Phenylpropanoids Following Wounding and Infection of Sweet Sorghum Lines Differing in Responses to Stalk Pathogens.

Sweet sorghum (Sorghum bicolor) lines M81-E and Colman were previously shown to differ in responses to Fusarium thapsinum and Macrophomina phaseolina, stalk rot pathogens that can reduce the yields and quality of biomass and extracted sugars. Inoculated tissues were compared for transcriptomic, phenolic metabolite, and enzymatic activity during disease development 3 and 13 days after inoculation (DAI). At 13 DAI, M81-E had shorter mean lesion lengths than Colman when inoculated with either pathogen. Transcripts encoding monolignol biosynthetic and modification enzymes were associated with transcriptional wound (control) responses of both lines at 3 DAI. Monolignol biosynthetic genes were differentially coexpressed with transcriptional activator SbMyb76 in all Colman inoculations, but only following M. phaseolina inoculation in M81-E, suggesting that SbMyb76 is associated with lignin biosynthesis during pathogen responses. In control inoculations, defense-related genes were expressed at higher levels in M81-E than Colman. Line, treatment, and timepoint differences observed in phenolic metabolite and enzyme activities did not account for observed differences in lesions. However, generalized additive models were able to relate metabolites, but not enzyme activities, to lesion length for quantitatively modeling disease progression: in M81-E, but not Colman, sinapic acid levels positively predicted lesion length at 3 DAI when cell wall-bound syringic acid was low, soluble caffeic acid was high, and lactic acid was high, suggesting that sinapic acid may contribute to responses at 3 DAI. These results provide potential gene targets for development of sweet sorghum varieties with increased stalk rot resistance to ensure biomass and sugar quality.

Potential Adverse Outcomes of Shared Decision Making about Palliative Cancer Treatment: A Secondary Analysis of a Randomized Trial.

BACKGROUND: While shared decision making (SDM) is advocated for ethical reasons and beneficial outcomes, SDM might also negatively affect patients with incurable cancer. The current study explored whether SDM, and an oncologist training in SDM, are associated with adverse outcomes (i.e., patient anxiety, tension, helplessness/hopelessness, decisional uncertainty, and reduced fighting spirit). DESIGN: A secondary analysis of a randomized clinical trial investigating the effects of SDM interventions in the context of advanced cancer. The relations between observed SDM (OPTION12), specific SDM elements (4SDM), oncologist SDM training, and adverse outcomes were analyzed. We modeled adverse outcomes as a multivariate phenomenon, followed by univariate regressions if significant. RESULTS: In total, 194 patients consulted by 31 oncologists were included. In a multivariate analysis, observed SDM and adverse outcomes were significantly related. More specifically, more observed SDM in the consultation was related to patients reporting more tension (P = 0.002) and more decisional uncertainty (P = 0.004) at 1 wk after the consultation. The SDM element "informing about the options" was especially found to be related to adverse outcomes, specifically to more helplessness/hopelessness (P = 0.002) and more tension (P = 0.016) at 1 wk after the consultation. Whether the patient consulted an oncologist who had received SDM training or not was not significantly related to adverse outcomes. No relations with long-term adverse outcomes were found. CONCLUSIONS: It is important for oncologists to realize that for some patients, SDM may temporarily be associated with negative emotions. Further research is needed to untangle which, when, and how adverse outcomes might occur and whether and how burden may be minimized for patients. HIGHLIGHTS: Observed shared decision making was related to more tension and uncertainty postconsultation in advanced cancer patientsHowever, training oncologists in SDM did not affect adverse outcomes.Further research is needed to untangle which, when, and how adverse outcomes might occur and how burden may be minimized.

Using Sound Location to Monitor Farrowing in Sows.

Precision Livestock Farming systems can help pig farmers prevent health and welfare issues around farrowing. Five sows were monitored in two field studies. A Sorama L642V sound camera, visualising sound sources as coloured spots using a 64-microphone array, and a Bascom XD10-4 security camera with a built-in microphone were used in a farrowing unit. Firstly, sound spots were compared with audible sounds, using the Observer XT (Noldus Information Technology), analysing video data at normal speed. This gave many false positives, including visible sound spots without audible sounds. In total, 23 of 50 piglet births were visible, but none were audible. The sow's behaviour changed when farrowing started. One piglet was silently crushed. Secondly, data were analysed at a 10-fold slower speed when comparing sound spots with audible sounds and sow behaviour. This improved results, but accuracy and specificity were still low. When combining audible sound with visible sow behaviour and comparing sound spots with combined sound and behaviour, the accuracy was 91.2%, the error was 8.8%, the sensitivity was 99.6%, and the specificity was 69.7%. We conclude that sound cameras are promising tools, detecting sound more accurately than the human ear. There is potential to use sound cameras to detect the onset of farrowing, but more research is needed to detect piglet births or crushing.

Evidence-based perioperative opioid-sparing techniques during the United States opioid crisis.

PURPOSE OF REVIEW: The current United States opioid epidemic resulted from the overprescribing of opioids by physicians and surgeons in response to deceptive and unlawful marketing campaigns by pharmaceutical companies seeking to profit from opioid sales. Surgeons have a moral obligation to employ evidence-based opioid-sparing analgesia protocols for management of perioperative pain. RECENT FINDINGS: Recent evidence strongly supports the use of NSAIDs in perioperative pain management, with large studies demonstrating no increased risk of postoperative hemorrhage or renal insult. SUMMARY: We present an evidence-based approach for opioid-sparing perioperative pain management, including multimodal analgesia guidelines used at our center for patients undergoing free flap facial reanimation procedures.

Driving performance of outpatients achieving discharge criteria after deep sedation is worse than these of their escort-driver: a prospective observational study on simulator.

Background: Achieving post-anesthesia discharge criteria after surgery or outpatient procedures does not mean that the patient has regained all his or her faculties, such as driving. Although mandated by many clinical guidelines, there is no evidence that escort-drivers reduce the risk of traffic accidents after deep sedation. The purpose of this study was to evaluate that hypothesis that driving performance as measured using a driving simulation would not differ between patients who had undergone deep sedation for gastrointestinal endoscopy meeting discharge criteria and their escorts. Methods: This prospective study included patients scheduled for ambulatory gastrointestinal endoscopy under deep propofol sedation (patient group) and their escorts (escort group). Driving performance of escorts and patients (when discharge criteria were met) was assessed using a driving simulator. Results: 30 patients and their escorts were included. Patients crossed the midline significantly more frequently than escorts (3 [2-4] (median [IQR]) and 2 [1-3] crossings, respectively, p=0.015]. Patients were speeding for a higher proportion of the distance traveled compared with escorts (37 (20)% (mean (SD)) and 24 (17)% in patients and escorts, respectively, p = 0.029). There were no significant differences between groups in other simulation parameters. Conclusions: The ability to stay within the traffic lanes, as measured by the number of midline crossing during a simulated driving performance, is impaired in patients who meet discharge criteria after gastrointestinal endoscopy under deep sedation compared with their escorts. This finding does not support a practice of allowing patients to drive themselves home after these procedures.

Climate and demography drive 7000 years of dietary change in the Central Andes.

Explaining the factors that influence past dietary variation is critically important for understanding changes in subsistence, health, and status in past societies; yet systematic studies comparing possible driving factors remain scarce. Here we compile the largest dataset of past diet derived from stable isotope δ13C‰ and δ15N‰ values in the Americas to quantitatively evaluate the impact of 7000 years of climatic and demographic change on dietary variation in the Central Andes. Specifically, we couple paleoclimatic data from a general circulation model with estimates of relative past population inferred from archaeologically derived radiocarbon dates to assess the influence of climate and population on spatiotemporal dietary variation using an ensemble machine learning model capable of accounting for interactions among predictors. Results reveal that climate and population strongly predict diet (80% of δ15N‰ and 66% of Î´13C‰) and that Central Andean diets correlate much more strongly with local climatic conditions than regional population size, indicating that the past 7000 years of dietary change was influenced more by climatic than socio-demographic processes. Visually, the temporal pattern suggests decreasing dietary variation across elevation zones during the Late Horizon, raising the possibility that sociopolitical factors overrode the influence of local climatic conditions on diet during that time. The overall findings and approach establish a general framework for understanding the influence of local climate and demography on dietary change across human history.

Pathogen and drought stress affect cell wall and phytohormone signaling to shape host responses in a sorghum COMT bmr12 mutant.

BACKGROUND: As effects of global climate change intensify, the interaction of biotic and abiotic stresses increasingly threatens current agricultural practices. The secondary cell wall is a vanguard of resistance to these stresses. Fusarium thapsinum (Fusarium stalk rot) and Macrophomina phaseolina (charcoal rot) cause internal damage to the stalks of the drought tolerant C4 grass, sorghum (Sorghum bicolor (L.) Moench), resulting in reduced transpiration, reduced photosynthesis, and increased lodging, severely reducing yields. Drought can magnify these losses. Two null alleles in monolignol biosynthesis of sorghum (brown midrib 6-ref, bmr6-ref; cinnamyl alcohol dehydrogenase, CAD; and bmr12-ref; caffeic acid O-methyltransferase, COMT) were used to investigate the interaction of water limitation with F. thapsinum or M. phaseolina infection. RESULTS: The bmr12 plants inoculated with either of these pathogens had increased levels of salicylic acid (SA) and jasmonic acid (JA) across both watering conditions and significantly reduced lesion sizes under water limitation compared to adequate watering, which suggested that drought may prime induction of pathogen resistance. RNA-Seq analysis revealed coexpressed genes associated with pathogen infection. The defense response included phytohormone signal transduction pathways, primary and secondary cell wall biosynthetic genes, and genes encoding components of the spliceosome and proteasome. CONCLUSION: Alterations in the composition of the secondary cell wall affect immunity by influencing phenolic composition and phytohormone signaling, leading to the action of defense pathways. Some of these pathways appear to be activated or enhanced by drought. Secondary metabolite biosynthesis and modification in SA and JA signal transduction may be involved in priming a stronger defense response in water-limited bmr12 plants.

Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study.

BACKGROUND: Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. OBJECTIVE: This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. METHODS: We designed a web-based, physician-assisted prediction tool-Source-to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds-a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. RESULTS: The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. CONCLUSIONS: The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making.

A pooled analysis of six large-pen feedlot studies: effects of a noncoated initial and terminal implant compared with a single initial and delayed-release implant on arrival in feedlot heifers.

Randomized complete block design experiments (n = 6 experiments) evaluating steroidal implants (all from Merck Animal Health, Madison, NJ) were conducted in large-pen feedlot research facilities between 2015 and 2018 comparing an 80 mg trenbolone acetate (TBA) and 8 mg estradiol-17ß (E2) initial implant (Revalor-IH) and reimplanted with 200 mg TBA and 20 mg E2 (Revalor-200; REPEATED) to a single 80 mg TBA and 8 mg E2 uncoated; 120 mg TBA and 12 mg E2 coated implant (Revalor-XH) at arrival (SINGLE) on growth and carcass responses in finishing heifers. Experiments occurred in Nebraska, Oklahoma, Washington, and Texas. Similar arrival processing was used across experiments where 17,675 heifers [initial body weight = 333 kg SEM (4.1)] were enrolled into 180 pens (90 pens per treatment with 65-240 heifers per pen) and fed for 145-222 d. Only REPEATED heifers were removed from their pen at reimplant. Diets contained monensin and tylosin, consisted of ingredients common to each region, and contained greater than 90% concentrate. Ractopamine hydrochloride was fed for a minimum of 28 d prior to harvest. Linear mixed models were used for all analyses; model-adjusted means for each implant group and the corresponding SEM were generated. Distributions of U.S. Department of Agriculture (USDA) quality grade (QG) and yield grade (YG) were analyzed as ordinal outcomes. No differences (P ≥ 0.11) were detected for any performance parameters except dry matter intake (DMI), where SINGLE had greater (P = 0.02) DMI (9.48 vs. 9.38 ± 0.127 kg) compared with REPEATED. Heifers implanted with REPEATED had greater (P ≤ 0.02) hot carcass weight (HCW; 384 vs. 382 ± 2.8 kg), dressing percentage (64.54 vs. 64.22 ± 0.120%), and ribeye area (91.87 vs. 89.55 ± 0.839 cm2) but less (P ≤ 0.01) rib fat (1.78 vs. 1.83 ± 0.025 cm) and calculated YG (2.82 vs. 2.97 ± 0.040) and similar (P = 0.74) marbling scores (503 vs. 505 ± 5.2) compared with SINGLE heifers. Distributions of USDA YG and QG were impacted (P ≤ 0.03) by treatment such that REPEATED had fewer USDA Prime and YG 4 and 5 carcasses. Heifer growth performance did not differ between implant regimens, but HCW and muscling did, perhaps indicating that REPEATED may be suited for grid-based marketing, and SINGLE might be suited for heifers sold on a live basis depending upon market conditions and value-based grid premiums and discounts. However, these decisions are operational dependent and also may be influenced by factors including animal and employee safety, stress on animals, processing facilities, time of year, labor availability, and marketing strategies.

Effects of various ractopamine hydrochloride withdrawal periods on performance, health, and carcass characteristics in yearling steers.

Ractopamine hydrochloride (RAC) is a ß-adrenergic agonist approved for feeding during the last 28 to 42 d prior to cattle slaughter to improve feedlot performance and carcass characteristics. Three thousand crossbred yearling steers (527 ± 2.4 kg; AVG ± SD) were used in two periods to evaluate the effects of various RAC withdrawal times on feedlot performance, health, and carcass characteristics. In Period 1, 6 blocks of 30 pens totaling 1,500 steers were utilized, which was repeated for Period 2. In a randomized complete block design, cattle were assigned to 1 of 5 treatments consisting of 1) No RAC fed (CON), 2) 12-h RAC withdrawal (12-hRAC), 3) 2-d RAC withdrawal (2-dRAC), 4) 4-d RAC withdrawal (4-dRAC), and 5) 7-d RAC withdrawal (7-dRAC). Cattle were fed for a total of 62 d, and applicable treatments were supplemented with 30.0 ppm (dry matter basis) of RAC (average dose = 322 mg per steer per day) for 33 d at the end of the feeding period, corresponding to their respective withdrawal times. Initial body weight (BW) displayed a quadratic curve, with 2-dRAC and 4-dRAC withdrawal periods having the greatest BW. Accordingly, dry matter intake (DMI) responded quadratically (P = 0.034), with 2-dRAC and 4-dRAC treatments demonstrating the greatest DMI. No significant treatment differences (P ≥ 0.641) were observed in final live BW, average daily gain (ADG), or feed efficiency. Alternatively, when using a common dressing percentage to calculate live BW, cattle on RAC treatments exhibited 7.6 kg additional live BW (P < 0.001) compared to CON cattle. Furthermore, carcass-adjusted ADG and feed efficiency did not differ (P > 0.10) between RAC treatments but were improved compared to the CON treatment (P ≤ 0.002). Hot carcass weight (HCW) was on average 4.9 kg greater (P < 0.001) for RAC treatments vs. CON, and no differences were detected (P > 0.10) among RAC treatments. Within RAC treatments, carcass cutability responded quadratically (P ≤ 0.005) to withdrawal period, with the 2-dRAC and 4-dRAC treatments containing more Yield Grade 4 and 5 and fewer Yield Grade 1 and 2 carcasses than the other RAC treatments. On the basis of the results of this experiment, feeding RAC improves dressing percentage, HCW, and carcass-adjusted BW, ADG, and feed efficiency. Furthermore, extending the RAC withdrawal period to 7 d does not have a significant impact on cattle performance or health and has minimal effects on carcass characteristics.

Standardized Volume Dosing Protocol of 23.4% Hypertonic Saline for Pediatric Critical Care: Initial Experience.

Background: Standardized volume dosing of 23.4% hypertonic saline (HTS) exists for adults, but the concentration, dosing and administration of HTS in pediatrics is variable. With emerging pediatric experience of 23.4% HTS, a standard volume dose approach may be helpful. Objective: To describe initial experience with a standardized 23.4% HTS weight-based volume dosing protocol of 10, 20, or 30 mL in the pediatric intensive care unit. Methods: Standard volume doses of 23.4% HTS were developed from weight dosing equivalents of 3% HTS. Pre and post sodium and intracranial pressure (ICP) measurements were compared with paired t-test or Wilcoxon rank-sum test. The site of administration and complications were noted. Results: A total of 16 pediatric patients received 37 doses of 23.4% HTS, with the smallest patient weighing 11 kg. For protocol compliance, 17 doses (46%) followed recommended dosing, 19 were less volume than recommended (51%), and 1 dose (3%) was more than recommended. Mean increase in sodium was 3.5 mEq/L (95% CI = 2-5 mEq/L); P < 0.0001. The median decrease in ICP was 10.5 mm Hg (interquartile range [IQR] 8.3-19.5) for a 37% (IQR 25%-64%) reduction. Most doses were administered through central venous access, although peripheral intravenous administrations occurred in 4 patients without complication. Conclusion and Relevance: Three standard-volume dose options of 23.4% HTS based on weight increases sodium and reduces ICP in pediatric patients. Standard-volume doses may simplify weight-based dosing, storage and administration for pediatric emergencies, although the optimum dose, and safety of 23.4% HTS in children remains unknown.

A systematic review on the safety and efficacy of Blumea balsamifera (L.) DC (NIRPROMP Tablet) for the treatment of Urinary Tract Stone

Objective@#To evaluate the safety and efficacy of Blumea balsamifera (L.) DC for the treatment of urinary tract stones.@*Methods@#Data were collected from online databases, the Philippine National Library, and unpublished clinical trials. We obtained permission from authors of unpublished clinical trials but with existing patent applications. Studies were selected based on the criteria: randomized controlled trials (RCT) on the efficacy of Blumea balsamifera (L.) DC for the treatment of urinary tract stones given alone or in combination with a non-pharmacological/pharmacological intervention in comparison to a pharmacological/non-pharmacological intervention for urinary tract stones with participants aged 15 to 65 years in an ambulatory setting.@*Results@#Our search methods yielded a total of 20 studies. Four studies met our inclusion criteria. Patients who took sambong had a reduction in stone size by radiographic evidence 23.45 times more than those who took the placebo (p=0.001). Also, patients taking sambong were 38.04 times more likely to pass stones compared to those patients taking a placebo (p=0.0004). Patients taking sambong were 7.48 times more likely to have reduction or disappearance of signs and symptoms compared to the placebo group (p=0.008).@*Conclusions@#Sambong treatment is effective in treating patients with urolithiasis by radiographic evidence of a decrease in size and/or number of stones, the passage of stone/s and/or disappearance or reduction of signs and symptoms with no serious adverse events.

Is the "in situ" simulation for teaching anesthesia residents a lower cost, feasible and satisfying alternative to simulation center ? A 24 months prospective observational study in a university hospital.

BACKGROUND: The value of simulation in medical education is increasingly obvious. Nevertheless, the high cost of running a simulation center and the time's availability for students to get to simulation center remain a major problem. Technological developments and miniaturization of computer systems now allow handling of simulation manikins. Therefore, "in situ" simulation seems a valuable alternative to center simulation. OBJECTIVE(S): To identify the costs and feasibility of "in situ" simulation. To conduct an evaluation of the sessions by participants in order to adapt the educational objectives. DESIGN: Observational study. SETTING: 118 "in situ" simulation sessions were organized between March 2011 and February 2013 in the university hospital of Université Catholique de Louvain. Sessions took place in OR facilities. At the end of each session, a questionnaire was given to each participant. PARTICIPANTS: 357 of 368 participants completed a questionnaire. For each session, one or two nurses and 2 residents in anesthesia were invited. MAIN OUTCOME MEASURES: Total costs for organizing the sessions. Number of realized sessions. Global satisfaction of participants. RESULTS: Total cost for organizing the sessions is 18 414 Euro. One hundred and one among the 118 scheduled sessions were performed, which corresponds to a rate of 85%. Three hundred and sixty-five people participated in training simulations. During the sessions, 357 questionnaires were completed. The global satisfaction was high with a median Likert scale of 5 (5-5) to the question "I would like to participate in other sessions in the future". CONCLUSION: The "in situ" simulation in anesthesia is feasible in a university hospital using the available facilities of the operating theater during the working hours of both participants and trainers. However, the number of annual sessions may be limited by the availability of the simulation room or staff.

Should the "in situ" simulation become the new way in Belgium? Experience of an academic hospital.

The place of simulation in medical education, particularly in anesthesia, appears to be more and more evident. However, the history of simulation in Belgium showed that the associated costs remain a barrier. The use of 'in situ' simulation, defined as the practice of simulation in the usual workplace, could solve the problem of providing access to this educational tool. Indeed, it allows reducing equipment and manpower costs: the needed equipment comes from the hospital, and supervision and organization are provided by staff members. It also provides access to simulation for a larger number of individuals on site. The environment is more realistic because the participants operate in their usual workplace, with their customary equipment and team. Furthermore, 'in situ' simulation allows participation of the paramedical staff. This allows developing skills related to teamwork and communication. Despite those numerous advantages, several difficulties persist. The associated logistic and organizational constraints can be cumbersome.

Insights into fast-track colon surgery: a plea for a tailored program.

BACKGROUND: This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay. DESIGN: This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression. RESULTS: Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001). CONCLUSIONS: The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.

In vivo optical spectroscopy monitoring in a new model of muscular compartment syndrome.

BACKGROUND: Muscular compartment syndrome (MCS) is a rare but serious postoperative complication. In vivo optical spectroscopy (INVOS) monitors continuously and non-invasively regional oxygen saturation (rSO(2)), and could predict the development of MCS. METHODS: In 10 healthy volunteers, we inflated a tourniquet to the mean arterial pressure to produce slight venous congestion and arterial hypoperfusion. Comparisons were made between the relative reduction in rSO(2) with baseline (deltaINVOS) and the time to observe motor nerve block (with non-invasive electromyography). Neurological symptoms, pain, and invasive intracompartmental pressure (ICP) were assessed. RESULTS: In the eight volunteers completing the protocol, we observed a profound motor nerve conduction block, immediately reversible. Baseline values were: [mean (sd)] INVOS: 73.3 (8.9)% and ICP: 16.9 (8.6) mm Hg. At the time of the block, values were: INVOS: 46.4 (10.9)%, deltaINVOS: 28.7 (10.6)%, and ICP: 70.0 (5.5) mm Hg. The time to reach the block was 33.0 (10.9) min, and to a deltaINVOS>10%: 27.4 (10.4) min. Receiver-operating characteristic curves demonstrated a similar accuracy of ICP and INVOS to predict the occurrence of the block. Twenty minutes with a deltaINVOS>10% or ICP>30 mm Hg were associated with a sensitivity and a specificity of 95% and 70%; or 91% and 65%, respectively. CONCLUSIONS: We have developed a model of acute immediately reversible MCS. Monitoring using the INVOS technology is as accurate as measurement of ICP, and could be a useful tool to prevent development of intraoperative MCS.

An unusual cause of regurgitation during colonoscopy.

Aspiration after regurgitation of gastric content is a rare but potentially serious complication of colonoscopy. This is a case report of a patient who had a regurgitation followed by laryngospasm and hypoxemia during an elective colonoscopy for Crohn's disease. The original feature of this case is the type of regurgitated liquid, namely fecal. Indeed, this patient had an unknown colo-gastric fistula. Pulmonary aspiration was ruled out and a vigilant attitude allowed a favorable outcome.

Loudness and satisfaction ratings for hearing aid users.

BACKGROUND: Hearing aids amplify low-intensity sounds to make them audible while keeping high-intensity sounds at an acceptable loudness for listeners with impaired hearing. PURPOSE: The purpose of this analysis was to assess loudness and satisfaction at the same time using a combined loudness and satisfaction questionnaire to rate 18 everyday environmental sounds. RESEARCH DESIGN: Ten sets of data from four studies, covering three conditions, were analyzed. The three conditions were unaided, wide dynamic range compression (WDRC), and adaptive dynamic range optimization (ADRO). In total, there were 61 subjects giving over 3,000 pairs of ratings for loudness and satisfaction. RESULTS: The analysis found a strong relationship between loudness and satisfaction ratings for this set of listeners and conditions. The maximum satisfaction ratings corresponded to sounds with "comfortable" loudness ratings. Satisfaction was lowest for sounds that were "uncomfortably loud." Sounds that were very soft or inaudible also received low satisfaction ratings unless the sounds were expected to be soft, such as the sound of one's own breathing. CONCLUSIONS: Hearing aid fittings that place most sounds at a comfortable level are likely to be more satisfactory than hearing aid fittings that produce more sounds close to hearing thresholds or discomfort levels. Aided conditions gave higher loudness and satisfaction ratings than the unaided condition, and the ADRO hearing aids gave significantly higher satisfaction ratings than the WDRC hearing aids.

Postoperative use of nasal intermittent positive pressure in a patient with spinal muscular atrophy type II.

We report the successful use of nasal intermittent positive pressure ventilation (NIPPV) in the perioperative period of a 51 yr-old woman with a type II spinal muscular atrophy (SMA II). The patient was treated chronically with nocturnal NIPPV at home and scheduled for endoscopic retrograde cholangiopancreatography (ERCP) under general anesthesia. Some criteria of difficult intubation were present (forced mouth opening of 1.5 cm, short neck and thyromental distance of 5 cm). Nasal endotracheal fiberoptic intubation during spontaneous breathing under sedation with propofol was performed. The ERCP procedure was conducted without complications. At the end of the procedure, IPPV was maintained until recovery of respiratory function. After extubation, NIPPV was continued in the recovery room. The patient was discharged from the post-anesthesia care unit 4 hours after the procedure. Management of patients with SMA remains a challenge and clinicians must be aware that the use of NIPPV may be a useful and life-saving tool in the perioperative period for these patients.

A comparison of intubation conditions and time-course of action with rocuronium and mivacurium for day case anaesthesia.

BACKGROUND AND OBJECTIVE: To compare intubation conditions and time-course of action of rocuronium and mivacurium for day case anaesthesia. METHODS: Fifty ASA I or II patients were enrolled. Anaesthesia was induced with propofol using a target controlled infusion system (target 6-8 microg mL(-1) ) and sufentanil (0.25 microg mL(-1). It was maintained with propofol (target 3.5-4.5 microg mL(-1) and 50% nitrous oxide in oxygen. Muscle relaxation was achieved with either mivacurium (0.15 mg kg(-1)) or rocuronium (0.3 mg kg(-1)). Neuromuscular transmission was monitored and recorded continuously by acceleromyography using a TOF-WATCH SX (Biometer; Denmark) with supramaximal train-of-four stimulation of the ulnar nerve. Tracheal intubation was carried out by an experienced anaesthetist blinded to the type of the muscle relaxant. Intubation conditions were evaluated according to a standard scheme (ease of laryngoscopy, position of vocal cords, airway reaction and limb movements). RESULTS: Intubation conditions were good or excellent for both mivacurium 0.15 mg kg(-1) (good = 8%; excellent = 92%) and rocuronium 0.3 mg kg(-1) (excellent = 100%). Times to maximum blockade and clinical duration were not different. CONCLUSIONS: There is no significant difference between mivacurium and rocuronium concerning the onset and the recovery of muscle relaxation. Rocuronium is an alternative to mivacurium for short procedures, without the risk of unexpected prolonged relaxation due to a possible defect in plasma cholinesterase.