Fourth Hour Research Articles

Massive hemorrhage after percutaneous liver biopsy in a pediatric patient with graft-versus-host disease; a successful angiographic embolization

Most cases of bleeding that develop after percutaneous liver biopsies can be managed with follow-up and supportive treatment. In life-threatening situations, however, open surgery or minimally invasive methods are required. This case report describes the clinical course of an 11-year-old patient with a diagnosis of Wiskott-Aldrich syndrome who experienced a major hemorrhage following a percutaneous liver biopsy. Clinical findings, imaging, interventions, and results were evaluated. Allogeneic hematopoietic stem cell transplantation was performed without any problem. The patient's bilirubin level started to increase on the 20th day after transplantation. Profuse watery diarrhea started on the 24th day. Graft-versus-host disease of the gastrointestinal tract and liver was considered as his diarrhea continued to the 29th day. An ultrasound-guided Tru-cut® liver biopsy (Merit medical, South Jordan, UT, USA) was performed with an 18-gauge needle on the 52nd day after transplantation. In the fourth hour after the procedure, the general condition of the patient started to deteriorate. Active bleeding was detected in the patient with computed tomography, and he was hypotensive and tachycardic. The patient was urgently transferred to the angiography unit and a successful angiographic embolization was performed. Angiographic embolization is an intervention with high success rates in cases of bleeding where the patient is hemodynamically stable. However, it can also be successfully applied in selected patients who are hemodynamically unstable.

Mobile bag technique for estimation of nutrient digestibility when hay is supplemented with alternative fibrous feedstuffs in horses

To evaluate the effect of substituting hay with alternative fibrous feedstuffs, the total collection of faeces was used to measure the apparent total tract digestibility (ATTD). Nutrient disappearance and digestion kinetics were examined with the mobile bag technique (MBT) and marker passage measurements. Four caecally-cannulated horses (body weight (BW) 558 ± 32 kg) were used in a cross-over design experiment with two periods of 14 days adaptation and four days of faecal collection. Horses were fed three times a day with either a hay-only (HAY) diet or a mixture of hay:supplement (MIX) (15.1 and 8.4:6.7 g dry matter (DM)/kg BW/day, respectively). The hay used in both treatments (HAY and MIX) was mainly of Timothy and first cut. The MIX supplement diet consisted of oat hulls, alfalfa-, sugar beet pulp- (SBP), grass- and soya hull pellets, each given in 0.44 g DM/kg BW/meal. On day 15 in each period, 20 bags of either hay or SBP and 6–12 bags (1×2x12 cm; 37 µm pore size; 0.5 g feed) of each feedstuff and ytterbium (Yb, 3 g) were placed in the stomach or caecum, respectively. Bags were harvested from the caecum every hour and faeces were checked for bags every fourth hour, collection time was noted and data from the bags were used to estimate pre-caecal, hindgut and total tract nutrient disappearance. Further, faecal subsamples of 300 g were collected, weighed and stored for Yb analysis and further estimation of feed mean retention time. Rate and extent of feed degradation were estimated from the MBT assuming exponential degradation. The ATTD of DM was similar between the two diets (P > 0.05), but the HAY diet had higher ATTD of crude protein (CP) (P = 0.001), neutral detergent fibre assayed with heat-stable amylase and expressed inclusive of residual ash (aNDF) (P = 0.006), acid detergent fibre (ADF) (P = 0.017), hemicellulose (P = 0.001) and celluloseNDF (P < 0.001). The hindgut mean retention time (MRT) for Yb was longer for the MIX than the HAY diet (P < 0.001). No differences for DM, aNDF or ADF digestibility were measured when comparing the ATTD with nutrient disappearance from bags found in the time interval 20–30 h, indicating the ATTD of these nutrients can be predicted by the MBT. The estimated degradation (Dt), but not effective degradation (ED), is preferred when the MBT is used to predict the ATTD. It can be concluded that hay can be substituted partly by fibrous feedstuffs and that the MBT can predict the ATTD of DM, aNDF and ADF in a mixed ration based on MBT measures on individual feedstuffs.

Evolution of Human Salivary Stress Markers during an Eight-Hour Exposure to a Mediterranean Holm Oak Forest. A Pilot Study

The current study analyses the evolution of different human stress markers during an 8 h exposure to a Mediterranean Holm oak forest. We conducted a pre-post study with thirty-one subjects in which saliva samples were collected before the exposure (baseline) and after 1, 2, 4 and 8 h. Our results show: (A) a significant decrease in cortisol saliva concentrations from the second hour until the end compared to basal time; (B) a significant increase in alpha amylase activity after the first hour of exposure compared to basal time that remained elevated during the rest of the study; (C) a significant decrease in IgA from the fourth hour of exposure compared to the basal time. These findings indicate an effect of forest exposure in salivary biomarkers of stress and provide relevant data for the scientific and healthcare community encouraging further research in the field.

Predicting donor lung acceptance for transplant during ex vivo lung perfusion: The EX vivo lung PerfusIon pREdiction (EXPIRE)

Ex vivo lung perfusion (EVLP) has being increasingly used for the pretransplant assessment of extended-criteria donor lungs. Mathematical models to predict lung acceptance during EVLP have not been reported so far. Thus, we hypothesized that predictors of lung acceptance could be identified and used to develop a mathematical model describing the clinical decision-making process used in our institution. Donor lungs characteristics and EVLP physiologic parameters included in our EVLP registry were examined (derivation cohort). Multivariable logistic regression analysis was performed to identify predictors independently associated with lung acceptance. A mathematical model (EX vivo lung PerfusIon pREdiction [EXPIRE] model) for each hour of EVLP was developed and validated using a new cohort (validation cohort). Two hundred eighty donor lungs were assessed with EVLP. Of these, 186 (66%) were accepted for transplantation. ΔPO2 and static compliance/total lung capacity were identified as independent predictors of lung acceptance and their respective cut-off values were determined. The EXPIRE model showed a low discriminative power at the first hour of EVLP assessment (AUC: 0.69 [95% CI: 0.62-0.77]), which progressively improved up to the fourth hour (AUC: 0.87 [95% CI: 0.83-0.92]). In a validation cohort, the EXPIRE model demonstrated good discriminative power, peaking at the fourth hour (AUC: 0.85 [95% CI: 0.76-0.94]). The EXPIRE model may help to standardize lung assessment in centers using the Toronto EVLP technique and improve overall transplant rates.

Requirement of Postoperative Ventilation and analgesics during Off-Pump Coronary Artery Bypass (OPCAB) surgery – A Comparison between Combined High Thoracic Epidural Anaesthesia (HTEA) with GA and GA Alone

Beckground: This is often difficult to achieve optimal pain relief after coronary artery bypass surgery and also great challenge to choice appropriate analgesics with minimize the duration of mechanical ventilation. In the postoperative period inadequate analgesia may increase morbidity by causing adverse haemodynamic, metabolic, immunologic and haemostatic attentions and prolong mechanical ventilation with more ICU stay. High Thoracic Epidural Anaesthesia (HTEA) as an adjunct to general anaesthesia has been shown to be potentially beneficial in postoperative pain relief and the requirement of mechanical ventilationin patients with off-pump coronary artery bypass surgery (OPCAB). HTEA provides good protection from stress response, ensures hemodynamic stability, improves distribution of coronary blood flow with reducing demand of oxygen, less requirement of postoperative analgesia , mechanical ventilation and ICU stay. Objective: This study has been undertaken with a view to compare requirement of postoperative mechanical ventilation and analgesics in OPCAB surgery between HTEA with GA and GA alone. Methods: This prospective, randomized case control comparative study was carried out in sixty patients without having left main coronary artery disease, left ventricular ejection fraction &lt;30% or contraindication of regional anaesthesia scheduled for OPCAB. They were divided into two groups, thirty in each group. Group A received GA alone and group B received high thoracic epidural anaesthesia with GA. Requirement of postoperative analgesics, pain score, consciousness score, sedation score, satisfection level and duration of ventilation with length of stay in intensive care unit were recorded in the post-operative period. Results: Rescue analgesics received and found 16(53.3%) and 6(20.0%) needed analgesia in group A and group B respectively and the difference was statistically significant (p&lt;0.05). Regarding the pain score (VAS) during maintenance with ventilator with awareness at first fourth hour significant (p&lt;0.05) change between two groups. After extubation at rest in different time interval and found significant (p&lt;0.05) change between two groups in all follow-up times. Post-operative pain score (VAS) after extubation at movement in different time interval and found significant (p&lt;0.05) change between two groups. Post-operative pain score (VAS) after extubation at during coughing in different time interval and found significant (p&lt;0.05) change between two groups. Post-operative sedation score at first six hour (hourly) and found significant (p&lt;0.05) change between two groups except 1st hour, which was not significant (p&gt;0.05). The mean extubation hours were 7.4±1.09 hours in group A and 5.3±0.81 hours in group B. The mean ICU stay was 72.9±9.2 hours in group A and 57.1±12.0 hours in group B and the difference was statistically significant (p&lt;0.05) in unpaired t-test. No postoperative complication was observed in both groups. Conclusion: HTEA with GA appeared to be most reliable postoperative pain relief, shorter mechanical ventilation, ICU stay in OPCAB surgery Bangladesh Heart Journal 2021; 36(2): 74-81

The Effects of Cool Dialysate on Vital Signs, Adequacy and Complications during Hemodialysis.

Background:Cooling the dialysate is an important factor that contributes to the hemodynamic stability in patients during hemodialysis. The aim of this study was to determine the effect of cool dialysate on vital signs, and the adequacy and common complications of hemodialysis.Materials and Methods:The present crossover, triple-blind, clinical trial was performed on 62 dialysis patients, who were selected through stratified block randomization. First, one group underwent hemodialysis using a cool dialysate (35°C), and the other received routine hemodialysis (36.5°C). Each patient received a total of eight hemodialysis sessions. Then, treatment methods were swapped, and each group received the other group's method. The patients' blood pressure, pulse rate, and temperature were measured before dialysis, and in the first, second, third, and fourth hours of dialysis. The frequency of common complications of hemodialysis and dialysis efficacy were measured. The marginal model and Generalized Estimating Equations (GEE) were used to analyze the data.Results:The participants' systolic (p = 0.01) and diastolic blood pressures significantly increased with a decrease in temperature (p = 0.005). The patients' pulse rate (p = 0.143), adequacy of dialysis (p = 0.922), and common complications of hemodialysis did not significantly differ between the two temperatures (p > 0.05).Conclusions:Reducing dialysate temperature from 36.5 to 35°C led to hemodynamic stability; the blood pressure of the patients undergoing hemodialysis was more stable with the cool dialysate method and the number of drops in the blood pressure during the hemodialysis was reduced.

I See You.

I took a deep breath of surrender as I logged onto Zoom for the fourth straight hour of the day – my new COVID-19 work-from-home reality. But this hour would be different. This would be about listening to the narrative of my dear friend and colleague, Rachel (name changed to protect confidentiality), as she talked about providing tele-palliative care for oncology inpatients during the first pandemic surge in New York City.

A Basis for the Decision to Rule in or out Acetaminophen Toxicity: Assessment of the Serum Level Within 4 Hours Post Overdose

Background: Acetaminophen is a popular antipyretic and analgesic medication worldwide; however, its therapeutic window is narrow, which may lead to overdose or toxicity. This study was conducted to assess the correlation between the serum acetaminophen levels before and 4 hours after the acute toxicity with this drug. The objective of this study was to test the validity of the serum level to arrive at a clinical decision on the toxicity with acetaminophen. Methods: This cross-sectional study was performed on patients hospitalized and treated with a diagnosis of acute acetaminophen overdose during one year (Sept. 2018 to Sept. 2019) at the Toxicology Department of Imam Reza Hospital, Mashhad, Iran. Patients were analyzed for demographics, time of ingestion, their first and second serum acetaminophen concentrations. Results: A total of 204 patients (106 male &amp; 98 female) were included in this study. The average dose of acetaminophen ingestion by these patients was 14.5±3.50 g and all patients were treated successfully with N-Acetyl-Cysteine (NAC). The variables of age (P=0.293), serum acetaminophen levels at 1-2 h (P=0.679), and at 2-3 h (P=0.126) did not have significant relationships with the serum acetaminophen level on the fourth hour. However, the serum acetaminophen levels tested between 3-4 h and acetaminophen intoxication dosage had significant relationships with the acetaminophen level on the fourth hour. Conclusion: In patients with acute acetaminophen toxicity, the data on the serum levels obtained before a 4-hour timepoint from the ingestion were not useful to decide on the need for the rescue treatment with N-acetyl-cysteine.

A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

Abstract Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P &amp;lt; 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P&amp;gt;0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P &amp;lt; 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P &amp;lt; 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.

Influence of an L-type SALMFamide neuropeptide on locomotory performance and muscle physiology in the sea cucumber Apostichopus japonicus.

Neuropeptides in the SALMFamide family serve as muscle relaxants in echinoderms and may affect locomotion, as the motor behavior in sea cucumbers involves alternating contraction and extension of the body wall, which is under the control of longitudinal muscle. We evaluated the effect of an L-type SALMFamide neuropeptide (LSA) on locomotory performance of Apostichopus japonicus. We also investigated the metabolites of longitudinal muscle tissue using ultra performance liquid chromatography and quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) to assess the potential physiological mechanisms underlying the effect of LSA. The hourly distance, cumulative duration and number of steps moved significantly increased in sea cucumbers in the fourth hour after injection with LSA. Also, the treatment enhanced the mean and maximum velocity by 9.8% and 17.8%, respectively, and increased the average stride by 12.4%. Levels of 27 metabolites in longitudinal muscle changed after LSA administration, and the increased concentration of pantothenic acid, arachidonic acid and lysophosphatidylethanolamine, and the altered phosphatidylethanolamine/phosphatidylcholine ratio are potential physiological mechanisms that could explain the observed effect of LSA on locomotor behavior in A. japonicus.

The Effectiveness of Bandotan (Ageratum conyzoides L.) Leaf Extract on Mortality of Boophilus microplus In Vitro

The purpose of this research is to find the effectiveness of bandotan’s (Ageratum conyzoides L.) leaf extract on mortality of Boophilus microplus in vitro and also to get of lethal concentration and lethal time. This research used 125 Boophilus microplus. This research used five treatments, namely neguvon suspensionon (K+), ethanol 1% (K-), 1% concentration (P1), 2% concentration (P2) and 3% concentration (P3). The observation of mortality was done every six hours. Boophilus microplus dies when there is no movement. The data were analyzed using one-way ANOVA and followed by Duncan's Multiple Distance Test. The result is said to be significant if p&lt;0.05. Probit analysis of LC50 is 1.63% at the first hour, 0.85% at the second hour, 0.54% at the third hour, 0.34% at the fourth hour, 0.04% at the fifth hour and 0.04% at the sixth hour, LC90 reached by using 5.6%, 2.9%, 1.8%, 1.2%, 0.16 and 0.16% concentration in 1, 2, 3, 4, 5 and 6 hours, respectively. The LT50 of ethanol 1% (K-) was at 10.142 hours, neguvon suspension on (K+) was at 0.747 hours, 1% concentration (P1) was at 2.184 hours, 2% concentration (P2) was at 1.579 hours, 3% concentration (P3) was at 0.923 hours and LT90 was at 23.734, 1.749, 5.110, 3.695 and 2.159 hours. The conclusion of this study was bandotan’s (Ageratum conyzoides L.) leaf extract was effective as an acaricide based on the mortality of Boophilus microplus.

An Investigation of Algerian Dates (Phoenix dactylifera L.); Antioxidant, Anti-inflammatory Properties and Phenolic Compositons H

Date fruit (Phoenix dactylifera L.) is not only known for its nutritional properties but also its therapeutic virtues. The objective was to investigate the phenolic compounds and evaluate the antioxidant and anti-inflammatory activities of pulp, seed, and whole fruit of Algerian dates. The total phenolic and flavonoid contents of ethanolic pulp (EP), seed (ES), and whole fruit (EF) extracts were measured using colorimetric methods. Phenolic acids and flavonoid profiles were determined by RP-HPLC-UV. The examination of the antioxidant potential was established by Free radical scavenging DPPH and FRAP assays. Anti-inflammatory activity of aqueous pulp (AP), seed (AS), and whole fruit (AF) of dates at 100, 200, and 300 mg/kg BW of each extract were carried out according to the experimental model of carrageenan-induced acute paw edema in mice, using diclofenac (50 mg/kg) as a reference product. Measurement of the percentage of inhibition of paw edema in mice as well as the histological study of the paw tissue, allowed us to assess the anti-inflammatory effect of the extracts investigated. Ethanolic pulp, seed, and whole fruit of date extracts contained total phenolic and flavonoids compounds at different concentrations as well as a diverse phenolic profile. The strongest antioxidant capacity was determined in ethanolic date seed extract. Concerning anti-inflammatory activity, the administration of aqueous pulp (100 and 200 mg/kg), seed (100mg/kg), and fruit (100, 200, and 300 mg/kg) of date extract induced a higher anti-inflammatory response from the fourth hour after carrageenan injection compared to the standard group treated with diclofenac. It is concluded that pulp, seed, and whole fruit of Algerian date possess antioxidant activity with phenolic and flavonoid contents and anti-inflammatory activity and dates with pulp and seed parts could be used as a natural bioactive substance for supporting anti-inflammatory therapies.

Metabolite profiling, anti-inflammatory, analgesic potentials of edible herb Colocasia gigantea and molecular docking study against COX-II enzyme

Ethnopharmacological relevanceConsumable herbs play a basic part in sustenance and human health. Traditionally, Colocasia gigantea Hook (Araceae) is used to treat fever, infection, wounds healing, drowsiness, tuberculosis, stomach problems etc. Aim of the studyThe study aspired to identify bioactive compounds, to evaluate anti-inflammatory and analgesic potentials of edible herb C. gigantea, and to molecular docking study against anti-inflammatory enzyme Cyclooxygenase-2 (COX-2). Materials and methodsChemical components of C. gigantea were discerned by HPLC and GCMS assays. In vitro anti-inflammatory activity was appraised by heat-induced, hypotonicity, and hydrogen peroxide-induced hemolysis assays and in vivo by formalin-induced paw edema assay. In vivo analgesic activity was evaluated by acetic acid-induced pain modulation assay. Also, molecular docking of the identified compounds was explored against the anti-inflammatory enzyme cyclooxygenase-2. ResultsHPLC-DAD analysis divulged the presence of trans-cinnamic acid along with (−)-epicatechin as a prime component. Also, 9, 12-Octadecadienoic acid (37.86%) and n-Hexadecanoic acid (25.89%) as the major as well as 24 other compounds were confirmed through GCMS in the extract. In in vitro anti-inflammatory study, C. gigantea extract indicated prominent erythrocyte membrane stabilization activity with good percentage aegis in all experimental assays. In addition to, formalin-induced in vivo anti-inflammatory assay revealed the maximum (42.37% and 48.72%) suppression of edema at the fourth hour at 250 and 500 mg/kg body weight, respectively. Moreover, an in-vivo pain modulation assay exposed significant (p < 0.05) activity at experimental doses. Furthermore, in the docking study, (−)-epicatechin was more active rather than other identified compounds with strong binding affinity to COX-2 protein. ConclusionsThe extract evinced remarkable anti-inflammatory and analgesic activities. Identified bioactive components along with other components of the extract might play a pivotal role in the observed bioactivity and the results vindicate the use of edible herb C. gigantea in ancestral medicine.

The Effect of Zinc Oxide Scallop-Shell Powder and Complications After Coronary Angiography

Introduction: Coronary angiography is often associated with complications such as hemorrhage and hematoma that should be considered and be minimized. Objective: This study aimed to determine the effect of Zinc oxide scallop-shell powder as a topical hemostatic agent (composed mainly of calcium) on complications after coronary angiography. These complications include hemostasis time, low back pain, hemorrhage, hematoma, the necessity of sandbags, and patient ambulation. Materials and Methods: The current research was a blind, parallel, randomized clinical trial done on 150 patients under coronary angiography. They were randomly divided into three equal groups of A (control), B (case 1), and C (case 2). In group A, hemostasis was done with manual compression, use of ChitoHem powder, putting sandbag for 4-6 h in a supine position, and getting out of bed after 24 h. In group B, instead of ChitoHem powder, we used Zinc oxide scallop-shell powder. In group C, hemostasis was done with manual compression, Zinc oxide scallop-shell powder, putting sandbag for 1 h in a supine position, and getting out of bed after 2 h. The duration of hemostasis, bleeding, and hematoma after hemostasis and the severity of low back pain were investigated at 8 point intervals during 24 h. Data analysis was done using descriptive statistics indicators and Kolmogorov-Smirnov, ANOVA, Chi Square, Fisher exact test and Kruskal-Wallis tests. Results: The mean ±SD ages of groups of A, B, and C were 60.08 ±11.32, 60.22 ±10.30, and 61.69 (10.61), respectively, which was not statistically different. Furthermore, there was no significant difference between these three groups regarding their demographic information. There were statistically significant differences between groups about the amount of low back pain at the second, third, and fourth hours after angiography (P= 0.001). There was a significant difference in the amount of bleeding between the three groups (P=0.017). The difference in time of hemostasis in the three groups was not statistically significant. Conclusion: The Zinc oxide scallop-shell powder reduces catheter site bleeding after coronary angiography and bed rest time and ultimately the severity of low back pain. Performing a similar study is recommended.

Influence of gender on postoperative pain in percutaneous nephrolithotomy: A prospective observational study.

Background and Aims:Percutaneous nephrolithotomy (PCNL) is the procedure of choice for managing large renal calculi. Although minimally invasive, it is associated with pain due to dilatation of renal capsule, parenchymal tract, and nephrostomy tube placement. Gender differences in pain perception and analgesic requirement have not been studied in PCNL surgeries. This study was done to evaluate the influence of gender on pain.Material and Methods:It was a prospective observational study including 60 ASA physical status I and II patients. The number of males and females were 29 and 31, respectively. Analgesic requirement and postoperative pain score were assessed by visual and dynamic visual analog scales (VAS, DVAS) score fourth hourly for first 24 h. Rescue analgesia was IV paracetamol 1 g when pain score exceeded four. VAS scores were assessed using Mann–Whitney test. Rescue analgesia was calculated as frequency and proportions. A P value of <0.05 was considered statistically significant.Results:The mean pain score values (VAS P = 0.361; DVAS P = 0.332) and postoperative fentanyl (P = 0.703) did not show a statistically significant difference in males and females. The requirement of rescue paracetamol was higher in females with 30 out of 31 females demanding a rescue analgesic in comparison to 15 out of 29 male patients (P = 0.001).Conclusion:No significant difference was observed in postoperative pain among males and females in patients undergoing PCNL surgery. The analgesic requirement, however, was found to be more in females than in males.

Evaluation of the performance of rapid antibiotic susceptibility test results using the disk diffusion directly from the positive blood culture bottles

PurposeIn this study, we aimed to evaluate the compliance of rapid antibiotic susceptibility test (RAST) and conventional laboratory procedures. MethodsThe RAST was performed directly from the blood cultures of 71 Gram negative bacilli (GNB) and 38 Gram positive cocci (GPC) isolates. The results were evaluated at fourth, sixth and eighth hour. Categorical agreement (CA), very major error (VME), major error (ME) and minor error (mE) were calculated and compared with the results of conventional Vitek-2 system. ResultsCategorical agreement was detected ≥90 in cefotaxime and meropenem at fourth hour in Escherichia coli isolates. An encourage positive CA results were obtained from meropenem, ceftazidime and ciprofloxacin at the fourth hour in Klebsiella pneumoniae isolates. CA was compatible in imipenem, ciprofloxacin, gentamicin, and tobramycin for Pseudomonas aeruginosa at sixth hour. CA was low (<90%) in piperacillin-tazobactam for E. coli and K. pneumoniae, and meropenem in P. aeruginosa isolates. A good CA (≥90) with all tested antibiotics were found at all hours for Acinetobacter baumannii and also very high CA (100%) was detected at sixth and eighth hour in Staphylococcus aureus isolates. CA remained below the standard criteria at fourth hour in vancomycin and high level gentamicin, in addition to imipenem at sixth hours in enterococci isolates. VME and ME were not detected and mE was 12.7% in GNB and 50% in GPC at eighth hour. ConclusionsEUCAST RAST at eighth hour will be beneficial in urgent patients due to their high CA rate, easy preparation, inexpensive, and could be performed with the available equipment and personnel.

Effects of herbage mass and herbage allowance on bite mass of grazing dairy cows

Dry matter intake (DMI) of herbage is a product of bite rate and bite mass and is a determinant of the performance of grazing ruminants. This research tested the effect of herbage allowance and herbage mass on average bite mass of individual dairy cows grazing perennial ryegrass herbage (Lolium perenne L.). Two experiments were conducted, one in each of winter (Experiment 1) and spring (Experiment 2). In each experiment, 24 Holstein-Friesian dairy cows grazed individual perennial ryegrass plots over 10 d. In each experiment cows grazed one of six treatments: low or medium herbage mass (1900 or 2200 kg DM.ha−1 in Experiment 1 and 2200 or 3000 kg DM.ha−1 in Experiment 2) combined with either low, medium or high herbage allowance (15, 25 or 40 kg DM.cow−1.d−1 in Experiment 1 and 20, 30 or 40 kg DM.cow−1.d-1 in Experiment 2). Grazing behaviour was measured with jaw movement sensors and DMI was determined by herbage disappearance measured with a rising plate meter daily, and at hourly intervals during the first 4 h of grazing after the morning milking. Average bite mass (g DM.bite−1) per day and per hour was determined as the mass of herbage that had disappeared in each period (g.d−1 or g. h−1) divided by number of prehension bites in that period. The combined data from two experiments was analysed by Linear Mixed Model and it was found there was no effect of herbage mass (P = 0.686) on bite mass per day. However, cows offered high herbage allowance had greater (P < 0.001) bite mass per day (0.62 g DM.bite-1) than cows offered the lowest herbage allowance (0.38 g DM.bite-1) across both experiments. The effect of herbage allowance was similar across both herbage masses. Bite mass per hour was the highest (P < 0.001) in the first hour of grazing in both experiments with average bite mass per hour across two experiments in the first hour of grazing (0.69 g DM.bite−1) greater than in the second (0.40 g DM.bite−1), third (0.35 g DM.bite−1) and fourth (0.32 g DM.bite−1) hours of grazing. We conclude that herbage allowance is a significant factor in determining bite mass and should be included in models aimed at predicting bite mass and hence daily herbage intake of grazing dairy cows.

Post-Cardiac Arrest Hydrocortisone Use Ameliorates Cardiac Mitochondrial Injury in a Male Rat Model of Ventricular Fibrillation Cardiac Arrest.

BackgroundSteroid use after cardiac arrest has been reported to improve survival and neurological outcome in cardiac arrest survivors. The study aimed to evaluate the effect of post‐arrest hydrocortisone use on myocardial damage and cardiac mitochondrial injury in a rat model of ventricular fibrillation cardiac arrest.Methods and ResultsVentricular fibrillation cardiac arrest was induced and left untreated for 5 minutes in adult male Wistar rats. Cardiopulmonary resuscitation and electric shocks were then applied to achieve return of spontaneous circulation (ROSC). Successfully resuscitated animals were randomized into 3 groups: control, low‐dose hydrocortisone (2 mg/kg), and high‐dose hydrocortisone (8 mg/kg). The low‐dose hydrocortisone and high‐dose hydrocortisone (treatment) groups received intravenous hydrocortisone immediately after ROSC and the control group received saline as placebo. Each group consisted of 15 animals. Within 4 hours of ROSC, both treatment groups showed a higher cardiac output than the control group. At the fourth hour following ROSC, histological examination and transmission electron microscopy demonstrated less myocardial damage and mitochondrial injury in the animals treated with hydrocortisone. In the treatment groups, hydrocortisone mitigated the acceleration of Ca2+‐induced mitochondrial swelling and suppression of complex activity observed in the control group. At the 72nd hour after ROSC, a significantly higher proportion of animals treated with hydrocortisone survived and had good neurological recovery compared with those given a placebo.ConclusionsHydrocortisone use after cardiac arrest may mitigate myocardial injury and cardiac mitochondrial damage and thus improve survival, neurological and histological outcomes in a rat model of ventricular fibrillation cardiac arrest.

109 Chemogenetic silencing of corticotropin releasing factor neurons in the paraventricular nucleus: the effect on post-stress sleep

Abstract Introduction We have previously shown that pharmacological elevation of corticotropin releasing factor (CRF) signaling in the brain results in exacerbation of sleep disturbances evoked by the exposure of rats to an acute stressor, the dirty cage of a male rat. In the present study we (1) assessed wake-sleep behavior of mice after the exposure to the dirty cage stress paradigm, and (2) examined the effect of chemogenetic silencing of CRF neurons in the hypothalamic paraventricular nucleus (PVN) on sleep occurring following the exposure to this stressor. Methods First, a group of mice (n=12) was implanted with EEG/EMG electrodes. In two weeks, post-surgery, six mice were transferred to dirty cages of male rats and recorded for 24 hours. Control mice were transferred to clean cages. In the second study, a group of CRF-ires-cre mice (n=8) received bilateral injections of AAV-hSyn-DIO-hM4Di-mCherry targeting the PVN. The other group of CRF-ires-cre mice (n=8) was injected AAV-hSyn-DIO-mCherry (control vector). All mice were implanted with EEG/EMG electrodes. Dirty cage experiments were started following a 4-week postsurgical period to allow gene recombination and expression. Mice were subjected to intraperitoneal (IP) administration of clozapine-n-oxide (CNO; 3 mg/kg) at ZT1, placed into dirty cages, and recorded for post-stress sleep. Results: Results In mice expressing hM4Di inhibitory DREADDs (designer receptors activated by designer drugs) versus mice injected with control AAV, IP CNO (3 mg/kg) resulted in a significant decrease of post-stress sleep onset latency, decrease of time spent in wakefulness (first hour, 74±5.3 vs. 89±11.0, second hour, 37.2±10.3% vs. 81.3±9.3%; third hour, 40.1±3.3% vs. 47.1±14.3%; fourth hour, 44.4±6.0 vs. 55.5±9.9), and increase in non-rapid eye movement (NREM) sleep time (26.0±5.4% vs. 11.0±11.1%; 62.8%±9.8 vs. 18.7 ± 9.6%; 59.9±3.2% vs. 52.9±14.5%; 55.6±6.2 vs. 44.5±10.0). The hM4Di expressing mice exhibited longer episodes of NREM sleep, compared to mice injected with control AAV (first hour, 133.3±80.1sec vs. 21±1.7sec; second hour, 43256±83.4sec vs. 73.5±44.1sec; third hour, 459.2±139.8sec vs. 139±80.6sec; fourth hour, 233.1±82.6sec vs. 190±72.3sec). Conclusion Chemogenetic silencing of CRF neurons in the PVN attenuates acute stress-induced sleep disturbance in mice. Support (if any) Supported by Department of Veterans Affairs Merit Review Grant # BX00155605 and SRNSF (Georgia) grant FR-18-12533

Changes in sleep-wake cycle after microinjection of agonist and antagonist of endocannabinoid receptors at the medial septum of rats

The role of medial septum in the genesis of slow-wave sleep and the inhibition of rapid eye movement sleep has been established using neurotoxic lesion and chemical stimulation of the medial septum. Intracerebroventricular injection of endocannabinoids (anandamide) decreases wake and increases slow-wave and rapid eye movement sleep in rats. Central cannabinoid (CB1) receptors are localized in the rat medial septum; however, the role of cannabinoid receptors at the medial septum on the regulation of sleep-wakefulness in rats lacks evidence. In this study, we have examined the changes in sleep architecture of 21 male Wistar rats, divided into three groups. Initially, 6 rats were used for dose standardization. Subsequently, one group (n = 6) was microinjected with CB1 receptor agonist, R-(+)-WIN 55,212–2 mesylate salt, the second group (n = 6) received microinjection of CB1 receptor antagonist LY 320,135, and the third group (n = 5) was microinjected with the vehicle, DMSO at the medial septum using stereotaxy. The sleep-wake cycle was recorded using electroencephalogram, electro-oculogram, and electromyogram. Microinjection of CB1 receptor agonist at the medial septum decreased slow-wave sleep and increased total sleep time. The increase in total sleep time was due to an increased percentage of rapid eye movement sleep. After the third and fourth hour of CB1 receptor antagonist microinjection at the medial septum, slow-wave sleep decreased when compared to vehicle injection, while rapid eye movement sleep decreased compared to baseline. We conclude that the endocannabinoid system at the septal nucleus acts through CB1 receptors to increase rapid eye movement sleep in rats.