Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

Background Both the transversus abdominis plane (TAP) block and the anterior quadratus lumborum block (QLB) have been shown effective in reducing postoperative pain after laparoscopic inguinal hernia repair. Our hypothesis was that there is no difference in analgesic effect between the two blocks for this procedure. Methods In this prospective, double-blind, randomised controlled study, 60 adult patients undergoing laparoscopic inguinal hernia repair were equally randomly assigned to either a preoperative TAP block or an anterior QLB. The primary outcome was oral morphine equivalent (OME) consumption at 4 h postoperatively. Secondary outcomes were OME consumption at 24, 48 h and 7 days, pain scores at rest and when coughing, nausea, and level of sedation measured at 1, 2, 3, 24, and 48 h and 7 days postoperatively. Results Fifty-three patients completed the study. There was no significant difference in OME consumption at 4 h postoperatively, TAP group (10.3 ± 7.85 mg) (mean ± SD) versus the anterior QLB group (10.9 ± 10.85 mg) (p = .713). The pain scores were similar at rest and when coughing during the 7 day observation period, as were the level of sedation and incidence of nausea. There were no cases of serious side-effects or muscle weakness of the thigh on the same side as the block. Conclusion There is no difference in OME consumption, pain, nausea or sedation between the TAP and the anterior QLB. Thus, the choice between the two blocks in a clinical setting of laparoscopic inguinal hernia repair should be based on other aspects, such as skills, practicalities, and potential risks.publishedVersio

Exploring postoperative handover quality in relation to patient condition: A mixed methods study

Aims and Objectives To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. Background High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. Design Observational mixed methods convergent design. Methods Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. Results Information omissions in the handovers observed ranged from 1–13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: “adaptation of handover,” “strategies for information transfer” and “contextual and individual factors.” Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. Conclusions The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. Relevance to clinical practice It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.publishedVersio

Spread of local anesthetics after erector spinae plane block: an MRI study in healthy volunteers

Background Erector spinae plane block (ESPB) is a truncal fascial block with a disputed mechanism and anatomical site of effect. This study aimed to perform a one-sided ESPB and use MRI to investigate the spread of the local anesthetic (LA) and the corresponding cutaneous loss of sensation to pinprick and cold. Methods Ten volunteers received a right-sided ESPB at the level of the seventh thoracic vertebra (Th7), consisting of 30 mL 2.5 mg/mL ropivacaine with 0.3 mL gadolinium. The primary outcome was the evaluation of the spread of LA on MRI 1-hour postblock. The secondary outcome was the loss of sensation to cold and pinprick 30–50 min after the block was performed. Results All volunteers had a spread of LA on MRI in the erector spinae muscles and to the intercostal space. 9/10 had spread to the paravertebral space and 8/10 had spread to the neural foramina. 4/10 volunteers had spread to the epidural space. One volunteer had extensive epidural spread as well as contralateral epidural and foraminal spread. Four volunteers had a loss of sensation both posterior and anterior to the midaxillary line, while six volunteers had a loss of sensation only on the posterior side. Conclusion We found that LA consistently spreads to the intercostal space, the paravertebral space, and the neural foramina after an ESPB. Epidural spread was evident in four volunteers. Sensory testing 30–50 min after an ESPB shows highly variable results, and generally under-represents what could be expected from the visualized spread on MRI 60 min after block performance. Trial registration number NCT05012332.publishedVersio

MicroRNAs in Differentiation of Embryoid Bodies and the Teratoma Subtype of Testicular Cancer

Background: Testicular germ cell tumours (TGCTs) are the most frequent tumour type among young, adult men. TGCTs can be efficiently treated, but metastases of the teratoma subtype, for which there are no circulating biomarkers, represent a challenge. Materials and Methods: Global microRNA expression in teratoma tissue and embryoid bodies was assessed using next-generation sequencing. Levels of microRNAs identified as potential biomarkers were obtained from serum of patients with teratoma and matched healthy men. Results: We identified miR-222-5p, miR-200a-5p, miR-196b-3p and miR-454-5p as biomarker candidates from the tumour tissue and embryoid body screening but the expression of these microRNAs was very low in serum and not statistically different between patients and controls. miR-375-3p was highly expressed, being highest in patients with teratoma (p=0.012) but the levels of expression in serum from these patients and healthy controls overlapped. miR-371a-3p was not expressed in serum from patients with pure teratoma, only in patients with mixed tumours. Conclusion: The microRNA profiles of the teratoma subtype of TGCT and embryoid bodies were obtained and assessed for candidate circulating biomarkers, but none with high sensitivity and specificity for teratoma were identified in our study. We conclude that neither the proposed teratoma marker miR-375-3p nor miR-371a-3p are suitable as circulating teratoma markers.publishedVersio

Alpha-2-adrenergic receptor agonists for the prevention of delirium and cognitive decline after open heart surgery (ALPHA2PREVENT): protocol for a multicentre randomised controlled trial

INTRODUCTION: Postoperative delirium is common in older cardiac surgery patients and associated with negative short-term and long-term outcomes. The alpha-2-adrenergic receptor agonist dexmedetomidine shows promise as prophylaxis and treatment for delirium in intensive care units (ICU) and postoperative settings. Clonidine has similar pharmacological properties and can be administered both parenterally and orally. We aim to study whether repurposing of clonidine can represent a novel treatment option for delirium, and the possible effects of dexmedetomidine and clonidine on long-term cognitive trajectories, motor activity patterns and biomarkers of neuronal injury, and whether these effects are associated with frailty status. METHODS AND ANALYSIS: This five-centre, double-blind randomised controlled trial will include 900 cardiac surgery patients aged 70+ years. Participants will be randomised 1:1:1 to dexmedetomidine or clonidine or placebo. The study drug will be given as a continuous intravenous infusion from the start of cardiopulmonary bypass, at a rate of 0.4 µg/kg/hour. The infusion rate will be decreased to 0.2 µg/kg/hour postoperatively and be continued until discharge from the ICU or 24 hours postoperatively, whichever happens first.Primary end point is the 7-day cumulative incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Secondary end points include the composite end point of coma, delirium or death, in addition to delirium severity and motor activity patterns, levels of circulating biomarkers of neuronal injury, cognitive function and frailty status 1 and 6 months after surgery. ETHICS AND DISSEMINATION: This trial is approved by the Regional Committee for Ethics in Medical Research in Norway (South-East Norway) and by the Norwegian Medicines Agency. Dissemination plans include publication in peer-reviewed medical journals and presentation at scientific meetings. TRIAL REGISTRATION NUMBER: NCT05029050

International Olympic Committee consensus statement on pain management in elite athletes

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic

Automatic Sarcasm Detection in Twitter Messages

In the past decade, social media like Twitter have become popular and a part of everyday life for many people. Opinion mining of the thoughts and opinions they share can be of interest to, e.g., companies and organizations. The sentiment of a text can be drastically altered when figurative language such as sarcasm is used. This thesis presents a system for automatic sarcasm detection in Twitter messages. To get a better understanding of the field, state-of-the-art systems for detecting sarcasm in Twitter messages are explored. Many such systems already exist, and a common theme among them is the use of automatically annotated data for both training and testing. In addition to presenting a system for detecting sarcasm, this thesis also looks into the use of manually annotated data for testing. To this end, a dataset of tweets manually annotated with respect to the presence of sarcasm was built. The result was very similar to that of a previously made set, and both of them showed considerable deviation from automatic annotation. This implies that using automatically annotated data for the task of sarcasm detection in tweets is a mediocre approximation. Experiments with both of the manually annotated datasets also gave very similar results, showing that they are well annotated and reasonably representative for sarcasm detection in tweets