Volume 143, No. 1112

Robert L. Steward Jr., Sonia R. Rosner, Enhua H. Zhou, Jeffrey Fredberg (Author)

Illuminating human health through cell mechanics

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Cells reside in mechanically rich and dynamic microenvironments, and the complex interplay between mechanics and biology is widely acknowledged. Recent research has yielded insights linking the mechanobiology of cells, human physiology, and pathophysiology. In particular, we have learned of the cell’s astounding ability to sense and respond to its mechanical microenvironment. This seemingly innate behaviour of the cell has driven efforts to characterise precisely the cellular behaviour from a mechanical viewpoint. Here we present an overview of technologies used to probe cell mechanical and material properties, how they have led to the discovery of seemingly strange cellular mechanical behaviours, and their influential role in health and disease, including asthma, cancer, and glaucoma. The properties reviewed here have implications in physiology and pathology and raise questions that will fuel research opportunities for years to come.

Anna Gamell, Emili Letang, Boniface Jullu, Geoffrey Mwaigomole, Angelo Nyamtema, Christoph Hatz, Manuel Battegay, Marcel Tanner (Author)

Uptake of guidelines on prevention of mother-to-child transmission of HIV in rural Tanzania: time for change

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Guidelines on prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) are inconsistently implemented in low-income countries. Strategies are needed to improve the uptake of these guidelines to prevent avoidable new HIV infections of infants. In 2010 the World Health Organisation presented its new PMTCT guidelines, offering two options for short courses of antiretroviral prophylaxis: Option A and Option B. Option A consists of antenatal prophylaxis with zidovudine followed by intrapartum and postpartum prophylaxis with single-dose nevirapine and zidovudine plus lamivudine. Option B recommends triple antiretroviral prophylaxis until after finishing breastfeeding. Tanzania has adopted Option A, and it is currently implementing it. A new option termed Option B+ has emerged recently, which recommends providing lifelong antiretroviral treatment to all HIV-positive pregnant women.

In this article, we discuss the likely impact of this last PMTCT strategy in rural Africa with an example of an observational cross-sectional analysis in a rural referral hospital in Tanzania aiming to assess the uptake of PMTCT recommendations. Gaps were identified at all steps of the PMTCT pathway.

Effective uptake of PMTCT guidelines has been shown to be extremely challenging in this setting. The continuously changing recommendations on PMTCT stress the need for a much simpler and effective approach. We argue in favour of implementing Option B+ in Tanzania. Financial challenges need to be faced, but Option B+ would help to overcome many barriers that prevent guidelines to be implemented in order to increase coverage and ultimately achieve the goal of ‘virtual elimination’ of mother-to-child transmission in sub-Saharan Africa.

Guy Haller (Author)

Improving patient safety in medicine: is the model of anaesthesia care enough?

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Avoiding iatrogenic adverse outcomes and providing safe care to patients is a priority in modern healthcare systems. Because anaesthetic practice is inherently risky, the specialty has developed a broad range of strategies to minimise human error and risk for patients. These are part of a hierarchical model developed by industrial safety experts to minimise risk. It is known as the safety hierarchy model. This review will describe the use of this model in anaesthesia and show why the specialty is often cited as a role model for patient safety improvement. It will also explore the extension of the model to other specialties and analyse its intrinsic limitations due to new challenges to patient safety: teamwork and communication issues. These will conclude the review.

Amir Moayedoddin, Dominik A. Moser, Nathalie Nanzer (Author)

The impact of brief psychotherapy centred on parenthood on the anxio-depressive symptoms of mothers during the perinatal period

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OBJECTIVES: Depression and anxiety are major causes of distress amongst parents during the perinatal period. Their pervasive effects on the parents’ self-confidence, on the parent-infant relationship and on the child’s development have been well documented. The aims of the present study were to describe the psychological characteristics of mothers consulting during the perinatal period and to assess the effect of brief Psychotherapy Centred on Parenthood (PCP) on the mothers’ depressive and anxiety symptoms. The evolution of the mother-infant relationship is also documented. PCP is a brief mother-infant psychotherapy which focuses on the mother-infant relationship as well as the mother’s mental representations in order to reduce her psychological conflicts.

METHOD: Thirty-four mothers consulting an infant-parent outpatient clinic were assessed with respect to depression, anxiety, global functioning, severity of symptoms and the quality of their adaptation to the infant (T1). They were offered a brief PCP with an average of seven sessions. Outcome measures were collected after the end of the therapy (T2).

RESULTS: Overall, 28 of 34 mothers completed the therapy (83%), and 23 participated in the post-therapy evaluation. Paired samples t-tests showed that completers of PCP displayed significant improvement in post-treatment measures of depression (EPDS: t = 5.13; p <0.001), anxiety (STAI-State: t = 3.06; p = 0.006), clinical impression (CGI: n = 21; t = 4.50; p <0.001), and global functioning (GAF: t = –5.05; p <0.001). The quality of adaptation in the infant-parent relationship showed a tendency to improve (PIRGAS: t = –1.98; p = 0.062).

CONCLUSIONS: These preliminary results suggested that providing PCP to this sample of consulting mothers is feasible and accompanied by high rate of clinical and functional improvement.

Zheng Chen, Dong-Hua Shao, Li-Hua Hang (Author)

Effects of dexmedetomidine on performance of bispectral index as an indicator of loss of consciousness during propofol administration

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OBJECTIVE: The performance of bispectral index (BIS) for the measurement of the sedative depth when dexmedetomidine is administered in propofol anaesthesia and sedation has not yet been established. This study evaluated the effects of adjunctive dexmedetomidine on the accuracy of BIS to predict loss of consciousness (LOC) and BIS values predicting LOC during propofol administration.

METHODS: In this randomised, double-blind and placebo-controlled trial, 225 patients scheduled for general anaesthesia were assigned to one of three groups. Dexmedetomidine 0.5 and 1.0 µg kg^–1 were intravenously infused for 15 minutes in the dexmedetomidine 0.5 and 1.0 µg kg^–1groups, and saline was infused in the control group. Propofol was administered as an effect-site target-controlled infusion after completion of dexmedetomidine infusion. Patients in each group were allocated to five subgroups in which the concentration of propofol was set at 0, 1, 2, 3 and 4 μg ml^–1, respectively. Three minutes after propofol administration, the BIS values and Observer’s Assessment of Alertness/Sedation (OAA/S) scores were recorded.

RESULTS: There were no significant differences in the prediction probability of BIS for detecting LOC in the three groups. At the time of LOC, BIS₅₀ values were 71.1 and 71.4 in the dexmedetomidine 0.5 and 1.0 µg kg^–1groups, respectively, which were significantly larger than the BIS₅₀ of 63.2 in the control group.

CONCLUSIONS: The ability of BIS to predict LOC is not influenced by dexmedetomidine during propofol administration, but BIS values are enhanced at the time of LOC.

This study has been registered with http://www.ClinicalTrials.gov (number NCT00479661)