Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding

BACKGROUND Superimposed high-frequency jet ventilation(SHFJV)is suitable for respiratory motion reduction and essential for effective lung tumor ablation.Fluid filling of the target lung wing one-lung flooding(OLF)is necessary for therapeutic ultrasound applications.However,whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear.AIM To compared SHFJV with pressure-controlled ventilation(PCV)during OLF by assessing hemodynamics and gas exchange in different animal positions.METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF.The animal positions were changed from left lateral position to supine position(SP)to right lateral position(RLP)every 30 min.In each position,ventilation was maintained for 15 min in both modalities.Hemodynamic variables and arterial blood gas levels were repeatedly measured.RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels.SHFJV slightly decreased oxygenation in SP and RLP compared with PCV;the lowest values of PaO_(2) and PaO_(2)/FiO_(2) ratio were found in SP[13.0;interquartile range(IQR):12.6-5.6 and 32.5(IQR:31.5-38.9)kPa].Conversely,during SHFJV,the shunt fraction was higher in all animal positions(highest in the RLP:0.30).CONCLUSION In porcine model,unilateral SHFJV may provide adequate ventilation in different animal positions during OLF.Lower oxygenation and CO_(2) removal rates compared to PCV did not lead to hypoxia or hypercapnia.SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.

Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study

AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.

Climate change and human health: Last call to arms for us

Climate change,now the foremost global health hazard,poses multifaceted challenges to human health.This editorial elucidates the extensive impact of climate change on health,emphasising the increasing burden of diseases and the exacerbation of health disparities.It highlights the critical role of the healthcare sector,particularly anaesthesia,in both contributing to and mitigating climate change.It is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.

Epidural anaesthesia restores pancreatic microcirculation and decreases the severity of acute pancreatitis

瞄准：在尖锐胰腺炎(AP ) 期间在胰腺的微循环上调查硬膜上的麻醉(EA ) 的效果。方法：AP 被牛磺胆酸钠的注射导致进 Sprague-Dawley 老鼠的胰腺的管。认识到 EA，一根导管被介绍进在 T7 和 T9 之间的硬膜外腔， bupivacaine 被注射。Microcirculatory 流动被激光 Doppler flowmetry 测量。动脉的血气体分析被执行。在实验(【or=5 h ) 的结束，胰为组织学被移开。动物被划分成三个组：组织 1 (n=9 ) ，没有 EA 的 AP；组织 2 (n=4 ) ，没有 AP 的 EA；并且组织 3 (n=6 ) ， AP 由 EA 对待。结果：在组 1，在 AP 以前的胰腺的微循环流动是 141+/- 39 个灌注单位(PU ) 。在 AP 以后，微循环流动显然减少了到 9+/- 6 PU (P【0.05 ) 。与基础过量开发的新陈代谢的酸中毒()-14+/-3 mmol/L。组织学揭示了广泛的浮肿和织物坏死。在组 2， EA 显著地没修改微循环流动。被仍然是未改变、组织学的分析显示出正常胰腺的织物。在组 3， AP 开始从 155+/-25 在微循环流动引起了重要减少到 11+/-7 PU (P【0.05 ) 。在 EA 的开始以后，微循环流动显然再增加了到 81+/-31 PU (P【0.05 ) 。是 -6+/-4 mmol/L，它与组 1 相比是显著地不同的(P【0.05 ) 。而且，组织学在组 1 在比那的组 3 在胰腺的组织揭示了不太广泛的浮肿和坏死。结论：AP 在胰以内引起了戏剧的微循环变化，与新陈代谢的酸中毒和织物坏死的开发。EA 允许微循环流动的部分恢复并且阻止了织物坏死和全身的复杂并发症的开发。因此， EA 应该被看作治疗学的选择阻止进化水肿到坏死的 AP。

Fulminant liver failure following a marathon: Five case reports and review of literature

BACKGROUND The growing popularity of marathon and half-marathon runs has led to an increased number of patients presenting with exertion-induced heat stroke. Mild hepatic involvement is often observed in these patients;however, fulminant liver failure may occur in approximately 5% of all cases. Liver transplantation is a potentially curative approach for exertion-induced liver failure, although there is a lack of consensus regarding the criteria and optimal timing of this intervention. CASE SUMMARY This paper describes 5 patients (4 men and 1 woman) who were referred to the department where this study was performed with the diagnosis of exertioninduced acute liver failure. Three patients underwent liver transplantation, 1 recovered spontaneously, and 1 patient died on day 11 following the exertion. CONCLUSION Exertion-induced heat stroke may present as fulminant liver failure. These patients may recover with conservative treatment, may require liver transplantation, or may die. No definitive criteria are available to determine patient suitability for a conservative vs surgical approach.

German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005–2015

BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classifi cation resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure.CONCLUSION: Communication defi cits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.

Effect of diltiazem and lidocaine on arterial pressure or heart rate and the quality of extubation in patients undergoing uvulopalatopharyngoplasty

Objective:To evaluate the effect of diltiazem and lidocaine on arterial pressure or heart rate and the quality of extubation in patients undergoing uvulopalatopharyngoplasty.Methods:Sixty patients were randomly divided into 4 groups:In the control group patients were given saline;in the lidocaine group patients were given 1.0 mg/kg lidocaine;in the diltiazem group patients were given 0.2 mg/kg dilti- azem;and in the lidocaine plus diltiazem group patients were given 1.0 mg/kg lidocaine and 0.2 mg/kg dil- tiazem.These drugs were given 2 min before tracheal extubation.Values for SBP,DBP,and HR were recorded,on arriving at the operating room,immediately at the end of the surgery,at the time of injection of the study drugs,at trachealextubation,at 1 minand 5 min after extubation.The quality ofextubation according to the Sebel's grading scale were compared among the 4 groups.Results:During extubation in the control group HR,SBP and DBP increased significantly when compared to baseline levels.Both lido- caine(1.0 mg/kg)and diltiazem(0.2 mg/kg)successfully alleviated these increases.The suppressive ef- fect of diltiazem was greater than that of lidocaine.The combinative use of the two drugs minimized the in- creases.The administration of lidocaine significantly suppressed bucking or coughing compared with the other groups.Conclusions:The pressor responses and tachycardia occurring in patients with uvu- lopalatopharyngoplasty during emergence from anesthesia and tracheal extubation,can be easily blocked by a bolus dose of 1.0 mg/kg lidocaine,0.2 mg/kg diltiazem or the combinative use of the two drugs.And the concurrent use of lidocaine and diltiazem alleviated the hemodynamic changes more obviously.

Effect of Higher Mean Arterial Pressure with Norepinephrine on Tissue Oxygenation and Perfusion in Patients of Septic Shock

The current survival sepsis guideline proposes the use of vasopressors and fluid resuscitation to maintain the mean arterial pressure (MAP) ≥ 65 mmHg. Titrating catecholamine infusion to achieve higher MAP has been demonstrated to improve tissue oxygenation, microcirculation, renal function and overall outcome of the patient in some studies and literature on actual hemodynamic goals is scarce. AIM: To study the influence of two MAP on tissue oxygenation and perfusion parameters in patients of septic shock on norepinephrine infusion. SUBJECT AND MATERIALS: Forty adult patients with the diagnosis of septic shock were enrolled. In all patients norepinephrine was titrated to first stabilize the MAP at 65 ± 5 mmHg (Set I), followed by MAP of 85 ± 5 mmHg (Set II). Heart rate (HR), Central venous oxygen saturation (SCVO2), Transcutaneous partial pressure of oxygen (PtcO2) by TCM 400/TINA (using miniature Clark electrode), Arterial partial pressure of oxygen(PaO2), PtO2/PaO2 ratio, Urine output and Serum Base deficit were recorded in each Set after 2 hrs of stabilization. RESULTS: There was a significant increase in transcutaneous partial pressure of oxygen PtcO2 (p tO2/PaO2 (p < 0.0001), ScvO2 (p < 0.0001), urine output (p < 0.006) on increasing the MAP from 65mmHg to 85mmHg. Serum base deficit also improved (p < 0.0001). CONCLUSION: Higher MAP with norepinephrine is associated with better perfusion, oxygenation parameters in patients with established septic shock. These findings suggest that there is improvement in tissue oxygenation parameters using escalating doses of norepinephrine to achieve higher MAP without inherent adverse

Paravertebral Block for Post-Operative Analgesia after Breast Cancer Surgery, Effects of Adding Morphine: Double Blind, Randomised Clinical Trial

Introduction: Thoracic paravertebral block (PVB) block is frequently used in breast cancer surgery for postoperative pain management. Adding opioids to local anaesthetics has been shown to have beneficial effects during epidural analgesia. Our hypothesis was that adding morphine to bupivacaine for PVB would improve analgesia provided by this procedure. Methods: 60 patients (25 - 75 years) undergoing elective surgery for breast cancer were randomly assigned to one of two groups. Both groups received a single injection thoracic paravertebral block;group BAM with 20 ml 0.5% bupivacaine, epinephrine and morphine while group BA received identical block except morphine was given subcutaneously. All patients had general anaesthesia. Results: Severity of pain and nausea was low in both groups. Pain scores remained below 20/100 after the first 2 hours throughout the 72 hours of the study. There was no significant difference between the groups in pain scores, consumption of additional morphine or nausea scores. Shoulder mobility was also very good in both groups. Conclusion: Thoracic paravertebral block with bupivacaine and epinephrine was associated with good postoperative analgesic effects and low incidence of nausea and vomiting. The addition of morphine to the local anaesthetic solution in paravertebral block did not have any additional analgesic effects.

Validation of the VitalPAC Early Warning Score at the Intermediate Care Unit

AIM To assess the performance and clinical relevance of the Early Warning Scoring(EWS)system at the Intermediate Care Unit(IMCU).METHODS This cohort study used all the Vital PAC EWS(Vi EWS)scores collected during each nursing shift from 2014through 2016 at the mixed surgical IMCU of an academic teaching hospital.Clinical deterioration defined as transfer to the Intensive Care Unit(ICU)or mortality within 24 h was the primary outcome of interest.RESULTS A total of 9113 aggregated Vi EWS scores were obtained from 2113 admissions.The incidence of the combined outcome was 272(3.0%).The area under the curve of the Vi EWS was 0.72(CI:0.69-0.75).Using a threshold value of six,the sensitivity was 68%with a positive predictive value of 5%and a number needed to trigger(e.g.,false alarms)of 19%.CONCLUSION The Vi EWS at the IMCU has a discriminative performance that is considerably lower than at the hospital ward.The number of false alarms is high,which may result in alarm fatigue.Therefore,use of the Vi EWS in its current form at the IMCU should be reconsidered.

Comparison of Three Methods of Regional Anesthesia of Peripheral Nerves and Plexuses

Aim: There were acquitted 1105 nerve blocks on 762 patients by means of three methods of peripheral nerves and plexuses identification to compare the safety and efficiency of the methods of regional anesthesia. Methods: Depending on the technique of carrying out the peripheral nerve blocks, patients were divided into 3 groups. 1st group: the identification of the correct placement of the injection needle was done by eliciting paresthesia (572 blocks were performed on 395 patients);2nd group: an electrical nerve stimulator was used to locate the nerve (164 blocks on 110 patients);3rd group: the location of the nerve was identified using ultrasonic visual guidance (369 blocks on 257 patients). Results and Conclusion: In 1st group 8 (1.4%) accidental intravascular injections of local anesthetic, 1 case of Horner syndrome (0.17%), 1 case of phrenical nerve were registered. In 17 cases there were performed other methods of anesthesia by reason of inefficiency of the block. In 2nd group 1 case (0.61%) of intravascular injection was noticed. The block was ineffective in single case. There was no complication received in the 3rd group. All the blocks were effective.

Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p < 0.001). Mean RR, SpO2, EtCO2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

COVID-19:Masks do not influence neurocognitive performance during a shift at the emergency department

The COVID-19 pandemic has led to the widespread mandatory use of personal protective equipment(PPE),including filtering face pieces(FFP).Emergency medical care providers now commonly use this equipment.

Pneumothorax in a Thiel cadaver model of cardiopulmonary resuscitation

INTRODUCTION There has been some previous research in the field of cardiopulmonary resuscitation (CPR) using cadaver models.[1]The Thiel method was developed by Professor Walter Thiel (Graz, Austria) and described in 1992 and 2002. It consists of both an intravascular injection of the embalming solution and submersion of the bodies in a tank with the same solution for a determined period.[2,3]

Innovative immunohistochemistry identifies MMP-9 expressing macrophages at the invasive front of murine HCC

AIM:To investigate the proteolytic contribution of tumor-associated macrophages(TAM)in tumor invasion,we analyzed whether TAM at the invasive front of small HCC in Abcb4-/--mice show an enhanced expression of MMP-9. METHODS:Liver cryosections of the hepatocellular carcinoma(HCC)invasive front from 12 mo old Abcb4-/--mice were stained for collagen typeⅠand MMP-9 using Alexa488 and Alexa568 labeled secondary antibodies.Afterwards,the Alexa568 dye was bleached and the macrophage marker F4/80 was visualized using Alexa568 labeled secondary antibodies.Finally, photographs of the invasive tumor front were digitally overlaid and analyzed. RESULTS:After complete bleaching of the primary dye,specific fluorescence staining of a third antigen, here F4/80,was successfully performed on the same histological section.With this method,we were able to identify conglomerates of matrix metalloproteinase (MMP-9)expressing macrophages within the tumor capsule of HCC. CONCLUSION:MMP-9 expressing macrophages are involved in matrix remodelling at the invasive tumor front of HCC.The described staining protocol provides a simple yet powerful extension of conventional immuno-histochemistry,facilitating visualization of at least three different antigens plus nuclei in one single histological section.

Incidence and risk factors for early renal dysfunction after liver transplantation

AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed(n = 187). Patients with no renal replacement therapy(RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, bodymass index(BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status(cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done.RESULTS: There were 78 patients in group 1(41.7%), 46 in group 2(24.6%), 38 in group 3(20.3%) and 25 in group 4(13.4%). Twenty patients required RRT: 13(7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubin and urea, aspartate aminotransferase(ASAT), and hemoglobin levels and the need for transfusion. The multivariate analysis showed that BMI(OR = 1.1, P = 0.004), preoperative creatinine level(OR = 11.1, P < 0.0001), use of vasopressor(OR = 3.31, P = 0.0002), maximal postoperative bilirubin level(OR = 1.44, P = 0.044) and minimal postoperative hemoglobin level(OR = 0.059, P = 0.0005) were independent predictors of early post-liver transplantation renal dysfunction. Neither donor status nor ASAT levels had significant impact on early postoperative renal dysfunction in multivariate analysis. Absence of renal dysfunction(group 1) was also predicted by the intraoperative hemostatic agent used, independently of the extent of bleeding and of the preoperative creatinine level.CONCLUSION: More than half of receivers experienced some degree of early renal dysfunction after liver transplantation. Main predictors were preoperative renal dysfunction, postoperative anemia and vasopressor requirement.

Metalloproteinase expression after desflurane preconditioning in hepatectomies:A randomized clinical trial

BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury;however,pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients.The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases,which may signal pathologic hepatic tissue reformation.AIM To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy.METHODS This is a single-center,prospective,randomized controlled trial conducted at the 4th Department of Surgery of the Medical School of Aristotle University of Thessaloniki,between August 2016 and December 2017.Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning(by replacement of propofol with desflurane,administered 30 min before induction of ischemia)or the control group for standard intravenous propofol.The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion.The secondary endpoints of neutrophil infiltration,coagulation profile,activity of antithrombin III(AT III),protein C(PC),protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups.RESULTS The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2,significantly decreased levels of matrix metalloproteinases 2 and 9,decreased neutrophil infiltration,and less profound changes in the coagulation profile.During the 5-d postoperative period,all patients showed significantly decreased activity of AT III,PC and protein S(vs baseline values,P<0.05).The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5(P<0.05),showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group.Compared to the control group,the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days(P<0.005)and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3(P<0.05).Total length of stay was significantly less in the desflurane group(P=0.009).CONCLUSION Desflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization.

Recovery rates of combination antibiotic therapy using in vitro microdialysis simulating in vivo conditions

Microdialysis is a technique used to measure the unbound antibiotic concentration in the interstitial spaces, the target site of action. In vitro recovery studies are essential to calibrating the microdialysis system for in vivo studies. The effect of a combination of antibiotics on recovery into microdialysate requires investigation. In vitro microdialysis recovery studies were conducted on a combination of vancomycin and tobramycin, in a simulated in vivo model. Comparison was made between recoveries for three different concentrations and three different perfusate flow rates. The overall relative recovery for vancomycin was lower than that of tobramycin. For tobramycin, a concentration of 20μg/mL and flow rate of 1.0μL/min had the best recovery. A concentration of 5.0μg/mL and flow rate of 1.0μL/min yielded maximal recovery for vancomycin. Large molecular size and higher protein binding resulted in lower relative recoveries for vancomycin. Perfusate flow rates and drug concentrations affected the relative recovery when a combination of vancomycin and tobramycin was tested. Low perfusate flow rates were associated with higher recovery rates. For combination antibiotic measurement which includes agents that are highly protein bound, in vitro studies performed prior to in vivo studies may ensure the reliable measurement of unbound concentrations.

Clinical Validation of Cambridge Neuropsychological Test Automated Battery in a Norwegian Epilepsy Population

Introduction: Semi-automatic neuropsychological testing has gained a position both in clinical use and in research. Comparison studies with traditional neuropsychological tests are sparse and the role of such semi-automated testing is debated. To integrate semi-automated neuropsychological testing in the established clinical setting the tests must be validated in the patient groups addressed. The aim of this study was to validate Cambridge Neuropsychological Tests Automated Battery (CANTAB) in patients with epilepsy. Material and Methods: Patients scheduled for traditional neuropsychological testing with Category test (CT), Trail Making Test part B (TMT-B), WAIS-III and WMS-R were also asked to complete the CANTAB battery. Our hypothesis was that memory tests from CANTAB (DMS, PAL) would correlate with visual memory tests from WMS-R and that a test of executive functions from CANTAB (SOC) would correlate with functions tested with TMT-B, CT and WAIS-III. Results: Scores from DMS correlated strongly with Visual Paired Associations 1 from WMS-R. From SOC results correlated both with Visual Paired Association 1 & 2, General Memory Index and Full Scale IQ. Results from PAL correlated with several results from the traditional battery: Verbal, Visual and General Memory Index, Paired Associations, Visual Memory Span Backwards, TmtB and Visual IQ. Conclusion: Our results indicate that DMS primarily tests visual matching to sample. SOC tests executive functions and also depends on non-verbal IQ and memory. Numerous correlations between PAL and traditional tests illustrates that PAL is a complex task depending on several cognitive domains, but mainly memory.

Retrospective Diagnosis of COVID-19 in an Asymptomatic Patient Undergoing Emergency Surgery

Background: With reports of higher mortality and complications occurring in patients with perioperative 2019 novel coronarvirus disease (COVID-19), most elective surgeries have been postponed. However, evidence regarding emergency surgeries in patients with COVID-19 remains scarce. We report the case of a patient with asymptomatic perioperative COVID-19, presenting with an acute abdomen requiring surgery. Case: A 25-year-old male, with a prior nasopharyngeal swab that was negative for SARS-CoV-2, presented with classical signs and symptoms of acute appendicitis. Clinical examination and investigations were not suggestive of COVID-19 infection. He underwent laparoscopic appendicectomy with infection control precautions. Post-operatively, he was found to be positive for SARS-CoV-2 but remained asymptomatic and had an uneventful recovery. Conclusion: In asymptomatic individuals with higher risks, negative test results should be viewed cautiously. The benefits of urgent surgical interventions must be weighed against the risks of complications due to perioperative COVID-19 in these patients.