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Patient-centered precision care in anaesthesia - the PC-square (PC)2 approach.
Get PDFPURPOSE OF REVIEW
This review navigates the landscape of precision anaesthesia, emphasising tailored and individualized approaches to anaesthetic administration. The aim is to elucidate precision medicine principles, applications, and potential advancements in anaesthesia. The review focuses on the current state, challenges, and transformative opportunities in precision anaesthesia.
RECENT FINDINGS
The review explores evidence supporting precision anaesthesia, drawing insights from neuroscientific fields. It probes the correlation between high-dose intraoperative opioids and increased postoperative consumption, highlighting how precision anaesthesia, especially through initiatives like Safe Brain Initiative (SBI), could address these issues. The SBI represents multidisciplinary collaboration in perioperative care. SBI fosters effective communication among surgical teams, anaesthesiologists, and other medical professionals.
SUMMARY
Precision anaesthesia tailors care to individual patients, incorporating genomic insights, personalised drug regimens, and advanced monitoring techniques. From EEG to cerebral/somatic oximetry, these methods enhance precision. Standardised reporting, patient-reported outcomes, and continuous quality improvement, alongside initiatives like SBI, contribute to improved patient outcomes. Precision anaesthesia, underpinned by collaborative programs, emerges as a promising avenue for enhancing perioperative care
A Synthesis of Global Coastal Ocean Greenhouse Gas Fluxes
Get PDFThe coastal ocean contributes to regulating atmospheric greenhouse gas concentrations by taking up carbon dioxide (CO2) and releasing nitrous oxide (N2O) and methane (CH4). In this second phase of the Regional Carbon Cycle Assessment and Processes (RECCAP2), we quantify global coastal ocean fluxes of CO2, N2O and CH4 using an ensemble of global gap-filled observation-based products and ocean biogeochemical models. The global coastal ocean is a net sink of CO2 in both observational products and models, but the magnitude of the median net global coastal uptake is ∼60% larger in models (−0.72 vs. −0.44 PgC year−1, 1998–2018, coastal ocean extending to 300 km offshore or 1,000 m isobath with area of 77 million km2). We attribute most of this model-product difference to the seasonality in sea surface CO2 partial pressure at mid- and high-latitudes, where models simulate stronger winter CO2 uptake. The coastal ocean CO2 sink has increased in the past decades but the available time-resolving observation-based products and models show large discrepancies in the magnitude of this increase. The global coastal ocean is a major source of N2O (+0.70 PgCO2-e year−1 in observational product and +0.54 PgCO2-e year−1 in model median) and CH4 (+0.21 PgCO2-e year−1 in observational product), which offsets a substantial proportion of the coastal CO2 uptake in the net radiative balance (30%–60% in CO2-equivalents), highlighting the importance of considering the three greenhouse gases when examining the influence of the coastal ocean on climate
Clinical evaluation of a novel protocol for supportive periodontal care: A randomized controlled clinical trial.
Get PDFBACKGROUND
The aim of this study was to compare the clinical efficacy and the patient perception of subgingival debridement with either guided biofilm management (GBM) or conventional scaling and root planing (SRP) during supportive periodontal care (SPC).
METHODS
Forty-one patients in SPC were randomly assigned to either treatment with GBM or SRP every 6 months. The primary outcome was the percentage of bleeding on probing (BoP) at 1 year. Moreover, pocket probing depths (PPD), recession, and furcation involvements were also measured. Full-mouth and specific site analyzes were performed at baseline, 6 and 12 months of SPC. Patient comfort was evaluated using a visual analogue scale (VAS) at 12 months.
RESULTS
At 1 year, mean BoP percentage decreased from 12.2% to 9.0% (p = 0.191) and from 14.7% to 7.9% (p = 0.004) for the GBM and SRP groups, respectively. Furcation involved multirooted teeth but no through-and-through lesions were significantly fewer in the GBM than in the SRP group after 12 months (p = 0.015). The remaining parameters showed slight improvement in both groups without any statistically significant differences between the two groups after 1 year. Pain evaluation as patient reported outcome measures (pain evaluation) was in favor (p = 0.347) of the SRP group, while overall satisfaction was similar for both groups. Treatment time was not statistically significantly different between the two groups (p = 0.188).
CONCLUSION
In well-maintained SPC patients, SRP protocols resulted in significant clinical improvements in terms of BoP; however, for the other clinical improvements, similar efficacy for both GBM and SRP was observed
Post tuberculosis lung disease and tuberculosis sequelae: A narrative review.
No full textPost Tuberculosis lung disease (PTLD) and post tuberculosis sequelae is a global and poorly recognized problem, amplified by social factors and immunocompromising conditions, inadequate treatment, lack of effective prevention of tuberculosis (TB) infection and disease. As a disease, it remained until recently poorly defined, with studies heterogenous with regards to regions, population demographics, risk factors, cohort sizes, and methods. Pathophysiologically, even successfully treated pulmonary TB disease has sequelae i.e. involving central and peripheral airways, lung parenchyma and pleura, resulting in airway narrowing and dilatation, fibrocavitation and emphysema, pulmonary vascular changes as well as pleural fibrosis. Functionally patients have airflow limitation, restrictive disease or a mixture of both not rarely associated with respiratory, or even ventilatory failure. Quality of life is often impaired through disability, TB relapse, superinfections and through increased susceptibility to reinfection and persistent inflammation, leading to progressive lung function decline and an increased risk of cardiovascular disease and cancer. Premature mortality due to PTLD is very likely, but poorly described
Swiss cohort on Traumatic Childbirth and Health (SwiTCH): protocol for a prospective, population-based cohort study on parents' mental health from pregnancy to one year postpartum.
Get PDFINTRODUCTION
Approximately 4%-5% of mothers develop childbirth-related post-traumatic stress disorder (CB-PTSD) and approximately 12.3% of mothers develop some CB-PTSD symptoms (CB-PTSS). To date, there is a dearth of studies on fathers and other coparents. Parental CB-PTSD and CB-PTSS may have a negative impact not only on the parents but also on the infant. Understanding risk and protective factors of CB-PTSD for both parents and its consequences on the family is key to detecting or anticipating it, to developing interventions aimed at reducing its detrimental effects and to supporting parents.
METHODS AND ANALYSIS
This study protocol describes an observational, population-based study, consisting of a longitudinal prospective cohort with online surveys at four time points. The population of interest consist of women, in the third trimester of pregnancy or at 6-12 weeks postpartum, and their partner/coparent, who will give birth or gave birth in the French-speaking part of Switzerland. The target sample size is 300-500 women and a proportional number of partners. The primary outcome of this study is the prevalence of CB-PTSD and CB-PTSS. The secondary outcomes focus on: (1) the impact of CB-PTSD and CB-PTSS on the marital and coparental relationships, the bonding with the infant, parental burnout and healthcare seeking behaviours, (2) the role of the childbirth experience in the development of CB-PTSD and CB-PTSS and (3) the social and economic determinants of CB-PTSD and CB-PTSS.
ETHICS AND DISSEMINATION
Ethical approval was granted by the human research ethics committee of the Canton de Vaud (study number 2022-00284). All study participants signed an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.
TRIAL REGISTRATION NUMBER
NCT05865704
Inter-relations of precipitation, aerosols, and clouds over Andalusia, southern Spain, revealed by the Andalusian Global ObseRvatory of the Atmosphere (AGORA)
Get PDFThe south-central interior of Andalusia experiences intricate precipitation patterns as a result of its semi-arid Mediterranean climate and the impact of Saharan dust and human-made pollutants. The primary aim of this study is to monitor the inter-relations between various factors, such as aerosols, clouds, and meteorological variables, and precipitation systems in Granada using ground-based remote sensing and in situ instruments including a microwave radiometer, ceilometer, cloud radar, nephelometer, and weather station. Over an 11-year period, we detected rain events using a physical retrieval method that employed microwave radiometer measurements. A composite analysis was applied to them to construct a climatology of the temporal evolution of precipitation. It was found that convective rain is the dominant precipitation type in Granada, accounting for 68 % of the rain events. The height of the cloud base is mainly distributed at an altitude of 2 to 7 km. Integrated water vapor (IWV) and integrated cloud liquid water (ILW) increase rapidly before the onset of rain. Aerosol scattering at the surface level and hence the aerosol concentration are reduced during rain, and the predominant mean size distribution of aerosol particles before, during, and after rain is almost the same. A meteorological environment favorable for virga formation is observed in Granada. The surface weather station detected rainfall later than the microwave radiometer, indicating virga according to ceilometer and cloud radar data. We used 889 rain-day events identified by weather station data to determine precipitation intensity classes and found that light rain is the main precipitation intensity class in Granada, accounting for 72 % of the rain-day events. This can be a result of the high tropospheric temperature induced by the Andalusian climate and the reduction of cloud droplet size by the high availability of aerosol particles in the urban atmosphere. This study provides evidence that aerosols, clouds, and meteorological variables have a combined impact on precipitation which can be considered for water resource management and improving rain forecasting accuracy
Pharmacogenomics of poor drug metabolism in greyhounds: Canine P450 oxidoreductase genetic variation, breed heterogeneity, and functional characterization.
Get PDFGreyhounds metabolize cytochrome P450 (CYP) 2B11 substrates more slowly than other dog breeds. However, CYP2B11 gene variants associated with decreased CYP2B11 expression do not fully explain reduced CYP2B11 activity in this breed. P450 oxidoreductase (POR) is an essential redox partner for all CYPs. POR protein variants can enhance or repress CYP enzyme function in a CYP isoform and substrate dependent manner. The study objectives were to identify POR protein variants in greyhounds and determine their effect on coexpressed CYP2B11 and CYP2D15 enzyme function. Gene sequencing identified two missense variants (Glu315Gln and Asp570Glu) forming four alleles, POR-H1 (reference), POR-H2 (570Glu), POR-H3 (315Gln, 570Glu) and POR-H4 (315Gln). Out of 68 dog breeds surveyed, POR-H2 was widely distributed across multiple breeds, while POR-H3 was largely restricted to greyhounds and Scottish deerhounds (35% allele frequencies), and POR-H4 was rare. Three-dimensional protein structure modelling indicated significant effects of Glu315Gln (but not Asp570Glu) on protein flexibility through loss of a salt bridge between Glu315 and Arg519. Recombinant POR-H1 (reference) and each POR variant (H2-H4) were expressed alone or with CYP2B11 or CYP2D15 in insect cells. No substantial effects on POR protein expression or enzyme activity (cytochrome c reduction) were observed for any POR variant (versus POR-H1) when expressed alone or with CYP2B11 or CYP2D15. Furthermore, there were no effects on CYP2B11 or CYP2D15 protein expression, or on CYP2D15 enzyme kinetics by any POR variant (versus POR-H1). However, Vmax values for 7-benzyloxyresorufin, propofol and bupropion oxidation by CYP2B11 were significantly reduced by coexpression with POR-H3 (by 34-37%) and POR-H4 (by 65-72%) compared with POR-H1. Km values were unaffected. Our results indicate that the Glu315Gln mutation (common to POR-H3 and POR-H4) reduces CYP2B11 enzyme function without affecting at least one other major canine hepatic P450 (CYP2D15). Additional in vivo studies are warranted to confirm these findings
Glueballs in Nf=1 QCD
Get PDFWe present an evaluation of the glueball spectrum for configurations produced with Nf=1 dynamical fermions as a function of the mPCAC mass. We obtained masses of states that fall into the irreducible representations of the octahedral group of rotations in combination with the quantum numbers of charge conjugation C and parity P. Due to the low signal to noise ratio, practically, we can only extract masses for the irreducible representations RPC= A++1, E++, T++2 as well as A−+1. We make use of the Generalized Eigenvalue Problem (GEVP) with an operator basis consisting only of gluonic operators. Throughout this work we are aiming towards the identification of the effects of light dynamical quarks on the glueball spectrum and how this compares to the statistically more precise spectrum of SU(3) pure gauge theory. We used large gauge ensembles which consist of ∼ (10K) configurations. Our findings demonstrate that the low-lying spectrum of the scalar, tensor as well as pseudo-scalar glueballs receive negligible contributions from the inclusion of Nf=1 dynamical fermions
Bisphosphonates do not affect healing of a critical-size defect in estrogen-deficient mice.
Get PDFBisphosphonates (BP) are anti-resorptive drugs that are widely used to prevent bone loss in osteoporosis. Since inhibition of bone resorption will cause a decrease in bone formation through a process called coupling, it is hypothesized that extended treatment protocols may impair bone healing. In this study, β-tri‑calcium-phosphate (βTCP) ceramics were inserted into critical-size long bone defects in estrogen-deficient mice under BP therapy. The study assessed the benefits of coating the ceramics with Bone Morphogenetic Protein-2 (BMP2) and an engineered BMP2 analogue (L51P) that inactivates BMP antagonists on the healing process, implant resorption, and bone formation. Female NMRI mice (11-12 weeks of age) were ovariectomized (OVX) or sham operated. Eight weeks later, after the manifestation of ovariectomy-induced osteoporotic bone changes, BP therapy with Alendronate (ALN) was commenced. After another five weeks, a femoral critical-size defect was generated, rigidly fixed, and βTCP-cylinders loaded with 0.25 μg or 2.5 μg BMP2, 2.5 μg L51P, and 0.25 μg BMP2/2.5 μg L51P, respectively, were inserted. Unloaded βTCP-cylinders were used as controls. Femora were collected six and twelve weeks post-implantation. Histological and micro-computer tomography (MicroCT) evaluation revealed that insertion of cylinders coated with 2.5 μg BMP2 accelerated fracture repair and induced significant bone formation compared to controls (unloaded cylinders or coated with 2.5 μg L51P, 0.25 μg BMP2) already six weeks post-implantation, independent of estrogen-deficiency and BP therapy. The simultaneous administration of BMP2 and L51P (0.25 μg BMP2/2.5 μg L51P) did not promote fracture healing six and twelve weeks post-implantation. Moreover, new bone formation within the critical-size defect was directly linked to the removal of the βTCP-implant in all experimental groups. No evidence was found that long-term therapy with ALN impaired the resorption of the implanted graft. However, osteoclast transcriptome signature was elevated in sham and OVX animals upon treatment with BP, with transcript levels being higher at six weeks than at twelve weeks post-surgery. Furthermore, the transcriptome profile of the developing repair tissue confirmed an accelerated repair process in animals treated with 2.5 μg BMP2 implants. L51P did not increase the bioefficacy of BMP2 in the applied defect model. The present study provides evidence that continuous administration of BP does not inhibit implant resorption and does not alter the kinetics of the healing process of critical-size long bone defects. Furthermore, the BMP2 variant L51P did not enhance the bioefficacy of BMP2 when applied simultaneously to the femoral critical-size defect in sham and OVX mice
Intraoperative Neurophysiologic Monitoring and Mapping During Surgery on Intramedullary Spinal Cord Tumors in Children and Adolescents.
No full textSurgical resection of intramedullary spinal cord tumors carries significant risks of neurologic deficits, especially in cases of infiltrative tumors. In pediatric patients, this type of surgery may be associated with a high risk of poor neurologic outcome. Intraoperative neurophysiologic monitoring has been adopted as part of the clinical routine by many centers as a useful adjunct for intraoperative assessment of neurologic integrity. To what extent intraoperative neurophysiologic mapping strategies may further support intraoperative decision-making is still a matter of debate. Here, we report on a small cohort of five pediatric patients in whom mapping with the double-train paradigm was used to identify the dorsal column and corticospinal tract and to guide the surgical resection. We also discuss the possible benefits and challenges regarding the available literature
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