Assessment of dynamic variables of fluid responsiveness to predict desufflation-induced hypotension during paediatric laparoscopic surgery

Abstract

Background: During laparoscopic surgery in paediatric patients, sudden hypotension may occur following peritoneal desufflation due to hypovolaemia or an acute increase in gastrointestinal venous capacitance by the release of intra-abdominal pressure. This study examined whether dynamic variables of fluid responsiveness during pneumoperitoneum can predict the occurrence of hypotension following desufflation.Methods: A total of 120 paediatric subjects were prospectively enrolled. A predictor was derived from the initial 83 subjects and validated thereafter in 37 high-risk subjects. The pleth variability index, respiratory variation in the pulse oximetry plethysmographic waveform (ΔPOP), systolic pressure variation and pulse pressure variation during pneumoperitoneum were obtained 1 min before desufflation. Predictors of desufflation-induced hypotension were investigated using the multivariable logistic regression analysis. Predictability was assessed using the area under the receiver-operating characteristic curve (AUC).Results: In the derivation cohort, 27% (n=23) of subjects developed hypotension. Only ΔPOP was found to be a predictor, and showed high predictability of desufflation-induced hypotension [AUC 0.87, P<0.0001, 95% confidence interval (CI): 0.78–0.93]. A ΔPOP cut-off point of 38% predicted hypotension with a sensitivity of 83% and a specificity of 90%. In the validation cohort, 43% (n=16) of subjects developed hypotension, and ΔPOP was verified to be highly predictive of the occurrence of hypotension (AUC 0.90, P<0.0001, 95% CI: 0.76–0.98). The sensitivity and specificity of a ΔPOP cut-off point of 38% to predict hypotension was 88% and 90%, respectively.Conclusions: The ΔPOP during pneumoperitoneum is useful in predicting desufflation-induced hypotension during paediatric laparoscopic surgery.Clinical trial registration: NCT02536521.

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Clinical Similarity of the Biosimilar ABP 501 Compared With Adalimumab After Single Transition: Long-Term Results From a Randomised, Double-Blind, 52-Week, Phase 3 Study in Moderate-to-Severe Plaque Psoriasis Patients

Abstract

Background

ABP 501, an FDA- and EMA-approved biosimilar, is highly similar to adalimumab in structure, function, and pharmacokinetics.

Objective

Demonstrate similarity in efficacy, safety, and immunogenicity of ABP 501 versus adalimumab for moderate-to-severe plaque psoriasis.

Methods

Patients were randomised (1:1) to receive ABP 501 or adalimumab 40 mg every 2 weeks for 16 weeks. At Week 16, patients with ≥50% improvement from baseline in psoriasis area-and-severity index score (PASI) were eligible to continue to Week 52. Patients receiving ABP 501 continued; adalimumab patients were re-randomised (1:1) to continue adalimumab or undergo a single transition to ABP 501. Key efficacy assessments included % PASI improvement from baseline, PASI responders, and mean change in affected body surface area (BSA) from baseline to Weeks 16, 32, and 50. Safety was monitored via adverse events (AEs) and antidrug antibodies (ADAs) were assessed.

Results

308 patients were re-randomised at Week 16 (ABP 501/ABP 501, n=152; adalimumab/adalimumab, n=79; adalimumab/ABP 501, n=77). PASI percent improvements from baseline were similar across groups for Weeks 16, 32, and 50 (range: 85.8%-88.2%), with no significant differences detected across groups in percentages of PASI 50, 75, 90, and 100 responders. Changes from baseline in %BSA affected were similar across groups and timepoints. No new safety signals were detected. AEs were balanced between groups. Percentages of patients with binding and neutralizing ADAs were similar across treatments.

Conclusions

ABP 501 and adalimumab have similar clinical efficacy, safety, and immunogenicity profiles over 52 weeks, including after single transition, in this patient population.

This article is protected by copyright. All rights reserved.

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An index for the evaluation of 3D masticatory cycles stability

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Claudia Lúcia Pimenta Ferreira, Matteo Zago, Cláudia Maria de Felício, Chiarella Sforza
ObjectivesTo introduce an index (Masticatory Stability Index, MSI) to analyze the stability of chewing cycles in standardized conditions and test it in a group of patients with subclinical mild temporomandibular disorder (TMD).Design23 subjects with mild subacute TMD and 21 healthy subjects were involved; they all responded to a questionnaire about signs and symptoms of TMD (ProTMDmulti) and underwent a myofunctional orofacial evaluation with scores, using the protocol of orofacial myofunctional evaluation with scores (OMES). Their mandibular kinematics was assessed with a 3D motion capture system during deliberate unilateral gum chewing. The MSI was computed synthesizing the information contained in nine kinematics parameters into a single global figure. Patients' and controls' MSI were compared considering the preferred and non-preferred chewing side using a 2-way ANOVA (factors: group, side).ResultsTogether with a lower total score of myofunctional orofacial status, the TMD group showed a reduced stability based on MSI (p<0.05).ConclusionsThe MSI is an efficient method to measure the stability of the masticatory cycles. These preliminary results encourage validating the index on a larger sample. The variability in the motor behavior of chewing can impair the objectivity of its evaluations in several types of patients, including those with TMD. The MSI could be useful to complement clinical assessments, providing data for planning the rehabilitation of masticatory function in these patients.



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Obturator hernia: a rare cause of bowel obstruction

An obturator hernia is a rare condition and an unusual cause of intestinal obstruction. With a challenging diagnosis, it has one of the highest mortality rates of all abdominal wall hernias. The authors present a case of an elderly woman with bowel obstruction secondary to an incarcerated obturator hernia. An 80-year-old woman presented at the emergency room with complaints for the last 2 days of nausea, vomiting, constipation and lower right abdominal pain that radiated down to the right medial thigh. Abdominal tenderness to deep palpation of the right iliac fossa and mildly distention were noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated obturator hernia. The patient underwent emergency exploratory laparotomy. The incarcerated bowel was reduced and the defect was repaired with a plug of polypropylene mesh covered with peritoneum. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day.

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A case of deep infection after instrumentation in dorsal spinal surgery: the management with antibiotics and negative wound pressure without removal of fixation

Until today the role of spinal instrumentation in the presence of a wound infection has been widely discussed and recently many authors leave the hardware in place with appropriate antibiotic therapy. This is a case of a 65-year-old woman suffering from degenerative scoliosis and osteoporotic multiple vertebral collapses treated with posterior dorsolumbar stabilisation with screws and rods. Four months later, skin necrosis and infection appeared in the cranial wound with exposure of the rods. A surgical procedure of debridement of the infected tissue and package with a myocutaneous trapezius muscle flap was performed. One week after surgery, negative pressure wound therapy was started on the residual skin defect. The wound healed after 2 months. The aim of this case report is to focus on the utility of this method even in the case of hardware exposure and infection. This may help avoid removing instrumentation and creating instability.

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Thrombolytic therapy for the treatment of acute ischaemic stroke in adults with homozygous sickle cell disease

Stroke is a significant cause of morbidity and mortality in patients with homozygous sickle cell disease (SCD). A specific large-vessel vasculopathy is often responsible for both haemorrhagic and ischaemic strokes in patients with SCD. Although intravenous thrombolysis has been considered as a therapeutic option for acute ischaemic strokes in SCD, its use remains debated because of an increased risk of spontaneous intracranial haemorrhage reported in this disease. This risk of haemorrhage is mainly supported by the presence of a Moyamoya syndrome often associated with the specific vasculopathy in patients with homozygous SCD. We report two cases of patients with homozygous SCD treated with intravenous thrombolysis for an acute ischaemic stroke without haemorrhagic transformation. Our cases suggest that reperfusion strategy in acute ischaemic stroke in patients with homozygous SCD can be considered once associated Moyamoya syndrome has been ruled out. An international registry would be of interest as these situations are rare.

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Longitudinal Midline Sacral Split Fracture - A Rare Entity

Fractures involving the central canal of the sacrum are rare injuries and can be transverse or longitudinal. Transverse fractures are by far common and associated with high incidence of neurological injuries. On the contrary, longitudinal midline split fracture is an extremely rare injury with minimal or no neurological injury. They are always associated with anterior pelvic ring fracture and are vertically stable needing only fixation of the anterior pelvic injury. Plating of the anterior pelvic ring in two planes would be beneficial than single plate to prevent gradual loss of reduction.

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