Δευτέρα 21 Αυγούστου 2017

Renal denervation decreases susceptibility of the heart to ventricular fibrillation in a canine model of chronic kidney disease

Abstract

Renal denervation (RDN) has been shown to have therapeutic values in patients with chronic kidney disease (CKD). This study aimed to investigate whether RDN could decrease susceptibility of the heart to ventricular fibrillation in a canine model of CKD. Twenty-one dogs were included in this study. CKD was produced by subtotal nephrectomy in sixteen dogs with RDN treatment (CKD + RDN group, N = 8) or sham RDN (CKD group, N = 8). Another 5 dogs underwent sham operation and sham RDN to serve as controls (CTR group). Parameters of renal function, blood pressure, echocardiography, electrocardiogram, norepinephrine and inflammation were measured at baseline and 6 weeks after the surgical procedure. The ventricular fibrillation threshold (VFT) was determined at the end of study. Subtotal nephrectomy successfully induced a canine CKD model. When compared to CTR group, subtotal nephrectomy in CKD group significantly elevated blood pressure; increased the left ventricular mass, the end-diastolic left ventricular internal dimension, the left ventricular end-diastolic posterior wall thickness, the end-diastolic interventricular septum thickness; prolonged the intervals of QT, corrected QT, Tpeak to Tend (Tp-e), corrected Tp-e, and increased the QT dispersion and the Tp-e/QT ratio; decreased the VFT; increased the serum levels of norepinephrine, C reactive protein, and interleukin 6. However, RDN significantly attenuated these changes induced by CKD. The present study demonstrated that RDN could decrease susceptibility of the heart to ventricular fibrillation in this CKD model. Improvement of left ventricular hypertrophy, sympathetic activation, and inflammation by RDN may be responsible for its beneficial effects.

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Effects of Autologous Cytokine-Induced Killer Cells Infusion in Colorectal Cancer Patients: A Prospective Study

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 221-226.


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In Vivo and In Vitro Effects of ATM/ATR Signaling Pathway on Proliferation, Apoptosis, and Radiosensitivity of Nasopharyngeal Carcinoma Cells

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 193-203.


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Clinical Effects of CpG-Based Treatment on the Efficacy of Hepatocellular Carcinoma by Skewing Polarization Toward M1 Macrophage from M2

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 215-219.


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Selected Literature Watch

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 227-228.


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Effects of Autologous Cytokine-Induced Killer Cells Infusion in Colorectal Cancer Patients: A Prospective Study

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 221-226.


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In Vivo and In Vitro Effects of ATM/ATR Signaling Pathway on Proliferation, Apoptosis, and Radiosensitivity of Nasopharyngeal Carcinoma Cells

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 193-203.


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Clinical Effects of CpG-Based Treatment on the Efficacy of Hepatocellular Carcinoma by Skewing Polarization Toward M1 Macrophage from M2

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 215-219.


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Selected Literature Watch

Cancer Biotherapy & Radiopharmaceuticals Aug 2017, Vol. 32, No. 6: 227-228.


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Fetal Alcohol Spectrum Disorders: What Pediatric Providers Need to Know

Prenatal alcohol exposure is the cause of fetal alcohol spectrum disorders (FASDs), the prevalence of which is similar to that of other developmental disabilities like Down syndrome and autism. Children, adolescents, and adults who live with the disabilities associated with prenatal alcohol exposure face extraordinary challenges throughout their lives. Pediatric providers need to be able to identify patients with FASD because early recognition and intervention is known to improve life outcomes for affected individuals.

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NAPNAP: It is not Just for Primary Care Anymore

NAPNAP has grown steadily over the years. This is great news because some similar organizations have struggled in recent years. Our membership is now currently at 8,800 members and growing. Not only is the foundation of pediatric primary care strong in the organization, but acute care and specialty care members are gaining in numbers. It is in part due to the utilization of nurse practitioners (NPs) in hospitals that the growth of the NP movement has been so robust (Hittle & Kline-Tilford, 2010).

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Volume loading augments cutaneous vasodilatation and cardiac output of heat stressed older adults

Abstract

Primary ageing markedly attenuates cutaneous vasodilatation and the increase in cardiac output during passive heating. However, it remains unclear if these responses are maximally restrained by age-related changes in cutaneous microvascular and cardiac functions. We hypothesized that rapid volume loading performed during heat stress would increase cardiac output in older adults without parallel increases in cutaneous vasodilatation. Twelve young (Y: 26 ± 5 yrs) and ten older (O: 69 ± 3 yrs) healthy adults were passively heated until core temperature increased by 1.5°C. Cardiac output (thermodilution), forearm vascular conductance (FVC, venous occlusion plethysmography) and cutaneous vascular conductance (CVC, laser-Doppler) were measured before and after rapid infusion of warmed saline (15 mL kg−1, ∼7 min). While heat stressed, but prior to saline infusion, cardiac output (O: 6.8 ± 0.4 vs. Y: 9.4 ± 0.6 L min−1), FVC (O: 0.08 ± 0.01 vs. Y: 0.17 ± 0.02 mL/100 mL min−1 mmHg−1), and CVC (O: 1.29 ± 0.34 vs. Y: 1.93 ± 0.30 units mmHg−1) were lower in older adults (all P < 0.01). Rapid saline infusion increased cardiac output (O: +1.9 ± 0.3, Y: +1.8 ± 0.7 L min−1), FVC (O: +0.015 ± 0.007, Y: +0.048 ± 0.013 mL/100 mL min−1 mmHg−1), and CVC (O: +0.28 ± 0.10, Y: +0.29 ± 0.16 units mmHg−1) in both groups (all P < 0.01). The absolute increase in cardiac output and CVC were similar between groups, whereas FVC increased to a greater extent in young adults (P < 0.01). These results demonstrate that healthy older adults can achieve greater levels of cutaneous vasodilatation and cardiac output during passive heating.

This article is protected by copyright. All rights reserved



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Table of Contents



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Fetal Alcohol Spectrum Disorders: What Pediatric Providers Need to Know—Continuing Education Posttest



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Editorial Board



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Information for Readers



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Society



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Social and Emotional Learning

As I write this, it is in the middle of one of those weeks where the news seems to be coming at us fast and furious, with regular 'breaking news' updates on my phone about the continuing politics and terror attacks in the United Kingdom. There was also a bewildering and distressing announcement that 10 students who were admitted to a highly competitive and prestigious university had their acceptance letters rescinded after they had sent sexually explicit and racially charged memes and messages that had targeted minority groups in a private Facebook chat.

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Emergency contraception in a public health emergency “Zika virus outbreak”

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Beuy Joob, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2017 10(3):748-748



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A newer toolkit to respond to sexual violence on a global scale: World Health Organization

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Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):495-496



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Relationship of strategies for emotion cognitive adjustment with psychological well-being and anxiety in mothers with cancer children

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Abed Mahdavi, Mahjubeh Pahlevani, Maryam Aghaei, Vian Aminnasab, Hurieh Haji, Simin Gholamrezaei

Annals of Tropical Medicine and Public Health 2017 10(3):702-706

Background and Purpose: The present study was aimed to examine the relationship between strategies of emotion cognitive adjustment and psychological well-being with anxiety in mothers with cancer children. Materials and Methods: The statistical population of the study consisted of 86 individuals, who were selected using convenience sampling method; they responded to psychological well-being and anxiety questionnaires. Results: The research method was descriptive of a correlational type. Data obtained from questionnaires were analyzed through multivariate regression in SPSS software, after being marked. Findings showed that there is a significant relationship between emotion cognitive adjustment strategies and anxiety and psychological well-being in mothers with cancer children. Conclusion: Results showed that emotion cognitive adjustment predicts about 27.1% of anxiety changes and about 26.8% of psychological well-being changes in mothers with cancer children.

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Addressing the challenges of diagnostic delay and longer treatment duration for multidrug resistant tuberculosis: World Health Organization

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Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):497-498



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Zika virus disease: Potential risk for the athletes and the international visitors in the Rio Olympic Games, 2016

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Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):762-764



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Strengthening research and development activities to effectively contain the epidemics of infectious diseases: World health organization

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Saurabh R Shrivastava, Prateek S Shrivastava, Ramasamy Jegadeesh

Annals of Tropical Medicine and Public Health 2017 10(3):499-500



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Network creation to support the international collaboration: A short note on Surindra – Niigata University relationship

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Atchara Phanurat, Wasana Kaewla, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2017 10(3):738-739



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Safe space: An effective option to ensure normalcy in the lives of refugee women and girls in conflict-affected Syria

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Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):501-502



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Reactome analysis of Zika virus genes: Implication for pathogenesis

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Somsri Wiwanitkit, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2017 10(3):755-755



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Involving fathers in achieving gender equality through a television reality show

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Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):503-504



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How can we eradicate informal payments for health care in Asia?

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Mohammad Meskarpour-Amiri, Abbas Assari, Hosein Sadeghi, Lotfali Agheli

Annals of Tropical Medicine and Public Health 2017 10(3):771-772



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Self-care and self-medication: A commentary

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Tanmay Mahapatra

Annals of Tropical Medicine and Public Health 2017 10(3):505-506



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The challenges of antenna modification in medical practice: The MRI machine

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ME Emetere, ES Sanni

Annals of Tropical Medicine and Public Health 2017 10(3):726-730

The challenges of modifying the antenna of imaging systems, e.g., MRI, are enormous. The electromagnetic principles for the non-ionizing radiation technique to view internal structures in the human body depend on many factors such as the ratings of the magnetic field, computer, digitizer, RF source, and electrical field. An incorporation of the Bloch NMR flow equation alongside the electromagnetic principles is quite complex. However, the modality was successfully developed to predict the radiofrequency appropriate for the successful imaging session. It was observed that the patient is currently under severe danger of excess exposure to electromagnetic fields.

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INSPIRE: A comprehensive package to reduce violence against children and provide a safe and nurturing environment

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Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):507-508



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Taking major strides in dengue vaccine research: World health organization

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Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):743-744



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Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets

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Saurabh RamBihariLal Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):509-510



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Liver problem in zika virus infection: Possibility?

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Beuy Joob, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2017 10(3):751-752



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Census: A systematic and comprehensive tool to address the needs of the disadvantaged population groups

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Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):511-512



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What can we learn from Google Map base GIS system on opisthorchiasis in northeastern Thailand?

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Sora Yasri, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2017 10(3):758-759



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Legal protection for women in Yemen: A sorry state

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Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2017 10(3):513-514



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10 things to know to improve pediatric out-of-hospital cardiac arrest survival in your community

Follow these 10 steps when treating pediatric cardiac arrest to save lives

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Top EMS Game Changers – #9: Electronic Patient Care Reports

ePCRs allow virtually limitless information extraction through automated data storage and retrieval

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Top EMS Game Changers – #9: Electronic Patient Care Reports

Electronic PCRs, now used by roughly three quarters of U.S. EMS agencies, were pretty far from commonplace in 1995 when I started my first two paramedic jobs. One of those positions was administrative; I was responsible for keeping manual records of day-to-day patient encounters by ALS providers in our county. Creating, sorting and sometimes tabulating paper reports was no fun. I'd gotten into ...

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Progressive Paramedicine: 3 most important parts of the patient care report

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An effective radio report from EMS to the hospital is critical for patient safety and continuing care. Learn the three most important pieces of the patient radio report in this episode of Progressive Paramedicine, an EMS1 original video series. Brought to you by Pulsara.

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Progressive Paramedicine: 3 most important parts of the patient care report

Pulsara-Insertion-video3reasons-1.png

An effective radio report from EMS to the hospital is critical for patient safety and continuing care. Learn the three most important pieces of the patient radio report in this episode of Progressive Paramedicine, an EMS1 original video series. Brought to you by Pulsara.

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5 things to know about EMS chaplains

It's no secret that EMS providers have a dangerous job. While we want every responder to return home safely after a shift, sadly it doesn't always happen. In the event of a sudden death, seriously injured responder or line of duty death, an EMS chaplain provides both counseling to responders and other department members. EMS providers often help people on the worst day of their life. In the ...

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EMS Innovations: #9 Electronic Patient Care Reports

Electronic PCRs, now used by roughly three quarters of U.S. EMS agencies, were pretty far from commonplace in 1995 when I started my first two paramedic jobs. One of those positions was administrative; I was responsible for keeping manual records of day-to-day patient encounters by ALS providers in our county. Creating, sorting and sometimes tabulating paper reports was no fun. I'd gotten into ...

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EMS Innovations: #9 Electronic Patient Care Reports

ePCRs allow virtually limitless information extraction through automated data storage and retrieval

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Progressive Paramedicine: 3 most important parts of the patient care report

Pulsara-Insertion-video3reasons-1.png

An effective radio report from EMS to the hospital is critical for patient safety and continuing care. Learn the three most important pieces of the patient radio report in this episode of Progressive Paramedicine, an EMS1 original video series. Brought to you by Pulsara.

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Progressive Paramedicine: 3 most important parts of the patient care report

Pulsara-Insertion-video3reasons-1.png

An effective radio report from EMS to the hospital is critical for patient safety and continuing care. Learn the three most important pieces of the patient radio report in this episode of Progressive Paramedicine, an EMS1 original video series. Brought to you by Pulsara.

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Percutaneous management of complex acquired aortic coarctation in an adult with tetralogy of Fallot and pulmonary atresia

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Michael D Seckeler, Emily Lawson, Brent J Barber, Scott E Klewer

Annals of Pediatric Cardiology 2017 10(3):295-297

We present the case of a female adult with complex cyanotic congenital heart disease who had long-standing thoracic aortic obstruction due to scarring from earlier surgical procedures. She was symptomatic but felt to be too high risk for surgical intervention. With careful planning, she was able to undergo successful stenting of her aorta with subsequent clinical improvement. This case highlights some of the complexities of caring for adults with congenital heart disease and the importance of a thorough understanding of their anatomy and physiology and prior interventions before undertaking interventions.

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Change of guard: Introducing the new editor of the Annals of Pediatric Cardiology, Dr. KS Iyer

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Raman Krishna Kumar

Annals of Pediatric Cardiology 2017 10(3):223-223



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Quantification of ventricular unloading by 3D echocardiography in single ventricle of left ventricular morphology following superior cavo-pulmonary anastomosis and Fontan completion – a feasibility study

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Deepa Sasikumar, Bijulal Sasidharan, Baiju S Dharan, Arun Gopalakrishnan, Kavasseri M Krishnamoorthy, Sivasubramanian Sivasankaran

Annals of Pediatric Cardiology 2017 10(3):224-229

Background: Three-dimensional echocardiography. (3DE) is comparable to cardiac magnetic resonance imaging for estimating ventricular volume in congenital heart diseases. However, there are limited data on estimation of ventricular volumes by 3DE in univentricular heart and change in ventricular volumes after surgical creation of cavopulmonary connection. We sought to quantify the unloading of the single ventricle of left ventricular. (LV) morphology by 3DE after superior cavopulmonary anastomosis. (SCPA) or Fontan operation over a period of 3 months and thereby derive a preliminary 3DE data set on this patient subset. Patients and Methods: Eighteen patients with functional single ventricle of LV morphology, who underwent SCPA or completion of Fontan circulation, were included in the study. Volume of the ventricle was estimated by 3DE before surgery and after surgery. (in the early postoperative phase and 3 months after surgery), and indexed end-diastolic volume. (EDV), end.systolic volume. (ESV), and ejection fraction. (EF) were derived. Results: Twelve patients underwent SCPA and six patients underwent staged completion of Fontan circulation. Before surgery, EDV was similar in both groups. There was a significant fall in EDV immediately after SCPA (from 48.3 ± 14.9 ml/m2 to 39.5 ± 12.3 ml/m2). However, EDV increased at 3 months' follow-up to 41.3 ± 10.5 ml/m2. There was no significant fall in EDV immediately after Fontan operation (47.2 ± 10.1 ml/m2−46.6 ± 14.2 ml/m2), but EDV continued to fall at 3 months of follow-up (44.7 ± 10. ml/m2). There was no significant change in ESV in either group, but EF fell significantly after SCPA. Conclusions: We provide preliminary information on 3DE volume data of single ventricle of LV morphology and the pattern of unloading after SCPA and Fontan operation. Immediate significant volume unloading occurred after SCPA which tended to catch-up after 3 months, whereas continued fall in ventricular volume with time was noted after Fontan.

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Hypoplastic left heart syndrome with coronary-cameral fistulas: Echocardiographic demonstration of coronary artery steal and successful interventional treatment

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Arshid Mir, Mary Niu, Merick Yamada, Ed Overholt

Annals of Pediatric Cardiology 2017 10(3):306-309

We report a case of a patient with hypoplastic left heart syndrome with significant coronary-cameral fistulas and exertional symptoms from coronary steal. Symptoms resolved following successful coil occlusion of his left ventricle.

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Speckle tracking evaluation of right ventricular functions in children with sickle cell disease

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Osama Abd Rab Elrasol Tolba, Mohamed Ramadan El-Shanshory, Mohamed Abd Elaziz El-Gamasy, Walid Ahmed El-Shehaby

Annals of Pediatric Cardiology 2017 10(3):230-233

Background: Cardiac dysfunction is a risk factor for death in patients with sickle cell disease (SCD). Aim of the Work: Aim of the work is to evaluate the right ventricular systolic and diastolic functions by tissue Doppler and speckling tracking imaging in children with SCD. Subjects and Methods: Thirty children with SCD and thirty controls were subjected to clinical, laboratory evaluations, and echocardiographic study using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) including; Two-dimensional and tissue Doppler echocardiographic study (lateral tricuspid valve annulus peak E' velocity, lateral tricuspid valve annulus peak A' velocity, E'/A' ratio, isovolumetric relaxation time, lateral tricuspid valve annulus S' and septal S' waves and peak longitudinal systolic strain [PLSS] and time to PLSS) were done in six right ventricular segments. Results: There was a significant decrease in right ventricular systolic and diastolic function in patients group when compared to controls. Conclusions: Children with SCD have impaired right ventricular systolic and diastolic functions when compared to healthy children with early evaluation of the systolic dysfunction by speckle tracking imaging technique.

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Flecainide toxicity in a preterm neonate with permanent junctional reciprocating tachycardia

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Balaganesh Karmegaraj, Danish Menon, Mukund A Prabhu, Balu Vaidyanathan

Annals of Pediatric Cardiology 2017 10(3):288-292

We report a case of flecainide toxicity in a premature neonate with permanent junctional reciprocating tachycardia which was managed successfully by reversal of the sodium blockade with intravenous sodium bicarbonate and supportive care. This report highlights the importance of strict supervision and monitoring while administering antiarrhythmic drugs in neonates and prompt institution of appropriate remedial action for treatment when toxicity is suspected.

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Intraocular pressure in children after congenital heart surgery: A single-center study

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Sunali Goyal, Paul H Phillips, Lamonda A Corder, Michael J Robertson, Xiomara Garcia, Michael L Schmitz, Punkaj Gupta

Annals of Pediatric Cardiology 2017 10(3):234-239

Background: The impact of varied cardiac physiologies on intraocular pressure (IOP) among children undergoing heart operations is unknown. Aim: The aim of this study was to determine the IOP among children with varying cardiovascular physiologies and varying hemodynamics after their heart operation. Setting and Design: This was a prospective, observational study. Materials and Methods: Patients ≤18 years undergoing congenital heart surgery were included in this study. IOP measurement was performed by Icare® tonometer between 3 and 14 days after heart operation. Statistical Analysis: Summary statistics were estimated for all demographic, anthropometric, and clinical data. Results: A total of 116 eyes from 58 children were included. The mean and standard deviation age was 28.4 (45.8) months. Single-ventricle anatomy was present in 26 patients (45%). Despite similar heart rate and blood pressure, the mean IOP among the patients with single-ventricle anatomy was significantly elevated as compared to patients with two-ventricle anatomy (18 mm Hg vs. 12 mm Hg, P < 0.001). There was no difference in IOP measurements based on the complexity of operation performed. We noted that patients undergoing surgical palliation with central shunt (21 mm Hg), Fontan operation (19 mm Hg), bidirectional Glenn operation (19 mm Hg), Norwood operation (19 mm Hg), or definitive repairs such as tetralogy of Fallot repair (17 mm Hg), and atrioventricular canal repair (19 mm Hg) were associated with the highest IOPs in the study cohort. Conclusions: This study demonstrates that IOPs vary with varying cardiovascular physiology after pediatric cardiac surgery.

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Anomalous origin of the left brachiocephalic artery in the right aortic arch: Is there a method to the madness?

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Mani Ram Krishna, Ganesh Kumar Gnanappa, Rachel Fitzpatrick, Julian Ayer, David Winlaw

Annals of Pediatric Cardiology 2017 10(3):301-303

The anomalous origin of the left brachiocephalic artery in a right sided aortic arch is a rare vascular ring which might lead to esophageal compression. The exact embryological origin of this anomaly is still widely debated. We present an infant who presented with esophageal compression symptoms and review the various hypotheses about the embryological origin of this anomaly.

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Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients

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Zachary Hena, Nicole J Sutton, Gregory J Gates, Benjamin H Taragin, Robert H Pass

Annals of Pediatric Cardiology 2017 10(3):240-244

Background: Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Materials and Methods: Review of patients ≤20 kg in whom the Mongoose® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann–Whitney U-test; P < 0.05 was statistically significant. Results: Twelve (9 female) patients were catheterized with a 3.3 Fr Mongoose®. Median weight 10.5 kg (range 6.4–18.2), height 81 cm (range 37–111), and body surface area (BSA) 0.47 m2 (range 0.33–0.75) were similar to ten patients (3 females) in the 4 Fr control group (P = NS); median weight 9.9 kg (range 6–16.8), height 80 cm (range 64–102), and BSA 0.46 m2 (range 0.31–0.74). Angiographic quality was subjectively adequate with both with no difference in the median pixel density between the two techniques (3.3 Fr: 76.7 [range 33.5–90] and 4 Fr: [70; 38–102]; P = NS). Contrast used was similar between the groups (3.3 Fr: median 4.2 ml/kg and 4 Fr: 4.9 ml/kg; P = NS). Median radiation dose was similar in the two groups (3.3 Fr: 28.1 mGy [range 17.2–38] and 4 Fr: 38 mGy [range 20.4–58.5]; P = NS). All ducts were closed at latest follow-up ( P = NS). No complications were encountered. Conclusions: The 3.3 Fr Mongoose® allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children.

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Staphylococcal endocarditis after chicken pox in a child with structurally normal heart

AnnPediatrCard_2017_10_3_312_213359_f1.j

Dheeraj Deo Bhatt, Nihit Kharkwal, Dinesh Kumar Yadav

Annals of Pediatric Cardiology 2017 10(3):312-313



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Does heart-type fatty acid-binding protein predict clinical outcomes after pediatric cardiac surgery?

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Egmond S Evers, Varsha Walavalkar, Suresh Pujar, Latha Balasubramanian, Frits W Prinzen, Tammo Delhaas, Ward Y Vanagt, Shreesha Maiya

Annals of Pediatric Cardiology 2017 10(3):245-247

Introduction: The early identification of vulnerable pediatric cardiac surgery patients can help clinicians provide them with timely support. Heart-type fatty acid-binding protein. (H-FABP) is an early biomarker of myocardial injury in acute myocardial infarction in adults. In this study, we evaluated the correlations between postoperative H-FABP, creatine kinase-myocardial band (CK-MB), troponin-I, total bypass time, and clinical outcomes. Methods: In 32 pediatric patients that underwent ventricular septal defect. closure we measured H-FABP, troponin-I and CK-MB preoperatively and 1, 3, and 6 h after aortic declamping. Spearman's Rho correlations were calculated between laboratory and clinical parameters including inotropic support duration, aortic cross-clamp time, total bypass time, ventilation.weaning.time, and total Intensive Care Unit stay. Results: H-FABP, CK-MB, troponin-I, and total bypass time have a similarly weak to moderate correlation with clinical outcome measures. Conclusions: The predictive value of H-FABP for clinical outcome is not stronger than that of CK-MB, Troponin-I, or bypass times.

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Chronic antepartum maternal hyperoxygenation in a case of severe fetal Ebstein's anomaly with circular shunt physiology

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Alisa Arunamata, David M Axelrod, Katherine Bianco, Sowmya Balasubramanian, Amy Quirin, Theresa A Tacy

Annals of Pediatric Cardiology 2017 10(3):284-287

Perinatal mortality remains high among fetuses diagnosed with Ebstein's anomaly of the tricuspid valve. The subgroup of patients with pulmonary valve regurgitation is at particularly high risk. In the setting of pulmonary valve regurgitation, early constriction of the ductus arteriosus may be a novel perinatal management strategy to reduce systemic steal resulting from circular shunt physiology. We report the use of chronic antepartum maternal oxygen therapy for constriction of the fetal ductus arteriosus and modulation of fetal pulmonary vascular resistance in a late presentation of Ebstein's anomaly with severe tricuspid valve regurgitation, reversal of flow in the ductus arteriosus, and continuous pulmonary valve regurgitation.

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Brugada syndrome in children - Stepping into unchartered territory

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Shashank P Behere, Steven N Weindling

Annals of Pediatric Cardiology 2017 10(3):248-258

Brugada syndrome (BrS) is an autosomal dominant inherited channelopathy. It is associated with a typical pattern of ST-segment elevation in the precordial leads V1–V3 and potentially lethal ventricular arrhythmias in otherwise healthy patients. It is frequently seen in young Asian males, in whom it has previously been described as sudden unexplained nocturnal death syndrome. Although it typically presents in young adults, it is also known to present in children and infants, especially in the presence of fever. Our understanding of the genetic pathogenesis and management of BrS has grown substantially considering that it has only been 24 years since its first description as a unique clinical entity. However, there remains much to be learned, especially in the pediatric population. This review aims to discuss the epidemiology, genetics, and pathogenesis of BrS. We will also discuss established standards and new innovations in the diagnosis, prognostication, risk stratification, and management of BrS. Literature search was run on the National Center for Biotechnology Information's website, using the Medical Subject Headings (MeSH) database with the search term "Brugada Syndrome" (MeSH), and was run on the PubMed database using the age filter (birth–18 years), yielding 334 results. The abstracts of all these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.

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Congenital left atrial appendage aneurysm: Atypical presentation

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Mehdi Bamous, Mahdi Aithoussa, Ayoub Abetti, Abdelatif Boulahya

Annals of Pediatric Cardiology 2017 10(3):293-294

Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.

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Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children

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Surabhi Reddy, Eva Eliassen, Gerhard R Krueger, Bibhuti B Das

Annals of Pediatric Cardiology 2017 10(3):259-268

Over the last decade, human herpesvirus 6 (HHV-6) has been implicated in the etiology of pediatric myocarditis and subsequent dilated cardiomyopathy (DCM). This review provides an overview of recent literature investigating the pathophysiological relevance of HHV-6 in inflammatory cardiomyopathy. We examined 11 cases of previously published pediatric myocarditis and/or DCM associated with HHV-6 and also our experience of detection of virus particles in vascular endothelium of HHV-6 positive endomyocardial biopsy tissue by electron microscopy. The exact role of the presence of HHV-6 and its load remains controversial as the virus is also found in the heart of healthy controls. Therefore, the question remains open whether and how cardiac HHV-6 may be of pathogenetic importance. Quantitative polymerase chain reaction or mRNA testing allows differentiation between low-level latent virus found in asymptomatic myocardium and active HHV-6 infection. Although only a small number of pediatric cases have been reported in literature, HHV-6 should be considered as a causative agent of inflammatory cardiomyopathy, especially in children under three who might be experiencing a primary infection. Future studies are needed to establish a threshold for determining active infection in biopsy samples and the role of coinfections other cardiotropic viruses.

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Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease

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Nayan T Srivastava, John J Parent, Marcus S Schamberger

Annals of Pediatric Cardiology 2017 10(3):298-300

Feeding difficulty has been reported at a higher incidence in infants with cyanotic heart disease and single ventricle physiology necessitating specialized feeding strategies. However, structural causes of feed intolerance in this subset of patients should not be ignored. This case series highlights three recent cases of pyloric stenosis in infants with left-sided obstructive lesions at our institution. In all three cases, the initial presumed diagnosis was feeding intolerance related to heart disease, and there was significant clinical improvement following identification and correction of pyloric stenosis.

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Clarifying the anatomy and physiology of totally anomalous systemic venous connection

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Saurabh Kumar Gupta, Rajnish Juneja, Robert H Anderson, Gurpreet S Gulati, Velayoudam Devagorou

Annals of Pediatric Cardiology 2017 10(3):269-277

The description of totally anomalous systemic venous connection is limited to case reports. In this review, we seek to clarify anatomic, physiologic, and hemodynamic aspects of this extremely rare anomaly. We also present findings of two patients in whom connection of all the systemic veins was anomalous. In the first patient, with usual atrial arrangement, all systemic veins, including the coronary sinus, were connected anomalously to the morphologically left atrium. Limited left-to-right shunt across an atrial septal defect provided the only source of blood flow to the lungs. The diagnosis was established by saline contrast echocardiography and cardiac catheterization. Extreme hypoplasia of the right ventricle precluded corrective surgery, so we performed a bidirectional Glenn operation, along with atrial septectomy. The second patient had isomerism of the left atrial appendages, which creates problems in the definition in anatomic terms since the connection of the systemic veins can never be normal anatomically when both atriums possess a morphologically left appendage. Our patient, nonetheless, had all the systemic and pulmonary veins, connected to the left-sided atrial chamber which then connected to the left ventricle, thus producing hemodynamics of totally anomalous systemic venous connection. We propose an algorithm for evaluation of this hemodynamic combination and discuss management options. We also intend to clarify the potential differences between connection and drainage, with particular attention to the arrangement of atrial appendages. Even though the hemodynamics may be comparable, in anatomic terms, both systemic and pulmonary venoatrial connection will always be anomalous with isomeric atrial appendages.

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Central perforation of atretic pulmonary valve using coronary microcatheter

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Saurabh Kumar Gupta, Rajnish Juneja, Anita Saxena

Annals of Pediatric Cardiology 2017 10(3):304-305

Percutaneous perforation of pulmonary valve, using 0.014" guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation.

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Anomalous origin of right pulmonary artery from innominate artery: Repair using pulmonary artery pedicled flap plasty

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Roy Varghese, Jai Ganesh, Jeeva Nandam, Sujathaa Ravikumar, Sivakumar Kothandam

Annals of Pediatric Cardiology 2017 10(3):278-280

Origin of the right pulmonary artery from innominate artery is an exceedingly rare anomaly. We report two cases with this anomaly that underwent surgical repair. The surgical technique described achieves tissue-to-tissue anastomosis using a pedicled flap from the main pulmonary artery.

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Ductal aneurysm with postsubclavian coarctation of aorta in an adult

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Dibya Ranjan Behera, Krishna Kumar Mohanan Nair, Bijulal Sasidharan

Annals of Pediatric Cardiology 2017 10(3):310-311

We describe a case of ductal aneurysm in an adult patient with post subclavian coarctation of aorta, which is a very rare association.

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Placing Health Trajectories in Family and Historical Context: A Proposed Enrichment of the Life Course Health and Development Model

Abstract

Purpose This article offers constructive commentary on The Life Course Health and Development Model (LCHD) as an organizing framework for MCH research. Description The LCHD has recently been proposed as an organizing framework for MCH research. This model integrates biomedical, biopsychosocial, and life course frameworks, to explain how "individual health trajectories" develop over time. In this article, we propose that the LCHD can improve its relevance to MCH policy and practice by: (1) placing individual health trajectories within the context of family health trajectories, which unfold within communities and societies, over historical and generational time; and (2) placing greater weight on the social determinants that shape health development trajectories of individuals and families to produce greater or lesser health equity. Assessment We argue that emphasizing these nested, historically specific social contexts in life course models will enrich study design and data analysis for future developmental science research, will make the LCHD model more relevant in shaping MCH policy and interventions, and will guard against its application as a deterministic framework. Specific ways to measure these and examples of how they can be integrated into the LCHD model are articulated. Conclusion Research applying the LCHD should incorporate the specific family and socio-historical contexts in which development occurs to serve as a useful basis for policy and interventions. Future longitudinal studies of maternal and child health should include collection of time-dependent data related to family environment and other social determinants of health, and analyze the impact of historical events and trends on specific cohorts.



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Factitious disorder: a rare cause of haematemesis

Abstract

Acute upper gastrointestinal (GI) bleeding is a common condition in the UK with 50–70,000 admissions per year. In 20% of cases no cause can be found on endoscopy. Here, we present the case of a young female patient who was admitted on three occasions with large volume haematemesis and bleeding from other sites. She was extensively investigated and underwent multiple endoscopic procedures. She was eventually diagnosed with factitious disorder after concerns were raised about the inconsistent nature of her presentations. She was found to be venesecting herself from her intravenous cannula, and ingesting the blood to simulate upper GI bleeding. This is a rare cause of 'haematemesis' but perhaps not as rare as is thought.



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Visuo-manual tracking: does intermittent control with aperiodic sampling explain linear power and non-linear remnant without sensorimotor noise?

Abstract

The human operator is described adequately by linear translation of sensory input to motor output. Motor output also always includes a non-linear remnant resulting from random sensorimotor noise from multiple sources, and non-linear input transformations, for example thresholds or refractory periods. Recent evidence showed that manual tracking incurs substantial, serial, refractoriness (insensitivity to sensory information; 350, 550 ms; 1st 2nd order systems respectively). Our two questions are (i) the comparative merits of explaining the non-linear remnant using noise or non-linear transformations (ii) can non-linear transformations represent serial motor decision making within the sensorimotor feedback loop intrinsic to tracking?

Twelve participants (instructed to act in three prescribed ways) manually controlled two systems (1st, 2nd order) subject to a periodic multi-sine disturbance. Joystick power was analysed using three models, continuous-linear-control (CC), continuous-linear-control with calculated noise spectrum (CCN), and intermittent control with aperiodic sampling triggered by prediction error thresholds (IC). Unlike the linear mechanism, the intermittent control mechanism explained the majority of total power (linear and remnant) (77–87% v. 8–48%, IC v CC). Between conditions, IC used thresholds and distributions of open loop intervals consistent respectively with instructions and previous measured, model independent values; whereas CCN required changes in noise spectrum deviating from broadband, signal dependent noise. We conclude manual tracking uses open loop predictive control with aperiodic sampling. Because aperiodic sampling is inherent to serial decision making within previously identified, specific frontal, striatal and parietal networks we suggest that these structures are intimately involved in visuomanual tracking.

This article is protected by copyright. All rights reserved



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Rocuronium bromide: clinical application of single-dose pharmacokinetic models to continuous infusion



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Pharmacokinetic and pharmacodynamics of intravenous dexmedetomidine in morbidly obese patients undergoing laparoscopic surgery

Abstract

Background

This study was designed to investigate the pharmacokinetics and pharmacodynamics of dexmedetomidine in morbidly obese patients undergoing laparoscopic surgery.

Methods

Morbidly obese (body mass index ≥40 kg/m2) and normal weight patients scheduled for elective laparoscopic surgery were included (n = 8, each group). After baseline hemodynamic measurement, dexmedetomidine 1 μg/kg was administered over 10 min. General anesthesia was induced with propofol 1.5 mg/kg and fentanyl 4 μg/kg 20 min after completion of dexmedetomidine infusion; the lungs were mechanically ventilated after tracheal intubation. The pharmacokinetics of dexmedetomidine was analyzed by a noncompartment model. Hemodynamic data and peripheral oxygen saturation (SpO2) were measured up to 30 min after starting dexmedetomidine infusion. Sedation level was measured with the Observer's Assessment of Alertness/Sedation (OAA/S) scale.

Results

Peak plasma concentration, area under the curve to infinity, elimination half-life, and apparent volume of distribution were significantly larger in morbidly obese than in normal weight patients (3.75 ± 0.56 vs. 2.54 ± 0.32 µg/l, P < 0.001; 2174 ± 335 vs. 1594 ± 251 ng h/l, P < 0.001; 225 ± 55 vs. 158 ± 53 min, P = 0.02; 310 ± 63 vs. 164 ± 41 l, P < 0.001, respectively). Although clearance was also higher in obese patients than in normal body weight patients (58.6 ± 10.7 vs. 44.9 ± 9.0 l/h, P = 0.02), it was lower in obese patients than in normal body weight patients after normalization to total body weight (0.47 ± 0.07 vs. 0.64 ± 0.09 l/h/kg, P < 0.001). There were no differences in systolic or diastolic blood pressure or heart rate between the two groups within the 30 min. Sedation level was deeper and SpO2 was lower in morbidly obese than in normal weight patients. More patients in the morbidly obese patient group experienced deeper sedation after the start of the dexmedetomidine infusion (P < 0.05).

Conclusion

The pharmacokinetics and pharmacodynamics of dexmedetomidine are significantly different in morbidly obese patients compared with normal weight patients. Level of sedation was significantly deeper, and oxygen saturation was significantly lower, in morbidly obese than in normal weight patients, probably resulting from higher plasma concentration after infusion of 1.0 µg/kg.

Clinical trial number, registry URL

ClinicalTrials.gov (NCT01864187), http://ift.tt/2vWvn43.



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Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure-flow analysis

Neurogastroenterology & Motility

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US House Democrats launch probe into MS drug pricing

Reuters Health News

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Surveying the effect of a self-care education program on severity of nausea and emesis in colorectal cancer patients under chemotherapy

Journal of Multidisciplinary Healthcare

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Errors found in study claiming physicians underestimate women's heart risks

Reuters Health News

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Prospective evaluation of the clinical implications of the tumor metabolism and chemotherapy-related changes in advanced biliary tract cancer

The Journal of Nuclear Medicine

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Thiopurines prevented surgical recurrence in patients with Crohn's disease after intestinal resection: Strategy based on risk stratification

Journal of Gastroenterology and Hepatology

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Sacral nerve stimulation for constipation and fecal incontinence in children: Long-term outcomes, patient benefit, and parent satisfaction

Neurogastroenterology & Motility

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Higher mortality despite early ART in HIV and hepatitis B virus coinfected patients with high HBV replication

Clinical Infectious Diseases

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Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy: A systematic review and meta-analysis

International Journal of Surgery

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Use of laboratory markers in diagnosis of inflammatory bowel disease in children

JAMA Pediatrics

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Pancreatic intraductal tubulopapillary neoplasm is genetically distinct from intraductal papillary mucinous neoplasm and ductal adenocarcinoma

Modern Pathology

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Add-on neurological benefits of antiviral therapy in HCV patients with chronic kidney disease - A nationwide cohort study

BMC Gastroenterology

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Surgeries to remove weight-loss devices on the rise

Reuters Health News

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Subclinical hypothyroidism and low-normal thyroid function are associated with nonalcoholic steatohepatitis and fibrosis

Clinical Gastroenterology and Hepatology

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Conservative treatment versus surgery for uncomplicated appendicitis in children: A systematic review and meta-analysis

Archives of Diseases in Childhood

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Patient characteristics associated with quality of colonoscopy preparation: A systematic review and meta-analysis

Clinical Gastroenterology and Hepatology

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Evaluation of HCC response to locoregional therapy: Validation of MRI-based response criteria versus explant pathology

Journal of Hepatology

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Poor adherence to hepatocellular carcinoma surveillance: A systematic review and meta-analysis of a complex issue

Liver International

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Nasogastric decompression not associated with a reduction in surgery or bowel ischemia for acute small bowel obstruction

The American Journal of Emergency Medicine

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Endoscopic characteristics of infection-associated peptic ulcers

Helicobacter

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Gene therapy: Human genome editing in heart disease

Nature Reviews Genetics. doi:10.1038/nrg.2017.69

Author: Gregory B. Lim



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Human genetic variation and the gut microbiome in disease

Nature Reviews Genetics. doi:10.1038/nrg.2017.63

Authors: Andrew Brantley Hall, Andrew C. Tolonen & Ramnik J. Xavier



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Erratum to: Sitting position affects performance in cross-country sit-skiing



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