Cabazitaxel versus abiraterone or enzalutamide in poor prognosis metastatic castration-resistant prostate cancer: a multicentre, randomised, open-label, phase II trial.

BACKGROUND: Treatment of poor prognosis metastatic castration-resistant prostate cancer (mCRPC) includes taxane chemotherapy and androgen receptor pathway inhibitors (ARPI). We sought to determine optimal treatment in this setting. PATIENTS AND METHODS: This multicentre, randomised, open-label, phase II trial recruited patients with ARPI-naive mCRPC and poor prognosis features (presence of liver metastases, progression to mCRPC after <12 months of androgen deprivation therapy, or ≥4 of 6 clinical criteria). Patients were randomly assigned 1 : 1 to receive cabazitaxel plus prednisone (group A) or physician's choice of enzalutamide or abiraterone plus prednisone (group B) at standard doses. Patients could cross over at progression. The primary endpoint was clinical benefit rate for first-line treatment (defined as prostate-specific antigen response ≥50%, radiographic response, or stable disease ≥12 weeks). RESULTS: Ninety-five patients were accrued (median follow-up 21.9 months). First-line clinical benefit rate was greater in group A versus group B (80% versus 62%, P = 0.039). Overall survival was not different between groups A and B (median 37.0 versus 15.5 months, hazard ratio (HR) = 0.58, P = 0.073) nor was time to progression (median 5.3 versus 2.8 months, HR = 0.87, P = 0.52). The most common first-line treatment-related grade ≥3 adverse events were neutropenia (cabazitaxel 32% versus ARPI 0%), diarrhoea (9% versus 0%), infection (9% versus 0%), and fatigue (7% versus 5%). Baseline circulating tumour DNA (ctDNA) fraction above the cohort median and on-treatment ctDNA increase were associated with shorter time to progression (HR = 2.38, P < 0.001; HR = 4.03, P < 0.001). Patients with >30% ctDNA fraction at baseline had markedly shorter overall survival than those with undetectable ctDNA (HR = 38.22, P < 0.001). CONCLUSIONS: Cabazitaxel was associated with a higher clinical benefit rate in patients with ARPI-naive poor prognosis mCRPC. ctDNA abundance was prognostic independent of clinical features, and holds promise as a stratification biomarker.

Microbial enrichment of blackcurrant press residue with conjugated linoleic and linolenic acids.

AIMS: The aim of the study was to investigate the isomerization of linoleic (LA) and linolenic acids (LNAs) into their conjugated isomers by Propionibacterium freudenreichii DSM 20270 and utilize this feature for microbial enrichment of blackcurrant press residue (BCPR) with health-beneficial conjugated fatty acids. METHODS AND RESULTS: First, the ability of P. freudenreichii to isomerize 0·4 mg ml-1 of LA and LNA was studied in lactate growth medium. Free LA and α-LNA were efficiently converted into conjugated linoleic (CLA) and α-linolenic acid (α-CLNA), being the predominant isomers c9,t11-CLA and c9,t11,c15-CLNA, respectively. The bioconversion of α-LNA by P. freudenreichii was more efficient in terms of formation rate, yield and isomer-specificity. Thereafter, free LA and LNAs obtained from hydrolysed BCPR neutral lipids, by lipolytically active oat flour, were subjected to microbial isomerization in BCPR slurries. In 10% (w/v) slurries, a simultaneous enrichment in c9,t11-CLA and c9,t11,c15-CLNA of up to 0·51 and 0·29 mg ml-1 was observed from starting levels of 0·96 mg LA ml-1 and 0·37 mg α-LNA ml-1 respectively. CONCLUSIONS: This study shows that growing cultures of P. freudenreichii DSM 20270 are able to simultaneously enrich BCPR with health-beneficial conjugated isomers of LA and α-LNA. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates that microbial isomerization technique can be utilized to enrich lipid-containing plant materials with bioactive compounds and thereby enable valorization of low value plant-based side streams from food industry into value-added food ingredients.

Characterization of Clostridium perfringens isolates from healthy turkeys and from turkeys with necrotic enteritis.

Clostridium perfringens is an important bacterial pathogen, especially in poultry, where it can lead to both subclinical and clinical disease. The aim of this study was to present data on pathological findings at outbreaks of necrotic enteritis (NE) in turkey production in Finland during the period from 1998 to 2012. Furthermore, C. perfringens isolates from healthy and diseased turkeys were characterized and their genetic diversity was investigated using pulsed-field gel electrophoresis (PFGE). Isolates (n = 212) from birds with necrotic gut lesions and from healthy flocks of 30 commercial turkey farms were characterized for the presence of cpa, cpb, iA, etx, cpb2, and cpe and netB genes. A total of 93 C. perfringens isolates, including 55 from birds with necrotic gut lesions and 38 from healthy birds from 13 different farms, were analyzed with PFGE. All contract turkey farmers (n = 48) of a turkey company that produces 99% of domestic turkey meat in Finland were interviewed about background information, management at the farm, and stress factors related to NE outbreaks. Pulsed-field gel electrophoresis analysis with SmaI restriction enzyme resulted in 30 PFGE patterns among the 92 C. perfringens isolates of high diversity. Out of all isolates, 212 (100%) were α-toxin-positive and one isolate (0.5%) was both α- and ß2 toxin-positive. Fourteen isolates (6.6%) were necrotic enteritis toxin B (NetB) positive; all were recovered from turkeys with NE. In none of the isolates obtained from healthy turkeys was the netB toxin identified. In conclusion, a high diversity of C. perfringens isolates from turkeys with different health status was shown. All isolates produced α toxin, whereas only low percentages of isolates carried the netB toxin gene. The role of the netB toxin in NE in turkeys needs to be further investigated.

Hyperbaric articaine with or without fentanyl in spinal anaesthesia: patient and observer blinded comparison.

BACKGROUND: The rapid and short-acting local anaesthetic articaine is a feasible spinal anaesthetic for day-case open inguinal herniorrhaphy (OIH). We hypothesised that similarly to other spinal local anaesthetics, the addition of fentanyl may prolong articaine spinal analgesia without prolonging motor block. METHODS: We performed a randomised, controlled study in 100 adult patients undergoing OIH. Spinal anaesthesia was induced by injecting hyperbaric articaine 72 mg with (Group A + F) or without (Group A) fentanyl 10 µg with the patient in lateral decubitus position. The distribution of sensory block was tested using pinprick and controlled by tilting the operating table 10 up or down. Motor block testing was based on the patient's ability to flex knees and ankles. Rescue analgesic was intravenous (i.v.) fentanyl. Pain scores were registered, and i.v. paracetamol 1 g was given as the first post-operative analgesic. RESULTS: There were no differences (A + F vs. A) in the maximum median extension of the sensory block (T5 vs. T5), mean duration of sensory block ≥ T10 (76 min vs. 73 min), or total duration of sensory (146 min vs. 146 min) or motor block (99 min vs. 107 min). Fewer patients in Group A + F needed fentanyl (5 vs. 14, P < 0.05) perioperatively or paracetamol (3 vs. 18, P < 0.001) post-operatively. CONCLUSION: Fentanyl 10 µg added to spinal hyperbaric articaine improved analgesia and reduced analgesic consumption during and after OIH. Fentanyl did not prolong motor block or delay recovery.

Pro-inflammatory and Th2-type cytokine responses in PBMC in infants are associated with parental smoking.

BACKGROUND: During infancy, a disturbed cytokine balance leads to an atopic immune response. Many risk factors have been associated with the development of atopy. These include parental smoking, elevated cord blood IgE, early exposure to pets and family history of atopy, but the knowledge of their impact on cytokine balance is limited. OBJECTIVE: To assess the cytokines induced by mitogen in peripheral blood mononuclear cells (PBMC) of infants at 3 months and 12 months of age and their potential association with fatty acid (FA) intervention, parental atopy, atopic dermatitis and parental smoking. METHODS: Infants from an intervention study using black currant seed oil (BCSO, n = 34) or placebo (n = 34) were included. PBMC samples were taken at the age of 3 and 12 months. Signs of atopic dermatitis and parental smoking were registered. PBMC were isolated from heparinized blood samples, stimulated with ConcanavalinA mitogen and the cytokine responses were detected at 72 h of stimulation by Luminex technology. RESULTS: Children of smoking parents had elevated levels of IL-4 (P = 0.0004), IL-5 (P = 0.0002), IFN-γ (P = 0.039) and TNF (P = 0.0003) at 12 months of age. Children who had atopic dermatitis by the age of 3 months showed elevated levels of IL-5 at 3 months (P = 0.0027) and 12 months of age (P = 0.022). The production of TNF at the age of 3 months was higher (P = 0.010) and the production of IL-12 at the age of 12 months was lower (P = 0.025) in infants whose parents were atopic. BCSO intervention did not have any effect on any cytokine production or mRNA expression. CONCLUSION: Children of smoking parents had highly significantly elevated levels of Th2-type cytokines IL-4, IL-5 and pro-inflammatory cytokine TNF. The detrimental effects of parental smoking on the child's immune function should lead us to pay more attention to supporting parents to stop smoking.

Reduction of intra-ocular pressure by ocular compression before combined peri- and retrobulbar block.

The intra-ocular pressure immediately before glaucoma surgery can be raised. We wished to investigate if ocular compression for 20 min before a combined peri- and retrobulbar injection would result in a lower pressure after the block. Sixty consecutive patients scheduled for filtration surgery were randomly assigned to receive ocular compression using an external pressure device for 20 min before combined peri- and retrobulbar injection (intervention group, who also received compression after the block) or to a control group in whom pressure was applied only after the block was completed. The intra-ocular pressure was measured at baseline, after the 20-min pre-injection compression (intervention group), after injecting the block, and after the 10-min post-injection compression. The pressure did not differ between groups at baseline, after the block or after the post-injection compression. In the intervention group, the compression before the block reduced the median (IQR [range]) pressure from 21.0 (17.0-25.0 [12.0-40.0]) mmHg to 16.8 (12.5-22.5 [7.5-33.5]) mmHg (p<0.001). We conclude that external ocular compression reduces the intra-ocular pressure, but applying an additional compression for 20 min before injecting the block is not beneficial.

Different berries and berry fractions have various but slightly positive effects on the associated variables of metabolic diseases on overweight and obese women.

BACKGROUND/OBJECTIVES: Dietary habits have a major role in obesity, type 2 diabetes and atherosclerotic cardiovascular diseases. In this study, we compared the effects of sea buckthorn (SB) and its fractions, and bilberries (BBs) on associated variables of metabolic diseases on overweight and obese women. SUBJECTS/METHODS: In total, 110 female volunteers were recruited, and they followed four different berry diets (BB, SB, SB phenolic extract (SBe) and SB oil (SBo)) in a randomized order for 33-35 days. Each intervention was followed by a wash-out period of 30-39 days. Blood samples were drawn and physical measurements were performed after each period. Eighty volunteers completed the study. RESULTS: There was statistically significant decrease in waist circumference after BB (Δ, -1.2 cm; P = 0.041) and SB (Δ, -1.1 cm; P = 0.008) periods and also a small decrease in weight after BB diet (Δ, -0.2 kg; P = 0.028). Vascular cell adhesion molecule decreased after BB (Δ, -49.8 ng/ml; P = 0.002) and SBo (Δ, -66.1 ng/ml; P = 0.001) periods, and in intercellular adhesion molecule (ICAM) after SBe diet (Δ, -6.1 ng/ml; P = 0.028). CONCLUSIONS: Based on the results, it can be stated that different berries and berry fractions have various but slightly positive effects on the associated variables of metabolic diseases.

Chloroprocaine vs. articaine as spinal anaesthetics for day-case knee arthroscopy.

BACKGROUND: Chloroprocaine and articaine have recently gained interest as short-acting spinal anaesthetics. They have not, however, previously been compared in an ambulatory surgery setting. METHODS: In this double-blind, randomised, controlled trial, adult patients (≤65 years, ASA I-II, body mass index<36 kg/m2) underwent day-case knee arthroscopy under spinal anaesthesia with either 40 mg of plain chloroprocaine (20 mg/ml) (group C40; n=39) or 60 mg of plain articaine (40 mg/ml) (group A60; n=39). Study parameters included the onset, degree, and regression of both sensory and motor block. Standardised telephone interviews on the first and seventh post-operative day were aimed at detecting any untoward sequelae, e.g., transient neurologic symptoms (TNSs). RESULTS: The groups were comparable regarding demographic data, onset and maximal spread of spinal anaesthesia, and duration of surgery. All arthroscopies were performed successfully under spinal anaesthesia, except for one patient (C40, unforeseen delay in the start of surgery). The duration of sensory block≥dermatome L1 was significantly shorter in C40 vs. A60. Correspondingly, complete recovery was significantly faster (P<0.0001, Mann-Whitney U-test) in C40 vs. A60 for both motor [75 (60/90) vs. 135 (105/150) min] and sensory [105 (105/135) vs. 165 (135/180) min] block, respectively [data are median (25th/75th percentiles)]. No TNSs were noted. CONCLUSIONS: Both anaesthetics used provided a rapid onset of spinal anaesthesia of about 1 h and were satisfactory for day-case knee arthroscopy. Recovery, however, was significantly faster in group C40. The data add to earlier results that TNSs seem to be uncommon after spinal chloroprocaine and articaine.

Postprandial hyperglycemia and insulin response are affected by sea buckthorn (Hippophaë rhamnoides ssp. turkestanica) berry and its ethanol-soluble metabolites.

BACKGROUND/OBJECTIVES: Repeated postprandial hyperglycemia and subsequent mild, late hypoglycemia as well as high postprandial insulin response lead to metabolic events that may eventually develop into type 2 diabetes. The aim of this study was to assess how sea buckthorn berries as well as two sea buckthorn extraction residues modulate the postprandial metabolism after a high-glucose meal. SUBJECTS/METHODS: Ten healthy normal-weight male volunteers consumed four study breakfasts, one control (A) and three sea buckthorn meals on four distinct study days. All the meals contained yoghurt and glucose (50 g). The sea buckthorn ingredients used were dried and crushed whole berries (meal B1), supercritical fluid (SF)-carbon dioxide (CO(2))-extracted oil-free berries (meal B2) or ethanol-extracted SF-CO(2)-extraction residue (meal B3). Blood samples for glucose, insulin and tumor necrosis factor-α analyses were collected before and during the 6-h study period. RESULTS: Meal B1 suppressed the postprandial peak insulin response when compared with meal A (Δconcentration of 30-min peak value--21.8 mU/l, P=0.039), and stabilized postprandial hyperglycemia and subsequent hypoglycemia (Δconcentration of 30-min peak value--120-min value -30.4 mU/l, P=0.036). Furthermore, meal B2 resulted in a more stable insulin response than the control meal (Δconcentration of 30-min peak value--120-min value -25.9 mU/l, P=0.037). CONCLUSIONS: Removal of the CO(2)-soluble oil component from the berries did not show a significant change in the studied postprandial effects of the berries. The EtOH soluble components, again showed advantageous properties in both insulin and glucose responses.

Blackcurrant seed oil for prevention of atopic dermatitis in newborns: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: The present increased incidence of atopic diseases has been associated with an altered intake of essential fatty acids (EFAs). The composition of blackcurrant seed oil (BCSO) corresponds to the recommended dietary intake of EFAs, and as a dietary supplement could, in small doses, modify the imbalance of EFAs in an efficient way. OBJECTIVE: To assess the effect of dietary supplementation with BCSO on the prevalence of atopy at 12 months of age. METHODS: Three hundred and thirteen pregnant mothers were randomly assigned to receive BCSO (151) or olive oil as placebo (162). The first doses were administered at 8th-16th weeks of pregnancy and were continued until the cessation of breastfeeding, followed by supplementation to the infants until the age of 2 years. Atopic dermatitis and its severity (SCORAD index) were evaluated, serum total IgE was measured and skin tests were performed at the age of 3, 12 and 24 months. RESULTS: Parental atopy was common (81.7%) among study subjects, making them infants with increased atopy risk. There was a significantly lower prevalence of atopic dermatitis in the BCSO group than in the olive oil group at the age of 12 months (33.0% vs. 47.3%, P=0.035). SCORAD was also lower in the BCSO group than in the olive oil group at 12 months of age (P=0.035). No significant differences in the prevalence of atopic dermatitis were observed between the groups at the age of 24 months (P=0.18). CONCLUSION: Dietary supplementation with BCSO was well tolerated and it transiently reduced the prevalence of atopic dermatitis. It could therefore be one potential tool in the prevention of atopic symptoms when used at an early stage of life. (Registration number SRCTN14869647, http://www.controlled-trials.com)

Berry meals and risk factors associated with metabolic syndrome.

BACKGROUND/OBJECTIVES: Nonalcoholic fatty liver disease is commonly associated with obesity, insulin resistance, dyslipidemia and type 2 diabetes, and can thus be regarded as the hepatic manifestation of metabolic syndrome. In this study we compared the effects of lifestyle intervention with and without industrial berry products, on risk factors associated with metabolic syndrome on slightly overweight women. SUBJECTS/METHODS: Sixty-one female volunteers (average age 42.9 years) were recruited and randomized for a 20-week dietary intervention trial with two parallel treatment groups, one lifestyle intervention group with berry products equaling with an average daily dose of 163 g of northern berries (berry group, diet 1, N=31, of which 28 completed the study) and the other group with lifestyle intervention only (control group, diet 2, N=30, of which 22 completed the study). RESULTS: Increased berry consumption as part of the normal daily diet was the only lifestyle difference between the two intervention groups. The major effects achieved by diet 1 were changes in the levels of alanine aminotransferase (ALAT) and adiponectin (at P-values <0.001 and 0.002, respectively). A statistically significant difference between the two intervention groups was the higher decrease in the ALAT value in the berry group (P=0.003). CONCLUSIONS: The 23% decrease in the ALAT value, from 20.29 to 15.66 U/l in the berry group may be regarded as nutritionally significant by enhancing the liver function. This may contribute positively to the low-grade systemic inflammation in body and decrease the risk of cardiovascular diseases.

Type C bovine botulism outbreak due to carcass contaminated non-acidified silage.

The first reported bovine botulism outbreak in Finland is described. Nine out of 90 cattle on a dairy farm died after being fed non-acidified silage contaminated by animal carcasses. Type C botulinum neurotoxin gene was detected in one heifer by polymerase chain reaction (PCR) and the neurotoxin was detected by the mouse bioassay. Clostridium botulinum type C was isolated from liver samples. The isolated strain was identified with amplified fragment length polymorphism (AFLP) analysis as group III C. botulinum. To our knowledge, this is the first time that a type C bovine botulism outbreak has been diagnosed by PCR and confirmed by subsequent isolation and AFLP identification of the disease strain. The importance of the acidification process in silage production to inhibit C. botulinum toxin production in silage and thus to prevent further botulism outbreaks is emphasized. Nevertheless, preformed toxin in the carcass is not destroyed by acid.

Comparison of hyperbaric and plain articaine in spinal anaesthesia for open inguinal hernia repair.

BACKGROUND: Fast onset and short duration are prominent properties of the amide-type local anaesthetic articaine. Similar to bupivacaine, a hyperbaric solution of articaine may produce faster onset and shorter duration of spinal anaesthesia than a plain solution. METHODS: Patients undergoing open inguinal hernia repair received in random order articaine 84 mg in either hyperbaric (HyperA, n=49) or plain solution (PlainA, n=48) intrathecally. A blinded observer tested the dermatomal spread (pinprick) and motor block (Bromage scale). RESULTS: Median (range) onset time to the T(10) dermatome was 2 (2-8) (n=46) and 6 (2-30) min (n=39) (P<0.001), and the duration of the sensory block at (or above) the T(10) dermatome was 86 (39-148) and 69 (15-118) min (P=0.007), in Groups HyperA and PlainA, respectively. Peak sensory block was greater in Group HyperA T(4) (L(2)-C(2)) than in Group PlainA T(8)-T(7) (L(3)-T(3)) dermatome, median (range), P<0.001. Spread of the block to the cervical dermatomes associated with hypotension occurred in three patients of Group HyperA (one patient C(2) and two C(4)). The sensory block resolved to the S(2) dermatome significantly faster in Group HyperA, 2.5 (1.5-4.5) h, than in Group PlainA, 3.5 (2.0-4.5) h (P<0.001). Median duration of the motor block was significantly shorter in Group HyperA, 2.0 (1.3-3.5) vs 3.0 (1.5-4.0) h (P<0.001). CONCLUSIONS: Hyperbaric articaine 84 mg had a faster onset and shorter duration of spinal anaesthesia than the plain solution.

Measurement of surgical stress in anaesthetized children.

BACKGROUND: The surgical stress index (SSI), derived from a combination of heart rate (HR) and photoplethysmographic amplitude (PPGA) time series, is a novel method for continuous monitoring of intraoperative stress and has been validated in adults. The applicability of SSI and its constituents to monitoring children has not been previously evaluated. METHODS: In this controlled trial, 22 anaesthetized patients, aged 4-17 yr, undergoing strabismus surgery were randomized into two groups, Group LL and Group BSS. Patients in Group LL received topical conjunctival anaesthesia with a 1:1 mixture of lidocaine 2% and levobupivacaine 0.75%, and patients in Group BSS received balanced salt solution. RESULTS: Endotracheal intubation (n=22) increased median (range) SSI from 39.2 (22.6-55.6) to 53.6 (35.8-63.3) (P<0.001), decreased PPGA from 5.62 (2.79-9.69) to 5.27 (2.59-7.54)% (P=0.001), and increased the difference of response entropy (RE) and state entropy (SE) of frontal biopotentials (RE-SE) from 3.1 (0.06-9.1) to 5.7 (0.6-9.4) (P=0.01). Conventional haemodynamic variables also increased, median (range) HR from 72.9 (56.7-113.8) to 84.2 (60.4-124.8) beats min(-1) (P<0.001), and systolic non-invasive arterial pressure (S-NIBP) from 87 (78-143) to 103 (79-125) (P=0.007). When 3 min baseline before surgery was compared with 12 min of surgery, median (range) SSI increased from 43.3 (31.2-58.0) to 49.9 (39.3-57.2) (P=0.042) vs from 46.6 (26.8-57.8) to 52.1 (31.7-60.1) (P=0.024) and PPGA decreased from 6.60 (3.10-8.24) to 5.80 (3.03-7.65)% (P<0.001) vs from 5.51 (3.25-9.84) to 5.06 (3.08-8.99)% (P=0.042), in Groups LL and BSS, respectively, but SSI or other indicators did not differ significantly between the groups. CONCLUSIONS: SSI, PPGA, HR, NIBP, RE, and RE-SE detect autonomic responses to nociceptive stimuli in anaesthetized children undergoing strabismus surgery.

I.V. ropivacaine compared with lidocaine for the treatment of tinnitus.

BACKGROUND: I.V. lidocaine has been used to ameliorate tinnitus, but in general its effect has been limited. The longer acting local anaesthetic ropivacaine may be more effective. METHODS: A total of 19 randomized, double-blind, cross-over study patients suffering from chronic tinnitus were given a 30 min i.v. infusion of ropivacaine or lidocaine 1.5 mg kg(-1) at an interval of 2-3 months. The intensity of tinnitus was evaluated on tinnitus handicap inventory (THI) scale and on the visual analogue scale (VAS). Plasma ropivacaine and lidocaine concentrations were determined. RESULTS: In both treatments, the infusion decreased the VAS score significantly. At the end of infusion, a > or =50% reduction in VAS score was observed in five patients by ropivacaine and in one patient by lidocaine, but this effect was sustained for 1 h only in three patients. However, the THI scores did not differ significantly within or between treatments. On the post-infusion day, three patients after ropivacaine and five after lidocaine treatment had > or =30% improvement in the THI score. Four weeks later, one patient after ropivacaine and two after lidocaine had a > or =30% reduction in the THI score. One patient developed seizures soon after ropivacaine infusion from which he recovered uneventfully. His plasma concentration of ropivacaine was 1817 ng ml(-1). The highest individual ropivacaine and lidocaine concentrations were 3483 and 1680 ng ml(-1), respectively. CONCLUSIONS: Temporary clinically significant alleviation of tinnitus was observed only in a few individuals after both i.v. ropivacaine and lidocaine. The toxicity of ropivacaine limits its usefulness.

Effects of sea buckthorn berries on infections and inflammation: a double-blind, randomized, placebo-controlled trial.

OBJECTIVE: To study the effect of sea buckthorn berries on the number and duration of common cold (CC) infections. As secondary objectives the effects on digestive and urinary tract infections (DTI, UTI), and serum C-reactive protein (CRP) concentrations were also investigated. SUBJECTS: A total of 254 healthy volunteers were randomly assigned to receive sea buckthorn or placebo product during the study, which 233 of them completed. RESULTS: There were no significant differences in the number or duration of CC or DTI between groups (CC: relative risks (sea buckthorn vs placebo) for the number and duration were 1.15 (95% CI 0.90-1.48) and 1.05 (95% CI 0.87-1.27), respectively). In the sea buckthorn group, as compared to the placebo, the serum CRP concentrations decreased significantly (difference in median change -0.059 mg/l, P=0.039). The number of UTI was too small to draw solid conclusions, but the results indicate the subject merits further investigation. CONCLUSION: Sea buckthorn berries did not prevent CC or DTI. However, a reductive effect on CRP, a marker of inflammation, and a risk factor for cardiovascular diseases, was detected.

Stearic acid is well absorbed from short- and long-acyl-chain triacylglycerol in an acute test meal.

OBJECTIVE: Absorption of stearic acid from natural oils has been shown to be efficient, but it is claimed to be lower from short- and long-acyl-chain triacylyglycerol molecules (Salatrim). The aim was to measure the apparent absorption of stearic acid from Salatrim fat in an acute test meal. DESIGN: Double-blind crossover study. SUBJECTS: Ten healthy male volunteers, of whom eight completed the study. METHODS: The subjects were studied on two occasions after consumption of a single high-fat meal either without (control) or with 30 g of Salatrim. Fecal samples were collected for 96 h after the meal and the fat was extracted for analysis of the content and composition of free and esterified long-chain fatty acids. RESULTS: Baseline fecal fat was 5.6+/-2.6 g/day increasing to 10.4+/-4.9 g/day after addition of Salatrim (P=0.001). During the whole collection period, the baseline fecal free and esterified fatty acids were 2.6+/-2.3 and 0.8+/-0.7 g, respectively. After Salatrim meal the corresponding figures increased to 5.9+/-3.6 g (P=0.001) and 1.5 (+/-1.2) g (P=0.003), respectively. The total fecal stearic acid after control meal was 0.97+/-0.9 g. Consumption of Salatrim with 16.7+/-0.5 g of stearic acid increased the content to 3.12+/-1.6 g (P<0.001), with apparent absorption of 87%. CONCLUSIONS: The apparent absorption of stearic acid does not differ from its absorption from natural fats. The status of Salatrim as a low-energy fat substitute needs to be re-evaluated. SPONSORSHIP: University of Turku.

Hyperbaric articaine for day-case spinal anaesthesia.

BACKGROUND: Articaine and lidocaine are clinically very similar suggesting that articaine could be suitable for day-case spinal anaesthesia. A dose-response study with articaine in ambulatory spinal anaesthesia was therefore performed. METHODS: In this randomized double-blind study, 90 day-case surgery patients received spinal anaesthesia with 60 mg (A60), 84 mg (A84) or 108 mg (A108) of hyperbaric articaine hydrochloride. Sensory block was tested with pinprick and motor block on a modified Bromage scale. A structured interview was performed on the first and seventh postoperative days. RESULTS: Sensory block reached the T10 dermatome in a median (range) of 5 (5-10) and was maintained at this level for 70 (35-145), 70 (15-115) and 85 (20-115) min in the A60, A84 and A108 groups, respectively. Six patients in the A108 group, two in the A84 group and one in the A60 group had maximum spread of analgesia to T(1) or higher (NS). Patients in the A108 group needed more medication for hypotension (P=0.018), had more often nausea and vomiting (P=0.027), took oral fluids later (P=0.031) and both sensory block recovery [median (range)] [2.5 (2-4.5) h] (P=0.017) and motor block recovery [2 (1.3-4) h] (P=0.009) were delayed. No patients in the A108 group needed opioid intraoperatively while fentanyl was needed in 5 (17%) and 2 (7%) patients in the A60 and A84 groups, respectively. Discharge criteria were attained in approximately 4.5 h after articaine injection (NS) and no drug-related sequelae were observed. CONCLUSIONS: Hyperbaric articaine 60 and 84 mg resulted in spinal anaesthesia allowing surgery of the lower extremities for about 1 h. Recovery was rapid. Use of 108 mg of articaine is not recommended because of frequent extensive cephalad spread of the block, accompanied by arterial hypotension and nausea.

Combination of hyperbaric lidocaine and ropivacaine in spinal anaesthesia for day surgery.

BACKGROUND AND OBJECTIVE: Motor function recovers rapidly but the extended duration of sensory block after spinal anaesthesia with hyperbaric ropivacaine may delay patients' ambulation after surgery. We tested whether compensating a reduction of the ropivacaine dose with a small dose of lidocaine would be adequate for surgery and shorten recovery from spinal anaesthesia. METHODS: Fifty-six consecutive outpatients, who were scheduled for lower extremity surgery under spinal anaesthesia, were randomized into two groups to receive either a hyperbaric solution of lidocaine 20 mg and ropivacaine 5 mg (Group LR) or hyperbaric ropivacaine 10 mg (Group R). Sensory block was tested with pinprick and motor block on the Bromage scale at 5-min intervals until 30 min, then at 15-min intervals until 90 min, and thereafter at 30-min intervals until full bilateral recovery. Blinded interviews were performed on the first and seventh postoperative day. RESULTS: The groups did not differ significantly regarding success of sensory block reaching T10 dermatome on the operative side, 24 (86%) in Group LR and 23 (82%) in Group R, median (range) onset time 5 (5-20) vs. 10 (5-25) min or median duration of T10 sensory block 68 (5-115) vs. 50 (20-115) min, respectively. Two patients in each group required general anaesthesia. Recovery did not differ between the groups, median time of full motor recovery was 75 min in both groups, sensory recovery of S2 2.5 h vs. 2.8 h, first voluntary micturition 4.2 (2.2-6.1) vs. 4.5 (2.4-6.6) h in the LR vs. R Group, respectively. Transient neurological symptoms did not appear. CONCLUSION: It is concluded that spinal anaesthesia with hyperbaric lidocaine 20 mg+ropivacaine 5 mg and hyperbaric ropivacaine 10 mg was quite similar regarding frequency, onset, duration of T10 dermatome sensory block and recovery. The patients would have been ready for discharge after voluntary micturition, 4.2-4.5 h from the subarachnoid injection of local anaesthetics.

Advances in ophthalmic regional anaesthesia.

Although retrobulbar and peribulbar regional anaesthetic techniques are used (by both anaesthesiologists and ophthalmologists) in various types of eye surgery, topical anaesthesia of the conjunctiva and cornea, followed--as needed--by sub-Tenon's block, is now common in routine cataract surgery. Intracameral administration of local anaesthetic by the ophthalmologist is also performed. Sedation during ophthalmic surgery is distinctly lighter than for other surgery because it is essential that the patient remains alert and can cooperate with the surgeon. Continuous insufflation of oxygen-enriched air is needed to ascertain that CO2 has been flushed away. With a catheter placed into the nostril, the patient (whose head is draped and 'hidden') can have the end-tidal CO2 monitored. Finger index (FI), a palpation method that assesses the ease of performing retrobulbar block, is introduced. Because of the risk of life-threatening complications in ophthalmic regional anaesthesia, the services of an anaesthesiologist must be available and training of anaesthesia residents in ophthalmic regional anaesthesia is highly recommended.