Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery

Context: Ultrasound (US) guidance is strongly recommended when performing peripheral nerve blocks in infants and children. Aims: To assess whether US-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks with local anesthetic (LA) would provide comparable postoperative analgesia to blind technique caudal block with LA following pediatric unilateral groin surgery. Secondary endpoints included analgesic consumption, parental satisfaction, and postoperative complications. Settings and Design: Prospective, crossover randomized controlled trial performed on children undergoing unilateral groin surgery. Methods: Fifty children aged 1-6 years scheduled for unilateral groin surgery were included in the study. After induction of general anesthesia and prior to surgical incision, patients were prospectively randomized into one of two groups: Group B received US-guided II/IH nerve blocks with 0.1 ml.kg−1 of 0.25% bupivacaine and Group C received a caudal blockade with 0.7 ml.kg−1 of 0.25% bupivacaine. Patients were assessed in the recovery room, the day-stay unit and for 24 h at home for pain score, analgesic consumption, and parental satisfaction. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test or Fisher exact test for non-continuous variables. P<0.05 was considered significant. Results: The average pain scores during hospital stay were 1.82±1.71and 1.52±1.41 for group C and group B respectively (P>0.05). The average time to first rescue analgesia was longer in group B 253±102.6 min as compared to 219.6±48.4 min in group C. In recovery room, four patients in group C required pain rescue medication compared to five patients in group B (P>0.05). Similarly eight patients in the group C and six patients in group B required pain rescue medication at day-stay unit or at home (P>0.05). Group C received 0.74 pain rescue medication doses (range 0-8), while group B received 0.65 pain rescue medication doses (range 0-6) at hospital and at home (P>0.05). Conclusions: US-guided II/IH nerve blocks is an ideal postoperative analgesic for unilateral groin surgery in children, particularly hernia repairs and is as effective as caudal block, with a lower volume of local anesthetics

Comparison of streamlined liner of the pharynx airway (SLIPA™) with the laryngeal mask airway Proseal™ for lower abdominal laparoscopic surgeries in paralyzed, anesthetized patients

Context: Supraglottic airway devices have been used as an alternative to tracheal intubation during laparoscopic surgery. Aims: The study was designed to compare the efficacy of Streamlined Liner of the Pharynx Airway (SLIPA) for positive pressure ventilation and postoperative complications with the Laryngeal Mask Airway ProSeal (PLMA) for patients undergoing lower abdominal laparoscopies under general anesthesia with controlled ventilation. Settings and Design: Prospective, crossover randomized controlled trial performed on patients undergoing lower abdominal laparoscopic surgeries. Methods: A total of 120 patients undergoing lower abdominal laparoscopic surgeries were randomly allocated into two equal groups; PLMA and SLIPA groups. Number of intubation attempts, insertion time, ease of insertion, and fiberoptic bronchoscopic view were recorded. Lung mechanics data were collected 5 minutes after securing the airway, then after abdominal insufflation. Blood traces and regurgitation were checked for; postoperative sore throat and other complications were recorded. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test for noncontinuous variables. P value <0.05 was considered significant. Results: Insertion time, first insertion success rate, and ease of insertion were comparable in both groups. Fiberoptic bronchoscopic view was significantly better and epiglottic downfolding was significantly lower in SLIPA group. Sealing pressure and lung mechanics were similar. Gastric distension was not observed in both groups. Postoperative sore throat was significantly higher in PACU in PLMA group. Blood traces on the device were significantly more in SLIPA group. Conclusions: SLIPA can be used as a useful alternative to PLMA in patients undergoing lower abdominal laparoscopic surgery with muscle relaxant and controlled ventilation

Ahorro de Combustibles Fósiles de una Planta de Energía Fotovoltaica en un Sistema de Generación Eléctrica Aislado en Arabia Saudita

[ES] El Reino de Arabia Saudita posee alrededor del 15,6% de las reservas mundiales probadas de petróleo crudo, solo superada por Venezuela. La producción de petróleo crudo de Arabia Saudita fue de 585 Mt y las exportaciones netas superaron los 375 Mt en 2016, lo que convierte a Arabia Saudita en el mayor productor de crudo de la OPEP. También es el mayor exportador de petróleo crudo en el mundo con importantes inversiones en el sector petrolero y bajos costos de producción. Además, el petróleo crudo es la principal fuente de ingresos de Arabia Saudita y cualquier problema que afecte a este valioso recurso natural puede dañar seriamente su economía. Además, Arabia Saudita posee el 4,5% de las reservas probadas de gas natural del mundo. Produjo aproximadamente 109,4 Bcm en 2016], aunque todo el gas natural saudí se usa en el país y no se exporta. Sin embargo, existe un serio problema energético en el país. El consumo de petróleo crudo y gas natural en Arabia Saudita ha crecido a una tasa promedio anual de 5.4% y 5.1% desde el año 2000 alcanzando 167.9 Mt y 4.7 Bcm en 2016 respectivamente, lo que genera preocupación sobre la capacidad del país para mantener futuras exportaciones de petróleo crudo. o incluso convertirse en un importador neto de petróleo crudo en poco más de 20 años. Una de las principales razones del aumento en el consumo local de petróleo crudo es el hecho de que la mayoría absoluta de la generación de electricidad en Arabia Saudita se basa en fuentes de combustibles fósiles (gas natural, petróleo crudo, combustible pesado y diesel). Además, el rápido crecimiento de la población y la expansión de la infraestructura industrial, junto con las bajas tarifas de electricidad, aumentan continuamente la demanda de electricidad y, en consecuencia, de combustibles fósiles. El aumento en el consumo de electricidad y el enorme consumo de combustibles fósiles ha causado daños visibles al medio ambiente en diversas formas. La Autoridad Reguladora de la Electricidad y la Cogeneración de Arabia Saudita prevé que la demanda de electricidad aumente de 80 GWe en 2020 a más de 120 GWe en 2030. El objetivo de esta investigación es determinar cuánto combustible fósil se podría ahorrar anualmente mediante la optimización de la combinación de generación de energía en un sistema aislado de generación eléctrica de una ciudad determinada en Arabia Saudita mediante la inversión en un tipo específico de planta de energía sostenible y renovable conectada a la red eléctrica sin una instalación de almacenamiento de energía.[EN] The Kingdom of Saudi Arabia is in possession of about 15.6% of the world s proven crude oil reserves, only second to Venezuela. The crude oil production of Saudi Arabia was at 585 Mt and the net exports exceeded 375 Mt in 2016, making Saudi Arabia by far the biggest crude oil producer in OPEC. It is also the biggest crude oil exporter in the world having significant investments in the oil sector and low production costs. In addition, crude oil is Saudi Arabia s main source of income and any problem that affects this precious natural resource can seriously harm its economy. Moreover, Saudi Arabia has 4.5% of the world s proven natural gas reserves. It produced about 109.4 Bcm in 2016], although all Saudi natural gas is used domestically and not exported. Nevertheless, there exists a serious energetic problem in the country. Crude oil and natural gas consumption in Saudi Arabia has grown at an average annual rate of 5.4% and 5.1% since the year 2000 reaching 167.9 Mt and 4.7 Bcm in 2016 respectively, raising concerns over the ability of the country to maintain future crude oil exports or even becoming a net importer of crude oil in a little more than 20 years. One of the main reasons for the increase in the local crude oil consumption is the fact that the absolute majority of electricity generation in Saudi Arabia is based on fossil fuel sources (Natural gas, Crude oil, Heavy fuel oil and Diesel). Furthermore, the rapidly growing population and the expanding industrial infrastructure, along with low electricity tariffs, is continuously increasing the demand on electricity and consequently fossil fuels. The increase in electricity consumption and the huge consumption of fossil fuels has caused visible damage to the environment in various forms. The demand for electricity is predicted by the Electricity and Cogeneration Regulatory Authority of Saudi Arabia to increase from 80 GWe by 2020 to more than 120 GWe by 2030. The objective of this research is to determine how much fossil fuel could be saved yearly by optimizing the power generation mix in an isolated electricity generation system of a certain city in Saudi Arabia by means of investing in a specific kind of sustainable utility scale grid connected renewable energy power plant without an energy storage facility.Abualhassan, ATA. (2018). Photovoltaic Power Plant Fossil Fuels Savings in an Isolated Electricity Generation System in Saudi Arabia. Universitat Politècnica de València. http://hdl.handle.net/10251/14322

Post-transplant venous thromboembolic events and their effect on graft survival

Venous thromboembolic events (VTEs) are a major cause of post-operative morbidity and mortality. Our objective is to establish the prevalence of VTEs in kidney transplant recipients and assess its impact on graft survival. Data regarding renal transplant patients with VTEs from 1985 to 2010 were identified and analyzed. After excluding recipients of combined grafts and late VTE development, 1596 recipients were included in this analysis. The prevalence of post-operative VTEs and graft survival were determined. Cox regression was used to analyze the survival data and data on prognostic (confounding) variables. The observed prevalence of VTEs in kidney transplant recipients was 1.6%. Of the 1596 kidney recipients, 25 recipients who developed VTEs had a mean graft survival of 12.3 years (compared with 20.5 years in patients without). The hazard ratio was 1.1 (95% confidence interval: 0.4-3.0, P = 0.447). The prevalence of VTEs post kidney transplantation is small. Although it did not reach statistical significance, it increased the risk of graft failure by 30%

Islet cell transplantation for the treatment of type 1 diabetes: recent advances and future challenges

Anthony Bruni, Boris Gala-Lopez, Andrew R Pepper, Nasser S Abualhassan, AM James Shapiro Clinical Islet Transplant Program and Department of Surgery, University of Alberta, Edmonton, AB, Canada Abstract: Islet transplantation is a well-established therapeutic treatment for a subset of patients with complicated type I diabetes mellitus. Prior to the Edmonton Protocol, only 9% of the 267 islet transplant recipients since 1999 were insulin independent for &gt;1 year. In 2000, the Edmonton group reported the achievement of insulin independence in seven consecutive patients, which in a collaborative team effort propagated expansion of clinical islet transplantation centers worldwide in an effort to ameliorate the consequences of this disease. To date, clinical islet transplantation has established improved success with insulin independence rates up to 5 years post-transplant with minimal complications. In spite of marked clinical success, donor availability and selection, engraftment, and side effects of immunosuppression remain as existing obstacles to be addressed to further improve this therapy. Clinical trials to improve engraftment, the availability of insulin-producing cell sources, as well as alternative transplant sites are currently under investigation to expand treatment. With ongoing experimental and clinical studies, islet transplantation continues to be an exciting and attractive therapy to treat type I diabetes mellitus with the prospect of shifting from a treatment for some to a cure for all. Keywords: islet transplantation, type I diabetes mellitus, Edmonton Protocol, engraftment, immunosuppressio

Lung-Derived Microscaffolds Facilitate Diabetes Reversal after Mouse and Human Intraperitoneal Islet Transplantation

<div><p>There is a need to develop three-dimensional structures that mimic the natural islet tissue microenvironment. Endocrine micro-pancreata (EMPs) made up of acellular organ-derived micro-scaffolds seeded with human islets have been shown to express high levels of key beta-cell specific genes and secrete quantities of insulin per cell similar to freshly isolated human islets in a glucose-regulated manner for more than three months <i>in vitro</i>. The aim of this study was to investigate the capacity of EMPs to restore euglycemia <i>in vivo</i> after transplantation of mouse or human islets in chemically diabetic mice. We proposed that the organ-derived EMPs would restore the extracellular components of the islet microenvironment, generating favorable conditions for islet function and survival. EMPs seeded with 500 mouse islets were implanted intraperitoneally into streptozotocin-induced diabetic mice and reverted diabetes in 67% of mice compared to 13% of controls (p = 0.018, n = 9 per group). Histological analysis of the explanted grafts 60 days post-transplantation stained positive for insulin and exhibited increased vascular density in a collagen-rich background. EMPs were also seeded with human islets and transplanted into the peritoneal cavity of immune-deficient diabetic mice at 250 islet equivalents (IEQ), 500 IEQ and 1000 IEQ. Escalating islet dose increased rates of normoglycemia (50% of the 500 IEQ group and 75% of the 1000 IEQ group, n = 3 per group). Human c-peptide levels were detected 90 days post-transplantation in a dose-response relationship. Herein, we report reversal of diabetes in mice by intraperitoneal transplantation of human islet seeded on EMPs with a human islet dose as low as 500 IEQ.</p></div

IPGTTs of the transplanted mouse islets six weeks post-transplantation.

<p>Blood glucose measurements after dextrose bolus (A) and AUC analysis (B) did not differ between Naïve (n = 5) and EMP (n = 6) groups (p> 0.05, One way ANOVA with Tukey’s post hoc test). Animals that received free intraperitoneal islets (n = 8) were intolerant to glucose challenge compared to EMP, Naïve and KC (n = 9) groups (*p < 0.05, *** p< 0.001, and ****p< 0.0001 respectively; One way ANOVA with Tukey’s post hoc test). All mice received 3 g/kg 25% dextrose i.p. bolus for this test and blood glucose measurements were taken at t = 0, 15, 30, 60, 90 and 120 min. Data are presented as mean ± SEM.</p