The risk tool developed and validated from our study cohort identified 5 risk factors: age ≤ 3 years (versus >3 years), ASA physical status II and III (versus ASA physical status I), morbid obesity, preexisting pulmonary disorder, and surgery (versus radiology) for PRAE. This tool can be used to provide an individual risk score for each patient to predict the risk of PRAE in the preoperative period.

Objective To examine the relationship between HIV-1 antigenic load (plasma RNA copies/ml) and broad HIV-1 neutralizing antibody activity. Methods Plasma from 120 HIV-1 infected patients, including HIV-1 Natural Viral Suppressors (similar to Elite Controllers), was tested for neutralization against 15 Tier 1/Tier 2 HIV-1 pseudoviruses. Broad HIV-1 neutralizing antibody activity was confirmed with IgG and heterlogous clade testing (18 pseudoviruses from Clades A, C, and CRF02_AG). Statistical analysis was performed to determine factors associated with broad HIV-1 neutralizing antibody activity. Results Ten individuals with broad HIV-1 neutralizing antibody activity were identified. These individuals had a median CD4 count of 589 cells/ul (range 202–927), 1,611 HIV-1 RNA copies/ml (range 110–8,964), and 13 years since HIV diagnosis (range 1–22). There was a significant correlation between the presence of broadly neutralizing antibodies in those with HIV-1 RNA between 100 and 10,000 copies/ml compared to those <100 or >10,000 copies/ml (p=.0003 and .0245, respectively). Individuals with HIV-1 RNA 100–10,000 copies/ml had a higher number of Tier 2 viruses neutralized compared to the <100or >10,000 copies/ml groups (p=< .0001 and p=.076, respectively). Male sex was associated with broad HIV-1 neutralizing antibody activity (p=.016). Conclusion These results indicate that low but persistent HIV antigen expression correlates with broad HIV-1 neutralizing antibody activity. At higher levels of plasma viremia, neutralization titers were diminished. Conversely, at lower levels, there appears to be insufficient antigen stimulation to maintain high neutralization titers. These findings may have important implications in furthering the understanding of the humoral response to HIV infection.

Purpose We designed this retrospective observational study on the use of a 2 -agonist dexmedetomidine to determine the optimum intranasal dose to achieve sedation for pediatric transthoracic echocardiography and to identify any dose-related adverse effects. Methods Outpatient children aged three months to three years with diverse diagnoses of congenital heart disease, including cyanotic cardiac defects, underwent transthoracic echocardiography under dexmedetomidine sedation. Aerosolized intranasal dexmedetomidine was administered with initial doses ranging from 1-3 lgÁkg -1 . A rescue dose of 1 lgÁkg -1 was administered if adequate sedation was not achieved within 45 min following the first dose. The primary study outcome was the achievement of adequate sedation to allow transthoracic echocardiography (TTE) scanning, including subxiphoid and suprasternal probe manipulation.Results Sedation with intranasal dexmedetomidine for transthoracic echocardiography was successful in 62 of the 63 (98%) patients studied, with an intranasal rescue dose required in 13 (21%) patients. Intranasal doses of dexmedetomidine 2.5-3.0 lgÁkg -1 were required for tolerating TTE probe placement, including subxiphoid and suprasternal manipulation, with minimal response and a 90% success rate. Excluding patients who required a second dose of dexmedetomidine, the mean (standard deviation) time from administration to achieving such sedation (onset time) was 26 (8) min for low-dose (1-2 lgÁkg -1 ) dexmedetomidine and 28 (8) min for moderate-dose (2.5-3.0 lgÁkg -1 ) dexmedetomidine (P = 0.33). Time from administration of low-dose dexmedetomidine to discharge, including TTE scan time, was 80 (14) min, and it increased with moderate-dose dexmedetomidine to 91 (22) min (P = 0.05). Mild to moderate bradycardia and hypotension were observed, but no interventions were required. Conclusion We found that aerosolized intranasal dexmedetomidine offers satisfactory conditions for TTE in children three months to three years of age with an optimal dose of 2.5-3.0 lgÁkg -1 administered under the supervision of a pediatric cardiac anesthesiologist. RésuméObjectif Nous avons conçu cette étude observationnelle rétrospective sur l'utilisation de la dexmédétomidine, un agoniste des récepteurs a 2 , afin de déterminer la dose intranasale optimale pour obtenir une sédation pour l'échocardiographie transthoracique chez l'enfant et d'identifier tout effet secondaire néfaste lié à la dose.Presentation: Children's Hospital of Philadelphia ''Cardiology 2015''; Scottsdale, AZ, USA.

These results suggest that the described dose regimen of propofol used alone or in combination with sevoflurane appears to be associated with more oxygen desaturations and a lower rate of successful completion than a combination of dexmedetomidine and ketamine during DISE in children with OSA.

Administration of a prophylactic anticholinergic with Dex shows no advantage other than a transient clinically insignificant increase in HR and SBP, and it may precipitate transient exaggerated SBP in more patients compared with not using a prophylactic anticholinergic.