Objectives To determine whether preoperative dexamethasone reduces postoperative vomiting in patients undergoing elective bowel surgery and whether it is associated with other measurable benefits during recovery from surgery, including quicker return to oral diet and reduced length of stay. Design Pragmatic two arm parallel group randomised trial with blinded postoperative care and outcome assessment. Setting 45 UK hospitals. Participants 1350 patients aged 18 or over undergoing elective open or laparoscopic bowel surgery for malignant or benign pathology. Interventions Addition of a single dose of 8 mg intravenous dexamethasone at induction of anaesthesia compared with standard care. Main outcome measures Primary outcome: reported vomiting within 24 hours reported by patient or clinician. Secondary outcomes: vomiting with 72 and 120 hours reported by patient or clinician; use of antiemetics and postoperative nausea and vomiting at 24, 72, and 120 hours rated by patient; fatigue and quality of life at 120 hours or discharge and at 30 days; time to return to fluid and food intake; length of hospital stay; adverse events. Results 1350 participants were recruited and randomly allocated to additional dexamethasone (n=674) or standard care (n=676) at induction of anaesthesia. Vomiting within 24 hours of surgery occurred in 172 (25.5%) participants in the dexamethasone arm and 223 (33.0%) allocated standard care (number needed to treat (NNT) 13, 95% confidence interval 5 to 22; P=0.003). Additional postoperative antiemetics were given (on demand) to 265 (39.3%) participants allocated dexamethasone and 351 (51.9%) allocated standard care (NNT 8, 5 to 11; P<0.001). Reduction in on demand antiemetics remained up to 72 hours. There was no increase in complications. Conclusions Addition of a single dose of 8 mg intravenous dexamethasone at induction of anaesthesia significantly reduces both the incidence of postoperative nausea and vomiting at 24 hours and the need for rescue antiemetics for up to 72 hours in patients undergoing large and small bowel surgery, with no increase in adverse events. Trial registration EudraCT (2010-022894-32) and ISRCTN (ISRCTN21973627).

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This paper describes a CMOS integrated potentiostatic control circuit. The design maintains a constant bias potential between the reference and working electrodes for an amperometric chemical sensor. A technique of converting input currents into time for amperometric measurements is proposed. Redox currents ranging from 1pA to 200nA can be measured with a maximum non-linearity of ±0.1% over this range. Analog inputs are processed and digital outputs are generated without requiring a power-hungry A/D converter. A prototype chip has been fabricated in the 0.5µm AMI CMOS process. Experimental results are reported showing the performance of the circuit as a chemical sensor. INTRODUCTIONWith the recent advances in the development of micro arrays that can transmit very low signals [1]-[2], there is a growing need for precise chemical sensors that can accurately measure the chemical activity and maintain fixed potential between electrodes of the chemical reaction. Threats of chemical and biological terror have made it even more important to design portable sensors, many of which can be integrated onto a single IC. This mandates the need for precise measurement of electrochemical activity caused by certain reactions at the electrodes of an electrochemical cell. Previously, some designs have been proposed for VLSI potentiostats [3,4,5,6,7]. Each of these designs amplifies smaller currents to the µA range and then measures the input current by calibrating their design at higher current range. By converting input current directly into time we eliminate amplifying circuitry, avoid matching problems and save on area and power consumption. We have designed a potentiostat circuit that accepts an electrical signal, proportional to current flowing through the electrolyte (in the electrochemical cell) and measure the time it takes to charge or discharge a capacitor. We eliminate sources Authors thank NSF for funding this project. Funds were provided by NSF award # 0087676. of noise and mismatch by directly converting input current into time and then performing time-based computation. A similar approach is discussed using a dual-slope converter [8], but the design suffers from errors due to charge injection and requires complex calibration. Instead our design technique provides better results and we are able to measure current as low as 1pA. The proposed design is more sensitive, portable, inexpensive and consumes lower power than earlier designs.In an electrochemical cell, any change in the potential of the cathodic electrode, results in a flow of current in the electrolyte so the potential of the electrode is maintained. The current will be conveyed using novel nanowires developed in the Martin lab [2] at the University of Florida to the electrodes of our potentiostat circuit. Two designs have been made for positive and negative flow of current that charge or discharge the capacitor at a speed proportional to the current flowing through the electrolyte and is given bywhere ∆V is the change in voltage across capacitor C, ...

Dual left anterior descending artery is a rare coronary artery anomaly showing two left anterior descending arteries. Short anterior descending artery usually arises from the left coronary artery, while long anterior descending artery has anomalous origin and course. Dual left anterior descending artery with origin of long anterior descending artery from the pulmonary artery (ALCAPA) is a very rare coronary artery anomaly which has not been reported previously in the literature. We present the computed tomography coronary angiographic findings of this rare case in a young female patient who presented with atypical chest pain.

Pulmonary carcinosarcoma is a rare lung tumor, which contains both malignant carcinomatous and heterotopic sarcomatous components. There are only few case reports on the imaging diagnosis of this rare tumor. Herein, we present the radiological findings of this rare tumor, which was suspected on computed tomography (CT) scan due to atypical CT findings of malignant lung mass (not usually seen in bronchogenic carcinoma) and was finally confirmed histologically.