Impact of Temporary Portocaval Shunting and Initial Arterial Reperfusion in Orthotopic Liver Transplantation

Perioperative Medicine: Efficacy, Safety and Outcom

Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study

PURPOSE: We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS: We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS: Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS: In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies

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Comparison of morphine-6-glucuronide and morphine on respiratory depressant and antinociceptive responses in wild typ

What is considered long-term pain relief in chronic pain management? Re: Sigtermans et al., Pain 2009;145:304-311 Response

Perioperative Medicine: Efficacy, Safety and Outcom

Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies

Although a contribution of sex in opioid efficacy has garnered much attention, the confirmation and direction of any such difference remain elusive. We performed a systematic review of the available literature on sex differences in mu and mixed mu/kappa opioid effect on acute and experimental pain. Fifty unique studies (including three unpublished studies) were included in the analyses. Across the 25 clinical studies on mu-opioids there was no significant sex-analgesia association. Restricting the analysis to patient-controlled analgesia (PCA) studies (irrespective of the opioid) yielded greater analgesia in women (n = 15, effect size 0.22, 95% c.i. 0.02-0.42, P = 0.028). Further restricting the analysis to PCA morphine studies yielded an even greater effect in women (n = 11, effect size = 0.36, 95% c.i. 0.17-0.56, P = 0.003). Meta-regression indicated that the longer the duration of PCA, the difference in effect between the sexes further increased. Across experimental pain studies on mu-opioids women had greater antinociception from opioids (n = 11, effect size = 0.35; 95% c.i. 0.01-0.69, P = 0.047), which was predominantly due to 6 morphine studies. Female patients had greater mu/kappa opioid analgesia (n = 7, effect size 0.84; 95% c.i. 0.25-1.43, P = 0.005), but no sex-analgesia association was present in experimental studies (n = 7). Sex differences exist in morphine-induced analgesia in both experimental pain studies and clinical PCA studies, with greater morphine efficacy in women. The data on non-morphine mu and mixed mu/kappa-opioids are less convincing and require further study. (C) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.Development and application of statistical models for medical scientific researc

Core-shell latices based on conductive polymers

A poly(butyl methacrylate) (PBMA) latex was coated with a thin polypyrrole (PPy) layer in a chemical in situ polymerization. Ammonium persulfate and Fenton's reagent were used as the oxidants. The influence of reaction time on the conversion of pyrrole and on the conductivity of the resulting coated latices was investigated. Furthermore, the influence of the reaction atmosphere was investigated. It was found that the ammonium persulfate-oxidized reaction was quite insensitive towards the reaction atmosphere, whereas the Fenton's reagent oxidized system was very sensitive. In the latter system, when kept in air the conductivity reached a maximum after 30 minutes. In a nitrogen reaction atmosphere the conductivity gradually increased. The maximum conductivity, which was about 20 times as high as in air, was reached after 90 minutes and remained stable