To determine the impact of different central optical zone diameters (COZDs), obtained from pupil size, on the visual performance of presbyopic subjects fitted with centre-distance simultaneous-image ...multifocal contact lenses (SIMCLs).
Thirty-two presbyopic volunteers, between 45–58 years of age, participated in this prospective, controlled, double-blind study. Subjects were fitted with 5 centre-distance SIMCLs of variable COZD, determined from the measurement of pupil size under photopic light conditions and corresponding to 60, 70, 80, 90 and 100 % of pupil diameter. Subjects visual performance was evaluated through the measurement of distance, intermediate and near visual acuity (VA), “visual functional range” (VFR) obtained from the VA Defocus Curve (VADC) and Contrast Sensitivity Function (CSF), using a third-generation retina display iPad.
Statistically significant differences were obtained for both distance (p = 0.01) and intermediate (p = 0.001) VA amongst designs. Best results were obtained with 80 % and 90 % COZDs compared to 60 %. No significant differences in VFR (p > 0.05) were obtained amongst the different COZDs. 90 and 100 % COZDs offered statistically significant better results at 6 and 18 cycles per degree (cpd) in the CSF, compared to the 60 and 70 % designs.
SIMCLs with COZDs of 80–90 % and of 90–100% of photopic pupil diameter offered better distance and intermediate VA, without a decline in near performance, and superior contrast sensitivity at medium and high spatial frequencies respectively, compared to lower COZD designs.
Objective
To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type ...of components of ERAS play a key role on the decrease of surgical morbidity.
Materials and methods
We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate.
Results
Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (
p
< 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%,
p
= 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively,
p
= 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted RR = 0.815; 95% confidence interval (CI) 0.667–0.996;
p
= 0.045. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications.
Conclusions
Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS
This paper proposes a mathematical model for the oxidation process of zirconium under the theory of oxygen diffusion in Zircaloy. The model considers ZrO2, α-Zr(O), and β-Zr phases at high ...temperatures (1273 K–1800 K) in an equivalent fuel rod. The model also considers the heat transfer phenomenon, the decay heat after shutdown, the heat released by the oxidation reaction, the loss of coolant water in the core and the heat transported by the steam produced. A computer program was coded in the C++ environment. The accident scenario of a BWR short term station blackout was simulated with this model. The results are compared with the ones obtained using MELCOR and RELAP/SCDAP codes. The comparison yielded an approximate result for total hydrogen production at the end of the simulation, with a difference of −2.7% compared with RELAP/SCDAP, and a difference of −1.11% with MELCOR. With the present model it is possible to calculate the growth of ZrO2, α-Zr(O), and β-Zr phases through the cladding.
•A nuclear fuel rod cladding oxidation and hydrogen production model.•The diffusion theory in a multiphase environment is considered.•Results are compared with specialized codes, RELAP/SCDAP and MELCOR.•The oxygen concentration distribution within the cladding thickness is explicitly determined.•Model predicts the pre and post transition process in the growth of the ZrO2 and α-Zr layers.
Ossification of the anterior longitudinal ligament of the spine, known as Forestier disease or diffuse idiopathic skeletal hyperostosis, is usually an asymptomatic disorder. The area most frequently ...affected is the thoracic spine, followed by lumbar and cervical regions. In the case of cervical involvement with clinical manifestations, the most common symptoms include dysphagia, dyspnoea, dysphonia, and can exceptionally cause an acute airway obstruction. The airway management of these patients represents a great anaesthetic challenge. The case is reported of an eighty-five-year-old patient who had an acute airway obstruction associated with Forestier disease. A fibre-optic-assisted intubation was accomplished under sevoflurane inhaled anaesthesia, maintaining spontaneous ventilation, with subsequent tracheostomy performed by ENT surgeons.
Summary
Some, but not all studies have suggested intra‐operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta‐analysis of randomised controlled ...trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a ‘nitrous oxide group’ (total 2297 patients) vs a ‘no‐nitrous oxide group’ (2301 patients). Omitting nitrous oxide significantly reduced postoperative nausea and vomiting (pooled relative risk 0.80, 95% CI 0.71–0.90, p = 0.0003). However, the absolute incidence of nausea and vomiting was high in both the nitrous oxide and no‐nitrous oxide groups (33% vs 27%, respectively). In subgroup analysis, the maximal risk reduction was obtained in female patients (pooled relative risk 0.76, 95% CI 0.60–0.96). When nitrous oxide was used in combination with propofol, the antiemetic effect of the latter appeared to compensate the emetogenic effect of nitrous oxide (pooled relative risk 0.94, 95% CI 0.77–1.15). We conclude that avoiding nitrous oxide does reduce the risk of postoperative nausea and vomiting, especially in women, but the overall impact is modest.
We studied the incidence and clinical characteristics of persistent diplopia related to anaesthesia for cataract surgery in a general hospital.
This was a retrospective review of anaesthesia for 3587 ...cataract surgeries. Of all the cases of diplopia referred to the ocular motility clinic after cataract surgery, those involving anaesthesia-related diplopia lasting longer than 1 month were studied.
During the study period, 3450 cataract surgeries were performed by phacoemulsification and 137 by extracapsular extraction. Retrobulbar block was used in 2024 cases, peribulbar block in 98, topical anaesthesia in 1420 and general anaesthesia in 43. Twenty-six cases of persistent diplopia were found (0.72% incidence), nine of which (0.25%) were considered to be related to anaesthetic factors; five of the latter involved the left eye. Five were caused by paresis of the inferior rectus muscle and three by fibrosis. In one patient, the inferior oblique muscle was affected. Anaesthesia was by retrobulbar block in eight cases (0.39%) and by peribulbar block in one. No diplopia was found in patients who had topical or general anaesthesia. Treatment was with surgery in two patients and with prisms in six. One patient continues to be studied.
Persistent diplopia can occur after cataract surgery using retrobulbar block predominantly through direct damage to the inferior rectus muscle. The overall incidence of anaesthesia-related diplopia in this series was 0.25%.
Postoperative monitoring of ventilation is largely restricted to the measurement of haemoglobin-oxygen saturation (SpO2) and respiratory rate (RR) derived from the ECG. SpO2 measurement is inadequate ...when used with supplemental oxygen and ECG-derived RR is subject to artifacts. A new monitor measures RR by quantifying the humidity of exhaled air (respiR8®).
The accuracy of the system was tested using a breathing simulator. In healthy volunteers, the respiR8® monitor was compared with two other methods of measuring RR: capnometry and counting of thoracic breathing movements. The ability of the monitor to track changes in RR resulting from the infusion of 2.5 μg kg−1 fentanyl was assessed and compared with RR measured from a validated flow measurement system. The RR in 50 postoperative patients measured with the respiR8® was compared with that derived from the ECG. RR values were compared by population-based Bland–Altman analyses.
The respiR8® monitor was accurate in the range required in clinical practice. There was a close agreement between RR from respiR8®, capnometry, and manual counting of respiratory movements without bias (limits of agreement ±1 bpm). The respiR8® monitor was well able to accurately track RR changes from fentanyl. In postoperative patients, RR from respiR8® and ECG had a bias of 1.7 (5.7) bpm due to greater RR values observed from the ECG due to artifacts.
The respiR8® gives an accurate measurement of RR and is useful in postoperative care.
The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in ...10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.
La aparición de úlceras perianales en relación con una pomada antihemorroidal es una condición nunca antes reportada en la literatura. Presentamos una serie de 11 casos de 10 hospitales españoles con diagnóstico de úlceras perianales tras la aplicación de una misma pomada antihemorroidal con acetónido de triamcinolona, lidocaína y pentosano polisulfato sódico como principios activos. No se ha podido identificar ninguna condición previa o enfermedad concomitante que pudiera justificar un diagnóstico etiológico alternativo y tras retirar la pomada antihemorroidal se ha evidenciado una resolución completa de las úlceras en un periodo medio de 8 semanas. Esta serie de casos evidencia el potencial efecto dañino de un producto farmacéutico no sujeto a prescripción ni seguimiento médico y la necesidad de interrogar por el uso de agentes tópicos ante la aparición de úlceras perianales.
Experimental assessment of marine bacterial respiration MARTÍNEZ-GARCÍA, Sandra; FERNÁNDEZ, Emilio; DEL VALLE, Daniela A ...
Aquatic microbial ecology : international journal,
09/2013, Letnik:
70, Številka:
3
Journal Article
Recenzirano
Odprti dostop
We present a systematic experimental assessment of the effect of pre-incubation filtration procedures on marine bacterial respiration (BR) measurements. The in vivo electron transport system (ETS) ...method, which enables measurements of BR using short incubation times ( similar to 1 h) and without the requirement of pre-incubation size-fractionation procedures, was employed in 20 experiments from 2 different ecosystems: the NW Iberian Peninsula shelf and shelf-break, and the North Pacific Subtropical Gyre. BR was determined in both pre-incubation size-fractionated filtered (PF) and pre-incubation unfiltered (PU) treatments. Additionally, the effect of incubation time (up to 24 h) on BR, community respiration (CR), bacterial production (BP), and picoplankton community composition was assessed in 6 of the experiments; the standard oxygen consumption method (i.e. Winkler) was also applied in PF treatments. The mean contribution of BR to total CR (%BR) obtained with the in vivo ETS method in PU and short-time incubated samples was 31 plus or minus 4% (mean plus or minus SE; n = 20). PF procedures increased BR by 264 plus or minus 46% (n = 20). This overestimation increased with incubation time. The %BR in PF 24 h-incubated samples was >100% using either the in vivo ETS method (%BR = 109 plus or minus 31%, n = 6) or the Winkler method (%BR = 185 plus or minus 34%, n = 6). By contrast, incubation time did not significantly affect BR or CR rates in the PU experiments. Metabolic changes during extended incubations following PF coincided with a significant increase in the proportion of very high nucleic acid content bacteria to total heterotrophic bacteria. In this study, PF combined with extended incubation times resulted in an overestimation of BR and %BR of similar to 300% and an underestimation of bacterial growth efficiency of similar to 50% compared to PU, short-incubated samples. These results may partially reconcile bacterial carbon consumption assessments and estimates of organic carbon flow in oligotrophic waters.
Coagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of ...the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes.
Children with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications.
1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8–538.5, P=.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology.
Our results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.
Las pruebas de evaluación de la coagulación en niños siguen realizándose con frecuencia en muchos países, para evaluar el riesgo de hemorragia. El objetivo de este estudio fue evaluar el manejo de la prolongación imprevista del tiempo de tromboplastina parcial activada (APTT) y el tiempo de protrombina (PT) en niños previa a la cirugía electiva, y el riesgo hemorrágico perioperatorio.
Se incluyó a los niños con APTT y/o PT prolongados que acudieron a consulta de anestesia preoperatoria desde enero de 2013 a diciembre de 2018. Se agrupó a los pacientes en función de si habían sido derivados a Hematología o habían sido programados para cirugía sin pruebas adicionales. El resultado primario fue comparar las complicaciones de las hemorragias perioperatorias.
Se evaluó para elegibilidad a 1.835 niños. Ciento dos de ellos presentaron resultados anormales (5,6%). De ellos, el 45% fue derivado Hematología. Los trastornos hemorrágicos significativos estuvieron asociados a antecedentes hemorrágicos positivos, odds ratio de 51 (95% IC de 4,8 a 538,5, P= 0,0011). No se encontró diferencia en términos de resultados de hemorragia perioperatoria entre los grupos. Se observó un coste adicional de 181 Euros por paciente y una demora preoperatoria media de 43 días en los pacientes derivados a Hematología.
Nuestros resultados sugieren que la derivación a Hematología tiene un valor limitado en niños asintomáticos con APTT y/o PT prolongados. Las complicaciones hemorrágicas fueron similares entre los pacientes derivados y los no derivados a Hematología. Una historia familiar positiva de hemorragia puede ayudar a identificar a los pacientes con mayor riesgo de sangrado, por lo que servirá de guía para los análisis de coagulación y la derivación a Hematología. Deberán realizarse esfuerzos adicionales para estandarizar las herramientas preoperatorias de evaluación hemorrágica en niños.
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