Effect of Dexmedetomidine on Incidence of Emergence Delirium in Adult Nasal Surgery

Background/Purpose/Question.  Emergence delirium (ED) is an acute phenomenon that develops in the early phase of recovery from general anesthesia, and characterized by confusion, disorientation, & possible violent behavior, and is a common occurrence particularly with nasal surgery. Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that results in anxiolysis, sedation, analgesia, and sympatholysis without depressing ventilation. This educational scholarly project aimed to review the literature and investigate the effect of intraoperative dexmedetomidine on the incidence of ED in adults recovering from general anesthesia after nasal surgery. Methods/Evidence Search.  PubMed and EMBASE were structurally searched from 2011 to 2021. Five randomized controlled studies (RCT) were selected that compared intraoperative dexmedetomidine to a placebo and how the recovery profile was affected in adults after nasal surgery. Key search terms included “anesthesia”, “dexmedetomidine”, “emergence”, “nasal surgery”. Synthesis of Literature/Results/Discussion.  There were collectively 392 participants across these five studies, and the incidence of ED in dexmedetomidine groups was significantly lower than control groups (respectively 21% vs. 50%). The mean arterial pressure (MAP) and heart rate (HR) among dexmedetomidine groups exhibited less variability during emergence without hypotension, which indicates a more stable hemodynamic profile. Analgesic and antiemetic requirements in the post-anesthesia care unit (PACU) were decreased in dexmedetomidine groups, however these results were not statistically significant. Conclusion/Recommendations for Practice.  Intraoperative dexmedetomidine significantly decreases the incidence of ED. Secondary effects, like hemodynamic stability and analgesia, were observed, but these qualities need to be further studied before they can be generalized. Overall, dexmedetomidine is a safe and effective anesthetic adjunct that facilitates a smoother emergence after nasal surgery without any complications. Keywords: Anesthesia, dexmedetomidine, emergence, nasal surger

Identifying body parameters of Arenicola marina based on the diameter of fecal strings

The lugworm Arenicola marina is a widely distributed inhabitant of the Wadden Sea along North European coasts. The worm resides inside a u-shaped tube, subsisting sand from one opening and leaving fecal strings of digested sand on the other one. We investigated a possible correlation between the diameter of fecal strings and body parameters of the lugworm: length, diameter and weight. These findings could be useful for fishermen and other biologists investigating the lugworm. Specimens collected in the field were examined in the lab or studied in a custom made aquarium for analysis of the diameter of fecal strings under labora- tory conditions. A linear correlation between all three parameters and the diameter of fecal strings could be determined, whether data was acquired in the lab or out in the field. Nonetheless, length and weight are variable and uncertain values, thus, the diameter of fecal strings leads utmost to an accurate conclusion about the diameter of the lugworm. These findings complement other investigations of height and abundance of fecal mounds.Der Wattwurm Arenicola marina ist ein weit verbreiteter Bewohner des Wattenmeeres entlang der nordeuropäischen Küsten. Der Wurm befindet sich in einem U-förmigen Rohr, bestehend aus Sand aus einer Öffnung und hinterlässt Fäkalien aus verdautem Sand auf der anderen. Wir untersuchten einen möglichen Zusammenhang zwischen dem Durchmesser der Fäkalfäden und den Körperparametern des Wattwurms: Länge, Durchmesser und Gewicht. Diese Erkenntnisse könnten für Fischer und andere Biologen von Nutzen sein, die den Wattwurm untersuchen. Im Freiland gesammelte Proben wurden im Labor untersucht oder in einem speziell angefertigten Aquarium untersucht, um den Durchmesser von Fäkalienfäden unter Laborbedingungen zu bestimmen. Es konnte ein linearer Zusammenhang zwischen allen drei Parametern und dem Durchmesser der Fäkalien festgestellt werden, unabhängig davon, ob die Daten im Labor oder im Feld gewonnen wurden. Länge und Gewicht sind jedoch variable und unsichere Werte, so dass der Durchmesser von Fäkalienfäden weitestgehend zu einer genauen Aussage über den Durchmesser des Wattwurms führt. Diese Befunde ergänzen andere Untersuchungen zur Höhe und Häufigkeit von Fäkalienhügeln.Peer Reviewe

Isotopic discontinuities in ground water beneath Yucca Mountain

ABSTRACT Analytical data for stable isotopes in ground water from beneath Yucca Mountain, when examined in map view, show area! patterns of heterogeneity that can be interpreted in terms of mixing of at least three end members. One end member must be isotopically heavy in terms of hydrogen and oxygen and have a young apparent 14 C age such as water found at the north end of Yucca Mountain beneath Fortymile Wash. A second end member must contain isotopically heavy carbon and have an old apparent U C age such as water from the Paleozoic aquifer. The third end member cannot be tightly defined. It must be isotopically lighter than the first with respect of hydrogen and oxygen and be intermediate to the first and second end members with respect to both apparent W C age and ft i3 C. The variable isatopic compositions of hydrogen and oxygen indicate that two of the end members are waters, but the variable carbon isotopic composition could represent either a third water end member or reaction of water with a carbon-bearing solids such as caldte

Highly purified human-derived follicle-stimulating hormone (Bravelle®) has equivalent efficacy to follitropin-beta (Follistim ®) in infertile women undergoing in vitro fertilization

BACKGROUND: These data compare the efficacy and safety of highly purified human-derived follicle-stimulating hormone (Bravelle(R)) and recombinant follitropin-β (Follistim(R)) in women undergoing in vitro fertilization. METHODS: This report describes the pooled data from two, nearly identical, randomized, controlled, parallel-group, multicenter studies conducted in a total of 19 academic and private IVF-ET centers in the United States. Infertile premenopausal women underwent pituitary down-regulation using leuprolide acetate followed by a maximum of 12 days of subcutaneous Bravelle(R) (n = 120) or Follistim(R) (n = 118), followed by administration of human chorionic gonadotropin, oocyte retrieval and embryo transfer. The primary efficacy measure was the mean number of oocytes retrieved; secondary efficacy measures included the total dose and duration of gonadotropin treatment; peak serum estradion levels; embryo transfer and implantation rates; chemical, clinical and continuing pregnancies; and live birth rates. All adverse events were recorded and injection site pain was recorded daily using a patient, self-assessment diary. RESULTS: Similar efficacy responses were observed for all outcome parameters in the two treatment groups. Although patients receiving Bravelle(R) consistently reported a greater number of chemical, clinical and continuing pregnancies, as well as an increased rate of live birth, the data did not attain statistical significance (P > 0.05). The overall incidence of adverse events was similar in both groups, but compared to Follistim(R), injections of Bravelle(R) were reported by patients to be significantly less painful (P < 0.001). CONCLUSIONS: Bravelle(R) and Follistim(R) had comparable efficacy in controlled ovarian hyperstimulation in women undergoing IVF-ET. There were no differences in the nature or number of adverse events between the treatment groups although Bravelle(R) injections were reported to be significantly less painful

Status of understanding of the saturated-zone ground-water flow system at Yucca Mountain, Nevada, as of 1995

Yucca Mountain, which is being studied extensively because it is a potential site for a high-level radioactive-waste repository, consists of a thick sequence of volcanic rocks of Tertiary age that are underlain, at least to the southeast, by carbonate rocks of Paleozoic age. Stratigraphic units important to the hydrology of the area include the alluvium, pyroclastic rocks of Miocene age (the Timber Mountain Group; the Paintbrush Group; the Calico Hills Formation; the Crater Flat Group; the Lithic Ridge Tuff; and older tuffs, flows, and lavas beneath the Lithic Ridge Tuff), and sedimentary rocks of Paleozoic age. The saturated zone generally occurs in the Calico Hills Formation and stratigraphically lower units. The saturated zone is divided into three aquifers and two confining units. The flow system at Yucca Mountain is part of the Alkali Flat-Furnace Creek subbasin of the Death Valley groundwater basin. Variations in the gradients of the potentiometric surface provided the basis for subdividing the Yucca Mountain area into zones of: (1) large hydraulic gradient where potentiometric levels change at least 300 meters in a few kilometers; (2) moderate hydraulic gradient where potentiometric levels change about 45 meters in a few kilometers; and (3) small hydraulic gradient where potentiometric levels change only about 2 meters in several kilometers. Vertical hydraulic gradients were measured in only a few boreholes around Yucca Mountain; most boreholes had little change in potentiometric levels with depth. Limited hydraulic testing of boreholes in the Yucca Mountain area indicated that the range in transmissivity was more than 2 to 3 orders of magnitude in a particular hydrogeologic unit, and that the average values for the individual hydrogeologic units generally differed by about 1 order of magnitude. The upper volcanic aquifer seems to be the most permeable hydrogeologic unit, but this conclusion was based on exceedingly limited data

Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome

Background The polycystic ovary syndrome is a common cause of infertility. Clomiphene and insulin sensitizers are used alone and in combination to induce ovulation, but it is unknown whether one approach is superior. Methods We randomly assigned 626 infertile women with the polycystic ovary syndrome to receive clomiphene citrate plus placebo, extended-release metformin plus placebo, or a combination of metformin and clomiphene for up to 6 months. Medication was discontinued when pregnancy was confirmed, and subjects were followed until delivery. Results The live-birth rate was 22.5% (47 of 209 subjects) in the clomiphene group, 7.2% (15 of 208) in the metformin group, and 26.8% (56 of 209) in the combinationtherapy group (P\u3c0.001 for metformin vs. both clomiphene and combination therapy; P=0.31 for clomiphene vs. combination therapy). Among pregnancies, the rate of multiple pregnancy was 6.0% in the clomiphene group, 0% in the metformin group, and 3.1% in the combination-therapy group. The rates of first-trimester pregnancy loss did not differ significantly among the groups. However, the conception rate among subjects who ovulated was significantly lower in the metformin group (21.7%) than in either the clomiphene group (39.5%, P=0.002) or the combinationtherapy group (46.0%, P\u3c0.001). With the exception of pregnancy complications, adverse-event rates were similar in all groups, though gastrointestinal side effects were more frequent, and vasomotor and ovulatory symptoms less frequent, in the metformin group than in the clomiphene group. Conclusions Clomiphene is superior to metformin in achieving live birth in infertile women with the polycystic ovary syndrome, although multiple birth is a complication. (ClinicalTrials.gov number, NCT00068861.

Infertility and the provision of infertility medical services in developing countries

developing countrie

Gleichheit und Diskriminierung im sportlichen Wettbewerb: Möglichkeiten der Teilhabe intergeschlechtlicher Sportler*innen vor dem Hintergrund des Beschlusses des BVerfG zur personenstandsrechtlichen Anerkennung intergeschlechtlicher Menschen

Der Beitrag befasst sich mit der Verwirklichung des Rechts intergeschlechtlicher Menschen auf Teilhabe am Geschlechterbinär gestalteten Sportwettkampf. Erläutert werden verschiedene Lösungsansätze anhand des Falls der Läuferin Caster Semenya, die seit mehreren Jahren für ein unbeschränktes Teilnahmerecht an internationalen Leichtathletikwettbewerben kämpft