Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil / Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery

En la enfermedad quirúrgica de cadera es esencial el manejo y el control efectivo del dolor peri y postoperatorio que minimice el uso de opioides y sus efectos adversos. Una de las dificultades de la analgesia regional eficaz para el control del dolor de cadera es la compleja inervación de la articulación que procede de múltiples nervios. Las técnicas regionales comúnmente realizadas se asocian en ocasiones a complicaciones, entre las que se han descrito la anestesia parcial, la hipotensión o la debilidad de los miembros inferiores. Presentamos el caso de una niña de 5 años con antecedentes de parálisis cerebral infantil que fue intervenida de osteotomía derrotativa y varizante de ambas caderas y tenotomía de los aductores por luxación paralitica a la que se le realizó un bloqueo PENG bilateral asociado al bloqueo del nervio femorocutáneo, por ser una técnica sencilla que no requiere de punciones múltiples para cubrir cada uno de los nervios implicados en la inervación sensitiva de la cápsula articular.(AU)

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.(AU)

Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery.

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block-a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.

Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery. / Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil.

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.

Evaluating the impacts of agricultural land management practices on water resources: A probabilistic hydrologic modeling approach.

Evaluating the effectiveness of agricultural land management practices in minimizing environmental impacts using models is challenged by the presence of inherent uncertainties during the model development stage. One issue faced during the model development stage is the uncertainty involved in model parameterization. Using a single optimized set of parameters (one snapshot) to represent baseline conditions of the system limits the applicability and robustness of the model to properly represent future or alternative scenarios. The objective of this study was to develop a framework that facilitates model parameter selection while evaluating uncertainty to assess the impacts of land management practices at the watershed scale. The model framework was applied to the Lake Creek watershed located in southwestern Oklahoma, USA. A two-step probabilistic approach was implemented to parameterize the Agricultural Policy/Environmental eXtender (APEX) model using global uncertainty and sensitivity analysis to estimate the full spectrum of total monthly water yield (WYLD) and total monthly Nitrogen loads (N) in the watershed under different land management practices. Twenty-seven models were found to represent the baseline scenario in which uncertainty of up to 29% and 400% in WYLD and N, respectively, is plausible. Changing the land cover to pasture manifested the highest decrease in N to up to 30% for a full pasture coverage while changing to full winter wheat cover can increase the N up to 11%. The methodology developed in this study was able to quantify the full spectrum of system responses, the uncertainty associated with them, and the most important parameters that drive their variability. Results from this study can be used to develop strategic decisions on the risks and tradeoffs associated with different management alternatives that aim to increase productivity while also minimizing their environmental impacts.

Upper washita river experimental watersheds: nutrient water quality data.

Climate variability, changing land use and management, and dynamic policy environments are the main reasons why long-term research is needed to understand and predict possible water quality outcomes to alternative future scenarios. Long-term water quality data sets are needed to address these water issues. Such data sets were acquired by the USDA-ARS in three watersheds in Oklahoma: the Southern Great Plains Research Watershed (SGPRW), the Little Washita River Experimental Watershed (LWREW), and the Fort Cobb Reservoir Experimental Watershed (FCREW). We provide: (i) a description of these water quality data sets, (ii) the sample collection and processing procedures used and an assessment of the data quality, (iii) summary analyses of the variability in each data set, and (iv) details about how to access these data sets. Water quality data collection in the SGPRW began in the 1960s and continued through 1978, while that in the LWREW covered the 1960s to 1990 period. Data collection began in the FCREW in 2004 and continues through the present. The data were collected from streams, unit source watersheds, groundwater wells, and reservoirs. The water quality data described for a given site are generally complete for a given period of record; however, not all sites were monitored continuously and were not necessarily analyzed for the same water quality parameters. These data sets are expected to improve modeling and assessments of conservation practices in relation to climate variability, land use changes, and other environmental factors and may be useful in developing strategies to mitigate these environmental impacts.

Upper washita river experimental watersheds: meteorologic and soil climate measurement networks.

Hydrologic, watershed, water resources, and climate-related research conducted by the USDA-ARS Grazinglands Research Laboratory (GRL) are rooted in events dating back to the 1930s. In 1960, the 2927-km Southern Great Plains Research Watershed (SGPRW) was established to study the effectiveness of USDA flood control and soil erosion prevention programs. The size of the SGPRW was scaled back in 1978, leaving only the 610-km Little Washita River Experimental Watershed (LWREW) to be used as an outdoor hydrologic research laboratory. Since 1978, the number of measurement sites and types of instruments used to collect meteorologic and soil climate data have changed on the LWREW. Moreover, a second research watershed, the 786-km Fort Cobb Reservoir Experimental Watershed (FCREW), was added in 2004 to the GRL's outdoor research laboratories to further study the effects of agricultural conservation practices on selected environmental endpoints. We describe the SGPREW, FCREW, and LWREW and the meteorologic measurement network (historic and present) deployed on them, provide descriptions of measurements, including information on accuracy and calibration, quality assurance measures (where known), and data archiving of the present network, give examples of data products and applications, and provide information for the public and research communities regarding access and availability of both the historic and recent data from these watersheds.

Seasonal sediment and nutrient transport patterns.

It is essential to understand sediment and nutrient sources and their spatial and temporal patterns to design effective mitigation strategies. However, long-term data sets to determine sediment and nutrient loadings are scarce and expensive to collect. The goal of this study was to determine seasonal patterns of suspended sediment (SS), total N (TN), and total P (TP) concentrations and loadings for three USGS gauge sites located at the Fort Cobb Reservoir Experimental watershed (FCREW) located in southwestern Oklahoma. Measured instantaneous discharge, SS, TN, and TP concentration data were used to develop lognormal water quality-discharge relationships. The water quality-discharge relationships were used to generate estimated seasonal concentrations and loads based on hourly or 30-min interval discharge. The estimated concentrations and loads were used to determine seasonal patterns for SS, TN, and TP relative to the respective state water quality criteria. Decreasing and increasing monotonic trends were observed for the seasonal time series loads for all three sites, but they were insignificant based on the Spearman test (α = 0.05). The largest loads were estimated during the wet springs and summers. The study SS, TN, and TP target concentrations were exceeded in one season or another. The study results showed that the priority locations to implement the TN and TP conservation practices were the Lake Creek and Willow Creek subwatersheds during the winter and spring seasons. Common practices to mitigate nutrients and suspended sediments include nutrient management, no-till, conversion of cultivated land to pasture, riparian buffers, and animal exclusion.

Intravesical ligation as a new technique to manage a refluxing native ureter without simultaneous nephrectomy in renal transplantation.

BACKGROUND: This article aims to describe an original technique to correct refluxing native ureters observed during a prerenal transplantation study. The correction is performed by intravesical ligation of the native refluxing ureters at the same time as renal transplantation without simultaneous nephrectomy. METHODS: Between January 2004 and December 2010 we performed intravesical ligation of a refluxing ureter simultaneous with a transplantation procedure without a concomittant native nephrectomy in 12 of 345 subjects (3.47%). The 8 bilateral and 4 unilateral ligations were performed on 11 cadaveric and 1 living-related nonidentical donor transplantations. The implantation of the kidney donor ureter was performed anatomically in the bladder trigone through a transvesical ureteroneocystostomy with a transmural, submucosal antireflux tunnel. RESULTS: Early and late postoperative recovery was satisfactory in all patients. There was no documented kidney area pain, proven urinary tract infection, morbidity or mortality attributed to the procedure. CONCLUSIONS: Intravesical ligation is a practical technique to manage vesicoureteral reflux into the native ureters simultaneously with the ureteral implantation of the kidney donor in a single surgical renal transplant procedure without native kidney nephrectomy.

Interacción paciente-ventilador / Patient-ventilator interaction

La ventilación mecánica es una terapia estándar en pacientes ingresados ​​en la UCI en una situación de insuficiencia respiratoria aguda grave. Además de los trastornos del intercambio gaseoso, la principal indicación para comenzar es la presencia de signos de la fatiga muscular respiratoria. Para la ventilación mecánica es esencial para tener éxito y ventilación del paciente están sincronizadas, es decir, el esfuerzo que hace el paciente de la fuente de inspiración para comenzar a ser reconocido por el ventilador y se entrega rápidamente un flujo de gas, el caudal aportado por el ventilador tendrá que adaptarse al flujo de pacientes durante la entrega de gas y que el ventilador reconocer el cese de la actividad inspiratorio del paciente, completar la entrega de gas y la válvula de espiración se abre para permitir la expiración del paciente. Esta secuencia de acontecimientos que parecen tan lógicas, casi nunca alcanzados en la práctica clínica, siendo comunes en los pacientes ventilados ver algún tipo de asincronía. La presencia de asincronía o desfase patientventilator conduce invariablemente a un aumento del trabajo respiratorio, lo que frustraría el objetivo fundamental de la asistencia respiratoria que no es otro que la disminución del trabajo paciente de la respiración (AU)

Mechanical ventilation is a standard therapy in patients admitted to the ICU in a situation of severe acute respiratory failure. Addition to the disruption of gas exchange, the main indication to start is the presence of signs of respiratory muscle fatigue. For mechanical ventilation is essential to succeed and patient ventilator are synchronized, ie the effort that the patient does the inspiration to start being recognized by the fan and it quickly delivers a gas flow, the flow contributed by the fan will need to adapt to patient flow during the delivery of gas and that the fan recognize the termination of inspiratory activity of the patient, complete the delivery of gas and expiratory valve opens to allow the expiration of the patient. This sequence of events that seem so logical, almost never achieved in clinical practice, still common in ventilated patients see some kind of asynchrony. The presence of mismatch or patient-ventilator asynchrony invariably leads to an increased work of breathing, which will defeat the fundamental objective of ventilatory support which is none other than the decrease of the patient work of breathing (AU)

Is the exponent 3/2 justified in analysis of loading curve of pyramidal nanoindentations?

Kaupp and Naimi-Jamal (2010) claimed that the analysis of published loading curves reveals the exponent 3/2 to the depth for nanoindentations with sharp pyramidal or conical tips. To demonstrate this, they plotted the load vs. the penetration depth to the power 3/2. We show, through examples, the authors' assertion is not credible because the methodology used is misleading and it cannot be asserted that the exponent 3/2 has a universal validity that applies to all kinds of materials.

[Patient-noninvasive mechanical ventilation interaction]. / Interacción paciente-ventilador en ventilación mecánica no invasiva.

Noninvasive mechanical ventilation is one more step in the treatment of patients with acute respiratory failure. In addition to gas exchange disorders, its primary indication to initiate it is the presence of signs of respiratory muscles fatigue. To assure successful mechanical ventilation, the ventilator and patient must be synchronized, that is, the effort the patient makes to start inspiration is recognized by the ventilator and it quickly delivers gas flow, that the flow provided by the ventilator adapts to the flow need of the patient during delivery of gas phase and that the ventilator recognizes the cessation of inspiratory activity by the patient, ends the delivery of gas and opens the expiratory valve to allow the patient expiration. This sequence of events, which seem so logical, is almost never achieved in the clinical practice, commonly observing some asynchrony in ventilated patients. The presence of patient-ventilator asynchrony leads to increased breathing work, which would lead to the failure of the main objective of ventilatory support, that is none other than decline in the patient's respiratory work.

Interacción paciente-ventilador en ventilación mecánica no invasiva / Patient-noninvasive mechanical ventilation interaction

La ventilación mecánica no invasiva constituye un escalón más del tratamiento del paciente en situación de fallo respiratorio agudo. Además de los trastornos del intercambio de gases, la indicación principal para iniciarla la constituye la presencia de signos de fatiga de los músculos respiratorios. Para que la ventilación mecánica tenga éxito es fundamental que ventilador y paciente estén sincronizados, es decir, que el esfuerzo que el enfermo hace para iniciar la inspiración sea reconocido por el ventilador y este entregue rápidamente un flujo de gas, que el flujo aportado por el ventilador se adapte a la necesidad de flujo del paciente durante la fase de entrega de gas, y que el ventilador reconozca el cese de la actividad inspiratoria del paciente, finalice la entrega de gas y abra la válvula espiratoria para permitir la espiración del paciente. Esta secuencia de hechos, que parecen tan lógicos, casi nunca se consigue en la práctica clínica, siendo habitual observar en los pacientes ventilados algún tipo de asincronía. La presencia de desadaptación o asincronía paciente-ventilador conduce invariablemente a un aumento del trabajo respiratorio, lo que hará fracasar el objetivo fundamental del soporte ventilatorio, que no es otro que la disminución del trabajo respiratorio del paciente(AU)

Noninvasive mechanical ventilation is one more step in the treatment of patients with acute respiratory failure. In addition to gas exchange disorders, its primary indication to initiate it is the presence of signs of respiratory muscles fatigue. To assure successful mechanical ventilation, the ventilator and patient must be synchronized, that is, the effort the patient makes to start inspiration is recognized by the ventilator and it quickly delivers gas flow, that the flow provided by the ventilator adapts to the flow need of the patient during delivery of gas phase and that the ventilator recognizes the cessation of inspiratory activity by the patient, ends the delivery of gas and opens the expiratory valve to allow the patient expiration. This sequence of events, which seem so logical, is almost never achieved in the clinical practice, commonly observing some asynchrony in ventilated patients. The presence of patient-ventilator asynchrony leads to increased breathing work, which would lead to the failure of the main objective of ventilatory support, that is none other than decline in the patient’s respiratory work(AU)

Antibody seroprevalences against rabies in dogs vaccinated under field conditions in Bolivia.

Bolivia currently has one of the highest numbers of cases for human and canine rabies and is thus clue to the elimination process. The objective of the present study was to assess antibody seroprevalences against rabies in dogs vaccinated under field conditions and other factors that might influence the success of the on-going rabies control programmes in an endemic area of the disease, Santa Cruz de la Sierra, Bolivia. All 240 study animals, selected using area-stratified random sampling, were investigated in April 2007. Test prevalences were adjusted for the imperfect test characteristics using the Rogan-Gladen estimator (deterministic and stochastic functions) and Bayesian inference. Ninety-four of the tested 240 vaccinated dogs were classified as test-positive for rabies-specific antibodies. With regard to adjusted overall antibody seroprevalence, Bayesian true prevalence estimates (41%, 95% CI: 37-46%) were lower than both of the Rogan-Gladen estimates. The effect of various epidemiological factors on post-vaccination response was also assessed.

Antibody response to an anti-rabies vaccine in a dog population under field conditions in Bolivia.

Rabies remains an important public health issue in Bolivia, South America. Public concern and fears are most focussed on dogs as the source of rabies. The objective of the present study was to assess immunity of an inactivated suckling mouse brain vaccine against canine rabies used for the official vaccination campaigns under field conditions in an endemic area of rabies in Bolivia. A total of 236 vaccinated and 44 unvaccinated dogs in Santa Cruz de la Sierra, selected using stratified random sampling, were investigated in order to obtain owned dog characteristics and antibody titres against rabies in April 2007. The proportion of vaccinated dogs with an antibody titre exceeded the protection threshold value of 0.5 EU/ml was 58% [95% confidence intervals (CI): 52-65], indicating that vaccination is likely to elicit an antibody response (odds ratio 6.3, 95% CI: 1.2-11.5). The range of geometric mean of antibody titre for vaccinated dogs (0.89 EU/ml; 95% CI: 0.75-1.04) was considered to meet the minimal acceptable level indicating an adequate immune response to the vaccine. However, the titre level was not satisfactory in comparison with the results from other field investigations with inactivated tissue culture vaccines. It is recommended for public health authorities to (1) consider modernizing their vaccine manufacturing method because the level of immunity induced by the current vaccine is comparably low, (2) conduct frequent vaccination campaigns to maintain high levels of vaccination coverage, and (3) actively manage the domestic dog population in the study area, which is largely responsible for rabies maintenance.

Species distribution and antimicrobial resistance of enterococci isolated from surface and ocean water.

AIMS: The species identification and antimicrobial resistance profiles were determined for enterococci isolated from Southern California surface and ocean waters. METHODS AND RESULTS: Species identification was determined for 1413 presumptive Enterococcus isolates from urban runoff, bay, ocean and sewage water samples. The most frequently isolated species were Enterococcus faecalis, Enterococcus faecium, Enterococcus hirae, Enterococcus casseliflavus and Enterococcus mundtii. All five of these species were isolated from ocean and bay water with a frequency ranging from 7% to 36%. Enterococcus casseliflavus was the most frequently isolated species in urban runoff making up 36-65% of isolates while E. faecium was the most frequently isolated species in sewage making up 53-78% of isolates. The similar distribution of species in urban runoff and receiving water suggests that urban runoff may be the source of Enterococcus. No vancomycin or high level gentamycin resistance was detected in E. faecalis and E. faecium isolates. CONCLUSIONS: Enterococcus faecalis, E. faecium, E. casseliflavus and E. mundtii are the most commonly isolated Enterococcus species from urban runoff and receiving waters in Southern California. SIGNIFICANCE AND IMPACT OF THE STUDY: Determination of the Enterococcus species isolated from receiving waters and potential pollution sources may assist in determining the sources of pollution.

Antidiarrheal activity of dehydroleucodine isolated from Artemisia douglasiana.

Dehydroleucodine (DhL), a sesquiterpene lactone obtained from Artemisia douglasiana, was screened for antidiarrheal effects. DhL inhibited castor oil-induced diarrhea in mice by judged by a decrease in the number of wet faeces in the DhL-treatment groups. DhL significantly reduced intestinal transit in mice. Yohimbine and phentolamine counteracted the inhibitory effect of DhL. It is suggested that alpha2-adrenergic receptors mediate the effect of DhL in intestinal motility. DhL reduced also intraluminal accumulation of fluid. Thus, the antidiarrheal activity of DhL is possibly related, at least in part, to its inhibitory action against gastrointestinal motility and the inhibition of enteropooling property.

Anti-inflammatory activity and effect on gastric acid secretion of dehydroleucodine isolated from Artemisia douglasiana.

The effect of Dehydroleucodine (DhL) on gastric acid secretion in rats was investigated at a dose of 40 mg/kg, while its anti-inflammatory effect was investigated in two experimental models: arthritis induced by Freund's adjuvant carrageenan- and cotton pellet-induced granuloma. DhL did not inhibit gastric acid secretion, suggesting that its anti-ulcerogenic effect can be attributed to its action on the mucosa defense factors. On the other hand, DhL inhibited both chronic and acute adjuvant carrageenan-induced inflammation phases, being most effective in the chronic phase. In the granuloma test, DhL also inhibited inflammation. It is suggested that the anti-inflammatory activity of DhL may be attributed to interference with multiple targets on the level of transcription factors, such as NF-kappaB, and cytokines.

Dopamine-1 receptor stimulation attenuates the vasoconstrictive response to gut ischemia.

The effects of fenoldopam, a dopamine-1 (DA-1) receptor agonist, were studied in two groups of anesthetized dogs before and after induction of splanchnic ischemia by way of hemorrhage. During the first portion of the experiment, both groups received fenoldopam (1.5 microg x kg(-1) x min(-1)) for 45 min followed by a 45-min washout. During the second portion, hemorrhage (10 ml/kg) was induced, followed by no intervention in group I (controls) and restarting of the fenoldopam infusion in group II. Prehemorrhage, fenoldopam increased composite portal blood flow by 33% (P < 0.01). After hemorrhage-induced splanchnic ischemia, fenoldopam restored portal vein blood flow to near baseline, maintained the splanchnic fraction of cardiac output, and attenuated the rise in gut mucosal PCO(2). DA-1 receptor stimulation increased portal blood flow and redistributed blood flow away from the serosal layer in favor of the mucosa during basal conditions and after hemorrhage, suggesting a more concentrated distribution of splanchnic DA-1 receptors within the mucosal layer vasculature. Fenoldopam maintained splanchnic blood flow during hypoperfusion and attenuated the splanchnic vasoconstrictive response to hemorrhage.