Infusion Of Solution Research Articles

Fluid mechanical evaluation of in-line filter for fluid-handling systems by means of computational fluid dynamics (CFD)

Abstract Administering fluids and drugs intravenously is crucial in caring for vulnerable patient cohorts such as critically ill patients as well as neonatal and paediatrics patient populations. Studies have revealed severe contamination of infusion solution that could be avoided by utilizing in-line filters. The filtration performance consequently depends on the geometry of the filter housing. The purpose of our numerical study was to analyse the flow situation in filter housings depending on the geometry (diameter of the filter housing and distance between entrance and membrane). We compared the flow of two circular filter system with different housing width (D = 25 mm; L = 1.5 mm/3.0 mm) by means of computational fluid dynamics (CFD). The filter membrane was modelled by a porous jump condition. Both filter systems showed a highly reduced inflow on the membrane compared to the velocity in the Luer Lock ports. The wide filter housing facilitates a more homogenous inflow on the membrane (>92% of the membrane area is applied within a range of 5% of the mean velocity) compared to the narrow filter housing. Despite that difference both filter housings induced a well distributed flow through the filter membrane. However, for large filter systems (>50 mm diameter) the design of the filter housing could play a crucial role in optimising filter performance and therefore CFD should be considered.

Pembrolizumab (Keytruda)

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform nonbinding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec. This review assesses pembrolizumab (Keytruda), 100 mg/4 mL vial, solution for infusion. Indication: Pembrolizumab, in combination with trastuzumab, fluoropyrimidine- and platinum-containing chemotherapy, is indicated for the first-line treatment of adult patients with locally advanced unresectable or metastatic HER2-positive gastric or gastroesophageal junction (GEJ) adenocarcinoma, whose tumours express PD-L1 (combined positive score [CPS] ≥ 1), as determined by a validated test.

Usefulness of hot shot intermittent infusion online hemodiafiltration plus far-infrared therapy for dialysis patients with lower extremity arterial disease: a case report

BackgroundLower extremity arterial disease (LEAD) occurs at a high frequency in dialysis patients and is associated with a poor prognosis. In recent years, intermittent infusion online hemodiafiltration (I-OHDF) combined with far-infrared therapy (FIR) has been reported as being useful in dialysis patients with LEAD. However, there are also reports of worsening of the ulcers and gangrene in some cases. Hot shot I-OHDF (HS I-OHDF), which involves intermittent infusion of heated dialysate, is reported as being more effective than conventional I-OHDF for improving the plasma refilling rate (PRR) and peripheral circulation. We report the case of a patient in whom a lower extremity ulcer healed only after we switched from I-OHDF + FIR to HS I-OHDF + FIR, and the usefulness of this treatment.Case presentationThe patient was a 41-year-old male dialysis patient with LEAD who showed worsening of the ulcers in the lower extremity before he was switched from I-OHDF plus FIR to HS I-OHDF plus FIR; we compared the changes in the lower extremity blood flow, PRR, degree of wound healing, and subjective symptoms over time after the switch to HS I-OHDF plus FIR as compared with the values prior to the switching. As compared with the values during I-OHDF plus FIR, the lower extremity blood flow and PRR increased markedly during HS I-OHDF plus FIR. The wounds in the lower extremity improved over time during HS I-OHDF plus FIR and showed complete healing after 6 months; evaluation by visual analog scales (VASs) showed improved scores for all of fatigue, pain, coldness, and insomnia, and the patient reported improved subjective symptoms. The mechanism underlying the effectiveness of HS I-OHDF plus FIR in promoting wound healing is unknown, however, we speculated that the temperature change in the intermittent infusion solution resulted in increased blood flow in the true capillaries (resting vessels) and transfer of the nonthermal effects of FIR to more peripheral vessels.ConclusionsThis case demonstrates that combined use of HS I-OHDF with FIR can enhance the efficacy of FIR in dialysis patients with LEAD by increasing the lower extremity blood flow and PRR, which is useful for wound healing.

What is the optimal timing and solution for the intravenous infusion of thawed cryopreserved mesenchymal stem cells?

What is the optimal timing and solution for the intravenous infusion of thawed cryopreserved mesenchymal stem cells?

Albumin adjuvant therapy for acute ischemic stroke with large vessel occlusion (AMASS-LVO): rationale, design, and protocol for a phase 1, open-label, clinical trial.

Acute ischemic stroke (AIS) is an acute brain injury caused by sudden occlusion of a blood vessel. Endovascular therapy is the most effective way to restore blood flow. However, despite the restoration of blood flow in some patients, their clinical prognosis often remains unsatisfactory. Albumin has shown neuroprotective effects in animal models of AIS. Therefore, this study aims to evaluate the safety, feasibility, and efficacy of local arterial infusions of 20% human serum albumin solution as an adjuvant therapy after endovascular therapy in patients with AIS. This study is a prospective, therapeutic exploratory, non-randomized, open-label, phase 1 clinical trial testing the use of 20% human serum albumin solution injected via the artery immediately after successful reperfusion in patients with AIS. The study is divided into two stages. In the first stage, a single-dose-finding will explore the maximum safe dose according to the 3 + 3 dose escalation principle;, with the maximum dose being 0.60 g/kg. After recanalizing the occluded blood vessel, human serum albumin solution will be injected into the internal carotid artery region through a guiding catheter for 30 min. The second stage involves an albumin adjuvant therapy cohort (AT) and an endovascular treatment lonely cohort (ET). The AT cohort will encompass at least 15 additional participants to complete safety trials at the maximum safe dose determined in the first stage. The ET cohort will include well-matched patients receiving endovascular therapy alone, derived from a contemporaneous prospective registry, who will be excluded from having cardiopulmonary disorders and from receiving any neuroprotective therapy. The primary outcome of this study will be symptomatic intracranial hemorrhage. Efficacy outcomes will include the proportion of patients with the progression of cerebral infarction volume, a modified Rankin Scale of 0-2 on day 90 after randomization. An exploratory secondary outcome will be the analysis of thromboinflammatory and neuroprotective molecule profiles. This pilot trial aims to explore the safety and efficacy of arterial infusion of an albumin solution after occlusive vessel opening in AIS. The results will provide data parameters for subsequent tests on the arterial infusion of albumin solutions. ClinicalTrials.gov, NCT05953623.

Determination of Superoxide Radical Scavenging Activity and Total Antioxidant Capacity by Modified DMPD Method

Among the reactive oxygen species, Superoxide radicals can produce dangerous species that cause lipid peroxidation. Therefore, the determination and scavenging of superoxide radicals is critical. Our study is based on the interaction of the superoxide radical produced from the β-Nicotinamide adenine dinucleotide reduced disodium salt hydrate and phenazine methosulfate (NADH-PMS) system with N, N-dimethyl-p-phenylenediamine dihydrochloride (DMPD) to form the pink colored DMPD-quinone (DMPDQ) radical. In the presence of scavengers with superoxide radical scavenging activity (antioxidants, herbal teas) the color intensity decreases due to reduced DMPDQ radical production. The absorbance of the colored reference solution and the sample solution containing the radical scavenger was measured at 552 nm. The difference in absorbance (ΔA) between the reference solution and the sample solution was found. ΔA is proportional to the scavenger concentration. In the study, the superoxide radical scavenging effect of trolox (TR) and different AOXs was investigated. The superoxide radical scavenging effect of three different herbal tea infusion solutions was measured with this method. From the graph drawn between herbal tea concentrations and percentage inhibition values, 50% inhibition (EC50) values of herbal teas were found. EC50 method values were compared with the EC50 values of the nitroblue tetrazolium (NBT) and the 2,2'-azino-bis(3-etilbenzotiyazolin-6-sülfonik asit (ABTS) method. In addition, ABTS, cupric reducing antioxidant capacity (CUPRAC), and this study total antioxidant capacity (TAC) values of herbal tea infusions were calculated and compared.

Advancing Reduction Mammaplasty Surgery: Advancements and Outcomes with Tumescent Local Anaesthesia.

Tumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years. During the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. The solution was injected diffusely throughout the mammary gland. The average volume of tumescent solution infiltrated during TLA was 350mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery. No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%). No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1year. Reduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field. The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intraoperative infusion support in surgery and intensive care

The article analyzes the principles of intraoperative infusion therapy and the pathophysiology of water-electrolyte disorders in children. Patients in critical condition especially need infusion therapy. The rules for calculating the volume of infusion therapy during surgery are given and the liberal and restrictive strategies of infusion are reflected, the negative consequences of hypervolemia and infusion of hypoosmolar solutions are demonstrated based on the results of numerous studies. The historical and practical aspect of intraoperative infusion therapy to prevent dehydration and shock manifestations is highlighted.

Anaphylactic Shock Caused by Eating Buckwheat.

Background: Urticaria is a common disease with a marked influence on quality of life. The key cell involved is the mast cell, which can be activated by a vast variety of stimuli, and the major mediator is histamine. Allergic urticaria is a disorder with a large variety of causes: food, drugs, insect venom, skin contact with allergens, and physical exercise. Buckwheat consumption has increased in European countries and the USA because it is gluten-free. It can trigger anaphylactic shock if ingested, inhaled, or handled with the hands. Five common buckwheat allergens named Fag e1 to 5 (Fag e1, 2, and 3 are considered the major allergens) and two tartary buckwheat allergens named Fag t1 and Fag t2 have been described. Method: We present the case of a patient who experienced two anaphylactic shocks and in whom the etiological factor was buckwheat. The patient presented to the Allergology department for the evaluation of two episodes of severe allergic reactions that required emergency therapy, episodes that involved the loss of consciousness and were of major severity. At each anaphylactic shock, an ambulance was requested, and emergency therapy was administered, leading to the patient's recovery within a few hours. Diagnosis: Since each episode occurred a few minutes after eating, the diagnosis was established based on a detailed anamnesis and prick skin tests, followed by specific IgE dosages. Other foods consumed by the patient, assessed by prick skin testing and specific IgE dosages of suspected foods, were excluded as the etiological cause. Increased levels of buckwheat-specific immunoglobulin E were highlighted, thus identifying the etiological agent. The treatment of anaphylactic shock was performed urgently by the ambulance crew with adrenaline, infusion solutions, cortisone preparations, and antihistamines. Result: Following the treatment that was initiated, there was a partial remission of the lesions after a few hours. Conclusions: Buckwheat allergy is rare, but it produces symptoms that affect the skin, gastrointestinal tract, and respiratory tract, as well as anaphylaxis. In a professional environment, it can trigger allergic rhinitis, asthma, and hives. Although buckwheat allergens have been described, their clinical relevance has only been studied in a small number cases. In current practice, the only commercially available allergen is Beech e2 per the ImmunoCAP ISAC microarray. Diagnosis can be difficult in clinical practice. This reported case suggests the need for a thorough anamnesis, since buckwheat is consumed as a hidden allergen, and in Europe, it is not necessary to label foods containing this allergen.

Bioreactance noninvasive cardiac output monitoring in euvolemic adult horses subjected with 7.2% saline and 6% hydroxyethyl starch (130/0.4) solution infusions.

To compare the ability of bioreactance noninvasive cardiac output (BR-NICO) with thermodilution cardiac output (TDCO) for the measurement of cardiac output (CO) in healthy adult horses receiving 2 different IV volume replacement solutions. Prospective randomized crossover study from September to November 2021. University teaching hospital. Six university-owned adult horses. Horses were randomly assigned to receive 7.2% hypertonic saline solution (HSS) or 6% hydroxyethyl starch (130/0.4) solution (HETA). BR-NICO and TDCO were measured simultaneously at baseline, 10, 20, 30, 40, 50, 60, 90, and 120minutes before fluid administration and again at the same times after starting a bolus infusion of IV volume replacers. All solutions were administered within 10minutes. BR-NICO and TDCO were strongly correlated (Pearson r2=0.93; P<0.01). Regression analysis showed the relationship between TDCO and BR-NICO was BR-NICO=0.48×TDCO+0.6. For the corrected BR-NICO values, the Bland-Altman agreement mean bias and lower/upper limits of agreement were -0.62 and -5.3 to 3.9L/min, respectively. Lin's concordance (95% confidence interval) between methods was 0.894 (0.825-1.097). Compared with baseline, HSS increased the CO at 10 and 20minutes (TDCO and BR-NICO). Compared with baseline, HETA decreased the CO at 10 and 20minutes (TDCO and BR-NICO) and increased the CO at 90 (TDCO only) and 120minutes (TDCO and BR-NICO). BR-NICO strongly agreed with TDCO in the measurement of CO in healthy unsedated adult horses. HSS administration significantly increased CO in the first 30minutes, while HETA initially decreased CO at 10minutes but increased CO to above baseline values by 90minutes.

PREPARATION AND STANDARDIZATION OF EXPERIMENTAL BATCHES OF "PHOTORAN E6, LYOPHILIZATE FOR THE PREPARATION OF SOLUTION FOR INFUSIONS", A DRUG FOR PHOTODYNAMIC THERAPY USING HOGWEED LEAVES AS RAW MATERIALS

Introduction. In recent years, there has been a sharp increase in the number of oncological diseases associated with more frequent detection of malignant neoplasms, including in the early stages. Photosensitizers are widely used for the diagnosis and treatment of oncological diseases. Already at the beginning of the twentieth century, it was discovered that a cancer cell is able to accumulate and retain colored substances [1]. In Russia, the photosensitizer "Photoran E6, lyophilizate for the preparation of an infusion solution" is widely used for the diagnosis of malignant tumors. The sub-stance for its production is sodium chloride E6, obtained by chemical synthesis from methylpheophorbide A. which, according to the patent, is extract-ed from the biomass of the green microalgae Spirulina Platensis, native to Japan and California. In this regard, there is an urgent question of replacing imported intermediates with more affordable ones. For this purpose, Sosnowski's hogweed (Heraculum sosnowskyi) was chosen. In connection with the above, the aim of this study was to obtain and standardize in terms of quality the finished drug for photodynamic therapy "Pho-toran E6, lyophilizate for the preparation of an infusion solution" produced from sodium chloride E6, synthesized using a new type of raw material (leaves of borscht Sosnowski). Material and methods. The object of the study was three series of the finished medicine product (hereinafter referred to as GLS) "Photoran, lyophi-lizate for the preparation of an infusion solution", produced from an active pharmaceutical substance synthesized from methylpheophorbide a, ob-tained, in turn, from the leaves of borscht Sosnovsky as an alternative source of vegetable raw materials [2]. The quality indicators of the finished me-dicinal product were determined according to the methods described in the regulatory documentation in accordance with the Regulatory Documentation of the XIV and XV editions. Results. For the research, the aseptic production of three series of GLS was carried out from the previously produced active pharmaceutical sub-stance Sodium Chloride E6. AFS was synthesized from an intermediate obtained from the leaves of borscht Sosnowski. The standardization of the ob-tained series of the drug has been carried out. The possibility of using Sosnowski's hogweed as a plant raw material for the production of photosensi-tizers based on chlorophyll derivatives has been evaluated. Conclusion. In the course of the study, the technology of aseptic production of GLS "Photoran, lyophilizate for the preparation of solution for infusions" was implemented. The quality indicators of the three produced batches of the finished drug have been determined.

Prolonged in-use physicochemical and biological stability of nivolumab and pembrolizumab diluted in saline infusion bags and in partially used medication vials.

The aim of this study was to determine long-term physicochemical and biological stability of nivolumab and pembrolizumab diluted in saline infusion bags and partially used medication vials. This may enable the prolonged clinical use of these expensive monoclonal antibodies (mAbs) to minimize the economic loss. Sterile nivolumab and pembrolizumab concentrates in partially used medication vials and compounded nivolumab and pembrolizumab infusion solutions were stored for two and four weeks, respectively, at 2-8°C in the dark. Subsequently, concentrates and compounded solutions were stored for an additional two weeks under ambient temperature and light conditions. A panel of validated and complementary methods, consisting of enzyme-linked immunosorbent assay, size exclusion chromatography, and dynamic light scattering, were used to assess the biological and physiochemical stability of these mAbs. All samples showed that purity and concentration had remained within the criteria of <5% as stated in the European Pharmacopoeia. Diluted in infusion bags, nivolumab and pembrolizumab remained biologically and physiochemically stable for up to four weeks when stored at 2-8°C in the dark with an additional two weeks of ambient temperature and light. Stability in partially used medication vials was demonstrated for at least two weeks when stored at 2-8°C in the dark with an additional two weeks of ambient temperature and light. The findings of this study justify the storage and clinical re-use of sterile nivolumab and pembrolizumab in partially used medication vials and compounded IV infusion bags for up to six weeks. This minimizes the risk of economic loss due to waste. Moreover, these findings support the batch-wise compounding of fixed-dose and dose-banded nivolumab and pembrolizumab infusion bags.

Propyl acetate protects intestinal barrier during parenteral nutrition in mice and Caco-2 cells.

Gut microbiota dysbiosis induces intestinal barrier damage during parenteral nutrition (PN). However, the underlying mechanisms remain unclear. This study aimed to investigate gut microbiota dysbiosis, luminal short-chain fatty acids, and autophagy in a mouse model and how these short-chain fatty acids regulate autophagy. Eight-week-old male specific-pathogen-free mice were randomly divided into a Chow group (standard diet and intravenous normal saline infusion) and a PN group (continuous infusion of PN nutrient solution) for 7 days. Caco-2 cells were also treated with intestinal rinse solutions from Chow and PN mouse models. Compared with the Chow group, the PN group exhibited increased Proteobacteria and decreased Firmicutes, correlating with decreased propyl acetate. In the PN group, intestinal tissue exhibited elevated adenosine monophosphate-activated protein kinase (AMPK) phosphorylation, LC3II protein levels, and Atg3 and Atg7 messenger RNA levels. P62 protein levels were decreased, indicating an increase of autophagy flux in the PN group. In the Caco-2 cell model, cells treated with PN solution plus propyl acetate exhibited increased Claudin-1 and occluding along with decreased interleukin-6 and tumor necrosis factor α compared with those treated with PN solution alone. Propyl acetate addition inhibited the AMPK-mammalian target of rapamycin (mTOR) pathway, mitigating the excessive autophagy induced by the PN intestinal rinse solution in Caco-2 cells. PN led to a significant reduction in propyl acetate levels in the intestine, excessive activation of autophagy, and barrier dysfunction. Propyl acetate inhibited excessive autophagy via the AMPK/mTOR signaling pathway and protected the intestinal barrier during PN.

Study on the application of a segmented sodium citrate solution anticoagulation strategy in critically ill patients receiving CRRT: a prospective, randomized controlled study

BackgroundTo explore the feasibility and effectiveness of a segmented sodium citrate solution anticoagulation strategy in patients receiving CRRT.MethodsA prospective, randomized controlled study was conducted.ResultsAccording to the inclusion and exclusion criteria, 80 patients were included and randomly divided into two groups. Moreover, coagulation indices, liver function indices, renal function indices, and SOFA and APACHE II scores did not significantly differ between the two groups (P > 0.05). The coagulation grade of the venous ports in the experimental group was lower than that in the control group and the two groups of filters, but the difference was not statistically significant (P = 0.337). Both sodium citrate solution infusion methods maintained a low blood calcium concentration (0.25–0.45 mmol/L) in the peripheral circulation pathway, and no patient developed hypocalcaemia (< 1.0 mmol/L). The lifespans of the extracorporeal circulation tube in the experimental group and the control group were 69.43 ± 1.49 h and 49.39 ± 2.44 h, respectively (t = 13.316, P = 0.001).ConclusionThe segmented citrate solution anticoagulation strategy could extend the lifespan of the extracorporeal circulation tube and improve CRRT efficacy.Trial registrationThe Chinese Clinical Trial Registry number is ChiCTR2200057272. Registered on March 5, 2022.

Edetate Disodium–Based Chelation for Patients With a Previous Myocardial Infarction and Diabetes

In 2013, the Trial to Assess Chelation Therapy (TACT) reported that edetate disodium (EDTA)-based chelation significantly reduced cardiovascular disease (CVD) events by 18% in 1708 patients with a prior myocardial infarction (MI). To replicate the finding of TACT in individuals with diabetes and previous MI. A 2 × 2 factorial, double-masked, placebo-controlled, multicenter trial at 88 sites in the US and Canada, involving participants who were 50 years or older, had diabetes, and had experienced an MI at least 6 weeks before recruitment compared the effect of EDTA-based chelation vs placebo infusions on CVD events and compared the effect of high doses of oral multivitamins and minerals with oral placebo. This article reports on the chelation vs placebo infusion comparisons. Eligible participants were randomly assigned to 40 weekly infusions of an EDTA-based chelation solution or matching placebo and to twice daily oral, high-dose multivitamin and mineral supplements or matching placebo for 60 months. This article addresses the chelation study. The primary end point was the composite of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina. Median follow-up was 48 months. Primary comparisons were made from patients who received at least 1 assigned infusion. Of the 959 participants (median age, 67 years [IQR, 60-72 years]; 27% females; 78% White, 10% Black, and 20% Hispanic), 483 received at least 1 chelation infusion and 476 at least 1 placebo infusion. A primary end point event occurred in 172 participants (35.6%) in the chelation group and in 170 (35.7%) in the placebo group (adjusted hazard ratio [HR], 0.93; 95% CI, 0.76-1.16; P = .53). The 5-year primary event cumulative incidence rates were 45.8% for the chelation group and 46.5% for the placebo group. CV death, MI, or stroke events occurred in 89 participants (18.4%) in the chelation group and in 94 (19.7%) in the placebo group (adjusted HR, 0.89; 95% CI, 0.66-1.19). Death from any cause occurred in 84 participants (17.4%) in the chelation group and in 84 (17.6%) in the placebo group (adjusted HR, 0.96; 95% CI, 0.71-1.30). Chelation reduced median blood lead levels from 9.03 μg/L at baseline to 3.46 μg/L at infusion 40 (P < .001). Corresponding levels in the placebo group were 9.3 μg/L and 8.7 μg/L, respectively. Despite effectively reducing blood lead levels, EDTA chelation was not effective in reducing cardiovascular events in stable patients with coronary artery disease who have diabetes and a history of MI. ClinicalTrials.gov Identifier: NCT02733185.

Preoperative fasting for elective surgery in children

This review investigated preoperative fasting in children who need elective surgical interventions. Fifty publications included in the abstract databases PubMed and elibrary for the period from 2017 to 2023 were reviewed. For the analysis, we used articles on the effect of preoperative fasting on indicators of the cardiovascular system and water and carbohydrate metabolism and assessed the course of the perioperative period depending on the duration of refusal of solid food and liquids before surgery. The article presents historical information that formed the basis for the modern paradigm of refusal of solid food and liquids in the preoperative period, especially the negative consequences of prolonged refusal of food in the preoperative period, indicating the main ones, namely, euglycemic ketosis and ketoacidosis, which are common in children. Hypoglycemia due to food refusal before surgery is rare and is not a serious problem in most patients, except in children in the first year of life. In most cases, it has been demonstrated that the time of preoperative fasting significantly exceeds the recommended intervals and amounts to more than 10 hours, and 75% of patients experience a strong feeling of hunger. Infusion of dextrose solutions has not been found to reduce feelings of hunger and thirst before surgery. An increase in preoperative fasting time is often associated with improper organization of the process (35.1%), an increase in surgical time (34.1%), and surgical plan changes (20.9%). It is noted that the optimal volume of liquid that a child can drink before surgery is 3 ml/kg. Data indicates that preoperative fasting can cause arterial hypotension after induction of anesthesia, at the stage of preparing the surgical field. It has been demonstrated that a residual gastric volume of 1.25 ml/kg is a risk factor for aspiration during the induction of anesthesia. There is currently no convincing evidence of the negative effect of preoperative fasting on treatment outcome; however, clearly, the time to abandon clear liquids before elective surgery in children should be minimal.

Dysglycaemia in Ebola virus disease: a retrospective analysis from the 2018 to 2020 outbreak

BackgroundEbola virus disease (EVD) is associated with multisystem organ failure and high mortality. Severe hypoglycaemia is common, life-threatening, and correctable in critically ill patients, but glucose monitoring may be limited in EVD treatment units. MethodsWe conducted a retrospective review of patients admitted to EVD treatment units in Butembo and Katwa, Eastern DRC. Glucose measurements were done using a handheld glucometer at the bedside or using the Piccolo xpress Chemistry Analyzer on venous samples. Findings384 patients (median age 30 years (interquartile range, IQR, 20-45), 57% female) and 6,422 glucose measurements (median 11 per patient, IQR 4 to 22) were included in the analysis. Severe hypoglycaemia (≤2.2mmol/L) and hyperglycaemia (>10mmol/L) were recorded at least once during the ETU admission in 97 (25%) and 225 (59%) patients, respectively. A total of 2,004 infusions of glucose-containing intravenous solutions were administered to 302 patients (79%) with a median cumulative dose of 175g (IQR 100 to 411). The overall case fatality rate was 157/384 (41%) and was 2.2-fold higher (95%CI 1.3 to 3.8) in patients with severe hypoglycaemia than those without hypoglycaemia (p=0.0042). In a multivariable Cox proportional hazards model, periods of severe hypoglycaemia (adjusted hazard ratio (aHR) 6.2, 95%CI 3.2-12, p<0.0001) and moderate hypoglycaemia (aHR 3.0, 95%CI 1.9-4.8, p<0.0001) were associated with elevated mortality. InterpretationHypoglycaemia is common in EVD, requires repeated correction with intravenous dextrose solutions, and is associated with mortality. FundingThis study was not supported by any specific funding.

The effects of simulated gastroesophageal reflux on infant pig oropharyngeal feeding physiology.

The neural connectivity among the oral cavity, pharynx, and esophagus is a critical component of infant feeding physiology. Central integration of oral and pharyngeal afferents alters motor outputs to structures that power swallowing, but the potential effects of esophageal afferents on preesophageal feeding physiology are unclear. These effects may explain the prevalence of oropharyngeal dysphagia in infants suffering from gastroesophageal reflux (GER), though the mechanism underlying this relationship remains unknown. Here we use the validated infant pig model to assess the impacts of simulated GER on preesophageal feeding parameters. We used high-speed videofluoroscopy and electromyography to record bottle-feeding before and following the infusion of a capsaicin-containing solution into the lower esophagus. Sucking parameters were minimally affected by capsaicin exposure, such that genioglossus activity was unchanged and tongue kinematics were largely unaffected. Aspects of the pharyngeal swallow were altered with simulated GER, including increased thyrohyoid muscle activity, increased excursions of the hyoid and thyroid per swallow, decreased swallow frequency, and increased bolus sizes. These results suggest that esophageal afferents can elicit changes in pharyngeal swallowing. In addition, decreased swallowing frequency may be the mechanism by which esophageal pathologies induce oropharyngeal dysphagia. Although recent work indicates that oral or pharyngeal capsaicin may improve dysphagia symptoms, the decreased performance following esophageal capsaicin exposure highlights the importance of designing sensory interventions based upon neurophysiology and the mechanisms underlying disordered feeding. This mechanistic approach requires comprehensive data collection across the entirety of the feeding process, which can be achieved using models such as the infant pig.NEW & NOTEWORTHY Simulated gastroesophageal reflux (GER) in an infant pig model resulted in significant changes in pharyngeal swallowing, which suggests that esophageal afferents are centrally integrated to alter motor outputs to the pharynx. In addition, decreased swallow frequency and increased bolus sizes may be underlying mechanisms by which esophageal pathologies induce oropharyngeal dysphagia. The infant pig model used here allows for a mechanistic approach, which can facilitate the design of intervention strategies based on neurophysiology.

Programmed Intermittent Epidural Boluses of 0.1% Ropivacaine Versus 0.2% Ropivacaine for the Maintenance of Epidural Analgesia in Labor.

Objective The gold standard for pain management during labor is epidural analgesia, which can be administered in two different ways to the parturients, either bybolus doses or continuous infusions of local anesthetic solutions with opioids. Recently, programmed intermittent epidural boluses (PIEBs) via a pump are gaining popularity as a very effective method with minimal side effects. The aim of this study was to evaluate the optimum ropivacaine concentration between two different regimens (0.1% or 0.2% both with fentanyl 2 μg/ml) that can provide satisfactory analgesia with the minimum degree of motor blockade, using PIEBs. Methods A prospective randomized controlled study was performed from March 2020 to March 2022. Two different concentrations of ropivacaine 0.1% and 0.2% via PIEBs were equally allocated to two groups of parturients with an additional patient control epidural rescue bolus if needed. Our primary endpoint was motor blockade, as assessed by the modified Bromage scale (MBS). We also recorded visual analog scale (VAS) scores, heart rate, blood pressure, total local anesthetic consumption, labor duration and method of delivery, and APGAR score of the newborns. Results All patients presented Bromage scores equal to 6, and the total consumption of the anesthetic solution was comparable between the two groups. Women in the 0.2% group showed higher pain relief and satisfaction compared to the 0.1% group. Concerning the 0,2% group, diastolic blood pressure and APGAR scores were lower alongside with a lower satisfactory extrusion stage observed bythe obstetrician. Conclusion Both ropivacaine regimens provide satisfactory labor epidural analgesia for the expectant mother without any motor blockade.

Whole Cancer Visualization using Gadobutrol-glucose Solution and 7.0 T Magnetic Resonance Imaging.

Cancer tissue absorbs 3-8 times more glucose than normal tissue. Therefore, we developed a gadobutrol-glucose solution for 7.0T magnetic resonance imaging to visualize whole cancerous regions at high contrast. The contrast medium consists of gadobutrol and glucose solutions, and these solutions are mixed before the vein infusion. We used readily available solutions, and the concentrations of the gadobutrol and glucose solutions were 60% and 5.0%, respectively. To visualize the cancerous region, we used two rabbits with VX7 thigh cancer. First, vein injection was carried out using a gadobutrol-saline solution containing 0.3 ml gadobutrol, and T1-weighted imaging (T1WI) was performed. Twenty-four hours after the first experiment, we performed T1WI of the VX7-cancer region using 50.3 mL gadobutrol-glucose solution including 0.3 ml gadobutrol. Compared with T1WI using the gadobutrol-saline solution, the signal intensity of the cancerous region substantially increased using the gadobutrol-glucose solution. We confirmed significant signal-intensity increases in the whole VX7-cancer region of a rabbit thigh utilizing vein infusion of gadobutrol-glucose solution since the gadobutrol molecules were absorbed throughout the cancerous region along with glucose molecules.