A Review of Pain Control in Pediatric Cardiac Bypass Surgery

Background: Children undergoing cardiac surgery with cardiopulmonary bypass receive high dose opioids for analgesia and to reduce the neurohormonal stress response. While opioids have excellent pharmacodynamics profiles adverse effects include: respiratory depression, bradycardia, nausea, vomiting, and tolerance. Additionally, opioids with short half-lives like fentanyl require several boluses to be administered during surgery causing fluctuating levels analgesia. Several strategies to advance pain control incorporate regional and neuraxial anesthetic techniques, however anticoagulation preclude its routine use. Alternatively using opioids with longer half-lives for analgesia may improve pain control and reduce adverse effects. Objective: The objective of this study is to quantify postoperative opioid requirements in pediatric patients following cardiac bypass surgery. Methods: Electronic medical records were retrospectively reviewed for 64 pediatric patients following cardiac bypass surgery at Children’s National Health System from June of 2014 through February of 2016. Intraoperative and postoperative opioid class and dose was recorded for outpatients with designation ASA class 2-4. The data was compiled and analyzed to obtain a mean and standard deviation for future study. Results: 64 cardiac surgery patients (mean age 4.3±1.7, mean weight 17.1±7.5 kg) receiving between 10-30mcg/kg of fentanyl, the mean total dose of morphine in the first 24-hour postoperative period was 0.363mg/kg, with a standard deviation of 0.239. Conclusions: The data from this internal case review of pain control in pediatric cardiac bypass surgery will be used delineate the appropriate sample size for studying postoperative pain control. This is applicable to our study that compares intraoperatively administered fentanyl to methadone on postoperative opioid requirement. This internal case review of 64 cardiac surgery patients (mean age 4.3±1.7, mean weight 17.1±7.5 kg) receiving between 10-30 mcg/kg of fentanyl showed a mean total dose of morphine in the first 24-hour postoperative period was 0.363 mg/kg, with a standard deviation of 0.239. Assuming no difference between the two treatment strategies in the population, a total sample size of 76 in each group will provide 80% power to detect a difference of 0.109 in means, using a two-sample t-test at the 0.05 significance level. The high amount of postoperative morphine required, as determined by this study, reveals the need to find alternative pain control strategies such as opioids with longer half-lives and regional techniques. Exploring the effectiveness of methadone, a long acting opioid, to reduce postoperative adverse effects is an area of future study

Relationship between sperm quality traits and field-fertility of porcine semen

An investigation involving seven boars, active in artificial insemination, and 1,350 multiparous sows was conducted at a private farm and aimed at examining the relationship between sperm quality traits and boar fertility in terms of farrowing rate and litter size. This experiment was done for 6 months. The semen samples were evaluated for subjective sperm motility and concentration. Ejaculates with at least 1 × 108 sperm/mL and 70% sperm progressive motility were extended with a commercial medium to 30 × 106 sperm/mL and used for artificial insemination (AI). AI dose was 100 mL semen containing 3 × 109 spermatozoa. Aliquots of diluted semen were assessed for live morphologically normal spermatozoa (LMNS, eosin-nigrosin stain exclusion assay) and sperm chromatin instability (SCI, acridine orange assay). Farrowing rates according to different boar sperm varied (p < 0.001) from 59.3 to 88.92%. The mean values of LMNS (47.2~76.5%) and SCI (0.16~4.67%) differed significantly among boars. LMNS (r = 0.79, p < 0.05) and SCI (r = -0.90, p < 0.02) accounted for 62.2 and 81.7% of the variability in farrowing rates, respectively. After the combination of sperm traits, the relationship between percentage of LMNS with stable chromatin structure and farrowing rate was significant (r = 0.86, p < 0.05). The number of live piglets per parturition was not significantly correlated with sperm quality attributes. In conclusion, boar fertility after AI with freshly diluted semen can be predicted based on the evaluation of sperm morphology and chromatin integrity

Mismatch negativity generation in the human 5HT2A agonist and NMDA antagonist model of psychosis

RATIONALE: Many studies have reported deficits of mismatch negativity (MMN) in schizophrenic patients. Pharmacological challenges with hallucinogens in healthy humans are used as models for psychotic states. Previous studies reported a significant reduction of MMN after ketamine (N-methyl-D-aspartate acid [NMDA] antagonist model) but not after psilocybin (5HT2A agonist model). OBJECTIVES: The aim of the present study was to directly compare the two models of psychosis using an intraindividual crossover design. MATERIALS AND METHODS: Fifteen healthy subjects participated in a randomized, double-blind, crossover study with a low and a high dose of the 5HT2A agonist dimethyltryptamine (DMT) and the NMDA antagonist S-ketamine. During electroencephalographic recording, the subjects were performing the AX-version of a continuous performance test (AX-CPT). A source analysis of MMN was performed on the basis of a four-source model of MMN generation. RESULTS: Nine subjects completed both experimental days with the two doses of both drugs. Overall, we found blunted MMN and performance deficits in the AX-CPT after both drugs. However, the reduction in MMN activity was overall more pronounced after S-ketamine intake, and only S-ketamine had a significant impact on the frontal source of MMN. CONCLUSIONS: The NDMA antagonist model and the 5HT2A agonist model of psychosis display distinct neurocognitive profiles. These findings are in line with the view of the two classes of hallucinogens modeling different aspects of psychosis

Evidence for Training-Induced Plasticity in Multisensory Brain Structures: An MEG Study

Multisensory learning and resulting neural brain plasticity have recently become a topic of renewed interest in human cognitive neuroscience. Music notation reading is an ideal stimulus to study multisensory learning, as it allows studying the integration of visual, auditory and sensorimotor information processing. The present study aimed at answering whether multisensory learning alters uni-sensory structures, interconnections of uni-sensory structures or specific multisensory areas. In a short-term piano training procedure musically naive subjects were trained to play tone sequences from visually presented patterns in a music notation-like system [Auditory-Visual-Somatosensory group (AVS)], while another group received audio-visual training only that involved viewing the patterns and attentively listening to the recordings of the AVS training sessions [Auditory-Visual group (AV)]. Training-related changes in cortical networks were assessed by pre- and post-training magnetoencephalographic (MEG) recordings of an auditory, a visual and an integrated audio-visual mismatch negativity (MMN). The two groups (AVS and AV) were differently affected by the training. The results suggest that multisensory training alters the function of multisensory structures, and not the uni-sensory ones along with their interconnections, and thus provide an answer to an important question presented by cognitive models of multisensory training

Gratings for synchrotron and FEL beamlines a project for the manufacture of ultra precise gratings at Helmholtz Zentrum Berlin

Blazed gratings are of dedicated interest for the monochromatization of synchrotron radiation when a high photon flux is required, such as, for example, in resonant inelastic X ray scattering experiments or when the use of laminar gratings is excluded due to too high flux densities and expected damage, for example at free electron laser beamlines. Their availability became a bottleneck since the decommissioning of the grating manufacture facility at Carl Zeiss in Oberkochen. To resolve this situation a new technological laboratory was established at the Helmholtz Zentrum Berlin, including instrumentation from Carl Zeiss. Besides the upgraded ZEISS equipment, an advanced grating production line has been developed, including a new ultra precise ruling machine, ion etching technology as well as laser interference lithography. While the old ZEISS ruling machine GTM 6 allows ruling for a grating length up to 170 mm, the new GTM 24 will have the capacity for 600 mm 24 inch gratings with groove densities between 50 lines mm 1 and 1200 lines mm 1. A new ion etching machine with a scanning radiofrequency excited ion beam HF source allows gratings to be etched into substrates of up to 500 mm length. For a final at wavelength characterization, a new reflectometer at a new Optics beamline at the BESSY II storage ring is under operation. This paper reports on the status of the grating fabrication, the measured quality of fabricated items by ex situ and in situ metrology, and future development goal

Tropical summer induces DNA fragmentation in boar spermatozoa: implications for evaluating seasonal infertility

Summer infertility continues to undermine pig productivity, costing the pig industry millions in annual losses. The boar’s inefficient capacity to sweat, non-pendulous scrotum and the extensive use of European breeds in tropical conditions, can make the boar particularly vulnerable to the effects of heat stress; however, the link between summer heat stress and boar sperm DNA damage has not yet been demonstrated. Semen from five Large White boars was collected and evaluated during the early dry, late dry and peak wet seasons to determine the effect of seasonal heat stress on the quality and DNA integrity of boar spermatozoa. DNA damage in spermatozoa during the peak wet was 16-fold greater than during the early dry and nearly 9-fold greater than during the late dry season. Sperm concentration was 1.6-fold lower in the peak wet than early dry whereas no difference was found across several motility parameters as determined by computer-assisted sperm analysis. These results demonstrate that tropical summer (peak wet season) induces DNA damage and reduces concentration without depressing motility in boar spermatozoa, suggesting that traditional methods of evaluating sperm motility may not detect inherently compromised spermatozoa. Boar management strategies (such as antioxidant supplementation) need to be developed to specifically mitigate this problem

Cerebral cortical thickness in chronic pain due to knee osteoarthritis: the effect of pain duration and pain densitization

Objective This study investigates associations between cortical thickness and pain duration, and central sensitization as markers of pain progression in painful knee osteoarthritis. Methods Whole brain cortical thickness and pressure pain thresholds were assessed in 70 participants; 40 patients with chronic painful knee osteoarthritis (age = 66.1± 8.5 years, 21 females, mean duration of pain = 8.5 years), and 30 healthy controls (age = 62.7± 7.4, 17 females). Results Cortical thickness negatively correlated with pain duration mainly in fronto-temporal areas outside of classical pain processing areas (p<0.05, age-controlled, FDR corrected). Pain sensitivity was unrelated to cortical thickness. Patients showed lower cortical thickness in the right anterior insula (p<0.001, uncorrected) with no changes surviving multiple test correction. Conclusion With increasing number of years of suffering from chronic arthritis pain we found increasing cortical thinning in extended cerebral cortical regions beyond recognised pain-processing areas. While the mechanisms of cortical thinning remain to be elucidated, we show that pain progression indexed by central sensitization does not play a major role