Yale researchers have found that the lactate component of a common saline solution used in hospitals may have anti-inflammatory effects that can reduce injury to major organs. The finding has clinical implications for the treatment of pancreatitis, kidney injury, strokes, and even heart attacks.
The researchers induced acute pancreatitis or hepatitis in various mouse models. They then injected a portion of the mice with sodium lactate, which is a component of fluids often given intravenously to patients in hospitals to maintain proper blood pH levels.
The sodium lactate reduced the activation of toll-like receptors, components of the innate immune system that recognize foreign pathogens and launch the immune system

Postsurgical cognitive side effects can have major implications for the level of care, length of hospital stay, and the patient’s perceived quality of care, especially in elderly and fragile patients. A nationwide survey of Swedish anaesthesiologists and nurse anaesthetists has found there is low awareness of the risks of cognitive side effects following surgery. Furthermore, only around half of the respondents used depth-of-anaesthesia monitors.

Patients generally expect to make a rapid recovery from anaesthesia with a minimum of side effects. The main focus by anaesthesia personnel centres around how to minimize cardiovascular and pulmonary risks and on the management of postoperative pain, nausea, and vomiting. According to the survey results, less attention is being paid to cognitive side effects following surgery, yet these complications can have major implications for the patient.

‘We found that Swedish anaesthesia personnel viewed risk assessment, prevention, and handling of postoperative delirium and postoperative cognitive dysfunction of rather low importance. Protocol and/or standardized routines were only rarely implemented,’ observes senior investigator Professor Jan G. Jakobsson, MD, PhD, of the Department of Anesthesia & Intensive Care, Institute for Physical Science, Karolinska Institute, Stockholm, Sweden.

Postoperative cognitive impairments may arise early on after surgery, such as the short-lasting, but still distressful postoperative emergence agitation (EA). Postoperative delirium (POD) usually makes its debut one or two days after surgery, sometimes giving rise to major concerns. The more subtle but longer lasting postoperative cognitive dysfunction (POCD) generally starts during the first week after surgery, but may last for a month. Although these side effects are of major concern for both hospitals and patients, they have received less attention from anaesthesia personnel.

To gain insight regarding routines and practice for risk assessment, diagnosis, and management of postoperative cognitive side effects, and the use of EEG-based depth-of-anaesthesia monitoring (DOA), investigators sent a web-based validated questionnaire to over 2,500 Swedish anaesthesiologists and nurse anaesthetists. The questionnaire consisted of three sections covering subjective preferences, routines, and practices related to the perioperative handling of EA, POD, POCD, and awareness. The response rate was 52%.

In general the respondents considered the risk for neurocognitive side effects to be the least important during the preoperative assessment, while the risk of awareness with recall (when patients are able to recall the surgery) as well as traditional cardiac and pulmonary risk was considered of high importance.

It has been suggested that the use of EEG-based DOA monitoring to fine-tune and tailor anaesthetic delivery can reduce the risk of postoperative cognitive side effects. Previous surveys of anaesthetic practice in Sweden showed a high degree of standardization and that structured protocols for the perioperative management are in place. However, the results of this survey were more diverse. EEG-based DOA monitors were used in half of all departments, but the frequency and indication for their use varied.

‘Respondents were overall quite skeptical about the value of EEG-based DOA monitors, however their use in patients at risk for awareness was more positive among the nurse anaesthetists than the anaesthesiologists,’ notes Professor Jakobsson. ‘This attitude to DOA monitoring may be due to the rather negative stance of the Swedish Council on Health Technology Assessment regarding these devices. This is in contrast to the national guidelines in the UK, which support the use of DOA monitoring in at-risk patients.’

‘The results show there is a need to improve the knowledge of anaesthesia personnel about risk factors, prevention and management of postoperative cognitive side effects,’ concludes Professor Jakobsson. EurekAlert

Many women struggling to become pregnant may suffer from some degree of tubal blockage. Traditionally, an x-ray hysterosalpingogram (HSG) that uses dye is the most common procedure to determine whether a blockage exists, but it can cause extreme discomfort to the patient. UC San Diego Health System

Isis Innovation, the technology transfer arm at the University of Oxford and Canada

In many parts of the world, leprosy and tuberculosis live side-by-side. Worldwide there are approximately 233,000 new cases of leprosy per year, with nearly all of them occurring where tuberculosis is endemic.

The currently available century-old vaccine Bacille Calmette-Guerin, or BCG, provides only partial protection against both tuberculosis and leprosy, so a more potent vaccine is needed to combat both diseases. UCLA-led research may have found a stronger weapon against both diseases.

In a study, researchers found that rBCG30, a recombinant variant of BCG that overexpresses a highly abundant 30 kDa protein of the tuberculosis bacterium known as Antigen 85B, is superior to BCG in protecting against tuberculosis in animal models, and also cross protects against leprosy. In addition, they found that boosting rBCG30 with the Antigen 85B protein, a protein also expressed by the leprosy bacillus, provides considerably stronger protection against leprosy.