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The objective of this study was to evaluate the health and economic effects of an influenza vaccination campaign. A prospective, non-randomised, non-placebo cost–benefit study was conducted in a petrochemical plant in Malaysia, involving two cohorts: vaccinated and not vaccinated. Cost–benefit analyses were performed from the employer''s perspective. The total number of employees involved in the study was 1022. The attack rates of influenza-like illness (ILI) were 8.13% in vaccinated and 30.31% in non-vaccinated. The mean (±CI 95%) length of sick leave taken for ILI was significantly greater among non-vaccinated (4.22±0.26 vs. 3.00±0.39) as well as the number of days until feeling well again (5.80±0.13 vs. 5.37±0.18). The effectiveness rate in reducing the ILI occurrence was 73.16%. The mean annual cost savings were US$39.9 and US$899.7 per employee vaccinated respectively in the base and upper case scenarios. This study showed that influenza vaccination had significant impact on ILI occurrence and lead to high return on investment for the employer. [Copyright &y& Elsevier]

Objective: The authors compared the performance of a novel self-collect device with clinician-collected samples for detection of high-risk human papillomavirus (hrHPV)., Materials and Methods: Eighty-two (82) participants were recruited from 5 clinical sites in the United States. Each participant performed self-collect sampling using the self-collect device followed by a standard of care clinician-collected sample. Both samples were evaluated for hrHPV using polymerase chain reaction (PCR)-based HPV assays. A subset of HPV-positive samples underwent dual staining (p16/Ki-67), and concordance was evaluated. Biopsy results collected per standard of care were recorded., Results: On the Roche cobas assay, the preliminary positive percent agreement (PPA) and negative percent agreement (NPA) was 91%. Agreement for hrHPV using the BD OnClarity in PreservCyt was 100% PPA (n = 10), and 100% PPA, 93% NPA in SurePath. Dual-stain concordance was 93% (n = 16) overall, and 100% for HPV other genotypes. Seventy-one participants (n = 71; 89%) indicated they would feel confident using the self-collect device for screening if they knew they could get equal results, and 86% (n = 69) indicated that they would be more likely to get screened with this option., Conclusions: The self-collect device shows high (>92%) positive and negative agreement for detection of HPV when compared with reference clinician-collected samples, with very high acceptability and preference. Furthermore, the self-samples collected with the self-collect device showed highly concordant results by dual stain, which is a novel and emerging application for a self-collected sampling device, thus enabling potential triage from 1 sample., Competing Interests: Role of funding source: The study was funded by Teal Health, Inc, which is a biotechnology startup company. The funding source was involved in the study design, collection, analysis, and interpretation of data, as well as the writing of the report and decision to submit the article for publication. All authors have access to the data and take responsibility for the integrity of the data and accuracy of data analysis. All potential conflicts of interest have been disclosed. MBF is a current employee at Teal Health. No other relationships or activities have influenced the submitted work. The other authors have declared they have no conflicts of interest., (Copyright © 2024, ASCCP.)

SNAPSHOT USA is a multicontributor, long-term camera trap survey designed to survey mammals across the United States. Participants are recruited through community networks and directly through a website application (https://www.snapshot-usa.org/). The growing Snapshot dataset is useful, for example, for tracking wildlife population responses to land use, land cover, and climate changes across spatial and temporal scales. Here we present the SNAPSHOT USA 2021 dataset, the third national camera trap survey across the US. Data were collected across 109 camera trap arrays and included 1711 camera sites. The total effort equaled 71,519 camera trap nights and resulted in 172,507 sequences of animal observations. Sampling effort varied among camera trap arrays, with a minimum of 126 camera trap nights, a maximum of 3355 nights, a median 546 nights, and a mean 656 ± 431 nights. This third dataset comprises 51 camera trap arrays that were surveyed during 2019, 2020, and 2021, along with 71 camera trap arrays that were surveyed in 2020 and 2021. All raw data and accompanying metadata are stored on Wildlife Insights (https://www.wildlifeinsights.org/), and are publicly available upon acceptance of the data papers. SNAPSHOT USA aims to sample multiple ecoregions in the United States with adequate representation of each ecoregion according to its relative size. Currently, the relative density of camera trap arrays varies by an order of magnitude for the various ecoregions (0.22-5.9 arrays per 100,000 km 2 ), emphasizing the need to increase sampling effort by further recruiting and retaining contributors. There are no copyright restrictions on these data. We request that authors cite this paper when using these data, or a subset of these data, for publication. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the US Government., (© 2024 The Ecological Society of America.)

Wildlife must adapt to human presence to survive in the Anthropocene, so it is critical to understand species responses to humans in different contexts. We used camera trapping as a lens to view mammal responses to changes in human activity during the COVID-19 pandemic. Across 163 species sampled in 102 projects around the world, changes in the amount and timing of animal activity varied widely. Under higher human activity, mammals were less active in undeveloped areas but unexpectedly more active in developed areas while exhibiting greater nocturnality. Carnivores were most sensitive, showing the strongest decreases in activity and greatest increases in nocturnality. Wildlife managers must consider how habituation and uneven sensitivity across species may cause fundamental differences in human-wildlife interactions along gradients of human influence., (© 2024. The Author(s).)

Managing wildlife populations in the face of global change requires regular data on the abundance and distribution of wild animals, but acquiring these over appropriate spatial scales in a sustainable way has proven challenging. Here we present the data from Snapshot USA 2020, a second annual national mammal survey of the USA. This project involved 152 scientists setting camera traps in a standardized protocol at 1485 locations across 103 arrays in 43 states for a total of 52,710 trap-nights of survey effort. Most (58) of these arrays were also sampled during the same months (September and October) in 2019, providing a direct comparison of animal populations in 2 years that includes data from both during and before the COVID-19 pandemic. All data were managed by the eMammal system, with all species identifications checked by at least two reviewers. In total, we recorded 117,415 detections of 78 species of wild mammals, 9236 detections of at least 43 species of birds, 15,851 detections of six domestic animals and 23,825 detections of humans or their vehicles. Spatial differences across arrays explained more variation in the relative abundance than temporal variation across years for all 38 species modeled, although there are examples of significant site-level differences among years for many species. Temporal results show how species allocate their time and can be used to study species interactions, including between humans and wildlife. These data provide a snapshot of the mammal community of the USA for 2020 and will be useful for exploring the drivers of spatial and temporal changes in relative abundance and distribution, and the impacts of species interactions on daily activity patterns. There are no copyright restrictions, and please cite this paper when using these data, or a subset of these data, for publication., (© 2022 The Authors. Ecology © 2022 The Ecological Society of America.)

More than 2 million years ago in East Africa, the earliest hominin stone tools evolved amidst changes in resource base, with pounding technology playing a key role in this adaptive process. Olduvai Gorge (now Oldupai) is a famed locality that remains paramount for the study of human evolution, also yielding some of the oldest battering tools in the world. However, direct evidence of the resources processed with these technologies is lacking entirely. One way to obtain this evidence is through the analysis of surviving residues. Yet, linking residues with past processing activities is not simple. In the case of plant exploitation, this link can only be established by assessing site-based reference collections inclusive of both anthropogenic and natural residues as a necessary first step and comparative starting point. In this paper, we assess microbotanical remains from rock clasts sourced at the same quarry utilized by Oldowan hominins at Oldupai Gorge. We mapped this signal and analysed it quantitatively to classify its spatial distribution objectively, extracting proxies for taxonomic identification and further comparison with freestanding soils. In addition, we used blanks to manufacture pounding tools for blind, controlled replication of plant processing. We discovered that stone blanks are in fact environmental reservoirs in which plant remains are trapped by lithobionts, preserved as hardened accretions. Tool use, on the other hand, creates residue clusters; however, their spatial distribution can be discriminated from purely natural assemblages by the georeferencing of residues and statistical analysis of resulting patterns. To conclude, we provide a protocol for best practice and a workflow that has the advantage of overcoming environmental noise, reducing the risk of false positive, delivering a firm understanding of residues as polygenic mixtures, a reliable use of controls, and most importantly, a stronger link between microbotanical remains and stone tool use., (© 2022. The Author(s).)

With the accelerating pace of global change, it is imperative that we obtain rapid inventories of the status and distribution of wildlife for ecological inferences and conservation planning. To address this challenge, we launched the SNAPSHOT USA project, a collaborative survey of terrestrial wildlife populations using camera traps across the United States. For our first annual survey, we compiled data across all 50 states during a 14-week period (17 August-24 November of 2019). We sampled wildlife at 1,509 camera trap sites from 110 camera trap arrays covering 12 different ecoregions across four development zones. This effort resulted in 166,036 unique detections of 83 species of mammals and 17 species of birds. All images were processed through the Smithsonian's eMammal camera trap data repository and included an expert review phase to ensure taxonomic accuracy of data, resulting in each picture being reviewed at least twice. The results represent a timely and standardized camera trap survey of the United States. All of the 2019 survey data are made available herein. We are currently repeating surveys in fall 2020, opening up the opportunity to other institutions and cooperators to expand coverage of all the urban-wild gradients and ecophysiographic regions of the country. Future data will be available as the database is updated at eMammal.si.edu/snapshot-usa, as will future data paper submissions. These data will be useful for local and macroecological research including the examination of community assembly, effects of environmental and anthropogenic landscape variables, effects of fragmentation and extinction debt dynamics, as well as species-specific population dynamics and conservation action plans. There are no copyright restrictions; please cite this paper when using the data for publication., (© 2021 The Authors. Ecology © 2021 The Ecological Society of America.)

Rapid environmental change is a catalyst for human evolution, driving dietary innovations, habitat diversification, and dispersal. However, there is a dearth of information to assess hominin adaptions to changing physiography during key evolutionary stages such as the early Pleistocene. Here we report a multiproxy dataset from Ewass Oldupa, in the Western Plio-Pleistocene rift basin of Olduvai Gorge (now Oldupai), Tanzania, to address this lacuna and offer an ecological perspective on human adaptability two million years ago. Oldupai's earliest hominins sequentially inhabited the floodplains of sinuous channels, then river-influenced contexts, which now comprises the oldest palaeolake setting documented regionally. Early Oldowan tools reveal a homogenous technology to utilise diverse, rapidly changing environments that ranged from fern meadows to woodland mosaics, naturally burned landscapes, to lakeside woodland/palm groves as well as hyper-xeric steppes. Hominins periodically used emerging landscapes and disturbance biomes multiple times over 235,000 years, thus predating by more than 180,000 years the earliest known hominins and Oldowan industries from the Eastern side of the basin.

This article studies soil and plant phytoliths from the Eastern Serengeti Plains, specifically the Acacia-Commiphora mosaics from Oldupai Gorge, Tanzania, as present-day analogue for the environment that was contemporaneous with the emergence of the genus Homo . We investigate whether phytolith assemblages from recent soil surfaces reflect plant community structure and composition with fidelity. The materials included 35 topsoil samples and 29 plant species (20 genera, 15 families). Phytoliths were extracted from both soil and botanical samples. Quantification aimed at discovering relationships amongst the soil and plant phytoliths relative distributions through Chi-square independence tests, establishing the statistical significance of the relationship between categorical variables within the two populations. Soil assemblages form a spectrum, or cohort of co-ocurring phytolith classes, that will allow identifying environments similar to those in the Acacia - Commiphora ecozone in the fossil record., Competing Interests: Dale Walde is a member of the ASM Research Group. All authors declare that they have no competing interests., (©2019 Mercader et al.)

Mechanical stimulation is recognized as a potent modulator of cellular behaviors such as proliferation, differentiation, and extracellular matrix assembly. However, the study of how cell-generated traction force changes in response to stretch is generally limited to short-term stimulation. The goal of this work is to determine how cells actively alter their traction force in response to long-term physiological cyclic stretch as a function of cell pre-stress. We have developed, to our knowledge, a novel method to assess traction force after long-term (24 h) uniaxial or biaxial cyclic stretch under conditions of high cell pre-stress with culture on stiff (7.5 kPa) polyacrylamide gels (with or without transforming growth factor β1 (TGF-β1)) and low pre-stress by treating with blebbistatin or culture on soft gels (0.6 kPa). In response to equibiaxial stretch, valvular interstitial cells on stiff substrates decreased their traction force (from 300 nN to 100 nN) and spread area (from 3000 to 2100 μm(2)). With uniaxial stretch, the cells had similar decreases in traction force and area and reoriented perpendicular to the stretch. TGF-β1-treated valvular interstitial cells had higher pre-stress (1100 nN) and exhibited a larger drop in traction force with uniaxial stretch, but the percentage changes in force and area with stretch were similar to the non-TGF-β1-treated group. Cells with inhibited myosin II motors increased traction force (from 41 nN to 63 nN) and slightly reoriented toward the stretch direction. In contrast, cells cultured on soft gels increased their traction force significantly, from 15 nN to 45 nN, doubled their spread area, elongated from an initially rounded morphology, and reoriented perpendicular to the uniaxial stretch. Contractile-moment measurements provided results consistent with total traction force measurements. The combined results indicate that the change in traction force in response to external cyclic stretch is dependent upon the initial cell pre-stress. This finding is consistent with depolymerization of initially high-tension actin stress fibers, and reinforcement of an initially low-tension actin cytoskeleton., (Copyright © 2016 Biophysical Society. Published by Elsevier Inc. All rights reserved.)

Molecular diagnostics can offer important benefits to patients and are a key enabler of the integration of personalised medicine into health care systems. However, despite their promise, few molecular diagnostics are embedded into clinical practice (especially in Europe) and access to these technologies remains unequal across countries and sometimes even within individual countries. If research translation and the regulatory environments have proven to be more challenging than expected, reimbursement and value assessment remain the main barriers to providing patients with equal access to molecular diagnostics. Unclear or non-existent reimbursement pathways, together with the lack of clear evidence requirements, have led to significant delays in the assessment of molecular diagnostics technologies in certain countries. Additionally, the lack of dedicated diagnostics budgets and the siloed nature of resource allocation within certain health care systems have significantly delayed diagnostics commissioning. This article will consider the perspectives of different stakeholders (patients, health care payers, health care professionals, and manufacturers) on the provision of a research-enabled, patient-focused molecular diagnostics platform that supports optimal patient care. Through the discussion of specific case studies, and building on the experience from countries that have successfully integrated molecular diagnostics into clinical practice, this article will discuss the necessary evolutions in policy and health technology assessment to ensure that patients can have equal access to appropriate molecular diagnostics., (© 2016 S. Karger AG, Basel.)

Introduction: The 21-gene breast cancer assay (Oncotype DX(®); Genomic Health, Inc.) is a validated diagnostic test that predicts the likelihood of adjuvant chemotherapy benefit and 10-year risk of distant recurrence in patients with hormone-receptor-positive, human epidermal growth receptor 2-negative, early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Mexico., Methods: A Markov model was developed to make long-term projections of distant recurrence, survival, and direct costs in scenarios using conventional diagnostic procedures or the 21-gene assay to inform adjuvant chemotherapy recommendations. Transition probabilities and risk adjustment were taken from published landmark trials. Costs [2011 Mexican Pesos (MXN)] were estimated from an Instituto Mexicano del Seguro Social perspective. Costs and clinical benefits were discounted at 5% annually., Results: Following assay testing, approximately 66% of patients previously receiving chemotherapy were recommended to receive hormone therapy only after consideration of assay results. Furthermore, approximately 10% of those previously allocated hormone therapy alone had their recommendation changed to add chemotherapy. This optimized therapy allocation led to improved mean life expectancy by 0.068 years per patient and increased direct costs by MXN 1707 [2011 United States Dollars (USD) 129] per patient versus usual care. This is equated to an incremental cost-effectiveness ratio (ICER) of MXN 25,244 (USD 1914) per life-year gained., Conclusion: In early-stage breast cancer patients in Mexico, guiding decision making on adjuvant therapy using the 21-gene assay was projected to improve life expectancy in comparison with the current standard of care, with an ICER of MXN 25,244 (USD 1914) per life-year gained, which is within the range generally considered cost-effective.

While personalised cancer medicine holds great promise, targeting therapies to the biological characteristics of patients is limited by the number of validated biomarkers currently available. The implementation of biomarkers has undergone many challenges with few biomarkers reaching cancer patients in the clinic. There have been many biomarkers that have been published and claimed to be therapeutically useful, but few become part of the clinical decision-making process due to technical, validation and market access issues. To reduce this attrition rate, there is a significant need for policy makers and reimbursement agencies to define specific evidence requirements for the introduction of biomarkers into clinical practice. Once these requirements are more clearly defined, in an analogous manner to pharmaceuticals, researchers and diagnostic companies can better focus their biomarker research and development on meeting these specific requirements, which should lead to the more rapid introduction of new molecular oncology tests for patient benefit., (© 2015 The Author(s) Published by S. Karger AG, Basel.)

During 2012-2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.

Background: The OnceMix and INITIATE studies have indicated that biphasic insulin aspart 30 (BIAsp 30) is more effective than insulin glargine (IGlarg), in terms of glycohemoglobin reductions, in patients with type 2 diabetes initiating insulin therapy. The cost-effectiveness of BIAsp 30 versus IGlarg in the Chinese setting is estimated here., Methods: The validated and peer-reviewed CORE Diabetes Model was used. The nephropathy, retinopathy, and stroke submodels were modified to incorporate available Chinese clinical data. Diabetes complication costs were derived from hospital surveys in Beijing and Chengdu. Simulated cohorts and insulin treatment effects were based on the OnceMix study for once-daily BIAsp 30 versus IGlarg and on the INITIATE study for twice-daily BIAsp 30 versus IGlarg. Life expectancy and direct medical costs were calculated. Projections were made over 30-year time horizons, with costs and life years discounted at 3% annually. Extensive sensitivity analyses were performed, including adjustments to cardiovascular risk for Chinese ethnicity., Results: Once-daily BIAsp 30 increased life expectancy by 0.04 years (12.37 vs. 12.33 years) and reduced direct medical costs by Chinese Yuan (CNY) 59,710 per patient (CNY 229,911 vs. CNY 289,621 per patient) compared with IGlarg in the OnceMix-based analysis. Twice-daily BIAsp 30 increased life expectancy by 0.08 years (12.99 vs. 12.91 years) and reduced direct medical costs by CNY 107,349 per patient (CNY 303,142 vs. CNY 410,491 per patient) compared with IGlarg in the INITIATE-based analysis. Improvements in life expectancy were driven by reduced incidences of most diabetes-related complications. Cost savings were attributable to lower lifetime insulin costs for BIAsp 30 compared with IGlarg in China. Lowered cardiovascular risk for Chinese ethnicity reduced the projected clinical improvements for BIAsp 30 but increased treatment-related lifetime cost savings., Conclusions: BIAsp 30, either once- or twice-daily, improved projected life expectancy and reduced projected costs compared with IGlarg in the Chinese setting.

Objectives: To review the cost-effectiveness of biphasic insulin aspart (BIAsp 30) compared to other insulin regimens in the treatment of type 2 diabetes based on published literature., Methods: The electronic databases MEDLINE, EMBASE, the Cochrane Library and EconLit and a selection of congress/meeting databases were systematically searched using combinations of search terms designed to identify publications describing cost-effectiveness analyses of BIAsp 30 in patients with type 2 diabetes. Searches were limited to studies in humans, and published in the English language between January 1999 and July 2009. All records were screened for inclusion in the review., Results: Seven published cost-effectiveness analyses and ten abstracts were identified. One was a health technology assessment from the UK, which evaluated cost-effectiveness using the UKPDS Outcomes Model and meta-analysis of published clinical trials and concluded that premixed insulin analogs were unlikely to be cost-effective versus insulin glargine or biphasic human insulin. In all other studies the cost-effectiveness of BIAsp 30 versus other insulin regimens was assessed using the validated CORE Diabetes Model and outcomes from either the INITIATE randomized controlled trial, or the PRESENT or IMPROVE observational studies. However, notable limitations include the fact that all cost-effectiveness analyses to date have been performed using a single model and that a number of these are based on data from observational studies rather than randomized controlled trials. Nevertheless, long-term clinical and economic outcomes were reported for several countries: UK, US, Sweden, Saudi Arabia, Poland, South Africa, South Korea and China. BIAsp 30 was associated with improvements in quality-adjusted life expectancy in all countries. Estimates of direct costs varied according to country and comparator, but incremental cost-effectiveness ratios for the US and UK were USD 46 533 and GBP 6951 per quality-adjusted life year gained for BIAsp 30 versus insulin glargine., Conclusions: Although cost-effectiveness data on BIAsp 30 are scarce the majority of the analyses identified in this review suggest that BIAsp 30 is likely to be cost-effective compared to insulin glargine and biphasic human insulin across a wide range of settings, and under certain circumstances would be a dominant treatment option.

Objectives: Identification of women who survived infiltrative breast cancer and subsequently conceived and determination of the rate of pregnancy, the time from diagnosis to pregnancy, the outcome of breast cancer and of subsequent pregnancies., Patients and Methods: Women treated for breast cancer at the Gynaecology and Obstetrics Unit of the University Hospital of Strasbourg between 1993 and 2007 who subsequently conceived were prospectively registered and followed yearly., Results: Twenty pregnancies subsequent to surgery for breast carcinoma were observed in 598 patients. This association accounted for 3.3% of the cases of infiltrative breast carcinoma in potentially fertile women under 45. Six pregnancies were observed less than two years after breast cancer diagnosis (four abortions and two live births) and 17 pregnancies occurred after two years (three abortions, three miscarriages, one extra-uterine pregnancy and 10 live births). Two patients who developed distant metastases after pregnancy (less than one year and more than five years after diagnosis respectively) died. One patient, whose pregnancy occurred three years after the diagnosis, is still alive with a lung cancer and brain metastases. One patient was treated for local breast cancer recurrence. The overall prognosis was good, 18 patients (90%) being alive with a mean follow-up of 105 (S.D. 43) months., Discussion and Conclusion: Pregnancy is more likely to occur in patients with a prolonged survival and no evidence of disease. Maternal prognosis is mainly related to initial stadification of breast cancer and not to its hormonodependence.

Objective: To evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes mellitus., Design: Systematic review of trials., Measurements and Main Results: We found no study that assessed Ayurvedic as a system of care. Botanical therapy was by far the most commonly studied Ayurvedic treatment. Herbs were studied either singly or as formulas. In all, 993 titles in Western computerized databases and 318 titles identified by hand-searching journals in India were examined, yielding 54 articles reporting the results of 62 studies. The most-studied herbs were G sylvestre, C indica, fenugreek, and Eugenia jambolana. A number of herbal formulas were tested, but Ayush-82 and D-400 were most often studied. Thirty-five of the studies included came from the Western literature, 27 from the Indian. Seven were randomized controlled trials (RCTs) and 10 controlled clinical trials (CCTs) or natural experiments. Twenty-two studies went on to further analysis based on a set of criteria. Of these, 10 were RCTs, CCTs, or natural experiments, 12 were case series or cohort studies. There is evidence to suggest that the herbs C indica, holy basil, fenugreek, and G sylvestre, and the herbal formulas Ayush-82 and D-400 have a glucose-lowering effect and deserve further study. Evidence of effectiveness of several other herbs is less extensive (C tamala, E jambolana, and Momordica charantia)., Conclusions: There is heterogeneity in the available literature on Ayurvedic treatment for diabetes. Most studies test herbal therapy. Heterogeneity exists in the herbs and formulas tested (more than 44 different interventions identified) and in the method of their preparation. Despite these limitations, there are sufficient data for several herbs or herbal formulas to warrant further studies.

The total costs to all payers, i.e., a societal perspective, of four rabies post-exposure regimens were evaluated in two dog bite centres and four local health centres in India. Results showed that the Thai Red Cross intra-dermal regimen (TRC-ID), which uses only one-fifth of the IM dose of purified vero cell vaccine (PVRV) was at most 20% more expensive than use of Purified Chick Embryo Cell (PCEC) vaccine at one-tenth of the IM dose: this cost difference needs to be balanced with the small margin of safety of low potency doses. In local health centres where the staffs are not specially trained in rabies vaccination, the Zagreb intra-muscular regimen is an economical option.

Objectives: The objective of this study was to characterize a multiparameter fiber optic sensor for detection of changes in intramyocardial perfusion and to demonstrate a method of determining critical values for pH, PCO2, and PO2 to indicate onset of anaerobic metabolism., Methods: Six swine underwent a 20-minute occlusion of the left anterior descending coronary artery (LAD). Myocardial pH, PCO2, and PO2 were measured continuously in the LAD and left circumflex coronary artery (CFX) territories. Critical values for each parameter were calculated from these data., Results: During occlusion LAD myocardial pH declined from 7.36 +/- 0.04 to 6.85 +/- 0.04; PCO2 rose from 57.0 +/- 2.9 to 154.0 +/- 18.0 torr, PO2 fell from 78 +/- 20 to 6 +/- 5 torr. No myocardial pH or PCO2 changes were observed in the CFX region, however, CFX PO2 was affected in some animals during LAD occlusion and release. Methods for determining the ischemic threshold from these sensor data are presented., Conclusions: Multiparameter fiber optic sensors reliably respond to coronary occlusion and thus have the potential to help guide myocardial protection strategies for both on- and off-pump cardiac surgery.

Background: During hemorrhagic shock blood flow to vital organs is maintained by the diversion of blood from both the splanchnic organs and skeletal muscle. In this swine study, we tested the hypotheses that (1). liver and muscle pH are correlated during both shock and resuscitation and (2). muscle pH during shock is an indicator of potential liver injury after resuscitation., Materials and Methods: Hemorrhagic shock was induced over 15 min to lower systolic blood pressure to 40 mm Hg and was maintained for 60 (n = 5) or 90 (n = 5) min. Resuscitation was achieved with shed blood and warm saline to maintain mean pressure >60 mm Hg for 120 min. Liver and muscle pH were measured with microelectrodes throughout the entire shock and resuscitation periods, along with hepatic venous oxygen saturation. Arterial lactate and aspartate aminotransferase were measured at baseline, end of shock, and resuscitation. Correlation between muscle and liver pH was determined. The ability of muscle pH to predict liver injury (40% increase in arterial aspartate aminotransferase) was compared with other predictors: liver pH, arterial lactate, and tonometric-arterial PCO(2) gap., Results: pH values and rates of change were similar in both muscle and liver tissue. Liver pH was well correlated with muscle pH during both shock and resuscitation, R(2) = 0.84. Muscle pH predicts potential liver injury with the same sensitivity as blood lactate in this swine shock model., Conclusions: Minimally invasive measurement of muscle pH warrants further study as a method to assess splanchnic hypoperfusion and resultant injury.

The feasibility of using near-infrared (NIR) spectroscopy in combination with partial least-squares (PLS) regression was explored to measure electrolyte concentration in whole blood samples. Spectra were collected from diluted blood samples containing randomized, clinically relevant concentrations of Na+, K+, and Ca2+. Sodium was also studied in lysed blood. Reference measurements were made from the same samples using a standard clinical chemistry instrument. Partial least squares (PLS) was used to develop calibration models for each ion with acceptable results (Na+, R2 = 0.86, CVSEP = 9.5 mmol/L; K+, R2 = 0.54, CVSEP = 1.4 mmol/L; Ca2+, R2 = 0.56, CVSEP = 0.18 mmol/L). Slightly improved results were obtained using a narrower wavelength region (470-925 nm) where hemoglobin, but not water, absorbed indicating that ionic interaction with hemoglobin is as effective as water in causing measurable spectral variation. Good models were also achieved for sodium in lysed blood, illustrating that cell swelling, which is correlated with sodium concentration, is not required for calibration model development.

Mechanical coronary artery occlusion is required for minimally invasive direct coronary artery bypass and off-pump coronary artery bypass surgery. It is important that the method of occlusion be minimally traumatic. Chronic effects of these methods have never been studied. Temporary occlusion of coronaries utilizing suture snare, silastic loop snare, and bulldog clamp was carried out in 12 Yucatan pigs. Three animals each were sacrificed acutely and at 3, 6, and 12 months. The area of occlusion of each vessel was examined by light microscopy and the degree of damage recorded. In the animals sacrificed acutely, there was more damage using the suture snare than with the other 2 methods, but there was minimal damage at longer intervals. There was slight damage acutely and chronically with the bulldog technique. No damage was seen acutely with the silastic loop technique, but some late damage was found. The techniques of coronary artery dissection and occlusion used for minimally invasive and off-pump bypass surgery may contribute to early postoperative graft occlusion.

The aim of this study was to investigate possible discrepancies between the drug prescribed and that recorded in the patient's file. A prospective open blind study was conducted with 178 patients included consecutively. We analysed 1011 prescriptions (the median (range) number of drugs per patient was 5 (1-37)) and identified 49 discrepancies (5 per cent of cases). In 18 cases, the drug given to the patient by a nurse was not the drug initially prescribed but the drug recorded in the patient's file was the drug actually given to the patient. In another 31 cases, the drug given to the patient was not the drug initially prescribed, but the drug recorded was that prescribed. This inquiry shows that there may be a discrepancy between the drug initially prescribed and that actually administrated and suggests that poor traceability may affect pharmacological surveillance surveys.

The authors performed a study to design and evaluate a device giving the surgeon added protection against pulmonary artery injury in a closed thoracic compartment. Eleven swine were used for a total of 12 lobectomies. A light-bearing, magnetic-tipped, modified Swan-Ganz catheter was passed through the jugular vein into the left pulmonary artery. By using magnetic guidance through a port site and balloon inflation, cessation of flow in the pulmonary artery was documented by Doppler. Twelve video-assisted lobectomies were performed. Nine of 12 (75%) lobectomies were completed successfully by using the magnetic-tipped, illuminated balloon catheter. In 4 cases, the catheter displaced because of the short left main pulmonary artery in swine. In one case, the balloon was recovered, and successful lobectomy was performed. The use of a magnetic-tipped, flow-directed device may provide an effective means of endovascular control during thoracoscopic pulmonary arterial dissection.

The purpose of this study was to investigate the feasibility of using near infrared (NIR) spectroscopy of the liver to simultaneously assess oxygen content in combination with tissue pH, an indicator of anaerobic metabolism. Six anesthetized swine were subjected to 45 min of hemorrhagic shock followed by resuscitation with blood and crystalloid. Calibration models between NIR spectra and reference measurements of tissue pH, hepatic venous oxygen saturation (S(V)O2), and blood hemoglobin concentration (Hb) were developed using partial least-squares regression. Model accuracy was assessed using cross validation. The average correlation (R2) between NIR and reference measurements was 0.87, 0.68, and 0.93, respectively for pH, Hb, and S(V)O2. Estimated accuracy, the root mean squared deviation between spectral, and reference measurements was 0.03 pH units, 0.3 g/dL, and 6%. NIR determination of hepatic oxygen content and tissue pH during shock and resuscitation demonstrated that there can be a variance between hepatic venous oxygenation and regional tissue acidosis. NIR spectroscopy provides a technique to explore the implications of post-shock depression of tissue pH and evaluate new methods of resuscitation.

Unlabelled: THEORY AND REALITY: Diabetes mellitus is known to be associated with excess cardiovascular risk. Prescription of antiplatelet agents such as acetylsalicylic acid would thus appear to be warranted. That is the theory, but the reality is much different. A review of the literature provides evidence on the use of acetylsalicylic acid for primary and secondary preventive care, but conclusions are often extrapolated from studies conducted in the general population. EVIDENCE OF A BENEFICIAL EFFECT IN DIABETICS: The HOT study, conducted in hypertensive patients) demonstrated that acetylsalicylic acid at the dose of 75 mg a day, reduced the rate of major cardiovascular events by 15% (p = 0.03) and of myocardial infarction by 36% (p = 0.02) with no effect on stroke. In diabetic patients (n = 1500), the benefit was even more pronounced., Risks: The risk of bleeding must be balanced against the beneficial cardiovascular effect. Diabetic retinopathy is not aggravated by aspirin. The data reported in the literature do not however enable any evidenced-based decision on dosing for the diabetic population with numerous cardiovascular risks.

Background: In clinical practice pulmonary artery balloon counterpulsation (PABC) has been utilized only in the operative setting with the balloon housed in a graft attached to the pulmonary artery. Clearly, percutaneous insertion of a dedicated pulmonary artery balloon is a desirable goal for patients requiring temporary assist for right ventricular failure., Methods: To address the question of right sided cardiopulmonary tolerance for a chronic indwelling pulmonary artery balloon, six adult ewes underwent percutaneous placement of an 11 ml pulmonary artery balloon, via the femoral vein. Effective pumping and timing were monitored for 48 hours at which time the animals were sacrificed. At autopsy gross and microscopic study of all right heart structures, the pulmonary arteries and the lungs were studied for adverse effects., Results: There were inconsequential minor abrasions to right heart structures in most animals. The pulmonary artery in five of six animals revealed ecchymoses and some transmural hemorrhage, but no necrosis or perforation. There was no pulmonary injury that could not be ascribed to postoperative atelectasis., Conclusions: This study demonstrates that chronic pulmonary artery balloon counterpulsation can be carried out for a period of 48 hours without significant injury to right heart and pulmonary structures in the ovine model

Ursodeoxycholic acid, employed in treatment of intrahepatic cholestasis as seen in primary biliary cirrhosis, primary sclerosing cholangitis, and chronic hepatitis; does not have marketing approval for prescription during pregnancy because of lack of data. In 3 cases of gravidic cholestasis, we administered oral ursodeoxycholic acid 1 g a day from the 34th week of amenorrhea to delivery. In each case, it took 3 days of treatment for the pruritus to regress incompletely and for plasma levels of biliary acid and transaminases to decrease. The infants, born between the 36th and 38th week of amenorrhea, presented with no problem. Forty-eight cases of gravidic cholestasis treated by ursodeoxocholic acid (0.4 to 1 g a day) have been reported in the literature; 18 cases belonging to 2 randomized studies. In 46 cases pruritus disappeared generally 3 days after treatment onset, and plasma level of biliary acid and transaminase decreased in one week. Only two patients experienced persisting pruritus despite biological improvement. No foetal adverse effect is reported. Ursodeoxycholic acid seems to be an efficient treatment of gravidic cholestasis. Long term observation of fetuses exposed in utero to this treatment is required to assess safety.

The authors report a bladder injury during laparoscopic procedure. A laparotomy is performed immediately and shows an urachal anomaly with the bladder reaching the umbilic. One of the accessory trocars perforates the bladder in its unusual position. Surgical repair is made and the patient discharged without sequelae 12 days later. Rate of bladder injury increases with development of advanced laparoscopy as Burch and hysterectomy. Careful drainage with folley catheter during all laparoscopic procedures present greater than morbidity. Previous laparotomy may change the usual position of the bladder. Care must be taken in case of wall anomalies as in our observation. Per-operative suspicion of bladder injury (hematuria, presence of gas in the urinary catheter collection bag) can be proved with the injection of methylene blue in the folley catheter. Laparoscopic repair is possible for an experienced surgeon, associated with 10 days continuous urinary drainage and quinolone antibiotherapy. Morbidity of unknown bladder injury is great with some death-case reports. All diagnosis technique possible must be used to light these clinical situations, urinary peritonitis symptomatology is often non specific.