To evaluate clinical and analgesic effects of IV lidocaine bolus followed by continuous infusion in cats undergoing ovariohysterectomy. 24 healthy female domestic shorthair cats were premedicated with IM acepromazine (0.05 mg/kg) and methadone (0.2 mg/kg). Anesthesia was induced with propofol and maintained with isoflurane in oxygen. Cats were randomly assigned to receive a lidocaine bolus (2 mg/kg) followed by infusion (3 mg/kg/h; GL), a lidocaine bolus followed by saline infusion (GB), or saline bolus and infusion (GC; n = 8/group). Intraoperative variables were monitored, and lidocaine-related adverse effects were clinically assessed. Pain was evaluated for 24 hours postoperatively with a validated feline pain scale. Analgesic rescue was provided with fentanyl (intraoperatively) or morphine (postoperatively) when indicated. End-tidal isoflurane concentration was significantly lower in GL compared to GC at 10 minutes after bolus administration, at musculature incision, and at 30 minutes after bolus administration (mean reduction of approx 18%). Despite this difference, all animals remained within stage 3 of anesthesia according to the Guedel classification. No differences were detected among groups in fentanyl rescue frequency, although GL had fewer events (17.86% and 32.35% reduction vs GC and GB, respectively). Total morphine rescues were significantly lower in GL (P = .038). No signs of lidocaine toxicity were observed in any cat. At the administered dose, lidocaine was tolerated and may have reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy. Continuous lidocaine infusion did not result in obvious signs of toxicity in healthy cats and it's use was likely to contribute to the reduction of postoperative analgesic rescue in this study.

Evolution of Electrosprayed Particles at a Static Air-Water Interface on Multiple Time Scales.

Continuous Opioid Infusion Among Patients Who Receive Mechanical Ventilation and Who Transition to Comfort-Focused Care

Intra-operative hypotension is common during cardiopulmonary bypass and may contribute to tissue hypoxia. Tissue hypoxia has been linked to the development of postoperative kidney and brain injury. Vasopressors are used to treat hypotension during and after cardiopulmonary bypass. However, the effects of these drugs on renal and cerebral tissue oxygenation and perfusion are unknown. We tested the effects of four vasopressors on renal and cerebral tissue perfusion and oxygenation in a clinically-relevant ovine model of cardiopulmonary bypass. We studied 16 sheep before and after induction of anaesthesia and during 2.5 h of cardiopulmonary bypass. After commencing cardiopulmonary bypass at a target non-pulsatile flow of 2.4 l.min-1.m-2, we observed a baseline period with a target mean arterial pressure of 50-60 mmHg, after which we targeted a mean arterial pressure of 75-85 mmHg using a continuous infusion of metaraminol (n = 8); noradrenaline (n = 8); phenylephrine (n = 8); or vasopressin (n = 7). Sheep were allocated randomly to receive two of the four vasopressors. Compared with the pre-induction state, cardiopulmonary bypass significantly decreased renal medullary tissue perfusion (median (IQR [range]) decrease 55 (4-82 [1-99])%; p = 0.01) and medullary oxygen tension (mean (SD) difference 3.1 (2.5) kPa; p < 0.001). Cardiopulmonary bypass did not significantly alter cerebral tissue perfusion or oxygenation compared with the pre-induction state. Infusing noradrenaline significantly decreased medullary oxygen tension (mean (SD) difference 2.7 (1.6) kPa; p = 0.003). This decreasein medullary oxygen tension was significant compared with vasopressin (mean difference -3.4kPa, 95%CI -5.7 to -1.0; p = 0.008). No vasopressor infusion significantly altered renal medullary perfusion, cerebral tissue perfusion or oxygenation. Intra-operative noradrenaline during ovine cardiopulmonary bypass worsens renal medullary tissue oxygenation relative to vasopressin. These findings suggest that the choice of vasopressors may affect renal oxygenation.

Bleeding peptic ulcers remain a major cause of non-variceal upper gastrointestinal hemorrhage, and optimizing post-endoscopic pharmacologic therapy is essential to reducing early rebleeding and improving clinical outcomes. This study evaluated the therapeutic effectiveness of high-dose versus low-dose omeprazole following endoscopic hemostasis. This retrospective observational study included patients with endoscopically confirmed bleeding peptic ulcers treated between August 2022 and August 2025. Patients received either high-dose omeprazole (80-mg intravenous loading dose followed by continuous infusion at 4 mg/h) or low-dose omeprazole (40 mg intravenously once daily) after endoscopic hemostasis. Hemoglobin, hematocrit, rebleeding rates, clinical recovery parameters, and adverse events were collected. Participants were followed for 30 days to evaluate delayed rebleeding. Continuous variables were analyzed using independent-samples t tests, and categorical variables using chi-square tests. A total of 119 patients were included (high-dose: n = 58; low-dose: n = 61). High-dose omeprazole significantly reduced rebleeding at 72 hours (6.9% vs 21.3%, P = .025) and 30 days (10.3% vs 29.5%, P = .009). Greater increases in hemoglobin and hematocrit, lower transfusion volume, faster cessation of bleeding, earlier hemodynamic stabilization, and shorter hospitalization were also observed (all P < .001). Adverse event rates were comparable between groups. High-dose omeprazole combined with endoscopic hemostasis enhances hemostatic stability, accelerates clinical recovery, and reduces short-term rebleeding without increasing treatment-related adverse events.

Pharmacologic pain management in a high-complexity neonatal intensive care unit: real-world patterns of analgesic and sedative use in neonates.

Continuous versus intermittent vancomycin infusions in critically ill children with gram-positive bacterial infections: a randomized controlled trial.

Age-related muscle mass is driven by a reduction in insulin sensitivity partly mediated by reduced amino acid and anabolic signalling kinetics. Insulin activates Akt-mTORC1 signalling in skeletal muscle, with inositol hexakisphosphate kinase 1 (IP6K1) shown to inhibit this signalling pathway in pre-diabetic humans. We aimed to compare muscle and plasma IP6K1 in young vs older adults and the possible role of IP6K1 in the anabolic response to protein and protein plus resistance exercise (RE). Nine young (24.9 ± 0.4years) and nine older (66.2 ± 0.5years), moderately active adults received primed continuous infusions of L-[ring-2H5]phenylalanine in basal and postprandial state. Blood and muscle biopsy samples were collected prior to and following ingestion of 25g whey protein with or without knee extension exercise to examine skeletal muscle protein signalling and whole-body phenylalanine kinetics. Young adults had greater plasma IP6K1 at all time points. Older adults had reduced muscle IP6K1 at 120min post-exercise. Muscle IP6K1 decreased 240min postprandially in young adults compared with basal and there was no effect of exercise in either group. Older adults presented with reduced plasma and muscle IP6K1 in both postprandially and post-RE states, as well as reduced phenylalanine rate of disappearance for the same comparisons. IP6K1 may be involved in the reduction in amino acid metabolism, and the insulin-mediated response to protein and RE.

Background: Type 1 diabetes (T1D) represents an increasing epidemiological challenge worldwide. In Europe, the fastest rise in T1D incidence is currently observed in the northern and central regions. Effective glycemic control remains crucial for preventing acute and chronic complications, particularly in physically active individuals. Aim: This study aims to evaluate the impact of modern technologies supporting intensive insulin therapy on glycemic regulation, with a special focus on their role during physical activity. Material and Methods: A comprehensive literature review was conducted analyzing the use of continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion (CSII) via personal insulin pumps. Emphasis was placed on their effects on metabolic control and the reduction of severe hypoglycemia risk compared to conventional treatment. The function of advanced hybrid closed-loop (AHCL) systems, such as the MiniMed 780G, was also examined in relation to exercise-induced glycemic fluctuations. Results: CGM systems enable predictive monitoring of glycemic trends, shortening the response time to imminent hypoglycemia by approximately 20 minutes during physical activity. The application of AHCL systems provides automated protection against intra- and post-exercise hypoglycemia through features such as the SmartGuard algorithm and temporary target adjustments. These technologies significantly improve metabolic stability, even under conditions of intensive training. Conclusion: The integration of advanced diabetes management technologies with regular physical activity offers a new standard in T1D care. This approach facilitates enhanced glycemic control and hypoglycemia prevention, supporting safer and more effective engagement in physical exercise.

ObjectiveWe aimed to present a patient who developed a severe chorea after orthopedic surgery, plausibly related to multiple anesthetic agents.CaseAn otherwise healthy 11-year-old girl developed choreiform movements and distressing behaviors (screaming, visual hallucinations) 24-36 hours after ankle-fracture surgery. With urgent stabilization needed and haloperidol not yet at an effective dose, continuous midazolam infusion provided prompt control. Other potential causes of chorea were excluded: brain magnetic resonance imaging and cerebrospinal fluid were normal; routine biochemistry and complete blood count were unremarkable; autoimmune encephalitis antibodies, antinuclear antibody, and anti-dsDNA were negative; anti-streptolysin O was not elevated, echocardiography was normal; throat culture and viral serologies were negative. After exclusion of alternative etiologies, the presentation was attributed to propofol and tramadol exposure (movement disorder component) with a paradoxical reaction to midazolam (psychiatric symptoms).ConclusionSuch adverse effects can occur after anesthesia and may appear in a delayed fashion, independent of drug half-lives. Benzodiazepine infusion can serve as an effective bridge/primary therapy in antipsychotic-refractory postoperative hyperkinesias of childhood.

Intravenous Continuous Infusion of Dexmedetomidine for Psychomotor Agitation in General Hospital Psychiatric Settings: A Transdiagnostic Case Series.

Background: Current sepsis guidelines recommend the best supportive treatment for severe sepsis, but they are limited on the effectiveness of immunomodulatory therapies. Recent data suggest that IgM-enriched immunoglobulin preparations may decrease mortality, but the exact pathomechanism remains unknown. The present experimental study aims to test the hypothesis that IgM-enriched immunoglobulin may improve hemodynamics in E-coli-induced severe sepsis. Subjects and methods: Sepsis was induced in the E. coli bacteriemia (n = 8), E. coli-parallel Pentaglobin treatment (PR-PG; n = 8), and E. coli-delayed Pentaglobin treatment (D-PG; n = 8). Sepsis was induced in the sepsis, PR-PG, and D-PG groups by infusing 38 mL of an E. coli suspension (2.5 × 105/mL) over 3 h. The PR-PG group received a 0.75 g/kg Pentaglobin bolus over 20 min concurrently with the start of E. coli infusion. The D-PG group was given a 0.67 g/kg Pentaglobin bolus one hour after starting E. coli, followed by a continuous infusion at 0.02 g/kg/h for 240 min. Hemodynamic parameters were monitored every 2 h using a pulse contour cardiac output monitoring technique (PiCCo™). Results: Heart rate increased in all groups to varying extents. Mean arterial pressure (MAP) remained stable in controls but declined in untreated sepsis. Both Pentaglobin-treated groups showed higher MAP than untreated septic animals. Mild cardiac index increases occurred in controls and untreated sepsis, whereas the treated groups maintained a consistently elevated CI after Pentaglobin administration. Systemic vascular resistance index (SVRI) transiently increased in controls before normalizing, while untreated septic animals experienced continuous SVRI decline. Treated animals showed an initial transient SVRI rise followed by a decline; yet, SVRI remained higher than in untreated sepsis. Conclusions: IgM-enriched immunoglobulin led to a slight stabilization of some hemodynamic parameters, probably due to the reduced extpnfiravasation of fluids into the interstitium and, hence, had an effect on preload.

Diabetes summer camp is a demanding, although joyful, setting with many unpredictable activities affecting glycemic control. Recent technological advances, such as automated insulin delivery (AID) systems, offer promising real-world benefits. Our aim was to evaluate the efficacy and safety of continuous subcutaneous insulin infusion (CSII) systems during a diabetes summer camp and compare the performance of the MiniMed 780G (AID) system with the sensor-augmented MiniMed 640G system. This is a retrospective, observational study collecting data from six summer camp weeks organized from 2019 to 2025 in Northern Greece. Children, adolescents, and adult staff with type 1 diabetes (T1D) using MiniMed insulin pumps and continuous glucose monitoring were included. Glycemic metrics (time in range, glucose coefficient of variation, time in hypoglycemia/hyperglycemia, glycemia risk index) were collected from CareLink platform across three weekly periods: during camp, pre-camp, and post-camp. Data from 93 participants/year (67 females,72.04%) were included. Mean time in range (TIR) during camp was 72.72%, with best outcomes in years 2023 to 2025 (TIR > 77%). Across all periods, MiniMed 780G users demonstrated markedly superior outcomes compared to 640G users: during the camp week, TIR was 78.68% vs 62.83% (P < .001), and post-camp TIR remained higher (70.02% vs 55.43%, P < .001), with lower time in hyperglycemia >180 mg/dL (22.67% vs 30.71%, P < .001). Camp weeks were associated with improved TIR and reduced hyperglycemia overall without increased hypoglycemia rates. Diabetes camps promote satisfactory glycemic control in youth with T1D, particularly when using AID systems. MiniMed 780G users maintained better outcomes even the week after camp compared to MiniMed 640G users.

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative cohort studies comparing continuous with intermittent intravenous hydrocortisone in adults with septic shock. Searches of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were conducted till July 2025. The primary outcome was all-cause mortality; secondary outcomes included hospital and ICU length of stay, shock reversal, hypernatremia, hypokalemia, and vasopressor use. Risk of bias was assessed using Cochrane RoB 2.0 for RCTs and the Newcastle-Ottawa Scale for cohort studies. A random-effects model was applied, and certainty of evidence was graded with GRADE. Eight studies (five RCTs, three cohort studies) including 609 patients were analyzed. Continuous infusion was not associated with a significant reduction in mortality compared with intermittent infusion (RR 0.83, 95% CI 0.65-1.06; p=0.13; I²=36%). No significant differences were observed in hospital stay (MD 0.10 days, 95% CI -1.40 to 1.61), ICU stay (MD -0.02 days, 95% CI -0.63 to 0.58), shock reversal (RR 0.94, 95% CI 0.61-1.46), hypernatremia (RR 1.05, 95% CI 0.51-2.16), hypokalemia (RR 0.64, 95% CI 0.40-1.03), or vasopressor duration (MD -0.97 days, 95% CI -4.00 to 2.05). Certainty of evidence ranged from very low to moderate. Continuous and intermittent hydrocortisone infusion demonstrated comparable clinical outcomes in septic shock. Large, multicenter RCTs are warranted to determine the optimal administration strategy. .

We present a step-by-step approach for hysteroscopic myomectomy in patients with submucosal fibroids, focusing on key surgical techniques that enhance safety, preserve uterine integrity, and ensure complete fibroid removal. A 49-year-old woman with heavy menstrual bleeding presented with a type I submucosal fibroid measuring 32 × 23 × 20 mm. The procedure was performed using a 27 Fr bipolar resectoscope. Intraoperative strategies include: minimal cervical dilation to reduce fluid leakage, continuous saline infusion with controlled suction for optimal visibility, avoidance of repeated scope removal to maintain intrauterine pressure and identification of myometrial margins to ensure complete resection and prevent perforation. This video highlights essential surgical techniques and intraoperative considerations for performing safe and effective hysteroscopic myomectomy. Attention to fluid management, visualization, and preservation of cervical and uterine integrity is critical for optimal outcomes, especially in women with prior uterine surgery or fertility concerns.

Triple-dose bolus versus continuous infusion of tranexamic acid: impacts on clinical outcomes in isolated coronary artery bypass surgery.

High-dose continuous infusion of cefepime is frequently employed in ICU patients with a creatinine clearance above 60 mL/min. The CEFTOX study aimed to investigate whether this regimen could lead to cefepime overexposure and cefepime-induced neurotoxicity (CIN) in a cohort of severe trauma and brain-injured patients. This retrospective cohort study included patients from a Level 1 Trauma Center who received a continuous infusion of 6 g/day of cefepime and had a therapeutic drug monitoring (TDM) within 24-48 h of treatment initiation. They were divided into three groups based on creatinine clearance: mild renal impairment (60-90 mL/min), normal clearance (90-150 mL/min), and augmented renal clearance (ARC) (>150 mL/min). The primary outcome was cefepime overexposure. A key secondary outcome was CIN. One hundred and sixty-two critically ill patients were included: 84 with ARC, 62 with normal renal clearance, and 16 with mild renal impairment. Cefepime overexposure occurred in 72 (44.4%) patients. While 50% of patients with normal renal clearance experienced overexposure, the rate was higher in those with mild renal impairment (87.5%) and lower in those with ARC (32.1%; P < 0.0001). In the ARC group, age > 33 years was a risk factor for overexposure (odds ratio [OR] 3.76; 95% CI [1.30-10.95]; P = 0.01), while sepsis was a protective factor (OR 0.30; 95% CI [0.11-0.83]; P = 0.02). CIN was observed in 24% of overexposed patients when TDM results were obtained ≤48 h compared to 57.4% when results were delayed >48 h (P = 0.006). These results highlight the need for early TDM and individualized dose adjustment to avoid CIN.

Background: Non-cardiac surgery in patients with cardiovascular risk can lead to Spine surgery often leads to significant postoperative pain, inflammation, and hemodynamic instability, necessitating opioid use, which increases the risk of side effects. Dexmedetomidine (DEX) and magnesium sulfate (MgSO₄) are anesthetic adjuvants that may enhance recovery and reduce opioid consumption. This study aimed to compare the effects of DEX and MgSO₄ as an anesthetic adjuvant on interleukin-6 (IL-6) levels, hemodynamic stability, postoperative recovery, and opioid consumption in spine surgery. Methods: A randomized controlled trial was performed on 24 patients undergoing spine surgery under general anesthesia. Participants were randomly divided into two groups: Group 1 received DEX (a 1 µg/kg bolus followed by a continuous infusion of 0.3–0.5 µg/kg/h), while Group 2 was given MgSO₄ (a 30–50 mg/kg bolus followed by an infusion of 10–20 mg/kg/h). Hemodynamic parameters, IL-6 levels (pre- and postoperatively), opioid use, and recovery outcomes were analyzed. Results: IL-6 levels decreased significantly in both groups (p=0.001), with a greater reduction in the DEX group (-60.5 pg/dL vs. -24.9 pg/dL), though not statistically significant. Hemodynamic stability was comparable, but DEX provided better pulse rate control. Opioid consumption was lower in the DEX group at 24 and 48 hours postoperatively (p &lt; 0.05). The DEX group also showed higher Aldrete scores (p&lt;0.05) and shorter hospital stays (3.75 vs. 4.83 days, p&lt;0.05). Conclusion: DEX provides superior anti-inflammatory effects, hemodynamic stability, reduced opioid use, and improved recovery compared to MgSO₄ as an anesthetic adjuvant in spine surgery patients.

Linezolid is an essential antimicrobial for treating multidrug-resistant gram-positive infections in critically ill patients. However, its pharmacokinetics (PK) are highly variable, potentially leading to subtherapeutic exposure or toxicity. Therapeutic drug monitoring (TDM) plays a critical role in guiding individualized dosing. We describe a 66-year-old intensive care unit (ICU) patient treated with linezolid for vancomycin-resistant Enterococcus faecium (VRE) peritonitis and empyema. Despite standard dosing (600 mg IV every 12 hours), linezolid concentrations remained below the limit of quantification for 6 days, coinciding with persistent VRE isolation. A switch to continuous infusion (CI) at 2,400 mg/day achieved therapeutic levels (mean concentration [Cmean], 6.17 mg/L), but subsequent supratherapeutic exposure (Cmean, 12.12 mg/L; 24-hour area under the curve, 290.9 mg · h/L) led to adrenergic toxicity. Linezolid clearance declined from 14.6 to 6.2 L/h, unrelated to renal function, suggesting the influence of nonlinear elimination and alternate metabolic pathways. Following empyema drainage and ketamine withdrawal, PK parameters stabilized. This case highlights the extreme intraindividual PK variability of linezolid in critical illness. Contributing mechanisms may include ROS-driven CYP2J2 upregulation in acute lung injury, autoinhibition of metabolite formation, and drug interactions. CI enabled PK and pharmacodynamic target attainment when intermittent dosing failed but required TDM to avoid overexposure. Routine TDM is essential to optimize the safely and effectively manage linezolid therapy in ICU patients. This case underscores the importance of integrating TDM with PK modeling to guide personalized dosing strategies in complex and dynamic clinical scenarios.

We report the case of a 27-year-old man with a history of speech delay and chronic, progressive movement disorder. He first developed gait difficulty at the age of 12. Given clinical signs of bradykinesia and resting tremor, he received a clinical diagnosis of childhood-onset parkinsonism. Treatment with oral levodopa initially improved symptoms, but after 2 years, he developed motor fluctuations and dyskinesias. Additional signs of spasticity and brain MRI showing a thin corpus callosum prompted genetic testing that identified a heterozygous pathogenic variant in the PRKN gene. However, he exhibited a progressive loss of response to chronic dopaminergic therapy, first with oral and later with continuous levodopa-carbidopa intestinal gel infusion, with disease progression over 7 years. This progression led to further genetic testing and the diagnosis of hereditary spastic paraplegia type 15 (SPG 15). Advancing motor symptoms prompted deep brain stimulation and botulinum toxin injections, although these had limited benefit. This case highlights the challenges of diagnosing and managing juvenile-onset parkinsonism and the value of comprehensive genetic analysis in evaluating genotypic-phenotypic correlations. Hereditary spastic paraplegias (HSPs) are a rare group of neurodegenerative disorders with diverse clinical and genetic features. They can be inherited in autosomal dominant, recessive, X-linked, or mitochondrial patterns. The SPG15 subtype (or HSP-ZFYVE26), caused by pathogenic variants in the ZFYVE26 gene, is a common form of autosomal recessive HSP. Presenting symptoms vary but commonly include cognitive impairment with a history of speech delay or learning disability and balance impairment or clumsiness from spasticity of the lower limbs.