Recovery Profile Research Articles

Quantitative dynamic wearable motion-based metric compared to patient-reported outcomes as indicators of functional recovery after lumbar fusion surgery

BackgroundLow back pain is a debilitating condition with poor patient outcomes despite the use of a wide variety of diagnostic and treatment modalities. A lack of objective metrics to support clinical decision-making may be a reason for these poor outcomes. This study aimed to compare patient recovery following lumbar fusion surgery using an objective motion-based metric (functional performance) and subjective patient-reported outcomes for pain, disability and kinesophobia. MethodsA prospective observational study was conducted on 121 patients that received a lumbar fusion surgery. A wearable motion system was used to quantify three-dimensional multi-planar lumbar motion and benchmark each patient's lumbar function prior to surgery and post-operatively at follow-up time points for up to 2 years. Patient recovery profiles after surgery were evaluated using the acquired functional motion data and compared to patient-reported outcomes. FindingsOur results found significant improvement after surgery in objective functional performance as well as patient-reported pain, disability, and kinesophobia. However, we found a delayed response in the objective metric, with meaningful improvement occurring only 6 months after fusion surgery. In contrast, we found significant improvement in all subjective scores as early as 6 weeks post-surgery. InterpretationObjective motion-based metric provides a unique perspective to assessing patient's functional recovery. While it is associated with dimensions of pain, disability and fear avoidance, it is also distinct and assesses a uniquely different dimension of functional health. This information can form the basis for the use of objective metrics to gauge patient recovery after lumbar fusion surgery.

High-resolution in vivo monophasic gastric slow waves to quantify activation and recovery profiles.

Gastric bio-electrical slow waves are, in part, responsible for coordinating motility. Spatial dynamics about the recovery phase of slow wave recordings have not been thoroughly investigated due to the lack of suitable experimental techniques. A high-resolution multi-channel suction electrode array was developed and applied in pigs to acquire monophasic gastric slow waves. Signal characteristics were verified against biphasic slow waves recorded by conventional surface contact electrode arrays. Monophasic slow wave events were categorized into two groups based on their morphological characteristics, after which their amplitudes, activation to recovery intervals, and gradients were quantified and compared. Coverage of activation and recovery maps for both electrode types were calculated and compared. Monophasic slow waves had a more pronounced recovery phase with a higher gradient than biphasic slow waves (0.5 ± 0.1 vs. 0.3 ± 0.1mV·s-1 ). Between the 2 groups of monophasic slow waves, there was a significant difference in amplitude (1.8 ± 0.5 vs. 1.1 ± 0.2mV), activation time gradient (0.8 ± 0.2 vs. 0.3 ± 0.1mV·s-1 ), and recovery time gradient (0.5 ± 0.1 vs. 0.3 ± 0.1mV·s-1 ). For the suction and conventional contact electrode arrays, the recovery maps had reduced coverage compared to the activation maps (4 ± 6% and 43 ± 11%, respectively). A novel high-resolution multi-channel suction electrode array was developed and applied in vivo to record monophasic gastric slow waves. Slow wave recovery phase analysis could be performed more efficiently on monophasic signals compared with biphasic signals, due to the more identifiable recovery phases.

International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials

BackgroundThe epidemiological international landscape of traumatic spinal cord injury (SCI) has evolved over the last decades along with given inherent differences in acute care and rehabilitation across countries and jurisdictions. However, to what extent these differences may influence neurological and functional recovery as well as the integrity of international trials is unclear. The latter also relates to historical clinical data that are exploited to inform clinical trial design and as potential comparative data.MethodsEpidemiological and clinical data of individuals with traumatic and ischemic SCI enrolled in the European Multi-Center Study about Spinal Cord Injury (EMSCI) were analyzed. Mixed-effect models were employed to account for the longitudinal nature of the data, efficiently handle missing data, and adjust for covariates. The primary outcomes comprised demographics/injury characteristics and standard scores to quantify neurological (i.e., motor and sensory scores examined according to the International Standards for the Neurological Classification of Spinal Cord Injury) and functional recovery (walking function). We externally validated our findings leveraging data from a completed North American landmark clinical trial.ResultsA total of 4601 patients with acute SCI were included. Over the course of 20 years, the ratio of male to female patients remained stable at 3:1, while the distribution of age at injury significantly shifted from unimodal (2001/02) to bimodal distribution (2019). The proportional distribution of injury severities and levels remained stable with the largest percentages of motor complete injuries. Both, the rate and pattern of neurological and functional recovery, remained unchanged throughout the surveillance period despite the increasing age at injury. The findings related to recovery profiles were confirmed by an external validation cohort (n=791). Lastly, we built an open-access and online surveillance platform (“Neurosurveillance”) to interactively exploit the study results and beyond.ConclusionsDespite some epidemiological changes and considerable advances in clinical management and rehabilitation, the neurological and functional recovery following SCI has remained stable over the last two decades. Our study, including a newly created open-access and online surveillance tool, constitutes an unparalleled resource to inform clinical practice and implementation of forthcoming clinical trials targeting neural repair and plasticity in acute spinal cord injury.

Comparative Evaluation of Dexmedetomidine and Magnesium Sulphate in Mitigating Pressor Response while Extubation in Patients undergoing Mastoidectomies

Background: Ear surgeries performed under general anaesthesia mandate smooth emergence after surgery to facilitate a good surgical outcome. We conducted this study with primary objective of comparing dexmedetomidine and magnesium sulfate (MgSO4) in attenuating extubation response after mastoid surgeries. The secondary outcome was to study the adverse effects if any.
 Methods: Sixty patients of ASA grade I and II, aged 18 -50 yrs were randomized into 2 groups of 30 each receiving either dexmedetomidine 0.5μg/kg or MgSO4 30 mg/kg respectively 10 minutes prior to completion of surgery. Efficacy of both drugs in attenuating cough reflex, PONV, shivering and fluctuations in haemodynamic response were recorded. Postoperative sedation was noted. Any laryngospasm, bronchospasm, hypotension, bradycardia, desaturation was also noted.
 Statistical analysis: The observations were recorded and analysed using statistics calculator SPSS 19.00 version. Student’s t test and χ2 (chi square) test were used to analyze quantitative and qualitative data respectively. P-value<0.05 was considered statistically significant.
 Results: The variations in systolic, diastolic blood pressure and heart rate were significantly less with dexmedetomidine as compared to MgSO4 (p<0.01). Incidence of coughing (p=0.002), PONV(p=0.002), was less with dexmedetomidine while shivering control was similar in both groups, the sedation was more with dexmedetomidine (p=0.004). Patients with dexmedetomidine infusion were more satisfied in terms of reduced nausea sensation, drowsiness.
 Conclusion: Dexmedetomidine provides a smoother recovery profile as compared to MgSO4 when administered prior to extubation improving the surgical outcome and patient satisfaction in patients undergoing mastoidectomies.

Effects of topical anesthesia with 1% tetracaine on hemodynamic responses in microlaryngosurgery

Objective: To observe the effects of topical anesthesia with 1% tetracaine on hemodynamic responses in general anesthesia patients undergoing microlaryngosurgery. Methods: From October 2021 to December 2021, 92 patients (46 males and 46 females) in Beijing Tongren Hospital, with a median age [M (Q1, Q3)] of 51 (42, 57) years who scheduled for microlaryngosurgery under general anesthesia, were divided into two groups (n=46 in each group) using the random number table method. Group T received topical anesthesia with 1% tetracaine at the root of the tongue and epiglottis and glottis on the basis of general intravenous anesthesia induction, with 0.5 ml at each position, while the control group (group C) received equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of patients entering the operating room (baseline), after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation. The recovery profiles, including time to recover breathing, time to open eyes, time to extubation and adverse reactions were evaluated during recovery period. Results: The MAP of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation were (99.4±12.9), (78.5±8.8), (79.2±10.2), (100.6±17.0), (101.9±14.7), (100.8±13.9), (97.4±12.1), (107.3±16.8) mmHg (1 mmH=0.133 kPa), respectively, while in group C were (99.5±11.6), (80.9±12.8), (90.5±16.0), (109.5±20.4), (108.0±18.9), (103.7±15.5), (100.1±13.3), (114.2±17.3) mmHg, respectively. The two critical time points of MAP after intubation and immediately suspending laryngoscopy in group C were significantly higher than group T (P<0.05).The HR of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation was (71.3±10.6), (66.0±10.1), (69.5±11.4), (61.3±14.2), (69.8±9.8), (71.0±10.6), (70.6±11.0), (78.8±11.6) bmp, respectively, while in group C were (73.1±10.9), (67.8±9.9), (79.5±12.9), (57.1±18.1), (69.2±12.8), (71.4±11.7), (70.7±11.5), (85.3±13.0) bmp, respectively. The two critical time points of HR after intubation and after extubation in group C were significantly higher than that of group T (P<0.05). The time to recover breathing in the two groups was (11.8±3.5) min and (11.3±4.6) min, respectively. The time to open eyes was (12.0±3.3) min and (11.5±5.0) min, respectively. The time to extubation was (13.2±3.7) min and (12.6±4.9) min, respectively. There were no statistically significant difference in time to recovery between the two groups (P>0.05). Likewise, there were no toxic reactions to local anesthetics, respiratory depression, hypoxemia, laryngospasm and cough occurred in either group. Conclusion: Topical anesthesia with 1% tetracaine can effectively reduce the hemodynamic changes without influencing patient's recovery, and does not increase the incidence of adverse reactions.

Evaluation of effect of intravenous dexmedetomidine infusion on intra-operative hemodynamic and recovery profile in patients undergoing intracranial surgery under general anaesthesia

Evaluation of effect of intravenous dexmedetomidine infusion on intra-operative hemodynamic and recovery profile in patients undergoing intracranial surgery under general anaesthesia

Randomized controlled study comparing a isobaric levobupivacaine to a conventional dose of hyperbaric bupivacaine for infra umbilical surgeries

Levobupivacaine is an attractive alternative to racemic bupivacaine for spinal anesthesia due to the lower potential for cardio-toxicity and faster recovery profile. Present study is undertaken to compare hemodynamic and analgesic characteristics using an isobaric levobupivacaine to a conventional dose of hyperbaric bupivacaine for infra umbilical surgeries. A prospective randomized double blind study was conducted involving 60 patients belonging to ASA gr I &amp; II coming for elective lower abdominal surgeries. They were randomly divided into 2 groups of 30 each. Group I received 3ml of 0.5% hyperbaric bupivacaine, group II received 3ml of 0.5% isobaric levobupivacaine. Hemodynamic parameters like heart rate, NIBP and SpO2 were monitored every 15mins till end of surgery and for 2 hours post operatively. Incidence of side effects such as hypotension, bradycardia and nausea and vomiting were noted. Demographic parameters in both groups were comparable. Onset of sensory block was slow in group L . Level of sensory block was comparable and duration of analgesia at L1(L1regression) was significantly shorter with Levobupivacaine compared to Bupivacaine. Onset of motor blockade was slower and duration of motor blockade was also shorter with levobupivacaine compared to bupivacaine. However all the patients in either group attained complete motor blockade.

Understanding, facilitating and predicting aphasia recovery after rehabilitation

Purpose: This paper reviews several studies whose aim was to understand the nature of language recovery in chronic aphasia and identify predictors of how people may recover their language functions after a brain injury. Method: Several studies that mostly draw from data collected within the Centre for Neurobiology of Language Recovery were reviewed and categorised in four aspects of language impairment and recovery in aphasia: (a) neural markers for language impairment and recovery, (b) language and cognitive markers for language impairment and recovery, (c) effective treatments and (d) predictive modelling of treatment-induced rehabilitation. Result: Language impairment and recovery in stroke-induced aphasia is multi-factorial, including patient-specific and treatment-specific factors. A combination of these factors may help us predict treatment responsiveness even before treatment begins. Conclusion: Continued work on this topic will lead to a better understanding of the mechanisms that underly language impairment and treatment-induced recovery in aphasia, and, consequently, use this information to predict each person's recovery profile trajectory and provide optimal prescriptions regarding the type and dosage of treatment.

Testosterone (T) recovery profiles after short-term androgen deprivation therapy (ADT)

ABSTRACT Introduction ADT plays a major role in several scenarios for men with prostate cancer. T recovery after ADT cessation may be incomplete with 10% of men estimated to suffer persistent castrate levels after long-term ADT. Objective The objective of this study was to evaluate T recovery after short courses of ADT. Methods Study population included men treated with ≤6 months of ADT in association with radiation therapy (RT). Early morning T levels were collected at baseline and periodically after ADT cessation. T recovery after ADT cessation was analyzed in 2 ways: improvement to non-castrate level (T ≥50 ng/dL), and recovery to normal (T ≥ 300 ng/dL). Recovery rates and median survival time were estimated using Kaplan-Meier statistics and predictors analyzed using Cox proportional hazard ratios. Results 88 men with a mean age of 68 ± 8 years at time of ADT were analyzed. Median duration of ADT was 3.1 months; 56% had an ADT duration between 1-3 months and 44% between 4-6 months. Mean pre-ADT T level was 390 ± 158 ng/dL. After cessation of ADT, median time to non- castrate levels was 9.3 (IQR = 6.3 – 18.5) months and 15.8 (IQR = 8.3 - 33.8) ‘months for recovery to T ≥300 ng/dL. Higher baseline T levels (T &amp;gt; 400 ng/dL) was associated with a faster recovery to normal T level (HR = 1.80, 95% CI = 1.09 – 2.95), but not to non-castrate level. Neither age &amp;gt; 65 years, prevalent diabetes, nor ADT duration of 4-6 months vs ≤ 3 months were significantly associated with a slower T recovery. Conclusions Most of our patients remained with low T levels one year after the cessation of ADT. Higher baseline T was associated with faster T recovery to normal (T ≥ 300 ng/dL). Disclosure Work supported by industry: no.

MP48-02 PERSISTENT TESTOSTERONE SUPPRESSION AFTER CESSATION OF ANDROGEN DEPRIVATION THERAPY FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP48-02 PERSISTENT TESTOSTERONE SUPPRESSION AFTER CESSATION OF ANDROGEN DEPRIVATION THERAPY FOR LOCALIZED PROSTATE CANCER Jessica Delgado, Jesse Ory, Joshua Bitran, Ruben Blachman Braun, Sirpi Nackeeran, and Ranjith Ramasamy Jessica DelgadoJessica Delgado More articles by this author , Jesse OryJesse Ory More articles by this author , Joshua BitranJoshua Bitran More articles by this author , Ruben Blachman BraunRuben Blachman Braun More articles by this author , Sirpi NackeeranSirpi Nackeeran More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002619.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Introduction: ADT plays a fundamental role in the treatment of localized prostate cancer. However, there is limited data regarding testosterone recovery in men who have received ADT for localized prostate cancer. Identification of T recovery profiles associated with ADT will facilitate personalization of ADT regimens and guide future treatment strategies to minimize the risk of T deficiency in patients following treatment for prostate cancer. Objective: Temporary use of Androgen Deprivation Therapy (ADT) is a cornerstone in the treatment of localized prostate cancer. However, the ability for testosterone to recover after ADT is not well understood. The aim of this study was to investigate testosterone recovery in men with localized prostate cancer following ADT. METHODS: A global federated health research network (TriNetX) was used to identify men with a diagnosis of prostate cancer who underwent temporary use of ADT. Three cohorts were identified: Men who received LHRH antagonists, LHRH agonists, and men who received combined ADT (LHRH agonist and antiandrogens). Further stratification was based on treatment duration of 6 or 18 months to compare T recovery profiles 5 years after ADT cessation. RESULTS: A total of 17,884 men received LHRH agonists alone, 12,767 men received combined ADT, and 628 men received LHRH antagonist therapy alone. Eugondal mean baseline T level (>300 ng/dL) prior to starting ADT was an inclusion criterion for all men. Five years after ADT cessation, 36% of patients who received LHRH agonists recovered eugondal T levels, 26% recovered after LHRH antagonist therapy, and 36.8% recovered after combined ADT. Overall, more than half of men who received ADT failed to recover eugondal T levels even 5 years after treatment cessation. CONCLUSIONS: Five years after ADT cessation for localized prostate cancer, incomplete testosterone recovery persists in >50% of the men. Since, testosterone deficiency will lead to metabolically adverse changes in body composition, increased insulin resistance, impaired bone health, and poor quality of life, serum T levels need to be closely followed in men receiving ADT. Source of Funding: Funding to access the TriNetX database was provided in part by an educational grant from Acerus Pharmaceuticals. Acerus Pharmaceuticals was not involved in the planning, design, writing or any other aspect of this project. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e820 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Delgado More articles by this author Jesse Ory More articles by this author Joshua Bitran More articles by this author Ruben Blachman Braun More articles by this author Sirpi Nackeeran More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of recovery times by using bispectral index monitoring versus end-tidal agent concentration monitoring in patients undergoing inhalational general anaesthesia.

Background and Aims:End-tidal anaesthetic gas concentration (ETAG) and bispectral index (BIS) are both used to monitor depth of anaesthesia. Maintaining an accurate depth of anaesthesia helps in early post-operative recovery. This study compared the recovery times from sevoflurane–nitrous oxide anaesthesia using ETAG monitoring with BIS monitoring.Methods:Four hundred and two patients undergoing elective surgeries under sevoflurane- nitrous oxide anaesthesia were enroled in this double blinded parallel group prospective randomised trial and allocated into two groups. The depth of anaesthesia was monitored using BIS in BIS group (n = 202) and end-tidal sevoflurane concentration (EtSevo) in ETAG group (n = 200). The time to extubation and recovery were compared between the groups. Parametric, non-parametric and categorical variables were compared using Student’s ‘t’ test, Wilcoxon’s rank sum test and Chi-square test, respectively.Results:Time to extubation (min) [BIS group – 10, 5; ETAG group – 10, 5 (median, inter-quartile range, IQR), P = 0.32] and time to recovery (min) [BIS group – 14, 6; ETAG group – 13.5, 7 (median, IQR), P = 0.34] did not differ significantly between the two groups. The EtSevo concentration (vol%) was significantly higher in the BIS group at 5 min [BIS group – 1.2, 0.4; ETAG group – 1.0, 0.4 (median, IQR), P < 0.001], 30 min [BIS group – 1.1, 0.4; ETAG group – 1.0, 0.3 (median, IQR), P = 0.002] and 120 min [BIS group – 1.11 ± 0.28; ETAG group – 0.96 ± 0.27 (mean ± standard deviation), P = 0.014] after induction of anaesthesia.Conclusions:BIS and ETAG monitoring are associated with comparable recovery profiles. ETAG monitoring is associated with significantly less sevoflurane consumption.

Comparison of Propofol Alone with Admixture of Propofol and Thiopentone Sodium for Laryngeal Mask Airway Insertion in Paediatric Elective Surgery

Background: Laryngeal Mask Airway (LMA) is mostly used for the application of general anesthesia. Intravenous Propofol is still preferable for induction of anesthesia due to its favorable recovery profile and low incidence of side effects. Thiopentone sodium is also one of the most commonly used intravenous induction agent. Combination of Propofol and thiopentone sodium may be more is beneficial rather than propofol alone. So we conducted this study to find more effective method. Objective: To compare the outcome of combination of Thiopentone sodium with Propofol versus Propofol alone for the Laryngeal mask airway insertion in pediatric patients. Methodology: This “Randomized controlled trial” was done at the Department of Anesthesia, Jinnah Hospital, Lahore for 6 months i.e. from July 2021 to Dec 2021. 80 children were selected for surgery through Non-Probability, Consecutive Sampling. Randomization of patients into group A &amp; B was done. Informed consent was obtained from parents. Intravenous induction agents were prepared, for Propofol group (A), propofol was mixed with lignocaine and for the combination group (B), Thiopentone was combined with propofol. A correct sized LMA was inserted. Excellent LMA insertion was assessed. Data was analyzed in SPSS. Excellent LMA insertion in both groups was analyzed using Chi Square test with p &lt;0.05 as statistically significant. Results: The mean age of patients in our study was 8.29±3.16 years. In Propofol group, there were 28 males and 12 were females while in combination group, 22 patients were male and 18 patients were females. In Propofol group, 15 cases had LMA score 1, 17 had LMA score 2 and 8 had LMA score 3. In combination group, 25 cases had LMA score 1 and 15 had LMA score 2 but no one had LMA score 3. The difference was significant (p&lt;0.05). In Propofol group, 15 cases had excellent outcome while in 25 cases, excellent outcome could not be achieved. In combination group, 25 cases had excellent outcome while in 15 cases, excellent outcome could not be achieved. The difference was significant (p&lt;0.05). Conclusion: So it has been proved that combination of Propofol with thiopentone sodium is more effective for effective insertion of LMA in children instead of using porpofol alone. Keywords: General Anesthesia, Laryngeal Mask Airway, Children, Propofol, Thiopentone Sodium

Dual Benefits of Enhanced Oil Recovery and CO2 Sequestration: The Impact of CO2 Injection Approach on Oil Recovery

Injection of CO2 to enhance oil recovery is widely used due to its multiple advantages such as mobilizing the oil and sequestration of carbon dioxide. Injection of CO2 can enhance oil recovery by reducing oil viscosity and improving overall fluid mobility. However, several problems are associated with CO2 injection such as viscous fingering, gravity override, and CO2 channeling that results in early gas breakthrough, low sweep efficiency, and low ultimate oil recovery. In this study, dual benefits of CO2 injection are presented: enhancing oil recovery and sequestering carbon dioxide. In this work, different scenarios of field scale simulation were conducted to evaluate oil recovery during CO2 injection, and the CMG (Computer Modeling Group) software package was used. Three main scenarios were examined which are CO2 injection into the reservoir, CO2 injection into the aquifer, and CO2 injection into the aquifer followed by waterflooding. Also, three well configurations were utilized—all injectors and producers are drilled vertically, all wells are drilled horizontally, and vertical injectors and horizontal producers are used. Therefore, the oil recovery profiles were examined for nine scenarios over a 20-year period. In all simulated models, CO2 injection was started at the residual oil saturation (Sor) conditions, to represent the cases of depleted oil reservoirs. The results indicated that the highest oil recovery of 73% of the original oil-in-place (OOIP) can be achieved by injecting CO2 into the reservoir, utilizing vertical injectors and producers. While injecting CO2 into aquifers can significantly enhance oil recovery by around 68–70% of the OOIP, using horizontal wells can provide more oil recovery (67.7%) than that using vertical wells (54.8%), in the same conditions. Moreover, around 7,928 tons of carbon dioxide can be sequestered in underground formations, on average. Finally, CO2 injection outperformed the conventional waterflooding, where 68 and 12% of the OOIP were obtained, respectively. Overall, injection of CO2 into the depleted reservoir can provide dual benefits of CO2 sequestration and improved oil recovery. CO2 can be injected into the water zone resulting in a slow release of CO2 which will reduce the fluid viscosity, enhance oil recovery, and reduce the greenhouse effect.

Heineke-Mikulicz Preputioplasty: Surgical Technique and Outcomes

To provide a summary of surgical technique and outcomes for Heineke-Mikulicz preputioplasty (HMP), a foreskin-preserving surgical treatment for phimosis in the adult population. We retrospectively reviewed 7 patients who underwent HMP by a single surgeon from May 2017 to May 2021. Variables included patient demographics, intraoperative considerations, and post-operative course. HMP is performed using a 2-3 cm vertical incision over the phimotic band on the dorsal surface to just above Buck's fascia. Additional incisions are made on the ventral surface if phimosis remains persistent after dorsal release. The incision is closed horizontally in 2 layers. Seven patients underwent HMP. Median age was 47.3 and median BMI was 24.3. Five patients reported bothersome phimosis and 1 each reported paraphimosis and frenular tethering. Six patients requested foreskin sparing surgery as a personal preference and 1 patient was an intraoperative consult. Topical betamethasone was attempted in 3 of 7 patients. The median time from diagnosis to surgery was 2 months. Median operative time was 45.5 minutes and median estimated blood loss was 5 mL. Two patients required both dorsal and ventral incisions. No intraoperative complications were reported and all patients were discharged the same day. At median follow-up of 1.8 months, 1 patient reported bothersome phimosis secondary to scar formation treated successfully with triamcinolone. HMP is a safe and effective method of treating even very significant phimosis in patients trying to avoid circumcision or intraoperative consults where preferences may be unclear. Our method takes less time than traditional circumcision with a comparable recovery and complication profile.

A double-blind randomized controlled trial to compare the safety and efficacy of dexmedetomidine alone and in combination with ketamine in uncooperative and anxious paediatric dental patients requiring pulpectomy.

To compare the sedation regimen Dexmedetomidine alone and its combination with low dose Ketamine through intravenous route in terms of safety, efficacy and recovery profile in uncooperative paediatric dental patients requiring pulpectomy. Thirty anxious and uncooperative 2-6-year-old children requiring pulpectomy in at least one primary molar were enrolled. Propofol was used as an induction agent. Drugs were administered through the intravenous route as per group assignment, i.e., Dexmedetomidine (1µg/kg) with ketamine (0.5mg/kg) administered over 10min followed by a maintenance dose of Dexmedetomidine (0.2-0.8µg/kg/h) in group A and Dexmedetomidine (1µg/kg) administered over 10min followed by a maintenance dose in group B. The sedation was titrated to achieve Houpt's overall behavior score of 4/5. The primary outcome measure was the successful completion of treatment. Secondary outcome measures were vital signs, quality of sedation, time need for the procedure, recovery time, intra-operative and post-operative adverse sequelae. Results showed that both of the regimens were similar in efficacy, safety and recovery profile. Also, the required dose of dexmedetomidine and the need for rescue boluses was similar in both of the study groups. Dexmedetomidine either alone or in combination with ketamine proved to be a safe and efficacious agent for paediatric dental sedation. No beneficial evidence of adding ketamine was observed.

Persistent Testosterone Suppression After Cessation of Androgen Deprivation Therapy for Localized Prostate Cancer

ABSTRACT Introduction ADT plays a fundamental role in the treatment of localized prostate cancer. However, there is limited data regarding testosterone recovery in men who have received ADT for prostate cancer. Identification of T recovery profiles associated with ADTs will facilitate personalization of ADT regimens and guide future treatment strategies to minimize the risk of T deficiency in patients with prostate cancer. Objective Temporary use of Androgen Deprivation Therapy (ADT) is a cornerstone in the treatment of localized prostate cancer. However, the ability for testosterone to recover after ADT is not well understood. The aim of this study was to investigate testosterone recovery in men with prostate cancer following varying ADT modalities and treatment durations. Methods A global federated health research network (TriNetX) was used to identify men with a diagnosis of prostate cancer who underwent temporary use of ADT. Three cohorts were identified: Men who received LHRH antagonists, LHRH agonists, and men who received combined ADT (LHRH agonist and antiandrogens). Further stratification was based on treatment duration of 6 or 18 months to compare T recovery profiles at follow up periods of 2 and 5 years. Results A total of 17,884 men received LHRH agonists alone, 12,767 men received combined ADT, and 628 men received LHRH antagonist therapy alone. Eugondal mean baseline T level (&amp;gt;300 ng/dL) prior to starting ADT was an inclusion criterion for all men. Five years after ADT cessation, 36% of patients who received LHRH agonists recovered eugondal T levels, 26% recovered after LHRH antagonist therapy, and 36.8% recovered after combined ADT. Overall, more than half of men who received ADT failed to recover eugondal T levels even 5 years after treatment cessation. Conclusions Five years after ADT cessation, incomplete testosterone recovery persists in more than 50% of men. Testosterone deficiency will lead to metabolically adverse changes in body composition, increased insulin resistance, impaired bone health, and poor quality of life and needs to be evaluated even after cessation of ADT. Disclosure No

Assessment of Intraoperative Hemodynamics and Recovery Characteristics in Pediatric Patients Receiving Buprenorphine and Propofol Anesthesia for Cleft Palate Surgery: A Prospective Observational Study.

Children with cleft palate are usually operated on before 18 months of age. Cleft palate surgery demands stable hemodynamic parameters, a bloodless surgical field, and an awake and pain-free child after surgery. We aimed to study the anesthesia technique using buprenorphine and propofol for cleft palate surgery. The design involves prospective observational study. The study was conducted at a tertiary care hospital. After the Institutional Ethics Committee approval, 42 patients aged 6 months to 12 years undergoing cleft palate surgery were enrolled. Anesthesia induction commenced with sevoflurane or propofol 3 mg.kg-1. After intubation, buprenorphine 3 μg.kg-1 was given, and propofol infusion was started at 2-8 mg.kg-1.h-1. Hemodynamic parameters, awakening time, and surgeon's satisfaction score were noted. After extubation, pain score, emergence agitation (EA) score, sedation score, recovery score, and adverse events were noted. All statistical analyses were performed using the 20.0 version of the Statistical Package for the Social Science (SPSS) software program. Continuous data were summarized as mean and standard deviation, and were analyzed using a two-sided Student's unpaired t-test. Categorical data were represented using frequencies and proportions. The single dose of buprenorphine with propofol infusion started immediately postintubation causes a significant decrease in heart rate after 1 h. This contributed to a favorable operative field, increasing the surgeon's satisfaction score. In the recovery room, patients were essentially pain-free till 2.5 h after surgery, with only one patient requiring rescue analgesia. Furthermore, 90% of patients showed a smooth and calm recovery with no EA. The Steward's recovery score remained high throughout without any complication. In cleft palate surgeries, a single-dose buprenorphine 3 μg.kg-1 and propofol maintenance infusion 2-8 mg.kg-1.h-1 were effective in maintaining hemodynamic parameters and a bloodless surgical field and managing postoperative pain with a good recovery profile.

Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary.

BackgroundDexmedetomidine is currently off-label for use in pediatric clinical care worldwide. Nevertheless, it is frequently prescribed to pediatric patients as premedication prior to induction of anesthesia or for procedural sedation. There is ample literature on the pharmacokinetics, efficacy and safety of dexmedetomidine in this vulnerable patient population, but there is a general lack of consensus on dosing. In this project, we aimed to use the standardized workflow of the Dutch Pediatric Formulary to establish best evidence-based pediatric dosing guidelines for dexmedetomidine as premedication and for procedural sedation.MethodThe available literature on dexmedetomidine in pediatrics was reviewed in order to address the following three questions: (1) What is the right dose? (2) What is known about efficacy? (3) What is known about safety? Relevant literature was compiled into a risk–benefit analysis document. A team of clinical experts critically appraised the analysis and the proposed dosing recommendations.ResultsDexmedetomidine is most commonly administered via the intravenous or intranasal route. Clearance is age dependent, warranting higher doses in infants to reach similar exposure as in adults. Dexmedetomidine use results in satisfactory sedation at parent separation, adequate sedation and a favorable recovery profile. The safety profile is good and comparable to adults, with dose-related hemodynamic effects.ConclusionFollowing the structured approach of the Dutch Pediatric Formulary, best evidence-based dosing recommendations were proposed for dexmedetomidine, used as premedication prior to induction of anesthesia (intranasal dose) and for procedural sedation (intranasal and intravenous dose) in pediatric patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-022-00498-y.

536 Objective Quantification of Hypertrophic Scar and Donor Scar between 2 to 7 months Post-burn Injury

IntroductionVery few objective scar evaluations have been conducted with the burn survivor population, which limits our knowledge of the clinical recovery profile of hypertrophic scars (HSc) and donor site scars (D), thus having an impact on rehabilitation intervention and treatment prioritization. The purpose of this study was to prospectively quantify the thickness, pliability, erythema and pigmentation of post-burn HSc, donor sites (normal scar) and normal skin in different anatomical locations between 2 and 7 months post-burn using objective instrumentation. A secondary objective was to compare this data with anatomic-specific normative data using the same objective instrumentation.MethodsSkin characteristics of HSc, D and N in 44 burn survivors were measured at 2, 3, 4, 5, 6 and 7 months post-burn using validated instrumentation: high-frequency ultrasound for thickness, Cutometer® to measure pliability and Mexameter® to measure erythema and pigmentation. Up to five sites were assessed on the same participant if their scar was located on the upper extremity (UE), lower extremity (LE) and trunk. A mixed model two-way analysis of variance was used to investigate the differences in means between sites at each time point and between time points at each site.ResultsThe results revealed that HSc sites were thicker than D and N at all time points and UE and trunk HSc were thicker than LE HSc at 7 months post-burn, pliability of trunk HSc did not improve over time, and UE HSc was more erythematous at 7 months compared to other anatomical sites whereas D erythema decreases from 2 to 7 months.ConclusionsScar management treatments should prioritize the UE and trunk sites which developed HSc during the first two months post-burn and continues to vary significantly from normal scar and normal skin at 7 months. Furthermore, these results provide preliminary evidence that the recovery profile of HSc varies at different anatomical sites and that thickness is the characteristic that distinguishes HSc from normal scar and normal skin.

Safety and efficacy of ketamine-dexmedetomidine combination versus dexmedetomidine alone in cirrhotic patients undergoing upper gastrointestinal endoscopy: a prospective controlled clinical trial

BackgroundPatients with liver cirrhosis commonly undergo diagnostic and/or therapeutic upper gastrointestinal endoscopy (UGIE). These fragile patients are at increased risk to develop complications as most sedative drugs are metabolized by the liver.This prospective, randomized controlled trial was performed to compare sedo-analgesia with ketamine-dexmedetomidine combination (KD1) (n = 35) versus dexmedetomidine alone (D2) (n = 35) in cirrhotic patients undergoing UGIE.ResultsUGIE could be performed effectively and safely with the KD1 (n = 35) group compared with the D2 group as no significant change in hemodynamics (HR and MBP) and O2 saturation (SPO2) from baseline values (P value > 0.05) while the D2 group revealed a statistically significant drop in hemodynamic parameters when compared with the KD1 group (P value < 0.001).Also, the induction time was statistically significantly lower in the KD1 group (3.9 ± 0.9 min) compared to the D2 group (5.2 ± 1.1min) (P value < 0.05).Recovery time was statistically significant faster in the KD1 group (4.5 ± 1 min) versus the D2 group (6.1 ± 1.6 min) with P value < 0.05.Endoscopic procedure was highly effective in KD1 (100%) compared with D2 (71.4%) with P value < 0.001.Supplementary fentanyl was given to 10 patients (28.6%) in the D2 group versus 0% in the KD1 group (P value < 0.001).Regarding post-operative adverse effects, there was statistically significant discomfort in D2 (28.6%) compared with KD1 (5.7%) with P value = 0.02. Also, gagging was statistically significant in D2 (22.9%) compared with KD1 (2.9%) with P value = 0.03.ConclusionsThe ketamine-dexmedetomidine sedo-analgesia group is highly effective than the dexmedetomidine-alone group in UGIE procedures with rapid induction time, good hemodynamic stability good recovery profile with less post-operative adverse effects.Trial registeration1. IRB approval: 5 December 2016(Chairperson of Institutional Review Board of Ethics committee of Qena University Hospitals Prof. Ahmed Abuelyosr). The committee reference number is not applicable. 2. This study is registered in the Australian Newzeland Clinical Trial Registry (ANZCTR) at the number 12615000367549. Trial Id: ACTRN12615000367549, universal trial number(UTN): U1111-1165-6212.