The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery - a prospective randomized trial.

UNLABELLED: ABSTRACT: BACKGROUND: Intravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, particularly nausea and vomiting. The optimum fluid regimen has not been established. This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann\u27s Solution). METHODS: 120 patients were randomized to receive intravenous colloid (N = 60) or crystalloid (N = 60) intra-operatively. The volume of fluid administered was calculated at 1.5 ml.kg-1 per hour of fasting. Patients were interviewed to assess nausea, vomiting, anti-emetic use, dizziness, sore throat, headache and subjective general well being at 30 minutes and 2, 24 and 48 hours post operatively. Pulmonary function testing was performed on a subgroup. RESULTS: At 2 hours the proportion of patients experiencing nausea (38.2 % vs 17.9%, P = 0.03) and the mean nausea score were increased in the colloid compared to crystalloid group respectively (1.49 ± 0.3 vs 0.68 ± 0.2, P = 0.028). The incidence of vomiting and anti-emetic usage was low and did not differ between the groups. Sore throat, dizziness, headache and general well being were not different between the groups. A comparable reduction on post-operative FVC and FEV-1 and PEFR was observed in both groups. CONCLUSIONS: Intra-operative administration of colloid increased the incidence of early postoperative nausea and has no advantage over crystalloid for symptom control after gynaecological laparoscopic surgery

Histone deacetylase inhibitors: potential targets responsible for their anti-cancer effect

The histone deacetylase inhibitors (HDACi) have demonstrated anticancer efficacy across a range of malignancies, most impressively in the hematological cancers. It is uncertain whether this clinical efficacy is attributable predominantly to their ability to induce apoptosis and differentiation in the cancer cell, or to their ability to prime the cell to other pro-death stimuli such as those from the immune system. HDACi-induced apoptosis occurs through altered expression of genes encoding proteins in both intrinsic and extrinsic apoptotic pathways; through effects on the proteasome/aggresome systems; through the production of reactive oxygen species, possibly by directly inducing DNA damage; and through alterations in the tumor microenvironment. In addition HDACi increase the immunogenicity of tumor cells and modulate cytokine signaling and potentially T-cell polarization in ways that may contribute the anti-cancer effect in vivo. Here, we provide an overview of current thinking on the mechanisms of HDACi activity, with attention given to the hematological malignancies as well as scientific observations arising from the clinical trials. We also focus on the immune effects of these agents

Publication rates of, and attitudes toward, summer research projects: 10-year experience from a single institution in New Zealand

Yassar Alamri,1 William Currie,2 Kate Magner,1 Ibrahim Saleh Al-Busaidi,1 Tim J Wilkinson,3 Lutz Beckert41Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand; 2Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; 3Medical Education Unit, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand; 4Department of Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New ZealandBackground: Research is increasingly being emphasized from an early stage in medical students’ careers. Medical student involvement in research and authorship of peer-reviewed manuscripts have been shown to enhance their academic performance—both in the short term and long term. The aim of this study was to evaluate outcomes and motivations of the summer studentship research program at our institution, using Vroom’s expectancy theory as a conceptual framework.Methods: We utilized a mixed-methods approach to our study. Two databases (PubMed™ and Google Scholar™) were searched for publication data. In addition, students and supervisors of the program at the University of Otago were invited to provide comments on the program. Qualitative data were analyzed using an inductive, pragmatic approach which involved coding responses and grouping codes into common themes.Results: Between 2007 and 2016, 1,345 projects were completed, of which 326 (24.2%) resulted in a peer-reviewed publication. Students made up 48.1% of the first-authors. Three themes each emerged from the students and the supervisors’ survey. Student themes included: motives for undertaking a summer studentship, administrative benefits and barriers, and perceived outcomes of the program. Supervisor themes included: motivations for engaging in the summer studentship program, administrative benefits and barriers, and expectations placed on the student. These themes are consistent with Vroom’s expectancy theory where motivation is related to expectancy, instrumentality, and valence.Conclusion: A dedicated program to foster an interest in research by medical students has great value as judged by an overall publication rate of 24.2%. In addition, it provides opportunities to explore areas of interest in depth, acquire research skills, pilot new avenues of research, and create professional networks. Student research program needs to be well founded and well supported including administrative and statistical support.Keywords: medical education, medical student, research, career development, publication, training, superviso