Paravertebral Block for Post-Operative Analgesia after Breast Cancer Surgery, Effects of Adding Morphine: Double Blind, Randomised Clinical Trial

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Introduction: Thoracic paravertebral block (PVB) block is frequently used in breast cancer surgery for postoperative pain management. Adding opioids to local anaesthetics has been shown to have beneficial effects during epidural analgesia. Our hypothesis was that adding morphine to bupivacaine for PVB would improve analgesia provided by this procedure. Methods: 60 patients (25 - 75 years) undergoing elective surgery for breast cancer were randomly assigned to one of two groups. Both groups received a single injection thoracic paravertebral block; group BAM with 20 ml 0.5% bupivacaine, epinephrine and morphine while group BA received identical block except morphine was given subcutaneously. All patients had general anaesthesia. Results: Severity of pain and nausea was low in both groups. Pain scores remained below 20/100 after the first 2 hours throughout the 72 hours of the study. There was no significant difference between the groups in pain scores, consumption of additional morphine or nausea scores. Shoulder mobility was also very good in both groups. Conclusion: Thoracic paravertebral block with bupivacaine and epinephrine was associated with good postoperative analgesic effects and low incidence of nausea and vomiting. The addition of morphine to the local anaesthetic solution in paravertebral block did not have any additional analgesic effects

A cross-sectional study on nutrient intake and -status in inflammatory bowel disease patients.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Inflammatory bowel disease (IBD) can be associated with nutritional problems. The aim of this study was to investigate diet and nutritional status of IBD patients.A total of 78 participants (35 men and 43 women aged 18-74 years) were included in this cross-sectional study. The majority (80 %) of the participant received infliximab treatment. Participants filled out disease related questionnaires and 31 participants also a 3-day food record. Body composition was measured and blood samples analysed in order to estimate nutritional status.The majority (87 %) claimed that diet affects digestive tract symptoms and 72 % had changed diet accordingly. The most common foods restricted were dairy products (60 %), processed meat (55 %), soft drinks (46 %), alcohol (45 %) and fast food (44 %). Body mass index was mostly in the overweight range but 46 % of the participants had been diagnosed with some nutritional deficiency since IBD diagnosis (most common was iron deficiency: 39 %). Patients who restricted meat products had lower ferritin values (48 ± 39 vs. 95 ± 74 μg/L, P = 0.011). Intake of vitamin D and calcium were not adequate (65 % below recommeded intake for both) and 60 % had poor vitamin D status.IBD patients often change their dietary intake in order to affect digestive tract symptoms. Many patients have a history of nutrient deficiency. Restriction of dairy and meat consumption is common and is negatively associated with intake or status of micronutrients like calcium and iron. Dietary advice by a dietitian and use of potentially helpful dietary supplements is indicated.Science funds of the Landspitali- The National University Hospital of Icelan

Boomerang returns unexpectedly

Experimental study of the anisotropy in the cosmic microwave background (CMB) is gathering momentum. The eagerly awaited Boomerang results have lived up to expectations. They provide convincing evidence in favor of the standard paradigm: the Universe is close to flat and with primordial fluctuations which are redolent of inflation. Further scrutiny reveals something even more exciting however -- two hints that there may be some unforeseen physical effects. Firstly the primary acoustic peak appears at slightly larger scales than expected. Although this may be explicable through a combination of mundane effects, we suggest it is also prudent to consider the possibility that the Universe might be marginally closed. The other hint is provided by a second peak which appears less prominent than expected. This may indicate one of a number of possibilities, including increased damping length or tilted initial conditions, but also breaking of coherence or features in the initial power spectrum. Further data should test whether the current concordance model needs only to be tweaked, or to be enhanced in some fundamental way.Comment: 11 pages, 3 figures, final version accepted by Ap

Self-Organized Criticality in Compact Plasmas

Compact plasmas, that exist near black-hole candidates and in gamma ray burst sources, commonly exhibit self-organized non-linear behavior. A model that simulates the non-linear behavior of compact radiative plasmas is constructed directly from the observed luminosity and variability. The simulation shows that such plasmas self organize, and that the degree of non-linearity as well as the slope of the power density spectrum increase with compactness. The simulation is based on a cellular automaton table that includes the properties of the hot (relativistic) plasmas, and the magnitude of the energy perturbations. The plasmas cool or heat up, depending on whether they release more or less than the energy of a single perturbation. The energy release depends on the plasmas densities and temperatures, and the perturbations energy. Strong perturbations may cool the previously heated plasma through shocks and/or pair creation. New observations of some active galactic nuclei and gamma ray bursters are consistent with the simulationComment: 9 pages, 5 figures, AASTeX, Submitted to ApJ

Liver safety assessment: required data elements and best practices for data collection and standardization in clinical trials.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.A workshop was convened to discuss best practices for the assessment of drug-induced liver injury (DILI) in clinical trials. In a breakout session, workshop attendees discussed necessary data elements and standards for the accurate measurement of DILI risk associated with new therapeutic agents in clinical trials. There was agreement that in order to achieve this goal the systematic acquisition of protocol-specified clinical measures and lab specimens from all study subjects is crucial. In addition, standard DILI terms that address the diverse clinical and pathologic signatures of DILI were considered essential. There was a strong consensus that clinical and lab analyses necessary for the evaluation of cases of acute liver injury should be consistent with the US Food and Drug Administration (FDA) guidance on pre-marketing risk assessment of DILI in clinical trials issued in 2009. A recommendation that liver injury case review and management be guided by clinicians with hepatologic expertise was made. Of note, there was agreement that emerging DILI signals should prompt the systematic collection of candidate pharmacogenomic, proteomic and/or metabonomic biomarkers from all study subjects. The use of emerging standardized clinical terminology, CRFs and graphic tools for data review to enable harmonization across clinical trials was strongly encouraged. Many of the recommendations made in the breakout session are in alignment with those made in the other parallel sessions on methodology to assess clinical liver safety data, causality assessment for suspected DILI, and liver safety assessment in special populations (hepatitis B, C, and oncology trials). Nonetheless, a few outstanding issues remain for future consideration

Electron-Positron Pairs in Hot Accretion Flows and Thin Disk Coronae

We investigate equilibrium accretion flows dominated by $e^+ e^-$ pairs. We consider one- and two-temperature accretion disk coronae above a thin disk, as well as hot optically thin two-temperature accretion flows without an underlying thin disk; we model the latter in the framework of advection-dominated accretion flows (ADAFs). In all three cases we include equipartition magnetic fields. We confirm the previous result that the equilibrium density of pairs in two-temperature ADAFs is negligible; and show that the inclusion of magnetic fields and the corresponding synchrotron cooling reduces the pair density even further. Similarly, we find that pairs are unimportant in two-temperature coronae. Even when the corona has significantly enhanced heating by direct transfer of viscous dissipation in the thin disk to the corona, the inefficient Coulomb coupling between protons and electrons acts as a bottleneck and prevents the high compactness required for pair-dominated solutions. Only in the case of a one-temperature corona model do we find pair-dominated thermal equilibria. These pair-dominated solutions occur over a limited range of optical depth and temperature.Comment: 38 pages, including 10 figures, LaTeX; to appear in Ap