Background: Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context. Methods: After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0e10) were obtained every 5 min for 15 min. Results: The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0e3 and 4e10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI. Conclusions: An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-tosevere pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age. Clinical trial registration: ACTRN12617001475336.

Urine screening by tandem mass spectrometry is a rapid, high-throughput test that can detect PH3 cases that may otherwise not be diagnosed.

The contamination rate of clean-catch urine did not improve with the implementation of a pre-made urine collection pack including standardised written instructions.

A 15-year-old boy presented to his paediatrician with abdominal pain for investigation 1 week following return from a 2-week family holiday in Bali. He was previously well with no significant past history. There was no history of allergy and he did not take any medication. Symptoms included intermittent abdominal pain, constipation and cloudy urine with intermittent blood streaks. The paediatrician had found nephrotic-range proteinuria of 6.75 g/day (normal <0.16 g/24 h), with a protein to creatinine (pr:cr) ratio of 0.46 g/mmol (normal <0.03 g/mmol). Microscopic haematuria (>100 × 10 6 /L RBC) was noted and spontaneously resolved by 2 months without treatment. Intermittent macroscopic haematuria resolved within 2 weeks of presentation. A repeat 24-h urine collection demonstrated persistent nephroticrange proteinuria (5.06 g/24 h).He was referred to a paediatric nephrologist and at nephrology review, examination revealed a well looking young man with no oedema or ascites. The patient reported that he noted milky coloured urine in the morning which improved throughout the day. His urine collected in the afternoon was macroscopically clear with no proteinuria (pr:cr ratio of 0.01 g/mmol) or haematuria. Biochemistry demonstrated normal serum albumin 38 g/L (35-45 g/L), a normal serum creatinine of 78 μmol/L (55-105 μmol/L) and a serum cholesterol level of 3.3 mmol/L. His haemoglobin and eosinophil count were within the normal range. A renal ultrasound was normal. An early morning fasting urine sample was taken for further investigation (Fig. 1) which showed nephrotic-range proteinuria (pr:cr ratio 0.46 g/mmol) and high triglycerides of 25.3 mmol/L(<0.