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Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP. Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods. Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.

Although the south Western Cape receives most of its rainfall between May and September, there are substantial rainfall events in some summers. These events are of interest in themselves as well as for their possible role in mitigating the frequent winter droughts that the region suffers from. Most recently, greater Cape Town suffered a devastating drought during 2015–18 known as the Day Zero drought due to the high risk of urban areas running out of piped water supply. Estimated data from the city show that major dam levels in the south Western Cape increased more than 1% in some cases after large rainfall events (LREs) in the summer of 2018/19. This increase is significant as dam levels often decrease by several percent per month during the hot summer. In this study, LREs over the south Western Cape during the summer (October–March) are investigated together with dam level data. Most summer LREs result from atmospheric rivers (ARs) or cutoff lows (COLs). ARs have not been previously studied in the South African region except for one study for winter that showed they are responsible for almost all the heavy rainfall events in the Western Cape. Although COLs are most common in the transition months, they can also occur in midwinter and summer. COLs tend to last longer and cover larger areas than ARs, which typically yield relatively short bursts of intense rainfall mostly concentrated around greater Cape Town. After each summer LRE, average dam levels increase by up to 5%, suggesting they are very important for drought recovery. In particular, summer LREs following the anomalously dry winters of 1980, 1984, 2003, 2004, and 2015–18 played an important role in mitigating those droughts.

Introduction: Perioperative events may affect the risk of breast cancer recurrence after surgery. Ketorolac, a non-steroidal anti-inflammatory drug routinely used to improve pain control postoperatively has been associated with better breast cancer outcome in retrospective studies. However, it is still unknown whether a single dose of pre-incisional ketorolac may be sufficient to prolong recurrence-free survival. Patients and methods: The KBCt trial (NCT01806259) is a national, multicenter, prospective, double-blind, placebo-controlled, randomized phase III trial in high risk breast cancer patients. Each patient was assigned to the ketorolac or the placebo group. Patients were given one dose of ketorolac tromethamine (Taradyl®, N.V. Roche S.A., Belgium) or a matching placebo 30 minutes before surgery. Eligible patients were ≥18 and ≤75 years old with histologically or cytologically confirmed, invasive ductal or lobular breast carcinoma planned for curative breast cancer surgery, and with at least one of these 3 criteria: a Neutrophil-to-Lymphocyte Ratio ≥4, node-positive disease (cN1-N3) or a triple-negative histology. The primary endpoint of the study was Disease-Free Survival (DFS). Secondary endpoints included safety, pain assessment and overall survival. Results: Two hundred and three patients were assigned to ketorolac (n=96) or placebo (n=107). Baseline characteristics were similar between arms. Patients had a mean age of 55.7 (SD 14) years. Both intra- and post-operative blood losses were not different between groups and there was no difference in pain at day 1 after surgery. There was no difference between the 2 arms for DFS (p=0.52) nor for OS (p=0.88). Discussion and conclusion: This study shows that a single administration of 30 mg of ketorolac tromethamine before surgery does not increase disease-free survival in high risk breast cancer patients. Overall survival is also comparable. No safety concerns were observed in this study. Citation Format: Berliere M, Bouche G, Duhoux F, Coulie P, De Cloedt J, Dekleermaker A, Guillaume J-E, Ledent M, Machiels J-P, Mustin V, Swinnen W, Vander Essen L, Van Maanen A, Verougstraete J-C, De Kock M, Forget P. Intraoperative ketorolac in high-risk breast cancer patients with and without inflammation. A prospective, randomized, placebo-controlled clinical trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-20-01.

Sulfadoxine/pyrimethamine is recommended for intermittent preventative treatment of malaria during pregnancy. Data from 98 women during pregnancy and 77 after delivery in four African countries were analysed using nonlinear mixed-effects modellingto characterise the effects of pregnancy, post-partum duration, and other covariates such as body-weight and haematocrit on sulfadoxine/pyrimethamine pharmacokinetic properties. During pregnancy, clearance increased 3-fold for sulfadoxine but decreased by 18% for pyrimethamine. Post-partum sulfadoxine clearance decreased gradually over 13 weeks. This finding, together with haematocrit-based scaling of plasma to whole-blood concentrations and allometric scaling of pharmacokinetics parameters with body weight, enabled site-specific differences in the pharmacokinetic profiles to be reduced significantly but not eliminated. Further research is necessary to explain residual site-specific differences and elucidate whether dose-optimisation, to address the 3-fold increase in clearance of sulfadoxine in pregnant women, is necessary, viable, and safe with the currentfixed dose combination of sulfadoxine/pyrimethamine.

Elderly surgical population is growing faster than the rate of population ageing. The risk of postoperative complication is higher in this population, the type of complication and the risk indicators are different from younger patients. There is also a huge heterogeneity in the elderly population. The concept of frailty-emerges to explain these specific aspects and to risk stratify older patients. The present work intends to help the anaesthesiologist to take into account the concept of frailty at the preoperative visit. We reviewed, in the light of surgical context, the physiopathology of ageing, the definitions of frailty concept,the current existing strategies for peri-operational optimisation and the different frailty assessment tools. Our conclusions are that preoperative frailty assessment is essential in modern perioperative medicine practice and that the Edmonton Frail Scale stands out from other tools even though it cannot yet be considered as a gold standard.

This technical report describes the outputs of avisioning workshop with stakeholders and experts on 4-8 September 2017 in Auckland, New Zealand. The workshop was hosted by the IPBES Scenarios and Models Expert Group in order to initiatethe development of a set of Multiscale Scenarios for Nature Futures based on positive visions for human relationships with nature. A total of 73 participants from inter-governmental organisations, national government organisations, non-governmental organisations, academia and the private sector, from 31 countries, and with a range of sectoral expertise on biodiversity topics, from urban development to agriculture to fisheries, worked together in a visioning exercise. This report documents the results from this visioning workshop to inform further stakeholder consultation and the development of the associated multiscale scenarios by modelers and experts.

Ce travail a pour but de remettre en question l’usage systematique de hautes doses d’opiaces synthetiques pendant l’anesthesie. Pour ce faire, les raisons qui ont conduit a cet usage seront discutees. L’origine de l’hyperalgesie et des interactions immunitaires provoquees par ces substances sera presentee. Cela en evoquant des elements de biologie comparative et les principes de fonctionnement des perceptions sensorielles.

BACKGROUND:An association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and better outcome after mastectomy and lung surgery for cancer has been recently suggested. In a retrospective analysis, we investigated the association between intraoperative NSAIDs use in conservative breast cancer surgery and breast cancer disease-free survival (DFS). Similarly, we also evaluated the association between breast cancer DFS and preoperative neutrophil:lymphocyte ratio (NLR). METHODS: A retrospective analysis of a single-centre cohort was performed in breast cancer patients (n=720) with uni- and multivariate analyses, using a Cox regression model. RESULTS: In conservative breast cancer surgery, the intraoperative use of NSAIDs (ketorolac or diclofenac) was associated with an improved DFS {hazard ratio (HR)=0.57 [95% confidence interval (CI): 0.37-0.89], P=0.01} and an improved overall survival (OS) [HR=0.35 (95% CI: 0.17-0.70), P=0.03]. In these patients, an NLR >3.3 (identified by a receiver-operating characteristic curve) was associated with a shorter DFS [HR=1.99 (95% CI: 1.16-3.41), P=0.01] and OS [HR=2.35 (95% CI: 1.02-5.43), P=0.046]. CONCLUSIONS: Intraoperative NSAIDs and higher preoperative NLR are associated with improved outcome in conservative breast cancer surgery. Prospective, randomized trials to evaluate if these associations are causal are warranted.

The difficulty of defining the three so-called components of « an-esthesia » is emphasized: hypnosis, absence of movement, and adequacy of anti-nociception (intraoperative « analgesia »). Data obtained from anesthetized animals or humans delineate the activation of cardiac and vasomotor sympathetic reflex (somato-sympathetic reflex) and the cardiac parasympathetic deactivation observed following somatic stimuli. Sympathetic activation and parasympathetic deactivation are used as monitors to address the adequacy of intraoperative anti-nociception. Finally, intraoperative nociception through the administration of nonopioid analgesics vs. opioid analgesics is considered to achieve minimal postoperative side effects.

There is a paucity of information concerning cardiac tumours of the pulmonary valve due to their rarity at this location. We report a case of a 47-year-old patient suffering from haemoptysis, asthenia, and acute kidney injury (AKI). A transthoracic echocardiography (TTE) revealed a mass on the pulmonary valve. Further diagnostic investigation was completed until he exhibited worsening hemodynamic instability. This case emphasizes the lack of information regarding the management of a pulmonary valve tumour.

The anesthesiologist's involvement in perioperative medicine has significantly changed. In order to identify patients at risks of perioperative complications, the anesthesiologist has to consider, amongst others, screening and management of undernutrition. For this purpose knowledge of prevalence and risk factors, along with screening tools and guidelines for an adapted nutritional management and outcomes of renutrition are mandatory. The present review intends to provide these tools to the Anesthesiologists.We conduct a literature review in Pubmed, Direct Science and Cochrane Library without limit of time related to undernutrition in the perioperative period.Undernutrition is common in surgical patients. Undernutrition is associated with an increase of morbidity, mortality, length of hospital stay and costs. Undernutrition could probably be detected during the anesthetic consultation with simple and rapid tests, such as SNAQ, MST, MUST and NRS-2002. Nevertheless, further studies are needed to validate such tests in surgical patients. Waiting for these results, we prefer MUST. The implementation of nutritional support recommendations would reduce postoperative complications.The anesthesiologist could play an important role in undernutrition screening and its management in order to reduce perioperative morbidity.

Objectif : Evaluer les trajectoires de douleur pour l’identification des patients a risque de douleur chronique apres hepatectomie pour don vivant de foie. Type d’etude : Etude retrospective des donneurs vivants (DoVi) de foie sur une duree de trois ans. Patients et methodes : Recueil des donnees chirurgicales et anesthesiques perioperatoires des DoVi de foie. Une trajectoire standard de douleur postoperatoire (DPO) a ete construite avec les donnees des patients ne presentant pas de douleur chronique post-chirurgicale (DCPC), a laquelle a ete comparee l’evolution postoperatoire des patients avec DCPC. Resultats : Soixante-cinq patients ont ete evalues (hommes/femmes : 35/30, âge median 34 ans). La chirurgie etait une bisegmentectomie hepatique pour 89 % des patients. Une analgesie peridurale a ete utilisee chez 66 %, les autres beneficiant d’une pompe de morphine. Le premier jour, 11 % et 37 % des patients ont rapporte une DPO severe (score > 6/10) au repos et au mouvement respectivement. Six patients (9 %) (trois hommes, trois femmes) presentaient des DCPC a trois mois et plus, sans correlation avec la technique d’analgesie. L’analyse des trajectoires de DPO a montre que les patients avec DCPC avaient presente des DPO plus intenses durant les premieres 24 heures ou une resolution anormale de leur DPO aigue. Conclusion : La DPO aigue chez les DoVi de foie est un facteur de risque de DCPC. L’identification des patients a risque par les trajectoires de DPO pourrait permettre une prise en charge plus precoce.

Summary To date, the dosing of sugammadex is based on real body weight without taking fat content into account. We compared the reversal of profound rocuronium-induced neuromuscular blockade in morbidly obese patients using doses of sugammadex based on four different weight corrections. One hundred morbidly obese patients, scheduled for laparoscopic bariatric surgery under propofol-sufentanil anaesthesia, were randomly assigned four groups: ideal body weight; ideal body weight + 20%; ideal body weight + 40%; and real body weight. Patients received sugammadex 2 mg.kg−1, when adductor pollicis monitoring showed two responses. The primary endpoint was full decurarisation. Secondary endpoints were the ability to get into bed independently on arrival to the post-anaesthetic care unit and clinical signs of residual paralysis. There was no residual paralysis in any patient. Morbidly obese patients can safely be decurarised from rocuronium-induced neuromuscular blockade T1-T2 with sugammadex dosed at 2 mg.kg−1 ideal body weight + 40% (p

We have an improved understanding of the pathophysiology and impact of perioperative pain. Targeted interventions to prevent and manage nociception are effective in improving patient satisfaction and surgical outcome. There are many alternatives, each with its own profile of benefits, risks and side-effects. A logical, stepwise, balanced approach utilising multiple modalities is effective, scales easily to the type of surgery, can adapt to changing requirements and resources, and promotes a seamless transition from theatre care to the ward and patient self-reliance.

Altered membrane integrity in hepatocellular carcinoma (HCC) tissue was indicated by an elevation in cholesterol and significant decrease in phosphatidylcholine (PC). The resultant decreased phosphatidylcholine/phosphatidylethanolamine (PC/PE) and increased cholesterol/phospholipid ratios are associated with decreased fluidity in the carcinoma tissue. The lower PC was associated with a decrease in the quantitative levels of the saturated (C16:0, C18:0), omega6 (C18:2, C20:4) and omega3 (C22:5, C22:6) fatty acids (FAs), resulting in reduced long-chain polyunsaturated fatty acids (LCPUFAs), total PUFA and an increase in omega6/omega3 FA ratio. In PE, the saturated and omega3 (C22:5, C22:6) FAs were reduced while the total omega6 FA level was not affected, leading to an increased omega6/omega3 FA ratio. Increased levels of C18:1omega9, C20:2omega6 and reduction of 22:6omega3 in PC and PE suggest a dysfunctional delta-6 desaturase. The reduced PC/PE ratio resulted in a decreased C20:4omega6 (PC/PE) ratio, implying a shift towards synthesis of the 2-series eicosanoids. Lipid peroxidation was reduced in both hepatitis B negative (HBV(-)) and positive (HBV(+)) HCC tissues. Glutathione (GSH) was decreased in HCC while HBV had no effect, suggesting an impairment of the GSH redox cycle. In contrast HBV infection enhanced GSH in the surrounding tissue possibly to counter oxidative stress as indicated by the increased level of conjugated dienes. Apart from the reduced LCPUFA, the low level of lipid peroxidation in the carcinoma tissue was associated with increased superoxide dismutase and glutathione peroxidase activity. The disruption of the redox balance, resulting in increased cellular antioxidant capacity, could create an environment for resistance to oxidative stress in the carcinoma tissue. Alterations in membrane cholesterol, phospholipids, FA parameters, C20:4omega6 membrane distribution and low lipid peroxidation are likely to be important determinants underlying the selective growth advantage of HCC cells.

OBJECTIVE: The Natural Killer cells (NK) are an important part of non-specific cellular-mediated and antitumoral immunity. The goal of this review is to recapitulate data published over NK activity during the perioperative period and the influence of anaesthesia, analgesia and modulation of sympathetic system. DATA SOURCES: Pubmed/Medline database. STUDY SELECTION AND DATA EXTRACTION: Keywords-based selection, without limit of date: fundamental studies, randomized controlled trials and non-randomized comparative studies. DATA SYNTHESIS: In human as in animal studies, an important correlation exists between NK activity and prognosis linked to the development of metastasis. The great depression of this cytotoxicity during the perioperative period could be able to compromise host defenses. The influence of anaesthetics and analgesics is important. The effects of the opioids, the agonists and the antagonists of the sympathetic nervous system, the prostaglandins, the NSAIDs, the ketamine, the hypnotics and the locoregional anaesthesia are systematically reviewed. The limits of experimental model presented are covered. CONCLUSION: The effects of anaesthetic/analgesic drugs and techniques, the consequences of sympathomodulation on NK activity are numerous and sometimes opposite. It is important for the anaesthesiologist to keep in mind that the long term consequences of his techniques on the patients' outcome must be clarified.

When archaeological skeletons are assessed, the prevalence (and patterns of bone involvement) of trauma is important. The number and pattern of fractures can be used to gain insight into the occurrence of interpersonal violence, workload and living conditions. However, the question remains as to how these results should be interpreted—such as what constitutes high or low levels of trauma? The aim of this study was to investigate the occurrence of trauma in a population of modern Greeks living in Crete, as well as South African (SA) whites and blacks in the Pretoria Bone and Raymond Dart collections. The sample comprised mostly of older individuals (n = 90–100 within a sex-population group). Each skeleton was studied for healed trauma. For the vertebrae, only spondylolysis was assessed. In the Greek sample, it was found that 42% of the males and 46% of females had at least one fracture, with corresponding figures of 63 and 44% for SA whites and 83 and 69% for SA blacks. Radius, rib and femur fractures were most common in Greeks, with skull, radius and ribs most common in SA whites and skull, ulna and ribs in SA blacks. These prevalences of trauma are high, but the composition of the samples (mostly of lower socio-economic origin) should be kept in mind. It may also be questioned whether these individuals reflect the society as a whole. It seems that the fractures in Greeks are mostly related to old age due to falls and accidents (radius and hip fractures), while the SA black sample reflects high prevalences of interpersonal violence (such as cranial vault and ulna fractures). The SA white sample follows a comparatively moderate pattern of trauma. These comparative figures may be useful when assessing trauma in other skeletal populations. Copyright © 2009 John Wiley & Sons, Ltd.

The use of ketamine for paediatric sedation-anaesthesia-analgesia is still growing despite the availability of adequate alternatives. Based on the literature, the present work will briefly review the well-known properties underlying the widespread use of this drug in this particular clinical situation. In adult patients, the use of ketamine as a new element of the balanced anaesthesia-analgesia is also ever growing. This is based on the recently demonstrate antihyperalgesic and anti-pro-inflammatory properties of this drug. This work questions the existence of such benefits in the paediatric population. Finally, the "dark side" of ketamine will be discussed. Experimental studies on developing brain clearly demonstrate that this old anaesthetic is a potent trigger for pathologic neuronal apoptosis.

We describe briefly the properties of the recently completed Southern African Large Telescope (SALT), along with its first light imager SALTICAM. Using this instrument, we present 4.3 hr of high speed unfiltered photometric observations of the eclipsing polar SDSSJ015543.40+002807.2 with time resolution as short as 112 ms, the highest quality observations of this kind of any polar to date. The system was observed during its high luminosity state. Two accreting poles are clearly seen in the eclipse light curve. The binary system parameters have been constrained: the white dwarf mass is at the low end of the range expected for cataclysmic variables. Correlations between the positions of the accretion regions on or near the surface of the white dwarf and the binary system parameters were established. The sizes of the accretion regions and their relative movement from eclipse to eclipse were estimated: they are typically 4-7 deg depending on the mass of the white dwarf. The potential of these observations will only fully be realised when low state data of the same kind are obtained and the contact phases of the eclipse of the white dwarf are measured.

Within the qualitative research genre, narrative inquiry remains controversial, particularly for the novice researcher, because of its uncertain boundaries and relationship to other qualitative methodologies. This article represents a novice researcher’s attempt to address the ambiguity by presenting a systematic, critical exploration of the analytical methods and methodology of narrative inquiry. The methods are grouped into three clusters for discussion: the performative cluster, the structural analysis cluster, and the literary analysis cluster. Each cluster of methods is described, associated with its theoretical framework, and applied to the compelling narratives collected from a series of interviews with two preservice educators. Issues of credibility and believability in the interpretative analysis of the narratives are also examined. In the conclusion of the article are topics for continued reflection gleaned from the experience of trying to make sense of narrative inquiry.

Male Fischer rats were fed the AIN 76A diet containing varying n-6/n-3 FA ratios using sunflower oil (SFO), soybean oil (SOY), and SFO supplemented with EPA-50 and GLA-80 (GLA) as fat sources. Hepatocyte nodules, induced using diethylnitrosamine followed by 2-acetylaminofluorene/partial hepatectomy promotion, were harvested, with surrounding and respective dietary control tissues, 3 mon after partial hepatectomy. The altered growth pattern of hepatocyte nodules in rats fed SFO is associated with a distinct lipid pattern entailing an increased concentration of PE, resulting in increased levels of 20:4n-6. In addition, there is an accumulation of 18:1 n-9 and 18:2n-6 and a decrease in the end products of the n-3 metabolic pathway in PC, suggesting a dysfunctional delta-6-desaturase enzyme. The hepatocyte nodules of the SFO-fed rats exhibited a significantly reduced lipid peroxidation level that was associated with an increase in the glutathione (GSH) concentration. The low n-6/n-3 FA ratio diets significantly decreased 20:4n-6 in PC and PE phospholipid fractions with a concomitant increase in 20:5n-3, 22:5n-3, and 22:6n-3. The resultant changes in the 20:4/20:5 FA ratio and the 20:3n-6 FA level in the case of the GLA diet suggest a reduction of prostaglandin synthesis of the 2-series. The GLA diet also counteracted the increased level of 20:4n-6 in PE by equalizing the nodule/surrounding ratio. The low n-6/n-3 ratio diets significantly increased lipid peroxidation levels in hepatocyte nodules, mimicking the level in the surrounding and control tissue while GSH was decreased. An increase in n-3 FA levels and oxidative status resulted in a reduction in the number of glutathione-S-transferase positive foci in the liver of the GLA-fed rats. Modulation of cancer development with low n-6/n-3 ratio diets containing specific dietary FA could be a promising tool in cancer intervention in the liver.

We investigated the effect of maternal nicotine exposure during pregnancy and lactation on carbohydrate metabolism in the neonatal lung. Female rats received nicotine (1 mg/kg body weight/day) subcutaneously from day 7 after mating. Control animals received saline. The suckling rats were killed 24 hours after the last dose of nicotine was administered to the mother on postnatal day 14. The lung tissue of 9 rat pups from 3 litters was surgically removed and the in vitro utilization of exogenous glucose (micromol/g wet lung tissue/h) was determined. Lactate production (micromol/g wet lung tissue/h) was also determined to assess glycolytic activity. Maternal nicotine exposure during pregnancy and lactation stimulated glucose turnover by 21.6% (P

Despite the advances in therapies such as chemotherapy and radiotherapy, tumours have been shown to be resistant to the treatments. Gold nanoparticles (AuNPs) have been recognized as effective radiosensitizers of low energy (e.g. 200–500 kV) X-rays, leading to the emission of Auger electrons that cause highly localised ionizing damage to cells. Spherical AuNPs were synthesised via the reduction of the chloroaurate ions by sodium citrate. Characterisation of AuNPs involved UV-visible spectrophotometry, zeta (Z) potential, dynamic light scattering (DLS) and polydispersity index (PDI) measurements for determination of surface plasmon resonance (SPR), surface charge and stability, as well as transmission electron microscopy (TEM) for hydrodynamic core sizes, size distribution width and shape of AuNPs. Both the 5 and 10 nm AuNPs were found to be anionic with λmax absorbance of 525 nm and uniform size distribution. DLS measurement at 38.12 nm and 48.50 nm, respectively for 5 nm and 10 nm AuNPs, points to aggregation of the AuNPs. However, TEM measurements confirmed the core size of the 10 nm AuNPs. Non-malignant Chinese hamster ovary (CHO-K1), brain endothelial (BEnd5), breast (MCF-10A), isolated human lymphocytes and malignant breast (MCF-7) cell lines were treated with 50 μg/ml of AuNPs, and irradiated with either 1, 2 or 4 Gy X-rays or 1 or 2 Gy p(66)/Be neutron radiation. The γ-H2AX foci assay, cytokinesis-block micronucleus assay, MTT assay and fluorescence-activated cell sorting (FACS) was used to determine that amount of double stranded breaks (DSBs) in isolated lymphocytes, the presence and number of micronuclei (MNi) within binucleated cells (BNCs), cell viability and cell cycle progression, respectively. Preliminary experiments that established the reliability of the study regarding the induction of DNA damage after the bombardment of AuNPs by scattered low kV X-rays, were carried out on lymphocytes. Combined treatment (AuNPs and radiation) resulted in more endogenous foci in comparison to lymphocytes that were treated with AuNPs only. The CHO-K1 and MCF-7 cells showed higher MNi frequencies after the combination treatment of AuNPs and radiation compared to the number of MNi in samples exposed to AuNPs and radiation separately. The AuNPs alone influenced the cellular kinetics of all cell types. Interaction indices, which is the enhancement factor of AuNPs in combination with radiation, for AuNPs and 6 MV 2 Gy X-rays of 1.6 to 1.7 and 1.3 to 1.4 have respectively been determined for CHO-K1 and MCF-7 cells, whilst that for the other cell types used in the study were not different from Unity. As expected, the interaction indices between AuNPs and p(66)/Be neutrons was lower than the interaction indices after 2 Gy X-rays, as p(66)/Be neutrons interact only with the nuclei of the AuNP's atoms and the X-ray photons interact with the orbital electrons of the atoms of the AuNPs leading to Auger electron emission. The cell viability assay showed that 50 μg/ml of AuNPs had an inhibitory effect on cellular…

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From 1981 to 1987, 77 GSB-II total knee arthroplasties were implanted in 65 patients. There were 23 men and 42 women aged on average 60 years old (range 30–85 years). The diagnosis was osteoarthritis (OA) in 21 knees, rheumatoid arthritis (RA) in 44 knees, and other in 12 knees. A clinical and radiological follow-up was performed in two stages after a mean of 6.7 years (61 knees) and 14.8 years (22 knees) to assess the medium- and long-term results and to determine if deterioration had occurred after mid-term follow-up. A survival analysis was done with two endpoints: (1) revision, and (2) revision, moderate or severe pain and lost to follow-up (worst-case scenario). At the last follow-up 36 patients (44 knees) had died, 2 patients (2 knees) refused examination, and 3 patients (3 knees) were lost to follow-up. Six knees had been revised for malposition (1.3%), septic (3.9%) and aseptic (2.6%) loosening. The mean Knee Society score after 6.7 and 14.8 years was 85 points (OA 82 points, RA 87 points). Lateralisation, subluxation or dislocation of the patella was present in 8 of 17 knees at the last follow-up. The 6- and 15-year survival rates with revision as the endpoint were 95% (CI 89%–100%) and 87% (CI 65%– 100%), respectively. For the worst-case scenario, the 6- and 15-year survival rates were 95% (CI 89%–100%) and 56% (CI 0%–100%), respectively. The medium- and long-term results of the GSB-II total knee arthroplasty were good, and a decline in the knee score did not occur beyond the mid-term follow-up. Patella complications were abundant, and a marked decrease in implant survival was noted when moderate or severe pain and lost to follow-up were included as endpoints.

Twenty early pregnancies were diagnosed and monitored in vervet monkeys by ultrasonography. Non-gravid uteri became increasingly echogenic from cycle days 7 to 26. The first definite sign of pregnancy was a gestational cavity of 2 mm (+/- 0.80) at 33.0 (+/- 1.48) days menstrual age, which was also used to date all subsequent features. Earlier signs, such as an endometrial line swelling or endometrial 'pregnancy' ring, as reported for other non-human primate species, could not be reliably and consistently used to diagnose pregnancy in vervet monkeys. A rapid increase of the gestational cavity size from days 37 to 49 corresponded closely to a rapid increase in plasma progesterone concentration from day 39 to 49. The first yolk sac was recognizable at 38.0 days (+/- 3.10) and measured 3.3 mm (+/- 0.40) in diameter. A heart beat could be detected at 45.5 (+/- 1.73) days and the size of the first measurable embryo at 35 days was 2 mm. The dating of most features was within the range reported for other non-human primate species.

The place of simulation in medical education, particularly in anesthesia, appears to be more and more evident. However, the history of simulation in Belgium showed that the associated costs remain a barrier. The use of 'in situ' simulation, defined as the practice of simulation in the usual workplace, could solve the problem of providing access to this educational tool. Indeed, it allows reducing equipment and manpower costs: the needed equipment comes from the hospital, and supervision and organization are provided by staff members. It also provides access to simulation for a larger number of individuals on site. The environment is more realistic because the participants operate in their usual workplace, with their customary equipment and team. Furthermore, 'in situ' simulation allows participation of the paramedical staff. This allows developing skills related to teamwork and communication. Despite those numerous advantages, several difficulties persist. The associated logistic and organizational constraints can be cumbersome.

Background Many studies have shown the beneficial effect of epidural clonidine in postoperative pain management. In these studies, the patients received local anesthetics, opioids, or both in combination with clonidine. Due to the interactive potentiation of those drugs, the importance of the intrinsic analgesic properties of the alpha 2-adrenoceptor agonist is difficult to establish. The authors investigated the analgesic potency of epidural clonidine when used as the sole analgesic agent during and after major abdominal surgery. Methods Fifty young adult patients undergoing intestinal surgery under general anesthesia with propofol were studied. At induction, the patients received epidurally either an initial dose of 2 micrograms/kg clonidine followed by an infusion of 0.5 microgram.kg-1.h-1 (group 1, n = 10) or 4 micrograms/kg followed by 1 microgram.kg-1.h-1 (group 2, n = 20) or 8 micrograms.kg-1.h-1 followed by an infusion of 2 micrograms.kg-1.h-1 (group 3, n = 20). During the operation, increases in arterial blood pressure or heart rate that did not respond to a propofol bolus (0.5 mg/kg) were treated with a bolus of intravenous lidocaine (1 mg/kg). Three successive injections were allowed. When baseline values were not restored, opioids were added and the patient was removed from the study. After operation, the clonidine infusions were maintained for 12 h. During this period and at every 30 min, sedation scores and visual analog scale values at rest and at cough were noted. In case of subjective scores up to 5 cm at rest or up to 8 cm at cough, the patients were given access to a patient-controlled analgesia device that delivered epidural bupivacaine. The end point of the study was reached once the patient activated the analgesic delivery button. Results During surgery, 60% of patients in group 1 compared with 33% of patients in group 2 and only 5% of patients in group 3 were removed from the study protocol because of inadequate anesthesia (P < 0.05). After operation, epidural clonidine provided complete analgesia lasting 30 +/- 21 min in group 1 compared with 251 +/- 237 min in group 2 or 369 +/- 256 min in group 3 (P < 0.05 for group 1 vs. groups 2 and 3 and group 2 vs. group 3). Conclusions Epidural clonidine used as the sole analgesic agent provided dose-dependent control of the hemodynamic changes associated with surgical stimulation. It also produced dose-dependent postoperative analgesia without major side effects.

The Eastern Cape Subtropical Thicket (ECST) forms the transition between forest, semiarid karroid shrublands, and grassland in the Eastern Cape, South Africa. Undegraded ECST forms an impenetrable, spiny thicket up to 3 m high consisting of a wealth of growth forms, including evergreen plants, succulent and deciduous shrubs, lianas, grasses, and geophytes. The thicket dynamics are not well understood, but elephants may have been important browsers and patch disturbance agents. These semiarid thickets have been subjected to intensive grazing by domestic ungulates, which have largely replaced indigenous herbivores over the last 2 centuries. Overgrazing has extensively degraded vegetation, resulting in the loss of phytomass and plant species and the replacement of perennials by annuals. Coupled with these changes are alterations of soil structure and secondary productivity. This rangeland degradation has largely been attributed to pastoralism with domestic herbivores. The impact of indigenous herbivores differs in scale, intensity, and nature from that of domestic ungulates. Further degradation of the ECST may be limited by alternative management strategies, including the use of wildlife for meat production and ecotourism. Producing meat from wildlife earns less income than from domestic herbivores but is ecologically sustainable. The financial benefits of game use can be improved by developing expertise, technology, and marketing. Ecotourism is not well developed in the Eastern Cape although the Addo Elephant National Park is a financial success and provides considerable employment benefits within an ecologically sustainable system. The density of black rhinoceros and elephant in these thickets is among the highest in Africa, with high population growth and the lowest poaching risk. The financial and ecological viability of ecotourism and the conservation status of these two species warrant expanding ecotourism in the Eastern Cape, thereby reducing the probability of further degradation of ECST.

Growth of tumors can accelerate during the peri-operative period. Accordingly, early relapse of cancer occurs in some patients during the first two postoperative years. Temporal and biologic analyses of cancer pathophysiology suggest a link between peri-operative pathophysiological changes and acceleration of tumor growth. Understanding the role of inflammation and its consequences (i.e., immune response, growth factors, dissemination of tumor cells) could lead to define a role of anesthesiologists in reducing cancer recurrence following surgery. We argue for peri-operative pharmacological interventions to reduce cancer relapse, with a focus on non-steroidal anti-inflammatory drugs.

A high concentration (50 micrograms/ml) of gamma-linolenic acid (GLA) induced morphological lesions typical of apoptosis, as well as DNA fragmentation, in HeLa cells. A lower concentration of GLA (20 micrograms/ml), caused an increased proliferating cell nuclear antigen (PCNA) labelling, with 92.7% cells positive, compared to 27.7% at a concentration of 50 micrograms/ml GLA. In correlation with these results, the number of cells with degraded DNA below the G0/G1 peak increased significantly in the 50 micrograms/ml GLA-treated cells, but increased only slightly in cells exposed to the lower level of GLA. The high levels of PCNA induced by 20 micrograms/ml GLA, in both G1 and S phases, may indicate a state of DNA repair synthesis, whilst at the higher concentration of GLA, most of the cells became apoptotic. Since apoptosis is associated with the deregulation of c-Myc expression, and as the Raf-1-MAP kinase cascade activates the expression of c-Myc and c-Jun, we investigated the effects of 20 and 50 micrograms/ml GLA on the Raf-1, c-Myc and c-Jun levels, and on the activity of MAP kinase. The results showed that 50 micrograms/ml GLA lowered the activity of MAP kinase. As expected with the decreased MAP kinase activity in the cells exposed to the higher level GLA, the c-Jun levels were also lowered. The levels of c-Myc, however, were increased. It is therefore possible that the deregulated expression of c-Myc in the HeLa cells exposed to the high level of GLA (50 micrograms/ml) may contribute to the induction of apoptosis in HeLa cells.

Introduction Auger electron-emitting radiopharmaceuticals are attractive for nano-irradiation therapy, given that DNA of malignant cells is selectively targeted. The limited penetration of kV X-rays, in comparison to megavoltage (MV), is a challenge of radiotherapy and gold nanoparticles (AuNPs) have been identified as effective radiosensitisers following bombardment with low energy (e.g. 200–500 keV) radiation. Materials and methods AuNPs were synthesised via the ‘green nanotechnology’ method using cinnamon (Cinn-), red-speckled beans (RSB-) and soybeans (SB-) as phytochemical reservoirs for the reduction and stabilisation of gold salts to AuNPs. Skin (HaCaT), breast (MCF10A), and malignant breast (MCF7) cell lines were treated with each AuNP type, and radiated with either 2 Gy 60 Co γ - or X-rays, or 1 Gy p(66)/Be(49) neutrons. The cytokinesis-block micronucleus assay was used to determine the presence of micronuclei (MNi) within binucleated cells. Results An overall increase in MNi numbers were recorded for non-malignant HaCaT and MCF10A cells treated with AuNPs and exposed to X-ray radiation, whilst 60 Co γ -radiation caused less MNi. However, AuNPs served as radioprotective devices within the neoplastic MCF7 cell line wherein MNi numbers were much less after incubation with AuNP types and X-ray exposure. Furthermore, the RSBGA-AuNP seemed to have the greatest effect on MNi occurrence: the nanoparticle caused a sensitisation effect in HaCaT and MCF10A cells to γ - and neutron radiation, whilst serving as a radioprotector against X-ray exposure. However, for the cancerous MCF7 cells, RSBGA-AuNPs caused radioprotection against γ -radiation, whilst sensitising the cells to X-ray and neutron radiation after 24h incubation with AuNPs. Conclusion Several explanations were provided for the above occurrences, including: the size of the AuNPs, the failure of the AuNPs to penetrate the nuclear membrane, the formation of possible autophagosomal and lysosomal bodies sequestering the AuNPs, the effect AuNPs have on the cell cycle, and the radical scavenging capabilities of the phytochemical-coated AuNPs.

Introduction Gold nanoparticles (AuNPs) have been recognized as effective radiosensitizers of low energy (e.g. 200–500 kV) X-rays, leading to the emission of Auger electrons that cause highly localized ionizing damage to cells. The aim of this study was to determine possible toxicity caused by AuNPs and to establish whether the AuNPs interacts with MV X-rays. Materials and methods The interaction between the 5 and 10 nm AuNPs with 6 MV X-rays were carried out in different cell lines, namely CHO-K1, BEnd5, MCF-7 and MCF-10A. The X-rays is a low linear energy transfer (LET) radiation type, which was scattered by using a Shonka chamber to obtain lower energies X-rays to interact with the AuNPs. The cells were incubated with 50 μg/ml of the respective AuNPs for 4 h and given a 2 Gy dose. The media was replaced and the cells were incubated for 24 h in the presence of cytochalasin B, then fixed and stained with acridine orange. Results In some of the cell types used in this study, higher MNi frequencies were induced by a combination treatment of radiation and AuNPs compared to the additive sum noted in samples exposed to AuNPs and radiation separately. The AuNPs alone reduced the growth rate of all types between 29% and 33%. Conclusion Interactions between the AuNPs and scattered 6 MV X-rays were noted for CHO-K1 and MCF-7 cells, but not for other cell types used in the study. The cellular uptake for AuNPs needs to be quantified to explain the results.

BACKGROUND: Muscular compartment syndrome (MCS) is a rare but serious postoperative complication. In vivo optical spectroscopy (INVOS) monitors continuously and non-invasively regional oxygen saturation (rSO(2)), and could predict the development of MCS. METHODS:In 10 healthy volunteers, we inflated a tourniquet to the mean arterial pressure to produce slight venous congestion and arterial hypoperfusion. Comparisons were made between the relative reduction in rSO(2) with baseline (deltaINVOS) and the time to observe motor nerve block (with non-invasive electromyography). Neurological symptoms, pain, and invasive intracompartmental pressure (ICP) were assessed. RESULTS: In the eight volunteers completing the protocol, we observed a profound motor nerve conduction block, immediately reversible. Baseline values were: [mean (sd)] INVOS: 73.3 (8.9)% and ICP: 16.9 (8.6) mm Hg. At the time of the block, values were: INVOS: 46.4 (10.9)%, deltaINVOS: 28.7 (10.6)%, and ICP: 70.0 (5.5) mm Hg. The time to reach the block was 33.0 (10.9) min, and to a deltaINVOS>10%: 27.4 (10.4) min. Receiver-operating characteristic curves demonstrated a similar accuracy of ICP and INVOS to predict the occurrence of the block. Twenty minutes with a deltaINVOS>10% or ICP>30 mm Hg were associated with a sensitivity and a specificity of 95% and 70%; or 91% and 65%, respectively. CONCLUSIONS: We have developed a model of acute immediately reversible MCS. Monitoring using the INVOS technology is as accurate as measurement of ICP, and could be a useful tool to prevent development of intraoperative MCS.

To assess pain trajectories in predicting risk of chronic postoperative pain (CPP) after liver resection for living donor transplantation.Retrospective analysis of patients undergoing liver resection for living donor transplantation during 3years.After recording perioperative data, patients presenting CPP at 3months were separated from patients without postsurgical pain problem in order to build a pain trajectory for liver donor patients without CPP. Postoperative course of liver donors with CPP was then compared to that standard pain trajectory.Sixty-five patients (30 females, 35 males) were included. Epidural analgesia was used in 66%; others received autocontrolled analgesia by morphine. Severe acute pain was expressed by 11% and 37% at rest and movement respectively on the first day. Chronic pain involved six patients without any link with gender or type of analgesia. Analysis of pain trajectories shown that these patients presented either higher initial pain at day 1 or positive slopes with worsening of pain.Acute postoperative pain is a risk factor of developing CPP. Identification of those people by pain trajectories can be useful to treat them early.

Ochratoxin A (OA), produced by strains of Aspergillus and Penicillium, at a dose of 20 micrograms/ml caused nuclear and nucleolar changes characteristic of apoptosis in hamster kidney (HaK) and HeLa cells. However, the morphological and biochemical lesions were not identical in the two cell types. In HaK cells micronuclei formation in prophase and interphase cells predominated but in HeLa cells apoptotic body formation was more prevalent. Indirect immunofluorescence indicated that nucleolar morphology was affected in both cell types with segregation of the fibrillar and granular components of the nucleolus present after 24 hr exposure. [35S]Methionine incorporation into SDS-PAGE-separated proteins was decreased after continuous exposure for 24 hr, but after only 3 hr exposure, the synthesis of three proteins was markedly increased in HaK (approximately 39, 90, and 180 kDa) and HeLa (approximately 40, 92, and 150 kDa) cells. Enhanced early synthesis of proteins was more pronounced in HaK cells in the G1-phase and in HeLa cells in the S-phase. Internucleosomal DNA breaks, characteristic of apoptosis, were present in G1 and S-phase HaK cells exposed to OA. In contrast, DNA of very high molecular weight was seen in synchronized HeLa cells. The results indicate that OA may activate different cellular processes involved in the degradation of DNA in HaK and HeLa cells.

Gamma-linolenic acid (GLA) inhibited cell proliferation in MG-63 and HeLa cells. Different morphological lesions were present in dividing cells; abnormal spindle formation in MG-63 cells and chromosome hypercondensation in HeLa cells. Different types of cell death were also present in interphase cells, no apoptosis but only 6% pycnosis in MG-63 cells and 90% apoptosis in HeLa cells. In MG-63 cells immunofluorescence showed segregation of nucleoli components, abnormal spindle formation and decreased labelling of microtubuli during interphase. In HeLa interphase cells prominently labelled abnormally arranged microtubuli were observed. The effects of GLA on protein synthesis in synchronized cells were determined with [35S]-methionine incorporation and SDS-PAGE. Decreased protein synthesis in both G1- and S-phase MG-63 cells was present. In S-phase HeLa cells, proteins of approximately 40, 92 and 150 kD were markedly expressed. Signalling mechanisms involved in cell proliferation and cell death may be differently affected in MG-63 and HeLa cells.

The postoperative analgesia afforded after colonic surgery by IV opioid, clonidine and lignocaine given intra- and postoperatively was evaluated. In a double-blind randomised trial, 80 male patients scheduled for colonic resection under general anaesthesia received fentany 15 μg.kg−1 at induction and another 4 μg.kg−1 before skin incision (group A) or fentanyl (same dose) plus clonidine 4 μg.kg−1 in 20 min + 2 μg.kg−1.h−1 (group B, C) or fentanyl plus clonidine (same dosage) plus lignocaine 2 mg.kg−1 before skin incision, repeated before peritoneal incision and retractor placement (group D). In the four groups, intraoperative boluses of fentanyl 2 μg.kg−1 were given in response to the painful stimulation of the procedure. Postoperative pain was managed with PCA delivering 2 mg morphine per request in group A, 1.5 mg morphine in group B, 1.5 mg morphine + 15 μg clonidine in group C and 1.2 mg morphine + 15 μg clonidine + 23 mg lignocaine in group D. Postoperative analgesia was assessed by recording the analgesic demands (met and unmet) and the dose of morphine delivered at 6, 12, 18, 24, 36 hours. Side-effects, pain and sedation analogue scores were also recorded. A nalgesic demands and delivered morphine dose were reduced, at any time interval considered, in groups B, C, D, compared with A (P Intraoperative clonidine was the major determinant of the reduction in analgesic demands and morphine delivered. Lignocaine, at the dose used, failed to afford any additional benefit.