bluuebunny/crossref_metadata_2025 huggingface dataset:
Ensemble rainfall–runoff and inundation simulations using 100 and 1000 member rainfalls by 4D LETKF on the Kumagawa River flooding 2020
Authors: Kobayashi Kenichiro , Duc Le , Kawabata Takuya , Tamura Atsushi , Oizumi Tsutao , Saito Kazuo , Nohara Daisuke , Sumi Tetsuya
Published: February 2023

This paper presents the 1000 ensemble flood simulations using ensemble rainfalls simulated by 4D LETKF. The number of ensemble rainfall members is large as 1000 compared to the operational rainfall products of two-digit numbers to avoid sampling errors in the three-dimensional meteorological simulation based on chaotic theory. Using the large data set, 1000 ensemble rainfall–runoff for dam catchments and high-resolution inundation simulations of large area are carried out focusing on the Kumagawa river catchment. Herewith, the comparisons were carried out with 21-member ensemble rainfalls of an operational forecast by Japan Meteorological Agency and 100-member 4D-LETKF ensemble rainfalls simulated independent of 1000-member 4D-LETKF. At the same time, the accuracy of selective 100-member ensembles out of 1000 members is investigated. As a result, although many previous research works show a large number of ensemble simulations are necessary for three-dimensional meteorological field, the number could be reduced in the catchment-average rainfall–runoff and 2.5-dimensional inundation simulations given that the rainfall prediction has a certain level of accuracy since improving the discharge prediction accuracy with lower dimension is sometimes possible by adjusting the horizontally/vertically integrated model parameters determined by topography and soil characteristics in advance against the observed rainfall. Also, the 1000 ensembles could be classified into several patterns in horizontally accumulated 2D rainfall field. Likewise, the flood flow moves toward the low elevation area and river; thus, the resultant 2.5-dimensional flood field does not show much variety as three-dimensional meteorological simulation. The paper summarizes these studies.
Alpha‐kinase1 promotes tubular injury and interstitial inflammation in diabetic nephropathy by canonical pyroptosis pathway
Authors: Cui Xinyuan , Li Yifu , Yuan Shuguang , Huang Yao , Chen Xiaojun , Han Yachun , Liu Zhiwen , Li Zheng , Xiao Yang , Wang Youliang , Sun Lin , Liu Hong , Zhu Xuejing
Published: February 2023

Background

Alpha‐kinase 1 (ALPK1) is a master regulator in inflammation and has been proved to promote renal fibrosis by promoting the production of IL-1β in diabetic nephropathy (DN) mice. Pyroptosis is involved in high glucose (HG)-induced tubular cells injury, characterized by activation of Gasdermin D (GSDMD) and the release of IL-1β and IL-18, resulting in inflammatory injury in DN. It is reasonable to assume that ALPK1 is involved in pyroptosis-related tubular injury in DN. However, the mechanism remains poorly defined.

Methods

Immunohistochemistry (IHC) staining was performed to detect the expression of pyroptosis- and fibrosis-related proteins in renal sections of DN patients and DN mice. DN models were induced through injection of streptozotocin combined with a high-fat diet. Protein levels of ALPK1, NF-κB, Caspase-1, GSDMD, IL-1β, IL-18 and α-SMA were detected by Western blot. HK-2 cells treated with high-glucose (HG) served as an in vitro model. ALPK1 small interfering RNA (siRNA) was transfected into HK-2 cells to down-regulate ALPK1. The pyroptosis rates were determined by flow cytometry. The concentrations of IL-1β and IL-18 were evaluated by ELISA kits. Immunofluorescence staining was used to observe translocation of NF-κB and GSDMD.

Results

The heat map of differentially expressed genes showed that ALPK1, Caspase-1 and GSDMD were upregulated in the DN group. The expression levels of ALPK1, Caspase-1, GSDMD and CD68 were increased in renal biopsy tissues of DN patients by IHC. ALPK1expression and CD68+ macrophages were positively correlated with tubular injury in DN patients. Western blot analysis showed increased expressions of ALPK1, phospho-NF-κB P65, GSDMD-NT, and IL-1β in renal tissues of DN mice and HK-2 cells, accompanied with increased renal fibrosis-related proteins (FN, α-SMA) and macrophages infiltration in interstitial areas. Inhibition of ALPK1 attenuated HG-induced upregulation expressions of NF-κB, pyroptosis-related proteins Caspase-1, GSDMD-NT, IL-1β, IL-18, α-SMA, and pyroptosis level in HK-2 cells. Also, the intensity and nuclear translocation of NF-κB and membranous translocation of GSDMD were ameliorated in HG-treated HK-2 cells after treatment with ALPK1 siRNA.

Conclusions

Our data suggest that ALPK1/NF-κB pathway initiated canonical caspase-1-GSDMD pyroptosis pathway, resulting in tubular injury and interstitial inflammation of DN.
Long-term follow-up of changes in ocular biometric parameters in orthokeratology lens wearers with relatively large-scale axial length reduction
Authors: Tang Tao , Li Xuewei , Chen Sitong , Xu Qiong , Zhao Heng , Wang Kai , Li Yan , Zhao Mingwei
Published: February 2023

Background

To investigate ocular biological characteristics for myopic children with axial length (AL) reduction during orthokeratology (Ortho-K) treatment and provide clinical clues for better myopia control effects.

Methods

Changes in ocular parameters and treatment zone (TZ) in 75 subjects who completed one-year Ortho-K treatment were retrospectively reviewed. The subjects were divided into two groups according to one-year AL change: the AL reduction group (n = 37) and the AL elongation group (n = 38). Univariate and multivariate regression analyses were performed to determine the association between TZ, ocular parameters, and AL change.

Results

There was no significant difference in baseline between the two groups (all P > 0.05). After one year of Ortho-K treatment, compared with those in the AL elongation group, children in the AL reduction group had a decreased anterior chamber depth (ACD) (P < 0.001), thickened crystalline lens thickness (CLT) (P = 0.002), thinned vitreous chamber depth (VCD) (P < 0.001) and smaller TZ (P = 0.03), but no difference in central corneal thickness (CCT) and pupil diameter (PD). In the multivariable analyses, AL reduction was negatively associated with baseline age (beta: − 0.048; 95% CI: − 0.083 to − 0.013; P = 0.009) and positively associated with the TZ (beta: 0.024; 95% CI: 0.009 to 0.040; P = 0.003).

Conclusions

In AL reduction eyes, thickened CLT, decreased ACD and thinned VCD were observed during Ortho-K treatment, which could be suggested as indicators for better myopia control effects in the clinic. Older baseline age and smaller TZ wearing Ortho-K were also associated with AL change. Thickened CLT may be a result of compensation for AL-reduction eyes.
Seasonal variation in food security, lifestyle, nutritional status and its associated factors of the urban poor adolescents in Kuala Lumpur, Malaysia: research protocol of a prospective cohort study
Authors: Tay Janice Ee Fang , Tung Serene En Hui , Kaur Satvinder , Gan Wan Ying , Che’Ya Nik Norasma , Tan Choon Hui
Published: February 2023

Background

Climate change, obesity and undernutrition have now become a worldwide syndemic that threatens most people’s health and natural systems in the twenty-first century. Adolescent malnutrition appears to be a matter of concern in Malaysia, and this is particularly relevant among the urban poor population. Mounting evidence points to the fact that underlying factors of malnutrition are subject to climate variability and profoundly affect nutritional outcomes. Hence, it is interesting to examine seasonal variation in nutritional status and its associated factors of urban poor adolescents in Malaysia.

Methods

This is a prospective cohort study following urban poor adolescents aged 10–17 years living in low-cost high-rise flats in Kuala Lumpur, Malaysia, across two monsoon seasons. The baseline assessment will be conducted during the onset of the Northeast Monsoon and followed up during Southwest Monsoon. Climate data will be collected by obtaining the climatological data (rainfall, temperature, and relative humidity) from Malaysia Meteorological Department. Geospatial data for food accessibility and availability, and also built (recreational facilities) environments, will be analyzed using the QGIS 3.4 Madeira software. Information on socio-demographic data, food security, lifestyle (diet and physical activity), and neighbourhood environment (food and built environment) will be collected using a self-administrative questionnaire. Anthropometric measurements, including weight, height, and waist circumference, will be conducted following WHO standardized protocol. WHO Anthro Plus was used to determine the height-for-age (HAZ) and BMI-for-age (BAZ). Anaemic status through biochemical analyses will be taken using HemoCue 201+® haemoglobinometer.

Discussion

The study will provide insights into the seasonal effects in nutritional status and its associated factors of urban poor adolescents. These findings can be useful for relevant stakeholders, including policymakers and the government sector, in seizing context-specific strategies and policy opportunities that are seasonally sensitive, effective, and sustainable in addressing multiple challenges to combat all forms of malnutrition, especially among urban poor communities.

Trial registration

The protocol for this review has not been registered.
Dietary habits after a physical activity mHealth intervention: a randomized controlled trial
Authors: Sjöblom Linnea , Bonn Stephanie Erika , Alexandrou Christina , Dahlgren Anna , Eke Helén , Trolle Lagerros Ylva
Published: February 2023

Background

A healthy diet and a sufficient amount of physical activity are important factors to reduce complications of type 2 diabetes. Diet and physical activity are associated behaviours. Individuals who are physically active have also been shown to have healthier eating habits than sedentary individuals. We aimed to evaluate the indirect effect of a smartphone-based physical activity intervention on dietary habits in patients with type 2 diabetes.

Methods

We performed analyses of secondary outcomes in a randomized controlled trial. The active intervention was use of a smartphone application to promote physical activity during 12 weeks. Dietary intake was assessed at baseline and after three months using a validated semi-quantitative food frequency questionnaire comprising 94 items. We analysed changes in the intake of fruit and vegetables, snacks, fibre, whole grains, vitamin C, saturated fat, unsaturated fat and total energy. We also assessed overall dietary habits using a dietary index developed by the Swedish National Board of Health and Welfare. Results were compared between the intervention and control group, as well as stratified by sex within the study groups. Paired t-tests and analysis of covariance were performed.

Results

A total of 181 patients were recruited to the DiaCert-study, whereof 146 patients had complete dietary data and were included in the analyses. Women in the intervention group had a higher fruit and vegetable intake (p = 0.008) and a higher dietary index (p = 0.007), at three-months compared to women in the control group. They had increased their daily intake of fruit and vegetables by on average 87.4 g/day (p = 0.04) and improved their dietary index by on average 0.8 points (p = 0.01) from baseline to follow-up. No effect was found in men.

Conclusions

Women, but not men, receiving a smartphone-based physical activity intervention improved their total intake of fruit and vegetables. The transfer effect, i.e. an intervention aimed at promoting one health behavior that facilitates changes in other health behaviors, may differ between the sexes.

Trial registration

ClinicalTrials.gov Identifier: NCT03053336; 15/02/2017.
Challenges and outcomes of pregnancy in an uncorrected Tetralogy of Fallot with pulmonary atresia and major aorta-pulmonary collateral arteries (MAPCA): a case report
Authors: Thakur Surekha , Rawat Neha , Sharma Bharti , Sikka Pooja , Dogra Neeti , Aggarwal Neelam , Suri Vanita , Vijayvergiya Rajesh , Gawalkar Atit A.
Published: February 2023

Background

Tetralogy of Fallot is a severe type of congenital heart disease (CHD) and one of the leading indirect causes of mortality & morbidity among women with CHD. We came across a rare case of an uncorrected Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in pregnancy.

Case presentation

We are reporting the challenges in managing a pregnancy of 25-years-old G3 P0110, previous one stillbirth and who was diagnosed to have congenital heart disease during pregnancy following spontaneous abortion.

Conclusions

This case report highlights the role of multidisciplinary care in managing such a high risk case. It also emphasizes the role of cardiac examination of every woman before pregnancy so that definitive treatment or optimization can be done in time for a better outcome.
Role of [18F] FDG PET-CT in detection of COVID-19 vaccine-associated hypermetabolic lymphadenopathy (VAHL) in lymphoma patients: with serologic testing correlation
Authors: El Sammak Dena Abd El Aziz , Abdelhay Rabab M.
Published: February 2023

Background

COVID-19 vaccination of the population has a great importance, especially in oncological patients. The high incidence of vaccine-associated hypermetabolic lymphadenopathy (VAHL) makes a difficulty in the diagnosis of PET-CT of oncological patients. They should be vaccinated in the side opposite to the expected malignant LNs to avoid unnecessary biopsy and change in therapy. The aim of this study was to assess the role of PET-CT in detection of VAHL after the 2nd dose of Pfizer-BioNTech vaccine in lymphoma patients and compare the incidence of VAHL among lymphoma patients treated with B cell depletion therapy during the 6 months prior to vaccination and those treated > 6 months before vaccination.

Results

This study comprised 120 lymphoma patients, referred for FDG PET/CT 1–3 weeks after the 2nd dose of Pfizer-BioNTech COVID-19 vaccine. Hypermetabolic LNs were identified in 55%. The incidence of VAHL in lymphoma patients treated with anti-CD20 antibody rituximab during the 6 months prior to vaccination (9%) was significantly lower compared with other lymphoma patients treated with anti-CD20 antibody rituximab > 6 months before vaccination (91%). The incidence and grades of VAHL are significantly high within the 1st week after the 2nd dose of Pfizer-BioNTech vaccine in patients younger than 60 years of age. Only 7 of 37 patients with negative serology had VAHL on PET-CT, whereas 10 of 26 patients with decreased anti-spike titers and 49 of 57 patients with increased anti-spike titers had VAHL on PET-CT.

Conclusions

VAHL makes challenges in the interpretation of FDG PET/CT in oncology patients. Accurate data collection, regarding the time and site of COVID vaccination, is important to help radiologists in identifying the cause of abnormal nodal FDG uptake. We suggest to schedule FDG PET-CT for lymphoma patients at least 3 weeks after the 2nd dose of Pfizer-BioNTech vaccine.
Fragility of FDI flows in sub-Saharan Africa region: does the paradox persist?
Authors: Adegboye Folasade Bosede , Okorie Uchechukwu Emena
Published: February 2023

The circumstances of the SSA region regarding the inflow of foreign direct investment (FDI) present a puzzle. In spite of the high rate of return on investment, the inflow of foreign investments keeps eluding the region, and the COVID-19 pandemic even perplexes the flow fragility the more. What factors then determine FDI flows aside from return on investment? Could there be more persuasive relative cost complexes? The study aimed at testing the effects of determining factors that influence FDI flows and their impact on economic development, considering the COVID-19 period. The study used cross-country pooled data from 30 SSA countries collected between 2001 and 2020. The study utilized five panel estimation techniques, namely Pooled Regression, Fixed Effect (FE), Random Effect (RE), Panel Two-Stage Least Square and Differenced Generalized Moments of Method (DGMM). The study found that the inflow of FDI has significant positive impact on economic development in the sub-Saharan African region. It is also ascertained that the outflow of FDI, and political stability has an inverse relationship with economic development. The study recommends that governments of host economies should hence ensure an enabling framework for their economies, so as to improve infrastructure, political stability, and institutional quality, in order to sufficiently encourage the inflow of FDI into the SSA region and make the environment inviting, sustainable, and beneficial for foreign investors and host economies alike.
Physiological predictors of resting pulmonary hypertension associated with COPD: a retrospective analysis
Authors: Atta Muhammad E. , Khalil Yehia M. , Abd-Elhameed Asmaa , Morsi Tamer S. , Elbehairy Amany F.
Published: February 2023

Background

Resting pulmonary hypertension (PH) is not uncommon in patients with chronic obstructive pulmonary disease (COPD). In the current study, we aimed to identify physiological predictors of resting PH in patients with COPD.

Methods

We retrospectively analyzed data derived from right heart catheterization in sixty-nine stable patients with COPD. Patients were categorized into COPD-PH (n = 33) and COPD-non-PH (n = 36), based on the “6th World Symposium on PH.”

Results

Demographics, forced expiratory volume in 1 s (FEV1), lung volumes, cardiac output, and cardiac index were similar between groups, yet COPD-PH had greater pulmonary vascular resistance (PVR) and lower resting PaO2 (P < 0.05). The proportion of COPD-PH patients did not differ across the range of FEV1 (χ2 = 3.01, P = 0.22). No correlations were found between PVR and the degree of airflow obstruction or resting hyperinflation. Resting PaO2 was the only predictor of both pulmonary artery pressure and PVR.

Conclusions

Increased PVR, in response to arterial hypoxemia or directly induced by tobacco smoking, is likely the key factor that led to resting PH in the current sample of patients with moderate-severe COPD, regardless of the degree of airflow limitation or resting hyperinflation.
Connected simultaneous rupture of the diaphragm and pericardium via congenitally fused site due to blunt trauma
Authors: Yamashita Takashi , Asai Katsuyuki , Ochiai Hideto , Kanai Toshikazu , Matsubayashi Yuta , Tanaka Keizo , Hashimoto Takashi
Published: February 2023

Background

In severe blunt trauma, multiple organ injuries are often observed. Patients with a ruptured diaphragm and pericardium are referred to as having pericardio-diaphragmatic rupture. However, few studies have reported a narrowly defined case of connected rupture of the diaphragm and pericardium via their congenitally fused site along with an abdominal visceral herniation and cardiac luxation into the thoracic cavity.

Case presentation

A 78-year-old man presented to our hospital with left chest pain caused by a traffic accident. Contrast-enhanced computed tomography revealed a left diaphragmatic rupture and an intestinal herniation into the thoracic cavity. Surgical repair of the diaphragm was performed, and pericardial rupture was noted during surgery. It was considered that the laceration had spread via the congenitally fused site of the diaphragm and pericardium. The diaphragm was sutured, but the pericardium was left open because the laceration was large and the risk of cardiac incarceration was thought to be low. One year after the operation, no recurrence of diaphragmatic hernia was observed and any circulatory symptoms were not occurred.

Conclusions

In cases of diaphragmatic laceration extending to the fused site of the pericardium, connected pericardial rupture should also be considered. It would be challenging to detect without intraoperative findings, and it is desirable to observe both the thoracic and abdominal cavities.
Impact of digital health technology on health insurance claims rejection rate in Ghana: a quasi-experimental study
Authors: Adzakpah Godwin , Dwomoh Duah
Published: February 2023

Introduction

An efficient medical claims billing system is critical to mitigating the challenges associated with claim denials and ensuring the sustainability of providing healthcare services. This study assessed the impact of Digital Health Technology (DHT) in reducing the claim rejection rate of health insurance claims submitted by health facilities to the National Health Insurance Authority in Ghana.

Methods

The study used longitudinal data on monthly claims adjustments due to errors from both paper-based and claims submitted using different DHT systems from 2010 to 2019. The claim rejection rate was estimated for each month. Prais-Winsten Segmented Interrupted Time-Series analysis was used to estimate the impact of DHT systems by comparing claims data before and after the system implementation for each facility. We employed meta-analysis techniques to generate a pooled impact estimate of DHT systems on the claim rejection rate of health insurance claims.

Results

The total cost of deductions due to errors from the DHT system was significantly lower than the paper-based system (DHT = 8.15%, paper-based system = 10.13%). DHT contributed to an immediate impact of 1.31 percentage point reduction in the claim rejection rate of health insurance claims compared to the paper-based system.

Conclusion

The DHT recorded lower denied claims costs than the paper-based claims system. Scaling up the use of DHT for claims submission will reduce the rate of claim denials and ensure the sustainability of providing healthcare services.
Intracellular to Interorgan Mitochondrial Communication in Striated Muscle in Health and Disease
Authors: Boardman Neoma T , Trani Giulia , Scalabrin Marco , Romanello Vanina , Wüst Rob C I
Published: February 2023

Mitochondria sense both biochemical and energetic input in addition to communicating signals regarding the energetic state of the cell. Increasingly, these signaling organelles are recognized as key for regulating different cell functions. This review summarizes recent advances in mitochondrial communication in striated muscle, with specific focus on the processes by which mitochondria communicate with each other, other organelles, and across distant organ systems. Intermitochondrial communication in striated muscle is mediated via conduction of the mitochondrial membrane potential to adjacent mitochondria, physical interactions, mitochondrial fusion or fission, and via nanotunnels, allowing for the exchange of proteins, mitochondrial DNA, nucleotides, and peptides. Within striated muscle cells, mitochondria-organelle communication can modulate overall cell function. The various mechanisms by which mitochondria communicate mitochondrial fitness to the rest of the body suggest that extracellular mitochondrial signaling is key during health and disease. Whereas mitochondria-derived vesicles might excrete mitochondria-derived endocrine compounds, stimulation of mitochondrial stress can lead to the release of fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) into the circulation to modulate whole-body physiology. Circulating mitochondrial DNA are well-known alarmins that trigger the immune system and may help to explain low-grade inflammation in various chronic diseases. Impaired mitochondrial function and communication are central in common heart and skeletal muscle pathologies, including cardiomyopathies, insulin resistance, and sarcopenia. Lastly, important new advances in research in mitochondrial endocrinology, communication, medical horizons, and translational aspects are discussed.
General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry
Authors: Seymour Lisa M. , Fernandes Nicole L. , Dyer Robert A. , Smit Maretha I. , van Dyk Dominique , Hofmeyr Ross
Published: February 2023

BACKGROUND:

In resource-limited environments, spinal anesthesia (SA) is preferred for cesarean delivery. In women at risk of spinal epidural hematoma, particularly those with hypertensive disorders of pregnancy, thrombocytopenia should be excluded before neuraxial blockade. In the context of emergency surgery for fetal distress, this investigation may be hampered by laboratory services being unavailable or off-site.

METHODS:

The Obstetric Airway Management Registry (ObAMR) is currently active across all anesthesia training institutions affiliated with the University of Cape Town. This multicenter observational study aimed to estimate the proportion of patients receiving general anesthesia (GA) for either confirmed or suspected thrombocytopenia, which was not excluded due to unavailability of laboratory results. To establish the number of GA uses that may have been avoided if platelet counts were available, we retrospectively searched for subsequent platelet counts in patients for whom thrombocytopenia was suspected. An algorithm was proposed, including a simple decision aid for estimating risk versus benefit of SA versus GA, to be followed in the setting of hypertensive disorders of pregnancy and thrombocytopenia.

RESULTS:

Thrombocytopenia was the indication for GA in 100 of 591 patients (16.9%) captured in the registry. In total, 48 of 591 (8.1%) had confirmed thrombocytopenia, and 52 of 591 (8.8%) had suspected thrombocytopenia. Of these patients, 91 of 100 had a hypertensive disorder of pregnancy. In the confirmed thrombocytopenia group, the indication for GA was a platelet count <75 × 109/L. In the suspected thrombocytopenia group, 46 of 52 (88.5%) platelet counts could be retrospectively traced. The median (interquartile range) platelet count was 178 × 109/L (93 – 233 × 109/L), and platelets exceeded 75 × 109/L in 41 of 46 patients (89.1%). In the 5 of 46 patients with retrospectively confirmed thrombocytopenia, 2 had hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, 2 had antepartum hemorrhage with preeclampsia, and 1 had isolated thrombocytopenia with preeclampsia.

CONCLUSIONS:

In 17% of patients, the indication for GA was thrombocytopenia. Of these, 52 of 100, or nearly 9% of the total of 591, received GA because a platelet count was unavailable at the time of surgery. The importance of early laboratory assessment, when available, should be emphasized. Overall, 41 of 591 (6.9%) had a platelet count >75 × 109/L and would not have needed GA if their platelet count had been known. After following the constructed algorithm and applying the decision aid to assess risk and benefit, there may be circumstances in which the clinician justifiably opts for SA when a platelet count is indicated but unavailable.
A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children
Authors: Bong Choon Looi , Balanza Gustavo A. , Khoo Charis Ern-Hui , Tan Josephine Swee-Kim , Desel Tenzin , Purdon Patrick Lee
Published: February 2023

The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.
Nociception Level Index–Guided Intraoperative Analgesia for Improved Postoperative Recovery: A Randomized Trial
Authors: Ruetzler Kurt , Montalvo Mateo , Bakal Omer , Essber Hani , Rössler Julian , Mascha Edward J. , Han Yanyan , Ramachandran Mangala , Keebler Allen , Turan Alparslan , Sessler Daniel I.
Published: February 2023

BACKGROUND:

Nociception is the physiological response to nociceptive stimuli, normally experienced as pain. During general anesthesia, patients experience and respond to nociceptive stimuli by increasing blood pressure and heart rate if not controlled by preemptive analgesia. The PMD-200 system from Medasense (Ramat Gan, Israel) evaluates the balance between nociceptive stimuli and analgesia during general anesthesia and generates the nociception level (NOL) index from a single finger probe. NOL is a unitless index ranging from 0 to 100, with values exceeding 25 indicating that nociception exceeds analgesia. We aimed to demonstrate that titrating intraoperative opioid administration to keep NOL <25 optimizes intraoperative opioid dosing. Specifically, we tested the hypothesis that pain scores during the initial 60 minutes of recovery are lower in patients managed with NOL-guided fentanyl than in patients given fentanyl per clinical routine.

METHODS:

We conducted a randomized, single-center trial of patients having major abdominal open and laparoscopic surgeries. Patients were randomly assigned 1:1 to intraoperative NOL-guided fentanyl administration or fentanyl given per clinical routine. The primary outcome was pain score (0–10 verbal response scale) at 10-minute intervals during the initial 60 minutes of recovery. Our secondary outcome was a measure of adequate analgesia, defined as a pain score <5, assessed separately at each interval.

RESULTS:

With a planned maximum sample size of 144, the study was stopped for futility after enrolling 72 patients from November 2020 to October 2021. Thirty-five patients were assigned to NOL-guided analgesic dosing and 37 to routine care. Patients in the NOL group spent significantly less time with a NOL index >25 (median reduction [95% confidence interval {CI}] of 14 [4–25] minutes) were given nearly twice as much intraoperative fentanyl (median [quartiles] 500 [330, 780] vs 300 [200, 330] µg), and required about half as much morphine in the recovery period (3.3 [0, 8] vs 7.7 [0, 13] mg). However, in the primary outcome analysis, NOL did not reduce pain scores in the first 60 minutes after awakening, assessed in a linear mixed effects model with mean (standard error [SE]) of 4.12 (0.59) for NOL and 4.04 (0.58) for routine care, and estimated difference in means of 0.08 (−1.43, 1.58), P = .895.

CONCLUSIONS:

More intraoperative fentanyl was given in NOL-guided patients, but NOL guidance did not reduce initial postoperative pain scores.
Effect of Tulobuterol Patch Versus Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies: A Randomized Controlled Trial
Authors: Kim Eun-Hee , Lee Sang Hyun , Kim Jin Kyoung , Park Yong-Hee , Kang Pyoyoon , Park Jung-Bin , Ji Sang-Hwan , Jang Young-Eun , Lee Ji-Hyun , Kim Jin-Tae , Kim Hee-Soo
Published: February 2023

BACKGROUND:

Perioperative respiratory adverse events are common in children. We aimed to evaluate the effect of the transdermal β-2 agonist, tulobuterol, compared with that of placebo on the incidence of perioperative respiratory adverse events in pediatric patients undergoing tonsillectomy.

METHODS:

In this triple-blinded (patient, anesthesia provider, and outcome assessor) randomized controlled trial, 188 patients were randomly allocated to receive tulobuterol or a placebo. The tulobuterol groups received a tulobuterol patch (1 mg) masked with a bandage, whereas the placebo only received the bandage. The assigned bandage was applied to the patients 8 to 10 hours before the surgery. The primary outcome was the occurrence of any perioperative respiratory adverse events: oxygen desaturation <95%, airway obstruction, laryngospasm, bronchospasm, severe coughing, or stridor. The outcomes were evaluated using the average relative effect test, which estimates the effect of individual components of a composite outcome and then averages effects across components.

RESULTS:

A total of 88 and 94 patients who received tulobuterol and placebo, respectively, were analyzed. The incidence of any perioperative respiratory adverse event was lower with tulobuterol (n = 13/88; 14.7%) than that with the placebo (n = 40/94; 42.5%), with an estimated average relative risk (95% confidence interval) across components of 0.35 (0.20–0.60; P < .001). The symptoms of airway obstruction were lower with tulobuterol (n = 8/88; 9.0%) than that with the placebo (n = 32/94; 34.0%), with relative risk (95% CI) of 0.31 (0.17–0.56; P < .001). The occurrence of severe coughing was lower with tulobuterol (n = 1/88; 1.1%) than that with the placebo (n = 8/94; 8.5%), with relative risk (95% CI) of 0.15 (0.03–0.68; P = .014).

CONCLUSIONS:

In preschool children undergoing tonsillectomy, the preoperative application of a tulobuterol patch could decrease the occurrence of perioperative respiratory adverse events. Further studies are needed to elucidate the effect of the tulobuterol patch in a broad spectrum of pediatric anesthesia.
Influence of Fibrinogen Concentrate on Neonatal Clot Structure When Administered Ex Vivo After Cardiopulmonary Bypass
Authors: Moiseiwitsch Nina , Nellenbach Kimberly A. , Downey Laura A. , Boorman David , Brown Ashley C. , Guzzetta Nina A.
Published: February 2023

BACKGROUND:

Bleeding is a serious complication of cardiopulmonary bypass (CPB) in neonates. Blood product transfusions are often needed to adequately restore hemostasis, but are associated with significant risks. Thus, neonates would benefit from other effective, and safe, hemostatic therapies. The use of fibrinogen concentrate (FC; RiaSTAP, CSL Behring, Marburg, Germany) is growing in popularity, but has not been adequately studied in neonates. Here, we characterize structural and degradation effects on the neonatal fibrin network when FC is added ex vivo to plasma obtained after CPB.

METHODS:

After approval by the institutional review board and parental consent, blood samples were collected from neonates undergoing cardiac surgery and centrifuged to yield platelet poor plasma. Clots were formed ex vivo from plasma obtained at several time points: (1) baseline, (2) immediately post-CPB, and (3) post-transfusion of cryoprecipitate. In addition, we utilized post-CPB plasma to construct the following conditions: (4) post-CPB +0.5 mg/mL FC, and (5) post-CPB +0.9 mg/mL FC. The resultant fibrin networks were imaged using confocal microscopy to analyze overall structure, fiber density, and alignment. Clots were also analyzed using a microfluidic degradation assay. Fibrinogen content was quantified for all plasma samples.

RESULTS:

The addition of 0.5 or 0.9 mg/mL FC to post-CPB samples significantly enhanced the median fiber density when compared to untreated post-CPB samples (post-CPB = 0.44 [interquartile range {IQR}: 0.36–0.52], post-CPB +0.5 mg/mL FC = 0.69 [0.56–0.77], post-CPB +0.9 mg/mL FC = 0.87 [0.59–0.96]; P = .01 and P = .006, respectively). The addition of 0.9 mg/mL FC to post-CPB samples resulted in a greater fiber density than that observed after the in vivo transfusion of cryoprecipitate (post-transfusion = 0.54 [0.45–0.77], post-CPB +0.9 mg/mL FC = 0.87 [0.59–0.96]; P = .002). Median fiber alignment did not differ significantly between post-CPB samples and samples treated with FC. Degradation rates were not statistically significant from baseline values with either 0.5 or 0.9 mg/mL FC. In addition, we found a significant correlation between the difference in the baseline and post-CPB fibrinogen concentration with patient age (P = .033) after controlling for weight.

CONCLUSIONS:

Our results show that clots formed ex vivo with clinically relevant doses of FC (0.9 mg/mL) display similar structural and degradation characteristics compared to the in vivo transfusion of cryoprecipitate. These findings suggest that FC is effective in restoring structural fibrin clot properties after CPB. Future studies after the administration of FC in vivo are needed to validate this hypothesis.
The Effect of Intrathecal Morphine on Postoperative Opioid Consumption in Patients Undergoing Abdominal Surgery for Gynecologic Malignancy: A Randomized Sham-Controlled Trial
Authors: Bang Yu Jeong , Lee Eun Kyung , Kim Chung Su , Hahm Tae Soo , Jeong Heejoon , Cho Yoon Jee , Noh Joseph J. , Lee Yoo-Young , Choi Chel Hun , Lee Jeong-Won , Jeong Ji Seon
Published: February 2023

BACKGROUND:

Surgery for gynecologic malignancy via midline-laparotomy leads to severe postoperative pain. Adequate pain control while sparing opioid consumption does offer benefits in postoperative complications and recovery. Intrathecal morphine (ITM) provides simple and effective analgesia. In this randomized trial, we compared postoperative opioid consumption in patients who received either ITM or a sham procedure.

METHODS:

We enrolled 68 adult patients undergoing open gynecologic oncology surgery from June 2021 to November 2021. They were randomly allocated to the ITM group (ITM; 200 μg injection) or sham group (sham procedure) to achieve a final 1:1 ratio between groups. We compared opioid consumption and pain severity during 72 hours after surgery. The variables regarding postoperative recovery and patient-centered outcomes were collected. The primary outcome is cumulative intravenous (IV) opioid consumption 24 hours after surgery.

RESULTS:

The median (interquartile range) cumulative IV opioid consumption during 24 hours after surgery was 18 mg (12–29) in the ITM group and 36 mg (27–42) in the sham group (median difference, 13; 95% confidence interval, 7.2–20.7; P < .001). Patient satisfaction regarding pain control was statistically significantly higher in the ITM group than in the sham group at postoperative 24 and 48 hours (P < .001 and P = .005, respectively). There were no significant differences in the variables associated with postoperative recovery and frequency of complications requiring treatment.

CONCLUSIONS:

ITM is a safe and effective analgesic method after curative intent laparotomy for gynecologic malignancy. ITM provides better pain relief, reduces opioid consumption, and improves patient satisfaction without additional evident adverse events.
Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block
Authors: Kim Ji Yeong , Kim Jiyoung , Kim Do-Hyeong , Han Dong Woo , Kim Sang Hyun , Kim Donghyun , Chung Siwook , Yu Sanghyuck , Lee U-Young , Park Hue Jung
Published: February 2023

BACKGROUND:

The pericapsular nerve group (PENG) block was recently suggested as a regional technique for managing acute pain after hip surgery. However, few anatomical studies have confirmed the spread of injectate during the PENG block. This cadaver study aimed to analyze injectate spread to the target nerves during single-injection ultrasound-guided PENG block.

METHODS:

Ultrasound-guided PENG block with 3 different injectate volumes (10, 20, or 30 mL) was performed in 18 cadavers. Injectate spread by the volume was first evaluated on computed tomography, followed by cadaver dissection. The spread of the dye over the pelvis and lower limb was evaluated.

RESULTS:

The articular branches of the femoral nerve were stained nearly sufficiently with 20- and 30-mL specimens. The femoral nerve itself was stained simultaneously in six of 12 (50%) 20-mL specimens and 12 of 12 (100%) 30-mL specimens. The accessory obturator nerve was observed only in three (9%) of 36 specimens. The articular branches of the obturator nerve were rarely affected, regardless of injectate volume (1/12, 10 mL specimens; 2/12, 20 mL specimens; 1/12, 30 mL specimens; P > .999). Rather, the obturator nerve was affected. However, the obturator nerve was not stained consistently even with 30 mL of injectate (50%).

CONCLUSIONS:

After combining the dissection and radiological findings, the single-injection ultrasound-guided PENG blocks with volumes of 10, 20, and 30 mL do not support motor sparing or selective anterior hip capsule innervation in a clinical setting. If early rehabilitation is needed, high-volume PENG block might not be the ideal option, and persisting pain after PENG block might be attributed in part to the lack of obturator nerve articular branches blockade.
Influence of Different Sevoflurane Concentrations on Postoperative Cognitive Function in Aged Rats
Authors: Yamamoto Natsuko , Kimura Tetsu , Niiyama Yukitoshi
Published: February 2023

BACKGROUND:

Postoperative cognitive dysfunction may be associated with neuroinflammation, and sevoflurane suppresses surgery-induced inflammation. We hypothesized that low concentrations of sevoflurane would result in more impaired postoperative cognitive function compared to high concentrations.

METHODS:

Aged male Sprague–Dawley rats (n = 21, 17–22 months) were randomly assigned to 1 of 3 groups: control (C), sevoflurane 2% (S2), and sevoflurane 4% (S4). Rats in the S2 and S4 groups underwent open femoral fracture and intramedullary fixation of the left hind limb under 2 hours of sevoflurane anesthesia. Neurological outcomes were evaluated using the Morris water maze (MWM) test, and histopathological outcomes were assessed 28 days after surgery.

RESULTS:

The S2 group showed prolonged swimming latency compared to S4 on day 7 (difference of means, 34.4; 95% confidence interval [CI], 2.57–66.3; P = .031) and compared to the C group on day 9 (difference of means, –33.4; 95% CI, –65.3 to –1.55; P = .037). The intact CA1 cells in the S2 group were significantly less than those in the C and S4 groups (H statistic, 10.87; P = .006 versus C; P = .033 versus S4).

CONCLUSIONS:

We found that low concentrations of sevoflurane prolonged the swimming latency of the MWM compared to high concentrations and reduced intact CA1 hippocampal neurons in aged rats. These results suggest that low-concentration sevoflurane anesthesia may be more detrimental than high concentration for spatial cognitive function and postoperative impairment of hippocampal CA1 cells in aged rats.
A Sensorised Surgical Glove to Analyze Forces During Neurosurgery
Authors: Layard Horsfall Hugo , Salvadores Fernandez Carmen , Bagchi Biswajoy , Datta Priyankan , Gupta Priya , Koh Chan Hee , Khan Danyal , Muirhead William , Desjardins Adrien , Tiwari Manish K. , Marcus Hani J.
Published: February 2023

BACKGROUND:

Measuring intraoperative forces in real time can provide feedback mechanisms to improve patient safety and surgical training. Previous force monitoring has been achieved through the development of specialized and adapted instruments or use designs that are incompatible with neurosurgical workflow.

OBJECTIVE:

To design a universal sensorised surgical glove to detect intraoperative forces, applicable to any surgical procedure, and any surgical instrument in either hand.

METHODS:

We created a sensorised surgical glove that was calibrated across 0 to 10 N. A laboratory experiment demonstrated that the sensorised glove was able to determine instrument-tissue forces. Six expert and 6 novice neurosurgeons completed a validated grape dissection task 20 times consecutively wearing the sensorised glove. The primary outcome was median and maximum force (N).

RESULTS:

The sensorised glove was able to determine instrument-tissue forces reliably. The average force applied by experts (2.14 N) was significantly lower than the average force exerted by novices (7.15 N) (P = .002). The maximum force applied by experts (6.32 N) was also significantly lower than the maximum force exerted by novices (9.80 N) (P = .004). The sensorised surgical glove's introduction to operative workflow was feasible and did not impede on task performance.

CONCLUSION:

We demonstrate a novel and scalable technique to detect forces during neurosurgery. Force analysis can provide real-time data to optimize intraoperative tissue forces, reduce the risk of tissue injury, and provide objective metrics for training and assessment.
Increased Circulating Chemokines and Macrophage Recruitment in Growing Vestibular Schwannomas
Authors: Hannan Cathal John , Lewis Daniel , O'Leary Claire , Waqar Mueez , Brough David , Couper Kevin N. , Dyer Douglas P. , Vail Andy , Heal Calvin , Macarthur Joshua , Cooper Christopher , Hammerbeck-Ward Charlotte , Evans D. Gareth , Rutherford Scott A. , Lloyd Simon K. , Mackenzie Freeman Simon Richard , Coope David John , King Andrew T. , Pathmanaban Omar Nathan
Published: February 2023

BACKGROUND:

There is evidence that macrophage infiltration in the tumor microenvironment promotes vestibular schwannoma (VS) growth. Efficacy of bevacizumab in NF2-associated VS demonstrates the value of therapies targeting the microvascular tumor microenvironment, and tumor-associated macrophages (TAMs) may represent another druggable target.

OBJECTIVE:

To characterize the relationship between growth, TAM infiltration, and circulating monocyte chemokines in a large cohort of patients with VS.

METHODS:

Immunostaining for Iba1 (macrophages), CD31 (endothelium), and fibrinogen (permeability) was performed on 101 growing and 19 static sporadic VS. The concentrations of monocyte-specific chemokines were measured in the plasma of 50 patients with growing VS and 25 patients with static VS.

RESULTS:

The Iba1+ cell count was significantly higher in growing as compared with static VS (592 vs 226/×20 HPF, P=<0.001). Similarly, the CD31+ % surface area was higher in growing VS (2.19% vs 1.32%, P = .01). There was a positive correlation between TAM infiltration and VS growth rate, which persisted after controlling for the effect of tumor volume (aR2 = 0.263, P=<0.001). The plasma concentrations of several monocytic chemokines were higher in patients with growing rather than static VS.

CONCLUSION:

There is a strong positive correlation between TAM infiltration and volumetric growth of VS, and this relationship is independent of tumor size. There is a colinear relationship between TAM infiltration and tumor vascularity, implying that inflammation and angiogenesis are interlinked in VS. Chemokines known to induce monocyte chemotaxis are found in higher concentrations in patients with growing VS, suggestive of a potential pathophysiological mechanism.