Miracle-dz/UniFAR-FTUs huggingface dataset:
Optimization of Oxygenation by CPAP During One-Lung Anesthesia Using Nitrous 0 xide : Oxygen

with pII 5 2.5, and percent with pH > 5.0). All six showed geriatric patients to have slightly lower gastric acidity than adults or children. Dr. Bourke expresses concern about the distribution of pH in the three age groups and recommends the use of median pH (although our percent at risk indicators provided the same type oi distribution-free description as the median, which is simply the pH with 50% a t risk). But even with a distribution-free test (the Kruskal-Wallis analysis of variance bv ranks), geriatric patients had significantly higher pH than adultb, and 'idult and pediatric patients did not differ significantly. Our seventh approach was to present a graph (Fig. 1) that displayed the regression line of pH on age and a plot of the age, pH data points for all 100 patients. Our hope was that the gradual slope of the regression line would communicate the weak, direct relationship between age and pH and that the considerable scatter of points around the regression line would emphasize the weak nature of the relationship. Dr. Bourke recommends the use of a very new technique, least median of squares regression, instead of ordinary least (sum or mean of) squares regression that we used (although the article referenced appeared after our paper had been accepted for publication) ( 1 ) . Apparently, though, the two techniques produced similar results. The least median of squares technique was said to result "in a virtually horizontal line at a pH near 2.0"; apparently, this means the line had an intercept of 2.0 and a slope near zero. But our results with ordinary least squares regression were quite similar; the intercept was 1.936 and the slope was 0.015 (virtually a horizontal line). To check the stability of our regression findings, we have subsequently analyzed data for 130controls(adultand geriatricpatients, aged 14-87) pooled from five of our previous studies (2-5). The results were virtually identical: the intercept and slope were 1.452 and 0.024, respectively. The slopes (0.015 and 0.024) of our regression lines did not differ significantly (P = 0.9442). Thus although the age-gastric aciditv relationship is weak and might not provide immediate o r direct clinical application, it would seem to be a stable, fundamental relationship of scientific, medical interest. Admittedly, a cursory reading of our paper (o r any paper) could lead to an unwarranted conclusion. But the problem here would not seem to be due to our statistical approach. While we agree with Dr. Bourke that statistical analyses "can produce a maze of impressive numbers that frequently miss obvious and important conclusions" and that "the current zeal for statistical rigor is occasionally counterproductive," the statistical presentation in our paper does not appear to exemplify either o f these points. We continue to believe that our presentation accurately communicates the relationship between age and gastric aciditv as shown bv our data.
Epidural Butorphanol for the Relief of Postoperative Pain

We congratulate Abboud et al. (Anesth Analg 1987;66: 887-93) for conducting a CO, challenge study on patients in the immediate postoperative period-certainly not an easy task to accomplish. Last year we reported a study utilizing epidural butorphanol 4 mg for pain relief in nonobstetric patients after abdominal operations (1) and showed that epidural butorphanol provided pain relief with rapid onset (15 minutes) but substantially shorter duration (5.6 hours) than that of epidural morphine 5 mg. In a subsequent study (unpublished data) we found that, with serial arterial blood gas measurements, epidural butorphanol 4 mg did produce statistically significant elevation in Paco, even though no clinically significant respiratory depression (respiratory rate 10 breathdmin) was observed in these patients. Our observation in nonobstetrical patients is similar to that reported by Abboud et al. However, we could not quite agree with the conclusion drawn by them: ”An agent providing &8 hours of pain relief such as butorphanol in the present study, would be ideal, because patients could be kept in the recovery room for this time. ” In most instances, it would be impractical and emotionally distressing to keep patients in the recovery room for that long a period of time. On the contrary, the short duration of action of epidural butorphano1 would require more frequent administration, a distinct disadvantage from the manpower standpoint. Furthermore, as advocated by the authors, close observation for signs of respiratory depression associated with epidural butorphanol are definitely needed, which appears to negate the one presumed advantage of epidural butorphanol, namely lack of respiratory depression (2,3). Epidural butorphanol might be an interesting alternative to epidural morphine, but the search for an ideal spinal opiate for postsurgical pain still must be continued.
Multicenter Study Versus Nausea Outcomes: The Value of Large Numbers and the Limitations

n ”The Postoperative Interview: Assessing Risk Factors for Nausea and Vomiting” (l), Cohen et al. I have extracted information regarding the incidence of nausea and emesis from a large four-center study conducted in Canada in 1988-1989, examining anesthetic outcomes during a period before the widespread introduction of propofol with its antiemetic properties. The massive scale of the study (15,992 patients) introduced logistic limitations to the data collected but simultaneously provided a window of observation to general outcomes during those years that can serve as a bellwether for future advances in the treatment of the pervasive postoperative problem of nausea and vomiting. The first implicit assumption which will allow one to generalize about the conclusions reached is that the anesthetic practices at the four institutions involved in the study were typical of contemporaneous anesthetic practice at that time. There is little information provided to assess this; however, knowledge of drugs available, surgical techniques practiced, and status of the four institutions as academic teaching centers makes such an inference tenable. Patient selection issues must next be addressed. Unfortunately, despite efforts to keep the research nurse arm consistent among the institutions, wide variations developed in the percentage of patients interviewed among the institutions (39%-73%). The reasons for this are not delineated. What information was lost as a result cannot be determined; i.e., was some factor determining interview accessibility in Hospital B related to anesthetic outcome in some way? Were the interviewed patients in each institution representative of postoperative inpatients as a whole? What information was potentially lost from excluding patients who were ”too ill” or ”could not be found on two attempts”?
Ketamine for Reducing Propofol-Induced Pain

To the Editor: Given the high frequency of pain on injection of propofol, I read the report by Koo et al. (1) with hope of a better solution to the problem. They conclude that pretreatment with ketamine just before propofol injection is an effective method of reducing the incidence and intensity of such pain. Their data suggest that the reduction in pain may be superior to that achieved with lidocaine, the most common adjunct currently used for this purpose. I question, however, the appropriateness of the comparison they utilized in their study protocol. Many investigations have shown that lidocaine is most effective when given IV during brief venous occlusion by tourniquet before propofol injection (2–4). Reportedly less effective (though faster and easier) is mixing lidocaine and propofol and injecting the mixture. The least effective method seems to be lidocaine pretreatment in the absence of a tourniquet. Unfortunately, it is this least effective method of using lidocaine that the authors chose for comparison with ketamine. Consequently, I am hesitant to accept ketamine as being superior to, or even equivalent to, best practices with lidocaine.
A Prospective, Randomized Study

The right internal jugular vein (RIJ) is a commonly used route for access to the central circulation because of its accessibility during surgery, direct route into the right atrium, and predictable location. The standard approach to RIJ cannulation uses visual and palpable anatomic landmarks to guide needle placement and is associated with a 95% success rate (1). Cannulation of the RIJ carries the potential for serious complications from unintentional puncture of surrounding structures (1-3). Ultrasound imaging, by providing visualization of the RIJ and surrounding structures, may facilitate RIJ location and decrease the incidence of complications. This study compares the ease, safety, and success rate of RIJ cannulation using a standard approach based on anatomic landmarks alone with an ultrasound-guided approach.
Combination to Hyperbaric Bupivacaine for Spinal Anesthesia in Cesarean Section

The aim of this prospective, randomized, double-blind study was to compare the effects of adding either preservative-free morphine, 0.2 mg (n = 20), epinephrine, 0.2 mg ( n = 211, or a combination of both (n = 29) to hyperbaric bupivacaine in parturients having elective cesarean sections during spinal anesthesia. Ten additional patients receiving spinal bupivacaine alone were studied as the Control Group. High-pressure liquid chromatography with a sensitivity of 20 pg/mL was used to measure serum bupivacaine in all subjects. The results showed that the spread and regression of the sensory and motor blocks were similar among the study groups. However, the intraoperative analgesia was superior in patients receiving bupivacaine combined with morphine and epinephrine, whereas there was no difference between those given an addition of either morphine or epinephrine. Postoperative analgesia was the shortest and opioid requirement in the first 24 h the most with epinephrine alone. No respiratory depression occurred. The neonatal condition was excellent in all groups. Serum concentrations of bupivacaine at 10 min, at delivery (25 ? 1.4 min), and at 60 min after the intrathecal injection were similar among the groups including the Control Group. The concentrations of bupivacaine in umbilical arterial and venous sera were less than the sensitivity level of the analytical method. We conclude that the addition of 0.2 mg of morphine plus 0.2 mg of epinephrine to hyperbaric bupivacaine improves the intraand postoperative analgesia without an added risk. This improvement is not due to vasoconstriction and a reduction in the absorption of bupivacaine from the subarachnoid space. (Anesth Analg 1993;77457-62)
Sonography of the Left Kidney : How Does the Normal Kidney Look Using

• Volume 116 • Number 3 www.anesthesia-analgesia.org 549 The search for clinical markers to detect and monitor acute kidney injury (AKI) as early as possible has been the focus of interest of investigators all around the world. The predictive value of serum creatinine, the most widely used variable to monitor renal function as an early marker of AKI, is rather poor.1 The ultrasound assessment of renal artery flow has been shown to be highly sensitive and specific in the early detection of AKI.2,3 On the basis of Doppler measurements of renal artery velocities, the resistive index (RI) is calculated as: RI = (peak systolic velocity – minimum diastolic velocity)/peak systolic velocity; and the pulsatility index (PI) is calculated as: PI = (peak systolic velocity – minimum diastolic velocity)/mean velocity.4 These indices are associated with resistance to flow distal to the point of measurement, with a higher value indicating increased resistance.2 However, they are affected by several interrelated variables (Table 1). The range of values of RI and PI in normal subjects is approximately 0.64 to 0.704,10 and 0.93 to 1.25,4 respectively. Bossard et al.3 recently reported that RI values >0.79 measured postoperatively in cardiac surgical patients predicted the onset of AKI, with values >0.83 predicting the need for dialysis. It may be worthwhile monitoring these indices in patients undergoing cardiopulmonary bypass having a higher risk of AKI (e.g., valvular surgery, prolonged bypass times, age >65 years)11 and those with preexisting comorbidities (e.g., decreased left ventricular ejection fraction, diabetes, borderline renal function). 12 Most of the studies assessing these indices were done using transcutaneous ultrasound, which is not feasible to perform in the operating room. Transesophageal echocardiography (TEE) is an alternative. We present a technique to image the left kidney and measure the RI and PI with TEE. As reported by Yang et al.,13 and consistent with our own experience, imaging of the right kidney is difficult because it lies too low inside the abdominal cavity, farther away from the esophagus. We therefore describe a technique to locate the left kidney.
Recent Highlights of ATVB: Arterial Smooth Muscle

The prime function of the arterial smooth muscle cell (SMC) in adult individuals is to contract and relax, thereby regulating blood flow to target tissues. However, in a number of vascular diseases, arterial SMCs in the adult vessel undergo major changes in structure and function. For example, SMCs can take on properties that allow them to proliferate and migrate, promote calcification, undergo apoptosis, and to orchestrate other cell types to take on different properties. These altered SMCs are often viewed as vascular trouble-makers. However, these responses can also be seen as an attempt of the SMC to mend a diseased blood vessel. The plasticity and diversity of SMC populations and the presence of SMC progenitor cells contribute to the growing complexity of SMC biology. In the past couple of years, a number of new mechanisms that allow SMCs to proliferate, migrate, promote calcification and communicate with and respond to other cell types have been discovered. Much of this work has been published in ATVB, and some of that body of work is highlighted in this article. We emphasize areas that have generated substantial interest, including novel mechanisms governing SMC phenotypic switching, SMC progenitor cells, non-coding RNAs as regulators of SMC function and phenotype, novel mechanisms of cross-talk between SMCs and other cells, and differences in regulation of SMCs and other vascular cells.
Transient Neurologic Symptoms After Spinal Anesthesia

We would first like to thank Dr. Lang for his positive comments regarding our study (1). Second, we would like to respond to his query regarding obturator nerve stimulation distal to the lumbar plexus: the direct and indirect (3-in-l) obturator nerve block in this study was administered for transurethral resection of urinary bladder tumors located on the lateral or inferolateral bladder wall. The goal was to investigate whether local anesthetic could extend medially or laterally (2) or retrogradely (3) to prevent thigh adductor muscle contractions during resection with electrocautery. We do not deny that there may indeed be cephalad spread of local anesthetic to include the obturator and lateral cutaneous nerve, despite controversy in the literature. We totally agree that the disappearance of the compound muscle action potential (CMAP) should not be surprising when the local anesthetic is injected via the stimulating needle. In fact, we addressed this issue in our discussion (1) and suggested that “repositioning of the needle immediately after the injection of the solution always resulted in the return of a near-maximum CMAP. ” Although we agree that it would be beneficial to design the study such that the obturator nerve would be stimulated at a proximal site while recording distally, this would be anatomically extremely difficult in the clinical setting.
A Method to Quickly Calculate Mixtures for Epidural Infusions

Epidural solutions of local anesthetics and opioids, such as bupivaCaine and fentanyl, are commonly employed for intraoperative use, labor and delivery, and postoperative analgesia. Clinicians frequently need to assemble mixtures of different concentrations from individual components. Knowing the initial and final concentrations of local anesthetic and opioid, this method allows one to quickly calculate the amount of each drug to be mixed and diluted to the desired final volume. Given that the final volume of solution is V,,,, the initial concentration of local anesthetic is CLA-i,,itial, and the final concentration of local anesthetic is CLA.anal, the volume of local anesthetic to be drawn up is:
Neck Contracture Release and Reinforced Tracheal Tube Obstruction

needle at the L4-5 interspace with modest difficulty because of lumbar hyperlordosis. We injected a mixture of bupivacaine, sufentanil, and morphine. There was no paresthesia on injection. The block reached a T4 level. The cesarean delivery proceeded uneventfully, recovery was unremarkable, and there was no postoperative exacerbation of her disease. The use of muscle relaxants is problematic in patients with paraparesis. Succinylcholine may induce hyperkalemia, and nondepolarizing muscle relaxants should be used with caution because of a possible exaggerated response (2). In addition, regional anesthesia has long been suspected to exacerbate neurological symptoms (3,4). However, prior reports have documented successful anesthetic management of patients with hereditary spastic paraparesis using general anesthesia (sevoflurane and N2O) (5) and epidural anesthesia (6). This case suggests that spinal anesthesia is also an option in these patients.
A rare case of composite type of gastric mixed adenoneuroendocrine carcinoma

Cancers exhibiting a combination of epithelial and neuroendocrine features can occur in various organs. In the WHO classification of neoplasms of the gastrointestinal tract, such tumors are called “mixed adenoneuroendocrine carcinomas”. They may be composite, combined or amphicrine type. We present here a rare case of composite adenocarcinoma and neuroendocrine carcinoma of stomach. Keywords: MANEC, Composite tumour, Stomach.
Increased Postoperative Arterial Blood Pressure Stability with Continuous Epidural Infusion of Clonidine in Children

control, case cost tracking, and nurse intraoperative documentation are currently either not meeting the needs of OR managers or completely unavailable to them. This was also true at smaller facilities, having less than 7 ORs (Table 1). As available commercial products do not offer many of the perceived necessary management functions, facilities may develop their own homegrown systems. Some of these functions, such as staff scheduling (2), block time allocation (3), and patient instructions (4) have been analyzed and could be implemented in the next generation of OR Mgt Info Systems. Return on this investment may come from lost supply charges recovered, savings on inventory carrying cost by increasing inventory turns per year, and increase in revenue from better case scheduling and OR efficiency. The editorial by Weinger et al. prompted us to report the results of our survey regarding the impressions of OR managers as to the key features of an OR Mgt Info System and unrealized opportunities to design and successfully implement new management technology in the surgical suite.
Detached Concern, Me and My Clients – Professionals’ Emotion Regulation, Burnout, and Patients’ Care Quality at Work

Abstract Detached Concern and its core dimensions – employees’ concern toward and detachment from their clients – are important facets of the emotion-generative process during client interaction in people-oriented work environments. We studied the intra- and interpersonal effects of Detached Concern on professionals’ burnout (N = 1411) and patient-centered care quality (N = 332 patients; 43 physicians). Our findings indicate different Detached Concern types. Balanced employees (scoring high on concern and detachment) yielded lower burnout levels compared to imbalanced professionals. Patients’ perception of care quality was positively related to their physicians’ concern and detachment, and was significantly higher for the balanced than for the imbalanced physicians.
Safety assessment – Application A 1154 Food derived from insect-protected cotton line MON 88702 Executive summary

A genetically modified (GM) cotton line with OECD Unique Identifier MON-887Ø2-4, hereafter referred to as MON88702, has been developed to be protected from piercing and sucking insects, in particular the Hemipteran cotton pests Lygus hesperus and L. lineolaris. This protection is achieved through expression of a modified Bacillus thuringiensis (Bt) gene mCry51Aa2, which encodes a novel Bt Cry protein.
pH responsive superporogen combined with PDT based on poly Ce6 ionic liquid grafted on SiO2 for combating MRSA biofilm infection

Background: Biofilm infection caused by multidrug-resistant bacteria is difficult to eradicate by conventional therapies. Photodynamic therapy (PDT) is an effective antibacterial method for fighting against biofilm infection. However, the blocked photosensitizers outside of biofilm greatly limit the efficacy of PDT. Methods: Herein, a novel acid-responsive superporogen and photosensitizer (SiO2-PCe6-IL) was developed. Because of the protonation of the photosensitizer and the high binding energy of the polyionic liquid, SiO2-PCe6-IL changed to positive SiO2-PIL+ in an acidic microenvironment of biofilm infection. SiO2-PIL+ could combine with negatively charged extracellular polymeric substances (EPS) and create holes to remove the biofilm barrier. To strengthen the interaction between SiO2-PIL+ and EPS, SiO2-PIL+ of high charge density was prepared by grafting the high-density initiation site of ATRP onto the surface of the SiO2 base. Results: Due to the rapid protonation rate of COO- and the strong binding energy of SiO2-PIL+ with EPS, SiO2-PCe6-IL could release 90% of Ce6 in 10 s. With the stronger electrostatic and hydrophobic interaction of SiO2-PIL+ with EPS, the surface potential, hydrophobicity, adhesion and mechanical strength of biofilm were changed, and holes in the biofilm were created in 10 min. Combining with the release of photosensitizers and the porous structure of the biofilm, Ce6 was efficiently concentrated in the biofilm. The in vitro and in vivo antibacterial experiments proved that SiO2-PCe6-IL dramatically improved the PDT efficacy against MRSA biofilm infection. Conclusion: These findings suggest that SiO2-PCe6-IL could rapidly increase the concentration of photosensitizer in biofilm and it is an effective therapy for combating biofilm infection.