X-Ray Microcomputed Tomography in Additive Manufacturing: A Review of the Current Technology and Applications

3D Printing and Additive Manufacturing, Ahead of Print.


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Acute Effects of Drugs on Caenorhabditis elegans Movement Reveal Complex Responses and Plasticity

Many drugs act very rapidly; they can turn on or off their targets within minutes in a whole animal. What are the acute effects of drug treatment and how does an animal respond to these? We developed a simple assay to measure the acute effects of drugs on C. elegans movement and examined the effects of a range of compounds including neuroactive drugs, toxins, environmental stresses and novel compounds on worm movement over a time period of 3 hours. We find that many treatments show complex acute responses, where a phase of rapid paralysis is followed by one or more recovery phases. The recoveries are not the result of some generic stress response but are specific to the drug e.g. recovery from paralysis due to a neuroactive drug requires neurotransmitter pathways whereas recovery from a metabolic inhibitor requires metabolic changes. Finally, we also find that acute responses can vary greatly across development and that there is extensive and complex natural variation in acute responses. In summary, acute responses are sensitive probes of the ability of biological networks to respond to drug treatment and these responses can reveal the action of unexplored pathways.

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Complex Haplotypes of GSTM1 Gene Deletions Harbor Signatures of a Selective Sweep in East Asian Populations

The deletion of the metabolizing Glutathione S-transferase Mu 1 (GSTM1) gene has been associated with multiple cancers, metabolic and autoimmune disorders, as well as drug response. It is unusually common, with allele frequency reaching up to 75% in some human populations. Such high allele frequency of a derived allele with apparent impact on an otherwise conserved gene is a rare phenomenon. To investigate the evolutionary history of this locus, we analyzed 310 genomes using population genetics tools. Our analysis revealed a surprising lack of linkage disequilibrium between the deletion and the flanking single nucleotide variants in this locus. Tests that measure extended homozygosity and rapid change in allele frequency revealed signatures of an incomplete sweep in the locus. Using empirical approaches, we identified the Tanuki haplogroup, which carries the GSTM1 deletion and is found in approximately 70% of East Asian chromosomes. This haplogroup has rapidly increased in frequency in East Asian populations, contributing to a high population differentiation among continental human groups. We showed that extended homozygosity and population differentiation for this haplogroup is incompatible with simulated neutral expectations in East Asian populations. In parallel, we found that the Tanuki haplogroup is significantly associated with the expression levels of other GSTM genes. Collectively, our results suggest that standing variation in this locus has likely undergone an incomplete sweep in East Asia with regulatory impact on multiple GSTM genes. Our study provides the necessary framework for further studies to elucidate the evolutionary reasons that maintain disease-susceptibility variants in the GSTM1 locus.

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Detection of swallow kinematic events from acoustic high resolution cervical auscultation signals in patients with stroke

Publication date: Available online 30 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Atsuko Kurosu, James L. Coyle, Joshua Dudik, Ervin Sejdic

Abstract

Objective

To examine whether there were any associations between high resolution cervical auscultation (HRCA) acoustic signals recorded by a contact microphone and swallowing kinematic events during pharyngeal swallow as assessed by a videofluoroscopic examination.

Design

Prospective pilot study

Setting

University teaching hospital, University research laboratories

Participants

35 patients with stroke who have suspected dysphagia (26 males + 9 females; age = 65.8 ± 11.2).

Methods

Videofluoroscopic recordings of one hundred liquid swallows from 35 stroke patients were analyzed, and a variety of HRCA signal features to characterize each swallow were calculated.

Main Outcome Measure(s)

Percent of signal feature maxima (peak) occurring within 0.1 seconds of swallow kinematic event identified from videofluoroscopic recording

Results

Maxima of HRCA signal features, such as standard deviation, skewness, kurtosis, centroid frequency, bandwidth, and wave entropy, were associated with hyoid elevation, laryngeal vestibule closure, and upper esophageal sphincter opening, and the contact of the base of the tongue and posterior pharyngeal wall.

Conclusions

Although the kinematic source of HRCA acoustic signals has yet to be fully elucidated, these results indicate a strong relationship between these HRCA signals and several swallow kinematic events. There is a potential for HRCA to be developed for diagnostic and rehabilitative clinical management of dysphagia.

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For Distinguished Contributions to Psychophysiology: Robert W. Levenson

Psychophysiology, EarlyView.


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Early automatic hyperarousal in response to neutral novel auditory stimuli among trauma‐exposed individuals with and without PTSD: An ERP study

Psychophysiology, EarlyView.


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For Distinguished Contributions to Psychophysiology: Brigitte Rockstroh

Psychophysiology, EarlyView.


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Assessment of the cerebral pressure‐flow relationship using psychological stress to manipulate blood pressure

Psychophysiology, EarlyView.


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Experimental and methodological factors affecting test‐retest reliability of amygdala BOLD responses

Psychophysiology, EarlyView.


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Developmental dynamics of autonomic function in childhood

Psychophysiology, EarlyView.


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Efficacy of stimulus intensity increases and decreases as inhibitors of the acoustic startle response

Psychophysiology, EarlyView.


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Issue Information

Psychophysiology, Volume 55, Issue 8, August 2018.


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Water drinking enhances the gain of arterial baroreflex control of muscle sympathetic nerve activity in healthy young humans

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Thirty minutes of handgrip exercise potentiates flow‐mediated dilation in response to sustained and transient shear stress stimuli to a similar extent

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Right ventricular dyssynchrony during hypoxic breathing but not during exercise in healthy subjects a speckle tracking echocardiography study

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Myths and Methodologies: Reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Phase waves and trigger waves: emergent properties of oscillating and excitable networks in the gut

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Uncovering a critical period of synaptic imbalance during postnatal development of the rat's visual cortex: role of brain‐derived neurotrophic factor

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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The role of the paravertebral ganglia in human sympathetic neural discharge patterns

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Ultrastructural basis of strong unitary inhibition in a binaural neuron

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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The muscle anabolic effect of protein ingestion during a hyperinsulinemic euglycemic clamp in middle‐aged women is not caused by leucine alone

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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New insights into arterial baroreflex function during acute exercise: Role of central angiotensin II

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Specific synaptic input strengths determine the computational properties of excitation − inhibition integration in a sound localization circuit

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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The anti‐arrhythmic drIP3 from a leaky SR

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Insulin transport across the blood‐brain barrier can occur independent of the insulin receptor

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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A moderate estradiol level enhances neutrophil number and activity in muscle after traumatic injury but strength recovery is accelerated

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Differences in autonomic innervation to the vertebrobasilar arteries in spontaneously hypertensive and Wistar rats

The Journal of Physiology, EarlyView.


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Intraoperative anesthetic management of an infant with a bridging bronchus: A case report

Pediatric Anesthesia, EarlyView.


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Dorsal penile nerve block for circumcision in pediatric patients: A prospective, observer‐blinded, randomized controlled clinical trial for the comparison of ultrasound‐guided vs landmark technique

Pediatric Anesthesia, EarlyView.


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Volatile anesthesia for a child with LPIN1 gene mutation and recurrent rhabdomyolysis

Pediatric Anesthesia, EarlyView.


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An inconvenient truth: Supraglottic devices can lead to potentially significant increases in the apparatus dead space in the anesthetized infant

Pediatric Anesthesia, Volume 28, Issue 7, Page 672-673, July 2018.


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Reply to Ho, Anthony; Mizubuti, Glenio; Dion, Joanna, regarding their comments “Comments on ‘Anesthesia of thoracic surgery in children’”

Pediatric Anesthesia, Volume 28, Issue 7, Page 679-680, July 2018.


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The hydra of anesthetic neurotoxicity: Myth or reality?

Pediatric Anesthesia, Volume 28, Issue 7, Page 576-577, July 2018.


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In this issue: July 2018

Pediatric Anesthesia, Volume 28, Issue 7, Page 575-575, July 2018.


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Correspondence to: Can noninvasive hemoglobin measurements reduce the need for preoperative venipuncture in pediatric outpatient surgery?

Pediatric Anesthesia, Volume 28, Issue 7, Page 675-675, July 2018.


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Inside out: Repurposing endobronchial intubation to facilitate extraluminal placement of a 5 Fr Arndt bronchial blocker in young infants

Pediatric Anesthesia, Volume 28, Issue 7, Page 668-669, July 2018.


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Recurrent laryngeal nerve monitoring with a modified laryngeal surface electrode in a 19‐month‐old child

Pediatric Anesthesia, Volume 28, Issue 7, Page 676-678, July 2018.


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Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Pediatric Anesthesia, Volume 28, Issue 7, Page 618-624, July 2018.


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A modification of ultrasound with nerve stimulation‐guided lumbar plexus block in supine position for pediatric hip surgery

Pediatric Anesthesia, Volume 28, Issue 7, Page 678-679, July 2018.


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Reply to Gentry, Katherine; Lepere, Katherine; Opel, Douglas, regarding their comment ‘Informed Consent in Pediatric Anesthesiology’

Pediatric Anesthesia, Volume 28, Issue 7, Page 674-674, July 2018.


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Response to “An inconvenient truth: Supraglottic devices can lead to potentially significant increases in the apparatus dead space in the anesthetized infant” by Templeton et al.

Pediatric Anesthesia, Volume 28, Issue 7, Page 675-676, July 2018.


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Postoperative behavior change in children: All sorted or a tangled mess of spaghetti?

Pediatric Anesthesia, Volume 28, Issue 7, Page 578-579, July 2018.


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Comments on “Anesthesia of thoracic surgery in children”

Pediatric Anesthesia, Volume 28, Issue 7, Page 670-671, July 2018.


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Airway topicalization—Beware of the MADgic™ “bullet”

Pediatric Anesthesia, Volume 28, Issue 7, Page 669-670, July 2018.


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Pediatrician referral rate in 10 864 children undergoing general anesthesia

Pediatric Anesthesia, Volume 28, Issue 7, Page 671-672, July 2018.


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Cover Image

Pediatric Anesthesia, Volume 28, Issue 7, Page i-i, July 2018.


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Issue Information

Pediatric Anesthesia, Volume 28, Issue 7, Page 573-573, July 2018.


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A 2‐year longitudinal study of the relationship between masticatory function and progression to frailty or pre‐frailty among community‐dwelling Japanese aged 65 and older

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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A 69‐year‐old woman with Coffin–Siris syndrome

American Journal of Medical Genetics Part A, EarlyView.


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A case of severe TBCE‐negative hypoparathyroidism‐retardation‐dysmorphism syndrome: Case report and literature review

American Journal of Medical Genetics Part A, EarlyView.


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A recognizable phenotype related to 19p13.12 microdeletion

American Journal of Medical Genetics Part A, EarlyView.


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Inflammatory facioscapulohumeral muscular dystrophy type 2 in 18p deletion syndrome

American Journal of Medical Genetics Part A, EarlyView.


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De novo KCNA1 variants in the PVP motif cause infantile epileptic encephalopathy and cognitive impairment similar to recurrent KCNA2 variants

American Journal of Medical Genetics Part A, EarlyView.


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Expanding the fetal phenotype: Prenatal sonographic findings and perinatal outcomes in a cohort of patients with a confirmed 22q11.2 deletion syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Is exon 8 the most critical or the only dispensable exon of the VCAN gene? Insights into VCAN variants and clinical spectrum of Wagner syndrome

American Journal of Medical Genetics Part A, EarlyView.


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Nonreentrant atrial tachycardia occurs independently of hypertrophic cardiomyopathy in RASopathy patients

American Journal of Medical Genetics Part A, EarlyView.


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Reassignment of HMX1 indicates copy number variation within 4p16.1 may be an alternative cause of oculoauricular phenotypes

American Journal of Medical Genetics Part A, EarlyView.


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M. Michael Cohen, Jr.: Author, diagnostician, geneticist, teacher, mentor, syndrome scholar extraordinaire (1937–2018)

American Journal of Medical Genetics Part A, EarlyView.


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Eduardo E. Castilla (1933–2017): El grande TROESMA*

American Journal of Medical Genetics Part A, EarlyView.


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A recessive truncating variant in thrombospondin‐1 domain containing protein 1 gene THSD1 is the underlying cause of nonimmune hydrops fetalis, congenital cardiac defects, and haemangiomas in four patients from a consanguineous family

American Journal of Medical Genetics Part A, EarlyView.


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Novel mosaic SRY gene deletions in three newborn males with variable genitourinary malformations

American Journal of Medical Genetics Part A, EarlyView.


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Health supervision for people with Bloom syndrome

American Journal of Medical Genetics Part A, EarlyView.


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De novo missense variants in MEIS2 recapitulate the microdeletion phenotype of cardiac and palate abnormalities, developmental delay, intellectual disability and dysmorphic features

American Journal of Medical Genetics Part A, EarlyView.


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A novel MYT1L mutation in a patient with severe early‐onset obesity and intellectual disability

American Journal of Medical Genetics Part A, EarlyView.


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In reply to “Short‐rib syndrome Beemer‐Langer type, a short history”

American Journal of Medical Genetics Part A, EarlyView.


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A founder nonsense variant in NUDT2 causes a recessive neurodevelopmental disorder in Saudi Arab children

Clinical Genetics, EarlyView.


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Mutations in Known Disease Genes Account for the Majority of Autosomal Recessive Retinal Dystrophies

Clinical Genetics, Volume 0, Issue ja, -Not available-.


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Clinical variability in inherited GPI deficiency disorders

Clinical Genetics, Volume 0, Issue ja, -Not available-.


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The future of utility meets durability in latest CORDURA® + Carhartt collaboration

WICHITA, KS — INVISTA's CORDURA® brand and Carhartt announce the latest collaboration in their long-standing partnership with the launch of Carhartt's newest generation Full Swing® Steel line, a dynamic workwear collection designed and developed through an extensive consumer insight program. The collection consists of a Men's Full Swing® Steel Jacket, Full Swing®...

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Winners of Inaugural Poster Session announced

LAKEVILLE, Minn. — ImageTrend, Inc. is pleased to announce the winners of the Inaugural Poster Session from ImageTrend Connect 2018. The posters were fitting in theme with the conference topics of using data to improve patient care, public safety and operational efficiencies. Participants demonstrated what they are doing to make an impact within their community using original research,...

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Early stage clear cell adenocarcinoma of the colon examined in detail with image-enhanced endoscopy: a case report

Abstract

Primary clear cell adenocarcinoma (CCA) of the colorectum is a rare tumor. We report on a 48-year-old man with early stage CCA in the descending colon who underwent detailed examination with image-enhanced endoscopy, such as magnifying endoscopy with narrow-band imaging and crystal violet staining. The tumor was treated successfully with endoscopic mucosal resection at our hospital.

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DNA methylation on N6-adenine in lepidopteran Bombyx mori

Publication date: Available online 30 July 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Xiaoyan Wang, Zhiqing Li, Quan Zhang, Bingqian Li, Chenchen Lu, Wanshun Li, Tingcai Cheng, Qingyou Xia, Ping Zhao

Abstract

Increasing knowledge of DNA methylation that occurs on the sixth position of adenine (N6-methyladenine, 6 mA) has emerged as a novel epigenetic mark in eukaryotes and plays an important role in regulating gene transcription, DNA replication and repair, transposable activities, and others. Here, we show DNA 6 mA methylation is present in Bombyx mori, a lepidopteran model insect, and identify the 6 mA methyltransferase, METTL4, and 6 mA demethylase, NMAD, which regulate the levels of 6 mA in embryogenesis and cultured cells of B. mori. Importantly, RNAi knockdown of METTL4 and NMAD not only induce cell cycle arrest at G1 phase but also result in defects of chromosome alignments at metaphase. We further demonstrate that 6 mA methylation is widely distributed across the genome of B. mori by 6 mA-Seq and primarily enriched in the regulatory regions as well as gene bodies. Integrated analysis of 6 mA-Seq and RNA-Seq reveals that 6 mA methylation in B. mori is preferentially related with lowly expressed genes and negatively correlated with active gene transcription, which provides a novel regulatory mechanism of DNA 6 mA methylation on target genes. Altogether, these data identify 6 mA methylation in B. mori and demonstrate a crucial role of 6 mA signaling in controlling cell cycle progression.

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Risk of colorectal cancer in patients with acute diverticulitis: A systematic review and meta-analysis of observational studies

Clinical Gastroenterology and Hepatology

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Cholesterol efflux capacity is impaired in subjects with an elevated Fatty Liver Index, a proxy of non-alcoholic fatty liver disease

Atherosclerosis

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Enhancing Healthier Birth Outcomes by Creating Supportive Spaces for Pregnant African American Women Living in Milwaukee

Abstract

Objectives Nationwide, African American women report higher stress levels and less access to pre- and postnatal resources. Wisconsin mirrors national infant mortality trends that show a persistent four-decade gap in infant survival between African American and White populations. The objective of the Milwaukee Birthing Project (MBP) was to implement a community-based health promotion intervention to improve birth outcomes for pregnant, low-income African American women, evaluate its effectiveness, and document its usefulness to inform development of future interventions. The project involved a mentoring and supportive relationship between 28 volunteer mentors (Sister Friends) and 20 pregnant women (Little Sisters). Methods The project implementation and evaluation were informed by the lifecourse perspective and a postcolonial feminist framework. Thematic analysis was used to analyze ethnographic data from monthly meetings and interviews with pregnant Little Sisters and Sister Friends. Results Our findings showed patterns both in community spaces and spaces created during the MBP. Program spaces contrasted with everyday life spaces and allowed women to experience community support. Based on our analysis, we classify these spaces as: (1) community spaces lacking support, (2) safe spaces of belonging and understanding, (3) spaces that foster meaningful interaction, and (4) safe, supportive spaces for other women in the future. Conclusions for Practice Future interventions should consider intentionally developing safe spaces to attain health goals. From a postcolonial feminist perspective, the voices of women who are at greatest risk for experiencing poor birth outcomes are crucial to the development of effective policies.

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Effect of Intravenous Dexamethasone on the Regression of Isobaric Bupivacaine Spinal Anesthesia: A Randomized Controlled Trial

The effect of intravenous dexamethasone on the regression of sensory and motor block after isobaric bupivacaine spinal anesthesia is unknown. We conducted a prospective, double-blind, randomized controlled trial on 60 patients who received intravenously either placebo (group P) or 8-mg dexamethasone (group D) during the intrathecal injection of 12-mg isobaric bupivacaine 0.5%. Primary outcome was the time from bupivacaine injection to regression of 2 dermatomes in relation to the highest dermatome blocked by the spinal local anesthetic. Time to 2-dermatome regression was 85 minutes (74–96 minutes) in group P versus 87 minutes (76–98 minutes) in group D (P = .79). Accepted for publication June 18, 2018. Funding: Internal. The authors declare no conflicts of interest. Clinical Trials identifier: NCT03078062. Protocol available at: https://ift.tt/2OsukBR NCT03078062. Reprints will not be available from the authors. Address correspondence to Stephan R. Williams, MD, PhD, Département d'anesthésiologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, QC H2L 4M1, Canada. Address e-mail to stephan.williams@umontreal.ca. © 2018 International Anesthesia Research Society

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Laryngeal Mask Airway Versus Other Airway Devices for Anesthesia in Children With an Upper Respiratory Tract Infection: A Systematic Review and Meta-analysis of Respiratory Complications

There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included. From 1030 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical differences between laryngeal mask airway (LMA®) and endotracheal tube (ETT) regarding breath holding or apnea (risk ratio [RR], 0.82; 95% confidence interval [CI], 0.41–1.65), laryngospasm (RR, 0.74; 95% CI, 0.18–2.95), and arterial oxygen desaturation (RR, 0.44; 95% CI, 0.16–1.17). The quality of evidence was low for the first outcome and very low for the 2 other outcomes, respectively. The LMA use produced a significant reduction of cough (RR, 0.75; 95% CI, 0.58–0.96, low quality of evidence) compared with ETT. The ideal airway management in children with a URTI remains obscure given that there are few data of perioperative respiratory complications during anesthesia. This systematic review demonstrates that LMA use during anesthesia in children with URTI did not result in decrease of the most feared PRAEs. However, LMA was better than ETT in reducing cough. Further research is needed to define the risks more clearly because cough and laryngospasm have similar triggers, and both bronchospasm and laryngospasm trigger cough. Accepted for publication June 18, 2018. Funding: This research was carried out without funding. A.L.R.C. was granted a scholarship from Coordination of Improvement for Higher Academic Staff (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [CAPES]). P.T.S.S. received a scholarship from São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP]; #2014/16734–6). CAPES and FAPESP are Brazilian governmental agencies dedicated to promoting scientific research. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Preliminary data for this study were presented as European Society of Anaesthesiology (ESA) Best Abstract Prize Competition at the ESA Euroanaesthesia May 30, 2015 to June 2, 2015, Berlin, Germany. LMA is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Ana Lygia R. de Carvalho, MD, PhD, Departamento de Anestesiologia, Universidade Estadual Paulista, UNESP, Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Bairro: UNESP, Campus de Botucatu, Botucatu, SP, Brazil. Address e-mail to analygiacarvalho@yahoo.com.br. © 2018 International Anesthesia Research Society

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Perioperative Blood Pressure Monitoring in Patients With Obesity

Blood pressure monitoring plays a key part in the preoperative, intraoperative, and postoperative care of all patients. In patients with obesity, hypertension indicates increased metabolic and surgical risk and may signal the presence of significant medical comorbidities, including obstructive sleep apnea. Avoidance of hypertension postoperatively is necessary to minimize bleeding risk after surgery. Hypotension in the postoperative period may be the first sign of significant complications that require urgent management. With the problem of being overweight or obese now affecting two-thirds of adults in Western countries, the proportion of patients with obesity in perioperative environments is similarly increasing. Detection of aberrations in blood pressure is contingent on the accuracy of blood pressure measurement methods. Patients with obesity tend to have a large arm circumference and "cone-shaped arms." Standard blood pressure cuffs fit such patients poorly, and this compromises the accuracy of measurements. Alternatives to arm blood pressure cuffs, some made specifically for individuals with obesity, have been evaluated but are not widely available to clinicians. This focused narrative review will discuss the relevance of hypertension management in the care of patients with obesity, highlight the currently available methods for perioperative monitoring of blood pressure, and explore the opportunities that exist to improve the perioperative blood pressure care in patients with obesity undergoing surgical procedures. Accepted for publication June 6, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Victoria A. Eley, PhD, Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD 2006, Australia. Address e-mail to va_eley@hotmail.com. © 2018 International Anesthesia Research Society

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Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study

BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure. METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables. RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001). CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined. Accepted for publication June 12, 2018. Huseyin O. Yilmaz, MD, is currently affiliated with the Department of Critical Care, Turkish Ministry of Health, Health Sciences University, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey. Rovnat Babazade, MD, is currently affiliated with the Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas. Wael Saasouh, MD, is currently affiliated with the Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan. Funding: Institutional and/or departmental. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Alparslan Turan, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, P-77, Cleveland, OH 44195. Address e-mail to turana@ccf.org. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Discharge Hemoglobin Level and 30-Day Readmission Rates After Coronary Artery Bypass Surgery

BACKGROUND: Restrictive transfusion strategies supported by large randomized trials are resulting in decreased blood utilization in cardiac surgery. What remains to be determined, however, is the impact of lower discharge hemoglobin (Hb) levels on readmission rates. We assessed patients with higher versus lower Hb levels on discharge to compare 30-day readmission rates after coronary artery bypass grafting (CABG). METHODS: We retrospectively evaluated 1552 patients undergoing isolated CABG at our institution from January 2013 to May 2016. We evaluated 2 Hb cohorts: "high" (above) and "low" (below) the mean discharge Hb level of 9.4 g/dL, comparing patient characteristics, blood utilization, and clinical outcomes including 30-day readmission rates. We further evaluated the effects of the lowest (12 g/dL), "mild anemia" (10–11.9 g/dL), "moderate anemia" (8–9.9 g/dL), and "severe anemia" (

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Preventing Adverse Events in Cataract Surgery

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda’s Referral Hospitals

BACKGROUND: A pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical outcomes in 5 of Uganda's referral hospitals. METHODS: A multicentre prospective cohort study was conducted in 5 referral hospitals in Uganda. Using a questionnaire based on the WHO SSC, patients undergoing surgical operations were systematically recruited into the study from April 2016 to July 2016. The patients were followed up daily for 30 days or until discharge for the purpose of documentation of complications. Logistic regression and linear regression were used to assess for association between compliance and perioperative surgical outcomes. RESULTS: We recruited 859 patients into the study. Overall compliance with the WHO SSC was 41.7% (95% confidence interval [CI], 39.7–43.8) ranging from 11.9% to 89.8% across the different hospitals. Overall compliance with "sign in" was 44.7% (95% CI, 43–45.6), with "time out" was 42.0% (95% CI, 39.4–44.6), and with "sign out" was 33.3% (95% CI, 30.7–35.9). There was no association between compliance and perioperative surgical outcomes: length of hospital stay, adverse events, and mortality. CONCLUSIONS: This study revealed low levels of compliance with the WHO SSC. There was a statistically significant association between this level of compliance and the incidence of pain and loss of consciousness postoperatively. Accepted for publication June 18, 2018. Funding: None. The authors declare no conflicts of interest. Study registration number: NCT03252860. Registry URL: ClinicalTrials.gov. Reprints will not be available from the authors. Address correspondence to Elizabeth N. Igaga, MBChB, Department of Anaesthesia, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. Address e-mail to lyzaigaga@gmail.com. © 2018 International Anesthesia Research Society

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