Exploring Mothers’ Influence on Preschoolers’ Physical Activity and Sedentary Time: A Cross Sectional Study

Abstract

Objectives Physical activity patterns can track from childhood into adulthood; therefore, establishing active behaviors early is imperative. Given the multidimensional nature of a mother's influence on their children, there is a need to utilize more comprehensive measures to assess the relationship between mother and child activity behaviors. Specifically, mothers have been identified as influencing preschoolers' activity behaviors and are often in control of organizing a family's opportunities to be active. The purpose of this study was to explore maternal influence on preschoolers' physical activity and sedentary time. Methods Preschoolers (n = 24) and their mothers (n = 24) wore Actical™ accelerometers for 7 consecutive days (e.g., 5 weekday, 2 weekend days), and mothers completed the adapted Environmental Determinants of Physical Activity in Preschool Children—Parent Survey. Direct entry regression analyses were conducted to explore maternal influence (e.g., role modeling through mothers' activity levels, maternal support, and enjoyment of being active) on preschoolers' activity levels. Results Maternal support was found to be a significant predictor of preschoolers' light and moderate–vigorous physical activity, and sedentary time (p < .05); accounting for 37.3–46.7% of the variation. Conclusions for Practice Mothers supportive behaviors influenced preschoolers' physical activity and sedentary time. Future research is needed to investigate facilitators/barriers that mothers with preschoolers encounter with regard to providing support to be active or modeling active behaviors themselves.

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A pilot study of direct delivery of hydroxypropyl-beta-cyclodextrin to the lung by the nasal route in a mouse model of Niemann-Pick C1 disease: motor performance is unaltered and lung disease is worsened

Abstract

We have tested the efficacy of hydroxypropyl-beta-cyclodextrin (HPBCD) delivered by the nasal route in the mouse model of juvenile Niemann-Pick C1 disease (NPC1), as pulmonary disease has not responded to systemic therapy with this drug. Since mice have no gag reflex, coating of the nasal cavity, with possible access to the brain, would be followed by delivery of HPBCD to the lung. While foamy macrophages, containing stored cholesterol, were found in the Npc1^nmf164 homozygous mice, a marked inflammatory response was found with inhaled HPBCD, both in mutant and wild-type animals. Slight inflammation also occasionally occurred with saline inhalation. There was no difference between the saline-treated, HPBCD-treated, and untreated Npc1^nmf164 homozygous mice for weight, balance beam performance, or coat hanger performance. Interestingly, there was a trend to longer survival in the HPBCD-treated Npc1^nmf164 homozygous mice, which, when combined with the survival times of the saline-treated survivals (each of which was not different), became significant.

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Dura to spinal cord distance at different vertebral levels in children and its implications on epidural analgesia: A retrospective MRI-based study

Summary

Background

The distance from the dura to spinal cord is not uniform at different vertebral levels. The dura to spinal cord distance may be a critical factor in avoiding the potential for neurological injury caused by needle trauma after a dural puncture. Typically, the greater the dura to spinal cord distance, the larger the potential safety margin. The objective of our study is to measure dura to spinal cord distance at two thoracic levels T₆-₇, T₉-₁₀, and one lumbar level L₁-₂ using MRI images.

Methods

Eighty-eight children under the age of 8 years old qualified for the study. The distance from dural side of ligamentum flavum to the posterior margin of the spinal cord was defined as dura to spinal cord distance. Sagittal T₂-weighted images of the thoracic and lumbar spine were used to measure the dura to spinal cord distance at the T_6-7, T_9-10, and L_1-2 interspaces. Measurements were taken perpendicular to long axis of the vertebral body at each level.

Results

The dura to spinal cord distance was 5.9 ± 1.6 mm at T_6-7 (range: 1.4-9.9 mm), 5.0 ± 1.6 mm at T_9-10 (1.2-8.1 mm), and 3.6 ± 1.2 mm at L_1-2 (1.2-6.8 mm). There were no evident differences in dura to spinal cord distance by gender, age, height, or weight.

Conclusion

The present study reports that the largest dura to spinal cord distance is found at the T_5-6 level, and the shortest dura to spinal cord distance at the L_1-2 level. There appears to be substantially more room in the dorsal subarachnoid space at the thoracic level. The risk of spinal cord damage resulting from accidental epidural needle advancement may be greater in the lumbar region due to a more dorsal location of the spinal cord in the vertebral canal compared to the thoracic region.

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Sympathetic vasomotor activity during dynamic exercise with resistive breathing: Sex differences and the nerve to show it!

Abstract

Respiratory muscle metaboreflexes exert substantial influence over cardiorespiratory and autonomic control, exemplified during heavy dynamic exercise in health, and in obstructive airways disease even at rest.

This article is protected by copyright. All rights reserved

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Mobility of 232Th and 210Po in red mud

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Miklós Hegedűs, Edit Tóth-Bodrogi, Jácint Jónás, János Somlai, Tibor Kovács
The valorization of industrial by-products such as red mud became a tempting opportunity, but the understanding of the risks involved is required for the safe utilization of these products. One of the risks involved are the elevated levels of radionuclides (in the 100–1300 Bq/kg range for both the ²³⁸U and ²³² Th decay chains, but usually lower than 1000 Bq/kg, which is the recommended limit for excemption or clearance according to the EU BSS released in 2013) in red mud that can affect human health. There is no satisfactory answer for the utilization of red mud; the main current solution is still almost exclusively disposal into a landfill. For the safe utilization and deposition of red mud, it is important to be able to assess the leaching behaviour of radionuclides. Because there is no commonly accepted measurement protocol for testing the leaching of radionuclides in the EU a combined measurement protocol was made and tested based on heavy metal leaching methods. The leaching features of red mud were studied by methods compliant with the MSZ-21470-50 Hungarian standard, the CEN/TS 14429 standard and the Tessier sequential extraction method for ²³²Th and ²¹⁰Po. The leached solutions were taken to radiochemical separation followed by spontaneous deposition for Po and electrodeposition for Th. The 332 ± 33 Bq/kg ²³²Th content was minimally mobile, 1% became available for distilled water 1% and 6% for Lakanen-Erviö solution; the Tessier extraction showed minimal mobility in the first four steps, while more than 85% remained in the residue. The ²¹⁰Po measurements had a severe disturbing effect in many cases, probably due to large amounts of iron present in the red mud, from the 310 ± 12 Bq/kg by aqua regia digestion, distilled water mobilized 23%, while Lakanen-Erviö solution mobilized ∼13%. The proposed protocol is suitable for the analysis of Th and Po leaching behaviour.



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Ontogeny-related pharmacogene changes in the pediatric liver transcriptome

Objectives The majority of drug dosing studies are based on adult populations, with modification of the dosing for children based on size and weight. This rudimentary approach for drug dosing children is limited, as biologically a child can differ from an adult in far more aspects than just size and weight. Specifically, understanding the ontogeny of childhood liver development is critical in dosing drugs that are metabolized through the liver, as the rate of metabolism determines the duration and intensity of a drug's pharmacologic action. Therefore, we set out to determine pharmacogenes that change over childhood development, followed by a secondary agnostic analysis, assessing changes transcriptome wide. Materials and methods A total of 47 human liver tissue samples, with between 10 and 13 samples in four age groups spanning childhood development, underwent pair-end sequencing. Kruskal–Wallis and Spearman's rank correlation tests were used to determine the association of gene expression levels with age. Gene set analysis based on the pathways in KEGG utilized the gamma method. Correction for multiple testing was completed using q-values. Results We found evidence for increased expression of 'very important pharmacogenes', for example, coagulation factor V (F5) (P=6.7×10−7), angiotensin I converting enzyme (ACE) (P=6.4×10−3), and solute carrier family 22 member 1 (SLC22A1) (P=7.0×10−5) over childhood development. In contrast, we observed a significant decrease in expression of two alternative CYP3A7 transcripts (P=1.5×10−5 and 3.0×10−5) over development. The analysis of genome-wide changes detected transcripts in the following genes with significant changes in mRNA expression (P

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Differential effect of ABCB1 haplotypes on promoter activity

Objective Promoter single-nucleotide polymorphisms (SNPs) of the ABCB1 gene, encoding the placental efflux transporter P-glycoprotein, can affect its expression and alter xenobiotic transfer from the maternal to the fetal circulation. Because SNPs are arranged in specific combinations as defined haplotypes, the aims of this study were to: (i) determine the placental haplotype structure of the ABCB1 promoter and (ii) determine the differential effect of these haplotypes on placental ABCB1 promoter activity. Materials and methods DNA samples from 100 healthy placentas were PCR-amplified and sequenced to identify existing SNPs in the proximal ABCB1 promoter. The haplotype structure encompassing these SNPs was inferred by PHASE analysis. Luciferase reporter constructs representing these haplotypes were generated and transfected into human placental 3A cells and their effect on ABCB1 promoter activity was determined using a dual-luciferase assay. Results We identified 12 ABCB1 promoter SNPs. These SNPs were predicted by PHASE to segregate into 28 haplotypes with frequencies ranging between 0.019 and 0.88. We found 12 of these haplotypes in our population in addition to two haplotypes not predicted by PHASE. We also generated two haplotypes to determine individual SNP effects for a total of 16 studied. Compared with the ancestral haplotype, three haplotypes significantly up-regulated (107–266% increase; P

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Whole-genome methylation profiling of peripheral blood mononuclear cell for acute exacerbations of chronic obstructive pulmonary disease treated with corticosteroid

Objective Although association studies in the general population may be relevant for determining susceptibility to chronic obstructive pulmonary disease (COPD), they may be less applicable for pharmacogenetics research in participants who have already acquired the disease. Patients and methods A genome-wide methylation profiling (generated by HumanMethylation450 BeadChips study was performed on peripheral blood mononuclear cells of 24 patients with AECOPD (acute exacerbation COPD), with good and poor responsiveness to standard corticosteroid treatment. Pyrosequencing was used to replicate the selected CpG sites in 50 patients with AECOPD with standard corticosteroid treatment. Results The results showed the patients with AECOPD with good and poor response to standard corticosteroid treatment have a distinct DNA methylation pattern. A total of 23 CpG loci located in 19 known gene regions, including gene-body and promoter, appeared to be significantly differentially methylated. Replication by pyrosequencing revealed that one CpG site in PSMD8 showed the same trend of differential methylation and reached to statistical significance as the microarray result. Conclusion Our preliminary findings provide evidence for molecular heterogeneity in patients with AECOPD, which may contribute to significant differences in their response to COPD treatment.

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Specific association of the rs6500265 and rs9933632 single-nucleotide polymorphisms in Japanese patients with antipyretic analgesic-related Stevens–Johnson syndrome and toxic epidermal necrolysis with severe ocular involvements

A recent study using the microarray for single-nucleotide polymorphisms (SNPs) genotyping specifically designed for the Japanese population in combination with genome-wide imputation showed the association of several SNPs with cold medicine-related Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with severe ocular complications. However, it remains to be determined whether these polymorphisms are associated with the onset of antipyretic analgesic (AA)-related SJS/TEN, the progression of severe ocular involvements (SOIs), or both AA-related SJS/TEN and SOI phenotypes. To gain a better understanding of the features of these genetic markers, we compared the allele and carrier frequencies of these SNPs among our original SJS/TEN patient groups: (a) AA-related SJS/TEN with SOIs, (b) AA-related SJS/TEN without SOIs, and (c) AA-unrelated SJS/TEN with SOIs. AA-related SJS/TEN with SOIs were found to be associated significantly with both rs6500265 [allele frequency: odds ratio (OR): 2.18; 95% confidence interval (CI): 1.30–3.65; P=0.0052; carrier frequency: OR: 2.52; 95% CI: 1.33–4.78; P=0.058] and rs9933632 (allele frequency: OR: 2.28: 95% CI: 1.37–3.79; P=0.0032; carrier frequency: OR: 2.76; 95% CI: 1.46–5.22; P=0.0031). In contrast, allele and carrier frequencies of these SNPs in patients with AA-related SJS/TEN without SOIs or with SOIs not treated with any AAs were comparable with those in healthy Japanese controls. Collectively, our findings indicate that the rs6500265 and rs9933632 SNPs could be specific markers for AA-related SJS/TEN with SOIs, suggesting that certain genetic backgrounds contribute toward the etiology of this complex syndrome.

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Long-term outcomes of a large, prospective observational cohort of older adults with back pain

Although back pain is common among older adults, there is relatively little research on the course of back pain in this age group.

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Issue Information

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Cover Image

The cover image, by Y. Satokawa et al., is based on the Original Article Short-term changes in chewing efficiency and subjective evaluation in normal dentate subjects after insertion of oral appliances with an occlusal fl at table, DOI : 10.1111/joor.12586.

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Physician turnover effect for in-hospital cardiopulmonary resuscitation: a 10-year experience in a tertiary academic hospital

Abstract

Purpose

Controversy exists as to whether the physician turnover affects patient outcome in academic hospitals. In-hospital cardiopulmonary resuscitation (CPR) is an important indicator of in-hospital mortality. This study aimed to investigate whether the physician turnover is associated with the in-hospital CPR rate.

Methods

This retrospective cohort study was conducted at a single center; all in-hospital CPR cases among in-patients from 1 January 2007 to 31 December 2016 were analyzed. The turnover period was defined as the changeover of the trainee workforce in March, May, and November. The primary outcome was any variation in the monthly in-hospital CPR events (per 1000 admissions). The secondary outcomes were return of spontaneous circulation (ROSC), CPR in intensive care unit (ICU), monthly in-hospital deaths per 1000 admissions, and average length of hospital stay.

Results

A total of 2182 in-hospital CPR cases were included in the analysis. Monthly in-hospital CPR rates were greater during the turnover period when compared to the non-turnover period (4.66 ± 1.02 vs. 4.18 ± 1.56, P = 0.027). There was no significant difference in ROSC rate, CPR in ICU rate, monthly in-hospital deaths per 1000 admissions, or average length of hospital stay between the two periods.

Conclusion

Our findings indicate that physician turnover may be associated with in-hospital CPR rate. However, physician turnover was not associated with ROSC rate, rate of CPR in the ICU, in-hospital death, or length of hospital stay.

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Abdominal Muscle Density is Inversely Related to Adiposity Inflammatory Mediators

ABSTRACTPurposeSkeletal muscle is the largest regulator of glucose metabolism but few population-based studies have examined the associations between muscle and inflammation. We studied the relationships between abdominal muscle area and density with selected adiposity associated inflammatory mediators.MethodsNearly 2,000 subjects underwent computed tomography (CT) of the abdomen and had venous fasting blood drawn concomitantly. The CT scans were interrogated for visceral and subcutaneous fat, as well as abdominal lean muscle areas and densities. We then categorized the muscle into locomotion (psoas) and stabilization (rectus, obliques and paraspinal) groups. Blood samples were assayed for interleukin-6 (IL-6), resistin, C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α).ResultsThe mean age was 64.7 years and 49% were female. Forty percent were White, 26% Hispanic/Latino American, 21% African American, and 13% Chinese American. The mean BMI was 28.0 kg/m2 and 30% were obese (BMI >30 kg/m2). Using multivariable linear regression models that included adjustment for abdominal muscle area, a 1-SD increment in the mean densities for total, stabilization and locomotive abdominal muscle were each significantly associated with lower levels of IL-6 (β= -15%, -15% and -9%, p 30 kg/m2). Using multivariable linear regression models that included adjustment for abdominal muscle area, a 1-SD increment in the mean densities for total, stabilization and locomotive abdominal muscle were each significantly associated with lower levels of IL-6 (β= -15%, -15% and -9%, p

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Prenatal detection of uniparental disomy of chromosome 2 carrying a CHRND pathogenic variant that causes lethal multiple pterygium syndrome

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Paediatric genomics: diagnosing rare disease in children

Paediatric genomics: diagnosing rare disease in children

Paediatric genomics: diagnosing rare disease in children, Published online: 05 February 2018; doi:10.1038/nrg.2017.116

The emerging field of paediatric genomics has leveraged the power of next-generation sequencing technologies to improve the diagnostic rates of rare disease in children. This Review addresses key considerations for safe and effective implementation of genomics in the clinic.

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Tandem repeats mediating genetic plasticity in health and disease

Tandem repeats mediating genetic plasticity in health and disease

Tandem repeats mediating genetic plasticity in health and disease, Published online: 05 February 2018; doi:10.1038/nrg.2017.115

DNA repeats are more liable to mutation than other genetic variants, which enables them to mediate genetic plasticity. The expansion of tandem repeats can cause a range of monogenic disorders, contribute to the missing heritability of polygenic disorders and regulate gene expression, as well as RNA and protein function, in healthy individuals.

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Waste anesthetic gas exposure and strategies for solution

Abstract

As inhaled anesthetics are widely used, medical staff have inevitably suffered from exposure to anesthetic waste gases (WAGs). Whether chronic exposure to WAGs has an impact on the health of medical staff has long been a common concern, but conclusions are not consistent. Many measures and equipment have been proposed to reduce the concentration of WAGs as far as possible. This review aims to dissect the current exposure to WAGs and its influence on medical staff in the workplace and the environment, and summarize strategies to reduce WAGs.

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Novel NALCN biallelic truncating mutations in siblings with IHPRF1 syndrome

Infantile hypotonia with psychomotor retardation and characteristic facies-1 (IHPRF1) is a severe autosomal recessive neurologic disorder with onset at birth or in early infancy. It is caused by mutations in the NALCN gene that encodes a voltage-independent, cation channel permeable to NM, K⁺ and Ca²⁺ and forms a channel complex with UNCSO and UNC79. So far, only 4 homozygous mutations have been found in 11 cases belonging to 4 independent consanguineous families. We studied a Sardinian family with 2 siblings presenting dysmorphic facies, hypotonia, psychomotor retardation, epilepsy, absent speech, sleep disturbance, hyperkinetic movement disorder, cachexia and chronic constipation. Polymorphic generalized seizures started at 4 and 6 years, respectively. Anti-epileptic drugs (AEDs) therapy was efficient for female proband's epilepsy, but the male still has weekly seizures. Whole exome sequencing identified 2 novel truncating mutations in NALCN allowing to assess the clinical phenotype to IHPRF1.This is the fifth family reported worldwide, and these are the first European cases with IHPRF1 syndrome with biallelic truncating mutations of NALCN.

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SmartTots Update Regarding Anesthetic Neurotoxicity in the Developing Brain

SmartTots (http://smarttots.org/) represents a public–private partnership between the International Anesthesia Research Society and the US Food and Drug Administration. Over the past 7 years, SmartTots has worked in collaboration with various stakeholders to determine whether anesthetic drugs have detrimental effects on the developing brain. SmartTots has funded clinical and preclinical studies, organized meetings, served as a repository of peer-reviewed information, and facilitated the development of consensus-based statements. Here, we report advances in the field of anesthetic neurotoxicity and provide an update on SmartTots' activities. Clinical studies have provided some reassurance that a brief exposure to anesthetic drugs does not cause overt, persistent cognitive deficits. New recommendations aim to increase the reproducibility and "clinical relevance" of data from studies of laboratory animals. Overall, the field has advanced substantially; however, it remains paramount to definitively resolve whether anesthetic drugs are neurotoxic to the immature brain. The results of SmartTots efforts will either ally unwarranted fears or substantially change pediatric anesthetic practice and prompt studies to identify neuroprotective strategies. Accepted for publication November 28, 2017. Funding: None. The authors declare no conflicts of interest. The opinions expressed in this article are those of the authors, not SmartTots or the US Food and Drug Administration (FDA). The authors represent the Board of Trustees of the International Anesthesia Research Society (IARS) on the Executive Council and Scientific Advisory Board of SmartTots. Reprints will not be available from the authors. Address correspondence to Beverley A. Orser, MD, PhD, University of Toronto, Room 3318, Medical Sciences Bldg, 1 King's College Cir, Toronto, Ontario M5S1A8, Canada. Address e-mail to Beverley.Orser@utoronto.ca. © 2018 International Anesthesia Research Society

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Chronic Pain and the Opioid Epidemic: Are We Ignoring the Potential Benefits of Nitrous Oxide?

No abstract available

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Teaching Medical Students Clinical Anesthesia

There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education. Accepted for publication December 5, 2017. Funding: Departmental. The author declares no conflicts of interest. Reprints will not be available from the author. Address correspondence to Saundra E. Curry, MD, Department of Anesthesiology, Columbia University, PH 5–133, 622 W 168th St, New York, NY 10032. Address e-mail to sc42@cumc.columbia.edu. © 2018 International Anesthesia Research Society

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Effect-Site Target-Controlled Infusion in the Obese: Model Derivation and Performance Assessment

BACKGROUND: The aim of this study is to derive a propofol pharmacokinetic (PK) pharmacodynamic (PD) model to perform effect-site target-controlled infusion (TCI) in obese patients, and to analyze its performance along with that of other available PK models. METHODS: In the first step of the study, a 3-compartment PK model linked to a sigmoidal inhibitory Emax PD model by a first-order rate constant (keo) was used to fit propofol concentration–bispectral index (BIS) data. Population modeling analysis was performed by nonlinear mixed effects regression in NONMEM (ICON, Dublin, Ireland). PK data from 3 previous studies in obese adult patients (n = 47), including PD (BIS) data from 1 of these studies (n = 20), were pooled and simultaneously analyzed. A decrease in NONMEM objective function (ΔOBJ) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. In the second step of the study, we analyzed the predictive performance (median predictive errors [MDPE] and median absolute predictive errors [MDAPE]) of the current model and of other available models using an independent data set (n = 14). RESULTS: Step 1: The selected PKPD model produced an adequate fit of the data. Total body weight resulted in the best size scalar for volumes and clearances (ΔOBJ, −18.173). Empirical allometric total body weight relationships did not improve model fit (ΔOBJ, 0.309). A lag time parameter for BIS response improved the fit (ΔOBJ, 89.593). No effect of age or gender was observed. Step 2: Current model MDPE and MDAPE were 11.5% (3.7–25.0) and 26.8% (20.7–32.6) in the PK part and 0.4% (−10.39 to 3.85) and 11.9% (20.7–32.6) in the PD part. The PK model developed by Eleveld et al resulted in the lowest PK predictive errors (MDPE =

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The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-Induced Contractility of Human Myometrium In Vitro

BACKGROUND: Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administration for induction and augmentation of labor is inconsistent with regard to maternal outcomes. We aimed to determine the effect of intermittent versus continuous oxytocin preexposure on myometrial responsiveness to subsequent oxytocin. We hypothesized that intermittent oxytocin pretreatment would result in superior subsequent oxytocin-induced contractility than continuous oxytocin pretreatment. METHODS: This in vitro study was undertaken using myometrium obtained from women undergoing elective cesarean deliveries. Each myometrial strip was mounted in an individual organ bath with physiological salt solution under homeostatic conditions and allocated to one of 3 groups: (1) control (no pretreatment); (2) continuous (pretreatment with oxytocin 10−5 M for 2 hours); or (3) intermittent (pretreatment with alternating oxytocin 10−5 M and physiological salt solution every 15 minutes, for 2 hours). After pretreatment, dose–response testing to oxytocin 10−10 to 10−5 M was performed and contractile parameters were measured. The primary outcome was motility index (MI, amplitude × frequency) of contractions. RESULTS: Eighteen women were recruited, and 86 successful experiments were performed (control n = 29, continuous n = 28, intermittent n = 29). The means (standard errors) of MI (√g·contractions/10 min) in the control, continuous, and intermittent groups were 2.34 (0.09), 1.78 (0.09), and 2.13 (0.11), respectively. The MI was significantly reduced in the continuous group when compared to the control (estimated difference [95% confidence interval {CI}], −0.56 [−0.81 to −0.31]; P

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In Response

No abstract available

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Adding Dopamine to Proxymetacaine or Oxybuprocaine Solutions Potentiates and Prolongs the Cutaneous Antinociception in Rats

Background: We evaluated the interaction of dopamine–proxymetacaine and dopamine– oxybuprocaine antinociception using isobolograms. Methods: This experiment uses subcutaneous drug (proxymetacaine, oxybuprocaine, and dopamine) injections under the skin of the rat's back, thus simulating infiltration blocks. The dose-related antinociceptive curves of proxymetacaine and oxybuprocaine alone and in combination with dopamine were constructed, and then the antinociceptive interactions between the local anesthetic and dopamine were analyzed using isobolograms. Results: Subcutaneous proxymetacaine, oxybuprocaine, and dopamine produced a sensory block to local skin pinpricks in a dose-dependent fashion. The rank order of potency was proxymetacaine (0.57 [0.52–0.63] μmol/kg) > oxybuprocaine (1.05 [0.96–1.15] μmol/kg) > dopamine (165 [154–177] μmol/kg; P oxybuprocaine > dopamine. Coadministration of proxymetacaine or oxybuprocaine with dopamine produced a synergistic antinociceptive effect. Dopamine prolonged the duration of skin antinociception caused by proxymetacaine or oxybuprocaine. This study tests subcutaneous injections under the hairy skin, thus simulating infiltration blocks that occur during surgery. Reprints will not be available from the authors. Address correspondence to Ching-Hsia Hung, PhD, Department of Physical Therapy, College of Medicine, National Cheng Kung University, No.1 Ta-Hsueh Rd, Tainan, Taiwan. Address e-mail to chhung@mail.ncku.edu.tw. © 2018 International Anesthesia Research Society

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Comparison of Nasal Intubations by GlideScope With and Without a Bougie Guide in Patients Who Underwent Maxillofacial Surgeries: Randomized Clinical Trial

BACKGROUND: Nasotracheal intubation is commonly performed to provide a secure airway for the maintenance of general anesthesia in maxillofacial surgeries. Routine nasotracheal intubation is performed under general anesthesia by direct laryngoscopy, frequently with the aid of Magill forceps. This method can be time-consuming and may cause bleeding in the field of view. A gum elastic bougie (GEB) is a cheap, slender, and flexible device that could expedite nasotracheal intubation. The aim of this study was to evaluate the use of a GEB during nasotracheal intubation to facilitate the procedure and reduce the rate of complications. METHODS: In this randomized clinical trial study, 110 patients with American Society of Anesthesiologists (ASA) physical status I–II from 15 to 65 years of age were randomized into 2 equal groups. In both groups, a GlideScope and armored tube were used. In the GEB group, GEB was used to facilitate nasal intubation while the nasal intubation was performed without the aid of GEB in the routine group. The difficult intubation (defined as >1 attempt for intubation) was the primary outcome, and the duration of the intubation, the presence of traces of bleeding, the need for a tube replacement, and the usage of Magill forceps were the secondary outcomes. RESULTS: The incidence of bleeding in the GEB group was 1.81% vs 43.63% in the routine group (P

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