Präoperative Nüchternzeiten: Sicht der Patienten

Zusammenfassung: Hintergrund: Mit dem Ziel der subjektiven perioperativen Qualitätsverbesserung scheint es wünschenswert, die präoperativen Nüchternzeiten im Rahmen der als sicher geltenden Grenzen so kurz als möglich zu halten. Diese Maßnahmen sollten mit einer messbaren Verminderung von präoperativem Hunger und Durst einhergehen und v.a. in einer Verbesserung der präoperativen Befindlichkeit resultieren. Welchen Einfluss Durst und Hunger aus Patientensicht auf den präoperativen Komfort haben, ist jedoch weit gehend unbekannt. Ziel dieser Studie war es, das Ausmaß der Beeinträchtigung der Patienten durch eine traditionelle Nüchternheitsregelung abzuschätzen. Patienten und Methoden: Ein Kollektiv von 412Patienten der "American-Society-of-Anesthesiologists"- (ASA-)RisikoklassenI und II, das sich einem kleineren chirurgischen Eingriff unterzog, wurde mithilfe eines Fragebogens zum Ausmaß und Stellenwert von präoperativem Durst und Hunger befragt. Ergebnisse: Es hatten 33% der Patienten mäßigen oder starken Durst, 19% mäßigen bis starken Hunger. Von den Befragten möchten 47% vor der Operation noch trinken, 72% hätten gern noch ein leichtes Frühstück eingenommen. Die mittlere Nüchternzeit war 12,8±3,4h für Flüssigkeiten und 15,5±4,4h für Essen. Durst wurde von 3,3% und Hunger von 0,8% der Patienten als Hauptgrund für die Beeinträchtigung des präoperativen Wohlbefindens genannt. Das lange Warten (8,5%), Nervosität (6,5%) und Angst (4,8%) wurden am häufigsten genannt. Die Antworten waren unabhängig von der Zeitdauer der präoperativen Nüchternheit. Schlussfolgerung: Der Patientenkomfort ist durch eine traditionelle Nüchternheitsregelung beeinträchtigt, und Minimierung der präoperativen Nüchternzeiten wird von den Patienten gewünscht. Anstrengungen mit dem Ziel der Reduktion von präoperativer Angst und Nervosität bergen jedoch zusätzliches großes Potenzial für eine Steigerung der perioperativen Behandlungsqualität aus Sicht der Patiente

Mechanistic-empirical models for better consideration of subgrade and unbound layers influence on pavement performance

It has been reported that the pavement performance predicted by the current mechanistic-empirical pavement design shows low or no sensitivity to subgrade and unbound layers. This issue has raised wide attention. Targeting this problem, this paper summarizes the process used by the authors to find better models of the influence of subgrade and unbound base course layers on the performance of flexible and rigid pavements. A comprehensive literature review is first conducted and the findings are categorized. It is found that the resilient modulus, permanent deformation, shear strength, and erosion are key factors. In particular, the properties that provide greater sensitivity are 1) the moisture-dependency of the modulus, shear strength, and permanent deformation; 2) stress-dependency of the modulus and permanent deformation; and 3) cross-anisotropy of the modulus. A number of unbound layer/subgrade models have been located and categorized. Three criteria are developed to identify the candidate models in terms of the degree of susceptibility, degree of accuracy, and ease of development. The first two criteria are used to evaluate the collected unbound layer/subgrade models, while associated development and implementation issues are planned as subsequent work. Two models that the authors previously developed are selected as examples to illustrate the improvement of the performance prediction, including the moisture-sensitive, stress-dependent, and cross-anisotropic modulus model for unbound layers and stress-dependent mechanistic-empirical permanent deformation model for unbound base layers. These two models are verified through laboratory tests and numerical simulations. Moreover, they are compared to their counterparts in the AASHTOWare Pavement ME Design. The advantages of accuracy and sensitivity to the operational conditions (e.g. moisture, traffic stress, and load-induced/particle-induced anisotropy) are obvious. In addition to these two models, the development of the shear strength model and erosion model are sketched. The candidate models need further development and implementation, which address issues such as hierarchical inputs, calibration/validation, and implementation. These are the on-going and planned work on this topic to better incorporate the influence of subgrade and unbound layers so as to contribute to the improvement of pavement designs

Clinical evaluation of the FloTrac/VigileoTM system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery†‡

Background Assessment of cardiac output (CO) by the FloTrac/Vigileo™ system may offer a less invasive means of determining the CO than either the pulmonary artery catheter (PAC) or the PiCCOplus™ system. The aim of this study was to compare CO measurements made using the FloTrac/Vigileo™ system with upgraded software (FCO, Edwards Lifesciences, Irvine CA, USA), the PiCCOplus™ system (PCO, Pulsion Medical Systems, Munich, Germany) and continuous CO monitoring using a PAC (CCO; Vigilance™ monitoring, Edwards Lifesciences, Irvine CA, USA) with intermittent pulmonary artery thermodilution (ICO). The study was conducted in patients undergoing elective cardiac surgery. Methods Thirty-one patients with preserved left ventricular function were enrolled. CCO, FCO, and PCO were recorded in the perioperative period at six predefined time points after achieving stable haemodynamic conditions; ICO was determined from the mean of three bolus injections. Bland-Altman analysis was used to compare CCO, FCO, and PCO with ICO. Results Bland-Altman analysis revealed a comparable mean bias and limits of agreement for all tested continuous CO monitoring devices using ICO as reference method. Agreement for all devices decreased in the postoperative period. Conclusion The performance of the FloTrac/Vigileo™ system, the PiCCOplus™, and the Vigilance™ CCO monitoring for CO measurement were comparable when tested against intermittent thermodilution in patients undergoing elective cardiac surger

Clinical Results of 40 Consecutive Basal Thumb Prostheses and No CRPS Type I After Vitamin C Prophylaxis

Complex regional pain syndrome (CRPS) type I may occur as complication after any type of surgery for basal joint arthritis of the thumb. We investigated prospectively in an ongoing study our results after a fully standardized treatment with a total joint prosthesis under vitamin C prophylaxis

Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery

Background. Cardiac preconditioning is thought to be involved in the observed decreased coronary artery reocclusion rate in patients with angina preceding myocardial infarction. We prospectively examined whether preconditioning by sevoflurane would decrease late cardiac events in patients undergoing coronary artery bypass graft (CABG) surgery. Methods. Seventy-two patients scheduled for elective CABG surgery were randomized to preconditioning by sevoflurane (10 min at 4 vol%) or placebo. For all patients, follow-up of adverse cardiac events was obtained 6 and 12 months after surgery. Transcript levels for platelet-endothelial cell adhesion molecule-1 (PECAM-1/CD31), catalase and heat shock protein 70 (Hsp70) were determined in atrial biopsies after sevoflurane preconditioning. Results. Pharmacological preconditioning by sevoflurane reduced the incidence of late cardiac events during the first year after CABG surgery (sevoflurane 3% vs 17% in the placebo group, log-rank test, P=0.038). One patient in the sevoflurane group and three patients in the placebo group experienced new episodes of congestive heart failure and three additional patients had coronary artery reocclusion. Perioperative peak concentrations for myocardial injury markers were higher in patients with subsequent late cardiac events [NTproBNP, 9031 (4125) vs 3049 (1906) ng litre−1, P<0.001; cTnT, 1.31 (0.88) vs 0.46 (0.29) µg litre−1, P<0.001]. Transcript levels were reduced for PECAM-1 and increased for catalase but unchanged for Hsp70 in atrial biopsies after sevoflurane preconditioning. Conclusions. This prospective randomized clinical study provides evidence of a protective role for pharmacological preconditioning by sevoflurane in late cardiac events in CABG patients, which may be related to favourable transcriptional changes in pro- and antiprotective protein

Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography

Background. End-diastolic volume indices determined by transpulmonary thermodilution and pulmonary artery thermodilution may give a better estimate of left ventricular preload than pulmonary capillary wedge pressure monitoring. The aim of this study was to compare volume preload monitoring using the two different thermodilution techniques with left ventricular preload assessment by transoesophageal echocardiography (TOE). Methods. Twenty patients undergoing elective cardiac surgery with preserved left-right ventricular function were studied after induction of anaesthesia. Conventional haemodynamic variables, global end-diastolic volume index using the pulse contour cardiac output (PiCCO) system (GEDVIPiCCO), continuous end-diastolic volume index (CEDVIPAC) measured by a modified pulmonary artery catheter (PAC), left ventricular end-diastolic area index (LVEDAI) using TOE and stroke volume indices (SVI) were recorded before and 20 and 40 min after fluid replacement therapy. Analysis of variance (Bonferroni-Dunn), Bland-Altman analysis and linear regression were performed. Results. GEDVIPiCCO, CEDVIPAC, LVEDAI and SVIPiCCO/PAC increased significantly after fluid load (P10% for GEDVIPiCCO and LVEDAI was observed in 85% and 90% of the patients compared with 45% for CEDVIPAC. Mean bias (2 sd) between percentage changes (Δ) in GEDVIPiCCO and ΔLVEDAI was −3.2 (17.6)% and between ΔCEDVIPAC and ΔLVEDAI −8.7 (30.0)%. The correlation coefficient (r2) for ΔGEDVIPiCCO vs ΔLVEDAI was 0.658 and for ΔCEDVIPAC vs ΔLVEDAI 0.161. The relationship between ΔGEDVIPiCCO and ΔSVIPiCCO was stronger (r2=0.576) than that between ΔCEDVIPAC and ΔSVIPAC (r2=0.267). Conclusion. GEDVI assessed by the PiCCO system gives a better reflection of echocardiographic changes in left ventricular preload, in response to fluid replacement therapy, than CEDVI measured by a modified PA

Adult BMI change and risk of Breast Cancer: National Health and Nutrition Examination Survey (NHANES) 2005-2010

OBJECTIVE: Breast cancer is the second leading cause of cancer mortality among women in the developed world. This study assessed the association between occurrence of breast cancer and body mass index (BMI) change from age 25 to age closest to breast cancer diagnosis while exploring the modifying effects of demographic variables. METHODS: The National Health and Nutrition Examination Survey data were used. Women included were ≥50 years, not pregnant and without a diagnosis of any cancer but breast. The total sample included 2895 women (172 with breast cancer and 2723 controls with no breast cancer diagnosis). Multivariate logistic regression was used to estimate the OR and 95 % CIs and interaction evaluated by including an interaction term in the model. RESULTS: Women whose BMI increased from normal or overweight to obese compared to those who remained at a normal BMI were found to have a 2 times higher odds (OR = 2.1; 95 % CI 1.11-3.79) of developing breast cancer. No significant association was observed for women who increased to overweight. However, a more pronounced association was observed in non-Hispanic black women (OR = 6.6; 95 % CI 1.68-25.86) and a significant association observed when they increased from normal to overweight (OR = 4.2; 95 % CI 1.02-17.75). CONCLUSIONS: Becoming obese after age 25 is associated with increased risk of breast cancer in women over 50 years old, with non-Hispanic black women being at greatest risk

Glial βii spectrin contributes to paranode formation and maintenance

Action potential conduction along myelinated axons depends on high densities of voltage-gated Na channels at the nodes of Ranvier. Flanking each node, paranodal junctions (paranodes) are formed between axons and Schwann cells in the peripheral nervous system (PNS) or oligodendrocytes intheCNS. Paranodal junctions contribute to both no deassembly and maintenance. Despitetheir importance, the molecular mechanisms responsible for paranode assembly and maintenance remain poorly understood. βII spectrin is expressed in diverse cells and is an essential part of the submembranous cytoskeleton. Here, we show that Schwann cell βII spectrin is highly enriched at paranodes. To elucidate the roles of glial βII spectrin, we generated mutant mice lacking βII spectrin in myelinating glial cells by crossing mice with a floxed allele of Sptbn1 with Cnp-Cre mice, and analyzed both male and female mice. Juvenile (4 weeks) and middle-aged (60 weeks) mutant mice showed reduced grip strength and sciatic nerve conduction slowing, whereas no phenotype was observed between 8 and 24 weeks of age. Consistent with these findings, immunofluorescence microscopy revealed disorganized paranodes in the PNS and CNS of both postnatal day 13 and middle-aged mutant mice, but not in young adult mutant mice. Electron microscopy confirmed partial loss of transverse bands at the paranodal axoglial junction in the middle-aged mutant mice in both the PNS and CNS. These findings demonstrate that a spectrin-based cytoskeleton in myelinating glia contributes to formation and maintenance of paranodal junctions.Fil: Susuki, Keiichiro. Baylor College of Medicine; Estados UnidosFil: Zollinger, Daniel R.. Baylor College of Medicine; Estados UnidosFil: Chang, Kae Jiun. Baylor College of Medicine; Estados UnidosFil: Zhang, Chuansheng. Baylor College of Medicine; Estados UnidosFil: Huang, Claire Yu Mei. Baylor College of Medicine; Estados UnidosFil: Tsai, Chang Ru. Baylor College of Medicine; Estados UnidosFil: Galiano, Mauricio Raul. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones en Química Biológica de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Centro de Investigaciones en Química Biológica de Córdoba; Argentina. Baylor College of Medicine; Estados UnidosFil: Liu, Yanhong. Baylor College of Medicine; Estados UnidosFil: Benusa, Savannah D.. Virginia Commonwealth University; Estados UnidosFil: Yermakov, Leonid M.. Wright State University; Estados UnidosFil: Griggs, Ryan B.. Wright State University; Estados UnidosFil: Dupree, Jeffrey L.. Virginia Commonwealth University; Estados UnidosFil: Rasband, Matthew N.. Baylor College of Medicine; Estados Unido

Differences in cervical cancer screening knowledge, practices, and beliefs: An examination of survey responses

Among the identified barriers to HPV vaccination is the concern that women may compensate for their reduced susceptibility to cervical cancers by reducing cervical cancer screening. This exploratory study examined the relationship between cervical cancer screening rates and HPV vaccination. We conducted a cross-sectional survey using a convenience sample of women aged 21-35 attending a local minority health fair in July 2015. Data were analyzed in 2015-2016. Outcomes assessed were: receiving a Pap test within the last three years, awareness and comfort with current Pap test recommendations, and knowledge regarding the purpose of a Pap test. A total of 291 women were included in the analyses. Mean age was 28.5 years and 62% were non-Hispanic black. 84% had received a Pap test in the last three years and 33% had received at least one HPV vaccine. Logistic regression results showed that women who had been vaccinated did not have lower odds of having a Pap test in the past three years (OR = 1.32; 95% CI = 0.66-2.65). In an adjusted regression model controlling for age and race, vaccinated women were significantly more likely to have had a Pap test (AOR = 3.06; 95% CI = 1.37-6.83). Yet only 26% of women knew the purpose of a Pap test and the proportion who answered correctly was higher among non-Hispanic white women. Women who have been vaccinated for HPV are more likely to have been screened for cervical cancer. These results suggest areas for more robust studies examining pro-health attitudes, behaviors, and communication regarding vaccination and preventive screening