Miracle-dz/UniFAR-FTUs huggingface dataset:
Perioperative Complications Greater Incidence of Emergence Agitation in Children After Sevoflurane Anesthesia as Compared With Halothane: A Meta-Analysis of Randomized Controlled Trials

Because of its favorable characteristics, sevoflurane is a popular inhalational anesthetic for children. However, it has a higher incidence of emergence agitation, which is often difficult to manage, compared with halothane. This study is a metaanalysis of randomized controlled trials comparing the incidence of emergence agitation in children after sevoflurane or halothane anesthesia. A systematic literature search was conducted to identify clinical studies that compared emergence agitation after the use of either of the 2 agents in children. Included studies were prospective randomized trials involving children younger than 12 years in which the state of agitation after general anesthesia was reported. Because age, preoperative anxiety, surgery type, and postoperative pain can be confounding factors for emergence agitation, subgroups were analyzed separately and included patients younger than 7 years, protocols using benzodiazepine premedication, patients anesthetized for insertion of myringotomy tubes, and patients anesthetized for minor inguinal or urologic procedures, with regional blocks appropriate for surgical analgesia. Data from each trial were combined using the Mantel-Haenszel fixed-effect model. From among 271 articles, 23 studies met the search strategy and inclusion criteria. These 23 studies included 1252 patients given sevoflurane and 1111 patients given halothane. The pooled odds ratio of the incidence of emergence agitation with sevoflurane was 2.21. The pooled odds ratio was 1.82 when highquality studies were evaluated for sensitivity analysis. When the pooled analysis considered only studies of patients younger than 7 years, the pooled odds ratiowas 1.88. The pooled odds ratios for studies examining sedative premedication, myringotomies, and inguinal or minor urologic procedures were 1.77, 1.79, and 3.20, respectively. Publication bias was not apparent in a funnel plot nor was it supported statistically by the Begg test. Emergence agitation was more frequent after sevoflurane anesthesia than halothane use in children. These results concur with the current consensus among pediatric anesthesiologists. Methods to prevent emergence agitation should be used to provide high-quality anesthesia for youngsters.
Combined Low-Dose Spinal-Epidural Anesthesia versus Single-Shot Spinal Anesthesia for Elective Cesarean Delivery

speculation may explain the differences in sensory block in the nonpregnant population, as studies suggested a negative epidural space pressure in this group of women.1 However, this is not true for pregnant women. Messih measured epidural space pressure in parturients without labor and observed positive pressure in lateral position; this pressure increased significantly when the parturients were placed in the supine position.2 The compression of inferior vena cava as well as increased intraabdominal pressure that accompanies pregnancy are the causes of these differences. So, the differences in sensory block height in this study in the CSE group can be explained by the reduction of the dural sac volume by the positive pressure in the pregnant women, as well as increased pressure exerted by introduction of air for the confirmation of epidural space. The median height of sensory block of C6 level in the present study is disturbing and has not been observed in other studies. The authors rightly mentioned that “our study was conducted in the Asian population and extrapolation of the results to other population must be done cautiously. ” Finally, to avoid this problem of high sensory anesthesia, one can reduce the spinal anesthetic dose for the CSE technique and rely, if necessary, on the epidural catheter for rescue. That is the reason that I don’t use CSE technique in women with difficult airway.
Effect of Aging on Elastin Functionality in Human Cerebral Arteries

Background and Purpose— Aging affects elastin, a key component of the arterial wall integrity and functionality. Elastin degradation in cerebral vessels is associated with cerebrovascular disease. The goal of this study is to assess the biomechanical properties of human cerebral arteries, their composition, and their geometry, with particular focus on the functional alteration of elastin attributable to aging. Methods— Twelve posterior cranial arteries obtained from human cadavers of 2 different age groups were compared morphologically and tested biomechanically before and after enzymatic degradation of elastin. Light, confocal, and scanning electron microscopy were used to analyze and determine structural differences, potentially attributed to aging. Results— Aging affects structural morphology and the mechanical properties of intracranial arteries. In contrast to main systemic arteries, intima and media thicken while outer diameter remains relatively constant with age, leading to concentric hypertrophy. The structural morphology of elastin changed from a fiber network oriented primarily in the circumferential direction to a more heterogeneously oriented fiber mesh, especially at the intima. Biomechanically, cerebral arteries stiffen with age and lose compliance in the elastin dominated regime. Enzymatic degradation of elastin led to loss in compliance and stiffening in the young group but did not affect the structural and material properties in the older group, suggesting that elastin, though present in equal quantities in the old group, becomes dysfunctional with aging. Conclusions— Elastin loses its functionality in cerebral arteries with aging, leading to stiffer less compliant arteries. The area fraction of elastin remained, however, fairly constant. The loss of functionality may thus be attributed to fragmentation and structural reorganization of elastin occurring with age.
Diagnostic Utility of IDH1/2 Mutation Analysis in Routine Clinical Testing of Formalin-Fixed Paraffin-Embedded Glioma

To the Editor: I read the recent report in the journal by Horbinski et al with great interest (1). The authors concluded that, BThese results indicate that testing for IDH1/2 mutations can be effectively performed in a clinical setting and can enhance the accuracy of diagnosis of gliomas when traditional diagnostic methods are not definitive[ (1). There is no doubt that the proposed method is useful in diagnosis, but for routine clinical use, I have the following concerns. First, the cost-effectiveness of this new approach versus the classical approach should be demonstrated. Second, the major question is whether the new technique is a time-consuming and easyto-use procedure in clinical practice. Third, it should be noted that not all gliomas possess IDH1/2 mutations (2); other kinds of brain tumors can also possess IDH mutations (3). The falsepositive, false-negative and predictive values of the new test need further verification.
DEPOSITION OF MONODISPERSE PARTICLES IN HOLLOW TRACHEOBRONCHIAL AIRWAYS MODELS REPRESENTING ADULT AND CHILD-SIZE

A series of experiments was performed to determine deposition efficiencies of four sizes of radiolabeled monodisperse particles in custom-made hollow tracheobronchial models. The particles had geometric diameters of about 1, 5, 10, and 15 pm. The tracheobronchial models, consisting of a trachea and two or more additional generations, had dimensions representative of a typical adult, a 7-y-old child, and a 4-y-old child; the child-size models were appropriately scaleddown replicas of the adult-size model. Each deposition experiment was conducted using a steady inspiratory airflow representative of low physical activity for the appropriate age of individual: 20 L min-' for the adult; 9 L min-' for the 7-y-old; 5.5 L min-l for the 4-y-old. The results indicate that deposition efficiency of the particles increased substantially (up to 35 times) in all three models as particle diameter increased from 1-15 pm, undoubtedly as a result of particle impaction and sedimentation-related phenomena. An analysis of variance demonstrated the occurrence of statistically-significant (p < 0.05) main effects of hollow model size and particle size; the interaction between the two parameters was also significant. In general, deposition efficiencies of the various sizes of particles were greater in the child-size models than in the adult-size model; this effect may have risk assessment implications. In addition, the results obtained experimentally agreed more closely with those predicted using a radiation-protection mathematical particle deposition formulation as the particle size increased for each of the sizes of models. Health Phys. 72(6):827-834; 1997
DISTRIBUTION IN THE ENVIRONMENT OF KAIGA OF SOUTH WEST COAST OF INDIA

Systematic studies on gamma radiation level and the distribution of natural radionuclides were carried out under a pre-operational survey for the establishment of baseline data on background radiation level and the distribution of radionuclides in the environment of Kaiga, in the south west coast of India, where a nuclear power reactor of 235 MWe has just been commissioned. The external gamma absorbed dose rates prevailing in the region were measured using a portable plastic scintillometer. Soil samples from 18 stations were collected from depth intervals of 0–5, 5–10, and 10–25 cm and analyzed for their 226Ra, 232Th, and 40K activity concentrations by gamma spectrometry employing a 90 cc PGT HpGe detector coupled to an EG&G ORTEC 8K multichannel analyzer. The activity of 226Ra was found to vary between 15.5–61.2 Bq kg 21 with a mean value of 31.3 Bq kg21, that of 232Th varies between 11.4–41.9 Bq kg21 with a mean value of 27.5 Bq kg21 and of 40K between 78.3–254.8 Bq kg 21 with a mean value of 159.9 Bq kg21 in 0–5 cm soil profiles of the region. The contributions of 238U, 232Th, and 40K to the total gamma absorbed dose rate were 39.9%, 40.7%, and 16.0%, respectively. The gamma absorbed dose rate in air estimated using the results of activity concentration of 226Ra, 232Th, and 40K are found to compare well with that of the direct measurement. The results of the study were compared with the literature values reported for other environs of the country as well as the world, and conclusions are drawn. Health Phys. 80(5):470–476; 2001
PII: S0304-3959(02)00422-0

Opioids produce analgesic effects through their modulatory role in nociceptive transmission. Under many circumstances opioids are the most efficacious analgesics commonly used in the clinical management of moderate to severe pain. Besides the known side effects, opioid treatment is associated with the development of tolerance to and dependence on opioid analgesics. A notable feature of opioid dependence is that hyperalgesic responses may occur both in animals and human subjects during a precipitated opioid withdrawal. This observation suggests that a pronociceptive process may have developed during opioid treatment, which may be unmasked following an opioid withdrawal. Over the last several years, compelling evidence has accumulated indicating that abnormal pain sensitivity including hyperalgesia and allodynia occurs in animals receiving opioid administration even in the absence of overt, precipitated opioid withdrawal. This paradoxical opioid-induced pain sensitivity may be contributory to the behavioral manifestation of apparent opioid tolerance, a need for a dose increase to maintain the same analgesic efficacy. Similar changes in pain sensitivity have been observed in pain patients with opioid therapy and in former opioid addicts maintained on methadone treatment. Moreover, a growing body of evidence suggests that the development of opioid-induced pain sensitivity is mediated through neural mechanisms that involve cellular changes and neural circuits and that interact with the mechanisms underlying the development of pathological pain. The current evidence also suggests that opioid-induced pain sensitivity may be preventable by interrupting the cellular and molecular changes associated with the development of opioid tolerance. These issues will be discussed in the article with the emphasis on their clinical implications. 2. Preclinical evidence of opioid-induced pain sensitivity
Trauma MIS

Minimally invasive surgical stabilization of thoracolumbar spinal injuries has the potential to reduce surgical morbidity and improve the postoperative care and rehabilitation of trauma patients. Minimally invasive surgery can even serve as a lifesaving procedure in the treatment of critically ill patients with multiple traumatic injuries. Initial investigations into the advantages of minimally invasive surgery in the treatment of thoracolumbar trauma have been performed. Although minimally invasive surgery seems to offer many important advantages over conventional open surgery, more outcome data are needed to prove its true advantages. The technique has limitations, as it does not yet permit all the reduction and correction maneuvers that are used in open surgery. The role of minimally invasive surgery in treating spine trauma should expand substantially as techniques continue to advance and become more broadly learned.
Note EARLY DOSE ASSESSMENT IN CRITICALITY ACCIDENTS

Early estimation of dose is useful in the medical evaluation of severe radiation accidents. In a prior publication, lymphocyte depletion kinetics were shown to follow an exponential decline for gamma accidents in which the average whole-body dose was in the range 50 cGy < D < 8–10 Gy. In that study, the depletion rate constant was linearly related to dose, within the statistical variation of the historical hematological data. This simple technique has now been extended to include analysis of various types of criticality accidents (liquid process; water moderated systems; metallic systems). Lymphocyte depletion in high-level mixed gamma/neutron accidents is found to be approximately equal, at a given effective dose, to that for gamma accidents. This universality would indicate a neutron RBE for human lymphocytes close to unity. Furthermore, the technique appears to be insensitive to the shape of gamma and neutron spectra, therefore making it especially robust for initial, approximate dose estimation. Health Phys. 81(4):446–449; 2001
Paper RADIATION SAFETY STANDARDS AND THEIR APPLICATION: INTERNATIONAL POLICIES AND CURRENT ISSUES

This paper briefly describes the current policies of the United Nations Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection and how these policies are converted into international radiation safety standards by the International Atomic Energy Agency, which is the only global organization—within the United Nations family of international agencies—with a statutory mandate not only to establish such standards but also to provide for their application. It also summarizes the current status of the established corpus of such international standards, and of it foreseeable evolution, as well as of legally binding undertakings by countries around the world that are linked to these standards. Moreover, this paper also reviews some major current global issues related to the application of international standards, including the following: strengthening of national infrastructures for radiation safety, including technical cooperation programs for assisting developing countries; occupational radiation safety challenges, including the protection of pregnant workers and their unborn children, dealing with working environments with high natural radiation levels, and occupational attributability of health effects (probability of occupational causation); restricting discharges of radioactive substances into the environment: reviewing current international policies vis-a-vis the growing concern on the radiation protection of the “environment;” radiological protection of patients undergoing radiodiagnostic and radiotherapeutic procedures: the current International Action Plan; safety and security of radiation sources: post-11 September developments; preparedness and response to radiation emergencies: enhancing the international network; safe transport of radioactive materials: new apprehensions; safety of radioactive waste management: concerns and connections with radiation protection; and radioactive residues remaining after the termination of activities: radiation protection response to the forthcoming wave of decommissioning of installations with radioactive materials. The ultimate aim of this paper is to encourage information exchange, cooperation, and collaboration within the radiation protection professional community. In particular, the paper tries to facilitate consolidation of the growing international regime on radiation safety, including the expansion of legally binding undertakings by countries, the strengthening of the current corpus of international radiation safety standards, and the development of international provisions for ensuring the proper worldwide application of these standards, such as a system of international appraisals by peer review. Health Phys. 87(3):258–272; 2004
CHRONIC GRAFT DYSFUNCTION IN RENAL TRANSPLANT PATIENTS

12. Bouma GJ, van der Meer-Prins EMW, van Bree FMPJ, van Rood JJ, Claas FHJ. Determination of cytotoxic T-lymphocyte precursor frequencies using europium labeling as a non-radioactive alternative to labeling with chromium-51. Hum Immunol 1992; 35: 85. 13. Strijbosch LWG, Buurman WA, Does RJMM, Zinken PH, Groenewegen G. Limiting dilution assays; experimental design and statistical analysis. J Immunol Methods 1987; 97: 133. 14. Zhang L, Li SG, Vandekerckhove B, Termijtelen A, van Rood JJ, Claas FHJ. Analysis of cytotoxic T cell precursor frequencies directed against individual HLA-A and -B alloantigens. J Immunol Methods 1989; 121: 39. 15. Koning F, Kardol M, van de Poel G, et al. The influence of workshop monoclonal antibodies on CML, PLT, ADCC and NK activity: Functional studies with workshop antibodies. In Rheinherz EL (ed): Proceedings of the Second International Workshop on Human Leukocyte Antigens. Heidelberg, Springer 1986 page 189. 16. van Kampen CA, Versteeg-vd Voort Maarschalk MFJ, Langerak-Langerak J, van Beelen E, Roelen DL, Claas FHJ. Pregnancy can induce longpersisting primed CTLs specific for inherited paternal HLA antigens. Hum Immunol 2001; 62: 201. 17. Falk JA, Cardella CJ, Halloran PF, Bear RA, Arbus GS. Graft outcome in the multiple transplant patient with a positive donor cross-match with non-current sera. Transplant Proc 1987; 19: 720. 18. Norman DJ, Barry JM, Wetzsteon PJ. Successful cadaver kidney transplantation in patients highly sensitized by blood transfusions. Transplantation 1985; 39: 253. 19. ten Hoor GM, Coopmans M, Allebes WA. Specificity and Ig Class of preformed alloantibodies causing a positive crossmatch in renal transplantation. Transplantation 1993; 56: 298. 20. Reed E, Ho E, Cohen DJ, et al. Anti-idiotypic antibodies specific for HLA in heart and kidney allograft recipients. Immunol Res 1993; 12: 1. 21. van Emmerik NEM, Loonen EHM, Vaessen LMB, et al. The avidity, not the mere presence, of primed cytotoxic T-lymphocytes for donor human leukocyte class II antigens determines their clinical relevance after heart transplantation. J Heart Lung Transplant 1999; 16: 240.
Fulminant haemophagocytic syndrome

ectopic hormonal production and in view of the massive tumour dimensions and complete resolution of the hypertension after surgery, the latter event most likely explains this process. Although there have been reports of nephrotic syndrome associated with oncocytomas, to our knowledge this is the first case of isolated hypertension in an asymptomatic patient with a large oncocytoma. Differentiating oncocytoma from chromophobe renal cell carcinoma is essential but can be difficult in some cases. They are both thought to be derivatives from distal tubules of the collecting system and show intercalated cells. In this case the typical tumour morphology and absence of CK7 staining supports the diagnosis of renal oncocytoma.
1,3-Galactosyltransferase Gene-Knockout Pigs for Xenotransplantation: Where Do We Go From Here?

The ability to genetically engineer pigs that no longer express the Gal (cid:1) 1,3Gal (Gal) oligosaccharide has been a significant step toward the clinical applicability of xenotransplantation. Using a chronic immunosuppressive regimen based on costimulatory blockade, hearts from these pigs have survived from 2 to 6 months in baboons. Graft failure was predominantly from the development of a thrombotic microangiopathy. Potential contributing factors include the presence of preformed anti-nonGal antibodies or the development of low levels of elicited antibodies to nonGal antigens, natural killer (NK) cell or macrophage activity, and inherent coagulation dysregulation between pigs and primates. The breeding of pigs transgenic for an “anticoagulant” gene, such as human tissue factor pathway inhibitor, hirudin, or CD39, or lacking the gene for the prothrombinase, fibrinogen-like protein-2, is anticipated to inhibit the change in the endothelium to a procoagulant state that takes place in the pig organ after transplantation. The identification of the targets for anti-nonGal antibodies and/or human macrophages might allow further genetic modification of the pig, and xenogeneic NK cell recognition and activation may be inhibited by the transgenic expression of human leukocyte antigen molecules and/or by blocking the function of activating NK receptors. The ultimate goal of induction of T-cell tolerance may be possible only if these hurdles in the coagulation system and innate immunity can be overcome.
Opera tionat Topic OVERVIEW OF RADIATION SAFETY IN THE TIN BY-PRODUCT (AMANG) INDUSTRY OF SOUTH EAST ASIA

Abstruct-Processing of by-product heavy minerals (amang) from tin mining involves potential exposure to external and internal sources of radioactivity. The radioactivity arises through the presence of thorium and uranium series radionuclides in the various minerals. Monazite is the most radioactive mineral, containing 3% to 7% thorium by weight, while ilmenite is generally the least radioactive mineral containing typically less than 0.05 % thorium. External exposure occurs when workers are in close proximity to accumulations or stockpiles of the radioactive minerals, whereas internal exposure occurs when workers are involved in dusty processes. This paper summarizes the nature of the amang industry in South East Asia and presents the results of preliminary measurements of external radiation and airborne radioactivity in twelve Malaysian and Thai plants. Although constrained by a paucity of exposure data, it is concluded that radiation doses to some amang plant workers may approach or exceed international standards and that appropriate control measures are required as a matter of priority. Radiation doses may approach or exceed 100 mSv in situations where workers are exposed to excessive levels of ambient dust and no protective measures are used. Observations and recommendations are made relating to monitoring and surveillance, instruction and training, and engineering and administrative protection measures. Health Phys. 71(2):225-234; 1996