Clamping Group Research Articles

Effect of peripheral hyperinsulinemia on assessment of pharmacokinetics and pharmacodynamics of insulin preparations in euglycemic clamp

Objective: To evaluate the effect of peripheral hyperinsulinemia on assessment of pharmacokinetics (PK) and pharmacodynamics (PD) of insulin preparations in euglycemic clamp. Method: A total of 40 healthy male volunteers aged 18-45 years old in West China Hospital between 2015 and 2017 were divided into euglycemic-hyperinsulinaemic clamp (A) group and euglycemic clamp (B) group. Humulin R (0.2 U/kg) was given subcutaneously at steady state of clamp after infusion of short-acting insulin in A group while in B group Humulin R was given subcutaneously without establishment of artificial hyperinsulinemia. The blood glucose was maintained within target range during the whole clamp. Result: Maximum insulin concentration [(667±141) pmol/L vs (267±68) pmol/L, P<0.01] and area under curve (AUC) of insulin concentration [(152±32) nmol·L(-1)·min vs (57±7) nmol·L(-1)·min, P<0.01] in A group were higher while maximum glucose infusion rate (GIR) [(3.70±0.70) mg·kg(-1)·min(-1) vs (7.66±2.11) mg·kg(-1)·min(-1), P<0.01] and AUC of GIR [(931±272) mg/kg vs (1 920±452) mg/kg, P<0.01] were lower compared to B group. The serum C-peptide levels were lower in both groups after administration of insulin compared with baseline. Conclusion: It is not necessary applying euglycemic-hyperinsulinaemic clamp to evaluate the PK/PD of insulin preparations, which may overestimate the PKparameters and underestimate the PD parameters of insulin preparations.

Infrahepatic Inferior Vena Cava Semi-Clamping can Reduce Blood Loss During Hepatic Resection but Still Requires Monitoring to Avoid Acute Kidney Injury.

The efficacy of infrahepatic inferior vena cava (IVC) semi-clamping for reducing blood loss during hepatic resection and its safety remain unclear. The aim of this study was to validate the effectiveness of IVC semi-clamping for reducing blood loss during hepatic resection and to confirm its safety. Patients who underwent anatomical hepatic resection between January 2011 and May 2018 were analysed by propensity score-matched and multivariate analyses. Of 437 patients who underwent anatomical hepatic resection, IVC semi-clamping was performed in 196 patients (44.9%; clamping group). A propensity score-matched analysis demonstrated that even though there was no significant difference in the characteristics of the 141 patients in each group, IVC semi-clamping reduced the blood loss during hepatic resection (clamping group versus non-clamping group: 836 ± 123 vs. 1198 ± 124ml, P = 0.04). Regarding post-operative complications, the multivariate analysis identified IVC semi-clamping as an independent risk factor for acute kidney injury on post-operative day 1 (P = 0.01, odds ratio = 9.23). A significant positive correlation was found between the duration of IVC semi-clamping and an increased level of serum creatinine (sCre) (P = 0.03), and a significant inverse correlation was found between the blood pressure after clamping and an increased level of sCre (P = 0.02). A receiver operating characteristic analysis revealed the duration and mean blood pressure after clamping that indicated a high risk of acute kidney injury to be 116min and 65mmHg, respectively. IVC semi-clamping can reduce blood loss during hepatic resection but still necessitates monitoring in order to avoid acute kidney injury.

Clamping the Umbilical Cord in Premature Deliveries (CUPiD): Neuromonitoring in the Immediate Newborn Period in a Randomized, Controlled Trial of Preterm Infants Born at

To compare cerebral activity and oxygenation in preterm infants (<32weeks of gestation) randomized to different cord clamping strategies. Preterm infants born at <32weeks of gestation were randomized to immediate cord clamping, umbilical cord milking (cord stripped 3 times), or delayed cord clamping for 60seconds with bedside resuscitation. All infants underwent electroencephalogram (EEG) and cerebral near infrared spectroscopy for the first 72hours after birth. Neonatal primary outcome measures were quantitative measures of the EEG (17 features) and near infrared spectroscopy over 1-hour time frames at 6 and 12hours of life. Forty-five infants were recruited during the study period. Twelve infants (27%) were randomized to immediate cord clamping, 19 (42%) to umbilical cord milking, and 14 (31%) to delayed cord clamping with bedside resuscitation. There were no significant differences between groups for measures of EEG activity or cerebral near infrared spectroscopy. Three of the 45 infants (6.7%) were diagnosed with severe IVH (2 in the immediate cord clamping group, 1 in the umbilical cord milking group; P=.35). There were no differences in cerebral EEG activity and cerebral oxygenation values between cord management strategies at 6 and 12hours. ISRCTN92719670.

Delayed clamping vs milking of umbilical cord in preterm infants: a randomized controlled trial

It has been established that delayed umbilical cord clamping in preterm infants results in improvement in neonatal anemia, need for transfusion, incidence of necrotizing enterocolitis, and intraventricular hemorrhage by increasing neonatal circulating blood volume. However, the effects of umbilical cord milking as an alternative to delayed clamping in preterm infants are unclear. The primary objective of this study was to compare the effect of delayed clamping vs milking of the umbilical cord on the initial hematocrit concentration in preterm births (23-34 weeks gestation). In addition, we sought to compare the effects of delayed clamping vs milking on the incidences of intraventricular hemorrhage, necrotizing enterocolitis, and need for transfusion (secondary objectives). The study was an unblinded randomized controlled trial of singleton preterm infants who were born 23 weeks 0 days to 34 weeks 6 days gestation and were assigned to 1 of 2 controlled study groups: delayed cord clamping for 60 seconds or milking of the cord towards the infant 4 times before clamping. Randomization occurred via block randomization with an allocation ratio of 1 to 1. The patients' third stage of delivery was standardized for route of delivery and randomization arm. All comparisons were preformed with an intent-to-treat analysis approach. The study was powered at 80% with a probability value of .05 for the primary outcome measure of a hematocrit difference of 3% between the 2 groups. Of the 204 randomized patients, 104 were assigned to the delayed subgroup, and 100 were assigned to the milking subgroup. There were no significant differences in baseline maternal characteristics noted between groups. Though there was not any statistically significant difference in neonatal outcomes between the cord clamping and milking groups, the occurrences of transfusion (15.5% vs 9.1%; P=.24), necrotizing enterocolitis (5.8% vs 3.0%; P=.49), and intraventricular hemorrhage (15.5% vs 10.1%; P=.35) were all lower in the milking group. The milking group had higher initial hematocrit concentration compared with the delayed clamping group, although this was not significant (51.8 [6.2%] vs 49.9 [7.7%]; P=.07]. Peak bilirubin levels and need for phototherapy were similar between groups. This study demonstrates that milking the umbilical cord may be an acceptable alternative to delayed cord clamping because there were similar effects on neonatal hematocrit concentrations and the need for neonatal transfusions and no increased risk for complications or neonatal morbidity. The present data support the concept that milking of the umbilical cord may offer an efficient and timely method of providing increased blood volume to the infant.

Fatigue testing of GFRP materials for the application in automotive leaf springs

Due to their high specific properties, fiber reinforced plastics are ideal candidates for the substitution of steel parts in the automotive sector enabling high weight savings and increasing the efficiency of automobiles. One possible application are leaf springs made of glass fiber reinforced plastics. Due to the simple bending load case, the fiber orientation can be aligned with the main stress direction. In real life such components as leaf springs are loaded under stochastic loads originated from different driving maneuvers. To replicate those fatigue load case, a high number of component tests are required. Aim of the present work (as a result of a joint research project between the Institute for Plastics Processing and Ford Motor Company) is to develop a simplified testing program that is able to reproduce the damage and the fatigue behavior which occurs in real composite components. For this purpose, three point bending experiments on unidirectional specimens made of glass fiber reinforced epoxy pre-preg material are performed. However, since the loading of the real component introduces additional transverse stresses in the region of the clamping group, the results on specimen level are not transferable to component level. For this purpose, a special clamping group is developed on specimen level to enable a better prediction of fatigue life and the transferability of the results of the fatigue tests to component level. This results in a more realistic representation of the leaf spring stress state in the fatigue experiments. As a result of this research, a higher safety margin in the design phase of such components and less testing time is achieved.

Effect of Delayed versus Early Cord Clamping on Neonatal Outcomes and Iron Status at 4 Months

Background: The optimal timing of umbilical cord clamping has been debated in the scientific literature for over a century. Early clamping of the umbilical cord is widely practised as part of the management of labour. Early clamping of the cord was one of the first routine medical interventions in labour. Its place in modern births was guaranteed by its incorporation into the triad of interventions that make up the active management of the third stage of labour. Babies who have immediate cord clamping have also been shown to be more likely to be anaemic, have decreased fine motor skills, and have decreased social skills during their first few years of age. Delayed umbilical cord clamping appears to have clear benefit for term infants. Delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first few months of life, which improve the developmental outcomes. There is growing evidence that delayed cord clamping is beneficial and can improve the infant’s iron status for up to 6 months after birth. For the first few minutes after birth, there is still circulation from the placenta to the infant. Waiting to clamp the umbilical cord for 2 - 3 min, or until cord pulsations cease, allows a physiological transfer of placental blood to the infant (placental transfusion), the majority of which occurs within 3 min. This placental transfusion provides sufficient iron reserves for the first 6 - 8 months of life, preventing or delaying the development of iron deficiency until other interventions. WHO’s findings suggest that late cord clamping (one to three minutes after delivery or longer) is recommended for all births. Aim of the study: 1) To evaluate the benefit of delayed cord clamping on the infant’s health status. 2) To assess hemoglobin, iron and ferritin at birth and at 4 months of age in infants who underwent early cord clamping (at 30 seconds) as compared with infants who underwent delayed cord clamping (at 60 seconds). Methods: A randomized controlled trial was conducted in Benghazi Medical Center and Elmgharif Hospital at Ejdabia. Study population was 256 women. The participants were randomized to delayed cord clamping or early cord clamping study groups. The data were checked manually for completeness, coded and analyzed by using Statistical Package for Social Sciences (SPSS). The incidence, relative risk, risk reduction, frequency percentage, mean, and standard deviation were used. Also t-test and chi sequare test (to test difference between means and proportions respectively) were used to compare between early and late cord clamping groups. Results: Two hundred forty seven participants completed the study (the attrition rate was 3.5%); 121 (49%) were control group (early cord clamping) and 126 (51%) were study group (delayed cord clamping) group. At birth no significant difference between two groups regarding the level of hemoglobin, iron and ferritin. At 4th month of age delayed cord clamping was associated with improved hemoglobin, iron and ferritin and that the incidence of anemia among infants who exposed to delayed cord clamping was 0.07, while the incidence of anemia among the infants who exposed to early cord clamping was 0.5. Conclusion: There was strong association between delayed umbilical cord clamping and improvement of iron indices and developmental mile stones in infants at 4th month of age.

Intraumbilical oxytocin compared to placental cord drainage in the management of third stage of labor: A randomized controlled study

Objective: To compare the effectiveness of intraumbilical oxytocin and placental cord drainage in the management of third stage of labor. Design: A prospective randomized clinical trial. Study started: 1 September 2017. Study completed: 30 January 2018. Setting: At Ain-Shams University Maternity Hospital. Subjects: One hundred and fifty pregnant women between 18-35 years of age with normal pregnancy and a singleton fetus at a gestational age of 37 - 42 weeks in a cephalic presentation with neonatal birth weight of 2500 to 4500 grams recruited from the delivery ward of our hospital. Methods: The 150 study participants were randomly allocated into three groups either 20 units of oxytocin injected in the umbilical vein after clamping (Group A, n = 50), placental cord drainage (Group B, n = 50) or no intervention (Group C, n = 50). Main outcome measure: Duration of the third stage of labor. Secondary outcome measure: Retained placenta, need for manual removal of placenta and the drop in Hemoglobin level postpartum. Results: there was a significant statistical difference between all groups regarding the duration of the third stage of labour (p &gt;0.05). With the duration was significantly shorter in the study groups A&amp;B than the control group C, with significantly shorter duration in group B compared to Group A (P1 is 0.001 &gt; 0.05). There was statistical difference between all groups regarding Hemoglobin reduction (p&gt;0.05).With hemoglobin level significantly reduced in the control group C than the study groups A&amp;B (P2 is 0.016&gt;0.05 and P3 is 0.0001&gt;0.05) with significantly higher reduction in group A than Group B (P1 is 0.001&gt;0.05). As regard Retained placenta and the need for manual removal of placenta there was non-significant increase in the control group C (2 cases) which wasn’t statistically significant (p&lt;0.05) while there were no cases in study groups A&amp;B. Conclusion: The present study demonstrated that the use of intraumbilical injection of oxytocin and placental cord drainage significantly reduced the duration of the third stage in addition a significant decrease in the hemoglobin and hematocrit drop postpartum, however there were non-significant reduction of Retained placenta and the need for manual removal of placenta, Larger studies are necessary to confirm these findings.

Pemerahan dan Penundaan Penjepitan Tali Pusat terhadap Kadar Hemoglobin Bayi Baru Lahir

The incidence of iron deficiency anemia in term infants from 0-6 months is 40.8%. Efforts to reduce anemia in infants and toddlers is by ensuring the baby gets blood from the placenta through the umbilical cord. Labor occurs when oxygen shifts from the heart to the lungs 8-10% of the fetal period to 50% in neonates. Immediate cord clamping vascular resistance from the disconnected placenta which results in the increased of resistance of the baby's vascular system and eliminates about 1/4 of the volume of blood and iron in the neonate. The time of cutting the umbilical cord is a determining factor for placental transfusion to the baby. Delay cord clamping and umbilical cord milking are expected to provide iron reserves in infant. The aim of this study was to determine the differences in umbilical cord milking and delayed cord clamping. The design used experimental study with posttest-Only Control Group. The sampling technique used simple random sampling differs into treatment group and control group. The treatment group was umbilical cord milking and the control group was delayed cord clamping. The highest average of Hb levels in the umbilical cord milking group was 17.3mmHg and the delayed cord clamping group was 15.75 mmHg. Difference test on umbilical cord milking group and delayed cord clamping group used independent T-test obtained P &lt;0.05 (p = 0,001). It is recommended that midwives used umbilical cord milking as an alternative action in providing midwifery care to newborns when clamping and cutting the umbilical cord. It was proven that there were differences in the haemoglobin levels of newborns between the umbilical cord milking group and delayed cord clamping group.

Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence.

In severe post-prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study evaluated cystometry and pressure flow studies (PFS) in men in whom severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Men who had undergone prior radical prostatectomy were identified from a database of patients attending for video urodynamic testing between 2012 and 2017. Symptom scores, bladder diary and free flow rate tests were retrieved. Measurements of the subgroup of men for whom a Thomson-Walker compression clamp was used to enable full urodynamic evaluation were evaluated. 166 patients were identified. In 30 patients (18%), severe SUI led to incomplete filling cystometry. Following application of the penile compression clamp, further filling was achieved in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs. 46.5 cm H2 O; P < 0.001), volume at strong desire to void (132 vs. 242 mL; P = 0.003) and cystometric capacity (226 mL with clamp applied vs. 310 mL; P < 0.001) than the overall post-prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs. 22 cm H2 O; P = 0.009). A penile clamp applied at the time when leakage becomes excessive during filling cystometry avoids premature test termination in men with severe incontinence.

Assessment of effectiveness of delayed cord clamping and umbilical cord milking in early term and preterm infants

Background: Early cord clamping and cutting of the umbilical cord is widely practiced as part of the management of labor; it could deprive the neonate of about a quarter of its blood volume and iron. This thesis is aimed at comparing effects of delayed cord clamping versus umbilical cord milking at birth in preterm and early term infants.Methods: This single centered randomized study was conducted in Department of Pediatrics and data collection was done on the basis of the preterm and early term infants delivered by vaginal or cesarean delivery in Department of Gynecology, Geetanjali Medical College and Hospital, Udaipur during period of January 2016 to January 2017. Total of 120 infants were included in the study.Results: Statistically it has been analyzed that in both pre-term and early term infants who underwent DDC and UCM, there was insignificant difference in level of hemoglobin (Hb), haematocrit (HCT), blood sugar, bilirubin level (TSB) and temperature of body. On the other hand, significant difference was observed in weight and cord pH of neonates of both groups. There is also insignificant difference in terms of NICU admission for RDS, sepsis, phototherapy, need of oxygen, saline boluses, PRBC transfusion, polycythemia.Conclusions: Thus, overall it was observed that there is insignificant difference in delayed cord clamping and umbilical cord milking group. Thus, both are found to be equally effective in improving hematologic parameters.

A simple and novel technique for training in microvascular suturing in a rat model

Though microvascular clamps are widely used for anastomosis training, there still have several shortcomings, including the bulging, expensiveness and unavailability due to sterilization. The aim of this study is to introduce a simple and novel microvascular training model without use of microvascular clamps. Femoral vessels of Sprague Dawley rats training model were used to evaluate the usefulness of 4-0 silk as a slipknot for performing arterio-arterial and veno-venous microvascular anastomoses. A total of 12 Sprague Dawley rats were randomly assigned to either slipknot group or vascular clamp group. We also assess other endpoints, including ischemic time, patency rate, and clinical features. An additional histological study was performed to compare their immediate traumatic effects on vessel wall. There was no ischemic change or congestive sign in the lower limb after microvascular anastomosis. The total warm ischemic time for the vascular anastomosis was not significantly different. We performed the patency test immediately after microvascular anastomosis and one week after surgery. No intraoperative vascular bleeding was found during these procedures and no thrombosis occurred postoperatively. The histologic damages to occluded area were not significantly different in both groups. We demonstrate a microsurgical suture technique performed without any vascular clamp on a rat model. This rat model was designed for training in the technique of microvascular anastomosis. Compared with microvascular clamps, silk slipknot is a cheap, easily available, less space-occupying technique while performing microvascular anastomoses training. This preliminary study provides a simple and effective alternative method for microvascular anastomosis training.

Effects of delayed cord clamping on periventricular-intraventricular hemorrhage in preterm infant with vaginal delivery

Objective To investigate the effect of delayed cord clamping on periventricular-intraventricular hemorrhage (PIVH) in preterm infant with vaginal delivery. Methods A total of 192 cases of preterm infant with vaginal delivery in Wuxi Maternal and Child Health Care Hospital from January 2016 to July 2017 were selected and randomly divided into delayed cord clamping group (DCC Group, 94 cases) and immediate cord clamping group (ICC group, 98 cases) . Umbilical cords were clamped after at least 60 s or until pulses diminished with no extrusion in DCC group, while in ICC group umbilical cords were clamped within 10 s. Apgar score, neonatal asphyxia, recovery situation, average arterial pressure, hemoglobin (Hb) , hematocrit (Hct) and incidence of PIVH were compared between two groups. Results The average arterial pressure, Hb at the 3rd day after the birth, and Hct of preterm infants in DCC group were (40.33±3.21) mmHg, (176.84±26.38) g/L, and (50.44±6.15) %, which were significantly higher than the ICC group (t=3.570, 3.358, 3.098; P<0.05) . The incidence of PIVH in the DCC group was 18.09%, which was significantly lower than the ICC group (30.61%) (Z=-2.018, P<0.05) . Considering the intracranial situation in preterm infant without PIVH, there were 59 cases in DCC group and 37 cases in ICC group; statistically significant difference was observed between two groups (χ2=7.693, P<0.05) . Conclusions Delayed cord clamping can effectively reduce the incidence of PIVH, and has no effect on neonatal asphyxia and recovery. Key words: Infant, premature; Delayed cord clamping; Periventricular-intraventricular hemorrhage

Physiological hyperinsulinemia caused by acute hyperglycemia minimizes renal sodium loss by direct action on kidneys.

This study used acute, renal artery insulin infusion in conscious rats to test the hypothesis that hyperinsulinemia attenuates glucose-induced natriuresis by a direct renal mechanism. We reported previously that hyperinsulinemia was required to prevent ad libitum eating or an acute glucose bolus from causing excessive renal sodium loss. Rats were instrumented with renal artery, aortic, and femoral vein catheters and Data Sciences International blood pressure telemeters and were housed in metabolic cages. Insulin was clamped chronically at normal levels in two groups [vehicle infused (irV) and insulin infused (irI)] by administering streptozotocin and then infusing insulin intravenously 24 h/day to maintain normal blood glucose. Bolus glucose administration was used as a meal substitute to produce hyperglycemia that was not different between groups, and urinary sodium excretion (UNaV) was measured over the next 4 h. In the irV and control (C) rats, vehicle was infused in the renal artery during that period, whereas insulin was infused in the renal artery of the irI rats. Plasma insulin increased significantly in C rats but not in either of the clamped groups. UNaV in the irV rats, which could not increase circulating insulin levels, was approximately threefold greater than in C rats, similar to our previous report. However, allowing the kidney of irI rats to experience hyperinsulinemia via the renal artery insulin infusion completely prevented this, with no blood pressure differences. These data support our hypothesis that meal-induced increases in plasma insulin are a major component of normal sodium homeostasis, and that this occurs by direct action of insulin on the kidney.

Intermittent chest tube clamping may shorten chest tube drainage and postoperative hospital stay after lung cancer surgery: a propensity score matching analysis.

Postoperative pleural drainage markedly influences the length of hospital stay and the financial costs of medical care. The safety of chest tube clamping before removal has been documented. This study aims to determine if intermittent chest tube clamping shortens the duration of chest tube drainage and hospital stay after lung cancer surgery. We retrospectively analyzed 285 consecutive patients with operable lung cancer treated using lobectomy and systematic mediastinal lymphadenectomy. The chest tube management protocol in our institution was changed in January 2014, and thus, 222 patients (clamping group) were managed with intermittent chest tube clamping, while 63 patients (control group) were managed with a traditional protocol. Propensity score matching at a 1:1 ratio was applied to balance variables potentially affecting the duration of chest tube drainage. Analyses were performed to compare drainage duration and postoperative hospital stay between the two groups in the matched cohort. Multivariate logistic regression analyses were performed to predict the factors associated with chest tube drainage duration. The rates of thoracocentesis after chest tube removal were similar between the clamping and control groups in the whole cohort (0.5% vs. 1.6%, P=0.386). The rates of pyrexia were also comparable in the two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Both chest tube drainage duration (3.9 vs. 4.8 days, P=0.001) and postoperative stay (5.7 vs. 6.4 days, P=0.025) were significantly shorter in the clamping group than in the control group. Factors significantly associated with shorter chest tube drainage duration were female sex, chest tube clamping, left lobectomy, and video-assisted thoracoscopic surgery (VATS) (P<0.05). Intermittent postoperative chest tube clamping may decrease the duration of chest tube drainage and postoperative hospital stay while maintaining patient safety.

Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

Background: One of the benefits of delayed cord clamping is a reduction in the rate of intraventricular hemorrhage. The findings in this regard are controversial and some negative effects of the procedure have been reported. Objectives: The purpose of this study was to investigate the effects of delayed cord clamping on intraventricular hemorrhage in preterm infants. Methods: This clinical trial was carried out on 70 preterm neonates delivered via cesarean section. Their gestational age was less than 32 weeks and the birth weight less than 1500 grams. Neonates were randomly assigned to two groups of early cord clamping (less than 10 seconds) or delayed clamping of the umbilical cord (30 - 45 seconds after birth). 3 to 7 days after birth, presence of Intraventricular hemorrhage (IVH) in both groups was checked by ultrasonography (Mindray machine, model m7) and. Rate and severity of IVH was compared between the two groups. Results: There was no significant difference in mean gestational age, birth weight, gender distribution and medications in both groups of delayed cord clamping and early clamping of the umbilical cord. The incidence of seizures in the early clamping was 8.6% and in the delayed clamping zero (P = 0.239). The incidence rate of IVH and periventricular leukomalacia (PVL) was 11.43% and 5.7%, respectively in the early clamping, while this rate was zero in the delayed clamping group. This difference was not statistically significant in both indicators (P = 0.12 and P = 0.493, respectively). Conclusions: The results showed that intraventricular hemorrhage in premature neonates with delayed clamping was less prevalent than those with early clamping, and may be used as a reliable method.

Off-clamp robot-assisted partial nephrectomy does not benefit short-term renal function: a matched cohort analysis.

In the interest of renal functional preservation, partial nephrectomy has supplanted radical nephrectomy as the preferred treatment for T1 renal masses. This procedure usually involves the induction of renal warm ischemia by clamping the hilar vessels prior to tumor excision. Performing robot-assisted partial nephrectomy (RAPN) "off-clamp" can theoretically prevent renal functional loss associated with warm ischemia. We describe our institutional experience and compare perioperative and renal functional outcomes using a propensity score matched cohort. We conducted a retrospective comparison from a prospectively maintained database of all patients who underwent RAPN from 2009 to 2015. Of those patients, 143 underwent off-clamp RAPN. Fifty off-clamp RAPN patients were propensity score matched with fifty clamped RAPN patients based on renal function, tumor size, and R.E.N.A.L. nephrometry score. The cohorts were compared across demographics, operative information, perioperative outcomes, and renal functional outcomes. For all off-clamp RAPN patients, mean nephrometry score was 7.1, mean estimated blood loss (EBL) was 236.9mL, perioperative complication rate was 7.7%, and mean decrease in estimated glomerular filtration rate (eGFR) was 7.1% at a median follow-up of 9.2months. In the propensity score matched cohorts, off-clamp RAPN resulted in a shorter mean operative time (172.0 versus 196.0min, p=0.025) and a lower mean EBL (179.7 versus 283.2mL, p=0.046). A lower complication rate of 6.0% in the off-clamp group compared with 20.0% in the clamped group approached significance (p=0.071). Mean preoperative eGFR was similar in both cohorts. Importantly, there was no significant difference in decrease in eGFR between the clamped cohort (9.8%) and off-clamp cohort (11.9%) at a median follow-up of 9.0months (p=0.620). Off-clamp RAPN did not result in improved renal functional preservation in our experience. Surprisingly, the off-clamp cohort experienced lower intraoperative blood loss, shorter operative times, and fewer complications.

Stabilizing a different cyclooctatetraene stereoisomer

An unconventional cis-cis-cis-trans or (Z,Z,Z,E) structure B of cyclooctatetraene (COT) is calculated to lie only 23 kcal/mol above the well-known tub-shaped (Z,Z,Z,Z) isomer A; one example of this type of structure is known. The barrier for B returning to A is small, 3 kcal/mol. However, by suitable choice of substituents, the (Z,Z,Z,E) isomer can be made to lie in energy below the tub-shaped structure. Steric, clamping, and electronic strategies are proposed for achieving this. In the steric strategy, the C8H4(CH3)2(C( t Bu)3)2 structure B is predicted to lie 21 kcal/mol below structure A, which is separated from form B only by a small barrier. A simple clamping strategy, effective for COT planarization, does not influence the A/B isomerization much. But, if the clamping group is aromatic (a fused benzene, pyrrole, thiophene, furan), the subtle interplay of potential aromaticity with clamping can be used to confer persistence if not stability on the (Z,Z,Z,E) isomer. An electronic strategy of a different kind, push-pull substitution on the COT ring, was not very effective in stabilizing the B form. However, it led us to vicinal amine-borane-substituted normal COTs that proved to be quite good at activating H2 in a frustrated Lewis pair scenario.

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Background: Recent protocol proposed by the World Health Organization to manage the third stage of labour replaced the early cord clamping by deferred cord clamping to induce numerous neonatal benefits. But this practice is still resisted in most of the Arab countries. The aim of this study was to evaluate the effectiveness of deferred versus early umbilical cord clamping on maternal and neonatal outcomes. Methods: A quasi experimental research design was utilized. The study was conducted at labour unit in Damanhour National Medical Institute. Sample: A convenience sample of 150 parturient women undergoing normal vaginal delivery were randomly divided in two groups; deferred cord clamping (n= 75) and early cord clamping (n= 75). Tools: Three tools were used for data collection; 1) Structured interview schedule to collect data about the women' demographic characteristics and reproductive history. 2) Maternal outcomes assessment sheet. 3) Neonatal outcomes assessment sheet to assess the immediate and late neonatal outcomes. Results: There were no statistically significant differences (P > 0.05) between deferred and early cord clamping groups in relation to the maternal risk for post-partum hemorrhage, duration of third stage of labour and the need for manual removal of the placenta. Furthermore, a highly statistically significant differences (p Conclusion: The study concluded that deferred umbilical cord clamping did not increase the risk of maternal post-partum hemorrhage, duration of third stage of labour or the need for manual removal of the placenta. Also, deferred cord clamping significantly increased neonatal hemoglobin, hematocrit, and red blood cells level without serious elevation in the total bilirubin level as it was still in the low intermediate risk or below 75th percentile. Recommendation: Institutionalization of deferred cord clamping in all governmental hospitals and medical educational settings through providing policies, procedures and guidelines regarding this practice. This could significantly improve the intra-natal care for the neonate without harmful consequences for the mother.

Hepatectomy for spontaneous rupture of hepatocellular carcinoma without portal triad clamping

Hepatectomy without portal triad clamping may decrease the incidence of liver injury; however, the effects of hepatectomy without portal triad clamping in the treatment of spontaneous rupture of hepatocellular carcinoma (SRHCC) remain unclear. The aims of the present study were to evaluate the therapeutic value of hepatectomy without portal triad clamping in the treatment of patients with SRHCC. The present study retrospectively reviewed patients with SRHCC who received hepatectomy without portal triad clamping (non-clamping group) and the therapeutic efficacy was compared with that of 20 patients with SRHCC undergoing the same surgery in the presence of portal triad clamping (clamping group). Following hepatectomy, the non-clamping group exhibited a significantly lower incidence of acute liver failure compared with the clamping group (P<0.05). No significant differences in operative time, intra-operative blood loss, disease-free or overall survival times between the two groups were identified (all P>0.05). At 1 week and 2 weeks after surgery, the non-clamping group exhibited significantly lower alanine aminotransferase, aspartate aminotransferase and total bilirubin serum levels compared with the clamping group (all P<0.05). Hepatectomy without portal triad clamping may decrease the incidence of liver injury and liver failure in patients with SRHCC, suggesting that it may be a safe and effective therapeutic strategy.

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

Objective: Prolongation of the third stage of labor may cause serious postpartum complications. Thus, timely expulsion of the placenta is essential for preventing complications of the third stage of labor. We conducted a prospective cohort study to determine the effect of placental cord drainage on the duration of the TSL in women administered intravenous oxytocin during this stage.Study Design: This was a prospective cohort study in which 112 low risk pregnant women were allocated to the study. There were 53 women in the placental cord drainage group, and 59 women in the cord clamping group without drainage. Immediately after fetal delivery, intravenous infusion of 20 IU oxytocin in 500 mL Ringers’ Lactate was started and infused within 2 hours in women in both groups. Outcome measures were the third stage duration and hemoglobin differences between admission and the postpartum sixth hour. Results: There were no significant differences between the two groups with regard to duration of stages 1 and 2 of labor, hemoglobin level on admission, and at the postpartum sixth hour, and hemoglobin differences between admission and the postpartum sixth hour. The median third stage duration in the study group was 3.40 (range: 0.35-16.20) minutes, and 5.10 (range: 2.30-11.00) minutes in the control group. This difference between the groups was statistically significant (p&lt;0.01). Conclusion: Placental cord drainage reduces the third stage duration following vaginal deliveries in patients receiving intravenous oxytocin. Placental cord drainage is simple, does not require additional cost, and is applicable for every delivery.