Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Deformasjonsanalyse, skadekartlegging og klassifisering av Gisundbrua

Denne rapporten omhandler modellering og analyse av Gisundbrua, med NovaFrame somhovedverktøy. Dette er ei fritt-frambygg bru fra 1970-tallet, som grunnet storenedbøyninger har blitt skadet og fått svekket funksjonalitet. I analysen er det fokusert på nøyaktig modellering av kryp, som er en sterk bidragsyter til langtidsdeformasjoner i betongkonstruksjoner. Delkrypmetoden har blitt manuelt implementert i NovaFrame.Beregninger av kryp, svinn og forspenningstap i brua, slik den er i arbeidstegningene, gir nedbøyninger på 450mm midt i begge hovedspennene over en periode på ca 40 år. For åjevne ut brubanen etter unøyaktig utbygging ble det lagt ekstra asfaltbelegg i det ene hovedspennet. Effekten av dette har blitt analysert i NovaFrame og gir en ytterligere nedbøyning på 70 mm midt i feltet. Når de to nevnte bidrag legges sammen stemmer det godt med måltenedbøyninger, dermed kan den ekstra asfalten fastslås som en fremtredende skadeårsak.Kragarmene i FFB-delen av brua er sammenkoblet med ledd. Nedbøyning medfører da atbegge kragarmene roterer innover slik at fugen i overkant av tverrsnittet trykkes sammen.Sammenligninger av resultatene fra NovaFrame med prosjekterte overhøyder for kryp, viserat det er tydelige forskjeller mellom beregningsmetodene som ble brukt da brua bleprosjektert og de som er benyttet i denne oppgaven. Den gamle metoden later til åoverestimere krypdeformasjonene i forhold til realiteten.Brua er klassifisert og påvist å tåle Bk10 ved kontroll av momentkapasitet i ULS. Største utnyttelsesgrad er på 93% over støtten mellom de to hovedspennene

Hvordan kan sykepleier opprettholde en profesjonell rolle ovenfor en pasient med borderline som over tid er innlagt på et psykiatrisk sykehus?

NORSK: Introduksjon: Utdanningsbakgrunn og ferdigheter for å utøve kompetent sykepleie ligger til grunn for en profesjonell sykepleier (Travelbee 2010). En profesjonell sykepleier må bygge sin omsorg på faglig og moralsk forsvarlighet (Kristoffersen og Nortvedt 2011). Hensikt: Få økt kompetanse og forståelse for pasienter med borderline personlighetsforstyrrelse og belyse viktigheten rundt opprettholdelsen av profesjonell rolle, med sikte på hvilke utfordringer sykepleier står ovenfor i samhandling med pasienten. Metode: Systematisk søk i databaser. Valg av litteratur er vurdert med kritisk blikk, analysert og deler fra studiene ble satt sammen til en ny tekst (Forsberg og Wengström 2013). Nøkkelord: Profesjonell rolle, borderline personlighetsforstyrrelse, og innlagt. Hovedresultat: Det blir kjent gjennom flere artikler at sykepleiere ser det utfordrende å forholde seg til pasienter med borderline (Ma m.fl. 2009, Bodner m.fl. 2011, Treloar 2009). Konklusjon: Litteraturen sier det kan være utfordrende for sykepleiere å opprettholde en profesjonell rolle i relasjon med pasientgruppen

How can a nurse maintain a professional role above a patient with borderline which over time is hospitalized in a psychiatric hospital?

NORSK: Introduksjon: Utdanningsbakgrunn og ferdigheter for å utøve kompetent sykepleie ligger til grunn for en profesjonell sykepleier (Travelbee 2010). En profesjonell sykepleier må bygge sin omsorg på faglig og moralsk forsvarlighet (Kristoffersen og Nortvedt 2011). Hensikt: Få økt kompetanse og forståelse for pasienter med borderline personlighetsforstyrrelse og belyse viktigheten rundt opprettholdelsen av profesjonell rolle, med sikte på hvilke utfordringer sykepleier står ovenfor i samhandling med pasienten. Metode: Systematisk søk i databaser. Valg av litteratur er vurdert med kritisk blikk, analysert og deler fra studiene ble satt sammen til en ny tekst (Forsberg og Wengström 2013). Nøkkelord: Profesjonell rolle, borderline personlighetsforstyrrelse, og innlagt. Hovedresultat: Det blir kjent gjennom flere artikler at sykepleiere ser det utfordrende å forholde seg til pasienter med borderline (Ma m.fl. 2009, Bodner m.fl. 2011, Treloar 2009). Konklusjon: Litteraturen sier det kan være utfordrende for sykepleiere å opprettholde en profesjonell rolle i relasjon med pasientgruppen.ENGLISH: Introduction: Education background to practice skilled nursing is the basis for a professional nurse (Travelbee 2010). A professional nurse must base their care on justifiability and morally defensible (Kristoffersen and Nortvedt 2011). Purpose: Provide increased competence and understanding of patients with borderline personality disorder and highlight the importance surrounding the maintenance of a professional role, aimed at the challenges nurses face in interactions with patients. Method: Systematic database searches. Selection of literature considered by a critical sight, analyzed and parts from the studies were combined into a new text (Forsberg and Wengström 2013). Keywords: Professional role, borderline personality disorder and hospitalized. Main Results: It has been known through several articles that many nurses find it challenging to deal with patients with borderline (Ma m.fl. 2009, Bodner m.fl. 2011, Treloar 2009) Conclusion: The literature claim that it can be challenging for nurses to maintain a professional role in relation with the patient group

Exercise in vivo marks human myotubes in vitro: Training-induced increase in lipid metabolism.

BACKGROUND AND AIMS:Physical activity has preventive as well as therapeutic benefits for overweight subjects. In this study we aimed to examine effects of in vivo exercise on in vitro metabolic adaptations by studying energy metabolism in cultured myotubes isolated from biopsies taken before and after 12 weeks of extensive endurance and strength training, from healthy sedentary normal weight and overweight men. METHODS:Healthy sedentary men, aged 40-62 years, with normal weight (body mass index (BMI) < 25 kg/m2) or overweight (BMI ≥ 25 kg/m2) were included. Fatty acid and glucose metabolism were studied in myotubes using [14C]oleic acid and [14C]glucose, respectively. Gene and protein expressions, as well as DNA methylation were measured for selected genes. RESULTS:The 12-week training intervention improved endurance, strength and insulin sensitivity in vivo, and reduced the participants' body weight. Biopsy-derived cultured human myotubes after exercise showed increased total cellular oleic acid uptake (30%), oxidation (46%) and lipid accumulation (34%), as well as increased fractional glucose oxidation (14%) compared to cultures established prior to exercise. Most of these exercise-induced increases were significant in the overweight group, whereas the normal weight group showed no change in oleic acid or glucose metabolism. CONCLUSIONS:12 weeks of combined endurance and strength training promoted increased lipid and glucose metabolism in biopsy-derived cultured human myotubes, showing that training in vivo are able to induce changes in human myotubes that are discernible in vitro

Effects of 12 weeks of exercise on myotube AMPKα phosphorylation.

<p>Satellite cells isolated from biopsies from <i>m</i>. <i>vastus lateralis</i> before and after 12 weeks of exercise were cultured and differentiated to myotubes. <b>(A-C)</b> AMPKα phosphorylation by immunoblotting. Protein was isolated and total AMPKα and pAMPKα expressions assessed by immunoblotting. A, one representative immunoblot. Bands selected from one membrane have been spliced together to show only relevant samples, as indicated by lines separating the spliced blots. B, quantified immunoblots for participants combined (n = 9) relative to before exercise. C, quantified immunoblots for study group when separated by BMI relative to normal weight before exercise (n = 5 in the normal weight group and n = 4 in the overweight group). Values are presented as means ± SEM. All samples were derived at the same time and processed in parallel.</p

Clinical and biochemical variables in normal weight (BMI < 25 kg/m²) and overweight men (BMI ≥ 25 kg/m²) at baseline (pre-training) and after 12 weeks of extensive endurance and strength training (post-training).

<p>Clinical and biochemical variables in normal weight (BMI < 25 kg/m²) and overweight men (BMI ≥ 25 kg/m²) at baseline (pre-training) and after 12 weeks of extensive endurance and strength training (post-training).</p

Effects of 12 weeks of exercise on mitochondria-related genes and proteins.

<p>Satellite cells isolated from biopsies from <i>m</i>. <i>vastus lateralis</i> before and after 12 weeks of exercise were cultured and differentiated to myotubes. <b>(A)</b> mRNA expression of <i>PPARGC1A</i>, <i>PDK4</i>, <i>CPT1A</i>, and <i>CYC1</i> after exercise relative to before exercise. mRNA was isolated and expression assessed by qPCR. All values were corrected for the housekeeping control <i>GAPDH</i>, and presented as means ± SEM for all participants combined (n = 18). <b>(B)</b> mRNA expression of <i>PPARGC1A</i>, <i>PDK4</i>, <i>CPT1A</i>, and <i>CYC1</i> after exercise relative to before exercise in study group when separated by BMI. mRNA was isolated and expression assessed by qPCR. All values were corrected for the housekeeping control <i>GAPDH</i>, and presented as means ± SEM (n = 7 in the normal weight group and n = 11 in the overweight group). <b>(C)</b> Pearson’s test of correlation was performed between exercise-induced changes in visceral fat area and mRNA expression of <i>PDK4</i> in myotubes. Δ = after exercise–before exercise. Full line represents the regression line for all donors (n = 18, Pearson’s correlation coefficient, r = -0.54, and <i>p</i> = 0.02), whereas stapled line represents the regression line for the overweight group (n = 11, Pearson’s correlation coefficient, r = -0.63, and <i>p</i> = 0.04). <b>(D)</b> DNA methylation of <i>PPARGC1A</i>, <i>PDK4</i> and <i>TFAM</i> after exercise relative to before exercise. gDNA was isolated and bisulfite treated, and methylation assessed by immunoblotting. Values are presented as means ± SEM (n = 6). <b>(E-G)</b> OXPHOS complexes by immunoblotting. Protein was isolated and OXPHOS complexes assessed by immunoblotting. E, one representative immunoblot. F, quantified immunoblots of complex V for participants combined. All values were corrected for the housekeeping control α-tubulin, and presented as means ± SEM (n = 10). G, quantified immunoblots of complex V in study group when separated by BMI. All values were corrected for the housekeeping control α-tubulin, and presented as means ± SEM (n = 5 in each group).</p

Effects of 12 weeks of exercise on myotube fatty acid metabolism.

<p>Satellite cells isolated from biopsies from <i>m</i>. <i>vastus lateralis</i> before and after 12 weeks of exercise were cultured and differentiated to myotubes. Oxidation, cell-associated (CA) radioactivity and lipid accumulation of [¹⁴C]oleic acid were measured, and total cellular uptake (CO₂+CA), oxidation (CO₂), fractional oxidation (), and lipid accumulation were determined. <b>(A)</b> Lipid accumulation presented as cpm/μg protein. Values are presented as means ± SEM for all participants combined (n = 18). <b>(B)</b> Oleic acid oxidation and total cellular uptake presented as nmol/mg protein. Values are presented as means ± SEM for all participants combined (n = 18). <b>(C)</b> Fractional oleic acid oxidation. Values are presented as means ± SEM for all participants combined (n = 18). <b>(D)</b> Fatty acid metabolism relative to before exercise. Values are presented as means ± SEM for all participants combined (n = 18). <b>(E)</b> Lipid accumulation presented as cpm/μg protein in study group when separated by BMI. Values are presented as means ± SEM (n = 7 in the normal weight group and n = 11 in the overweight group). <b>(F)</b> Oleic acid oxidation and total cellular uptake presented as nmol/mg protein in study group when separated by BMI. Values are presented as means ± SEM (n = 7 in the normal weight group and n = 11 in the overweight group). <b>(G)</b> Fractional oleic acid oxidation in absolute values in study group when separated by BMI. Values are presented as means ± SEM (n = 7 in the normal weight group and n = 11 in the overweight group). <b>(H)</b> Fatty acid metabolism relative to before exercise in study group separated by BMI. Values are presented as means ± SEM (n = 7 in the normal weight group and n = 11 in the overweight group). *Statistically significant vs. before exercise (<i>p</i> < 0.05, linear mixed-model analysis, SPSS). ^#Statistically significant vs. normal weight group after exercise (<i>p</i> < 0.05, linear mixed-model analysis, SPSS). ^$Statistically significant vs. normal weight group (<i>p</i> < 0.05, linear mixed-model analysis, SPSS).</p

Effects of 12 weeks of exercise on myotube expression of lipid metabolism associated genes.

<p>Satellite cells isolated from biopsies from <i>m</i>. <i>vastus lateralis</i> before and after 12 weeks of exercise were cultured and differentiated to myotubes. mRNA was isolated and expression assessed by qPCR. <b>(A)</b> mRNA expression after exercise relative to before exercise for all participants combined. All values were corrected for the housekeeping control <i>GAPDH</i>, and presented as means ± SEM (n = 18). <b>(B)</b> mRNA expression after exercise relative to before exercise for study group when separated by BMI. All values were corrected for the housekeeping control <i>GAPDH</i>, and presented as means ± SEM (n = 7 in the normal weight group and n = 11 in the overweight group).</p