A study to compare continuous epidural infusion and intermittent bolus of bupivacaine for postoperative analgesia following renal surgery

Background: Extradural administration of local anaesthetics, opioids or a combination of both is now a well-established technique for managing postoperative pain following upper abdominal, pelvic and thoracic procedures or orthopaedic procedures on the lower extremities. There are two techniques of administration of drugs via epidural catheter – one isby continuous infusion and the other is by intermittent boluses. At present there is controversy in the literature regarding the analgesic effects of the techniques.Methods: This study was conducted in a prospective, randomised manner on 60 patients of either sex of ASA class I or II, scheduled to undergo elective renal surgery. The general anaesthetic technique was standardised. The patients were divided randomly into two groups of 30 each. The patients in group 1 received a continuous infusion of 0.166% bupivacaine, while the patients in group 2 received intermittent boluses through epidural catheter. The efficacy of postoperative analgesia was assessed using pulmonary function tests up to 12 hours. The generated data were analysed statistically.Results: There were no significant changes in pulse rate and arterial pressure at different time intervals from the preoperative values. Respiratory rates in both the groups were found to be significantly higher than the preoperative values in the two groups (p < 0.05). Forced vital capacity (FVC) and peak exploratory flow rate (PEFR) were significantly lower than the preoperative values at all points in time in both groups, but the drop was greater in group 2 and pain scores on movement were also found to be significantly higher than those in group 1 at the times when the effect of the bupivacaine bolus was wearing off (p < 0.05). Pain scores at rest were found to be comparable in both groups postoperatively.Conclusions: We conclude that continuous infusion of bupivacaine (8.3 mg/h) provides better analgesia at rest and on movement than intermittent boluses, and is not associated with fluctuations in the level of analgesia. Incidences of adverse effects are similar and not insignificant with both schedules

Magnetophoresis of Flexible DNA-based Dumbbell Structures

Controlled movement and manipulation of magnetic micro and nanostructures using magnetic forces can give rise to important applications in biomedecine, diagnostics and immunology. We report controlled magnetophoresis and stretching, in aqueous solution, of a DNA-based dumbbell structure containing magnetic and diamagnetic microspheres. The velocity and stretching of the dumbbell were experimentally measured and correlated with a theoretical model based on the forces acting on individual magnetic beads or the entire dumbbell structures. The results show that precise and predictable manipulation of dumbbell structures is achievable and can potentially be applied to immunomagnetic cell separators.Comment: 4 pages, 3 figures, preprint, to be published in AP

Mediastinitis after oesophagoscopy: A case report

A 50-year-old male presented with signs and symptoms of oesophageal perforation after a biopsy. Suggestive symptoms and signs were pain in the neck radiating to the back, a rise in temperature and pulse, emphysema in the neck and widening of the mediastinum or a pneumothorax revealed by a chest X-ray. He survived with medical managemen

Addition of adenosine to hyperbaric bupivacaine in spinal anaesthesia does not prolong postoperative analgesia in vaginal hysterectomy

Background: Systemic administration of adenosine produces anti-nociception. Although literature supports intrathecal adenosine for neuropathic pain, its efficacy in postoperative pain remains unproven. There has been no study on the efficacy of adenosine on postoperative pain when administered with hyperbaric bupivacaine. The aim of our present study was to evaluate the efficacy of two different doses of intrathecal adenosine as an adjunct to 0.5% hyperbaric bupivacaine in patients undergoing vaginal hysterectomy under spinal anaesthesia. Method: Seventy-five women, aged 40-60 years and scheduled for vaginal hysterectomy under spinal anaesthesia, were included. Patients were allocated to three groups of 25 patients each to receive 500 &mu;g adenosine (group I), 1000 &mu;g adenosine (group II) and normal saline (group III) with 2.6 ml of 0.5% hyperbaric bupivacaine. Postoperative analgesia was provided with patient-controlled fentanyl. Time of administration of rescue analgesia and total dose of fentanyl were recorded. The times to full recovery of sensory and motor block were noted. Results: There were no differences in time to rescue analgesia and postoperative fentanyl consumption over 24 hours among the groups. There was no significant difference in onset of sensory and motor block or regression of sensory block, although statistically significant difference was noted in the time taken for regression of motor block. Conclusion: Intrathecal adenosine does not affect the postoperative analgesic requirement when administered with hyperbaric bupivacaine.Keywords: spinal anaesthesia, intrathecal adenosine, vaginal hysterectomy,postoperative analgesia, patient-controlled analgesi

The transferrin receptor CD71 delineates functionally distinct airway macrophage subsets during idiopathic pulmonary fibrosis

RATIONALE: Idiopathic pulmonary fibrosis (IPF) is a devastating progressive disease with limited therapeutic options. Airway macrophages (AMs) are key components of the defence of the airways and are implicated in the pathogenesis of IPF. Alterations in iron metabolism have been described during fibrotic lung disease and in murine models of lung fibrosis. However, the role of transferrin receptor-1 (CD71)-expressing AMs in IPF is not known. OBJECTIVES: To assess the role of CD71 expressing AMs in the IPF-lung. METHODS: We utilized multi-parameter flow cytometry, gene expression analysis and phagocytosis/transferrin uptake assays to delineate the role of AMs expressing, or lacking, CD71 in the BAL of patients with IPF or healthy controls. MEASUREMENTS AND MAIN RESULTS: There was a distinct increase in proportions of AMs lacking CD71 in IPF patients in comparison to healthy controls. Levels of BAL transferrin were enhanced in IPF-BAL and furthermore, CD71- AMs had an impaired ability to sequester transferrin. CD71+ and CD71- AMs were phenotypically, functionally and transcriptionally distinct, with CD71- AMs characterised by reduced expression of markers of macrophage maturity, impaired phagocytosis and enhanced expression of pro-fibrotic genes. Importantly, proportions of AMs lacking CD71 were independently associated with worse survival, underlining the importance of this population in IPF and as a potential therapeutic target. CONCLUSIONS: Taken together these data highlight how CD71 delineates AM subsets which play distinct roles in IPF and furthermore, CD71- AMs may be an important pathogenic component of fibrotic lung disease

Obstetric anal sphincter injury: a systematic review of information available on the internet.

OBJECTIVE: There is no systematic evaluation of online health information pertaining to obstetric anal sphincter injury. Therefore, we evaluated the accuracy, credibility, reliability, and readability of online information concerning obstetric anal sphincter injury. MATERIALS AND METHODS: Multiple search engines were searched. The first 30 webpages were identified for each keyword and considered eligible if they provided information regarding obstetric anal sphincter injury. Eligible webpages were assessed by two independent researchers for accuracy (prioritised criteria based upon the RCOG Third and Fourth Degree Tear guideline); credibility; reliability; and readability. RESULTS: Fifty-eight webpages were included. Seventeen webpages (30%) had obtained Health On the Net certification, or Information Standard approval and performed better than those without such approvals (p = 0.039). The best overall performing website was http://www.pat.nhs.uk (score of 146.7). A single webpage (1%) fulfilled the entire criteria for accuracy with a score of 18: www.tamesidehospital.nhs.uk . Twenty-nine webpages (50%) were assessed as credible (scores ≥7). A single webpage achieved a maximum credibility score of 10: www.meht.nhs.uk . Over a third (21 out of 58) were rated as poor or very poor. The highest scoring webpage was http://www.royalsurrey.nhs.uk (score 62). No webpage met the recommended Flesch Reading Ease Score above 70. The intra-class coefficient between researchers was 0.98 (95% CI 0.96-0.99) and 0.94 (95% CI 0.89-0.96) for accuracy and reliability assessments. CONCLUSION: Online information concerning obstetric anal sphincter injury often uses language that is inappropriate for a lay audience and lacks sufficient accuracy, credibility, and reliability

Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study.

The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. To identify programmatic (multitest) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based, screening program. Retrospective cohort study. Kaiser Permanente Northern and Southern California. Adults aged 50 to 75 years who were eligible for screening and had baseline quantitative FIT results (2013 to 2014) and 2 years of follow-up. Nearly two thirds (411 241) had FIT screening in the previous 2 years. FIT programmatic sensitivity for CRC and number of positive test results per cancer case detected, overall and by age and sex. Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75%) had at least 1 additional FIT and 1245 (0.19%) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0%) at 30 µg/g to 925 (74.3%) at 20 µg/g and 987 (79.3%) at 10 µg/g; the number of positive test results per cancer case detected increased from 43 at 30 µg/g to 52 at 20 µg/g and 85 at 10 µg/g. Reducing the positivity threshold from 20 to 15 µg/g would detect 3% more cancer cases and require 23% more colonoscopies. At the conventional FIT threshold of 20 µg/g, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0% vs. 70.6%; P = 0.011). Information on advanced adenoma was lacking. Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources. National Cancer Institute