Search

As pain in the intensive care unit (ICU) is still common despite important progress in pain management, we studied the efficacy of an intravenous bolus of morphine 2.5 vs 7.5 mg for procedural pain relief in patients after cardiothoracic surgery in the ICU. In a prospective double-blind randomised study, 117 ICU patients after cardiothoracic surgery were included. All patients were treated according a pain titration protocol for pain at rest, consisting of continuous morphine infusions and paracetamol, applied during the entire ICU stay. On the first postoperative day, patients were randomised to intravenous morphine 2.5 (n=59) or 7.5 mg (n=58) 30 minutes before a painful intervention (turning of patient and/or chest drain removal). Pain scores using the numeric rating scale (Numeric Rating Scale, range 0 to 10) were rated at rest (baseline) and around the painful procedure. At rest (baseline), overall incidence of unacceptable pain (Numeric Rating Scale ≥4) was low (Numeric Rating Scale >4; 14 vs 17%, P=0.81) for patients allocated to morphine 2.5 and 7.5 mg respectively. For procedure-related pain, there was no difference in incidence of unacceptable pain (28 vs 22%, P=0.53) mean pain scores (2.6 [95% confidence interval 2.0 to 3.2] vs 2.7 [95% confidence interval 2.0 to 3.4]) between patients receiving morphine 2.5 and 7.5 mg respectively. In intensive care patients after cardiothoracic surgery with low pain levels for pain at rest, there was no difference in efficacy between intravenous morphine 2.5 mg or morphine 7.5 mg for pain relief during a painful intervention. [ABSTRACT FROM AUTHOR]

The gold standard for quantification of pain is a person's self-report. However, we need objective parameters for pain measurement when intensive care patients, for example, are not able to report pain themselves. An increase in pain is currently thought to coincide with an increase in stress hormones. This observational study investigated whether procedure-related pain is associated with an increase of plasma cortisol, adrenaline, and noradrenaline. In 59 patients receiving intensive care after cardiac surgery, cortisol, adrenaline, and noradrenaline plasma levels were measured immediately before and immediately after patients were turned for washing, either combined with the removal of chest tubes or not. Numeric rating scale scores were obtained before, during, and after the procedure. Unacceptably severe pain (numeric rating scale ≥ 4) was reported by seven (12%), 26 (44%), and nine (15%) patients, before, during and after the procedure, respectively. There was no statistically significant association between numeric rating scale scores and change in cortisol, adrenaline, and noradrenaline plasma levels during the procedure. Despite current convictions that pain coincides with an increase in stress hormones, procedural pain was not associated with a significant increase in plasma stress hormone levels in patients who had undergone cardiac surgery. Thus, plasma levels of cortisol, adrenaline, and noradrenaline seem unsuitable for further research on the measurement of procedural pain. [ABSTRACT FROM AUTHOR]

Background Chronic thoracic pain after cardiac surgery is a serious condition affecting many patients. The aim of this study was to identify predictors for chronic thoracic pain after sternotomy in cardiac surgery patients by analysing patient and perioperative characteristics. Methods A follow-up study was performed in 120 patients who participated in a clinical trial on pain levels in the early postoperative period after cardiac surgery. The presence of chronic thoracic pain was evaluated by a questionnaire 1 yr after surgery. Patients with and without chronic thoracic pain were compared. Associations were studied using multivariable logistic regression analysis. Results Questionnaires of 90 patients were analysed. Chronic thoracic pain was reported by 18 patients (20%). In the multivariable regression model, remifentanil during cardiac surgery, age below 69 yr, and a body mass index above 28 kg m−2 were independent predictors for chronic thoracic pain {odds ratios 8.9 [95% confidence interval (CI) 1.6–49.0], 7.0 (95% CI 1.6–31.7), 9.1 (95% CI 2.1–39.1), respectively}. No differences were observed in patient and perioperative characteristics between patients receiving remifentanil (58%, n=52) compared with patients not receiving remifentanil (42%, n=38). The association between remifentanil and chronic thoracic pain appeared dose-dependent, both for total dose and for dose corrected for kilogram lean body mass and duration of surgery (P-value for trend: <0.01 and <0.005, respectively). Conclusions In this follow-up study in cardiac surgery patients, intraoperative remifentanil was predictive for chronic thoracic pain in a dose-dependent manner. Randomized studies designed to evaluate the influence of intraoperative remifentanil on chronic thoracic pain are needed to confirm these results. [ABSTRACT FROM PUBLISHER]

The article presents a study which examines the efficacy of an intravenous morphine for procedural pain relief in patients after cardiothoracic surgery in the intensive care unit (ICU). It compares the difference in efficacy between 2.5 milligram (mg) dosage of morphine and 7.5 mg morphine for pain relief during the procedure. The study suggests that no difference in unacceptable painful incidence was found in patients allocated to intravenous morphine with 2.5 and 7.5 mg.

The article presents a study which aims to examine the elevation of alanine aminotransferase after taking paracetamol four grams daily for acute postoperative pain. Levels of preoperative alanine aminotransferase of more than one time the upper limit of normal was measured in 11% of patients. The study reveals that the significant elevations of alanine aminotransferase after the use of paracetamol as cardiac surgery's analgesic agent was low and generally due to surgery complications.

We present evidence that electrical transport studies of epitaxial p-type GeMn thin films fabricated on high-resistivity Ge substrates are severely influenced by parallel conduction through the substrate, related to the large intrinsic conductivity of Ge due to its small band gap. Anomalous Hall measurements and large magnetoresistance effects are completely understood by taking a dominating substrate contribution as well as the measurement geometry into account. It is shown that substrate conduction persists also for well-conducting, degenerate, p-type thin films, giving rise to an effective two-layer conduction scheme. Using n-type Ge substrates, parallel conduction through the substrate can be reduced for the p-type epilayers, as a consequence of the emerging pn-interface junction. GeMn thin films fabricated on these substrates exhibit a negligible magnetoresistance effect. Our study underlines the importance of a thorough characterization and understanding of possible substrate contributions for electrical transport studies of GeMn thin films. [ABSTRACT FROM AUTHOR]

Abstract: We present structural, magnetic and transport properties of Mn-doped Ge layers grown by molecular beam epitaxy (MBE) at low substrate temperatures . Atomic force microscopy (AFM), reflection high energy electron diffraction (RHEED) and transmission electron microscopy (TEM) analysis of structures grown at and reveal defect-free epitaxy of Ge(Mn) on Ge(001) substrates. Despite the low we observe the formation of round shaped clusters with a diameter of 15–20nm which are incoherent with the Ge matrix in TEM analysis for a Mn concentration x of 3.4%. SQUID measurements reveal ferromagnetism and a of around for the layers, reminiscent of the intermetallic compound . Transport measurements, however, indicate that Mn is incorporated into the Ge matrix between the clusters as well. [Copyright &y& Elsevier]

Abstract: Thin film metal oxide materials exhibit a bell-shaped variation of the gas sensitivity with sensor operation temperature. With respect to the temperature T M at which a sensitivity maximum occurs, the distribution of the gas sensitivity is asymmetric exhibiting a relatively steep increase below T M and a more moderate drop-off above T M. In this paper a rate equation approach is described, which successfully reproduces temperature- and gas-concentration dependent sensitivity distributions S(T, c gas) experimentally determined for a number of reducing analyte gas molecules. We show that such distributions are determined by two energetic parameters, which are specific for the special adsorbate/adsorbent system involved. These are (i) the strength of adsorption of neutral analyte gas molecules E ads and (ii) the kinetic barrier E a that needs to be overcome to induce a surface combustion event involving an adsorbed analyte gas molecule and a surface oxygen ion. [Copyright &y& Elsevier]

Aiming at better fuel economy, the automotive industry makes increasing use of so-called lean-burn engines. Exhaust gases emerging from such engines need to be treated in NOx storage catalysts to comply with the low NOx emission standards prescribed by the legislation. Monitoring and controlling the state of filling and regeneration of NOx storage catalysts in turn requires the use of novel kinds of gas sensing devices besides the usual switching λ probes, widely used in the car industry. In the present paper, we would like to show that the filling and regeneration of NOx storage catalysts could be monitored with the help of simple two-sensor arrays consisting of: (i) a SiC-based field-effect gas sensor with a catalytic Pt gate (Pt-MOSiC), and (ii) a resistive thin-film metal oxide gas sensor. Measurements in a gas test rig reveal that both kinds of sensors exhibit significant levels of cross-sensitivity, responding in principle to all kinds of exhaust gas components. A more detailed comparison, however, shows that the main sensitivities of Pt-MOSiC sensors are more heavily biased towards reducing exhaust gas components, whereas resistive metal oxide gas sensors detect more sensitively oxidizing components. Experiments on a motor test bench reveal that these two kinds of sensors are sufficiently complementary in their gas sensing properties to provide a very clear and detailed picture of the momentary state of filling and of regeneration of a NOx storage catalyst. [Copyright &y& Elsevier]

X-ray absorption spectroscopy of epitaxial GeMn thin films reveals an experimentally indistinguishable electronic configuration of Mn atoms incorporated in Ge1-xMnx nanoclusters and in precipitates of the intermetallic compound Mn5Ge3, respectively. However, the average magnetic response of thin films containing Ge1-xMnx nanoclusters is lower than the response of films containing Mn5Ge3 precipitates. This reduced magnetic response of Ge1-xMnx nanoclusters is explained in terms of a fraction of Mn atoms being magnetically inactive due to antiferromagnetic coupling or the presence of structural disorder. A determination of the role of magnetically inactive Mn atoms in the self-assembly of the thermodynamically metastable Ge1-xMnx nanoclusters seems to be an essential ingredient for an enhanced control of this promising high Curie temperature magnetic semiconductor. [ABSTRACT FROM AUTHOR]

Under defined growth conditions ferromagnetic hexagonal Mn5Ge3 precipitates are formed in cubic Ge1-xMnx epilayers. To study the topotaxial relationship of these nanomagnets we perform x-ray diffraction experiments in coplanar as well as in grazing incidence geometries at synchrotron sources. Additionally, to the well defined topotaxial relation derived for buried nanomagnets deep within the Ge layer, we found an additional class of Mn5Ge3 precipitates very close to the surface, with larger inclusion diameter and several different crystallographic orientations with respect to the buried ones. [ABSTRACT FROM AUTHOR]

Background:The randomised phase III TURANDOT trial compared first-line bevacizumab-paclitaxel (BEV-PAC) vs bevacizumab-capecitabine (BEV-CAP) in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). The interim analysis revealed no difference in overall survival (OS; primary end point) between treatment arms; however, progression-free survival (PFS) and objective response rate were significantly superior with BEV-PAC. We sought to identify patient populations that may be most appropriately treated with one or other regimen.Methods:Patients with HER2-negative LR/mBC who had received no prior chemotherapy for advanced disease were randomised to either BEV-PAC (bevacizumab 10 mg kg−1 days 1 and 15 plus paclitaxel 90 mg m−2 days 1, 8 and 15 q4w) or BEV-CAP (bevacizumab 15 mg kg−1 day 1 plus capecitabine 1000 mg m−2 bid days 1-14 q3w). The study population was categorised into three cohorts: triple-negative breast cancer (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High- and low-risk HR+ were defined, respectively, as having ⩾2 vs ⩽1 of the following four risk factors: disease-free interval ⩽24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; and metastases in ⩾3 organs.Results:The treatment effect on OS differed between cohorts. Non-significant OS trends favoured BEV-PAC in the TNBC cohort and BEV-CAP in the low-risk HR+ cohort. In all three cohorts, there was a non-significant PFS trend favouring BEV-PAC. Grade ⩾3 adverse events were consistently less common with BEV-CAP.Conclusions:A simple risk factor index may help in selecting bevacizumab-containing regimens, balancing outcome, safety profile and patient preference. Final OS results are expected in 2015 (ClinicalTrials.gov NCT00600340). [ABSTRACT FROM AUTHOR]

A volunteer study suggested that taking paracetamol 4 g daily could result in elevated alanine aminotransferase plasma levels in a substantial proportion of healthy volunteers. The safety of this dose of paracetamol for acute postoperative pain remains controversial. This study aimed to examine the incidence of alanine aminotransferase elevations after short-term use of paracetamol 4 g daily, as part of the standard pain management protocol, for 93 consecutive patients after cardiothoracic surgery. Alanine aminotransferase levels and other liver function tests were measured preoperatively as baseline and once daily after surgery during the intensive care unit stay. Preoperative alanine aminotransferase levels of more than one time the upper limit of normal (ULN >40 U/l) was observed in 11% (n=10) of the patients but none of these baseline alanine aminotransferase levels exceeded three times the ULN (>3 x ULN). The average daily dose of paracetamol administered was 50 mg/kg (SD=16) after surgery. Postoperative alanine aminotransferase levels of >1 x ULN was observed in 17% (n=16), and 4% (n=4) exceeded >3 x ULN The other liver function tests of the latter four patients, including aspartate aminotransferase (range 173 to 5590 U/l), gamma-glutamyltransferase (range 56 to 103 U/l), lactate dehydrogenase (range 376 to 3518 U/l) and the International Normalised Ratio (range 2.0 to 6.6), were all abnormal. These four patients all had right ventricular failure or cardiogenic shock during the postoperative period which could explain the significant rises in alanine aminotransferase after surgery. In conclusion, the incidence of significant alanine aminotransferase elevations after using daily paracetamol as an analgesic agent for cardiac surgery, at a dose of 4 g per day, was low and mostly due to complications after surgery. Our results, albeit still very limited, provided some reassurance about the safety of paracetamol 4 g daily, as a supplementary analgesic agent for adult patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Hemoglobin-based oxygen carriers (HBOCs) show potential as safe, efficacious, pre-hospital resuscitation fluids. The major criticism of HBOC-201 is its vasoactive property, attributed partially to low-molecular weight (low-MW) tetrameric/dimeric (TD) hemoglobin (Hb) in HBOC solution. Here we sought to determine whether resuscitation with decreasing concentrations of low-MW Hb component of HBOC affects immune responses in hemorrhagic swine. 28 anesthetized swine underwent a soft muscle crush and controlled hemorrhage of 55% blood volume, followed by resuscitation with HBOC containing 31%, 2%, or 0.4% low-MW Hb in four 10 ml/kg infusions at 20, 30, 45 and 60 minutes before hospital arrival at 75 minutes. IL-10, cell activation and adhesion markers and CD4:CD8 ratio remained unchanged in all 3 groups compared to baseline. Leukocyte apoptosis was equally elevated across all groups. Purification from 31% to 0.4% low-MW Hb in HBOC solution did not alter immune effects in a swine model of severe controlled hemorrhagic shock. [ABSTRACT FROM AUTHOR]

Hemoglobin-based oxygen carrier-201 transports oxygen and improves survival in swine with hemorrhagic shock, but has potential to be immune activating. Herein, we evaluated HBOC-201's immune effects in swine with more severe hemorrhagic shock due to soft tissue injury and 55% blood volume catheter withdrawal over 15 minutes followed by fluid resuscitation at 20 minutes with HBOC-201, Hextend, or no treatment (NON) before hospital arrival. Survival rates were similar with HBOC-201 and Hextend (p > 0.05), but were higher than in (p = 0.007). There were no significant group differences in blood cell count, percentages of leukocyte sub-populations and immunophenotype (CD4:CD8 ratio), adhesion markers expression (neutrophil CD11b; monocyte or neutrophil CD49d) and apoptosis. There was a trend to higher plasma IL-10 in HBOC-201 and groups vs. Hextend. We conclude that in swine with severe controlled HS and soft tissue injury, immune responses are similar with resuscitation with HBOC-201 and Hextend. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To test our hypothesis that hemoglobin-based oxygen carrier (HBOC)-201 resuscitation in hemorrhagic shock (HS) will not lead to increased organ injury and dysfunction. DESIGN: Three swine HS models simulating military-relevant delayed evacuation: a) moderate controlled HS, b) severe controlled HS, and c) severe uncontrolled HS. SETTING: Military research laboratory. SUBJECTS: Swine. INTERVENTIONS: Swine were anesthetized/intubated and instrumented. To induce HS, in two controlled hemorrhage experiments, 40% (moderate controlled HS) or 55% (severe controlled HS) of blood volume was withdrawn; in an uncontrolled HS experiment, the liver was crushed/lacerated. During a 4-hr 'prehospital phase,' pigs were resuscitated with HBOC-201 (HBOC) or Hextend (HEX) or were nonresuscitated (NON). Upon 'hospital arrival,' liver injury was repaired (severe uncontrolled HS), blood or saline was infused, hemodynamics were monitored, and blood was collected. Upon animal death and/or 72 hrs, necropsy was followed by histopathologic evaluation of organ injury (hematoxylin and eosin, electron microscopy) and immunohistochemistry of oxidative potential (3-nitrotyrosine). Significance (p < .05) was assessed by Kruskal-Wallis, analysis of variance/Bonferroni, and mixed procedure tests. MEASUREMENTS AND MAIN RESULTS: Survival was significantly higher with HBOC than HEX only with severe uncontrolled HS (p = .002). Myocardial necrosis/fibroplasia, fluid requirements, cardiac output, and cardiac enzymes were generally similar or lower in HBOC than HEX pigs, but creatine kinase-MB (but not creatine kinase-MB/creatine kinase ratio) was higher with HBOC in moderate controlled HS. Alveolar/interstitial pulmonary edema was similar with HBOC and HEX, but Po2 was higher with HBOC in severe uncontrolled HS. Jejunal villar epithelial and hepatocellular necrosis were similarly minimal to moderate in all groups. Minimal biliary changes occurred exclusively with HBOC. Aspartate aminotransferase, lactate dehydrogenase, and alkaline phosphatase were generally higher with HBOC than HEX. Mild renal papillary injury occurred more frequently with HBOC, but consistent patterns for urine output, blood urea nitrogen, and creatinine, were not seen. The 3-nitrotyrosine staining intensity was not different. CONCLUSIONS: In comparison with hetastarch, HBOC-201 resuscitation of swine with HS increased survival (with severe HS), did not increase evidence of oxidative potential, and had histopathologic and/or functional effects on organs that were clinically equivocal (myocardium, lungs, hepatic parenchyma, jejunum, and renal cortex/medulla) and potentially adverse (hepatobiliary and renal papilla). The effects of HBOC-201-resuscitation in HS should be corroborated in controlled clinical trials. [ABSTRACT FROM AUTHOR]

Silicon micromachining technologies have been used to develop metal oxide gas sensor elements with very small heating power consumption. With the power consumption of a single micromachined sensor element being an order of magnitude less than that of commercial thick-film devices, novel kinds of gas sensing systems become feasible, which allow higher selectivity, lower drift and built-in self-test functionalities to be realised within the power budget of a single thick-film gas-sensing element. Such systems can be built up using components from an emerging MEMS toolkit for miniaturised gas sensing systems. The article presents components of this toolkit and points out system functionalities that can be achieved by combining elements from this kit. [Copyright &y& Elsevier]

In pot experiments under controlled environmental conditions, composted organic household waste showed a suppression of soilborne plant pathogens. The addition of 8 %, 10 % and 30 % compost to the potting material which was artificially infested with Pythium ultimum or Rhizoctonia solani considerably reduced the incidence of disease in different varieties of host plants. It became evident that the degree of protection provided by compost depends upon the amount of compost added and upon the vulnerability of the host plant to infection. In an experiment using increasing levels of inoculum, the compost proved suppressive to the pathogen even under extreme disease conditions. This suppressive effect was still evident in compost which had been stored for prolonged periods. [ABSTRACT FROM AUTHOR]

Background: BEV has been shown to significantly improve the efficacy of both paclitaxel (PAC) and capecitabine (CAP) as first-line therapy for HER2-negative mBC. TURANDOT, a randomized phase III trial comparing BEV-PAC vs BEV-CAP, includes extensive QoL evaluation. Methods: Patients (pts) with HER2-negative mBC who had received no prior chemotherapy for mBC were randomized to receive either BEV-PAC (BEV 10 mg/kg d1 & 15 + PAC 90 mg/m² d1, 8, & 15 q4w) or BEV-CAP (BEV 15 mg/kg d1 + CAP 1000 mg/m² bid d1-14 q3w) until disease progression, unacceptable toxicity, or withdrawal of consent. The primary endpoint is overall survival (OS); QoL, assessed using the EORTC QLQ-C30, is a secondary endpoint. Pts were asked to complete QLQ-C30 at baseline, q12w during study therapy, at the end of treatment, and 28 days after discontinuing from the study. Results: On-treatment QoL questionnaires were available from all 561 of the treated pts at baseline, 394 at week 12, 266 at week 24, 186 at week 36, 129 at week 48, and <100 at subsequent assessments. For time points up to week 48, there were more questionnaires available from the BEV-PAC than the BEV-CAP arm; the pattern reversed thereafter. Mean global health score was similar in the two treatment arms with little change from baseline over time. In the BEV-PAC arm, mean baseline score was 58.0, remaining above the baseline score up to week 60; mean changes from baseline ranged from +8.3 at week 96 (n = 4) to -9.2 at week 60; mean changes for time points with data from >50 pts ranged from +1.5 to +2.6. In the BEV-CAP arm, mean baseline score was 56.0; the mean score remained above the baseline mean score until week 96. Mean change from baseline ranged from -3.9 at week 84 to +4.9 at week 96. Mean scores for most individual symptom scales were low (typically <20) at baseline and remained low until week 96, suggesting that symptoms evaluated in QLQ-C30 did not represent a major burden to pts. The highest mean baseline symptom scores in both treatment arms were for fatigue (34.1 with BEVPAC vs 38.8 with BEV-CAP), pain (30.4 vs 34.3, respectively), and insomnia (29.3 vs 32.4, respectively). Mean scores for these symptom scales showed no meaningful increase (representing a deterioration in QoL) over time. Mean scores for the appetite loss and dyspnea scales slightly favored the BEV-CAP arm from week 36 onwards. Scores for financial difficulties fluctuated over time. Physical, role, emotional, cognitive, and social functioning scales showed slight or no change over time and no difference between treatment regimens. Conclusion: Extensive QoL evaluation in the TURANDOT trial revealed no clear difference in global health score and little or no difference in functioning and symptom scales between the treatment regimens. Importantly, BEV-containing therapy was not associated with a deterioration in global health score in either arm. This has important implications when considering the potential benefit of a treatment, particularly in the first-line mBC setting, where clinically meaningful endpoints continue to be debated. [ABSTRACT FROM AUTHOR]