Regional block via continuous caudal infusion as sole anesthetic for inguinal hernia repair in conscious neonates.

PURPOSE: The use of general anesthesia in young children has come under increasing scrutiny due to its potential long-term neurotoxic effects. Meanwhile, regional anesthesia for surgical procedures in neonates has many advantages, including preservation of respiratory status and faster return to feeding. We describe the successful use of 3% 2-chloroprocaine administered via continuous caudal infusion as the sole anesthetic agent during elective surgical procedures in infants. METHODS: A retrospective chart review of all patients who underwent elective surgical procedures under continuous caudal regional anesthetic at a single institution was performed. Thirty patients (27 males, three females) were identified: 28 patients underwent inguinal hernia repairs. Caudal anesthesia was established via continuous infusion of 3% 2-chloroprocaine through an indwelling catheter. RESULTS: Successful analgesia by regional block alone was achieved in all patients for the duration of each surgical procedure without need for rescue anesthesia. Mean operative time was 49 min. Patients were able to return to feeding immediately after surgery and were ready for discharge home within that day. CONCLUSION: Continuous caudal infusion of chloroprocaine is a safe and effective way to maintain adequate analgesia for elective surgeries in infants. This successful regional approach obviates the use of general anesthetic which reduces post-operative recovery time and avoids concerns for neurotoxicity.

Dip listening or modulation masking? Call recognition by green treefrogs (Hyla cinerea) in temporally fluctuating noise.

Despite the importance of perceptually separating signals from background noise, we still know little about how nonhuman animals solve this problem. Dip listening, an ability to catch meaningful 'acoustic glimpses' of a target signal when fluctuating background noise levels momentarily drop, constitutes one possible solution. Amplitude-modulated noises, however, can sometimes impair signal recognition through a process known as modulation masking. We asked whether fluctuating noise simulating a breeding chorus affects the ability of female green treefrogs (Hyla cinerea) to recognize male advertisement calls. Our analysis of recordings of the sounds of green treefrog choruses reveal that their levels fluctuate primarily at rates below 10 Hz. In laboratory phonotaxis tests, we found no evidence for dip listening or modulation masking. Mean signal recognition thresholds in the presence of fluctuating chorus-like noises were never statistically different from those in the presence of a non-fluctuating control. An analysis of statistical effects sizes indicates that masker fluctuation rates, and the presence versus absence of fluctuations, had negligible effects on subject behavior. Together, our results suggest that females listening in natural settings should receive no benefits, nor experience any additional constraints, as a result of level fluctuations in the soundscape of green treefrog choruses.

HELMINTH DIVERSITY OF GREEN TREEFROGS (HYLA CINEREA) IN THEIR EXPANDED GEOGRAPHICAL RANGE.

There has been a growing interest in characterizing the parasite faunas of species populations as they expand their geographical ranges as a result of climate change. Expanded-range populations often exhibit lower parasite diversity than historical-range populations, and reduced parasitism may, in part, be attributable to expanded-range populations escaping their native range parasites. The present study compares the helminth faunas of green treefrogs (Hyla cinerea) from 4 historical and 4 expanded-range populations to determine whether these latter populations have undergone parasite escape. Results of this study found relatively high degrees of similarity in species composition among helminth assemblages within historical or within range-expansion locations, with marked differences in the composition of helminth faunas between historical and expanded-range populations of these frogs. Because green treefrogs from expanded-range locations exhibited significant decreases in helminth species diversity compared with those from historical sites, they appear to be escaping levels of parasitism typically experienced by these frogs in their native range. Most notably, there was a decrease in the abundance of helminths with direct life cycles and the absence of trematode assemblages with indirect life cycles among expanded-range populations of H. cinerea. The low prevalence of trematode assemblages among historical populations of green treefrogs could limit these parasites' ability to be introduced and propagated in expanded-range locations. However, the lack of trematode assemblages among populations of H. cinerea in its expanded range may also be due to the absence or limited availability of other aquatic hosts that are required to complete the life cycles of these parasites. The reduction in helminth diversity among expanded-range populations of green treefrogs lends some credence to the notion that individuals at the front of a range expansion often invest less energy in reproduction and in doing so allocate more energy to dispersal and other life-history traits, including resistance to parasites. There may, however, be other explanations for differences in parasite species diversity between historical and expanded-range populations of H. cinerea. Because many of the helminths reported from this study are host generalists of amphibians whose recruitment and transmission among intermediate and paratenic hosts are known to be constrained by water and/or soil moisture conditions, we cannot ignore the role of both local amphibian diversity and local abiotic factors in influencing helminth diversity between the 2 population types of green treefrogs. These latter factors would decrease the role of parasite escape or energy trade-offs in driving helminth diversity among populations of H. cinerea and instead would suggest that local conditions play a more prominent role in structuring their helminth communities.

Hormonal modulation of phonotaxis and advertisement-call preferences in the gray treefrog (Hyla versicolor).

Hormonal levels fluctuate during the breeding season in many anurans, but the identity of the hormones that modulate breeding behavior and their effects remain unclear. We tested the influence of a combined treatment of progesterone and prostaglandin on phonotaxis, the key proceptive reproductive behavior of female anurans. First, we found that female gray treefrogs (Hyla versicolor) treated with progesterone and prostaglandin exhibited phonotaxis to synthetic male advertisement signals significantly more often than animals treated with ringers vehicle or uninjected controls. Responsive females had greater levels of plasma progesterone and estradiol compared to both control groups, suggesting that these steroids may be promoting phonotaxis. Second, we found that the selectivity of hormonally-induced phonotaxis in H.versicolor was similar to that observed in freshly captured breeding animals. Females made the same choices between acoustic signals after hormone treatments in tests of frequency, call rate and pulse rate, compared to their responses without treatment immediately after collection from the breeding chorus. The preference for a longer call was, however, significantly weaker after hormonal induction of phonotaxis. Hormonally primed females were also less likely to respond in any test and took longer to respond than did freshly collected females. Consequently, our study shows how progesterone-prostaglandin induced phonotaxis in female treefrogs influences both the quality and quantity of phonotaxis, relative to that exhibited by naturally breeding females.

Anesthesia for pediatric ophthalmologic surgery.

This review presents updated recommendations, based on existing clinical research, for anesthetic management of strabismus surgery in children. In children, unlike adults, eye surgery nearly always requires general anesthesia, even for brief procedures. Recommendations for preoperative anxiolysis, fasting guidelines, and management of upper respiratory infections are discussed. Airway considerations and the oculocardiac reflex are highlighted. The prevention of postoperative complications, including those related to opioid prescription therapy, is also addressed. Finally, given the 2016 warning from the Food and Drug Administration about anesthesia neurotoxicity in children, we discuss recent studies on anesthetic neurotoxicity in children undergoing general anesthesia.

A Comparison of Helminth Faunas of Cope's Gray ( Hyla chrysoscelis ) and Green ( Hyla cinerea ) Treefrogs in Areas of Recent Niche Overlap.

This study compares the helminth faunas between Cope's gray treefrogs ( Hyla chrysoscelis ) and green treefrogs ( Hyla cinerea ), in areas where they have recently overlapped due to range expansion by H. cinerea , to determine whether or not 2 species of frogs with a high degree of similarity in many of their life history traits also exhibit similarities in the composition of their helminth assemblages. Results of this study did not find significant differences in helminth species diversity when sympatric and allopatric populations of the same species of frog were compared. There was, however, a significant difference in helminth diversity among sympatric populations of H. chrysoscelis and H. cinerea , and this difference was in large part attributable to the significantly higher abundance of the gastrointestinal nematode Cosmocercoides variabilis among H. chrysoscelis . Additional studies will be required to determine whether the observed patterns are due to differences in arrival time, perch locations within the chorus, or parasite-mediated competition.

Systematic analysis of classification systems for osteonecrosis of the femoral head.

BACKGROUND: Multiple classification systems for osteonecrosis of the hip have been developed to assist physicians in the diagnosis and treatment of this potentially debilitating disorder. The purpose of this analysis was to delineate the classification systems utilized in reports published since 1985 and, through a comparison of the most commonly used systems, to identify consistent factors that would allow for cross-publication comparisons to be made. METHODS: We performed a PubMed search for reports of outcome studies concerning treatment methods for osteonecrosis of the hip. All studies of reported outcomes with greater than ten patients were included in the analysis. Various classification systems were tabulated to determine usage frequencies. The four most commonly used systems were then analyzed to determine common factors used for classification. RESULTS: One hundred and fifty-seven studies were available for analysis. Sixteen major classification systems that made use of more than one radiographic factor were identified, and nine of these systems had one to five modifications reported throughout the literature. Additionally, eleven other systems made use of single factors obtained from either magnetic resonance imaging or anatomic data. The review revealed that four classification systems accounted for greater than 85.4% of the reported studies. Parameters for these four systems were stratified to allow for uniformity of patient or study evaluation. CONCLUSIONS: This analysis of the reported classification systems for osteonecrosis of the femoral head revealed several similarities between the most commonly used systems. An analysis of patients can be made with any of the four major systems if specific data are collected according to various magnetic resonance imaging and radiographic findings. This approach will allow for easier comparison of studies across different centers. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

Progesterone and prostaglandin F2α induce species-typical female preferences for male sexual displays in Cope's gray treefrog (Hyla chrysoscelis).

Endocrine systems play critical roles in facilitating sexual behavior in seasonally breeding vertebrates. Much of the research exploring this topic has focused on the endocrine correlates of signaling behavior in males and sexual proceptivity in females. What is less understood is how hormones promote the expression of the often complex and highly selective set of stimulus-response behaviors that are observed in naturally breeding animals. In female frogs, phonotaxis is a robust and sensitive bioassay of mate choice and is exhibited by gravid females during the breeding season. In stark contrast, females exhibit low phonotactic responsiveness outside the breeding season, but the administration of hormones can induce sexual proceptivity. Here we test the hypothesis that manipulation of a minimal set of reproductive hormones-progesterone and prostaglandin F2α-are capable of evoking not only proceptive behavior in non-breeding females, but also the patterns of intraspecific selectivity for male sexual displays observed in gravid females tested during the breeding season. Specifically, we investigated whether preferences for faster call rates, longer call durations, and higher call efforts were similar between breeding and hormone-treated females of Cope's gray treefrog (Hyla chrysoscelis). Hormone injections induced patterns of selective phonotaxis in non-breeding females that were remarkably similar to those observed in breeding females. These results suggest that there may be an important contribution of hormonal pleiotropy in regulating this complex, acoustically-guided sexual behavior. Our findings also support the idea that hormonal induction could be used to evaluate hypotheses about selective mate choice, and its underlying mechanisms, using non-breeding females.

Knee arthroplasties have similar results in high- and low-activity patients.

With increased patient demand to return to active lifestyles, total knee arthroplasties have evolved from primarily providing pain relief to allowing for increased function and mobility. We evaluated the influence of activity on the outcome of total knee arthroplasties. The overall satisfaction, rate of revision, and clinical and radiographic results for high-activity patients were compared with a matched group of low-activity patients at a minimum followup of 4 years (mean, 7 years; range, 4-14 years). There were 22 men and 35 women (72 knees) in each group. High-activity patients fared as well as their low-activity counterparts with no differences in clinical outcomes. At the time of last followup, mean Knee Society objective scores were 95 points (range, 70-100 points) and 96 points (range, 80-100 points) for the high-activity and low-activity groups, respectively. The high-activity group had one clinical failure, and neither group had any revisions. The groups had similar radiographic outcomes with no progressive radiolucencies and no evidence of osteolysis. While we await long-term results, these results suggest that low- to moderate-impact sports activities had no effect on the clinical and/or radiographic outcomes of total knee arthroplasties at mid-term followup.