HYPOGLYCAEMIA AS A CONSEQUENCE OF PRE-OPERATIVE FASTING: MYTH OR REALITY?

Background: The fatal risk of pulmonary aspiration of gastric contents during anaesthesia had since been recognized and consequently preoperative fasting guideline is usually prescribed to prevent this. Concern about development of hypoglycaemia during prolonged fasting has often been expressed, especially in children. AIM: This study is intended to determine the fasting blood glucose in preoperative patients of different age groups who were fasted for varying duration of time, and determine whether indeed hypoglycaemia occurs during inadvertently prolonged fasting which we often encounter in our practice setting. Methodology: A prospective cohort study of fasting blood glucose (FBG) of patients presenting for elective surgery in the principal investigator\u27s operating rooms at the National Orthopaedic Hospital, Enugu, Nigeria was carried out. Blood glucose meter was used for estimation of glucose in capillary whole blood of the patients and the obtained data were analysed using SPSS version 16.0 statistical software. Comparison of mean values was done using the Chi-square test with statistical significance put at P < 0.05.  Results: Out of one hundred and thirty three patients studied with mean age of 30.2 ± 19.60 years (range: 1-72 years), and mean duration of fasting 12.73 ± 2.01 hours, (range: 8-16 hours), the mean fasting blood glucose was found to be 91.49 ± 13.36mg/dl (range: 58 - 124mg/dl). No relationship was found between age and FBG (Pearson\u27s correlation coefficient, r = 0.025). Likewise duration of fasting did not relate with FBG (Pearson\u27s correlation coefficient, r = 0.088). One patient (0.8%) had hypoglycaemia, with blood glucose of 58mg/dl. Conclusion: Hypoglycaemia as a consequence of pre-operative fasting is rare, even in non-infants fasted for considerably long hours. Neither patient\u27s age, gender, nor duration of fasting had any significant influence on the fasting blood glucose of the patients. Keywords: Hypoglycaemia; Pre-operative fasting; Whole blood; Plasma

HYPOGLYCAEMIA AS A CONSEQUENCE OF PRE-OPERATIVE FASTING: MYTH OR REALITY?

Background: The fatal risk of pulmonary aspiration of gastric contents during anaesthesia had since been recognized and consequently preoperative fasting guideline is usually prescribed to prevent this. Concern about development of hypoglycaemia during prolonged fasting has often been expressed, especially in children. AIM: This study is intended to determine the fasting blood glucose in preoperative patients of different age groups who were fasted for varying duration of time, and determine whether indeed hypoglycaemia occurs during inadvertently prolonged fasting which we often encounter in our practice setting. Methodology: A prospective cohort study of fasting blood glucose (FBG) of patients presenting for elective surgery in the principal investigator's operating rooms at the National Orthopaedic Hospital, Enugu, Nigeria was carried out. Blood glucose meter was used for estimation of glucose in capillary whole blood of the patients and the obtained data were analysed using SPSS version 16.0 statistical software. Comparison of mean values was done using the Chi-square test with statistical significance put at P < 0.05.  Results: Out of one hundred and thirty three patients studied with mean age of 30.2 ± 19.60 years (range: 1-72 years), and mean duration of fasting 12.73 ± 2.01 hours, (range: 8-16 hours), the mean fasting blood glucose was found to be 91.49 ± 13.36mg/dl (range: 58 - 124mg/dl). No relationship was found between age and FBG (Pearson's correlation coefficient, r = 0.025). Likewise duration of fasting did not relate with FBG (Pearson's correlation coefficient, r = 0.088). One patient (0.8%) had hypoglycaemia, with blood glucose of 58mg/dl. Conclusion: Hypoglycaemia as a consequence of pre-operative fasting is rare, even in non-infants fasted for considerably long hours. Neither patient's age, gender, nor duration of fasting had any significant influence on the fasting blood glucose of the patients. Keywords: Hypoglycaemia; Pre-operative fasting; Whole blood; Plasma

A hypomorphic Cbx3 allele causes prenatal growth restriction and perinatal energy homeostasis defects

Mammals have three HP1 protein isotypes HP1β (CBX1), HP1γ (CBX3) and HP1α (CBX5) that are encoded by the corresponding genes Cbx1, Cbx3 and Cbx5. Recent work has shown that reduction of CBX3 protein in homozygotes for a hypomorphic allele (Cbx3 hypo) causes a severe postnatal mortality with around 99% of the homozygotes dying before weaning. It is not known what the causes of the postnatal mortality are. Here we show that Cbx3 hypo/hypo conceptuses are significantly reduced in size and the placentas exhibit a haplo-insufficiency. Late gestation Cbx3 hypo/hypo placentas have reduced mRNA transcripts for genes involved in growth regulation, amino acid and glucose transport. Blood vessels within the Cbx3 hypo/hypo placental labyrinth are narrower than wild-type. Newborn Cbx3 hypo/hypo pups are hypoglycemic, the livers are depleted of glycogen reserves and there is almost complete loss of stored lipid in brown adipose tissue (BAT). There is a 10-fold reduction in expression of the BAT-specific Ucp1 gene, whose product is responsible for non-shivering themogenesis. We suggest that it is the small size of the Cbx3 hypo/hypo neonates, a likely consequence of placental growth and transport defects, combined with a possible inability to thermoregulate that causes the severe postnatal mortality

Non-Invasive Brain-to-Brain Interface (BBI): Establishing Functional Links between Two Brains

Transcranial focused ultrasound (FUS) is capable of modulating the neural activity of specific brain regions, with a potential role as a non-invasive computer-to-brain interface (CBI). In conjunction with the use of brain-to-computer interface (BCI) techniques that translate brain function to generate computer commands, we investigated the feasibility of using the FUS-based CBI to non-invasively establish a functional link between the brains of different species (i.e. human and Sprague-Dawley rat), thus creating a brain-to-brain interface (BBI). The implementation was aimed to non-invasively translate the human volunteer's intention to stimulate a rat's brain motor area that is responsible for the tail movement. The volunteer initiated the intention by looking at a strobe light flicker on a computer display, and the degree of synchronization in the electroencephalographic steady-state-visual-evoked-potentials (SSVEP) with respect to the strobe frequency was analyzed using a computer. Increased signal amplitude in the SSVEP, indicating the volunteer's intention, triggered the delivery of a burst-mode FUS (350 kHz ultrasound frequency, tone burst duration of 0.5 ms, pulse repetition frequency of 1 kHz, given for 300 msec duration) to excite the motor area of an anesthetized rat transcranially. The successful excitation subsequently elicited the tail movement, which was detected by a motion sensor. The interface was achieved at 94.0 +/- 3.0% accuracy, with a time delay of 1.59 +/- 1.07 sec from the thought-initiation to the creation of the tail movement. Our results demonstrate the feasibility of a computer-mediated BBI that links central neural functions between two biological entities, which may confer unexplored opportunities in the study of neuroscience with potential implications for therapeutic applications.open12

Identifying metabolite markers for preterm birth in cervicovaginal fluid by magnetic resonance spectroscopy

Introduction Preterm birth (PTB) may be preceded by changes in the vaginal microflora and metabolite profiles. Objectives We sought to characterise the metabolite profile of cervicovaginal fluid (CVF) of pregnant women by 1H NMR spectroscopy, and assess their predictive value for PTB. Methods A pair of high-vaginal swabs was obtained from pregnant women with no evidence of clinical infection and grouped as follows: asymptomatic low risk (ALR) women with no previous history of PTB, assessed at 20–22 gestational weeks, g.w., n = 83; asymptomatic high risk (AHR) women with a previous history of PTB, assessed at both 20–22 g.w., n = 71, and 26–28 g.w., n = 58; and women presenting with symptoms of preterm labor (PTL) (SYM), assessed at 24–36 g.w., n = 65. Vaginal secretions were dissolved in phosphate buffered saline and scanned with a 9.4 T NMR spectrometer. Results Six metabolites (lactate, alanine, acetate, glutamine/glutamate, succinate and glucose) were analysed. In all study cohorts vaginal pH correlated with lactate integral (r = -0.62, p\0.0001). Lactate integrals were higher in the term ALR compared to the AHR (20–22 g.w.) women (p = 0.003). Acetate integrals were higher in the preterm versus term women for the AHR (20–22 g.w.) (p = 0.048) and SYM (p = 0.003) groups; and was predictive of PTB\37 g.w. (AUC 0.78; 95 % CI 0.61–0.95), and delivery within 2 weeks of the index assessment (AUC 0.84; 95 % CI 0.64–1) in the SYM women, whilst other metabolites were not. Conclusion High CVF acetate integral of women with symptoms of PTL appears predictive of preterm delivery, as well as delivery within 2 weeks of presentation

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Morphometry Based on Effective and Accurate Correspondences of Localized Patterns (MEACOLP)

Local features in volumetric images have been used to identify correspondences of localized anatomical structures for brain morphometry. However, the correspondences are often sparse thus ineffective in reflecting the underlying structures, making it unreliable to evaluate specific morphological differences. This paper presents a morphometry method (MEACOLP) based on correspondences with improved effectiveness and accuracy. A novel two-level scale-invariant feature transform is used to enhance the detection repeatability of local features and to recall the correspondences that might be missed in previous studies. Template patterns whose correspondences could be commonly identified in each group are constructed to serve as the basis for morphometric analysis. A matching algorithm is developed to reduce the identification errors by comparing neighboring local features and rejecting unreliable matches. The two-sample t-test is finally adopted to analyze specific properties of the template patterns. Experiments are performed on the public OASIS database to clinically analyze brain images of Alzheimer's disease (AD) and normal controls (NC). MEACOLP automatically identifies known morphological differences between AD and NC brains, and characterizes the differences well as the scaling and translation of underlying structures. Most of the significant differences are identified in only a single hemisphere, indicating that AD-related structures are characterized by strong anatomical asymmetry. In addition, classification trials to differentiate AD subjects from NC confirm that the morphological differences are reliably related to the groups of interest

Family joint activities in a cross-national perspective

<p>Abstract</p> <p>Background</p> <p>Parents and children joint activities are considered to be an important factor on healthy lifestyle development throughout adolescence. This study is a part of the Cross-National Survey on Health Behaviour in School-aged Children – World Health Organization Collaborative Study (HBSC). It aims to describe family time in joint activities and to clarify the role of social and structural family profile in a cross-national perspective.</p> <p>Methods</p> <p>The research was carried out according to the methodology of the HBSC study using the anonymous standardized questionnaire. In total, 17,761 students (8,649 boys and 9,112 girls) aged 13 and 15 years from 6 European countries (Czech Republic, Finland, Greenland, Lithuania, Spain, and Ukraine) were surveyed in the 2001–2002 school-year. The evaluation of joint family activity is based on 8 items: <it>(1) </it>watching TV or a video, <it>(2) </it>playing indoor games, <it>(3) </it>eating meals, <it>(4) </it>going for a walk, <it>(5) </it>going places, <it>(6) </it>visiting friends or relatives, <it>(7) </it>playing sports, <it>(8) </it>sitting and talking about things (chatting).</p> <p>Results</p> <p>Students from Spain and Ukraine reported spending the most time together with their families in almost all kinds of joint activities, whereas students from Greenland and Finland reported spending the least of this time. Boys were more likely than girls to be spending time together with family. Joint family activity goes into decline in age from 13 to 15 years. Variability of family time in a cross-national perspective was relatively small and related to children age category. Considering national, gender and age differences of studied population groups, we found that the distribution of joint family activities tends to be dispersed significantly by family structure (intact/restructured family) and family wealth.</p> <p>Conclusion</p> <p>Our study compares children and parent joint activities in European countries and reveals differences and similarities in these patterns between countries. The findings underline the role of family structure (intact/restructured family) and family wealth in the distribution of time spent in joint family activities, which should be considered by health promoters.</p

Adjuvant radiation therapy in metastatic lymph nodes from melanoma

<p>Abstract</p> <p>Purpose</p> <p>To analyze the outcome after adjuvant radiation therapy with standard fractionation regimen in metastatic lymph nodes (LN) from cutaneous melanoma.</p> <p>Patients and methods</p> <p>86 successive patients (57 men) were treated for locally advanced melanoma in our institution. 60 patients (69%) underwent LN dissection followed by radiation therapy (RT), while 26 patients (31%) had no radiotherapy.</p> <p>Results</p> <p>The median number of resected LN was 12 (1 to 36) with 2 metastases (1 to 28). Median survival after the first relapse was 31.8 months. Extracapsular extension was a significant prognostic factor for regional control (p = 0.019). Median total dose was 50 Gy (30 to 70 Gy). A standard fractionation regimen was used (2 Gy/fraction). Median number of fractions was 25 (10 to 44 fractions). Patients were treated with five fractions/week. Patients with extracapsular extension treated with surgery followed by RT (total dose ≥50 Gy) had a better regional control than patients treated by surgery followed by RT with a total dose <50 Gy (80% vs. 35% at 5-year follow-up; p = 0.004).</p> <p>Conclusion</p> <p>Adjuvant radiotherapy was able to increase regional control in targeted sub-population (LN with extracapsular extension).</p

A Novel Immunological Assay for Hepcidin Quantification in Human Serum

Contains fulltext : 81054.pdf (publisher's version ) (Open Access)BACKGROUND: Hepcidin is a 25-aminoacid cysteine-rich iron regulating peptide. Increased hepcidin concentrations lead to iron sequestration in macrophages, contributing to the pathogenesis of anaemia of chronic disease whereas decreased hepcidin is observed in iron deficiency and primary iron overload diseases such as hereditary hemochromatosis. Hepcidin quantification in human blood or urine may provide further insights for the pathogenesis of disorders of iron homeostasis and might prove a valuable tool for clinicians for the differential diagnosis of anaemia. This study describes a specific and non-operator demanding immunoassay for hepcidin quantification in human sera. METHODS AND FINDINGS: An ELISA assay was developed for measuring hepcidin serum concentration using a recombinant hepcidin25-His peptide and a polyclonal antibody against this peptide, which was able to identify native hepcidin. The ELISA assay had a detection range of 10-1500 microg/L and a detection limit of 5.4 microg/L. The intra- and interassay coefficients of variance ranged from 8-15% and 5-16%, respectively. Mean linearity and recovery were 101% and 107%, respectively. Mean hepcidin levels were significantly lower in 7 patients with juvenile hemochromatosis (12.8 microg/L) and 10 patients with iron deficiency anemia (15.7 microg/L) and higher in 7 patients with Hodgkin lymphoma (116.7 microg/L) compared to 32 age-matched healthy controls (42.7 microg/L). CONCLUSIONS: We describe a new simple ELISA assay for measuring hepcidin in human serum with sufficient accuracy and reproducibility