Dexmedetomidine was evaluated for sedation of 401 post-surgical patients in this double-blind, randomized, placebo-controlled, multicenter trial. Dexmedetomidine or saline was started on arrival in the intensive care unit (ICU) (1.0 mcg/kg for 10 minutes), then titrated at 0.2 to 0.7 mcg/kg/h to effect. Patients could be given propofol if necessary. Morphine was administered for pain. Sixty percent of the dexmedetomidine patients required no other sedative to maintain an RSS > or = 3; 21% required < 50 mg propofol. In contrast, 76% of the control group received propofol; 59% required > or = 50 mg. Dexmedetomidine patients required significantly less morphine for pain relief (P <.001). Continuously given throughout the ICU stay, dexmedetomidine had no effect on respiratory rate, oxygen saturation, duration of weaning, or times to extubation. Nurses judged the dexmedetomidine patients were easier to manage. Later, fewer dexmedetomidine patients remembered pain or discomfort. The majority of dexmedetomidine patients maintained blood pressures within normal range, without rebound. Hypertension, atelectasis, and rigors occurred more frequently in the control group, while hypotension and bradycardia occurred more frequently in the dexmedetomidine group. Preoperative cardiovascular conditions were not risk factors for dexmedetomidine patients.

A series of experiments examined the abilities of infants to form categorical representations for the spatial relations above and below. Experiment 1 provided evidence that 3-to 4-month-olds can form categorical representations for above and below when a diamond shape was presented above or below a horizontal bar. Experiments 2 and 3 showed that 3-and 4-month-olds did not form categorical representations for above and below when a number of discriminably different shapes (e.g., a diamond, a triangle, a dot) appeared above or below the bar. These more abstract categorical representations for above and below were formed by 6-to 7-month-olds (Experiment 4). The findings suggest an experientially or maturationally based trend, from concrete to abstract, in the categorical representation of common spatial relations.

We evaluated the pattern of osteoporosis after spinal cord injury, determined the time-frame of the changes, and elucidated the relationship among parathyroid hormone levels, biochemical markers of bone formation, and the pattern of bone mass loss. We included 176 subjects with spinal cord injury and 62 subjects without spinal cord injury as controls in the study. Bone mineral density of the spine and the proximal femur was measured. The participants' age, level of injury, and length of time since injury were compared with the nonspinal cord-injured controls and with each other. Serum levels of calcium, calcitonin, biochemical markers of bone formation, and parathyroid hormone were determined. Our results revealed that bone mineral density of the proximal femur declined and reached fracture threshold at one to five years after injury. The decline was detected at 12 months after injury in all age groups. Spinal bone mineral density neither declined significantly nor reached fracture threshold. Parathyroid hormone levels declined before the end of the first year postinjury and increased at one to nine years postinjury in the 20- to 39-year age group. The increase correlated with the initial decline of bone mineral density of the proximal femur. Our studies in spinal cord-injured subjects revealed a pattern of osteoporosis similar to age and parathyroid dysfunction-related osteoporosis. No other correlation was detected between indexes of bone metabolism and bone mineral density measurements.

Infrahepatic IVC clamping is associated with significantly less intraoperative blood loss and may reduce the incidence of intraoperative hemodynamic instability. The potential association with postoperative pulmonary embolism represents a significant concern.

The purpose of the study was to use dual energy X-ray absorptiometry to measure bone mineral density (BMD) in the lumbar spine, the femoral neck, Ward's triangle, and the greater trochanter in 204 men (69 able-bodies controls and 135 spinal cord injured patients) strati®ed according to age (20 ± 39, 40 ± 59, and 60+ years old) in order to determine whether changes in BMD were age related, and to determine when these changes began to appear. The BMDs of the lumbar spine of both the 40 ± 59 year old and the 60+ year old patients were signi®cantly higher (P40.012) than the 40 ± 59 year old and 60+ year old controls, respectively. The femoral region BMDs of the 20 ± 39 year old and the 40 ± 59 year old patients were all signi®cantly lower (P40.027) than the 20 ± 39 year old and 40 ± 59 year old controls, respectively. When patients were grouped according to the time since their injury (0 ± 1, 1 ± 5, 6 ± 9, 10 ± 19, 20 ± 29, 30 ± 39, 40 ± 49, and 50 ± 59 years post injury) within the various age categories di erent results were obtained. In all the age categories, BMD loss occurred starting one year after spinal cord injury in the hip region. This bone loss took place gradually, reaching a signi®cant plateau (P40.017) at 19 years post injury and then started improving. The spine BMD in our patient population never signi®cantly decreased, and started improving as the age of the injury increased. Findings presented for the femoral regions were similar to other investigators' ®ndings; however, the steady bone mass maintained in the lumbar area, which increased with age regardless of the age of the injury, with the bone mass loss in the hip area, were the most notable new ®ndings.Keywords: spinal cord injury; spinal cord injury associated bone mass loss; bone mineral density (BMD); dual energy X-ray absorptometry (DEXA)