674 research outputs found
Blood loss in primary total knee arthroplasty-body temperature is not a significant risk factor-a prospective, consecutive, observational cohort study
BACKGROUND: Hypothermia related to anaesthesia and operating theatre environment is associated with increased blood loss in a number of surgical disciplines, including total hip arthroplasty. The influence of patient temperature on blood loss in total knee arthroplasty (TKA) has not been previously studied. METHODS: We recorded patient axillary temperature in the peri-operative period, up to 24 h post-operatively, and analysed the effect on transfusion rate and blood loss from a consecutive cohort of 101 patients undergoing primary TKA. RESULTS: No relationship between peri-operative patient temperature and blood loss was found within the recorded patient temperature range of 34.7–37.8 °C. Multivariable analysis found increasing age, surgical technique, type of anaesthesia and the use of anti-platelet and anticoagulant medications as significant factors affecting blood loss following TKA. CONCLUSION: Patient temperature within a clinically observed range does not have a significant impact on blood loss in primary TKA patients. As long as patient temperature is maintained within a reasonable range during the intra-operative and post-operative periods, strategies other than rigid temperature control above 36.5 °C may be more effective in reducing blood loss following TKA
Detection of Radioactive Isotopes from the Fukushima Daiichi Nuclear Power Plant in the Kittitas Valley of Washington State
Following the Fukushima Daiichi nuclear power plant disaster in March, 2011, various radioactive isotopes were emitted from the plant [Ewing, 2011]. We hypothesized that emissions would bind to particulate matter, which then could be dispersed by wind currents and deposited across the planet. We analyzed an aerosol sample collected with a high volume cascade impactor in the Kittitas Valley of Washington state. NaI(Tl) gamma spectrometry revealed the presence of the isotopes 132Te and 131I, consistent with the type of nuclear accident at Fukushima Daiichi
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Psychotropic Medication Use and Mortality in Long-Term Care Residents
This chapter examines associations between psychotropic medications and mortality in long-term care home (LTCH) settings. We report new findings with census-level data from all new admissions to long-term care homes in the province of Ontario, Canada (i.e., 20,414 new residents). The data include three linked sets that indicate mortality during the financial years 2010–2011 and 2011–2012. One dataset, the Resident Assessment Instrument 2.0 (RAI 2.0), provides information on demographics, functional capability, clinical conditions, clinical diagnoses, mortality risk, and psychotropic medications. The latter include antipsychotics, antidepressants, analgesics, anxiolytics, and hypnotics. Administration of the RAI 2.0 occurs at resident intake, at quarterly intervals and annually. New analyses reported here examine predictors of daily and pro re nata (i.e., PRN or “as needed”) prescriptions of psychotropic medications. However, the most important analyses concern predictors of mortality within intervals of up to 90 days from the final RAI 2.0 assessment. After control for confounding variables, the findings indicate (1) attenuated mortality with daily prescription of frequently prescribed psychotropics (i.e., antipsychotics, antidepressants, and analgesics), (2) augmented mortality with PRN prescriptions for each type of psychotropic medication, and (3) evidence that PRN prescribing overturns beneficial effects of daily prescriptions, whereas the latter reduces the deleterious effects of PRN prescribing
26-hour Storage of a Declined Liver Before Successful Transplantation Using Ex Vivo Normothermic Perfusion.
This is the author accepted manuscript. The final version is available at http://dx.doi.org/10.1097/SLA.000000000000183
Effects of Antipsychotic Medication on Mortality in Long-Term Care Home Residents
This chapter examines mortality in long-term care home (LTCH) residents as associated with the use antipsychotic medication when combined with other psychotropic medications. The data at census-level pertain to all new admissions to long-term care homes (LTCH) in Ontario, Canada, during a given financial year (i.e., over 20,000 LTCH residents). The observations include comprehensive assessment upon admission and at quarterly intervals thereafter for a maximal period of 1-year after the initial assessment. The mortality data derive from three linked databases, with mortality classified as death within 90 days of the final assessment. The findings indicate that combinations of concurrent daily usage of antipsychotic medication with daily usage of other psychotropic medications (particularly antidepressants and analgesics) are associated with relatively low mortality, whereas intermittent usage (e.g. pro re nata; as needed) is associated with relatively high mortality
Detection of Radioactive Isotopes from the Fukushima Daiichi Nuclear Power Plant in the Kittitas Valley of Washington State
Following the Fukushima Daiichi nuclear power plant disaster in March, 2011, various radioactive isotopes were emitted from the plant [Ewing, 2011]. We hypothesized that emissions would bind to particulate matter, which then could be dispersed by wind currents and deposited across the planet. We analyzed an aerosol sample collected with a high volume cascade impactor in the Kittitas Valley of Washington state. NaI(Tl) gamma spectrometry revealed the presence of the isotopes 132Te and 131I, consistent with the type of nuclear accident at Fukushima Daiichi
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Observations on the ex situ perfusion of livers for transplantation.
Normothermic ex situ liver perfusion might allow viability assessment of livers before transplantation. Perfusion characteristics were studied in 47 liver perfusions, of which 22 resulted in transplants. Hepatocellular damage was reflected in the perfusate transaminase concentrations, which correlated with posttransplant peak transaminase levels. Lactate clearance occurred within 3 hours in 46 of 47 perfusions, and glucose rose initially during perfusion in 44. Three livers required higher levels of bicarbonate support to maintain physiological pH, including one developing primary nonfunction. Bile production did not correlate with viability or cholangiopathy, but bile pH, measured in 16 of the 22 transplanted livers, identified three livers that developed cholangiopathy (peak pH 7.5). In the 11 research livers where it could be studied, bile pH > 7.5 discriminated between the 6 livers exhibiting >50% circumferential stromal necrosis of septal bile ducts and 4 without necrosis; one liver with 25-50% necrosis had a maximum pH 7.46. Liver viability during normothermic perfusion can be assessed using a combination of transaminase release, glucose metabolism, lactate clearance, and maintenance of acid-base balance. Evaluation of bile pH may offer a valuable insight into bile duct integrity and risk of posttransplant ischemic cholangiopathy
Iron Overload and Diabetes Risk: A Shift From Glucose to Fatty Acid Oxidation and Increased Hepatic Glucose Production in a Mouse Model of Hereditary Hemochromatosis
OBJECTIVE Excess tissue iron levels are a risk factor for diabetes, but the mechanisms underlying the association are incompletely understood. We previously published that mice and humans with a form of hereditary iron overload, hemochromatosis, exhibit loss of beta-cell mass. This effect by itself is not sufficient, however, to fully explain the diabetes risk phenotype associated with all forms of iron overload.
RESEARCH DESIGN AND METHODS We therefore examined glucose and fatty acid metabolism and hepatic glucose production in vivo and in vitro in a mouse model of hemochromatosis in which the gene most often mutated in the human disease, HFE, has been deleted (Hfe(-/-)).
RESULTS Although Hfe(-/-) mice exhibit increased glucose uptake in skeletal muscle, glucose oxidation is decreased and the ratio of fatty acid to glucose oxidation is increased. On a high-fat diet, the Hfe(-/-) mice exhibit increased fatty acid oxidation and are hypermetabolic. The decreased glucose oxidation in skeletal muscle is due to decreased pyruvate dehydrogenase (PDH) enzyme activity related, in turn, to increased expression of PDH kinase 4 (pdk4). Increased substrate recycling to liver contributes to elevated hepatic glucose production in the Hfe(-/-) mice.
CONCLUSIONS Increased hepatic glucose production and metabolic inflexibility, both of which are characteristics of type 2 diabetes, may contribute to the risk of diabetes with excessive tissue iron
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