Randomized Controlled Trial of Enhanced Recovery After Surgery Protocols in Live Kidney Donors: ERASKT Study.

Background: Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function. Methods: In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis plane block. Our primary outcome measure was postoperative opioid consumption. The secondary outcome measures were postoperative pain scores, first oral intake, and hospital length of stay. Results: There were no significant differences in demographics between the 2 groups. The ERAS group had a statistically significant reduction in total postoperative opioid consumption calculated in intravenous morphine equivalents (24.2 ±â€…20.2 versus 71 ±â€…39.5 mg, P < 0.01). Postoperative pain scores were significantly lower (P < 0.001) from 1 h postoperatively to 48 h. Surgical time was 45 min shorter (P = 0.037). Intraoperative PlasmaLyte administration was lower (PlasmaLyte: 1444 ±â€…907 versus 2168 ±â€…1347 mL, P = 0.049). Time to tolerating regular diet was shorter by 2 h (P < 0.008), and length of hospital stay was decreased by 10.1 h. Conclusions: The ERAS group experienced superior postoperative analgesia and a shorter length of hospital stay compared with controls.

Brave new E-world: Medical students' preferences for and usage of electronic learning resources during two different phases of their education.

E-learning strategies have become an important part of biomedical education. However, why and how medical students select hardware tools and software formats during their preclinical education has not been sufficiently evaluated. These aspects should be considered when designing or offering new e-learning modalities to learners. Two medical school classes at a major US medical school were surveyed about their use of e-learning resources during their first year of medical school or their preparation for their first licensing examination (USMLE® Step 1), respectively. Their responses were analyzed for patterns and significant changes. Students' answers indicated that computers and tablets were considered the most important hardware devices to support students' learning. During the first year, students often preferred resources that were tailored to the specific courses in their curriculum. In contrast, some preferences changed when students prepared for the USMLE Step 1, with students shifting almost exclusively to a solitary learning strategy using commercial e-learning resources. Across all phases of medical school education queried, peer advice was the major determinant influencing e-learning resource selection with faculty only playing a minor role. Videos were the most popular e-learning modality, and students cited efficient acquisition of knowledge and preparation for examinations as major reasons for e-learning tool utilization. These factors should be considered when offering e-learning resources to medical students during different phases of their preclinical training.

Rhabdias elegans (Nematoda: Rhabdiasidae) in the toad, Rhinella arenarum (Hensel, 1867) from Argentina.

This study describes the morphology of Rhabdias elegans Gutierrez, 1945, isolated from the lungs of the toad Rhinella arenarum (Hensel, 1867) from Lomas de Tafi Tucumán, Argentina. This is the first record of R. elegans in R. arenarum from northwestern Argentina as previously described Rhabdias truncata is a species inquirendae. The distribution of R. elegans is extended since it was previously recorded in Buenos Aires, Chaco and Corrientes Provinces, Argentina. Our light microscopical study of morphological details of R. elegans revealed a few previously unreported structures in the apical region including position of the excretory pore and lateral sessile papillae in the tail. In addition, morphometric variability was observed on comparing present specimens and those described in previous studies. Our study made it possible to validate the occurrence of three Rhabdias species occurring in Argentina: R. elegans, R. füelleborni and R. cf. sphaerocephala. The information presented in this study represents an important contribution to the parasitological knowledge of R. arenarum from northwestern Argentina.

Redescription of Hedruris mucronifer (Nematoda: Hedruridae) parasite of Telmatobius schreiteri (Anura, Telmatobiidae) from Tucumán, Argentina.

The species Hedruris mucronifer Schuurmans Stekhoven, 1952 parasite of Telmatobius schreiteri from Tafí del Valle, Tucumán, Argentina is herein redescribed. The main morphological characters used for its identification are illustrated. The lectotype and paralectotype are designated, respectively. The specific epithet of the host is rectified.

Endoparasites in Limnonectes magnus (Anura, Dicroglossidae) from Samar Island, Philippines with description of a new species of Aplectana (Nematoda, Cosmocercidae).

Aplectana samarensis sp. nov. (Ascaridida, Cosmocercidae) from the intestines of Limnonectes magnus (Anura, Dicroglossidae) is described and illustrated. Aplectana samarensis sp. nov. represents the 53rd species assigned to the genus and the 6th species reported from the Oriental region. It is easily separated from the 5 species previously reported from the region by the presence of a gubernaculum and the distribution pattern of male caudal papillae: A. macintoshii has an irregular pattern, no precloacal papillae in rows; both A. akhrami and A. dubrajpuri lack a gubernaculum; A. duttaphryni has 3 pairs of precloacal papillae forming 2 rows; A. ranae has 7 pairs of precloacal papillae forming 2 rows; A. samarensis sp. nov. has 4 pairs of precloacal papillae in 2 rows. In addition to the new species, individuals of Falcaustra dubia and Pseudoacanthocephalus bufonis as well as cestode plerocercoids were also found.

A new species of Aplectana (Nematoda, Cosmocercidae) in Goniurosaurus bawanglingensis (Squamata, Eublepharidae), from Hainan Province, China.

Aplectana hainanensis sp. nov. (Ascaridida, Cosmocercidae) from the intestines of Goniurosaurus bawanglingensis (Squamata, Eublepharidae) is described and illustrated. Aplectana hainanensis sp. nov. represents the 52nd species assigned to the genus and the 5th species reported from the Sino-Japanese region. It is easily separated from the 4 species previously reported from the region by the distribution pattern of male caudal papillae: A. macintoshii has an irregular pattern; A. hylae has no precloacal papillae; A. fujianae has 1 pair of precloacal papillae; A paucipapillosa has 3 pairs of precloacal papillae; Aplectana hainanensis sp. nov. has 7 pairs of precloacal papillae.

A new species of Spauligodon (Nematoda; Oxyuroidea; Pharyngodonidae) and other Nematodes in Cyrtodactylus epiroticus (Squamata; Gekkonidae) from Papua New Guinea.

Spauligodon papuensis sp. nov. from the large intestines of Cyrtodactylus epiroticus (Gekkonidae) from Papua New Guinea is described and illustrated. Spauligodon papuensis sp. nov. represents the 54th species assigned to the genus and the second species from the Oceanic Region. The new species is separated from congeners by the unique combination of aspinose filamentous tail and no spicule in the male; and spinose filamentous tail, fusiform, flanged eggs, and postbulbar vulva in the female. Four additional species of nematodes were also found in C. epiroticus: mature specimens of Cosmocerca zugi, Falcaustra papuensis, Physalopteroides milnensis and larvae of Abbreviata sp.

Spinicauda sumatrana sp. nov. (Nematoda: Heterakidae) from Ludeking's Crested Dragon, Lophocalotes ludekingi (Agamidae), from the Bukit Barisan Range of Sumatra.

Spinicauda sumatrana sp. nov. is described from the large intestine of Ludeking's Crested Dragon, Lophocalotes ludekingi (Agamidae) from the Bukit Barisan Range of Sumatra. The new species is assigned to Spinicauda based on the presence of off-set lips in both male and female and a ventrally directed sucker combined with the absence of caudal alae in males. It is the 17th species assigned to the genus and differs from all congeners in the combination of spicule length, presence of a gubernaculum, presence of a tail filament and fourteen pairs of caudal papillae.

Daily alcohol consumption and sickness absence in the GAZEL cohort.

Background: : Previous studies that examined the association between daily alcohol consumption and sickness absences (SA) were mostly retrospective and did not take into account the characteristics of SA. : A total of 9907 daily drinkers (8442 men and 1465 women) of the GAZEL prospective cohort were included. Daily alcohol consumption over the three previous years was self-reported at baseline and categorized as low, moderate, high or very high risk according to the World Health Organization. Duration of SA (short: ≤7 days; moderate: 8-28; long: >28) was collected from administrative records as well as causes for long SA. Negative binomial regression models were used to estimate Risk Ratios of SA according to alcohol consumption with low-risk category as reference. : Duration of follow-up (in years) for SA was 8.4 ± 3.7 in men and 11.2 ± 5.4 in women. Increasing alcohol consumption predicted increasing risk of SA with a dose-response relationship ( P < 0.01 for men; P = 0.01 for women). In men, strength of this association increased with SA duration [e.g. RRs from 1.41 (95% CI: 1.12-1.79) to 2.12 (95% CI: 1.49-3.00) in the very high-risk category, for short and long SA, respectively]. In men, even a moderate consumption predicted increased risk of SA whatever their duration (RR = 1.15; 95% CI: 1.07-1.23). In women, a moderate consumption predicted only long SA (RR = 1.22; 95% CI: 1.00-1.50). Daily alcohol consumption was associated with almost all causes of long SA in men, and with respiratory diseases, digestive diseases and injury in women. : We found a dose-response relationship between daily alcohol consumption and the risk of SA. Even moderate consumption could increase this risk, particularly in men.

Thubunaea eleodori sp. nov. (Nematoda: Physalopteridae) from Liolaemus eleodori (Sauria: Liolaemidae) from Argentina.

Thubunaea eleodori sp. nov. is described from the stomach of Liolaemus eleodori (Sauria: Liolaemidae) from San Guillermo National Park, Province of San Juan, Argentina. T. eleodori is most similar to those species lacking spicules, T. cnemidophorus, T. fitsimonsi, T. parkeri, T. schukurovi, and T. smogorzhewskii. T. eleodori is separated from these species based on the papilla pattern. T. eleodori has 12 pedunculate papillae and 14 sessile papillae, T. smogorzhewskii lacks pedunculate papillae, T. fitsimonsi and T. parkeri lack sessile papillae, and T. cnemidophorus has14-16 pedunculate papillae and 12 sessile papillae. T. eleodori represents the first member of the genus to be reported from Argentina.

Adverse Drug Effects and Preoperative Medication Factors Related to Perioperative Low-Dose Ketamine Infusions.

High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions and which ADEs most frequently led to discontinuation. Spine surgery was chosen because of its association with moderate to severe pain and a relatively high use of ketamine infusions in this population at our hospital.

A new species of Spauligodon (Nematoda; Oxyuroidea; Pharyngodonide) and other Helminths in Ptychozoon Kuhli (Squamata: Gekkonidae) from East Malaysia.

Spauligodon geckonis sp. nov. from the intestines of Ptychozoon kuhli (Gekkonidae) from East Malaysia is described and illustrated. Spauligodon geckonis sp. nov. represents the 52nd species assigned to the genus and the third species from the Oriental Region. The new species is separated from congeners by the unique combination of aspinose filamentous tail and spicule in the male and spinose filamentous tail and fusiform, two knobbed eggs in the female. Gravid individuals 3 species of Nematoda, Meteterakis singaporensis, Physalopteroides grismeri, and Skrjabinelazia machidai, as well as larvae assignable to the Ascaridae were also found.

More than Light Alcohol Consumption Predicts Early Cessation from Employment in French Middle-Aged Men.

AIMS: To investigate the association between alcohol consumption and different causes of work cessation and estimate the loss of occupational activity among high consumers compared with low consumers. METHODS: From the prospective study of men employed in the French gas and electric company, 8442 men during a median follow-up of 8.4 years reported on their alcohol consumption. Information on work cessation was collected from the company administrative records. Hazard Ratios (HRs) by cause of work cessation (death, disability, retirement before or after age 55) were estimated using a competing risk method. RESULTS: An increasing quantity of daily alcohol consumption was associated with an increased risk of death, disability and retirement before age 55 (P trend ≤ 0.01, = 0.03 and ≤ 0.01, respectively), but not of retirement after age 55 (P trend = 0.56). Moreover, compared with low consumption, moderate, high or very high daily intakes were associated with an increased risk of early work cessation (combination of the three causes: death, disability and retirement before age 55) (HR = 1.14, 95% confidence interval (CI) = 1.05-1.25; HR = 1.23, 95% CI = 1.12-1.35 and HR = 1.49, 95% CI = 1.15-1.92 respectively). Between ages 50 and 60, we estimated that high or very high consumers could gain 6.04 months of occupational activity if they drank like low consumers. CONCLUSIONS: Our results provide evidence of a dose-effect relationship between alcohol consumption and early work cessation.

New species of Cosmocercoides (Nematoda; Cosmocercidae) and other helminths in Gonocephalus liogaster (Squamata; Agamidae) from Peninsular Malaysia.

Cosmocercoides malayensis sp. nov. (Nematoda, Cosmocercidae) from the large intestine of Gonocephalus liogaster (Squamata, Agamidae) from Peninsular Malaysia is described and illustrated. Cosmocercoides malayensis sp. nov. represents the 23rd species assigned to the genus and the 10th species from the Oriental biogeographical region. Cosmocercoides malayensis sp. nov. differs from the previously described Oriental species in number and position of rosette papillae; however, it is most similar to C. bufonis and C. rickae in that these 3 species have 6 post cloacal rosette papillae. Cosmocercoides bufonis possesses a prebulbar copular swelling, which is absent in C. malayensis; C. rickae posssesess somatic papillae, which are absent in C. malayensis. Three addtional nematode species were found, adult specimens of Meteterakis singaporensis and Orneoascaris sandoshami and larva of Physocephalus sp.

A new species of Cosmocerca (Nematoda: Cosmocercidae) and other helminths in Cyrtodactylus gubaot (Squamata: Gekkonidae) from the Philippines.

Cosmocerca leytensis sp. nov. (Ascaridida, Cosmocercidae) from the large intestine of Cyrtodactylus gubaot (Squamata: Gekkonidae) collected on Leyte Island, Philippines is described and illustrated. Cosmocerca leytensis sp. nov. is the 30th species assigned to the genus, the 4th from the Oriental region, and the first from the Philippine Islands. The new species is most similar to those species possessing 4 pairs of plectanes, i.e., C. archeyi, C. australis, C. oroensis, and C sardiniae. Cosmocerca sardiniae lacks lateral alae; C. archeyi, C. australis, C. leytensis sp. nov. and C. oroensis possess lateral alae. Spicule length of C. oroensis is less than 75 µm, while C. archeyi, C. australis, and C. leytensis sp. nov. have spicule lengths greater than 75 µm. Males of C. australis possess 2 pairs of rosette caudal papillae, which are lacking in C. archeyi and C. leytensis sp. nov. Females of C. archeyi posses a conical tail, females of C. leytensis sp. nov. have a rounded posterior end supporting a flexible filament.

Description of a New Species of Parapharyngodon (Nematoda: Pharyngodonidae) from Mexico with a List of Current Species and Key to Species from the Panamanian Region.

Parapharyngodon guerreroensis n. sp. (Nematoda: Pharyngodonidae) from the large intestine of Lepidophyma smithii from Mexico is described and illustrated. A list of nominal species and a key to species from the Panamanian region are provided. Parapharyngodon guerreroensis n. sp. is the 57th species assigned to the genus and the 10th from the Panamanian region. It differs from other species in the genus in that males possess 3 pairs of caudal papillae, an anterior cloacal lip supporting 4 digitiform processes, and a blunt spicule 67-104 µm in length, while females possess long flexible caudal appendages.

New species of Bakeria (Nematoda; Strongylida; Molineidae), new species of Falcaustra (Nematoda; Ascaridida; Kathlaniidae) and other helminths in Cnemaspis mcguirei (Sauria; Gekkonidae) from Peninsular Malaysia.

Two new nematode species, Bakeria schadi sp. nov. and Falcaustra malaysiaia sp. nov. from the gastrointestinal tract of McGuire's rock gecko, Cnemaspis mcguirei (Sauria: Gekkonidae) collected in Peninsular Malaysia are described. The two species now assigned to Bakeria are separated on the bases of male bursa type and location of the excretory pore: type II in B. schadi sp. nov. and type I in B. bakeri; location of excretory pore, anterior to nerve ring in B. schadi sp. nov. and posterior to nerve ring in B. bakeri. Falcaustra malaysiaia sp. nov. is most similar to F. chabaudi, F. concinnae, F. condorcanquii, F. barbi, F. dubia, and F. tchadi in that these 7 species possess 1 pseudosucker, 1 median papilla plus 10 pairs caudal papillae, and spicules with lengths between 1 and 2 mm. F. barbi and F. tchadi lack adcloacal papillae; the remaining 5 species possess 1 pair of adcloacal papillae. Falcaustra chabaudi is known from Nearctic salamanders; F. concinnae from Nearctic turtles; F. condorcanquii from Neotropical frogs, F. dubia from Oriental frogs, and F. malaysiaia sp. nov. from Oriental geckos. Two additional species of Nematoda were found, Cosmocerca ornata and Meteterakis singaporensis. Cnemaspis mcguirei represents a new host record for Cosmocerca ornata and Meteterakis singaporensis.