Crowleylinnet5488

05) group. CONCLUSION Experienced clinicians can make much more accurate prediction on length of stay and the prognosis of the emergency patients so crowded follow-up areas of the emergency room can be planned much more effectively. PURPOSE The objective of this study was to evaluate whether sedation with ketamine without local anesthesia was sufficient in children undergoing primary repair. METHODS Randomized, double-blind trial conducted between December 2013 and October 2016 in a tertiary care pediatric emergency department in Korea. Children aged 1 to 10 years requiring sedation for primary repair were randomly assigned to receive local lidocaine anesthesia with ketamine sedation or local saline injection with ketamine sedation. Children's Hospital of Eastern Ontario Pain Scale scores was recorded during the procedures. The pain scales were recorded by nurses who were blinded to the study drugs, before ketamine sedation, after sedation, during the first injection of the study drugs for wound repair, during the first stitch, and after the procedure. RESULTS Twenty-five were randomized to receive ketamine sedation with local anesthesia and twenty-two to receive ketamine sedation without local anesthesia. There was no significant difference in pain scale before ketamine sedation (difference (mean) -1.11, CI -2.78-0.55, P value 0.18), after sedation (difference (mean) -0.60, CI -2.20-1.01, P = 0.46), during the first injection of the study drugs for wound repair (difference (mean) -0.03, CI -0.31-0.25, P = 0.84), during the first stitch (difference (mean) -0.15, CI 6.19-6.79, P = 0.62), during the primary repair (difference (mean) 0.20, CI -55-0.95, P = 0.59), and after the procedure (difference (mean) 0.17, CI -0.48-0.82, P = 0.59). CONCLUSION Sedating with ketamine for primary wound repair, there was no difference in pain and sedation scales between the patients treated with or without lidocaine local anesthesia, and local anesthesia was not needed. New functionalized acrylamide derivatives bearing sulfisoxazole moiety were designed to target bacterial dihydropteroate synthase (DHPS). The in vitro antimicrobial activities of these compounds were assessed. The E-configuration of compound 5b was proved by single crystal X-ray analysis. Compounds 5g and 5h displayed double the activity of ampicillin against B. subtilis. Also, 5h was two times more active than gentamycin against E. coli. Interestingly, compounds 5f-g, 7c, 8a, 8c exhibited two folds the potency of amphotericin B against S. racemosum while 5h displayed three folds the activity of amphotericin B against S. racemosum. Most of the synthesized compounds showed superior activities to the parent sulfisoxazole and were non-toxic to normal cells. DHPS is confirmed to be a putative target for our compounds via antagonizing their antibacterial activity by the folate precursor (p-aminobenzoic acid) and product (methionine) on E. coli ATCC 25922. Docking experiments against DHPS rationalized the observed antibacterial activity. Additionally, compound 5g was evaluated as a selective targeting vector for 99mTc that showed a remarkable uptake and targeting ability towards the infection site that was induced in mice. PURPOSE To investigate the effect of progressive muscle relaxation (PMR) exercise on pain and vital signs in patients undergoing open renal surgery. DESIGN Nonrandomized evaluation with intervention (n = 31) and control (n = 30) groups. METHODS In the intervention group, PMR exercise was performed twice daily on postoperative days 0, 1, 2, and 3. Pain severity and vital signs were evaluated 15 minutes after each exercise application. FINDINGS The study detected significant differences in the mean visual analog scale pain severity values in the intervention group, who received PMR exercise between 0 and 3 days. The repeated measurements 15 minutes after PMR exercise exhibited a statistically significant (P less then .05) decrease in systolic blood pressure values as well as heart and respiratory rates. CONCLUSIONS It was determined that PMR decreased the mean postoperative visual analog scale pain scores and vital signs in patients of the intervention group compared with the control group. PURPOSE The purpose of this study was to discuss the merits of using depth-sensing infrared camera technology in the brachytherapy operating room during interstitial brachytherapy for gynecologic malignancies. MATERIALS AND METHODS The infrared depth-sensing camera from a Microsoft Kinect that had been adapted for surgical use was introduced into a high-volume interstitial brachytherapy operating room. Brachytherapists then used the touchless, gestural interface to review preoperative MRI in real time to guide needle insertion. RESULTS The interface was used for 10 consecutive procedures by 4 separate brachytherapists. The initial training and adjustment to the technology was variable among brachytherapists. All brachytherapists found the controls intuitive and were able to successfully navigate MRI on the system after 1, 30, 30, and 45 min. Qualitatively, brachytherapists found the system helpful for interpretation of intraoperative ultrasound imaging. Furthermore, it ensured adequate needle positioning and deposition was maintained for large tumors. Surgeons involved in its use agreed on potential for considerable benefit when performing interstitial brachytherapy. CONCLUSIONS Adapting this technology for use in the brachytherapy suite provided a higher level of comfort with interstitial catheter placement. This novel tool or similar technology might be considered within other brachytherapy suites. RESEARCH QUESTION Are selected cell adhesion molecules useful as urinary biomarkers for diagnosing endometriosis? DESIGN Prospective, longitudinal study (the Endometriosis Marker Austria) in patients who underwent laparoscopic surgery for benign gynaecological pathologies. A total of 149 patients not receiving hormonal treatment for at least 3 months prior to recruitment were included and preoperative urine protein levels of soluble vascular adhesion molecule-1 (sVCAM-1), soluble intracellular adhesion molecule-1 (sICAM-1), E-selectin and P-selectin were measured using a magnetic bead-based multiplex assay, normalized to creatinine levels of each sample. Levels were correlated with endometriosis status, menstrual cycle phase, body mass index, cigarette smoking and severity and entity of the lesions. RESULTS Urine levels of sVCAM-1, sICAM-1, E-selectin and P-selectin did not differ between women with (n = 84) and without (n = 65) endometriosis and among subgroups. Accordingly, receiver operating characteristic analysis to examine the value of using sVCAM-1, sICAM-1, E-selectin and P-selectin levels and sVCAM/sICAM ratio to diagnose endometriosis were not significant. Whether the serum sVCAM-1 levels correlated with the urine levels of the protein in the same women was also investigated, which revealed no significant correlations for sVCAM or sICAM. CONCLUSION Although a previous study had suggested that serum sVCAM is a promising biomarker for diagnosing endometriosis, no significant differences were found in urine levels of sVCAM-1, sICAM-1, E-selectin and P-selectin between women with and without endometriosis. Other markers should be studied in an effort to establish a truly non-invasive urinary test for diagnosing endometriosis. RESEARCH QUESTION Does Embryogen®/BlastGen™ culture medium improve live birth rates compared with standard culture medium for women undergoing IVF and intracytoplasmic sperm injection (ICSI) with poor prognosis. DESIGN Randomized clinical trial. A total of 100 couples undergoing IVF/ICSI were randomly allocated to having their inseminated oocytes incubated in either Embryogen®/BlastGen™ sequential culture media or standard Cleavage/Blastocyst sequential culture media for 5 days (ClinicalTrials.gov Identifier NCT02305420). RESULTS No statistically significant difference in live birth rate was found between the control group and the Embryogen®/BlastGen™ group (17 [34%] versus 11 [22%], respectively) (OR 0.55; 95% CI 0.22 to 1.32; P = 0.18). After adjustment for maternal age, body mass index and fertilization procedure, the blastulation rate reduced (40.6 ± 26.5 versus 24.6 ± 26.7; RR 0.70, CI 0.52 to 0.95; P less then 0.05), and grade of the embryo transferred (OR 0.35, CI 0.16 to 0.77; P less then 0.01) when Embryogen®/BlastGen™ medium was used. CONCLUSION A significant reduction in day-5 embryo outcome parameters was found using Embryogen®/BlastGen™ compared with standard medium, and insufficient evidence of a difference in pregnancy outcomes. Taking into consideration the small samples size, study limitations and strict inclusion criteria of this single-centre study, further research is needed to determine the efficacy of Embryogen®/BlastGen™ medium in couples undergoing IVF/ICSI. BACKGROUND In the context of co-morbid illness and increasing age, data on excess morbidity from pertussis in older adults is crucial for immunisation policy but has been largely limited to case-series. METHODS We designed a matched case-control study nested within a population-based cohort of 267,153 adults aged ≥45 years in New South Wales, Australia (The 45 and Up Study cohort). Excess hospital bed days, emergency department (ED) admissions, general practitioner (GP) visits, and prescriptions were estimated using negative binomial regression models. An additional self-controlled analysis was also conducted to validate the main models, and to evaluate results for those with either asthma or a body mass index (BMI)≥30 compared to those without these risk factors. RESULTS Based on 524 pairs of PCR-confirmed pertussis cases and matched controls, we estimated an excess healthcare utilisation per case of 2.5 prescriptions (95% CI 0.2-4.7), of which 1.1 (95% CI 0.5-2.2) were antibiotics, 2.3 GP visits (95% CI 2.0-2.6), and 0.1 ED admissions (95% CI 0.1-0.2). Compared to those 45-64 years, cases ≥65 years had a significantly greater excess for all prescriptions (1.1 vs 4.7/case), antibiotic prescriptions (0.1 vs 2.2/case), and ED admissions (0.1 vs 0.2/case), but no significant excess of respiratory-related hospital bed days. An additional self-controlled analysis confirmed that cases with either asthma or BMI≥30 had higher overall healthcare utilisation but this was not associated with pertussis infection. Metabolism inhibitor CONCLUSION We found a substantial excess outpatient healthcare burden among adults aged 65 years and over with PCR-confirmed pertussis, supporting further evaluation of preventive measures. BACKGROUND Recent data suggest that routine drainage is unnecessary in patients undergoing hepatectomy, but many surgeons continue to utilize drains. We compared the outcomes of patients undergoing early versus routine drain removal after hepatectomy. METHODS Patients having drains placed during major (≥3 segments) or partial hepatectomy (≤2 segments) were identified in the 2014-16 ACS-NSQIP database. Propensity matching between early (POD 0-3) and routine (POD 4-7) drain removal and multivariable regressions were performed. RESULTS Early drain removal was performed in 661 (40%) of patients undergoing a partial hepatectomy and 211 (22%) of major hepatectomy patients. After matching, 719 early and 719 routine drain removal patients were compared. Early drain removal patients had lower overall (12 vs 19%, p  less then  0.001) and serious (9 vs 13%, p  less then  0.03) morbidity as well as fewer bile leaks (2.1% vs 5.0%, p  less then  0.003). Length of stay was two days shorter (4 vs 6 days, p  less then  0.01) and readmissions were less frequent (5.