SAB Group Research Articles

Factors associated with early and late Staphylococcus aureus bacteraemia after first cardiac implantable electronic device implantation a Danish nationwide cohort study

Abstract Background Staphylococcus aureus bacteraemia (SAB) is a serious condition with high morbidity and mortality. Patients with a cardiac implantable electronic device (CIED) and SAB carries a risk of up to 50 % for device related infection. Yet, little is known about risk factors for early and late SAB in CIED patients in real-world clinical practice. Purpose We aimed to identify risk factors associated with first-time early and late SAB following de novo CIED implantation among adult Danish patients. Methods Using the Danish Pacemaker and ICD Register, we identified all Danish patients aged 18 to 99 years with a first CIED implantation between 2000 and 2020. The primary outcome of first-time post-CIED implantation SAB was identified from The National Danish Staphylococcus Aureus Bacteriemia Database. Early SAB was defined as SAB ≤ 6 months from CIED implantation. Late SAB was defined as first-time SAB after CIED, occurring > 6 months from CIED implantation. Multivariable Cox regression with backward elimination was used to identify factors associated with increased risk of developing early and late SAB. Age, sex, device type, implantation year, preexisting co-morbidity, procedure related factors and prior surgery (thoracic, abdominal, orthopedic, gynecologic, or urologic) was evaluated. Statistically significant variables were fitted to the final models to obtain hazard ratios with 95% confidence intervals. Results We identified 87,216 patients with first-time CIED implantation within the study period: PM n = 66,151 (75.8%); Implantable Cardioverter Defibrillator (ICD) n = 13,498 (15.5%); Cardiac resynchronization therapy PM (CRT-P) n = 3,491 (4.0 %); Cardiac resynchronization therapy with defibrillator (CRT-D) n = 4,076 (4.7 %). Median age across the population was 75 years (IQR 66-82) and 62.6% were males. Median time to SAB in the early SAB group was 46 days (IQR 18-105) and 2,9 years (IQR 1.5-5.1) in the late SAB group. Post implantation SAB was observed in 1,399 (1.6%) patients; with 363 (25.9%) early SAB events and 1,036 (74.1%) late SAB events. Factors associated with early SAB included previous SAB, renal dialysis, COPD, surgery 1 year prior to CIED implantation, liver disease, diabetes, and congestive heart failure (Figure 1). Male sex, increasing age, previous SAB, congestive heart failure, aortic valve disease, diabetes, renal dialysis, COPD, cancer, liver disease and the use of systemic corticosteroids were associated with an increased risk of late SAB. Conclusions Renal dialysis, previous SAB, diabetes, congestive heart failure, COPD and liver disease were associated with an increased risk of both early and late SAB. Increasing age, male sex, aortic valve disease and cancer were associated with an increased risk of late SAB, while surgery within 1 year prior to CIED implantation was associated with early SAB. Most of the identified factors were non-modifiable and comparable to known risk factors for SAB in non-CIED patients.Figure 1

Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A Prospective, Randomized, Controlled Trial.

Background Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS). Methods We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0–12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group (P < 0.001), and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups (P=0.813). At 12–24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group (P < 0.001), and no great diversity in sufentanil consumption was found between the RIB and ESP groups (P=0.589). No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24–48 hours (P=0.192). At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group ((P < 0.05) for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients ((P < 0.05) for all contrasts). At 24 hours after surgery, a significant difference in IL-1β and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block ((P < 0.05) for all contrasts). However, no great diversities were observed in IL-1β, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively ((P < 0.05) for all comparisons). Conclusion The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.

1060. Risk Factors for Recurrent Staphylococcus aureus Bacteremia

BackgroundRecurrent Staphylococcus aureus bacteremia (Re-SAB) occurs in 2–17% of patients with SAB within 3–12 months after resolution of the first episode. The risk factors for Re-SAB are incompletely understood.MethodsRe-SAB was defined as a second episode of SAB after the resolution of the first episode occurring at least 14 days from the date of the last positive blood culture of the first episode. Using the SAB Group Prospective Cohort Study (SABG-PCS) data between January 2008 and May 2015, patients with Re-SAB were selected and compared with those without it. Pulsed-field gel electrophoresis (PFGE) was done for the clinical isolates from the Re-SAB group, and spa typing was for those from both groups. Baseline sera from patients with Re-SAB and age/race/gender matched (1:1) control subjects with SAB but without Recurrence underwent Luminex multiplex cytokine array.ResultsSeventy patients experienced Re-SAB (9.3%) and 686 SAB patients did not. In the Re-SAB group, 156 episodes of SAB were observed. Median time to Re-SAB was 147.5d (IQR, 76–358). Among 65 PFGE-analyzed pairs of isolates from the first and the subsequent episodes, the time to Re-SAB of <300 days was more commonly found in the PFGE-identical pairs than in the PFGE-different pairs (75.6% vs. 33.8%, P = 0.001). In the comparison of clinical factors between 56 Re-SAB patients with available data and 686 without Re-SAB, African American race, dialysis dependence, the presence of foreign body, persistent bacteremia, metastatic abscess formation, and methicillin-resistant S. aureus (MRSA) were more frequently observed in patients with Re-SAB. In a multivariate analysis to identify risk factors for Re-SAB, African American race, dialysis dependence, metastatic abscess formation, and MRSA were independent risk factors. The distribution of spa types between the two group was presented in Figure 1.ConclusionRe-SAB involves a combination of multiple factors of host, microbe, and treatment. Further laboratory investigation for any determinants in host and microbe is required. Disclosures V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.

Impact of the Ultrasound-Guided Serratus Anterior Plane Block on Post-Mastectomy Pain: A Randomised Clinical Study

A variety of methods, including neuraxial and regional blocks, have been used to manage post-mastectomy pain. This study evaluates the effect of serratus anterior plane block on acute pain after mastectomy. A total of 60 patients who were candidates for mastectomy under general anaesthesia were divided in this trial into two groups. After entering the recovery room, the first-experimental-group (SAB) underwent the ultrasound-guided serratus anterior block, but the second-control-group (CTL) received no block intervention. An intravenous patient-controlled analgesia (PCA) device was used to deliver fentanyl in both groups. Using the Visual Analog Scale (VAS), the patients' pain was assessed at intervals of 1, 6, 12 and 24 hours after entering the recovery room. Intravenous acetaminophen was administered as a rescue analgesic if the pain exceeded 3 on the VAS. A total amount of fentanyl consumed, the time to first PCA request, a total amount of acetaminophen consumption and possible adverse effects were evaluated. The pain scores assessed at the time intervals were not significantly different between the two groups (p>0.5). The total consumption of fentanyl was significantly lower in the SAB group than in the CTL group (p=0.0001). Duration of the time to first PCA request was remarkably longer in the SAB group than in the CTL group (p=0.0001). The total amount of acetaminophen consumed was notably higher in the CTL group than in the SAB group (p=0.001). None of the patients experienced side effects. Undertaking serratus anterior block following mastectomy can reduce pain scores and lower opioid usage.

LASER THERAPY AND ALPHA LIPOIC ACID IN THE TREATMENT OF ORAL BURNING THROUGH THE ANALYSIS OF TUMOR NECROSIS FACTOR ALPHA

To determine the effectiveness of low level laser therapy (LLLT) and alpha lipoic acid (ALA) in the treatment of oral burning syndrome (SAB) and secondary oral burning (SOB) through evaluation of sialometry at rest, symptomatology and salivary levels of TNF-α. 52 patients were randomized into 5 groups: SAB/laser (n=10), SAB/AAL (n=5), ABS/laser (n=15), ABS/AAL (n=14) and control (n=8). The symptomatology and sialometry at rest were compared before and after treatment, and the collected saliva was stored until analysis of TNF-α levels. Both treatments were effective in reducing symptoms of SAB and SOB, being this reduction associated with the increase of salivary flow only in SAB group. Comparing treatments, LTBI was more effective in reducing the symptoms than AAL. No differences were observed in TNF-α levels between the studied conditions and the control group, with no significant changes after treatments. The results of this study suggest that LTBI and AAL are effective therapies in reducing the symptoms of oral burning, with LTBI being more effective than AAL. In this sample, TNF-α levels were not associated with symptoms of oral burning.

Effects of heart rate variability biofeedback on cardiovascular responses and autonomic sympathovagal modulation following stressor tasks in prehypertensives.

Autonomic dysfunction is implicated in prehypertension, and previous studies have suggested that therapies that improve modulation of sympathovagal balance, such as biofeedback and slow abdominal breathing, are effective in patients with prehypertension at rest. However, considering that psychophysiological stressors may be associated with greater cardiovascular risk in prehypertensives, it is important to investigate whether heart rate variability biofeedback (HRV-BF) results in equivalent effects on autonomic cardiovascular responses control during stressful conditions in prehypertensives. A total of 32 college students with prehypertension were enrolled and randomly assigned to HRV-BF (n=12), slow abdominal breathing (SAB, n=10) or no treatment (control, n=10) groups. Then, a training experiment consisting of 15 sessions was employed to compare the effect of each intervention on the following cardiovascular response indicators before and after intervention: heart rate (HR); heart rate variability (HRV) components; blood volume pulse amplitude (BVPamp); galvanic skin response; respiration rate (RSP); and blood pressure. In addition, the cold pressor test and the mental arithmetic challenge test were also performed over two successive days before and after the invention as well as after 3 months of follow-up. A significant decrease in HR and RSP and a significant increase in BVPamp were observed after the HRV-BF intervention (P<0.001). For the HRV analysis, HRV-BF significantly reduced the ratio of low-frequency power to high-frequency power (the LF/HF ratio, P<0.001) and increased the normalized high-frequency power (HFnm) (P<0.001) during the stress tests, and an added benefit over SAB by improving HRV was also observed. In the 3-month follow-up study, similar effects on RSP, BVPamp, LF/HF and HFnm were observed in the HRV-BF group compared with the SAB group. HRV-BF training contributes to the beneficial effect of reducing the stress-related cardiovascular response in prehypertensives by improving autonomic sympathovagal modulation.

Effects of salvianolic-acid B on the p38MAPK signaling pathway and its transcriptional factor induced by transforming growth factor b1 in activated rat hepatic stellate cells

To investigate the effects of Salvianolic-acid B on p38MAPK signaling pathway and its transcriptional factor activated by Transforming growth factor b1 in rat hepatic stellate cells. Hepatic stellate cells were isolated from normal rat by in situ perfusion and Nycodenz density-gradient centrifugation method.TGFb1 (10 ng/ml), PD98059(50 mumol/L), SB203580(10 mumol/L) and SA-B (10-6 mol/L) were directly added to the medium of the isolated HSCs. Groups: (1)The detection of total p38, MKK3/6, MEF2A and MEF2C induced by TGFb1 in HSC: include control group, SA-B group, SA-B+TGFb1 group and TGFb1 group. (2)The detection of the phosphorylation of p38, MKK3/6 and a-SMA induced by TGFb1 in HSC: include control group, SA-B group, SA-B+TGFb1 group, TGFb1 group, PD98059 group, PD98059+SA-B group, PD98059+TGFb1 group and SA-B+PD98059+TGFb1 group. (3)The effects of SA-B on activity of MEF2 reporter and collagen a 1(I) reporter induced by TGFb1 in HSC: include mt group, wt group, TGFb1 group, SA-B+TGFb1 group, SA-B group, SB203580+TGFb1 group and SB203580 group. Total and phosphorylated p38 and MKK3/6, MEF2A, MEF2C and a-SMA were assayed by Western blot. HSCs were transfected with either MEF2 or collagen a1(I) luciferase reporter gene by Lipofectamine 2000 transfection method, Cellular extracts were assayed for both MEF2 and collagen a1(I) luciferase activities. Comparisons between groups were performed with Student-Newman-Keuls test. The relative expression level of the phosphorylation of p38 of SA-B group is 0.33+/-0.05,obviously lower than control group(q=7.08, P less than 0.01); SA-B+TGFb1 group is 0.46+/-0.04, obviously lower than TGF b1 group(q=10.45, P less than 0.01); The relative expression level of the phosphorylation of MKK3/6 of SA-B group is 0.11+/-0.07, obviously lower than control group(q=3.944, P less than 0.05); SA-B+TGF b1 group is 0.28+/-0.07, obviously lower than TGFb1 group (q=7.91, P less than 0.01); The relative luciferase activity of MEF2 reporter of SA-B+TGFb1 group and SB203580+TGF b1 group is 2.93+/-0.09 and 2.50+/-0.05 respectively, both obviously lower than TGFb1 group(q=35.35 and 37.2, P less than 0.01); The relative expression level of MEF2C and MEF2A of SA-B group is 15.82+/-0.97 and 13.00+/-0.40 respectively, obviously lower than control group(q is 5.18 and 13.32, both P less than 0.01); SA-B+TGF b1 group is 13.40+/-0.72 and 20.47+/-0.83 respectively, obviously lower than TGFb1 group(q is 43.93 and 12.52,both P less than 0.01); The relative expression level of a-SMA of SA-B+TGFb1 group is 8.76+/-0.44, obviously lower than TGFb1 group(q=20.35, P less than 0.01); SA-B+SB203580+TGFb1 group is only 3.57+/-0.49, obviously lower than TGFb1 group(q=39.78, P less than 0.01); The relative luciferase activity of collagen a1(I) reporter of SA-B+TGF b1 group and SB203580+TGFb1 group is 1.61+/-0.05 and 1.42+/-0.07 respectively, obviously lower than TGFb1 group(q=26.4 and 27.62, both P less than 0.01). SA-B could inhibit activation of HSC induced by TGFb1 through inhibiting p38MAPK signaling pathway in hepatic stellate cells.

Effectiveness of the biophysical barriers on the peridural fibrosis of a postlaminectomy rat model: An experimental research

Long term results after surgical treatment of disc herniation have shown that epidural and/or peridural fibrosis formed during the healing process after surgical intervention. We conducted this experimental study to evaluation of the effectiveness of the bioresorbable barriers (ADCON-L and Seprafilm(®) Adhesion Barrier) on formation of the peridural fibrosis in rat model performed laminectomy. Thirty-two male Wistar albino rats 250-350g body weight were distributed into three groups (CONTROL, AL group received ADCON-L; SAB group received Seprafilm(®) Adhesion Barrier). A dorsal laminectomy at L3, L4, L5 was performed, and then except those of the CONTROL group, the experimental material was left on the dura mater. Six weeks later spinal column of all rats was totally removed between the T10 and L5 levels, and peridural fibrosis, and dural adhesions were evaluated histologically and graded. The results were compared statistically by using the chi-square (χ(2)) test. Also three random regions were examined, and the fibroblast cells were counted. The fibroblast count results were statistically analysed by using the One-Way ANOVA test. The variation of histopathological grades was statistically significant regarding the comparison of the all groups obtained from the χ(2) test (χ(2)=16.40; p=0.003). However, the variation in the mean values of the fibroblast count result was not statistically significant obtained from the One-Way ANOVA test (F=2.114; p>0.05). Our study results suggest that Seprafilm(®) Adhesion Barrier and ADCON-L can be effective in reducing the prevalence of the postoperative peridural adhesions in rat laminectomy model. On the other hand, the fibroblast densities of the experimental groups were not different between groups. So, we could say that these materials can act as a foreign body in long term period in rat.

Randomised Comparison of General Anaesthesia &amp; Subarachnoid Block for Caesarean Delivary in Pregnancies Complicated by Eclampsia

General anaesthesia &amp; subaracnoid block were used randomly in women with eclampsia who required caesarian delivery to evaluate the maternal and foetal effects of the two anaesthetic methods. The haemodynamic parameters, level of consciousness of the mothers and APGAR scores of the neonates were assessed. A total 60 women with eclampsia underwent caesarean section were allocated randomly received either of the techniques. Both the techniques provided good quality anaesthesia. At arrival in OT, there was no significant difference of MAP between two groups. But following induction there developed significant difference between two groups &amp; within the same group. There was no significant difference of neurological status between two groups within 24 hours after operation. There were significant difference of Apgar scores in 1 min. after birth &amp; at 5 min. no significant difference were found between the two groups. Out of 30 infants of GA group II had to resuscitate with Ambu-mask ventilation &amp; 6 babies had to sent special care unit. From SAB group 2 infants received resuscitation &amp; one baby had to sent special care unit. In the context of Bangladesh, General anaesthesia as well as Subaracnoid block are equally acceptable for LUCS in eclamptic mothers, if steps are taken to ensure a careful approach to either method. Journal of BSA, Vol. 19, No. 1 &amp; 2, 2006 p.44-50

한우 복강 및 피하지방 감소 다클론 항체가 반추위 발효패턴 및 혈액 대사물질에 미치는 영향

본 연구는 반추위 캐뉼라가 장착된 거세한우 16두 (<TEX>$626.2\pm47.72$</TEX> kg)를 이용하여 한우 복강 및 피하지방 감소 항체를 생체 주사 처리 시 사료섭취량, 반추위 발효패턴 및 혈액 대사물질 등 영양생리대사에 미치는 영향을 조사하고자 실시하였다. Choi 등(2008)에서 개발된 한우복강(AAb) 및 피하지방 감소 항체(SAb)을 피하 주사하였을 때, 주사 후 2주차에서 수치적으로 체중의 감소가 발생했으나, 무처리구 및 비면역항체처리구에서도 체중의 감소가 발생해 항체 주사에 의한 처리의 영향이라기 보다는 다른 요인(혈액채취 등)에 의한 스트레스에서 기인하는 것으로 판단된다. 항체 주사 처리 시 반추위 pH 패턴, 휘발성 지방산 및 암모니아 농도에는 유의적 변화(P > 0.05)가 나타나지 않았고, 그 수준 또한 일반적인 수준 범위에서 벗어나지 않았다. 혈액 대사물질의 변화에서는 항체 주사 처리 전 BUN 농도에서 무처리구 기준, AAb 처리구는 낮게, 반면에 SAb 처리구는 높게 나타났으나(P < 0.05), 오히려 항체 주사 처리 후에서 유의적 차이가 나타나지 않았다(P > 0.05). 혈액 내 glucose 농도 역시 항체 주사 처리 전 비면역혈청처리구에서만 유의적 차이를 보였고(P < 0.05), 항체 주사 처리 후에서는 처리구별 유의적 영향은 없었다. 혈액 내 중성지방의 농도는 항체 주사 처리에 의한 유의적 차이는 나타나지 않았고, 그 농도도 11.4~19.9 mg/<TEX>$d{\ell}$</TEX>로 일반적인 농후사료 위주의 사료 급여시 거세한우의 혈액 내 중성지방의 수준으로 판단되었다. 따라서, 이상의 결과를 볼 때, 본 연구에서 이용된 AAb 및 SAb는 in vivo 영양생리대사에 부정적 영향을 미치지 않는 안전한 항체로 사료된다. Sixteen ruminally cannulated Korean native steers (Hanwoo; <TEX>$626.2\pm47.72$</TEX> kg) were used to investigate the effects of polyclonal antibodies against abdominal (AAb) and subcutaneous adipocyte membrane proteins (SAb) on ruminal fermentation patterns and blood metabolites. The body weight (BW) of Hanwoo was decreased 2-weeks after AAb and SAb injection, BW reduction was also observed in control and non-immunized serum groups, indicating that stress induced by other factors (e.g. blood sampling etc.) rather than antibodies injection may affect the BW reduction. Antibodies treatment did not affect (P > 0.05) rumen pH, volatile fatty acids and ammonia-N concentration. The ranges were similar with typical ranges of those in Hanwoo. Compared with control, blood urea N concentration was decreased in AAb group and increased (P < 0.05) in SAb group before antibodies treatment. However, none of the groups were significantly (P > 0.05) affected at 2- or 4-weeks after the treatment. Concentration of plasma glucose in the non-immunized serum group was significantly higher (P < 0.05) than the other groups at 0-week after treatment. However, antibodies treatment did not affect the concentration of plasma glucose. Concentration of plasma triglyceride showed no difference (P > 0.05) between the groups and ranged from 11.4 to 19.9 mg/dl, which is the perfect range of plasma triglyceride of Hanwoo fed concentrate based diets. In conclusion, these results may indicate that the present AAb and SAb have safety in nutritional physiological metabolism in Hanwoo. Further study on in vivo fat reduction of the antibodies against abdominal and subcutaneous adipocytes PMPs of Hanwoo is required for inedible fat-reduced high quality beef production.

Clinical Indications for Preimplantation Genetic Diagnosis (PGD)—A Lab Perspective and Comparison of the Type of Abnormalities Based on the Clinical Indication

To review the indications used in clinical practice to request PGD and to compare the rate of abnormalities observed by varying clinical indication. Retrospective analysis. Test requisition forms accompanying the PGD samples were reviewed for 303 cases received in the laboratory for 5 probe or 10 probe analysis. Blastomere samples of 2585 embryos from these 303 cases were analyzed for aneuploidy screen using either a 5-probe or a 10 probe fluorescence in situ hybridization (FISH) panel. The 5-probe panel screens for aneuploidy of chromosomes 13, 18, 21, X, and Y using probes RB1 at 13q14, D18Z1 at 18cen, D21S259/D21S341/D21S342 at 21q22.13-q22.2, DXZ1 at Xcen, and DYZ3 at Ycen (Vysis MultiVysion− PGT). The 10-probe set additionally screens for aneuploidy of chromosomes 8, 9, 15, 16, and 22 using probes D8Z2 at 8p11.1-q11.1, CEP9 at 9p11-q11, D15Z4 at 15p11.1-q11.1, D16Z3 at 16q11.2, and BCR at 22q11.2 (Vysis MultiVysion− Custom 5A). The most common referral indication for PGD was advanced maternal age (AMA-group). 62.2 % of cases received in our laboratory for analysis were for patients over 35 years of age. Recurrent miscarriages (SAB group) accounted for only 2.6 % of cases. Other indications (Other group), including male factor infertility, poor oocyte quality, repeated IVF failure, and family history of chromosome abnormalities was a referral indication in 1.6 % cases. Gender identification (Gender group) was specifically requested in about 5.9 % of cases, some of which included family history of X-linked disorders. 27.4 % of cases, our second biggest group were cases referred for aneuploidy screen (AS group) without another specific indication. Most of these cases were patients less than 35 years as based on the date of birth provided on the test requisition. The rate of abnormalities observed varied by the indication. Comparing the AMA group to AS group, the rate of abnormalities for complex and monosomic abnormalities were very similar at 63.2% and 61.7% respectively. The rate of abnormalities for complex and monosomic abnormalities were also very similar (statistically no significant difference was noted, p ≤ 1) in these two groups; but a statistically significant difference was noted for the trisomic and sex chromosome abnormalities. The rate of trisomic and sex chromosome abnormalities was 14.9 % and 8 % respectively in the AMA group as compared to 10.8 % and 6 % in the AS group (p ≤ 0.05). The rate of abnormality observed in the recurrent SAB group of 61.5 % was also similar to the AMA group (p ≤ 1). The rate of abnormality in the Other group was higher at 72% higher, but this was not found to be statistically significant (p ≤ 0.10). In contrast, the rate of abnormalities seen in the gender identification category was only 54 %. PGD has been increasingly used in infertility practices to improve the overall outcome and success rate. As expected, AMA cases are associated with increased incidence of aneuploidy. Therefore, offering PGD to this group of patients is most appropriate. Patients undergoing IVF for other indications may also benefit from aneuploidy screening.

A retrospective examination of regional plus general anesthesia in children undergoing open heart surgery.

The use of regional anesthesia in combination with general anesthesia for children undergoing cardiac surgery is receiving increasing attention from clinicians. The addition of regional anesthesia may improve clinical outcomes and decrease costs as a result of the reduced need for postoperative mechanical ventilation. The goal of this retrospective chart review was to evaluate whether spinal anesthesia (SAB) or epidural anesthesia (EPID) in combination with general anesthesia was associated with circulatory stability, satisfactory postoperative sedation/analgesia, and a low incidence of adverse effects. The medical records of 50 consecutive children having open heart surgery with SAB or EPID and general anesthesia between September 1996 and December 1997 were reviewed. We found no significant differences in the incidence of clinically significant changes in vital signs, oxygen desaturation, hypercarbia, or vomiting. Patients in the SAB group received significantly more sedative/analgesic interventions than those in the EPID group.

The impact of the homocysteine axis on first-trimester miscarriages

Objective: To evaluate if there is indeed a relationship between the three major components of the homocysteine axis and spontaneous miscarriages during early pregnancy.Study design: Sixty women—only 6 of whom were taking prenatal vitamins (PNV) presenting at the emergency room or clinic during the first trimester with either a complete miscarriage or blighted ovum were compared with 29 first-trimester controls from a private practice known to be taking daily multivitamins and 37 controls at 15–20 weeks of gestation from a primarily indigent population with unknown PNV status. All had serum samples evaluated. Homocysteine, folate, B12, progesterone, and β-hCG were determined in all samples by various forms of immunoassay. Resultant data were compared by Student’s t-test and regression and correlation analysis.Results: Both human chorionic gonadotropin (hCG) and progesterone (P <0.0001) were significantly decreased in the patients with miscarriage, compared with controls. Folate (0.0004) and homocysteine (0.0001) also were decreased. Significant correlations were noted in the controls for hCG and both folate and homocysteine (positive). In the patients with miscarriages, a correlation was noted between hCG and both B12 and progesterone (positive), as well as between B12 and homocysteine (negative). Only one patient in the SAB group had elevated homocysteine.Conclusions: The data suggest that spontaneous miscarriages are not related to circulating homocysteine but to the relative levels of folate, progesterone, and chorionic gonadotropin. These results affirm the need for PNV during early gestation, even before the normal first prenatal visit.

Regional anaesthetic technique and the incidence of tourniquet pain

The influence of regional anaesthetic technique on the incidence of lower extremity tourniquet pain was evaluated. We studied 60 patients undergoing orthopaedic procedures of the lower extremity with the use of a pneumatic tourniquet and anticipated inflation of 60 min or longer. Three different anaesthetic techniques were selected by random and draw; spinal anaesthesia (SAB) with plain 0.5% bupivacaine (15 mg) and 0.2 mg epinephrine added, lumbar epidural anaesthesia (EA) with 2% mepivacaine and 1:200,000 epinephrine added, and epidural anaesthesia (AEA) with the same solution alkalinized with bicarbonate. Onset and level of sensory blockade were determined by loss of painful sensation to pinprick. The incidence of tourniquet pain was determined at 15-min intervals or by patient complaint, by an observer unaware of group. Time to onset of pain, amount of treatment (i.v. fentanyl), and sensory level at the time of pain were determined. The SAB was compared with EA and AEA, and EA was compared with AEA. The SAB group was older. The sensory level achieved and duration of tourniquet inflation did not differ among groups. The incidence of tourniquet pain was lower with SAB than with EA and lower with AEA than with EA. There was no difference between SAB and AEA. This study demonstrated a lower incidence of tourniquet pain with spinal anaesthesia than with epidural anaesthesia to the same sensory level. However, this advantage is eliminated if the epidural anaesthetic was performed with an alkalinized local anaesthetic.

Enhanced ovarian steroid secretion before implantation in early human pregnancy.

Previous studies have compared ovarian steroid production in the luteal phase of nonconceptive and conceptive cycles. Some investigators reported higher preimplantational levels of progesterone in conceptive cycles vs. nonconceptive cycles, but other studies have found no differences. Many of these results were difficult to interpret because the studies included infertile women and/or women who received exogenous hormones. In this study we have characterized the profiles of gonadotropin secretion and ovarian steroid response during early pregnancy in a population of spontaneously ovulating women and compared them to those in nonconceptive cycles of recently fertile women. Blood samples were collected daily during the luteal phase from 24 women during 51 cycles of artificial insemination with donor semen. Cycles were segregated to those from women who had a successful term pregnancy (normal group) and those having an early spontaneous abortion (SAB group) and were also classified as nonconceptive or conceptive based on measurements of hCG. Serum LH and FSH did not show marked differences between nonconceptive and conceptive cycles in the periimplantation period in either the normal or SAB group. In the normal group, estradiol concentrations were significantly higher in conceptive cycles than in nonconceptive cycles beginning 6 days after the LH peak and continuing through the end of the cycle, while differences in progesterone concentrations bordered on or exceeded significance during the same time period. In the SAB group, preimplantation differences in pituitary gonadotropin and ovarian steroid secretion were not observed, whereas the postimplantation hCG concentrations in the SAB group were significantly lower than those in the normal group. It is reasoned that embryos with defective post-implantation hCG secretion may have had this defect before detection of hCG in serum, thus accounting for the lack of stimulation of steroid secretion in these pregnancies. These findings suggest that the enhanced ovarian steroid secretion in conceptive cycles may be due to a gonadotropic stimulus from the preimplantation embryo.

Recovery characteristics of three anaesthetic techniques for outpatient orthopaedic surgery

The goals of this study are to observe prospectively the perioperative recovery characteristics associated with general anaesthesia (GA), spinal anaesthesia (SAB), and epidural anaesthesia (EPID) in 200 patients scheduled for outpatient knee arthroscopy. Patients were observed from the time they entered the recovery room until they were discharged. Patients were contacted on postoperative days (POD) 1, 3, and 5. The EPID group had the quickest recovery times (125 ± 37 min, mean ± SD, ANOVA P < 0.01) compared with the GA group (165 ± 57 min) and SAB group (167 ± 51 min). Comparing the side effects of the three anaesthetic techniques, GA was associated with the highest incidence of nausea (27%) and vomiting (16%) on the day of surgery that persisted into the first postoperative day (nausea 41 % and vomiting 22%). There was no difference in the incidence of headache overall; however, SAB was associated with a 13% incidence of postdural puncture (PDP) headache that became apparent on POD 3. All the PDP headaches resolved with conservative therapy by the first postoperative week, except for two patients who required an epidural blood patch. The EPID group followed by the SAB and GA groups, had the highest incidence of backaches on POD 1 (respectively, 63%, 41% and 17%). By POD 3, the incidence of backache was not statistically different between groups. No specific treatment for backache was required. The ideal anaesthetic has not been developed, but our data suggests that an epidural technique is advantageous for knee arthroscopy in terms of a quick recovery and minimal adverse effects.

EFFECTS OF ANAESTHETIC TECHNIQUE ON DEEP VEIN THROMBOSIS: A Comparison of Subarachnoid and General Anaesthesia

Forty patients with fractured neck of femur were allocated randomly to undergo surgery under general anaesthesia (GA) or subarachnoid anaesthesia (SAB). After operation, the incidence of deep vein thrombosis (DVT), assessed by venography, was found to be 40% in the SAB group, which was significantly lower than the incidence (76.2%) in the GA group. These observations may account for the previously reported effect of SAB, in comparison with GA, in reducing early postoperative mortality in this category of patient.

COMPARISON OF THE EFFECTS OF SPINAL ANAESTHESIA AND GENERAL ANAESTHESIA ON POSTOPERATIVE OXYGENATION AND PERIOPERATIVE MORTALITY

One hundred patients presenting for surgical treatment of fractured neck of femur were allocated to receive either spinal (SAB) or general (GA) anaesthesia. Before operation, the mean PaO2 was 9.04 kPa. There was a significant decrease in PaO2 of 0.68 kPa in GA group at 1 h after operation, while blood-gas values were unchanged in SAB group. Eight patients (15.7%) in GA group and five patients (10.2%) in SAB group died within 4 weeks of surgery. The difference was not statistically significant.