Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial

Background: General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCT(drop)), and hypothermia, which may alter tissue oxygenation (StO(2)) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion. Methods: After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43 °C during epidural catheter placement. BCT (Spot on®, 3 M) was measured before (T(1)), after induction of GA (T(2)) at 15 min (T(3)) after start of surgery, and until 2 h after ICU admission (T(ICU2h)). Primary endpoint was BCT(drop) between T(1) and T(2). Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests. Results: BCT(drop) was 0.35 °C with prewarming and 0.9 °C without prewarming (p < 0.005) and BCT remained higher over the observation period (ΔT(4) = 0.9 °C up to ΔT(7) = 0.95 °C, p < 0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO(2) were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated (p < 0.001). Conclusion: Prewarming at 43 °C reduces the BCT(drop) and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion. Trial registration: ClinicalTrials.gov; ID: NCT02364219; Date of registration: 18-febr-2015

Preschool attendance, schooling, and cognitive skills in East Africa

We study the effects of preschool attendance on children's schooling and cognitive skills in Kenya and Tanzania. We use a within-household estimator and data from nationally representative surveys of school-age children's literacy and numeracy skills, which include retrospective information on preschool attendance. In both countries, school entry rules are not strictly enforced, and children who attend preschool often start primary school late. At ages 7–9, these children have thus attended fewer school grades than their same-aged peers without pre-primary education. However, they catch up over time: at ages 13–16, children who went to preschool have attended about the same number of school grades and score about 0.10 standard deviations higher on standardized tests in both countries. They are also 3 (5) percentage points more likely to achieve basic literacy and numeracy in Kenya (Tanzania)

Remote magnetic targeting of iron oxide nanoparticles for cardiovascular diagnosis and therapeutic drug delivery: where are we now?

Michael Bietenbeck,1 Anca Florian,1 Cornelius Faber,2 Udo Sechtem,3 Ali Yilmaz11Department of Cardiology and Angiology, 2Department of Clinical Radiology, University Hospital M&uuml;nster, M&uuml;nster, 3Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany Abstract: Magnetic resonance imaging (MRI) allows for an accurate assessment of both functional and structural cardiac parameters, and thereby appropriate diagnosis and validation of cardiovascular diseases. The diagnostic yield of cardiovascular MRI examinations is often increased by the use of contrast agents that are almost exclusively based on gadolinium compounds. Another clinically approved contrast medium is composed of superparamagnetic iron oxide nanoparticles (IONs). These particles may expand the field of contrast-enhanced cardiovascular MRI as recently shown in clinical studies focusing on acute myocardial infarction (AMI) and atherosclerosis. Furthermore, IONs open up new research opportunities such as remote magnetic drug targeting (MDT). The approach of MDT relies on the coupling of bioactive molecules and magnetic nanoparticles to form an injectable complex. This complex, in turn, can be attracted to and retained at a desired target inside the body with the help of applied magnetic fields. In comparison to common systemic drug applications, MDT techniques promise both higher concentrations at the target site and lower concentrations elsewhere in the body. Moreover, concurrent or subsequent MRI can be used for noninvasive monitoring of drug distribution and successful delivery to the desired organ in vivo. This review does not only illustrate the basic conceptual and biophysical principles of IONs, but also focuses on new research activities and achievements in the cardiovascular field, mainly in the management of AMI. Based on the presentation of successful MDT applications in preclinical models of AMI, novel approaches and the translational potential of MDT are discussed.Keywords: MRI, CMR, magnetic targeting, SPION, myocardial infarctio

Requirements for electronic laboratory reports according to the German guideline Rili-BAEK and ISO 15189

Objectives: Legal regulations and guidelines such as the Guidelines of the German Medical Association for the Quality Assurance of Laboratory Medical Examinations (Rili-BAEK) and ISO 15189 apply to electronic laboratory reports. However, many laboratories struggle with practical implementation of these regulations and guidelines. Methods: Laboratory and legal experts analyse the relevant guidelines and provide checklists and practical recommendations for implementation. Results: Laboratories have less control over the display of electronic laboratory reports than over paper documents. However, an electronic report alone is legally sufficient and need not be accompanied by a paper copy. Rili-BAEK and ISO 15189 stipulate a set of minimum information in every report. The laboratory must verify that reports are transmitted and displayed correctly. To help laboratories do so, agreements between laboratories and the report recipients can clarify responsibilities. Conclusions: Electronic laboratory reports can improve patient care, but laboratories need to verify their quality. Towards this end, Rili-BAEK and ISO 15189 set out helpful provisions