to tumor development by the downregulation of p53 by a negative feedback mechanism.

Removal of phosphorus from water using lignocellulosic material modified with iron species from acid mine drainage.

Lignocellulosic biosorbents, including juniper fiber, show promise as sorbents for removing pollutants from wastewater run-off because of their low cost. In this study, juniper fiber modified with iron species from acid mine drainage (AMD) was tested for its capacity to remove phosphorus from water compared to unmodified juniper fiber. In batch tests, the maximum adsorbate loading (Qmax) of phosphorus onto the modified adsorbent was 1.83 mg g(-1) at pH 4.0, obtained by fitting the isotherm results to the Langmuir isotherm model. This value is similar to the sorption capacity of other conventional adsorbents such as goethite, which implies that the modified lignocellulosic material would be effective as a sorbent for removing phosphorus from water. In the kinetic test, the pseudo-second order kinetic model fitted well the sorption of phosphorus onto the modified filter medium, showing the kinetic constant (k) of 8.09 x 10(-2) g(mg min)(-1) at initial phosphorus concentration of 10 mg l(-1).

Improvement of cadmium ion removal by base treatment of juniper fiber.

Juniper is a small-diameter underutilized lignocellulosic material. We evaluated the efficacy of base-treated juniper fiber (BTJF) for cadmium (Cd2+) sorption and the viability of juniper fiber as a sorbent for removing Cd2+ from water. Fourier transform infrared spectroscopy analysis indicated that carboxylate ion is a major functional group responsible for Cd2+ sorption. The apparent ideal sodium hydroxide concentration for base treatment is approximately 0.5M. A batch sorption isotherm test showed that equilibrium sorption data were better represented by the Langmuir model than the Freundlich model. After base treatment, the maximum Cd2+ sorption loading, Qmax, was greatly improved (9.18-29.54 mg/g), despite a decrease in specific surface area. A pseudo-second-order kinetic model fitted well for the sorption of Cd2+ onto BTJF. Initial metal ion concentration and treatment alkalinity were found to be major parameters influencing the kinetics of the sorption reaction. As a result of its strong ability to bind cadmium and its faster kinetics in low concentration, BTJF could be an inexpensive and efficient sorbent for removing heavy metals from stormwater runoff.

Metabolic effects of amylin in lactating goats.

The objective of this study was to investigate the role of amylin (a pancreatic hormone) in regulating metabolism in support of lactation. Rat amylin was infused (320 pmol.kg LW(-1).h(-1)) for 6 h via an external pudic (mammary) artery into six lactating goats. This dose of amylin led to a sixfold increase in plasma concentrations of amylin relative to baseline. Amylin infusion increased plasma concentrations (jugular) of glucose and NEFA up to 16 and 168%, respectively, relative to saline infusion. In contrast, plasma concentrations of Ca and PO4 during amylin infusion were reduced by 18 and 30%, respectively, relative to saline infusion. Plasma concentrations of IGF-I, insulin, and Mg were not different between the two treatments, although IGF-I concentrations in the amylin-infused group, 1 and 6 h postinfusion, were significantly higher than those in the saline-infused group. Similarly, amylin infusion failed to affect milk yield and major constituents of milk except protein; milk protein content decreased progressively until the end of amylin infusion and remained low thereafter. Amylin also had no effect on minerals in milk (Ca, PO4, Mg, Fe, Sr, S, K, or Na) except Zn, which was significantly decreased from 56.8+/-5.8 micromol/L at 0 h to 44.5+/-2.4 micromol/L at 6 h postinfusion. Mammary blood flow (measured with a transit-time blood flow probe) increased up to 26% during amylin infusion, although this effect lasted only for the first 3 h. In conclusion, amylin increased plasma concentrations of glucose and NEFA, and mammary blood flow, while decreasing plasma concentrations of Ca and PO4. Despite these metabolic changes, amylin infusion did not increase milk yield of lactating goats.