Early and Late Haemodynaemic Effects after Adding Fentanyl to Bupivacaine-Lignocaine Mixtures in Supraclavicular Brachial Plexus Block: A Randomized Control Trial

Background Objectives: Haemodynamic changes are very crucial issues during regional anaesthesia. The purpose of the present study was to observe the immediate and late haemodynaemic effects after adding fentanyl to bupivacainelignocaine mixtures in supraclavicular brachial plexus block. Methodology: This randomized clinical study was conducted in the Department of Anesthesiology in Chittagong Medical College Hospital (CMCH) from March 2011 to May 2012 for a period of one year. All patients with the age group of 18 to 65 years who were selected for upper limb surgery distal to the mid arm were the study population. The random allocation of the patient was done into Group A patients (control group) who were received injection Bupivacaine (0.25%) with injection lignocaine A (1%) with injection Normal saline (0.9%). Group B patients (treatment group) were received injection bupivacaine (0.25%) with injection Ligonocaine A (1%) with injection fentanyl. With all aseptic precaution, supraclavicular brachial plexus block was done using paresthesia technique. Pulse and blood pressure were measured at baseline, intra-operatively and post-operatively. Result: A total of 60 patients were enrolled in this study with 30 patients in each group named group A and group B. The mean age of group A and group B were 32.43±12.25 and 34.90±13.05 respectively (p=0.453). The mean pulse rate of group A (79.53±5.03) and group B (78.10±4.26) at baseline level increased at the time of injection (88.30±5.77 and 85.63±4.87 respectively). At 8 hours interval mean pulse rate of group A was 86.47±5.51 compared to that of group B (86.07±3.08). The mean systolic blood pressure of group A (126.50±18.21) and group B (120.07±11.61) at baseline level increased at 0 minute at the time of injection (129.70±15.34 and 123.17±10.57 respectively). The mean diastolic blood pressure of group A (71.73±11.20) and group B (72.73±11.45) at baseline level increased at 0 minute (75.97±12.74 and 75.80±12.85 respectively). At 8 hrs interval mean diastolic pressure of group A was71.73 ±11.20 compared to that of group B (71.73±11.20). Conclusion: In conclusion there is no significant immediate or late haemodynaemic effects after adding fentanyl to bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block. J Bangladesh Coll Phys Surg 2022; 40: 17-22

Using the Data Quality Dashboard to Improve the EHDEN Network

Federated networks of observational health databases have the potential to be a rich resource to inform clinical practice and regulatory decision making. However, the lack of standard data quality processes makes it difficult to know if these data are research ready. The EHDEN COVID-19 Rapid Collaboration Call presented the opportunity to assess how the newly developed open-source tool Data Quality Dashboard (DQD) informs the quality of data in a federated network. Fifteen Data Partners (DPs) from 10 different countries worked with the EHDEN taskforce to map their data to the OMOP CDM. Throughout the process at least two DQD results were collected and compared for each DP. All DPs showed an improvement in their data quality between the first and last run of the DQD. The DQD excelled at helping DPs identify and fix conformance issues but showed less of an impact on completeness and plausibility checks. This is the first study to apply the DQD on multiple, disparate databases across a network. While study-specific checks should still be run, we recommend that all data holders converting their data to the OMOP CDM use the DQD as it ensures conformance to the model specifications and that a database meets a baseline level of completeness and plausibility for use in research.

Do constituents know (or care) about the lawmaking effectiveness of their representatives?

Substantial evidence exists that members of the US Congress vary in their lawmaking effectiveness. Less known, however, is whether constituents are sufficiently informed and inclined to hold their representatives accountable, based on their effectiveness. We conduct two separate survey experiments, informing some constituents about lawmakers' effectiveness and comparing their responses to those with the baseline level of information. We find that voters demonstrate little knowledge of their elected officials' lawmaking effectiveness. When presented with objective and credible information about lawmaking effectiveness, however, respondents express greater approval of more effective lawmakers. Effects are strongest among ideological moderates, but are even pronounced among partisans, who approve of effective representatives of the opposing party, and disapprove of ineffective representatives from their own party.

Temporal and Quantitative Analysis of Aortic Immunopathologies in Elastase-Induced Mouse Abdominal Aortic Aneurysms

Objective. Elastase-induced abdominal aortic aneurysm (AAA) model is widely used for aneurysmal pathogenesis and translational research. However, temporal alternations in aneurysmal histologies remain unknown. This study is aimed at analyzing temporal immunopathologies of aneurysmal aorta following experimental AAA induction. Methods. Male C57BL/6J mice at the age of 10-14 weeks received intra-aortic infusion of elastase to induce AAAs. Aortic diameters at the baseline and indicated days after AAA induction were measured, and aortae were collected for histopathological analysis. Results. Aorta diameters increased from 0.52 mm at the baseline levels to 0.99 mm, 1.34 mm, and 1.41 mm at days 7, 14, and 28, respectively, corresponding 90%, 158%, and 171% increases over the baseline level. Average aortic diameters did not differ between days 14 and 28. Severe elastin degradation and smooth muscle cell depletion were found at days 14 and 28 as compared to the baseline and day 7. No difference in the scores of medial elastin and SMC destruction was noted between days 14 and 28. Consistent results were found for leukocyte accumulation, neoangiogenesis, and matrix metalloproteinase expression. Twenty-eight days after AAA induction, all aneurysmal pathologies showed an attenuated trend, although most histopathological parameters did no differ between days 14 and 28. Conclusion. Our data suggest that almost aneurysmal immunohistopathologies reach maximal 14 days following AAA induction. Analysis of day 14 histologies is sufficient for AAA pathogenesis and translational studies in elastase-induced mouse experimental AAAs.

Using the Data Quality Dashboard to Improve the EHDEN Network

Background: Observational health data has the potential to be a rich resource to inform clinical practice and regulatory decision making. However, the lack of standard data quality processes makes it difficult to know if these data are research ready. The EHDEN COVID-19 Rapid Col-laboration Call presented the opportunity to assess how the newly developed open-source tool Data Quality Dashboard (DQD) informs the quality of data in a federated network. Methods: 15 Data Partners (DPs) from 10 different countries worked with the EHDEN taskforce to map their data to the OMOP CDM. Throughout the process at least two DQD results were collected and compared for each DP. Results: All DPs showed an improvement in their data quality between the first and last run of the DQD. The DQD excelled at helping DPs identify and fix conformance is-sues but showed less of an impact on completeness and plausibility checks. Conclusions: This is the first study to apply the DQD on multiple, disparate databases across a network. While study-specific checks should still be run, we recommend that all data holders converting their data to the OMOP CDM use the DQD as it ensures conformance to the model specifications and that a database meets a baseline level of completeness and plausibility for use in research.

Longitudinal Plasma Lipidome and Risk of Type 2 Diabetes in a Large Sample of American Indians With Normal Fasting Glucose: The Strong Heart Family Study

<strong>OBJECTIVE:</strong> Comprehensive assessment of alterations in lipid species preceding T2D is largely unknown. We aimed to identify plasma molecular lipids associated with risk of T2D in American Indians. <p><strong>RESEARCH DESIGN AND METHODS</strong>: Using an untargeted LC-MS, we repeatedly measured 3,907 fasting plasma samples from 1,958 participants who attended two exams (~5.5 year apart) and were followed up to 16 years in the Strong Heart Study. Mixed-effect logistic regression was used to identify lipids associated with risk of T2D adjusting for traditional risk factors. Repeated measurement analysis was performed to examine the association between change in lipidome and change in continuous measures of T2D adjusting for baseline lipids. Multiple testing was controlled by false discovery rate at 0.05.</p> <p><strong>RESULTS:</strong> Higher baseline level of 33 lipid species, including TAGs, DAGs, PEs, and PCs, was significantly associated with increased risk of T2D (odds ratio [OR] per SD increase in log2-transformed baseline lipids: 1.50-2.85) at 5-year follow-up. Of these, 21 lipids were also associated with risk of T2D at 16-year follow-up. Aberrant lipid profiles were also observed in prediabetes (OR per SD increase in log2-transformed baseline lipids: 1.30-2.19 for risk lipids; 0.70-0.78 for protective lipids). Longitudinal changes in 568 lipids were significantly associated with changes in continuous measures of T2D. Multivariate analysis identified distinct lipidomic signatures differentiating high from low risk groups. </p> <p><strong>CONCLUSIONS:</strong> Lipid dysregulation occurs many years preceding T2D, and novel molecular lipids (both baseline level and longitudinal change over time) are significantly associated with risk of T2D beyond traditional risk factors. Our findings shed light on the mechanisms linking dyslipidemia to T2D and may yield novel therapeutic targets for early intervention tailored to American Indians.</p>

Longitudinal Plasma Lipidome and Risk of Type 2 Diabetes in a Large Sample of American Indians With Normal Fasting Glucose: The Strong Heart Family Study

<strong>OBJECTIVE:</strong> Comprehensive assessment of alterations in lipid species preceding T2D is largely unknown. We aimed to identify plasma molecular lipids associated with risk of T2D in American Indians. <p><strong>RESEARCH DESIGN AND METHODS</strong>: Using an untargeted LC-MS, we repeatedly measured 3,907 fasting plasma samples from 1,958 participants who attended two exams (~5.5 year apart) and were followed up to 16 years in the Strong Heart Study. Mixed-effect logistic regression was used to identify lipids associated with risk of T2D adjusting for traditional risk factors. Repeated measurement analysis was performed to examine the association between change in lipidome and change in continuous measures of T2D adjusting for baseline lipids. Multiple testing was controlled by false discovery rate at 0.05.</p> <p><strong>RESULTS:</strong> Higher baseline level of 33 lipid species, including TAGs, DAGs, PEs, and PCs, was significantly associated with increased risk of T2D (odds ratio [OR] per SD increase in log2-transformed baseline lipids: 1.50-2.85) at 5-year follow-up. Of these, 21 lipids were also associated with risk of T2D at 16-year follow-up. Aberrant lipid profiles were also observed in prediabetes (OR per SD increase in log2-transformed baseline lipids: 1.30-2.19 for risk lipids; 0.70-0.78 for protective lipids). Longitudinal changes in 568 lipids were significantly associated with changes in continuous measures of T2D. Multivariate analysis identified distinct lipidomic signatures differentiating high from low risk groups. </p> <p><strong>CONCLUSIONS:</strong> Lipid dysregulation occurs many years preceding T2D, and novel molecular lipids (both baseline level and longitudinal change over time) are significantly associated with risk of T2D beyond traditional risk factors. Our findings shed light on the mechanisms linking dyslipidemia to T2D and may yield novel therapeutic targets for early intervention tailored to American Indians.</p>

Association between recovered acute kidney injury within 48hours and mortality in patients following coronary angiography: a cohort study

Background The association of recovered acute kidney injury (AKI) with mortality was controversial. Our study aims to investigate the impact of recovered AKI on mortality in patients following coronary angiography (CAG). Methods Our study retrospectively enrolled 3,970 patients with pre-operative serum p creatinine (Scr) and twice measurements within 48hours after procedure. Recovered AKI defined as the diagnosis of AKI (Scr &gt;0.3 mg/dL or &gt;50% from the baseline level) on day 1 when Scr failed to meet the criteria for AKI on the day 2. Maintained AKI was defined as AKI not meeting the definition for recovered AKI. The primary outcome was 1-year all-cause mortality. Multivariable logistic regression was used to assess the association between recovered AKI and 1-year mortality. Results Among 3,970 participants, 861 (21.7%) occurred AKI, of whom 128 (14.9%) was recovered AKI and 733 (85.1%) was maintained AKI. 312 (7.9%) patients died within 1-year after admission. After multivariable analysis, recovered AKI was not associated with higher 1-year mortality (adjusted odds ratio [aOR], 1.37; CI, 0.68–2.51) compared without AKI. Among AKI patients, Recovered AKI was associated with a 52% lower 1-year mortality compared with maintained AKI. Additionally, maintained AKI was significantly associated with higher 1-year mortality (aOR, 2.67; CI, 2.05–3.47). Conclusions Our data suggested that recovered AKI within 48h was a common subtype of AKI following CAG, without increasing mortality. More attention need to be paid to the patients suffering from maintained AKI following CAG. FUNDunding Acknowledgement Type of funding sources: None. Association of AKI and mortality Subgroups analysis

Extracellular Calcium Ion Concentration Regulates Chondrocyte Elastic Modulus and Adhesion Behavior

Extracellular calcium ion concentration levels increase in human osteoarthritic (OA) joints and contribute to OA pathogenesis. Given the fact that OA is a mechanical problem, the effect of the extracellular calcium level ([Ca2+]) on the mechanical behavior of primary human OA chondrocytes remains to be elucidated. Here, we measured the elastic modulus and cell–ECM adhesion forces of human primary chondrocytes with atomic force microscopy (AFM) at different extracellular calcium ion concentration ([Ca2+]) levels. With the [Ca2+] level increasing from the normal baseline level, the elastic modulus of chondrocytes showed a trend of an increase and a subsequent decrease at the level of [Ca2+], reaching 2.75 mM. The maximum increment of the elastic modulus of chondrocytes is a 37% increase at the peak point. The maximum unbinding force of cell-ECM adhesion increased by up to 72% at the peak point relative to the baseline level. qPCR and immunofluorescence also indicated that dose-dependent changes in the expression of myosin and integrin β1 due to the elevated [Ca2+] may be responsible for the variations in cell stiffness and cell-ECM adhesion. Scratch assay showed that the chondrocyte migration ability was modulated by cell stiffness and cell-ECM adhesion: as chondrocyte’s elastic modulus and cell-ECM adhesion force increased, the migration speed of chondrocytes decreased. Taken together, our results showed that [Ca2+] could regulate chondrocytes stiffness and cell-ECM adhesion, and consequently, influence cell migration, which is critical in cartilage repair.

MRS-measured glutamate versus GABA reflects excitatory versus inhibitory neural activities in awake mice

To assess if magnetic resonance spectroscopy (MRS)-measured Glutamate (Glu) and GABA reflect excitatory and inhibitory neural activities, respectively, we conducted MRS measurements along with two-photon mesoscopic imaging of calcium signals in excitatory and inhibitory neurons of living, unanesthetized mice. For monitoring stimulus-driven activations of a brain region, MRS signals and mesoscopic neural activities were measured during two consecutive sessions of 15-min prolonged sensory stimulations. In the first session, putative excitatory neuronal activities were increased, while inhibitory neuronal activities remained at the baseline level. In the second half, while excitatory neuronal activities remained elevated, inhibitory neuronal activities were significantly enhanced. We assessed regional neurochemical statuses by measuring MRS signals, which were overall in accordance with the neural activities, and neuronal activities and neurochemical statuses in a mouse model of Dravet syndrome under resting condition. Mesoscopic assessments showed that activities of inhibitory neurons in the cortex were diminished relative to wild-type mice in contrast to spared activities of excitatory neurons. Consistent with these observations, the Dravet model exhibited lower concentrations of GABA than wild-type controls. Collectively, the current investigations demonstrate that MRS-measured Glu and GABA can reflect spontaneous and stimulated activities of neurons producing and releasing these neurotransmitters in an awake condition.