Predictors and outcome impact of perioperative serum sodium changes in a high-risk population.

BACKGROUND: The perioperative period may be associated with a marked neurohumoral stress response, significant fluid losses, and varied fluid replacement regimes. Acute changes in serum sodium concentration are therefore common, but predictors and outcomes of these changes have not been investigated in a large surgical population. METHODS: We carried out a retrospective cohort analysis of 27 068 in-patient non-cardiac surgical procedures in a tertiary teaching hospital setting. Data on preoperative conditions, perioperative events, hospital length of stay, and mortality were collected, along with preoperative and postoperative serum sodium measurements up to 7 days after surgery. Logistic regression was used to investigate the association between sodium changes and mortality, and to identify clinical characteristics associated with a deviation from baseline sodium >5 mmol litre(-1). RESULTS: Changes in sodium concentration >5 mmol litre(-1) were associated with increased mortality risk (adjusted odds ratio 1.49 for a decrease, 3.02 for an increase). Factors independently associated with a perioperative decrease in serum sodium concentration >5 mmol litre(-1) included age >60, diabetes mellitus, and the use of patient-controlled opioid analgesia. Factors associated with a similar increase were preoperative oxygen dependency, mechanical ventilation, central nervous system depression, non-elective surgery, and major operative haemorrhage. CONCLUSIONS: Maximum deviation from preoperative serum sodium value is associated with increased hospital mortality in patients undergoing in-patient non-cardiac surgery. Specific preoperative and perioperative factors are associated with significant serum sodium changes.This work was supported by the Cambridge University Division of Anaesthesia.This is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/bja/aeu40

Pharmacokinetics and pharmacodynamics of fenoldopam mesylate for blood pressure control in pediatric patients

<p>Abstract</p> <p>Background</p> <p>Fenoldopam mesylate, a selective dopamine1-receptor agonist, is used by intravenous infusion to treat hypertension in adults. Fenoldopam is not approved by the FDA for use in children; reports describing its use in pediatrics are limited. In a multi-institutional, placebo controlled, double-blind, multi-dose trial we determined the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics and side-effect profile of fenoldopam in children.</p> <p>Methods</p> <p>Seventy seven (77) children from 3 weeks to 12 years of age scheduled for surgery in which deliberate hypotension would be induced were enrolled. Patients were randomly assigned to one of five, blinded treatment groups (placebo or fenoldopam 0.05, 0.2, 0.8, or 3.2 mcg/kg/min iv) for a 30-minute interval after stabilization of anesthesia and placement of vascular catheters. Following the 30-minute blinded interval, investigators adjusted the fenoldopam dose to achieve a target mean arterial pressure in the open-label period until deliberate hypotension was no longer indicated (e.g., muscle-layer closure). Mean arterial pressure and heart rate were continuously monitored and were the primary endpoints.</p> <p>Results</p> <p>Seventy-six children completed the trial. Fenoldopam at doses of 0.8 and 3.2 mcg/kg/min significantly reduced blood pressure (p < 0.05) during the blinded interval, and doses of 1.0–1.2 mcg/kg/min resulted in continued control of blood pressure during the open-label interval. Doses greater than 1.2 mcg/kg/min during the open-label period resulted in increasing heart rate without additional reduction in blood pressure. Fenoldopam was well-tolerated; side effects occurred in a minority of patients. The PK/PD relationship of fenoldopam in children was determined.</p> <p>Conclusion</p> <p>Fenoldopam is a rapid-acting, effective agent for intravenous control of blood pressure in children. The effective dose range is significantly higher in children undergoing anesthesia and surgery (0.8–1.2 mcg/kg/min) than as labeled for adults (0.05–0.3 mcg/kg/min). The PK and side-effect profiles for children and adults are similar.</p

Use of near-infrared systems for investigations of hemodynamics in human in vivo bone tissue: a systematic review

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.A range of technologies using near infrared (NIR) light have shown promise at providing real time measurements of hemodynamic markers in bone tissue in vivo, an exciting prospect given existing difficulties in measuring hemodynamics in bone tissue. This systematic review aimed to evaluate the evidence for this potential use of NIR systems, establishing their potential as a research tool in this field. Major electronic databases including MEDLINE and EMBASE were searched using pre‐planned search strategies with broad scope for any in vivo use of NIR technologies in human bone tissue. Following identification of studies by title and abstract screening, full text inclusion was determined by double blind assessment using predefined criteria. Full text studies for inclusion were data extracted using a predesigned proforma and quality assessed. Narrative synthesis was appropriate given the wide heterogeneity of included studies. Eighty‐eight full text studies fulfilled the inclusion criteria, 57 addressing laser Doppler flowmetry (56 intra‐operatively), 21 near infrared spectroscopy, and 10 photoplethysmography. The heterogeneity of the methodologies included differing hemodynamic markers, measurement protocols, anatomical locations, and research applications, making meaningful direct comparisons impossible. Further, studies were often limited by small sample sizes with potential selection biases, detection biases, and wide variability in results between participants. Despite promising potential in the use of NIR light to interrogate bone circulation, the application of NIR systems in bone requires rigorous assessment of the reproducibility of potential hemodynamic markers and further validation of these markers against alternative physiologically relevant reference standards.This systematic review was supported by the College of Radiographers Industry Partnership Scheme (CORIPS) Doctoral Fellowship Grant (Applicant 003). The CORIPS are providing financial support but have no input into the design, performance or analysis of this systematic review. WDS, FC and CT would like to acknowledge the NIHR Exeter Clinical Research Facility and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR Exeter Clinical Research Facility, the NHS, the NIHR or the Department of Health in England

New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery

PG - e3954 AB - BACKGROUND: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery. METHODOLOGY/PRINCIPAL FINDINGS: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively). CONCLUSIONS/SIGNIFICANCE: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier los

La Rochefoucauld’s Maxims in English : towards a linguistic study of aphorisms

Cette thèse porte sur les traductions anglaises des Maximes de La Rochefoucauld et explore par ce prisme les propriétés linguistiques, pragmatiques et stylistiques de ces énoncés autonomes que sont les aphorismes. Notre étude compare la maxime à d’autres types d’aphorismes tels que les proverbes, adages, dictons et autres mots d’esprit que l’on trouve aussi dans la littérature anglophone. Une réflexion sur la forme des maximes est menée au travers de deux approches. L’une, contrastive, compare la version originale du livre de La Rochefoucauld à huit de ses versions anglaises. Une analyse des écarts entre formulations françaises et anglaises permet d’éclairer l’existence d’une vision très différente de l’aphorisme entre les deux langues. Ces conceptions de la maxime divergent du point de vue de la rhétorique mais aussi de la réception. L’autre approche est génétique : nous nous penchons sur l’élaboration de l’œuvre au travers d’une étude des variantes des maximes que nous livrent les manuscrits et la correspondance de l’auteur. Nous en tirons la conclusion que l’écriture des maximes est circonscrite par des contraintes énonciatives et grammaticales bien précises, qui confèrent aux énoncés autonomie discursive et statut citationnel. On peut ainsi considérer que La Rochefoucauld s’est attaché à approcher un canon aphoristique dont les proportions et les mesures sont à rattacher à la longue tradition littéraire des formes brèves. Ces considérations font la lumière sur les démarches très variées et parfois surprenantes des traducteurs (versification, narrativisation, proverbialisation…).This dissertation deals with the English translations of La Rochefoucauld’s Maxims in order to address the question of the linguistic, pragmatic and stylistic properties of the autonomous sentences referred to as aphorisms. My study carries out a comparison of the literary form of the maxim with other types of aphorisms such as proverbs, adages, sayings and sentences associated with the English tradition of wit. The formal features of maxims are analysed through a twofold approach. First, the translations of La Rochefoucauld’s sentences are studied in contrast: eight different English versions of the book are compared with the French original. The differences between both idioms’ wordings of such particular sentences point to very different conceptions of aphorisms as far as their use and structure are concerned. These conceptions differ in terms of rhetoric but also in terms of reception. Secondly, heed is paid to the very elaboration of the Maxims through a study of the book’s numerous variants that survived in the form of manuscripts and letters. The conclusion that is drawn sheds light on enunciative and grammatical constraints that define how maxims are written, giving the latter discursive autonomy and status of quotation. La Rochefoucauld’s work may thus be considered to be an attempt at reaching the perfection of an aphoristic canon, the proportions and features of which are to be linked to the ancient tradition of brevity in literature. These considerations contribute to explain and justify the very diverse, even sometimes surprising approaches of English translators since versified, dramatised or proverbialised versions are attested

Contrôle dimensionnel et contrôle de la couleur par vision artificielle pour le diagnostic hors ligne d'un four de cuisson en biscuiterie

Within the framework of a monitoring project on the cooking process, an artifical vision control system has been developed to follow the color and dimension evolution of dry biscuits out of the oven. The results presented here concern diameter, thickness and color measurements performed on a series of biscuits sampled during a normal production cycle. / Dans le cadre d'un projet de suivi de processus de cuisson, il a été développé un système de contrôle par vision artificielle permettant de suivre la tendance d'évolution colorimétrique et dimensionnelle de biscuits secs à la sortie d'un four de cuisson. Les résultats présentés concernent des mesures de diamètre, d'épaisseur et de couleur réalisées sur un ensemble de biscuits prélevés lors d'un cycle normal de production