The predictive value of the heart rate variability-derived Analgesia Nociception Index in children anaesthetized with sevoflurane: An observational pilot study.

BACKGROUND: The heart rate variability (HRV)-derived Analgesia Nociception Index (ANI™) is a continuous noninvasive tool to assess the nociception/antinociception balance in unconscious patients. It has been shown to be superior to haemodynamic variables in detecting insufficient antinociception in children, while little is known about its predictive value. METHODS: The primary objective of this prospective observational pilot study in paediatric surgical patients under sevoflurane anaesthesia was to compare the predictive value of the ANI and heart rate to help decide to give additional opioids. The paediatric anaesthesiologist in charge was blinded to ANI values. RESULTS: In patients with an ANI value <50 (indicating insufficient antinociception) at the moment of decision, ANI values dropped from ±55 (indicating sufficient antinociception) to ±35, starting 60 s before decision. Within 120 s after administration of fentanyl (1 µg/kg), ANI values returned to ±60. This phenomenon was only observed in the ANI values derived from HRV data averaged over 2 min. Heart rate remained unchanged. In patients with ANI values ≥50 at the time of decision, opioid administration had no effect on ANI or heart rate. The same accounts for morphine for postoperative analgesia and fentanyl in case of intraoperative movement. CONCLUSIONS: This study provides evidence of a better predictive value of the ANI in detecting insufficient antinociception in paediatric surgical patients than heart rate. The same accounts for depicting re-establishment of sufficient antinociception after opioid drug administration. SIGNIFICANCE: In paediatric surgical patients anaesthetized with sevoflurane, the heart rate variability-derived Analgesia Nociception Index (ANI) appears to be a better predictor of insufficient antinociception than heart rate. The ANI also appears to depict re-establishment of sufficient antinociception better than heart rate.

Cut-off values to rule out urinary tract infection should be gender-specific.

The diagnosis of urinary tract infection (UTI) by urine culture is an expensive and time-consuming procedure. Using a screening method, to identify negative samples, would improve the procedure and reduce costs. In this study, urine flow cytometry, of over 7000 urine samples, was assessed by retrospective analysis. With a cut-off value of >200bacteria/µl, we obtained a sensitivity of 93.0%, a specificity of 63.5%, and a negative predictive value (NPV) of 96.2%. As a result the culturing of 49% of all samples could be avoided. In addition, the data was retrospectively analyzed to determine if the introduction of gender-specific cut-off values could improve screening results. The obtained receiver operator curves are indeed significantly different when gender specific cut-offs were used. When a NPV of 95% is considered acceptable the unisex cut-off value of >200bacteria/µl can be used for women (NPV 94.9%), but the cut-off value for men could be raised to >400bacteria/µl without diminishing the NPV (NPV 95.0%).

Urine flow cytometry can rule out urinary tract infection, but cannot identify bacterial morphologies correctly.

The diagnosis of urinary tract infection (UTI) by urine culture is a time-consuming and costly procedure. Usage of a screening method, to identify negative samples, would therefore affect time-to-diagnosis and laboratory cost positively. Urine flow cytometers are able to identify particles in urine. Together with the introduction of a cut-off value, which determines if a urine sample is subsequently cultured or not, the number of cultures can be reduced, while maintaining a low level of false negatives and a high negative predictive value. Recently, Sysmex developed additional software for their urine flow cytometers. Besides measuring the number of bacteria present in urine, information is given on bacterial morphology, which may guide the physician in the choice of antibiotic. In this study, we evaluated this software update. The UF1000i classifies bacteria into two categories: 'rods' and 'cocci/mixed'. Compared to the actual morphology of the bacterial pathogen found, the 'rods' category scores reasonably well with 91% chance of classifying rod-shaped bacteria correctly. The 'cocci/mixed' category underperforms, with only 29% of spherical-shaped bacteria (cocci) classified as such. In its current version, the bacterial morphology software does not classify bacteria, according to their morphology, well enough to be of clinical use in this study population.

Spermatozoa as a transport system of large unilamellar lipid vesicles into the oocyte.

In addition to their role as man-made membranes, vesicles continue to be investigated as carriers for drug delivery. While most research focuses on their injectable properties, here a new delivery strategy is proposed. It is shown that spermatozoa can transport vesicles of variable composition. For human spermatozoa, the vesicles started to show binding after 20 mol% of the nonbinding vesicle backbone lipids were substituted with positive, negative, cerebroside or ganglioside lipids. Vesicle binding is a dynamic process with constant 'on' and 'off' binding. The physiological and motility attributes of the spermatozoa are not affected by the attached vesicles. Sperm swimming characteristics changed only marginally. Also, the activation status of the acrosomal membrane, tested with the fluorescent probe Pisum sativum agglutinin, was not affected by vesicle binding. Moreover, the hyaluronic acid-binding test showed that viable, fully developed spermatozoa will attach and remain bound to hyaluronic acid-coated slides regardless of vesicle binding. Therefore a new 'hybrid' delivery system was created with human spermatozoa, and tested with a mouse IVF system. Large unilamellar vesicles physisorbed to mouse spermatozoa can not only penetrate the mouse oocytes in these proof-of-principle experiments, but also deliver the cargo placed within the vesicles.

The novel HLA-A*24:215 allele, identified by sequencing-based typing of a stem cell transplant patient and the sibling donor.

We identified a new human leukocyte antigen-A allele, designated HLA-A*24:215, by sequencing-based typing of a stem cell transplant patient.

Temporal characteristics of appetitive stimulus effects of luteinizing hormone-releasing hormone in male rats.

Conditioned place preference, induced by intraperitoneal injections of 5 micrograms/kg luteinizing hormone-releasing hormone (LHRH), was studied by varying the interval between the injection of LHRH and the conditioning sessions. Place preference was investigated for five presession intervals (0, 15, 45, 75, and 120 min) in separate groups of gonadectomized male rats provided with a subcutaneous testosterone implant. It was shown that the presession interval is an important parameter in the development of LHRH-induced conditioned place preference. Place preference was not observed after conditioning with intervals of 0, 75, and 120 min. With 15 and 45 min, however, a reliable preference was induced by LHRH. This study provides insight into the onset and offset of the appetitive stimulus properties of LHRH in male rats.

Luteinizing hormone releasing hormone-induced conditioned place-preference in male rats.

Conditioned place-preference induced by intraperitoneal injections of luteinizing hormone releasing hormone (LHRH) was studied in male rats. In Experiment 1, dose-dependent effects (doses: 0, 0.2, 1 and 5 micrograms/kg) were observed in gonadectomized males provided with a subcutaneous silastic implant containing testosterone. Animals injected with 1 or 5 micrograms LHRH developed reliable preference for the LHRH-associated compartment of a two-compartment preference box. The 0 and 0.2 microgram doses were without effect. Experiment 2 further studied the place-preference effects induced by 5 micrograms LHRH, by varying the sex steroid baseline condition of the animals. A significant effect of LHRH on place-preference was found in gonadectomized males with a testosterone or estradiol implant and in gonadally intact males. Differences between these groups were not found. However, in gonadectomized males without steroid substitution, LHRH did not induce place-preference. These data indicate that rewarding properties related to LHRH treatment can be observed in male rats, provided that the males are additionally exposed to sufficient levels of circulating sex steroids.