Rate Saturation Research Articles

A quantitative multi-parameter mapping protocol standardized for clinical research in multiple sclerosis

Quantitative magnetic resonance imaging (qMRI) involves mapping microstructure in standardized units sensitive to histological properties and supplements conventional MRI, which relies on contrast weighted images where intensities have no biophysical meaning. While measuring tissue properties such as myelin, iron or water content is desired in a disease context, qMRI changes may typically reflect mixed influences from aging or pre-clinical degeneration. We used a fast multi-parameter mapping (MPM) protocol for clinical routine at 3T to reconstruct whole-brain quantitative maps of magnetization transfer saturation (MT), proton density (PD), longitudinal (R1), and transverse relaxation rate (R2*) with 1.6 mm isotropic resolution. We report reference MPM values from a healthy population with age and gender distributions typical of multiple sclerosis in whole brain white matter (WM), T2-weighted WM hyperintensities, cortical grey matter and deep grey matter regions and present post-processing optimizations including integration of lesions and normalization of PD maps against cerebrospinal fluid (CSF) for standardized research in multiple sclerosis (MS) and potentially also in related disorders. PD maps were affected by WM abnormalities in MS using WM calibration. The results acknowledge the impact of non-linear age effects on MPM and suggest using CSF calibration for future clinical application in MS.

Decreased cardio-respiratory information transfer is associated with deterioration and a poor prognosis in critically ill patients with sepsis.

Assessing illness severity in the ICU is crucial for early prediction of deterioration and prognosis. Traditional prognostic scores often treat organ systems separately, overlooking the body's interconnected nature. Network physiology offers a new approach to understanding these complex interactions. This study used the concept of transfer entropy (TE) to measure information flow between heart rate (HR), respiratory rate (RR), and capillary oxygen saturation (SpO2) in critically ill sepsis patients, hypothesizing that TE between these signals would correlate with disease outcome. The retrospective cohort study utilized the MIMIC III Clinical Database, including patients who met Sepsis-3 criteria on admission and had 30 minutes of continuous HR, RR, and SpO2 data. TE between the signals was calculated to create physiological network maps. Cox regression assessed the 48 relationship between cardiorespiratory network indices and both deterioration (SOFA score increase of ≥2 points at 48 hours) and 30-day mortality. Among 164 patients, higher information flow from SpO2 to HR [TE(SpO2→HR)] and reciprocal flow between HR and RR [TE(RR→HR) and TE(HR→RR)] were linked to reduced mortality, independent of age, mechanical ventilation, SOFA score, and comorbidity. Reductions in TE(HR → RR), TE(RR→HR), TE(SpO2→RR), and TE(SpO2→HR) were associated with increased risk of 48-hour deterioration. After adjustment for potential confounders, only TE(HR→RR) and TE(RR→HR) remained statistically significant. The study confirmed that physiological network mapping using routine signals in sepsis patients could indicate illness severity and that higher TE values were generally associated with improved outcomes. XXXX XXXX.

Comparing machine learning techniques for neonatal mortality prediction: insights from a modeling competition.

Predicting mortality risk in neonatal intensive care units (NICUs) is challenging due to complex, variable clinical and physiological data. Machine learning (ML) offers potential for more accurate risk stratification. To compare the performance of various ML models in predicting NICU mortality using a team-based modeling competition. We conducted a modeling competition with five neonatologist-led teams applying ML techniques-logistic regression, CatBoost, neural networks, random forest, and XGBoost-to a shared dataset from over 6,000 NICU admissions. The dataset included static demographic and clinical variables, alongside daily samples of heart rate and oxygen saturation. Each team developed models to predict mortality risk at baseline and within 7 days. Models were evaluated using the area under the receiver operator characteristic curve (AUC). Results were presented at a national meeting, where an audience poll ranked models before AUC results were revealed. The audience favored the most complex model (CNN) for real-world application, though logistic regression achieved the highest AUC on test data. Teams employed varied feature selection, tuning, and evaluation strategies. Logistic regression outperformed more complex models, highlighting the importance of selecting modeling methods based on data characteristics, interpretability, and expertise rather than model complexity alone. By demonstrating that model complexity does not necessarily equate to better predictive performance, this research encourages the careful selection of modeling approaches.

The Assessment of Muscle Strength and Cardiorespiratory Parameters Using Simple Tests in Older Adults With Recovery From Mild COVID-19.

To evaluate muscle strength and cardiorespiratory parameters, this study uses simple tests in older adults, including those who have and have not recovered from mild coronavirus disease 2019 (COVID-19). Eighty older adults (age≥60 years old) were divided into two groups: those without previous COVID-19 (control group, n=40) and those with recovery from mild COVID-19 (recovered group, n=40). Muscle strength was assessed using a handgrip strength test and the sit-to-stand test (STS10). Cardiorespiratory parameters were evaluated with a 1-minute sitto- stand (1-min STS) test and a 6-minute walk test (6MWT). Both groups had normal values for body mass index, blood pressure, heart rate, and pulse oxygen saturation. The recovered group showed significant differences in handgrip strength test (24.73±6.99 vs. 22.03±4.36, p=0.041) and duration for the STS10 (25.15±6.11 vs. 33.40±7.56, p<0.001) when compared to the control group. Furthermore, the recovered group had significantly decreased repetitions of a 1-min STS (31.38±4.89 vs. 21.25±3.64, p<0.001) and increased the rate of perceived exertion (RPE) (7.43±1.20 vs. 8.95±1.01, p=0.01) and leg fatigue (1.49±1.13 vs. 3.00±1.04, p=0.03) after performing a 1-min STS when compared with the control group. Moreover, the recovered group had also significantly decreased distances for the 6MWT (421.68±8.28 vs. 384.35±6.17, p<0.001) and increased the post-test RPE (7.63±1.37 vs. 12.05±1.63, p<0.001) and the post-test leg fatigue (1.71±0.88 vs. 5.28±0.91, p<0.001) compared with the control group. Older adults with recovery from mild COVID-19 reported reduced muscle strength and exercise tolerance when compared with older adults without COVID-19.

Run-and-tumble particle with saturating rates

Run-and-tumble particle with saturating rates

Cardiovascular Function and Autonomic Regulation in Urethane Anesthetized and Conscious Mice.

Urethane is widely used for its ability to induce prolonged anesthesia. Variability in previously reported cardiovascular parameters in murine models makes it challenging to definitively evaluate the cardiovascular effects of urethane anesthesia. We aimed to address these challenges, thereby advancing our understanding of urethane's effects on cardiovascular function in mice. In this study, we investigated how urethane anesthesia, with and without supplemental oxygen, impacts heart rate, arterial oxygen saturation (SpO2), blood pressure, and heart rate variability in mice. First, we conducted a literature review and found that data in mice was both limited and lacking in reproduction. Next, we conducted a series of physiological measurements to address gaps in the literature and subjected C57BL/6J mice to three conditions: 1) conscious, 2) urethane-anesthetized, and 3) urethane-anesthetized with supplemental oxygen. Blood pressure, heart rate, SpO2, and heart rate variability (via time, frequency, and M-curve analyses) were assessed. We observed an increase in heart rate with urethane anesthesia (p=0.012) compared to the conscious state. Urethane caused a decrease in heart rate variability which was independent of oxygen supplementation. Urethane anesthesia significantly reduced arterial blood pressure (p<0.001) with oxygen-supplemented mice remained hypotensive. Urethane decreased SpO2 (p=0.001), which was restored by oxygen supplementation (p<0.001). We did not observe sex effects of urethane anesthesia on blood pressure, heart rate, heart rate variability, or SpO2. Taken together, these results underscore the importance of a cautious approach when using urethane in mice, as urethane significantly impacts arterial blood pressure, heart rate, oxygen saturation, and heart rate variability.

An improved methodology for accelerated marine immersed corrosion testing of ship structural components

ABSTRACT Corrosion degradation is a prominent ageing mechanism in engineering structures (e.g. ships and offshore structures), leading to safety concerns and significant economic expenses. This study presents an improved methodology for indoor accelerated corrosion testing of structural components. The method involves controlling natural factors (oxygen saturation, temperature, salinity, and flow rate) to accelerate the corrosion in a controlled environment. The study uses small coupons, medium specimens, and stiffened plates made of steel with different thicknesses. Significant degradation acceleration was achieved compared to natural conditions (approx. twenty times faster). The mean corrosion equals 3.3 mm/year with a maximum 10% variation for different specimen sizes and thicknesses. A novel approach to account for the mass of corrosion products during periodical measurements was proposed and validated. The improved methodology offers an efficient and accurate way to simulate marine immersed corrosion, enabling further research on corrosion degradation behaviour and resistance in ship structures.

A novel nonlinear SAZIQHR epidemic transmission model: mathematical modeling, simulation, and optimal control

Abstract This study presents a seven-compartmental nonlinear epidemic model to explore the dynamics and control of the epidemic. The model extends the traditional susceptible-infected-recovered (SIR) framework by including additional compartments for aware, infodemic, hospitalized, and quarantined populations. It also incorporates three Holling type II saturated nonlinear incidence rates to better represent the disease transmission process. The ‘infodemic population’ refers to those spreading misinformation about the disease, its spread, control, and treatment. The study examines disease dynamics in the absence of a vaccine and identifies two key equilibria: the disease-free equilibrium (DFE) and the endemic equilibrium (EE). It is found that the DFE is locally asymptotically stable when the basic reproduction number ( R 0 ) is below one and becomes unstable when R 0 exceeds one. The model’s behavior at R 0 = 1 is analyzed using center manifold theory, revealing a forward bifurcation. Additionally, the existence of a positive endemic equilibrium is confirmed for R 0 &gt; 1 , with no backward bifurcation observed when R 0 ≤ 1 . The EE is also shown to be locally asymptotically stable when R 0 is greater than one. Furthermore, the study formulates and mathematically analyzes an optimal control problem. Finally, numerical simulations are presented to support the analytical results.

Effects of anodal transcranial direct current stimulation on intracranial compliance in the subacute phase of stroke

ObjectivesTranscranial direct current stimulation (tDCS) increases cerebral blood flow. This study evaluated the effects of anodal tDCS (A-tDCS) on intracranial compliance (ICC) in patients with subacute stroke using a non-invasive method. MethodsThis was a randomized, proof-of-concept, double-blind, pilot study. Patients with ischemic stroke of the middle cerebral artery (MCA) were divided into the following two groups: 1) A-tDCS in the motor cortex on the affected side for 30min at 2mA, and 2) sham tDCS in the motor cortex on the affected side. The primary outcomes were intracranial compliance (P2/P1 ratio and time-to-peak [TTP]) and ICC normalization after the intervention (P2/P1 ratio <1). Secondary outcomes were systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation. ResultsNo significant differences were observed in the P2/P1 ratio (P = 0.509) and TTP (P = 0.480) between the groups. However, the A-tDCS group was significantly associated with a normal P2/P1 ratio after intervention (B = 2.583; standard error [SE]: 1.277; P = 0.043; corrected for age and stroke severity). No significant associations were observed between the groups and systolic blood pressure (F = 0.16; P = 0.902), diastolic blood pressure (F = 0.18; P = 0.892), heart rate (F = 0.11; P = 0.950), or peripheral oxygen saturation (F = 0.21; P = 0.750). ConclusionICC morphology normalization was observed in the A-tDCS group. However, no differences were observed in the P2/P1 ratio, TTP, or hemodynamic variables between the groups. A sample size of 66 patients with ischemic stroke of the MCA can be estimated using the observed effect size and standard α = 5% and β = 20% for future trials. Furthermore, this will aid in conducting the necessary randomized trials targeting these populations.

Physics-based time-of-failure determination of rainfall-induced instability in lateritic soil slopes

Conventional time-of-failure estimated from slope surface displacement over time, ignores the crucial geotechnical and environmental causative factors that lead to slope instability. The instrumentation and monitoring are expensive, labour-intensive, and often not feasible for large number of hill slopes. This paper focuses on the physics-based determination of time-of-failure charts for laterite soil slopes prevalent in the Western Ghats of India, under rainfall infiltration. The finite element model was first validated by performing coupled flow deformation analysis of Kondavi soil cutting situated in the Ratnagiri district of Maharashtra, India. The soil samples were collected from the site for basic geotechnical characterisation in the laboratory. In addition, the soil water characteristics curve (SWCC) was determined using the filter paper method, and the unsaturated parameters were obtained using the van Genuchten model. Following the validation of numerical model with the failed Kondavi cutting, the factor of safety (FOS) and time-of-failure (TOF) were studied for varying rainfall intensity, and permeability of the soil. The FOS and TOF charts were then established for varying slope angles (30°, 45°, 60°), effective cohesion (10 kPa, 18 kPa, 25 kPa), effective friction angle (22°, 25°, 28°), water table depth (25 m, 28 m, 30 m, 35 m) and height of slope (15 m, 25 m, 35 m). Results indicate that if rainfall intensity is lower than soil permeability, TOF depends on both the intensity and duration of the rainfall. Higher rainfall intensity leads to a shorter time of failure, and vice versa. Conversely, when rainfall intensity exceeds soil permeability, TOF is determined by the duration of rainfall and the permeability of soil, as the rainfall infiltrates at the saturated permeability rate regardless of its intensity. It is also observed that friction is the dominant parameter for initial FOS, while cohesion is the dominant parameter for the TOF of a rainfall-induced landslide. Finally, charts are proposed that shall serve as a preliminary guide for the determination of the TOF for rainfall-induced instability in the lateritic soil slopes of India. The performance of the charts is further evaluated by comparing the observed and predicted TOF of two other failed laterite cuttings. The implications of these findings are profound, as the proposed TOF charts can be integrated into early warning systems, contributing towards improved disaster mitigation and preparedness with timely decision making for adequate management of landslide associated risks.

Continuous characterisation of exacerbation pathophysiology using wearable technologies in free-living outpatients with COPD: a prospective observational cohort study

The most recent exacerbation of COPD (ECOPD) classification criteria relies in part on changes in respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO2). Despite this paradigm shift, a thorough understanding of exacerbation patterns is still lacking, as is the identification of physiological exacerbation biomarkers. Using a convenience sampling approach, this prospective observational cohort study was conducted between February 2023 and January 2024. Continuous measurements of daytime/overnight respiratory (primary outcome), cardiovascular, autonomic, activity and sleep-related parameters were collected by a wearable biometric wristband and ring over 21 consecutive days in free-living outpatients experiencing and receiving treatment (≤3 days) for a current exacerbation from the home environment. The EXACT-PRO questionnaire served as the validated reference for daily symptom burden and to identify 'recovered' versus 'persistent worsening' participants. Unadjusted and adjusted (for age, sex, FEV1) linear mixed-effects models were fitted to estimate associations between each physiological parameter with daily EXACT-PRO score (points, pts), in all, 'recovered', and 'persistent worsening' participants. Results are presented as point estimates with 95% CIs. In 21 participants with COPD (43% female, mean age 66.8, BMI 27.7kg/m2, FEV1 36.3% predicted; 85.7% with GOLD 3-4 disease), significant associations in unadjusted models with daily EXACT-PRO score included RR variability (-1.45 [-2.84,-0.073] pts/breath/min) but not RR, daily step count (-0.56 [-0.82,-0.31] pts/1000 steps), and sleep efficiency (-0.12 [-0.20,-0.037] pts/%asleep). In 'recovered' participants (n=10), significant associations included nighttime HR, movement intensity and nightly SpO2. In 'persistent worsening' participants (n=11), significant associations included HR variability, nightly RR variability, nightly SpO2, sleep efficiency, and skin temperature. Similar results were found in adjusted models. This study provides a prospective continuous characterisation of exacerbations of COPD using remotely collected, ambulatory/free-living data. The physiological patterns presented may contribute to the understanding of exacerbations and may enhance the development of effective remote monitoring solutions. University hospital (MUHC-CAS) grant.

AVALIAÇÃO DA CAPACIDADE FUNCIONAL DE IDOSAS PRATICANTES DE PILATES E HIDROGINÁSTICA ATRAVÉS DO TESTE DE CAMINHADA DE SEIS MINUTOS (TC6’)

Functional capacity is described as the ability of an individual has to perform their daily living tasks independently and functional. OBJECTIVE: To evaluate and compare the functional capacity of older practitioners of Pilates and aerobics through the 6-minute walk test (6MWT). METHODS: This is a quantitative study, a population-based composed of 18 elderly 9 group pilates and 9 group water aerobics, which form collected anthropometric measurements, blood pressure, heart rate and oxygen saturation and then applied the test being carried out test at the beginning of training where all participants are returning from vacation and a second test after four weeks of training, the results were obtained by formula developed by Enright &amp; Sherrill, where they were analyzed descriptively because it is a small sample exposed in tables . RESULTS: The results indicate that both groups showed an improvement both in the post-training and in pre-training, but the average presented by the Pilates group both pre-training, as post-training to show more than the aerobics group presents average pre-training and post-training. CONCLUSION: The results suggest that the Pilates group is more efficient than the aerobics group, taking into account that factors such as age, weight and height can directly influence the outcome of the six-minute walk test, since older age high above weight and a high BMI tend to have greater difficulty in getting adversely affecting the test results.

An Intelligent Medical Monitoring System using Narrow Band –IOT

With the emergence of technology, the healthcare sector has seen tremendous growth, providing creative ways to improve patient care, increase productivity, and save expenses. Of these developments, the Internet of Things' (IoT) incorporation into the healthcare industry has emerged as a key component for developing intelligent medical systems that are able to remotely and in real-time monitor patients' health problems. Narrowband IoT (NB-IoT), a low-power, wide-area network (LPWAN) protocol created expressly to meet the expanding demands of the IoT ecosystem, particularly in healthcare, is one exciting technology facilitating this shift. Vital health indicators including heart rate, blood pressure, glucose levels, and oxygen saturation can be tracked by healthcare practitioners with the help of an NB-IoT-enabled smart healthcare monitoring system, which can monitor patients continuously and remotely. By providing more timely and individualized care, decreasing hospital stays, and enabling faster reaction times, this technology has the potential to completely transform the healthcare industry.

Cardiorespiratory Stability in Critically Ill Preterm Infants following Dexmedetomidine Initiation.

This study aimed to evaluate cardiorespiratory status in preterm infants receiving dexmedetomidine using high-resolution physiologic data. We analyzed preterm infants with continuous heart rate (HR) and oxygen saturation (SpO2) data for 24 hours preceding and 48 hours following dexmedetomidine initiation. Invasive arterial blood pressure (ABP), when available, was analyzed. In 100 infants with a mean gestational age of 28 weeks and high baseline illness severity, mean HR decreased from 152 to 141 beats per minute while mean SpO2 increased from 91 to 93% in the 48 hours after dexmedetomidine initiation (p < 0.01). In 57 infants with continuous ABP monitoring, mean ABP increased from 40 to 42 mm Hg (p = 0.01). Vasoactive-inotropic support increased before and after initiation. We observed cardiorespiratory changes in critically ill preterm infants following dexmedetomidine initiation; mean HR decreased and mean SpO2 increased in the 48 hours after initiation. In a subset, mean ABP increased along with vasoactive-inotropic support. · Limited evidence exists on the acute cardiorespiratory effects of dexmedetomidine in preterm infants.. · Evaluation of continuous HR, blood pressure, and oxygenation from two centers provides useful data.. · Dexmedetomidine consistently decreased the HR of preterm infants.. · Dexmedetomidine initiation during critical illness complicated the interpretation of physiologic effects.. · Oxygenation stabilized after initiation during invasive mechanical ventilation..

Evaluation of Effect of Distraction Techniques Using Virtual Reality and Eight-dimension Audio Analgesia Methods on Pain Perception and Anxiety Levels in Children During Restorative Procedures: A Comparative In Vivo Study.

Dental pain and dental anxiety are the most common determinants of negative dental experience, the reason for broken appointments and ignored oral health care affecting the quality of life. To evaluate the effects of distraction techniques using virtual reality and eight-dimension (8D) audio analgesia method on pain perception and anxiety levels in children during restorative procedures. A total of 120 children between the ages of 4 and 10 years old who visited for the first time to a pediatric dental department were grouped equally between three interventional groups. Group I was treated with conventional tell-show-do (TSD) method; patients selected for group II (8D audio analgesia) and group III (virtual reality method) underwent two-step procedure that initially involved the TSD technique, by explaining the distraction techniques method conditioned for restoration treatment. Clinical evaluation of anxiety levels was measured by using the Chotta Bheem-Chutki (CBC), face, legs, activity, cry, consolability (FLACC) scale, and recording pulse and oxygen saturation rate. One-way analysis of variance (ANOVA) followed by post hoc Tukey's test was done to compare all the parameters between the three groups. In comparison to the conventional TSD method, both 8D audio analgesia and virtual reality method showed statistically better results. One-way ANOVA followed by post hoc Tukey's test showed no significant difference between the virtual reality group and 8D audio analgesic group. Both 8D audio analgesia and virtual reality box distraction techniques can be used as an efficient distraction technique for TSD during dental procedures in children. Karuppiah M, Balamurugan SR, Rajashekaran S, et al. Evaluation of Effect of Distraction Techniques Using Virtual Reality and Eight-dimension Audio Analgesia Methods on Pain Perception and Anxiety Levels in Children During Restorative Procedures: A Comparative In Vivo Study. Int J Clin Pediatr Dent 2024;17(10):1087-1092.

Fractional-Calculus Analysis of the Dynamics of a Vector-Borne Infection with Preventive Measures

Vector-borne infections pose serious public health challenges due to the complex interplay of biological, environmental, and social factors. Therefore, comprehensive approaches are essential to mitigate the burden of vector-borne infections and minimize their impact on public health. In this research, an epidemic model for the vector-borne disease malaria is structured with a saturated incidence rate via fractional calculus and preventive measures. The essential results and concepts are introduced to examine the proposed model. The solution of the system is examined for some necessary results, and the threshold parameter of the model, indicated by R0, is calculated. In this paper, the proposed malaria model is analyzed both quantitatively and qualitatively. The fixed-point theorems of Banach and Schaefer are utilized to examine the uniqueness and existence of the solution dynamics. Furthermore, the necessary conditions for the stability of the model have been determined. A numerical approach is offered to visualize the solution pathways of the system and identify its key factors. Through the results, the most influential factors for the control and management of the disease are highlighted.

Predicting ICU Admission for Hospitalized COVID-19 Patients by Artificial Neural Network Combined with Elastic Net

Background: Machine learning models could assist physicians in identifying high-risk COVID-19 patients. This study aimed to predict the Intensive Care Unit (ICU) admission in COVID-19 hospitalized patients by the Artificial Neural Network (ANN) model combined with Elastic Net algorithm. Methods: In this prospective study, the data of 139 COVID-19 patients admitted to Imam Reza Hospital in Tabriz between 20 March and 5 April 2020, were analyzed. The Elastic Net method was used to choose features with high importance. The chosen variables were standardized and ANN was fitted to the data with one hidden layer based on the descending gradient algorithm. To validate the model, the training and test group method with a ratio of 70 to 30 was used. The model’s predictive power was reported by calculating the overall accuracy, sensitivity, specificity, and Area Under the ROC curve (AUC). Results: According to the results of the Elastic Net, the ANN model was constructed based on age, sex, body mass index, diabetes mellitus status, history of heart disease, and vital signs including systolic and diastolic blood pressure, saturated oxygen level, pulse rate, respiration rate, and body temperature. The overall accuracy of this model was 93.15%, sensitivity 80%, specificity 95.8%, and AUC 0.90. Saturated oxygen level, pulse rate, and age were the most important and predictive variables. Conclusion: In the investigated sample of patients admitted with COVID-19, the fitted ANN model had acceptable performance to predict the ICU admission. This finding could be useful for physicians and policy makers.

Reference ranges for preductal oxygen saturation and heart rate in moderate and late preterm infants with deferred cord clamping.

Moderate and late preterm (MLPT) infants represent a substantial percentage of all preterm infants and frequently need support in the delivery room (DR). Deferring cord clamping (DCC) improves SpO2 and heart rate (HR) stabilization in term infants. However, data on MLPT infants are limited. Prospective observational study collecting SpO2 and HR by pulse-oximetry (PO) in healthy MLPT infants with DDC to construct percentile graphs for the first 10 minutes after birth. 96 MLPT infants were monitored for preductal SpO2 and HR, and percentiles were calculated. SpO2 mean was significantly lower for MLPT than for term infants during the first six minutes after birth, and 15% didn't achieve SpO2 > 85% in the first five minutes after birth. HR was significantly lower in MLPT infants in the first 4 minutes after birth; however, HR consistently remained above bradycardic values (> 100 bpm). NICU admission and postnatal complications were not different between MLPT achieving SpO2 > 85% or not. MLPT infants with DCC achieved stable SpO2 and HR significantly later, 6 min and 4 min, respectively than term infants. In addition, 15% of MLPT infants didn't achieve SpO2  85% at five minutes after birth. However, admission to the NICU and clinical evolution didn't differ from newborns with SpO2 85% at 5 minutes. Larger studies including long-term follow-up are needed to assess if lower SpO2 in the first five minutes has clinical consequences in non-resuscitated MLPT.

Dual-route administration of balanced anesthesia using medetomidine, midazolam, and butorphanol provides both suitable anesthetic depth and reduced tissue injury in rabbits.

Medetomidine, midazolam, and butorphanol (MMB) anesthesia is the preferred choice for rodents but requires excess volume of intramuscular injection in rabbits, which can lead to muscular damage. This study aimed to evaluate a dual-route MMB administration via the intravenous and subcutaneous routes in rabbits. MMB was administered to male Kbs:JW rabbits with an intravenous injection of 0.2 mL/kg followed by a subcutaneous injection of 0.8 mL/kg, totaling 0.2 mg/kg medetomidine, 2.0 mg/kg midazolam, and 2.0 mg/kg butorphanol. We compared the anesthetic effects of this dual-route method with those of intramuscular administration. The dual-route method resulted in a shorter induction time and similar anesthetic duration compared with those of the intramuscular route. While it induced a temporary decrease in body temperature within 30 min post-injection, other vital signs, such as respiration rate, heart rate, and O2 saturation, remained similar. Notably, unlike intramuscular administration, dual-route administration did not increase tissue injury marker levels. This dual-route MMB administration provided sufficient anesthetic depth during surgery, eliminating pain reflexes. Double-dose administration extended anesthetic duration but resulted in rare fatalities, indicating room for protocol improvement. In conclusion, the novel anesthetic method is preferable for injectable anesthesia in rabbits, providing rapid induction and sufficient anesthetic duration, while potentially minimizing muscle injury. This technique may be beneficial for both laboratory and companion animals and significantly enhance animal welfare in anesthesia by reducing the pain associated with injectable anesthesia.

Sublingual Sufentanil Tablet for Analgesia in Emergency Medical Services and Search and Rescue Agencies

Objectives Pain management in the potentially austere search and rescue (SAR) and emergency medical services (EMS) environments can be challenging. Intravenous (IV) and intramuscular (IM) routes of administration may be less practical. This study assesses the efficacy and safety of the sublingual sufentanil tablet (SST) in prehospital settings and hypothesizes that its use will reduce pain while maintaining a reasonable safety profile. Methods This was a retrospective case analysis examining patient records from Teton County Search and Rescue, Grand Teton National Park EMS, and Jackson Hole Fire/EMS from 2021-2023, based on the criteria that they were administered SST in a prehospital setting. Cases in which SST was used were examined to assess patient characteristics, injury classification, patient reported pain scale before and after SST, other medications administered, and vital signs. Results Seventy patients met the inclusion criteria. Six individuals were excluded due to missing one or more of the key variables, and the analysis was carried out with the remaining (N = 64 cases). The mean pain score decreased from 8.0 ± 1.9 before medication administration to 5.5 ± 2.5 after administration, reflecting a statistically significant difference of 2.6 ± 2.1 (p < 0.001). The results also revealed statistically significant reductions in heart rate (HR) and systolic blood pressure (SBP) following SST administration (mean HR dropped by 4.2 ± 9.1 beats/min, p = 0.004, and mean SBP dropped by 11.1 ± 21.8 mmHg, p = 0.01). Changes in vital signs, although statistically significant, were not clinically significant and did not necessitate additional monitoring or intervention in any patients. Conclusions Our study demonstrated that SST administration led to a significant reduction in pain scores and exhibited a favorable safety profile regarding vital signs, including SBP, HR, respiratory rate (RR), and O2 saturation. These findings support the utilization of SST for pain management in the prehospital setting, particularly in austere environments where traditional routes of administration may be impractical.