Remifentanil versus dexmedtomidine for posterior spinal fusion surgery

Background: Controlling the hemodynamic situation of patients who have spinal operation is of prime importance, and maintaining the heart rate and blood pressure in normal or low- normal levels in these patients can reduce their bleeding loss. One of the commonly used drugs for this purpose is remifentanil. Another sedative-hypnotic-analgesic drug, with acceptable effects is dexmedetomidine. The aim of this study was to compare the effect of dexmedetomidine with remifentanil in spinal operation. Methods: In a double blind randomized clinical trial, using random sampling method, 60 patients with the age range of 15-65 years who were candidates for posterior spinal fusion operation were included. Induction of anesthesia was performed, and both groups received isoflurane 1 during the surgery. Remifentanil was injected via infusion pump in one group. The patients in the trial group received dexmedetomidine. As trial outcomes, heart rate and blood pressure were measured before, after induction and during the operation. Pain score, sedation score and the need to analgesic therapy were recorded in the recovery room and the ward. Independent sample t-test and chi-square were used for statistical analysis. Results: Dexmedetomidine had a significant lowering impact on intraoperative blood pressure and heart rate compared to remifentanil (p<0.001). The mean of sedation scores after extubation in patients who received dexmedetomidine was significantly higher than the sedation scores in patients who received remifentanil (p<0.001). The mean of post-extubation and recovery pain score in patients taking remifentanil was significantly higher than patients taking dexmedetomidine (p<0.05). Conclusion: Dexmedetomidine in patients with spinal operation is associated with lower postoperative pain score and intraoperative bleeding. Hemodynamic effects are significantly better in patients received dexmedetomidine

The interactive effect of water-borne cadmium and environmental hypoxia on common carp (Cyprinus carpio) metabolism

Regarding to the tight association between aquatic hypoxia and heavy metal contaminations in one hand and the role of both parameters on fish respiration, metabolism of carp could be assessed under single and mutual exposures to hypoxia and cadmium. Following measuring LC50-96h of cadmium (43.679 mg/l) for this species, 80 common carp were exposed to 10 different treatments, including control, acute (43.68 mg/l), sub-lethal (21.84 mg/l) and chronic (4.37 mg/l) cadmium as well as hypoxia for immediately (20% of saturation), 24h (40%) and 7 days (60%), and joint exposure of each similar treatment. By using of respirometer technique, we measured oxygen consumption rate in different time spans to calculate each individual standard metabolic rate (SMR), maximum metabolic rate (MMR), aerobic scope (AS), factorial aerobic scope (FAS) and critical oxygen tension (PCrit). Obtained data show that acute and sub-lethal cadmium treatments led to significant (P<0.05) increases in all metabolic indices in comparison with control group whilst the MMR and AS have been reduced (P<0.05) following hypoxia treatments. Combined treatments of hypoxia and cadmium led to reduce SMR and PCrit in all treatments and MMR, AS and FAS only in acute and sub-lethal treatments. In overall, hypoxia can act as a limiting stressor in carp while cadmium can account as a loading stressor

An iterative approach for obtaining nonlinear frequency of a conservative oscillator with strong nonlinearities

An iterative procedure is suggested for obtaining the higher-order approximate solutions of a conservative system comprising an oscillator with cubic and quintic restoring force function. The proposed method is similar to the traditional harmonic balance methods but unlike them the obtained from the previous step errors are considered in the present step to increase the accuracy of the solution. A comparison of results with those obtained by exact solution and other approximate analytical techniques confirms an accuracy of the method. It is shown that the achieved approximate solutions are valid for both small and large amplitudes of oscillation and can meet the exact solutions with a high level of accuracy in the lower-order of approximations. Furthermore, using the obtained analytical solutions, the effect of cubic and quintic terms on the frequency is discussed.Запропонована ітераційна процедура для отримання наближених розв’язків високого порядку консервативної системи, яка містить осцилятор з відновлювальною силою, що описується третім і п’ятим порядками нелінійності. Запропонований метод аналогічний до класичних методів гармонічного балансу, однак на відміну від них тут похибки, отримані на попередньому кроці, розглядаються на наступному кроці з метою підвищення точності розв’язку. Порівняння результатів з результатами, отриманими як точний розв’язок і іншими наближеними аналітичними методиками підтверджує точність методу. Показано, що отримані наближені розв’язки вірні як для малих, так і для великих амплітуд коливань і можуть узгоджуватись з точним розв’язком з високим рівнем точності при низьких порядках наближень. Далі обговорюється вплив членів третього і п’ятого порядків на основі отриманих аналітичних розв’язків

Hybrid Deep Neural Network for Brachial Plexus Nerve Segmentation in Ultrasound Images

Ultrasound-guided regional anesthesia (UGRA) can replace general anesthesia (GA), improving pain control and recovery time. This method can be applied on the brachial plexus (BP) after clavicular surgeries. However, identification of the BP from ultrasound (US) images is difficult, even for trained professionals. To address this problem, convolutional neural networks (CNNs) and more advanced deep neural networks (DNNs) can be used for identification and segmentation of the BP nerve region. In this paper, we propose a hybrid model consisting of a classification model followed by a segmentation model to segment BP nerve regions in ultrasound images. A CNN model is employed as a classifier to precisely select the images with the BP region. Then, a U-net or M-net model is used for the segmentation. Our experimental results indicate that the proposed hybrid model significantly improves the segmentation performance over a single segmentation model.Comment: The first two authors contributed equall

Plasma neurofilament light admission levels and development of axonal pathology in mild traumatic brain injury

Background: It is known that blood levels of neurofilament light (NF-L) and diffusion-weighted magnetic resonance imaging (DW-MRI) are both associated with outcome of patients with mild traumatic brain injury (mTBI). Here, we sought to examine the association between admission levels of plasma NF-L and white matter (WM) integrity in post-acute stage DW-MRI in patients with mTBI. Methods: Ninety-three patients with mTBI (GCS ≥ 13), blood sample for NF-L within 24 h of admission, and DW-MRI ≥ 90 days post-injury (median = 229) were included. Mean fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated from the skeletonized WM tracts of the whole brain. Outcome was assessed using the Extended Glasgow Outcome Scale (GOSE) at the time of imaging. Patients were divided into CT-positive and -negative, and complete (GOSE = 8) and incomplete recovery (GOSE < 8) groups. Results: The levels of NF-L and FA correlated negatively in the whole cohort (p = 0.002), in CT-positive patients (p = 0.016), and in those with incomplete recovery (p = 0.005). The same groups showed a positive correlation with mean MD, AD, and RD (p < 0.001—p = 0.011). In CT-negative patients or in patients with full recovery, significant correlations were not found. Conclusion: In patients with mTBI, the significant correlation between NF-L levels at admission and diffusion tensor imaging (DTI) measurements of diffuse axonal injury (DAI) over more than 3 months suggests that the early levels of plasma NF-L may associate with the presence of DAI at a later phase of TBI

Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury

Background: There is substantial interest in blood biomarkers as fast and objective diagnostic tools for traumatic brain injury (TBI) in the acute setting. Methods: Adult patients (≥18) with TBI of any severity and indications for CT scanning and orthopaedic injury controls were prospectively recruited during 2011–2013 at Turku University Hospital, Finland. The severity of TBI was classified with GCS: GCS 13–15 was classified as mild (mTBI); GCS 9–12 as moderate (moTBI) and GCS 3–8 as severe (sTBI). Serum samples were collected within 24 hours of admission and biomarker levels analysed with high-performance kits. The ability of biomarkers to distinguish between severity of TBI and CT-positive and CT-negative patients was assessed. Results: Among 189 patients recruited, neurofilament light (NF-L) was obtained from 175 patients with TBI and 40 controls. S100 calcium-binding protein B (S100B), heart fatty-acid binding protein (H-FABP) and interleukin-10 (IL-10) were analysed for 184 patients with TBI and 39 controls. There were statistically significant differences between levels of all biomarkers between the severity classes, but none of the biomarkers distinguished patients with moTBI from patients with sTBI. Patients with mTBI discharged from the ED had lower levels of IL-10 (0.26, IQR=0.21, 0.39 pg/mL), H-FABP (4.15, IQR=2.72, 5.83 ng/mL) and NF-L (8.6, IQR=6.35, 15.98 pg/mL) compared with those admitted to the neurosurgical ward, IL-10 (0.55, IQR=0.31, 1.42 pg/mL), H-FABP (6.022, IQR=4.19, 20.72 ng/mL) and NF-L (13.95, IQR=8.33, 19.93 pg/mL). We observed higher levels of H-FABP and NF-L in older patients with mTBI. None of the biomarkers or their combinations was able to distinguish CT-positive (n=36) or CT-negative (n=58) patients with mTBI from controls. Conclusions: S100B, H-FABP, NF-L and IL-10 levels in patients with mTBI were significantly lower than in patients with moTBI and sTBI but alone or in combination, were unable to distinguish patients with mTBI from orthopaedic controls. This suggests these biomarkers cannot be used alone to diagnose mTBI in trauma patients in the acute setting. Data availability statement: Data are available on reasonable request. De-identified clinical, imaging and biochemical data not published within the article can be shared with a qualified investigator by request

Derivation of the method of characteristics for the fluid dynamic solution of flow advection along porous wall channels

This paper describes in detail a novel formulation of the method of characteristics for its application to solve one-dimensional compressible unsteady non-homentropic flow advected along porous wall channels. In particular, the method is implemented into a wall-flow monolith Diesel particulate filter model whose purpose is the pressure drop prediction. The flow inside the monolith channels is considered to be one-dimensional and the flow through the porous wall treated as a source term agree with the Darcy's law. The flow dynamic behaviour at internal nodes of the channels is solved by means of shock capturing methods, whereas the end nodes, or boundary conditions, are solved applying the method of characteristics. The derived solution in this study of the Riemann variables and the entropy level includes the variation along the space-time plane due to cross-section area changes, friction and heat transfer as traditionally stated, but also takes into account the key influence on every line of the flow leaving or entering to the channels through the porous walls. © 2011 Elsevier Inc.Desantes Fernández, JM.; Serrano Cruz, JR.; Arnau Martínez, FJ.; Piqueras Cabrera, P. (2012). Derivation of the method of characteristics for the fluid dynamic solution of flow advection along porous wall channels. Applied Mathematical Modelling. 36:3134-3152. doi:10.1016/j.apm.2011.09.090S313431523

Admission Levels of Interleukin 10 and Amyloid β 1–40 Improve the Outcome Prediction Performance of the Helsinki Computed Tomography Score in Traumatic Brain Injury

BACKGROUND: Blood biomarkers may enhance outcome prediction performance of head computed tomography scores in traumatic brain injury (TBI). OBJECTIVE: To investigate whether admission levels of eight different protein biomarkers can improve the outcome prediction performance of the Helsinki computed tomography score (HCTS) without clinical covariates in TBI. MATERIALS AND METHODS: ighty-two patients with computed tomography positive TBIs were included in this study. Plasma levels of β-amyloid isoforms 1–40 (Aβ40) and 1–42 (Aβ42), glial fibrillary acidic protein, heart fatty acid-binding protein, interleukin 10 (IL-10), neurofilament light, S100 calcium-binding protein B, and total tau were measured within 24 h from admission. The patients were divided into favorable (Glasgow Outcome Scale—Extended 5–8, n = 49) and unfavorable (Glasgow Outcome Scale—Extended 1–4, n = 33) groups. The outcome was assessed 6–12 months after injury. An optimal predictive panel was investigated with the sensitivity set at 90–100%. RESULTS: The HCTS alone yielded a sensitivity of 97.0% (95% CI: 90.9–100) and specificity of 22.4% (95% CI: 10.2–32.7) and partial area under the curve of the receiver operating characteristic of 2.5% (95% CI: 1.1–4.7), in discriminating patients with favorable and unfavorable outcomes. The threshold to detect a patient with unfavorable outcome was an HCTS > 1. The three best individually performing biomarkers in outcome prediction were Aβ40, Aβ42, and neurofilament light. The optimal panel included IL-10, Aβ40, and the HCTS reaching a partial area under the curve of the receiver operating characteristic of 3.4% (95% CI: 1.7–6.2) with a sensitivity of 90.9% (95% CI: 81.8–100) and specificity of 59.2% (95% CI: 40.8–69.4). CONCLUSION: Admission plasma levels of IL-10 and Aβ40 significantly improve the prognostication ability of the HCTS after TBI