A multicentre, prospective, randomised, blinded clinical trial to compare some perioperative effects of buprenorphine or butorphanol premedication before equine elective general anaesthesia and surgery.

REASONS FOR PERFORMING STUDY: Buprenorphine, a µ-agonist opioid, has recently been licensed for equine use, but butorphanol, a κ-agonist opioid, is more commonly used in horses. The effect of the 2 opioids has not previously been compared in a large clinical study. OBJECTIVES: To compare post operative analgesia and physiological variables in horses undergoing elective surgery following premedication with either buprenorphine or butorphanol in a conventional clinical setting. STUDY DESIGN: Multicentre, prospective, randomised, blinded clinical investigation. METHODS: Eighty-nine healthy horses admitted for elective surgery to one of 6 UK equine veterinary clinics were premedicated with acepromazine, a nonsteroidal anti-inflammatory drug, and romifidine followed by intravenous (i.v.) buprenorphine or butorphanol. Anaesthesia was induced with diazepam/ketamine and maintained with isoflurane in oxygen. A range of surgical procedures were performed and supplementary anaesthetic agents given as required. Physiological variables were monitored during anaesthesia and pain, ataxia, sedation and vital function were assessed post operatively. Data were analysed using t-tests, ANOVA, Mann-Whitney U-test and Chi-squared test as appropriate and P<0.05 was regarded as significant, except for multiple comparisons, when P<0.01 was used. RESULTS: Surgery was carried out successfully in all cases and no mortality or serious morbidity occurred. Physiological variables remained within normal limits and all horses recovered successfully, most standing within 1 h of ceasing anaesthesia. There were no significant differences between groups in any variable except post operative pain when scores (simple descriptive scale) between 3 and 6 h were significantly lower after buprenorphine than after butorphanol. CONCLUSIONS: Horses experienced less post operative pain after buprenorphine than after butorphanol premedication. Compared with butorphanol, buprenorphine did not cause any different effects on vital function.

Postcastration analgesia in ponies using buprenorphine hydrochloride.

Buprenorphine has recently obtained UK Marketing Authorisation for horses. The analgesic effects are long lasting, and have considerable potential for postoperative pain relief. This observer blinded, randomised study aimed to evaluate postsurgical analgesia in ponies premedicated with buprenorphine prior to castration under intravenous anaesthesia. Ponies received either 0.01 mg/kg bodyweight (BW) buprenorphine (group B) or an equivalent volume of 5 per cent glucose (group C) given intravenously before induction of anaesthesia. Pain was assessed and recorded using dynamic interactive visual analogue scores (DIVAS 0-100) and a Simple Descriptive Scale (SDS 0-3) (high scores=most pain) before and 1, 3, 6, 9, 12 and 24 hours after anaesthesia. Rescue analgesia was given if DIVAS>40 mm. Data were analysed using the Mann-Whitney U test at P<0.05. Median (range) areas under the curve for DIVAS were 63 (0-383) mm hour in group B and 209 (0-391) mm hour in group C (P=0.0348). The SDS was lower in group B than in group C (P=0.038). Three group B and five group C animals required rescue analgesia. Buprenorphine did not produce any serious adverse effects. Buprenorphine at 0.01 mg/kg BW intravenously administered before anaesthesia provided near-comprehensive postoperative analgesia after surgical castration in ponies.

Effects of acepromazine, butorphanol and buprenorphine on thermal and mechanical nociceptive thresholds in horses.

REASONS FOR PERFORMING STUDY: To investigate the antinociceptive effects of buprenorphine administered in combination with acepromazine in horses and to establish an effective dose for use in a clinical environment. OBJECTIVES: To evaluate the responses to thermal and mechanical stimulation following administration of 3 doses of buprenorphine compared to positive (butorphanol) and negative (glucose) controls. METHODS: Observer blinded, randomised, crossover design using 6 Thoroughbred geldings (3-10 years, 500-560 kg). Thermal and mechanical nociceptive thresholds were measured 3 times at 15 min intervals. Horses then received acepromazine 0.05 mg/kg bwt with one of 5 treatments i.v.: 5% glucose (Glu), butorphanol 100 µg/kg bwt (But) buprenorphine 5 µg/kg bwt (Bup5), buprenorphine 7.5 µg/kg bwt (Bup7.5) and buprenorphine 10 µg/kg bwt (Bup10). Thresholds were measured 15, 30, 45, 60, 90, 120, 150, 180, 230 min, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 24 h post treatment administration. The 95% confidence intervals for threshold temperature (ΔT) for each horse were calculated and an antinociceptive effect defined as ΔT, which was higher than the upper limit of the confidence interval. Duration of thermal antinociception was analysed using a within-subjects ANOVA and peak mechanical thresholds with a general linear model with post hoc Tukey tests. Significance was set at P<0.05. RESULTS: Mean (± s.d.) durations of thermal antinociception following treatment administration were: Glu 0.5 (1.1), But 2.9 (2.0), Bup5 7.4 (2.3), Bup7.5 7.8 (2.7) and Bup10 9.4 (1.1) h. B5, B7.5 and B10 were significantly different from Glu and But. No serious adverse effects occurred, although determination of mechanical thresholds was confounded by locomotor stimulation. CONCLUSIONS: Administration of acepromazine and all doses of buprenorphine produced antinociception to a thermal stimulus for significantly longer than acepromazine and either butorphanol or glucose. POTENTIAL RELEVANCE: This study suggests that buprenorphine has considerable potential as an analgesic in horses and should be examined further under clinical conditions and by investigation of the pharmacokinetic/pharmacodynamic profile.

Assessment of the sedative effects of buprenorphine administered with 20 microg/kg detomidine in horses.

The aim of this randomised, observer-blinded, crossover study was to compare the effects of four treatments, administered intravenously to six horses: saline and saline; 10 µg/kg detomidine and 7.5 µg/kg buprenorphine; 20 µg/kg detomidine and 7.5 µg/kg buprenorphine; and 20 µg/kg detomidine and 10 µg/kg buprenorphine. Sedation was subjectively assessed and recorded on a visual analogue scale. Peak sedation and duration of sedation were investigated using a univariate general linear model with post-hoc Tukey tests (P<0.05). Increasing the dose of detomidine from 10 to 20 µg/kg increased the degree of sedation when administered with the same dose of buprenorphine (7.5 µg/kg). When administered with 20 µg/kg detomidine, increasing the dose of buprenorphine from 7.5 to 10 µg/kg did not influence the degree of sedation achieved.

Assessment of the sedative effects of buprenorphine administered with 10 µg/kg detomidine in horses.

The aim of this randomised, observer-blinded, crossover study was to compare the effects of six treatments, administered intravenously to six horses: saline and saline (S/S); detomidine and saline (D/S); detomidine and 5 µg/kg buprenorphine (D/B5); detomidine and 7.5 µg/kg buprenorphine (D/B7.5); detomidine and 10 µg/kg buprenorphine (D/B10); and detomidine and 25 µg/kg butorphanol (D/BUT). The detomidine dose was 10 µg/kg for all treatments in which it was included. Sedation was subjectively assessed and recorded on a visual analogue scale. Peak sedation, duration of sedation and the area under the curve (AUC) for sedation scores were investigated using a univariate general linear model with post-hoc Tukey tests (P<0.05). Peak sedation and duration of sedation were statistically significantly different between treatments (P<0.001). No sedation was apparent after administration of S/S. The AUC was significantly different between treatments (P=0.010), with S/S being significantly different from D/S, D/BUT, D/B5 and D/B7.5, but not D/B10 (P=0.051).

Analgesic effect of butorphanol in ponies following castration.

REASONS FOR PERFORMING STUDY: In the UK butorphanol has a marketing authorisation for administration to horses for sedation in combination with detomidine, and at a higher dose (0.1 mg/kg bwt), for the alleviation of pain. There is only a limited number of clinical studies designed to examine the analgesic effects of butorphanol administration following surgery. OBJECTIVE: To investigate the effect of premedication with butorphanol on post operative pain following castration under general anaesthesia in ponies. HYPOTHESIS: Ponies receiving butorphanol would experience less pain after castration than ponies that did not receive butorphanol. METHODS: A randomised, observer blinded clinical study in which 20 ponies received butorphanol and detomidine (Group B) or detomidine alone (Group C). Anaesthesia was induced with ketamine and diazepam and open castration performed. Pain was assessed by one individual using a dynamic interactive visual analogue scale (DIVAS) 100 mm in length (0 = no pain, 100 mm the maximum possible pain for that procedure). 'Rescue' analgesia was administered when DIVAS >50 mm and was butorphanol i.v. On the second occasion DIVAS was >50 mm, flunixin was administered i.v. Data from the DIVAS were analysed using a Mann Whitney Test. RESULTS: Only one animal did not require rescue analgesia after surgery (Group C). DIVAS were not significantly different between groups (P = 0.063). CONCLUSIONS AND POTENTIAL RELEVANCE: Castration is sufficiently painful that administration of a single preoperative dose of butorphanol does not provide adequate post operative analgesia.

Recovery characteristics following maintenance of anaesthesia with sevoflurane or isoflurane in dogs premedicated with acepromazine.

A standard anaesthetic protocol was used to anaesthetise 40 dogs for intravenous urography and a retrograde urethrogram or vaginourethrogram. The dogs were allocated by blocked randomisation to receive either isoflurane or sevoflurane for maintenance of anaesthesia after they had been premedicated with acepromazine and pethidine, and anaesthesia induced with propofol. An observer who was unaware of which agent had been used assessed ataxia 30 and 60 minutes after discontinuation of administration of the anaesthetic and assigned an overall recovery score. No complications occurred during anaesthesia of either group of dogs. The scores for ataxia were significantly lower after 60 minutes than after 30 minutes, but there was no significant difference between the groups. The quality of recovery was significantly better in the dogs that received sevoflurane than in those that received isoflurane, but the recovery times were similar.

[Predictive equations and analysis of influence factors of lung ventilation based on a large occupational population in North China].

OBJECTIVE: To establish suitable predictive equations of lung function for occupational population in North China. METHODS: A total of 5 002 on the job or retired healthy adults from five enterprises in North China with category of mild or moderate work intensity underwent spirometry using a Chest HI-198 spirometer and the procedures recommended by the American Thoracic Society, were a sample. RESULTS: The data of 3 913 subjects were used. A normal distribution of our data was shown using the normality test and distribution curve. Univariate analysis showed that both age and height were significantly correlated with FVC, FEV(1), FEV(1)/FVC (%) and MMF. Further multiple linear stepwise regression analysis indicated that the levels of FVC, FEV(1), FEV(1)/FVC (%) and MMF were highly influenced by age, height, and weight rather than chest circumference. Thus, only age, height, and weight were introduced into our regression equations. Data from the studied subjects and other source were utilised to examine the validity of the equations and a high accordance rate (> 90%) was obtained. No significant difference (P > 0.05) was found in the predictive values between the simplified equations and equations in which more variables were included. CONCLUSION: The studied predictive equations for male non-smokers, female non-smokers, and male smokers were established based on data from a large occupational population. These equations should be more applicable for evaluating lung ventilatory function of occupational populations in North China.

[Changes in bronchoalveolar lavage fluid of rats exposed to metal grinding dusts].

OBJECTIVE: To investigate the effects of composite grinding dusts on rat respiratory system. METHODS: Rats were administrated with grinding dusts by intratracheal injection. After 2 weeks, the total numbers of cells, the percentage of differential cell, the survival rate of cell, and the activity of lactate dehydrogenase(LDH) and alkaline phosphatase(ALP) in bronchoalveolar lavage fluid were analyzed. RESULTS: Along with increasing concentration of grinding dusts, the total number of cells in lavage also increased, and was more than that in quartz group. Compared with control group, the percentage of neutrophil in lavage of rats treated with grinding dust and quartz significantly increased and meanwhile that of macrophage significantly decreased[PMN: quartz group (33.83 +/- 4.54)%; grinding dusts group (26.50 +/- 3.99)%, (36.00 +/- 3.58)%, (38.00 +/- 2.10)% at 10, 25, 50 mg/ml respectively. Macrophages: quartz group (62.17 +/- 4.54)%; grinding dusts group (70.83 +/- 3.66)%, (60.83 +/- 2.14)%, (58.17 +/- 2.48)%] while those in control group were (2.83 +/- 0.75)%, (95.67 +/- 1.21)% respectively. The cell survival rate in lavage in control group was 80%, but that in grinding dust and TiO2 group significantly decreased(P < 0.01). The activity of LDH and ALP in all rats treated with dusts obviously increased, and there was significant difference compared with control group(P < 0.01 or P < 0.05). Furthermore, there was significant difference between grinding dust group and quartz group, and between grinding dust group and TiO2 group respectively. CONCLUSION: Metal grinding dust is very harmful to rat's lung cells and may cause fibrogenesis in the lungs.

Cardiopulmonary resuscitation performed in patients with terminal illness in Chiang Mai University Hospital, Thailand.

BACKGROUND: The original target of cardiopulmonary resuscitation (CPR) was victims of acute cardiopulmonary arrest. However, the use of CPR has expanded to a wide variety of patients including those with terminal illness for whom CPR is futile. The objective of this study was to identify the incidence of CPR performed, the severity of illness and the outcome of CPR attempted in terminal illness in a teaching hospital. METHODS: Cardiopulmonary resuscitation attempted in terminal illness was retrospectively assessed from the medical records of hospital deaths with any one of eight life-threatening diagnoses during a 3.5-year period. RESULTS: Of 532 hospital deaths from terminal illness, 411 records (77.3%) were reviewed and abstracted. Most of the 411 patients had a low pre-CPR functional status. Generally, CPR was performed in 270 (65.7%) cases; 114 of those given CPR (42.2%) initially survived, but all died shortly after the manoeuvre. The high death rate following CPR may reflect both terminal illnesses and the severity of pre-event functional capacity of patients. CONCLUSION: The criteria for CPR in this group of patients need to be re-assessed and use of a Cerebral Performance Categories (CPC) score may be helpful.

Prediabetes and perinatal mortality.

OBJECTIVE: The association between gestational diabetes mellitus (GDM) and perinatal outcome is largely based on case series and retrospective studies that found an increased risk of perinatal mortality and stillbirth as the onset of diabetes approached. Our objective was to assess the relationship between latency to diabetes and perinatal outcome of prediabetic pregnancies in a contemporary population of women with adult-onset diabetes. RESEARCH DESIGN AND METHODS: A population of 403 diabetic women from two recruitment sites completed a pretested questionnaire. RESULTS: Details of 1,181 pregnancy outcomes were obtained. This comprised 1,024 live births, 22 stillbirths, and 8 early neonatal deaths. Crude analysis suggested a relationship between time to diabetes (latency) < or =20 years and both perinatal death and stillbirth: odds ratio (95% CI), 2.41 (1.17-4.95) and 2.15 (0.93-4.98). Generalized additive modeling revealed a nonlinear relationship between the variables time to diabetes, and maternal age and perinatal outcome. Final logistic regression analysis was then performed for the outcomes perinatal death and stillbirth, with maternal age as a second-degree polynomial, year of birth as a continuous variable, and time to diabetes dichotomized < or =20 years to diagnosis and >20 years. This final analysis documented a significant association between time to diabetes < or =20 years and both perinatal death (4.06 [1.79-9.36]) and stillbirth (3.35 [1.25-9.05]). CONCLUSIONS: There appeared to be an increased risk of perinatal death and stillbirth in pregnancies occurring in the last 20 years before the diagnosis of diabetes.

Optimal timing of cleft palate closure.

Treatment objectives for the cleft palate patient--normal speech, normal maxillofacial growth, and normal hearing--are closely related. Controversy about the timing of cleft palate surgery is directed at the need for early palatoplasty for improved speech and hearing versus delayed hard palate repair for undisturbed facial growth. This controversy as to the value of early versus delayed closure continues into the present. The authors present an updated argument regarding this controversy along with a comprehensive literature review. They also present a logical algorithm based on the literature and their personal experience.

Mortality among involuntarily admitted psychiatric patients: a survival analysis.

BACKGROUND: Only a few studies have examined mortality among committed psychiatric patients, and most of them suffer methodologically from selected populations, small samples, and inappropriate methods of data analysis. The purpose of this study was to determine whether involuntarily admitted psychiatric inpatients are a high risk group for mortality compared to a group of voluntarily admitted psychiatric inpatients. METHOD: A retrospective cohort design was used with a maximum 9-year variable follow-up. A multistage sampling procedure was used to generate the sample, which consisted of 1064 involuntarily admitted patients and 1078 voluntarily admitted patients. RESULTS: During the follow-up period, 107 deaths were identified, 58 involuntary and 49 voluntary [chi 2 (1) = 0.9255, P = 0.336]. No significant differences were observed between the cohorts when survival analysis was used to examine survival experiences in the community. CONCLUSIONS: Compared to voluntary patients, involuntary patients do not appear to be at a higher risk for mortality. The high standard mortality ratios observed in both cohorts, however, are consistent with previous findings of high mortality among psychiatric patients in general, and support the need for intensive follow-up in the community following discharge from a psychiatric inpatient unit.

Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study.

This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.

Development, implementation, and validation of the Canadian Intercollegiate Sport Injury Registry.

PURPOSE: To outline the development and implementation of the Canadian Intercollegiate Sport Injury Registry (CISIR), to examine its validity, including the data collection forms, the recording of athlete exposure, and the mechanism of injury, and to determine the ability of the CISIR to meet its stated objectives of assessing rates and risk of injury. DESIGN: Prospective cohort study. SETTING: Canadian intercollegiate athletics. SUBJECTS: 344 varsity football players from five western Canadian universities. ASSESSMENT OF RISK FACTORS AND OUTCOME MEASURES: Three data collection instruments were developed to capture the principle types of information forming the cornerstones of the CISIR: a medical form for preseason assessment of risk factors, a weekly exposure sheet (WES) for the documentation of daily individual athlete participation, and an individual injury report form (IIRF) for collection of injury-related information. Design and implementation input was provided by therapists and physicians through initial meetings, pilot testing, site visits, questionnaire, and final consensus meeting. The completeness of injury reporting was assessed through cross-referencing with participation time loss data. An item analysis was conducted on the principal elements of the IIRF. The categorization of participation itself was also examined, as was the diagnostic agreement between the therapists and physicians involved in data collection. The recorded mechanism of injury was compared with that noted through a video analysis for game-related injuries. Lastly, a test analysis was conducted to extract data and compute rates and risks of injury. RESULTS: This developmental phase was successful, with 99.7% subject enrollment, high therapist satisfaction, and good flow of data. A relational database, incorporating dual-entry data verification, was designed and functioned well. The collection process revealed that 100% of the WESs were submitted, and the data therein was 99.7% complete. The injuries resulting in participation time loss were recorded on an IIRF 97.9% of the time. The exposure (participation) codes were thought to be overly precise, and a simplification of these categories is suggested. The diagnostic agreement between physicians and therapists was 70%. It was possible to validate game exposures, but no standard was identified to permit validation of the categories of exposure. Likewise, the mechanism of injury as recorded by the therapists was thought to be more precise than the video analysis. After two modifications in the table structure of the relational database, it was possible to extract data relating to rates and risks of injury. CONCLUSIONS: This study demonstrated a high degree of validity for many elements of the CISIR. One limitation was that no reference standard existed for some components, limiting some aspects of validity assessment. With the suggested revisions, the CISIR represents the current standard in athletic injury reporting in terms of individual injury risk assessment. This system will be used in the future to explore the prediction and prevention of sport injuries.

Association of semen quality and occupational factors: comparison of case-control analysis and analysis of continuous variables.

OBJECTIVE: To compare two statistical approaches, case-control and analysis of continuous parameters of semen, in examining the relationship between occupational exposures and male reproductive function. DESIGN: Case-control study. SETTING: Males providing semen samples at a university infertility clinic. PATIENT(S): Nonvasectomized males who provided at least one semen sample at an infertility clinic. MAIN OUTCOME MEASURE(S): Standard clinical semen analysis. RESULT(S): Analyses using a dichotomous dependent variable did not uncover significant associations between any occupational factor and infertility case status. However, linear models incorporating continuous variables identified a number of occupational factors that were associated with specific parameters of semen. A reduction in percentage of progressive sperm and an increase in percentage of coiled tail sperm defects in welders, compared with unexposed subjects, were found. Significant dose-response relationships between level of perceived job stress and percentage of progressive sperm, total motile count, morphology, abnormal heads, and coiled tail defects were found. CONCLUSION(S): The findings suggest that subtle changes in semen variables, possibly associated with workplace exposure, may be detected only with parametric analyses of continuous variables of semen.

[Sequencing and analysis of the NS5 region of HGV/GBV-C gene].

To study the genomic organization of non structural region 5 of HGV in China, 186 nucleotides of NS5 region of HGV were amplified, cloned and sequenced. The data were analyzed with computer programs. The results indicated that the gene sequence homology between 2 HGV isolates in this study was 95.2%. The comparison of these 2 isolates and 3 foreign isolates reported previously showed that the sequence homology was in the range of 84.4% to 92.4%, and was obvious by divergent from the foreign isolates. The results make us consider that HGV may have different genotypes, after a further inspection into the gene sequence of each region of HGV. The 2 isolates were from the sera collected in 1984, therefore the existence of HGV infection in Harbin was retrospectively traced to 1980s.

Athletic injury reporting. Development of universal systems.

There are numerous athletic injury reporting systems currently in place. In order for our understanding of athletic injury epidemiology to advance, we must be able to compare data from divergent sources. This paper provides a review of existing athletic injury reporting systems in North America. The epidemiological designs employed in these systems are outlined, along with a description of the strengths and weaknesses of each approach to reporting. The differences between the case-series and cohort methods are delineated and the importance of injury definition, sources of error, denominator data and exposure estimation are discussed within this context. Four recommendations are then offered to assist in moving toward more universal systems for athletic injury reporting. First, comparability of data between systems should be maximised through clear indication of the reporting system design and the methods of data collection. Secondly, an exact definition should be given as to what constitutes a reportable event ('injury'). Thirdly, whenever possible, outcome information should be collected on each reported event so that an injury definition may be applied at the time of data analysis. Lastly, any limitations or sources of error should be acknowledged.