The effects of Trendelenburg Position on Patient Care during Open Radical Prostatectomy: A Randomized Controlled Clinical Trial

Background: Low quality of surgical field is a common problem during open radical prostatectomy (ORP). Aim: This study was performed aimed to survey the effects of Trendelenburg position on the quality of surgical field, mean arterial blood pressure (MABP), heart rate (HR), regional cerebral oxygen saturation (rSO2) and cognitive function in patients undergoing ORP. Method: This randomized controlled clinical trial study was done on 60 patients candidates for ORP in Shahid Beheshti Hospital of Hamadan in 2022. Patients were selected by the convenience sampling method and were divided into two intervention and control groups using the random blocking method. In intervention group, patients were placed in a 15° head-down tilt before surgery. The control group was remained in a sleeping position on the back during surgery. The surgical field quality was assessed after surgery. The MABP, HR, and rSO2 were assessed after anesthesia induction, after positioning, and consecutively in 30-minute intervals during the surgery. Results: The mean age was 60.93±4.24 years. A significant difference was found between the two groups regarding the surgeon's satisfaction with the surgical field quality (P=0.04). There was a significant difference between the two groups regarding surgery time (t=-3.00, P=0.004). No significant differences were found between the two groups in terms of MABP, HR, and rSO2 in either of the measurements (P>0.05). Implications for Practice: It is recommended to use Trendelenburg position, as a safe position, to improve exposure to the pelvis during surgery

Association between type 2 diabetes and branched chain amino acids (BCAA); a case-control study

Background Several amino acids and their derivatives have been implicated in insulin resistance (IR) and Type 2 Diabetes Mellitus (T2DM). This research sought to establish a relationship between the dietary levels of branched-chain amino acids (BCAA) and the risk of T2DM. Methods This case-control study was carried out on 4200 participants consisting of 589 people with T2DM and 3611 non-diabetic aged 35 to 70 years residents in Sabzevar, Iran. Data on the economic-social, employment status, medical history, lifestyle, and sleep habits were collected via interview. The food frequency questionnaire (FFQ) was used to check the nutritional status. Participants’ dietary BCAA consumption was estimated using Nutritionist IV software. Results A significant negative association between the incidence of T2DM and the dietary levels of BCAAs after adjustment for age and sex (OR = 0.972, CI 95%:0.648–0.996, P = 0.022). The negative association remained significant after additional adjustments for body mass index (BMI) and physical activity (OR = 0.967, CI 95%: 0.943–0.992, P = 0.010). Interestingly, a positive association was found between T2DM and total BCAAs (OR = 1.067, CI 95%: 1.017–1.119, P = 0.008), Isoleucine (OR = 1.248, CI 95%: 1.043–1.494, P = 0.016), Leucine (OR = 1.165, CI 95%: 1.046–1.299, P = 0.006) and Valine (OR = 1.274, CI 95%: 1.088–1.492, P = 0.003) after further adjustment for calorie intake. Conclusions Our results demonstrate branched-chain amino acids (BCAAs) including isoleucine, leucine, and valine are negatively associated with the incidence of type 2 diabetes (T2DM) after adjusting for age and sex, BMI, and physical activity. However, adjusting for calorie intake reversed the association between T2DM and BCAAs. These findings suggest that the association between BCAAs and T2DM may be influenced by calorie intake. Future longitudinal studies are warranted