Propofol and remifentanil effect‐site concentrations estimated by pharmacokinetic simulation and bispectral index monitoring during craniotomy with intraoperative awakening for brain tumor resection.

J Neurosurg Anesthesiol. 2007 Jul;19(3):183-9. Propofol and remifentanil effect-site concentrations estimated by pharmacokinetic simulation and bispectral index monitoring during craniotomy with intraoperative awakening for brain tumor resection. Lobo F, Beiras A. SourceAnesthesiology Department, Hospital Geral de Santo António, Porto, Portugal. [email protected] Abstract Different anesthetic techniques have been suggested for craniotomy with intraoperative awakening. We describe an asleep-awake-asleep technique with propofol and remifentanil infusions, with pharmacokinetic simulation to predict the effect-site concentrations and to modulate the infusion rates of both drugs, and bispectral index (BIS) monitoring. Five critical moments were defined: first loss of consciousness (LOC1), first recovery of consciousness (ROC1), final of neurologic testing (NT), second loss of consciousness (LOC2), and second recovery of consciousness (ROC2). At LOC1, predicted effect-site concentrations of propofol and remifentanil were, respectively, 3.6+/-1.2 microg/mL and 2.4+/-0.4 etag/mL. At ROC1, predicted effect-site concentrations of propofol and remifentanil were, respectively, 2.1+/-0.3 microg/mL and 1.8+/-0.3 etag/mL. At NT, predicted effect-site concentrations of propofol and remifentanil were, respectively, 0.9+/-0.3 microg/mL and 1.8+/-0.2 etag/mL. At LOC2, predicted effect-site concentrations of propofol and remifentanil were, respectively, 2.1+/-0.2 microg/mL and 2.5+/-0.2 etag/mL. At ROC2, predicted effect-site concentrations of propofol and remifentanil were, respectively, 1.2+/-0.5 microg/mL and 1.4+/-0.2 etag/mL (data are mean+/-SE). A significative correlation was found between BIS and predicted effect-site concentrations of propofol (r=0.547, P<0.001) and remifentanil (r=0.533, P<0.001). Multiple regression analysis between BIS and propofol and remifentanil predicted effect-site concentrations at the different critical steps of the procedure was done and found also significative (r=0.7341, P<0.001)

Postoperative Heparin-Mediated Extracorporeal Low-Density Lipoprotein Fibrinogen Precipitation Aphaeresis Prevents Early Graft Occlusion after Coronary Artery Bypass Grafting

Background Early graft occlusion due to thromboembolic events is a well-known complication after coronary artery bypass grafting (CABG). Fibrinogen, the coagulation factor I, is a glycoprotein that is transformed by thrombin into fibrin. It plays amajor role in thrombus formation and is highly elevated after CABG. Our aim was to determine if postoperative lowering of fibrinogen levels by H.E.L.P. (heparin-mediated extracorporeal low-density lipoprotein [LDL] fibrinogen precipitation) aphaeresis could reduce the rate of early graft occlusion in patients with hypercholesterolemia undergoing CABG. Methods Between December 2004 and September 2009, 36 male patients with hypercholesterolemia (mean LDL cholesterol 128 +/- 12 mg/dL), mean age 58 +/- 9 years, underwent CABG. Mean preoperative fibrinogen level was 387 +/- 17 mg/dL. H.E.L.P. aphaeresis was postoperatively performed when fibrinogen levels exceeded 350 mg/dL on day 1 and 250 mg/dL every consecutive day up to day 8. Pre- and postaphaeresis blood samples were obtained and plasma fibrinogen level reduction was calculated. Early graft occlusion was evaluated by means of coronary angiography or multislice computed tomography before discharge. Results A total of 128 distal anastomoses were performed in 36 patients (mean 3.6/patient). Postoperatively, 191 H.E.L.P. aphaeresis sessions were performed (mean 5.3/patient). Fibrinogen levels were lowered from 391 +/- 10 mg/dL (preaphaeresis) to 171 +/- 5 mg/dL (postaphaeresis;p < 0.001). Coronary angiography (multislice computed tomography in 7 patients) revealed graft patency in 125 of 128 grafts (98% patency) with three occluded venous grafts to target vessels of 1.5 mm. H.E.L.P. aphaeresis-related complications were limited to hypotensive episodes in two patients and bacteremia in one patient. Conclusions H.E.L.P. apheresis offers an easy, save, and efficient method to decrease fibrinogen postoperatively in patients having CABG. Showing excellent graft patency rates in comparison to the literature, this method is a promising tool to reduce early graft occlusion after CABG

Postoperative Heparin-Mediated Extracorporeal Low-Density Lipoprotein Fibrinogen Precipitation Aphaeresis Prevents Early Graft Occlusion after Coronary Artery Bypass Grafting

Background Early graft occlusion due to thromboembolic events is a well-known complication after coronary artery bypass grafting (CABG). Fibrinogen, the coagulation factor I, is a glycoprotein that is transformed by thrombin into fibrin. It plays amajor role in thrombus formation and is highly elevated after CABG. Our aim was to determine if postoperative lowering of fibrinogen levels by H.E.L.P. (heparin-mediated extracorporeal low-density lipoprotein [LDL] fibrinogen precipitation) aphaeresis could reduce the rate of early graft occlusion in patients with hypercholesterolemia undergoing CABG. Methods Between December 2004 and September 2009, 36 male patients with hypercholesterolemia (mean LDL cholesterol 128 +/- 12 mg/dL), mean age 58 +/- 9 years, underwent CABG. Mean preoperative fibrinogen level was 387 +/- 17 mg/dL. H.E.L.P. aphaeresis was postoperatively performed when fibrinogen levels exceeded 350 mg/dL on day 1 and 250 mg/dL every consecutive day up to day 8. Pre- and postaphaeresis blood samples were obtained and plasma fibrinogen level reduction was calculated. Early graft occlusion was evaluated by means of coronary angiography or multislice computed tomography before discharge. Results A total of 128 distal anastomoses were performed in 36 patients (mean 3.6/patient). Postoperatively, 191 H.E.L.P. aphaeresis sessions were performed (mean 5.3/patient). Fibrinogen levels were lowered from 391 +/- 10 mg/dL (preaphaeresis) to 171 +/- 5 mg/dL (postaphaeresis;p < 0.001). Coronary angiography (multislice computed tomography in 7 patients) revealed graft patency in 125 of 128 grafts (98% patency) with three occluded venous grafts to target vessels of 1.5 mm. H.E.L.P. aphaeresis-related complications were limited to hypotensive episodes in two patients and bacteremia in one patient. Conclusions H.E.L.P. apheresis offers an easy, save, and efficient method to decrease fibrinogen postoperatively in patients having CABG. Showing excellent graft patency rates in comparison to the literature, this method is a promising tool to reduce early graft occlusion after CABG

Integrative assessment of ecological responses and chemical contamination of urban wastewater outfalls on soft bottom sediments of an estuarine system

Postprint1,95

Human lives versus viral deaths: Who can live with the virus?

Este artigo se propõe a um ensaio teórico e trata da distribuição diferencial da morte diante das epidemias virais. Tomaremos a pandemia presente de Sars-CoV-2 emarticulação com a epidemia de HIV, a fim de compreender como são erguidas esustentadas barreiras que dividem os humanos em grupos, pelas quais se decidequem pode ou não morrer de uma doença viral. Pensando a partir do feminismo eda crítica ao excepcionalismo humano de Donna Haraway, sua teoria é articuladaàs noções de biopolítica, necropolítica e enquadramento normativo, de modo a si-tuar as relações entre alguns humanos e estes vírus, considerando os atravessa-mentos como raça, gênero e sexualidade. Por fim, é possível entender que, mesmosem qualquer evidência científica que justifique encontros fatais entre alguns hu-manos e vírus, as histórias produzidas sobre estes patógenos orientam quem vive ou morre no contato com eles.This article deals with the differential distribution of death in the face of viral epidemics and pandemics. We will take the current Sars-CoV-2 pandemic in conjunction with the HIV epidemic in order to understand how barriers that divide humans into groups, by which it is decided who can or cannot die of a viral disease. Thinking from Donna Haraway's feminism and critique of human exceptionalism, her theory is articulated with the notions of biopolitics, necropolitics and framing, in order to situate the relationships between some humans and these viruses, considering crossings such as race, gender and sexuality. It is possible to understand that, even without any scientific evidence that justify fatal encounters between some humans and viruses, the stories produced about these pathogens guide those who live or die in contact with them.info:eu-repo/semantics/publishedVersio

Assessment of hydrocarbon pollution in NW Iberian Peninsula using bioaccumulation and molecular biomarkers in Mytilus galloprovincialis

Society of Environmental Toxicology and Chemistry - SETAC Europe 15th Annual Meeting, Lille, France, May 2005.Polycyclic aromatic hydrocarbons (PAH´s) are ubiquitous contaminants in marine environment as a result of uncontrolled spills, river transport, surface runoff and atmospheric deposition. A significant amount of industrial activity including shipping and oil refining is located along the NW Iberian Peninsula coast. The use of exposure biomarkers holds out promise due to the incipient state of the cost-effective methodologies for diagnosis and monitoring of oil pollution. This work presents the preliminary results concerning the identification of a set of biomarkers for an early warning detection of PAH toxicity. The bivalve Mytillus galloprovincialis was selected due to its ubiquitous distribution along coastline, being used as sentinels in pollution monitoring. This species has also an important value. Four locations in the vicinity of industrial wastewater discharges along the NW Iberian coast were selected and compared with a nearby (reference) site for (i) measurements of PAH body burdens and (ii) levels of enzyme activity: catalase (CAT), superoxide-dismutase (SOD), glutathione peroxidase (GPx), gluthathione S-transferase (GST) and Na+/K+ATPase (ATPase). The results will be discussed on the basis of their potential in providing additional evidence for discriminate between well known polluted and unpolluted sites

Ejercicio interlaboratorio de bioensayos marinos para la evaluación de la calidad ambiental de sedimentos costeros. IV. Ensayo de toxicidad sobre sedimento con crustáceos anfípodos

9 páginas, 2 figuras, 3 tablas.[EN] Interlaboratory variability was studied for the bioassay using crustacean amphipods. Nine series of data were obtained from different laboratories using four different species (Ampelisca brevicornis, Corophium volutator, Corophium multisetosum and Microdeutopus gryllotalpa), all previously used for sediment toxicity assessment in Spain. Results were studied for interlaboratory variability and according to different confounding factors. The coefficients of variation were similar to those previously reported for this bioassay and sample classification was homogeneous among the laboratories that successfully completed the exercise. No significant tendencies related to test species were identified and it seems that the factor most critically affecting test results and the classification of samples is storage time before testing.[ES] Se estudió la precisión interlaboratorio del bioensayo con crustáceos anfípodos. Se recogieron nueve series de datos procedentes de distintos laboratorios europeos y de cuatro especies distintas (Ampelisca brevicornis, Corophium volutator, Corophium multisetosum y Microdeutopus gryllotalpa), todas ellas usadas previamente para la caracterización de la toxicidad de sedimentos en España. Esos resultados se estudiaron para evaluar la variabilidad interlaboratorio de acuerdo a las diferentes especies y los distintos tiempos de almacenamiento de las muestras antes del ensayo. Los resultados mostraron coeficientes de variación similares a los encontrados en estudios previos y permitieron una clasificación homogénea de las muestras entre los laboratorios que completaron el ejercicio con éxito. No se identificaron tendencias significativas debidas al uso de distintas especies y, al parecer, el factor que puede afectar más críticamente la clasificación de las muestras y, por lo tanto, el uso de los resultados para la toma de decisiones, es el tiempo de almacenamiento de los sedimentos previamente al desarrollo del ensayo.This study was carried out under a joint research project between CEDEX and the University of Cádiz. Part of the work was funded by the Spanish Ministry of Science and Technology REN2002_01699/TECNO). The first author was supported by a grant (FPI) from the Spanish Ministry of Education and Science.Peer reviewe

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

Aims Mitral annuloplasty using the Carillon Mitral Contour System (CMCS) reduces secondary mitral regurgitation (SMR) and leads to reverse left ventricular remodelling. The aim of this study was to evaluate the effect of the CMCS on the mitral valve annulus (MA) and left atrial volume (LAV). Methods and results We retrospectively evaluated the data of all patients treated with the CMCS at our centre. Using transthoracic echocardiography, MA diameters were assessed by measuring the anterolateral to posteromedial extend (ALPM) and the anterior to posterior (AP) dimensions, respectively. Also, LAV and left ventricular end‐diastolic volume (LVEDV) were assessed. Patients were examined at three time points: baseline, at 20–60 days (30dFUP), and at 9–15 months (1yFUP), using paired analysis. From July 2014 until March 2019, 75 cases of severe SMR were treated using CMCS. Cases in which other devices were used in combination (COMBO therapy, n = 35) or in which the device could not be implanted (implant failure, n = 3) were excluded, leaving 37 patients in the present analysis. Analysis at 30dFUP showed a significant reduction of 16% in the mean ALPM diameter (7.27 ± 5.40 mm) and 15% in the AP diameter (6.57 ± 5.33 mm). Analysis of LAV also showed a significant reduction of 21% (36.61 ± 82.67 mL), with no significant change in LVEDV. At 1yFUP, the reduction of both the mean ALPM diameter of 14% (6.24 ± 5.70 mm) and the mean AP diameter of 12% (5.46 ± 4.99 mm) remained significant and stable. The reduction in LAV was also maintained at 23% (37.03 ± 56.91 mL). LAV index was significantly reduced by 17% at 30dFUP (15.44 ± 40.98 mL/m2) and by 13% at 1yFUP (11.56 ± 31.87 mL/m2), respectively. LVEDV index showed no significant change at 30dFUP and a non‐significant 10% reduction at 1yFUP (17.75 ± 58.79 mL/m2). Conclusions The CMCS successfully treats symptomatic SMR with a stable reduction of not only the AP diameter of the MA, but the current study also demonstrates an additional reduction of the ALPM dimension at both 30dFUP and 1yFUP. We have also shown for the first time that LAV and LAV index are significantly reduced at both 30dFUP and 1yFUP and a non‐significant positive remodelling of the LVEDV. This positive left atrial remodelling has not been looked for and demonstrated in earlier randomized studies of CMCS

Effectiveness of single-dose azithromycin to treat latent yaws: a longitudinal comparative cohort study

BACKGROUND: Treatment of latent yaws is a crucial component of the WHO yaws eradication strategy to prevent relapse and the resulting transmission to uninfected children. We assessed the effectiveness of single-dose azithromycin to treat patients with latent yaws. METHODS: This population-based cohort study included children (age <20 years) living on Lihir Island, Papua New Guinea, with high-titre (rapid plasma reagin titre >/=1:8) latent or active yaws, between April, 2013, and May, 2015. Latent yaws was defined as lack of suspicious skin lesions or presence of ulcers negative for Treponema pallidum subsp pertenue on PCR, and active yaws was defined as ulcers positive for T pertenue on PCR. All children received one oral dose of 30 mg/kg azithromycin. The primary endpoint was serological cure, defined as a two-dilution decrease in rapid plasma reagin titre by 24 months after treatment. Treatment of latent yaws was taken to be non-inferior to that of active yaws if the lower limit of the two-sided 95% CI for the difference in rates was higher than or equal to -10%. This study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS: Of 311 participants enrolled, 273 (88%; 165 with latent yaws and 108 with active yaws) completed follow-up. The primary endpoint was achieved in 151 (92%) participants with latent yaws and 101 (94%) with active yaws (risk difference -2.0%, 95% CI -8.3 to 4.3), meeting the prespecified criteria for non-inferiority. INTERPRETATION: On the basis of decline in serological titre, oral single-dose azithromycin was effective in participants with latent yaws. This finding supports the WHO strategy for the eradication of yaws based on mass administration of the entire endemic community irrespective of clinical status. FUNDING: Newcrest Mining Limited and ISDIN laboratories