bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective Reversal of Moderate Rocuronium- or Vecuronium-induced Neuromuscular Block with Sugammadex, a Selective Relaxant Binding Agent
Authors: Suy Koen , Morias Karl , Cammu Guy , Hans Pol , van Duijnhoven Wilbert G. F. , Heeringa Marten , Demeyer Ignace 
Published: January 2007

Background
Sugammadex rapidly reverses rocuronium-induced neuromuscular block. This study explored the dose-response relation of sugammadex given as a reversal agent at reappearance of the second muscle twitch after rocuronium- and vecuronium-induced block. A secondary objective was to investigate the safety of single doses of sugammadex.

Methods
In this two-center, phase II, dose-finding study, 80 patients (age >or= 18 yr, American Society of Anesthesiologists physical status I or II, surgery >or= 60 min requiring muscle relaxation for intubation) were randomly assigned to receive rocuronium (0.60 mg/kg) or vecuronium (0.10 mg/kg). Sugammadex or placebo was administered at reappearance of the second muscle twitch. The primary efficacy endpoint was time from starting sugammadex administration until recovery of the train-of-four ratio to 0.9.

Results
Compared with placebo, sugammadex produced dose-dependent decreases in mean time to recovery for all train-of-four ratios in the rocuronium and vecuronium groups. The mean time for recovery of the train-of-four ratio to 0.9 in the rocuronium group was 31.8 min after placebo compared with 3.7 and 1.1 min after 0.5 and 4.0 mg/kg sugammadex, respectively. The mean time for recovery of the train-of-four ratio to 0.9 in the vecuronium group was 48.8 min after placebo, compared with 2.5 and 1.4 min after 1.0 and 8.0 mg/kg sugammadex, respectively. Sugammadex was well tolerated.

Conclusion
Sugammadex rapidly reversed rocuronium- or vecuronium-induced neuromuscular block at reappearance of the second muscle twitch and was well tolerated. A dose-response relation was observed with sugammadex for reversal of both rocuronium- and vecuronium-induced neuromuscular block.
Effect of Combined Anticoagulation Using Heparin and Bivalirudin on the Hemostatic and Inflammatory Responses to Cardiopulmonary Bypass in the Rat
Authors: Welsby Ian J. , Jones Wilbert L. , Arepally Gowthami , De Lange Fellery , Yoshitani Kenji , Phillips-Bute Barbara , Grocott Hilary P. , Becker Richard , Mackensen G Burkhard 
Published: January 2007

Background
Despite high-dose heparin anticoagulation, cardiopulmonary bypass (CPB) is still associated with marked hemostatic activation. The purpose of this study was to determine whether a reduced dose of bivalirudin, added as an adjunct to heparin, would reduce thrombin generation and circulating markers of inflammatory system activation during CPB as effectively as full-dose bivalirudin, without adversely affecting postoperative hemostasis.

Methods
Using a model of normothermic CPB in rats, the authors prospectively compared markers of thrombin generation (thrombin-antithrombin complexes) and inflammatory markers (tumor necrosis factor alpha, interleukin 1beta, interleukin 6, and interleukin 10) in three groups: conventional high-dose heparin (H), full-dose bivalirudin (B), and a combined group (standard high-dose heparin with the addition of reduced dose bivalirudin or H&B), at baseline, after 60 min of CPB, and 60 min after CPB. Postoperative hemostasis was also assessed.

Results
Groups H&B and B showed reduced thrombin-antithrombin complex formation during CPB compared with group H (P = 0.0003), and this persisted after CPB for group B (P = 0.009). Perioperative increases in interleukin 6 and interleukin 10 showed a trend toward being reduced in animals receiving bivalirudin (P = 0.06). Evidence of residual anticoagulation was found in group H&B as measured by activated clotting time (P = 0.04) and activated partial thromboplastin time (P = 0.02), but no intergroup difference in primary hemostasis was found.

Conclusions
Bivalirudin attenuates hemostatic activation during experimental CPB with potential effects on markers of the inflammatory response. However, with this dosing regimen, the combination of heparin and bivalirudin does not seem to confer any measurable advantages over full-dose bivalirudin anticoagulation.
Propofol Modulates Na+–Ca2+Exchange Activity via Activation of Protein Kinase C in Diabetic Cardiomyocytes
Authors: Wickley Peter J. , Shiga Toshiya , Murray Paul A. , Damron Derek S. 
Published: January 2007

Background
The authors' objective was to identify the role of the Na+-Ca2+ exchanger (NCX) in mediating the contractile dysfunction observed in diabetic cardiomyocytes before and after exposure to propofol.

Methods
Freshly isolated ventricular myocytes were obtained from normal and diabetic rat hearts. Intracellular concentration of Ca2+ and cell shortening were simultaneously measured in electrically stimulated, ventricular myocytes using fura-2 and video-edge detection, respectively. Postrest potentiation (PRP) and sarcoplasmic reticulum Ca2+ load were used to assess propofol-induced changes in the activity of the NCX.

Results
Propofol (10 microM) increased PRP in diabetic cardiomyocytes but had no effect on PRP in normal cardiomyocytes. Removal of sodium enhanced and KB-R7943 (reverse mode NCX inhibitor) blocked PRP in both normal and diabetic cardiomyocytes. In the absence of sodium, propofol enhanced PRP in diabetic cardiomyocytes but had no additional effect in normal cardiomyocytes. KB-R7943 completely blocked propofol-induced potentiation of peak intracellular concentration of Ca2+ and shortening in both cell types. Propofol increased sarcoplasmic reticulum Ca2+ load and prolonged removal of cytosolic Ca2+ in diabetic cardiomyocytes, but not in normal cardiomyocytes. Removal of sodium enhanced propofol-induced increases in sarcoplasmic reticulum Ca2+ load and further prolonged removal of cytosolic Ca2+, whereas KB-R7943 completely blocked propofol-induced increase in sarcoplasmic reticulum Ca2+ load. Protein kinase C inhibition with bisindolylmaleimide I prevented the propofol-induced increase in PRP and prolongation in Ca2+ removal.

Conclusions
These data suggest that propofol enhances PRP via activation of reverse mode NCX, but attenuates Ca2+ removal from the cytosol via inhibition of forward mode NCX in diabetic cardiomyocytes. The actions of propofol are mediated via a protein kinase C-dependent pathway.
Opioid Self-administration in the Nerve-injured Rat
Authors: Martin Thomas J. , Kim Susy A. , Buechler Nancy L. , Porreca Frank , Eisenach James C. 
Published: January 2007

Background
Neuropathic pain is associated with several sensory abnormalities, including allodynia as well as spontaneous pain. Opioid intake in neuropathic pain patients is motivated by alleviation of both pain and allodynia. However, laboratory animal studies rely almost exclusively on reflexive withdrawal measures of allodynia. The authors examined the pharmacology of self-regulated intake of opioids in rats with or without nerve injury and compared the rate of drug intake to reversal of allodynia.

Methods
Rats were implanted with intravenous catheters, and the L5 and L6 spinal nerves were ligated in half of these animals. Rats were then trained to self-administer a commonly abused opioid (heroin) and commonly prescribed opioids (morphine, fentanyl, hydromorphone, and methadone). In addition, rats trained to self-administer heroin were given either clonidine or adenosine spinally before self-administration sessions to assess opioid-sparing effects.

Results
Nerve injury significantly decreased the reinforcing effects of low doses of opioids, and only doses of each opioid that reduced mechanical hypersensitivity maintained self-administration after spinal nerve ligation. The rate of drug consumption was correlated with the duration of the antiallodynic effect for each dose of opioid. Intrathecal administration of clonidine or adenosine reversed mechanical hypersensitivity, but only clonidine reduced heroin self-administration in rats with spinal nerve ligation.

Conclusion
Opioid self-administration is significantly altered by nerve injury, with rate of drug intake being correlated with reversal of allodynia. Intrathecal clonidine, but not adenosine, produces opioid-sparing effects in self-administering rats. The neurobiologic mechanisms that regulate opioid consumption in rats therefore seem to be altered after nerve injury.
A Computer Model of Electrical Stimulation of Peripheral Nerves in Regional Anesthesia
Authors: Johnson Chad R. , Barr Roger C. , Klein Stephen M. 
Published: January 2007

Background
Nerve stimulation for regional anesthesia can be modeled mathematically. The authors present a mathematical framework to model the underlying electrophysiology, the development of software to implement that framework, and examples of simulation results.

Methods
The mathematical framework includes descriptions of the needle, the resulting potential field, and the active nerve fiber. The latter requires a model of the individual membrane ionic currents. The model geometry is defined by a three-dimensional coordinate system that allows the needle to be manipulated as it is clinically and tracked in relation to the nerve fiber. The skin plane is included as an electrical boundary to current flow. The mathematical framework was implemented in the Matlab (The MathWorks, Natick, MA) computing environment and organized around a graphical user interface. Simulations were performed using an insulated needle or an uninsulated needle inserted perpendicular to the skin with the nerve fiber at a depth of 2 cm. For each needle design, data were obtained with the needle as cathode or anode. Data are presented as current-distance maps that highlight combinations of current amplitude and tip-to-nerve distance that evoked a propagated response.

Results
With the needle tip positioned 2 mm proximal to the depth of the nerve, an insulated needle required a current greater than 0.457 mA for impulse propagation when attached to the cathode; when attached to the anode, the minimal current was 2.354 mA. In the same position, an uninsulated needle attached to the cathode required a current greater than 2.395 mA to generate a response. However, when an uninsulated needle was attached to the anode, currents up to 7 mA were inadequate to produce a propagated response. Of particular interest were combinations of current amplitude and needle position that activated the fiber but blocked impulse propagation for cathodal stimulation.

Conclusions
Mathematical modeling of nerve stimulation for regional anesthesia is possible and could be used to investigate new equipment or needle designs, test nerve localization protocols, enhance clinical and experimental data, and ultimately generate new hypotheses.
Neosaxitoxin as a Local Anesthetic
Authors: Rodriguez-Navarro Alberto J. , Lagos Nestor , Lagos Marcelo , Braghetto Italo , Csendes Attila , Hamilton James , Figueroa Cristian , Truan Dominique , Garcia Carlos , Rojas Andres , Iglesias Veronica , Brunet Luis , Alvarez Francisco 
Published: January 2007

Background
Neosaxitoxin is a phycotoxin that reversibly blocks the voltage-gated sodium channels at the neuronal level. Its activity results in blocking the axonal conduction, stopping the propagation of the nerve impulse. The objective of the present work was to evaluate neosaxitoxin as a local anesthetic in a human trial.

Methods
The authors conducted a randomized, double-blind, placebo-controlled trial with 10 healthy volunteers. Subcutaneous injections were made in the middle posterior skin of the calf: one leg received 50 microg neosaxitoxin, and the contra-lateral leg received placebo. The anesthetic effect was evaluated using a standardized human sensory and pain model. TSA II Neurosensory Analyzer (Medoc Ltd, Minneapolis, MN) and von Frey technique were used to evaluate five parameters: sensory threshold for warm and cold, pain thresholds for heat and cold, and mechanical touch perception threshold. Measurements were made 0, 1, 3, 6, 9, 12, 16, 24, and 48 h after the injections.

Results
For all the patients, effective and complete blocking of the evaluated parameters was obtained. As the blocking began to revert gradually, heat pain was the first to return to normal values after 3 h. Cold pain was the longest sensation abolished, achieving 24 h of blockade. The toxin was undetected in blood and urine samples. No adverse reactions to neosaxitoxin were detected.

Conclusions
Neosaxitoxin showed an effective local anesthetic effect when injected in the subcutaneous plane. The efficacy of a 50-microg dose of neosaxitoxin was shown. This is the first report of neosaxitoxin as a local anesthetic in a human trial.
Influence of Patient and Hospital Characteristics on Anesthesia Time in Medicare Patients Undergoing General and Orthopedic Surgery
Authors: Silber Jeffrey H. , Rosenbaum Paul R. , Zhang Xuemei , Even-Shoshan Orit 
Published: January 2007

Background
Procedure time is a clinically important variable that is often analyzed when studying quality and efficiency. Norms for procedure length have not been reported from Medicare data sets, nor has the influence of patient and hospital characteristics on procedure time been estimated using Medicare data.

Methods
The authors obtained Medicare claims on all patients aged 65-85 years who underwent general surgical and orthopedic surgical procedures in Pennsylvania. Anesthesia procedure time was estimated from anesthesia time units bills supplied from Medicare on 20 common general and orthopedic surgery procedures, and models to determine the influence of hospital and patient characteristics were developed.

Results
Of the 77,638 patients, 31,472 had general surgery and 46,166 underwent orthopedic procedures. The median anesthesia time for general surgery was 133 min, and for orthopedic surgery it was 146 min. After adjusting for principal procedure, hospital, and physiologic severity, covariates associated with increased anesthesia time included: multiple procedure on same day + 18.3 min (P < 0.0001); transfer-in + 6.7 min (P = 0.0002); black race + 5.5 (P < 0.0001); coagulation disorders + 4.9 (P = 0.0012); and paraplegia + 4.5 (P = 0.0006). Lower-income black patients had significantly longer procedure times than lower-income white patients (+ 7 min; P < 0.0001). Among the 15 hospitals with the largest black surgical populations, 5 hospitals had statistically significant procedure lengths for black versus white patients, ranging from + 9 to + 16 min.

Conclusions
In addition to variation by patient comorbidities and procedure, anesthesia procedure time varies with hospital, medical history, and sociodemographic characteristics.
The psychological science of addiction
Authors: Gifford Elizabeth , Humphreys Keith 
Published: January 2007

ABSTRACTAim  To discuss the contributions and future course of the psychological science of addiction.Background  The psychology of addiction includes a tremendous range of scientific activity, from the basic experimental laboratory through increasingly broad relational contexts, including patient–practitioner interactions, families, social networks, institutional settings, economics and culture. Some of the contributions discussed here include applications of behavioral principles, cognitive and behavioral neuroscience and the development and evaluation of addiction treatment. Psychology has at times been guilty of proliferating theories with relatively little pruning, and of overemphasizing intrapersonal explanations for human behavior. However, at its best, defined as the science of the individual in context, psychology is an integrated discipline using diverse methods well‐suited to capture the multi‐dimensional nature of addictive behavior.Conclusions  Psychology has a unique ability to integrate basic experimental and applied clinical science and to apply the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the prevalence of addiction.
Predictors of mortality among injecting and non‐injecting HIV‐negative drug users in northern Thailand
Authors: Quan Vu Minh , Vongchak Tasanai , Jittiwutikarn Jaroon , Kawichai Surinda , Srirak Namtip , Wiboonnatakul Kanokporn , Razak Myat Htoo , Suriyanon Vinai , Celentano David D. 
Published: January 2007

ABSTRACTAims  To estimate mortality rates among HIV‐negative injecting drug users (IDUs) and non‐injecting drug users (non‐IDUs), and to assess predictors for mortality among the IDUs.Design  Prospective cohort study in northern Thailand with 2‐year follow‐up.Setting  IDUs and non‐IDUs who were admitted for detoxification treatment for opiate or amphetamine dependence in a regional drug treatment center were screened. After discharge, HIV‐negative individuals were followed‐up in the community.Participants  A total of 821 HIV‐negative drug users [346 IDUs (42%) and 475 non‐IDUs, median age = 32; 51% were ethnic minorities].Measurements  All‐cause mortality.Findings  There were 33 deaths over 1360 person‐years of follow‐up. The all‐cause mortality rate was 39 per 1000 person‐years among IDUs [standardized mortality ratio (SMR) = 13.9], and was 14 per 1000 person‐years among non‐IDUs (SMR = 4.4). Among male IDUs, the hazards for all‐cause deaths were ethnic minority status [adjusted hazard ratio (HR) = 2.9, 95% CI = 1.2–7.2], incident HIV infection (HR = 2.8, 95% CI = 1.1–7.7) and longer duration of drug injection (HR = 1.07, 95% CI = 1.01–1.14).Conclusions  The mortality among IDUs is high. Being from an ethnic minority, recent HIV acquisition, and a greater number of years of drug injection are predictors of mortality among the IDUs in this region.
Seed dispersal and recruitment limitation are barriers to native recolonization of old‐fields in western Australia
Authors: STANDISH R. J. , CRAMER V. A. , WILD S. L. , HOBBS R. J. 
Published: January 2007

Summary

Native recolonization of abandoned farmland in the wheat‐growing region of western Australia is slow to non‐existent, even 45 years after abandonment. Instead, old‐fields tend to be dominated by non‐native annual grasses. The native vegetation in the region is highly fragmented. We predicted that recovery is limited by seed availability and recruitment failure.
We compared the seed rain, soil seed bank and extant vegetation of three old‐fields and three adjacent native woodland remnants to test our predictions.
Seed dispersal limitation was evident at two old‐fields: species richness of the native seed in the soil seed bank declined at 50‐m increments (i.e. 0 m, 50 m and 100 m) into the old‐fields. Species richness of recolonizing native vegetation also declined along this transect.
Recruitment limitation was evident at one old‐field, probably linked to the few abundant non‐native species that dominated the vegetation. These non‐natives dominated the seed supply, and tended to germinate more rapidly than the native seeds.
In contrast, seed dispersal and recruitment had not limited native recolonization of the third old‐field: 91% of the species present in the adjacent remnant had recolonized this old‐field. Species richness and abundance of non‐natives in the seed supply and extant vegetation were minor compared with that of the other old‐fields. Therefore an adequate seed supply of natives, the lack of non‐natives and chance natural disturbance events (i.e. cyclone and fire) had probably contributed to this result.
Synthesis and applications. Native recolonization of wheatbelt old‐fields is contingent upon the unusual coincidence of seed availability, favourable conditions for recruitment and an absence of competitive non‐natives. Grasses, annual herbs and Acacia shrubs are dominant among the few native species that have consistently recolonized these old‐fields. In most cases, direct seeding and control of non‐natives are the minimum requirements for restoration of wheatbelt old‐fields to species‐rich eucalypt woodlands.
One‐year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients
Authors: Park W. B. , Choe P. G. , Kim S.‐H. , Jo J. H. , Bang J. H. , Kim H. B. , Kim N. J. , Oh M. , Choe K. W. 
Published: January 2007

Abstract.Objective.  To determine whether adherence to clinic visits early after initiation of highly active antiretroviral therapy (HAART) is predictive of long‐term clinical outcome.Design.  Observational cohort study.Setting.  A tertiary referral hospital.Subjects.  A total of 387 adult HIV patients who were followed for at least 1 year after initiation of HAART between January 1998 and December 2004.Main outcome measurements.  The effect of 1‐year adherence to clinic visits on the occurrence of new AIDS‐defining illness or death was assessed using Kaplan–Meier survival estimates, and hazard ratios were estimated using Cox proportional hazards regression model.Results.  Multivariate analysis revealed that advanced clinical stage, fewer new drugs in HAART, and longer total elapsed time without clinical visits for 1 year after HAART were all significant risk factors for the occurrence of new AIDS‐defining illnesses or death. Compared with no missed visits, the hazard ratio adjusted by clinical stage and number of new drugs in HAART was 2.87 (95% confidence interval [CI], 1.34–6.16, P = 0.007) for one missed appointment, 4.37 (95% CI: 1.74–10.98, P = 0.002) for two, and 8.19 (95% CI: 2.95–22.78, P < 0.001) for three or more.Conclusion.  Adherence to clinic visits early after initiation of HAART is an independent predictor for long‐term clinical progression in HIV patients.
Effects of rotating shift work on biomarkers of metabolic syndrome and inflammation
Authors: Sookoian S. , Gemma C. , Fernández Gianotti T. , Burgueño A. , Alvarez A. , González C. D. , Pirola C. J. 
Published: January 2007

Abstract.Objective.  The major function of the circadian system is the internal cycling of physiological and metabolic events. The present study sought to explore the effect of rotating shift work schedule on leucocyte count and its relationship with risk factors of metabolic syndrome (MS).Design and participants.  From a population‐based design, 1351 men of self‐reported European ancestry were included in a cross‐sectional study: 877 day workers were compared with 474 rotating shift workers. Medical history, health examination including anthropometric and arterial blood pressure measurements, a questionnaire on health‐related behaviours and biochemical determinations was given to all participants.Results.  In comparison with day workers, rotating shift workers had elevated (mean ± SE) body mass index (27.1 ± 0.3 vs. 26.3 ± 0.2, P < 0.0154), waist‐hip ratio (0.95 ± 0.01 vs. 0.93 ± 0.01, P < 0.00024), diastolic arterial blood pressure (78 ± 1 vs. 76 ± 1, P < 0.033), fasting insulin (65.5 ± 2.9 vs. 55.9 ± 1.9 pmol L−1, P < 0.017), Homeostasis Model Assessment index (2.12 ± 0.11 vs. 1.77 ± 0.07, P < 0.0027), triglycerides (1.71 ± 0.1 vs. 1.5 ± 0.1 mmol L−1, P < 0.002), uric acid (292.7 ± 2.8 vs. 282 ± 3.4 μmol L−1, P < 0.01) and leucocyte count (7030 ± 84 vs. 6730 ± 58, P < 0.0094). In multiple regression analysis, leucocyte count was correlated with rotating shift work independently of age, smoking, education and components of MS.Conclusion.  The odds ratio for MS in rotating shift workers compared with day workers was 1.51 (95% CI 1.01–2.25), independently of age and physical activity. Increased leucocyte count, a biological marker of systemic inflammation, was associated with rotating shift work.