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Showing papers by "University of Texas Medical Branch published in 2022"


Journal ArticleDOI
TL;DR: In this paper, a weakly-solvating structure formed spontaneously in a low-concentration electrolyte (merely 0.3 M) and thereby facilitates Na+ desolvation process.

32 citations


Journal ArticleDOI
TL;DR: In this article , a weakly-solvating structure formed spontaneously in a low-concentration electrolyte (merely 0.3 M) and thereby facilitates Na+ desolvation process.

32 citations


Journal ArticleDOI
TL;DR: In this article , a cloud computing system for 3D realistic failure process analysis (RFPA3D) was established to model the fine failure process of a real concrete structure, and the micromorphology of the EPS concrete specimens was obtained via CT scanning and further processed using digital image processing technology.

15 citations


Journal ArticleDOI
TL;DR: Stern-Ginossar et al. as discussed by the authors showed that nsp1, through inhibition of translation and induction of mRNA degradation, targets translated cellular mRNA and is the main driver of host shutoff during infection.

14 citations


Journal ArticleDOI
TL;DR: In this article , the authors describe current surveillance and treatment practices, cancer outcomes, and costs of care for low-grade papillary stage Ta (low-grade Ta) non-muscle-invasive bladder cancer (NMIBC) and identify factors associated with increased cost of care.
Abstract: Low-risk non-muscle-invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality; however, patients with low-risk NMIBC may often receive non-guideline-recommended and potentially costly surveillance testing and treatment.To describe current surveillance and treatment practices, cancer outcomes, and costs of care for low-grade papillary stage Ta (low-grade Ta) NMIBC and identify factors associated with increased cost of care.This population-based cohort study identified 13 054 older adults (aged 66-90 years) diagnosed with low-grade Ta tumors in the Surveillance, Epidemiology and End Results-linked Medicare database from January 1, 2004, through December 31, 2013. Medicare claims data through December 31, 2014, were also reviewed. Data were analyzed from April 1 to October 6, 2021.Surveillance testing and treatment among patients with low-grade Ta NMIBC.The primary outcome was patterns in population-level surveillance and treatment practice over time among patients with low-grade Ta NMIBC. Secondary outcomes were recurrence (defined as receipt of subsequent transurethral resection of bladder tumor >3 months after index diagnosis of NMIBC and initial transurethral resection of bladder tumor), progression (defined as receipt of definitive treatment for bladder cancer), and costs of care.Among 13 054 patients who met inclusion criteria, 9596 (73.5%) were male and 3458 (26.5%) were female, with a median age of 76 years (IQR, 71-81 years). A total of 403 patients (3.1%) were Black, 120 (0.9%) were Hispanic, 12 123 (92.9%) were White, and 408 (3.1%) were of other races and/or ethnicities. Rates of surveillance cystoscopy increased over the study period (from 79.3% in 2004 to 81.5% in 2013; P = .007), with patients receiving a median of 3.0 cystoscopies per year (IQR, 2.0-4.0 per year). Rates of upper tract imaging (particularly computed tomography or magnetic resonance imaging) also increased over the study period (from 30.4% in 2004 to 47.0% in 2013; P < .001), with most patients receiving a median of 2.0 imaging tests per year (IQR, 1.0-2.0 per year). The use of urine cytologic testing or other urine biomarker assessment also increased (from 44.8% in 2004 to 54.9% in 2013; P < .001). Rates of adherence to current guidelines were similar over time (eg, a median of 4398 patients [55.2%] received ≤2 cystoscopies per year in 2004-2008 vs a median of 2736 patients [53.8%] in 2009-2013; P = .11), suggesting overuse of all surveillance testing modalities. With regard to treatment, 2250 patients (17.2%) received intravesical bacillus Calmette-Guérin, and 792 patients (6.1%) received intravesical chemotherapy (excluding receipt of a single perioperative dose). Among all patients with low-grade Ta NMIBC, 217 (1.7%) experienced disease recurrence and 52 (0.4%) experienced disease progression. The total annual median costs of low-grade Ta surveillance testing and treatment increased by 60% (from $34 792 in 2004 to $53 986 in 2013), with higher 1-year median expenditures noted among those with disease recurrence ($76 669) vs no disease recurrence ($53 909) at the end of the study period.In this cohort study, despite low rates of disease recurrence and progression, rates of surveillance testing increased during the study period. The annual cost of care also increased over time, particularly among patients with recurrent disease. Efforts to improve adherence to current practice guidelines, with the focus on limiting overuse of surveillance testing and treatment, may mitigate associated increasing costs of care.

14 citations


Posted ContentDOI
TL;DR: In this article, the RBD203-N1 yeast expression construct was used to produce a recombinant protein capable of eliciting a robust immune response and protection in mice against SARS-CoV-2 challenge infections.

13 citations


Journal ArticleDOI
TL;DR: In this paper , the impact of SARS-CoV-2 on the olfactory pathway was studied over several time points using Syrian golden hamsters, and the authors found an incomplete recovery of the Olfactory sensory neurons, prolonged activation of glial cells in the OFT, and a decrease in the density of dendritic spines within the hippocampus.
Abstract: The impact of SARS-CoV-2 on the olfactory pathway was studied over several time points using Syrian golden hamsters. We found an incomplete recovery of the olfactory sensory neurons, prolonged activation of glial cells in the olfactory bulb, and a decrease in the density of dendritic spines within the hippocampus. These data may be useful for elucidating the mechanism underlying long-lasting olfactory dysfunction and cognitive impairment as a post-acute COVID-19 syndrome.

13 citations


Journal ArticleDOI
TL;DR: In this paper, the authors showed that berberine was able to bind to the kinase domain of non-phosphorylated MET, occupy the front of the binding pocket, and interact with the activation loop, in a similar way as other known MET inhibitors do.

11 citations


Journal ArticleDOI
TL;DR: In this article, the effect of maternal exposure to cadmium (Cd), an environmental toxin, using the FMi-OOC that incorporates maternal decidua cells and three different fetal cells was analyzed.

11 citations


Journal ArticleDOI
TL;DR: In this paper , the effect of maternal exposure to cadmium (Cd), an environmental toxin, using the FMi-OOC that incorporates maternal decidua cells and three different fetal cells was analyzed.

11 citations


Journal ArticleDOI
TL;DR: In this paper , the authors compared the current 5 investigation strategies to defer cardiac testing in patients with stable chest pain and found that the CACS-CL strategy had a stronger association between risk groups and obstructive coronary artery disease (odd ratios: 16.00 vs 2.00), major adverse cardiovascular events (HRs: 6.83 vs 1.90), and intensive subsequent clinical management as well as better metrics of diagnostic accuracy and positive net reclassification improvement.
Abstract: This study aimed to compare the current 5 investigation strategies to defer cardiac testing in patients with stable chest pain.For the clinical management of stable chest pain, the identification of patients unlikely to benefit from further cardiac testing is important, but the most appropriate investigation strategy is unknown.A total of 4,207 patients referred to coronary computed tomography angiography for stable chest pain were classified into low- and high-risk groups according to the 2016 National Institute of Health and Care Excellence (NICE) guideline-determined strategy; PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) minimal risk tool-based strategy; 2019 European Society of Cardiology (ESC) guideline-determined strategy; and coronary artery calcium score (CACS), either in isolation (the CACS strategy) or as part of a weighted clinical likelihood model-based strategy (the CACS-CL strategy). The associations of obstructive coronary artery disease on coronary computed tomography angiography, major adverse cardiovascular events, and subsequent clinical management with risk groups according to different strategies were evaluated and compared.The NICE, PROMISE, ESC, CACS, and CACS-CL strategies classified a proportion (22.63%, 29.21%, 41.84%, 46.76%, and 51.41%, respectively) of patients into low-risk groups. Compared with the NICE, PROMISE, ESC, and CACS strategies, the CACS-CL strategy had a stronger association between risk groups and obstructive coronary artery disease (odd ratios: 16.00 vs 2.93, 5.53, 7.94, and 10.39, respectively), major adverse cardiovascular events (HRs: 6.83 vs 1.90, 2.94, 4.23, and 5.13, respectively) and intensive subsequent clinical management as well as better metrics of diagnostic accuracy and positive net reclassification improvement.Among contemporary strategies used to identify patients with stable chest pain at low risk, the use of CACS, especially when combined with clinical risk features, showed the strongest potential to effectively defer cardiac testing.

Journal ArticleDOI
TL;DR: In this paper , the authors showed that higher TauO concentrations effectively outcompete AβO and become the prevailing synapticassociated species, while high concentrations of Aβ O facilitate synaptic TauO recruitment.
Abstract: Alzheimer's disease (AD) is characterized by progressive cognitive decline due to accumulating synaptic insults by toxic oligomers of amyloid beta (AβO) and tau (TauO). There is growing consensus that preventing these oligomers from interacting with synapses might be an effective approach to treat AD. However, recent clinical trial failures suggest low effectiveness of targeting Aβ in late-stage AD. Researchers have redirected their attention toward TauO as the levels of this species increase later in disease pathogenesis. Here we show that AβO and TauO differentially target synapses and affect each other's binding dynamics.Binding of labeled, pre-formed Aβ and tau oligomers onto synaptosomes isolated from the hippocampus and frontal cortex of mouse and postmortem cognitively intact elderly human brains was evaluated using flow-cytometry and western blot analyses. Binding of labeled, pre-formed Aβ and tau oligomers onto mouse primary neurons was assessed using immunofluorescence assay. The synaptic dysfunction was measured by fluorescence analysis of single-synapse long-term potentiation (FASS-LTP) assay.We demonstrated that higher TauO concentrations effectively outcompete AβO and become the prevailing synaptic-associated species. Conversely, high concentrations of AβO facilitate synaptic TauO recruitment. Immunofluorescence analyses of mouse primary cortical neurons confirmed differential synaptic binding dynamics of AβO and TauO. Moreover, in vivo experiments using old 3xTgAD mice ICV injected with either AβO or TauO fully supported these findings. Consistent with these observations, FASS-LTP analyses demonstrated that TauO-induced suppression of chemical LTP was exacerbated by AβO. Finally, predigestion with proteinase K abolished the ability of TauO to compete off AβO without affecting the ability of high AβO levels to increase synaptic TauO recruitment. Thus, unlike AβO, TauO effects on synaptosomes are hampered by the absence of protein substrate in the membrane.These results introduce the concept that TauO become the main synaptotoxic species at late AD, thus supporting the hypothesis that TauO may be the most effective therapeutic target for clinically manifest AD.

Journal ArticleDOI
TL;DR: In this article , the Coronavirus Disease 2019 (COVID-19) pandemic has impacted breast, colon, prostate, and lung cancer screening in the U.S. by decreasing screening numbers.

Journal ArticleDOI
TL;DR: In this paper, the authors examined associations between key risk factors for occupational stress among the intimate partner violence (IPV) and sexual assault (SA) workforce and found that gaps in knowledge related to occupational stress remain.
Abstract: Gaps in knowledge related to occupational stress among the intimate partner violence (IPV) and sexual assault (SA) workforce remain. This study examined associations between key risk factors for oc...

Journal ArticleDOI
TL;DR: In this paper , a descriptive literature-based treatise expounds on the underlying causality for physician burnout, its consequences for the healthcare workforce in the US, and provides individual- and institution-based solutions for its mitigation.
Abstract: Across the United States, physician burnout is progressively escalating, with accompanying negative sequelae for myriad stakeholders in healthcare, including communities, patients, physicians, and Healthcare Organizations (HCOs) with essential manpower implications. This ubiquitous trend is due to complex and multifactorial elements, including individual physician-related influences, generational perspectives, sociocultural communal effects, HCOs, and more recently the mounting challenges accompanying the COVID-19 pandemic. To achieve the overarching goals of US healthcare provision (ie, safe, effective, patient-centered, timely, efficient, and equitable patient care), proposed solutions should focus on longitudinal actionable data acquisition to meet workforce needs preemptively, resource allocation for wellness programs geared towards enhancing recruitment and retention, and shared responsibility at the level of individual physician and HCO. This descriptive literature-based treatise expounds on the underlying causality for physician burnout, its consequences for the healthcare workforce in the US, and provides individual- and institution-based solutions for its mitigation.

Journal ArticleDOI
TL;DR: In this article , the structural, physical and gamma-ray attenuation properties of α-TeO2 CMSs were extensively analyzed, which has unexpectedly been observed as a part of Sm2O3 doped TeO2-B2O-3-V2O5 glasses synthesis process.
Abstract: In this study, we extensively analyzed the structural, physical and gamma-ray attenuation properties of α-TeO2 CMS, which has unexpectedly been observed as a part of Sm2O3 doped TeO2–B2O3–V2O5 glasses synthesis process. The shape of α-TeO2 CMS was obtained from SEM analyses. Moreover, EDX, XRD and Raman examinations were utilized for systematic characterization of α-TeO2 CMS. In addition to experimental physical and structural studies on α-TeO2 CMSs, gamma-ray attenuation properties were also determined and compared with Quartz and some novel glasses such as PNCKM5, C25, SCNZ7 along with some commercial glasses such as RS253, RS253G18, RS323G19, RS360, RS520 using FLUKA general-purpose Monte Carlo code. EDX results indicated that only Te and O elements were available in the α-TeO2 CMS. The finding showed that gamma-ray attenuation competencies of α-TeO2 CMS is higher than many novel and commercial glasses in addition to traditional concrete shields. It can be concluded that further comparison studies can be done between normal glass structure and α-TeO2 CMS (or similar) occurred glass structures in terms of better understanding the total gamma-ray attenuation and the effect of α-TeO2 CMS.

Journal ArticleDOI
TL;DR: In this article , the authors conducted a systematic review and meta-analysis examining the immunogenicity and safety of SARS-CoV-2 vaccination in patients with rheumatic disease.
Abstract: Background Patients with rheumatic disease (RD) are at increased risk for COVID-19 infection. Large clinical trials have demonstrated efficacy and safety of SARS-CoV-2 vaccine. However, patients with RD are typically excluded from these trials. Objective The aim of this study was to conduct a systematic review and meta-analysis examining the immunogenicity and safety of SARS-CoV-2 vaccination in patients with RD. Methods We systematically searched PubMed/MEDLINE and Scopus to identify observational studies that examined the immunogenicity and safety of SARS-CoV-2 vaccination in RD patients. Information on disease, immunosuppressant, vaccine type, and proportion of patients with serologic response was obtained from each study. Results There were 25 eligible studies. The pooled rate of seroconversion was 0.79 (95% confidence interval [CI], 0.72–0.86). Compared with control subjects, the odds of seroconversion were significantly lower (odds ratio, 0.11; 95% CI, 0.05–0.24). Users of rituximab showed the lowest rate of seroconversion (0.39; 95% CI, 0.29–0.51) followed by mycophenolate (0.56; 95% CI, 0.40–71). On the other hand, users of interleukin 17 (0.94; 95% CI, 0.78–0.98) and tumor necrosis factor inhibitors (0.94; 95% CI, 0.84–0.98) showed high seroconversion rate. Regarding safety of COVID-19 vaccine, approximately 2% of patients reported severe adverse events and 7% reported diseases flares following the first or second dose. Conclusion Vaccination against SARS-CoV-2 appears to be safe. Most RD patients developed humoral immune response following vaccination. However, the odds of seroconversion were significantly lower in RD patients compared with controls. This is likely driven by certain immunosuppressants including rituximab and mycophenolate. Future studies need to identify strategies to improve vaccine response in these patients.

Journal ArticleDOI
TL;DR: In this paper , the authors demonstrate cavity-QED entanglement of external degrees of freedom to realize a matter-wave interferometer of 700 atoms in which each individual atom falls freely under gravity and simultaneously traverses two paths through space while also entangled with the other atoms.
Abstract: Entanglement is a fundamental resource that allows quantum sensors to surpass the standard quantum limit set by the quantum collapse of independent atoms. Collective cavity-QED systems have succeeded in generating large amounts of directly observed entanglement involving the internal degrees of freedom of laser-cooled atomic ensembles. Here we demonstrate cavity-QED entanglement of external degrees of freedom to realize a matter-wave interferometer of 700 atoms in which each individual atom falls freely under gravity and simultaneously traverses two paths through space while also entangled with the other atoms. We demonstrate both quantum non-demolition measurements and cavity-mediated spin interactions for generating squeezed momentum states with directly observed metrological gain $3.4^{+1.1}_{-0.9}$ dB and $2.5^{+0.6}_{-0.6}$ dB below the standard quantum limit respectively. An entangled state is for the first time successfully injected into a Mach-Zehnder light-pulse interferometer with $1.7^{+0.5}_{-0.5}$ dB of directly observed metrological enhancement. Reducing the fundamental quantum source of imprecision provides a new resource that can be exploited to directly enhance measurement precision, bandwidth, and accuracy or operate at reduced size. These results also open a new path for combining particle delocalization and entanglement for inertial sensors, searches for new physics, particles, and fields, future advanced gravitational wave detectors, and accessing beyond mean-field quantum many-body physics.

Journal ArticleDOI
TL;DR: In this article, a case study of hemorrhage resuscitation and intravenous propofol sedation was used to investigate how these individual treatment loops interact with each other, and the results showed that the influence of one treatment on the other must be taken into account in selecting treatment set point to maintain the safety of overall therapy, and that information sharing between control loops may enhance the efficacy and robustness of individual treatment loop.

Journal ArticleDOI
TL;DR: In this paper, the authors developed and characterized the relevance and potential utility of an electronically delivered acceptance and mindfulness-based approach to physical activity promotion for insufficiently active breast cancer survivors.
Abstract: The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors. The acceptance- and mindfulness-based physical activity intervention was delivered to participants electronically over the course of 4–8 weeks. It consisted of didactic videos, experiential exercises, and workbook-type activities that targeted principles from acceptance and commitment therapy (ACT). We conducted semi-structured, in-depth interviews with participants after they completed the intervention. Three coders conducted qualitative data analysis on interview transcripts to identify overarching themes and subthemes. We recruited 30 participants. Of those, 16 engaged in an individual interview. The mean age of the sample was 58.4 years (SD = 13.8). The sample was relatively well educated (50.0% college graduates) and mostly overweight or obese (58.8%). We identified two overarching themes from interviews. They were centered on (1) internal and external barriers to physical activity adherence and (2) the utility of targeting core ACT processes (acceptance and defusion, mindfulness, and values clarification) for physical activity promotion. Intervention content was perceived to be acceptable, relevant, and to fulfill important needs related to healthy living. Findings suggest that this approach to physical activity promotion can be delivered effectively online. Electronically delivered acceptance- and mindfulness-based approaches hold promise for helping insufficiently active breast cancer survivors increase physical activity.

Journal ArticleDOI
TL;DR: A 3-dimensional DNA tetrahedron (DNA TET) nanomaterial was meticulously designed and constructed for the enrichment of cancer biomarker heat shock protein 90 alpha in human plasma and highly efficient enrichment by controlled antibodies arrangement on thenanomaterials and accurate quantification of low-abundance proteins by MS were achieved.

Journal ArticleDOI
TL;DR: Interestingly, the subjects who were diagnosed with optic disc edema also tended to exhibit higher body temperature and overall higher levels of anxiety and insomnia during bed rest, which likely reflects regional differences in diet and nutritional status.

Journal ArticleDOI
TL;DR: In this paper , the impact of raising bank capital requirements on lending in an emerging market and exploring heterogeneous effects, depending on bank characteristics and economic conditions, is explored, and they find that higher capital requirements are associated with lower credit growth in Peru.
Abstract: This paper offers novel evidence on the impact of raising bank capital requirements on lending in an emerging market and explores heterogeneous effects, depending on bank characteristics and economic conditions. Using quarterly bank-level data and exploiting the adoption of bank-specific capital buffers, we find that higher capital requirements are associated with lower credit growth in Peru. But the effect is short-lived and becomes insignificant in about half a year. The impact of capital requirements varies with economic conditions and bank characteristics. The effects is stronger during periods of lower economic growth. Weaker (less profitable, less capitalized and less liquid) banks react more to changes in capital requirements. Our findings are robust to estimating a variety of specification to address concerns about the endogeneity of capital requirements.

Posted ContentDOI
28 Mar 2022
TL;DR: In this article , the neutralization of BNT162b2-vaccinated sera (collected at 1 month after dose 3) against the three Omicron sublineages was reported.
Abstract: Abstract The newly emerged Omicron SARS-CoV-2 has 3 distinct sublineages: BA.1, BA.2, and BA.3. BA.1 accounts for the initial surge and is being replaced by BA.2, whereas BA.3 is at a low prevalence at this time. Here we report the neutralization of BNT162b2-vaccinated sera (collected at 1 month after dose 3) against the three Omicron sublineages. To facilitate the neutralization testing, we engineered the complete BA.1, BA.2, or BA.3 spike into an mNeonGreen USA-WA1/2020 SRAS-CoV-2. All BNT162b2-vaccinated sera neutralized USA-WA1/2020, BA.1-, BA.2-, and BA.3-spike SARS-CoV-2s with titers of >20; the neutralization geometric mean titers (GMTs) against the four viruses were 1211, 336, 300, and 190, respectively. Thus, the BA.1-, BA.2-, and BA.3-spike SARS-CoV-2s were 3.6-, 4.0-, and 6.4-fold less efficiently neutralized than the USA-WA1/2020, respectively. Our data have implications in vaccine strategy and understanding the biology of Omicron sublineages.

Posted ContentDOI
07 Jun 2022
TL;DR: In this article , the neutralization activity of sera from BNT162b2 vaccinated individuals or unimmunized Omicron BA.1.1-infected individuals was reported.
Abstract: Abstract Distinct SARS-CoV-2 Omicron sublineages have evolved showing increased fitness and immune evasion than the original Omicron variant BA.1. Here we report the neutralization activity of sera from BNT162b2 vaccinated individuals or unimmunized Omicron BA.1-infected individuals against Omicron sublineages and “Deltacron” variant (XD). BNT162b2 post-dose 3 immune sera neutralized USA-WA1/2020, Omicron BA.1-, BA.2-, BA.2.12.1-, BA.3-, BA.4/5-, and XD-spike SARS-CoV-2s with geometric mean titers (GMTs) of 1335, 393, 298, 315, 216, 103, and 301, respectively; thus, BA.4/5 SARS-CoV-2 spike variant showed the highest propensity to evade vaccine neutralization compared to the original Omicron variants BA.1. BA.1-convalescent sera neutralized USA-WA1/2020, BA.1-, BA.2-, BA.2.12.1-, BA.3-, BA.4/5-, and Deltacron-spike SARS-CoV-2s with GMTs of 15, 430, 110, 109, 102, 25, and 284, respectively. The low neutralization titers of vaccinated sera or convalescent sera from BA. 1 infected individuals against the emerging and rapidly spreading Omicron BA.4/5 variants provide important results for consideration in the selection of an updated vaccine in the current Omicron wave.

Journal ArticleDOI
TL;DR: In this article , proximity proteomics was used to define the functional interactome of EBOV polymerase and to capture the functional host interactome and illuminate host-dependent regulation of viral RNA synthesis.

Journal ArticleDOI
TL;DR: In this paper , the prevalence of bed bug infestation in two rural areas of Senegal and determine the species present in the population was assessed using MALDI-TOF MS tools.
Abstract: Bed bugs are known to carry several microorganisms. The purpose of this study was to assess the prevalence of bed bug infestation in two rural areas of Senegal and determine the species present in the population. A screening was conducted to detect some arthropod associated pathogenic bacteria in bed bugs and to evaluate the prevalence of endosymbiont carriage. One survey took place in 17 villages in Niakhar and two surveys in Dielmo and Ndiop and surroundings area in the same 20 villages. Bed bugs collected were identified morphologically and by MALDI-TOF MS tools. Microorganisms screening was performed by qPCR and confirmed by sequencing. During the survey in the Niakhar region, only one household 1/255 (0.4%) in the village of Ngayokhem was found infested by bed bugs. In a monitoring survey of the surroundings of Dielmo and Ndiop area, high prevalence was found during the two rounds of surveys in 65/314 (21%) in 16/20 villages (January-March) and 93/351 (26%) in 19/20 villages (December). All bed bugs were morphologically identified as the species Cimex hemipterus, of which 285/1,637 (17%) were randomly selected for MALDI-TOF MS analysis and bacteria screening. Among the Bacteria tested only Wolbachia (Alphaproteobacteria, Rickettsiales, Rickettsiaceae) DNA was found in 248/276 (90%) of the bedbugs. We briefly describe a high level of non-generalized bed bug infestation in rural Senegal and the diversity of Wolbachia strains carried by C. hemipterus. This study opens perspectives for raising household awareness of bed bug infestations and possibilities for appropriate control.

Journal ArticleDOI
TL;DR: In this article , the effective dose of intrathecal chloroprocaine for 90% of patients undergoing prophylactic cervical cerclage placement was determined for a prospective 2-center double-blinded study.
Abstract: Chloroprocaine is a short-acting local anesthetic that has been used for spinal anesthesia in outpatient surgery. There is limited experience with spinal chloroprocaine for prophylactic cervical cerclage placement. We sought to determine the effective dose of intrathecal chloroprocaine for 90% of patients (ED90) undergoing prophylactic cervical cerclage placement. We hypothesized that the ED90 of intrathecal chloroprocaine when combined with 10-ug fentanyl would be between 33 and 54 mg.In this prospective 2-center double-blinded study, we enrolled women undergoing prophylactic cervical cerclage placement under combined spinal-epidural anesthesia. A predetermined dose of intrathecal 3% chloroprocaine with fentanyl 10 ug was administered. The initial dose was 45-mg intrathecal chloroprocaine. Subsequent dose adjustments were determined based on the response of the previous subject using an up-down sequential allocation with a biased-coin design. A dose was considered effective if at least a T12 block was achieved, and there was no requirement for epidural activation or intraoperative analgesic supplementation during the procedure. The primary outcome was the ED90 of intrathecal chloroprocaine with fentanyl 10 ug. Secondary outcomes included duration of surgery, anesthetic side effects, time to resolution of motor and sensory block, time to achieve recovery room discharge criteria, and patient satisfaction with anesthetic care. Isotonic regression was used to estimate the ED90.Forty-seven patients were enrolled into the study. Two patients were excluded (1 protocol violation and 1 failed block). In total, 45 patients completed the study. The estimated ED90 (95% confidence interval) for intrathecal chloroprocaine combined with fentanyl 10 ug was 49.5 mg (45.0-50.1 mg). The median (interquartile range [IQR]) duration of surgery was 15 (10-24) minutes. Resolution of the motor (Bromage 0) and sensory block took a median time of 60 (45-90) minutes and 90 (75-105) minutes, respectively. The median time to achieve recovery room discharge criteria was 150 (139-186) minutes. Satisfaction with anesthetic management was high in all patients. There were no reports of postdural puncture headache or transient neurological symptoms postoperatively.The ED90 of intrathecal chloroprocaine combined with fentanyl 10 ug was 49.5 mg. Intrathecal chloroprocaine was associated with rapid block recovery and high patient satisfaction, which makes it well suited for outpatient obstetric procedures.

Journal ArticleDOI
TL;DR: In this article, the authors used multinomial logistic regression to examine the associations of diabetes and body mass index (BMI), and diabesity, in 2012, with cognitive impairment and mortality in 2018, among participants aged ≥60 years with normal cognition at baseline (n = 7,885).