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2,334,500 |
Influence of the Headgroup on the Interaction of Poly(ethylene oxide)-Poly(propylene oxide) Block Copolymers with Lipid Bilayers.
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The lipid headgroup plays an important role in the association of polymers with lipid bilayer membranes. Herein, we report how a glycerol headgroup versus a choline headgroup affects the interaction of poly(ethylene oxide)-<i>b</i>-poly(propylene oxide) (PEO-PPO) block copolymers with lipid bilayer vesicles. Unilamellar vesicles composed of phosphatidylcholine and phosphatidylglycerol at various molar ratios were used as model membranes. The interactions between the block copolymers and lipid bilayers were quantified by pulsed-field gradient nuclear magnetic resonance (PFG-NMR) based on the distinctly different mobilities of free and bound polymers. All the investigated polymer species showed significantly higher binding with 1-palmitoyl-2-oleoyl-<i>sn</i>-glycero-3-phospho-(1'-rac-glycerol) sodium salt (POPG) liposomes than with 1-palmitoyl-2-oleoyl-<i>sn</i>-glycero-3-phosphocholine (POPC) liposomes, indicating stronger association with the glycerol headgroup compared to the choline headgroup. This effect did not become significant until the composition of mixed POPC/POPG liposomes contained more than 20 mol % POPG. A plausible explanation for the enhanced polymer binding with POPG invokes the role of hydrogen bonding between the glycerol headgroup and the ether moieties of the polymers.
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2,334,501 |
Effects of intravenous dexmedetomidine on spinal anesthesia and sedation - A comparison of two different maintenance infusions.
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Our aim was to study the effects of a low-dose bolus (0.5 mcg/kg) of dexmedetomidine followed by two different infusion doses (0.25, 0.5 mcg/kg/h) on spinal anesthesia, sedation, hemodynamics and side effects.</AbstractText>Eighty consenting patients were randomized into two groups A and B with 40 patients each. Patients in both groups were administered intravenous (IV) dexmedetomidine 0.5 mcg/kg over 10 min prior to SAB followed by IV dexmedetomidine 0.25 mcg/kg/h infusion (A) and 0.5 mcg/kg/h infusion (B) throughout the duration of surgery. Time for onset of sensory and motor block, duration of motor block and analgesia, time for two segment regression, intra operative hemodynamics and sedation were assessed. P</i> value less than 0.05 was taken as significant.</AbstractText>Onset of sensory block to T10 was 2.1 ± 0.3 min in group A and group B. Onset of motor block was 4.6 ± 0.9 min in group A and 4.3 ± 0.9 min in group B. Duration of motor block in group A was 235.6 ± 12.4 min compared to group B which was 245.3 ± 9.3 min. Time for 2 segment regression in group A was 139.7 ± 29.7 min compared to group B which was 152.3 ± 18.7 min. Total duration of analgesia was 259.3 ± 92.4 min in group A and 273.8 ± 52.3 min in group B. There was a significant reduction in heart rate and mean blood pressure compared to the baseline within both the groups. Sedation was comparable in both the groups.</AbstractText>IV dexmedetomidine bolus of 0.5 mcg/kg prior to subarachnoid block followed by maintenance infusion of 0.5 mcg/kg/h significantly prolonged duration of motor block, time for two segment regression, along with stable hemodynamics and adequate sedation.</AbstractText>Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology.</CopyrightInformation>
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2,334,502 |
Efficacy of multimodal analgesia with perineural buprenorphine or dexmedetomidine for surgeries performed under ultrasound-guided infraclavicular brachial plexus block.
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Perineural adjuvants when used as a part of multimodal analgesia (MMA) will maximize the quality and duration of analgesia of the nerve blocks. In the present study, we compared the duration of postoperative analgesia and other block characteristics of two groups of MMA comprising either perineural buprenorphine or dexmedetomidine in the upper limb surgeries performed under ultrasound-guided (US-guided) infraclavicular brachial plexus blocks.</AbstractText>A total of 100 adult patients undergoing elective upper limb orthopedic surgery under US-guided infraclavicular brachial plexus block were randomly divided into two groups. Group I received 150 μg buprenorphine and Group II received 50 μg dexmedetomidine, perineurally added to 30 ml of 0.375% bupivacaine. Both groups also received tramadol 50 mg IV, dexamethasone 4 mg IV, and diclofenac 75 mg infusion as part of MMA. Both groups were compared for the duration of postoperative analgesia, block characteristics, and incidence of adverse effects.</AbstractText>The duration of postoperative analgesia was significantly prolonged in Group II (937.6 ± 179.1 min vs 1280.4 ± 288.8 min). The onset of sensory and motor blocks was shorter in Group II (P</i> < 0.05). The duration of sensory and motor blocks was significantly prolonged in Group II (P</i> < 0.05). The number of rescue analgesics required in the first 24 hours was less in Group II (1.98 ± 0.62 vs 0.8 ± 0.64). Although heart rate and blood pressure levels were lower in Group II, all patients were hemodynamically stable.</AbstractText>For surgeries under brachial plexus block, perineural dexmedetomidine when used as a part of MMA provided a prolonged duration of postoperative analgesia and improved block characteristics than perineural buprenorphine.</AbstractText>Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology.</CopyrightInformation>
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2,334,503 |
Quantitative assessment of near-infrared spectroscopy time course under hypercapnia using an a priori model-based fitting.
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Partial arterial pressure of carbon dioxide (CO2</sub>) modulates cerebral blood flow through a vasoreactivity mechanism. Near infrared spectroscopy (NIRS) can be used to record these changes in cerebral hemodynamics. However, no laterality comparison of the NIRS signal has been performed despite being a prerequisite for the use of such a method in a vasoreactivity monitoring context. We propose to investigate the NIRS signal laterality in response to a CO2</sub>-inhalation-based hypercapnia paradigm in healthy volunteers.</AbstractText>Eleven healthy volunteers (6 women, 5 men, mean age: 31 ± 11) underwent a 3-block-design inhalation paradigm: normoxia (5min, "baseline") - hypercapnia (2min, "stimulation") - normoxia (5min, "post-stimulation"). NIRS signal was measured using a two-channel oximeter (INVOS 5100C, Medtronic, USA) with sensors placed symmetrically on both left and right sides on each subject's forehead. Additional heart rate (HR) monitoring was performed simultaneously. Based on the NIRS mean signal pattern, an a priori model of parametric identification was applied for each channel to quantify parameters of interest (amplitude, time delay, excitation and post-stimulation time) for each inhalation block.</AbstractText>HR increased significantly during the stimulation block. The quality of the model was satisfactory: mean absolute errors between modeled and experimental signals were lower than the resolution of the device. No significant lateralization was found between left and right values of most of the parameters.</AbstractText>Due to the lack of lateralization, this parametric identification of NIRS responses to hypercapnia could bring light to a potential asymmetry and be used as a biomarker in patients with cerebrovascular diseases.</AbstractText>Copyright © 2020 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,334,504 |
Post-Cardiotomy Parasternal Nerve Block with Bupivacaine may be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study.
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Postoperative pain treatment affects immediate and long-term outcomes in children undergoing cardiac surgery. Opioids, as part of multimodal analgesia, are effective in treating pain, however, they can be disadvantageous due to adverse side effects. Therefore, we assessed whether the local anesthetic bupivacaine as a parasternal nerve block in children post-cardiac surgery is an effective adjunct to pain management. This was a retrospective cohort study of all patients who underwent cardiothoracic surgery via median sternotomy at a large children's hospital between November 2011 and February 2014 with and without bupivacaine following the introduction of perioperative bupivacaine in late 2012 on a single unit. 62 out of 148 patients (age 3-17 years) who received bupivacaine demonstrated decreased postoperative opioid use. Within one day of surgery, patients who received bupivacaine required, on average, 0.57 mg/kg (95% CI, 0.46 to 0.68) of total morphine equivalent compared to 0.93 mg/kg (95% CI, 0.80 to 1.06) for patients who did not receive bupivacaine. This difference was statistically significant after adjusting for potential confounders (<i>p</i>-value = 0.002). Length of stay and intubation were shorter on average among patients who received bupivacaine, but these differences were not statistically significant after adjusting for potential confounders. The study results seem to suggest that the perioperative administration of bupivacaine may reduce opioid usage among children post-cardiotomy.
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2,334,505 |
Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest.
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Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates.</AbstractText>To examine the association between area deprivation, rurality, and screening for breast, cervical, and colorectal cancer in patients from an integrated health care delivery system in 3 US Midwest states (Minnesota, Iowa, and Wisconsin).</AbstractText><AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS">In this cross-sectional study of adults receiving primary care at 75 primary care practices in Minnesota, Iowa, and Wisconsin, rates of recommended breast, cervical, and colorectal cancer screening completion were ascertained using electronic health records between July 1, 2016, and June 30, 2017. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators and was calculated for all census block groups in Minnesota, Iowa, and Wisconsin (11 230 census block groups). Rurality was defined at the zip code level. Using multivariable logistic regression, this study examined the association between the ADI, rurality, and completion of cancer screening after adjusting for age, Charlson Comorbidity Index, race, and sex (for colorectal cancer only).</AbstractText>Completion of recommended breast, cervical, and colorectal cancer screening.</AbstractText>The study cohorts were composed of 78 302 patients eligible for breast cancer screening (mean [SD] age, 61.8 [7.1] years), 126 731 patients eligible for cervical cancer screening (mean [SD] age, 42.6 [13.2] years), and 145 550 patients eligible for colorectal cancer screening (mean [SD] age, 62.4 [7.0] years; 52.9% [77 048 of 145 550] female). The odds of completing recommended screening were decreased for individuals living in the most deprived (highest ADI) census block group quintile compared with the least deprived (lowest ADI) quintile: the odds ratios were 0.51 (95% CI, 0.46-0.57) for breast cancer, 0.58 (95% CI, 0.54-0.62) for cervical cancer, and 0.57 (95% CI, 0.53-0.61) for colorectal cancer. Individuals living in rural areas compared with urban areas also had lower rates of cancer screening: the odds ratios were 0.76 (95% CI, 0.72-0.79) for breast cancer, 0.81 (95% CI, 0.79-0.83) for cervical cancer, and 0.93 (95% CI, 0.91-0.96) for colorectal cancer.</AbstractText>Individuals living in areas of greater deprivation and rurality had lower rates of recommended cancer screening, signaling the need for effective intervention strategies that may include improved community partnerships and patient engagement to enhance access to screening in highest-risk populations.</AbstractText>
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2,334,506 |
Enhancement of Loading Efficiency by Coloading of Doxorubicin and Quercetin in Thermoresponsive Polymeric Micelles.
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Chemotherapy faces challenges, including poor aqueous solubility of the drugs, and cardiotoxicity. Micellar drug delivery systems (DDS) are used to encapsulate anticancer drugs for better therapeutic effects, however, with poor loading content. Herein, we synthesized a micellar DDS using γ-benzyloxy substituted poly(ε-caprolactone) as the hydrophobic block and coloaded anticancer doxorubicin (Dox) and antioxidant quercetin (Que). γ-Substituted oligo(ethylene) glycol (OEG) poly(ε-caprolactone)s were used as hydrophilic blocks to make the polymers thermoresponsive. Variation of the OEG chain allowed the tunability of the lower critical solution temperature. Moreover, drug loading and release were studied. Thermodynamic stability, size, and morphology were determined by fluorescence measurements, dynamic light scattering, and transmission electron microscopy. Combination loading demonstrated improved loading of Dox and Que. Biological studies were performed using HepG2 human liver cancer and H9c2 rat heart cells. The use of biodegradable, biocompatible, and thermoresponsive polymers along with the coloading approach is a good strategy in developing DDSs.
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2,334,507 |
Patterns and Trends in Advance Care Planning Among Older Adults Who Received Intensive Care at the End of Life.
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This study uses Medicare claims data to identify and assess disparities in the use of advance care planning among adults 65 years or older who died between 2000 and 2015 and received intensive care during the last 30 days of life.
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2,334,508 |
[Application of dural puncture epidural technique for labor analgesia].
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<b>Objective:</b> To investigate the effects of dural puncture epidural technique for labor analgesia on mothers and neonates. <b>Methods:</b> From January to June 2019, one hundred healthy and nulliparous women, scheduled for elective labor analgesia in the Second Affiliated Hospital of Wenzhou Medical University, met inclusion criteriaand were recruitedin this prospective study. The inclusion criteria are as follows: American Society of Anesthesiologists physical statusⅠorⅡ, New York Heart Association gradeⅠorⅡ,150-175 cm in height,50-90 kg in weight and 37-45 weeks of gestation. They were randomly divided into epidural analgesia group(group P, <i>n=</i>50)and dural puncture epidural group(group D, <i>n=</i>50) by using random number table. Parturients in group D received epidural catheterization immediate after successful epidural puncture, while parturients in group P received a single dural puncture into subarachnoid space with a 27 gauge needle (successful puncture: outflow of cerebrospinal fluid) before epidural catheterization. Epidural labor analgesia was performed with epidural infusion of 0.1% ropivacaine plus 0.25 μg/ml sufentanil in both groups. The VAS scores were evaluated at the following time points: before epidural infusion, each uterine contraction within 30 min after infusion, 30 min, 60 min and 90 min after infusion and withdrawal of infusion. Labor process, mode of delivery, cases of increased oxytocin using, effective PCA pressings, sufentanil and ropivacaine dosages, complications of analgesia, neonatal status were recorded, as well. <b>Results:</b> There were no significant differences in labor duration, mode of delivery, analgesia complications (nausea and vomiting, itching, headache after delivery and Bromage score for motor block), deceleration of fetal heart rate and neonatal Apgar score between the two groups (<i>P></i>0.05). The number of effective PCA pressings, sufentanil dosage, ropivacaine dosage and cases of increased using of oxytocin were significantly more in group P(<i>t=</i>8.663,7.024,6.509,χ(2)=4.159,all <i>P<</i>0.05), with (8.6±2.5) times, (29±4) μg,(105±15) mg,28% in group P, compared with (4.6±2.1) times,(23±4) μg,(88±12) mg,10% in group D, respectively. The first four VAS scores of uterine contraction after analgesia in group P(VAS=7.9±1.1,6.8± 0.9, 5.6±0.8, 4.5±0.8)were significantly higher than those in group D (VAS=6.8±0.7,4.7±0.8,3.5±0.8,2.9±0.7,<i>t=</i>5.966,12.332,13.125,10.643,all <i>P<</i>0.05). The VAS scores at 90 min after analgesia and withdrawal of analgesia (VAS=2.7±0.6, 2.9±0.7) in group P were significantly higher than those in group D (VAS=2.4±0.6, 2.5±0.6, <i>t=</i>2.500, 3.068, all <i>P<</i>0.05). <b>Conclusion:</b> Compared with traditional epidural technique, dural puncture epidural technique can provide a rapid and effective analgesia with less analgesics, but without increasing adverse effects on mother and infant.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Lu</LastName><ForeName>Y Y</ForeName><Initials>YY</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cai</LastName><ForeName>J J</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jin</LastName><ForeName>S W</ForeName><Initials>SW</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>C H</ForeName><Initials>CH</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhou</LastName><ForeName>Y F</ForeName><Initials>YF</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hu</LastName><ForeName>M P</ForeName><Initials>MP</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Li</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>Y20190518</GrantID><Agency>Science and Technology Planning Project of Wenzhou</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Yi Xue Za Zhi</MedlineTA><NlmUniqueID>7511141</NlmUniqueID><ISSNLinking>0376-2491</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000700">Analgesics</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000779">Anesthetics, Local</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D015360" MajorTopicYN="Y">Analgesia, Epidural</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016362" MajorTopicYN="Y">Analgesia, Obstetrical</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000700" MajorTopicYN="N">Analgesics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000779" MajorTopicYN="N">Anesthetics, Local</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007743" MajorTopicYN="Y">Labor, Obstetric</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011247" MajorTopicYN="N">Pregnancy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011677" MajorTopicYN="N">Punctures</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨硬脊膜穿破硬膜外阻滞技术在分娩镇痛时对母婴的影响。 <b>方法：</b> 本研究为前瞻性研究，选取2019年1至6月在温州医科大学附属第二医院拟行分娩镇痛的健康初产妇100例，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，美国纽约心脏病学会（NYHA）心功能分级Ⅰ或Ⅱ级。身高150~175 cm，体重50~90 kg，孕周37~45周。采用随机数字表法分为硬膜外镇痛组（P组，<i>n=</i>50）和硬脊膜穿破硬膜外镇痛组（D组，<i>n=</i>50）。硬膜外腔穿刺成功后P组作硬膜外置管；D组用27号腰麻穿刺针刺破硬脊膜到达蛛网膜下腔（确定标准：有脑脊髓液流出），再拔掉穿刺针，作硬膜外置管；两组均予0.1%罗哌卡因+0.25 μg/ml舒芬太尼方案的硬膜外分娩镇痛。评定注药前、注药后30 min内每次宫缩时，以及注药后30、60、90 min及停止用药时的疼痛视觉模拟评分（VAS）。记录各产程情况、分娩方式、缩宫素使用增加病例数、两组产妇自控镇痛泵（PCA）有效按压次数、舒芬太尼及罗哌卡因用量和镇痛并发症发生情况及新生儿情况等。 <b>结果：</b> 两组产妇产程、分娩方式及镇痛并发症（恶心呕吐、瘙痒、分娩后头痛、运动阻滞Bromage评分）等差异均无统计学意义（均<i>P></i>0.05）；两组胎儿胎心减速发生率及新生儿Aprar评分差异均无统计学意义（均<i>P></i>0.05）。P组PCA有效按压次数、舒芬太尼用量、罗哌卡因用量及缩宫素使用增加率分别为（8.6±2.5）次、（29±4）μg、（105±15）mg、28%，D组分别为（4.6±2.1）次、（23±4）μg、（88±12）mg、10%，差异均有统计学意义（<i>t=</i>8.663、7.024、6.509，χ(2)=4.159，均<i>P<</i>0.05）。P组在镇痛后前4次宫缩VAS评分分别为（7.9±1.1）、（6.8±0.9）、（5.6±0.8）、（4.5±0.8）分，均显著高于D组的（6.8±0.7）、（4.7±0.8）、（3.5±0.8）、（2.9±0.7）分，差异均有统计学意义（<i>t=</i>5.966、12.332、13.125、10.643，均<i>P<</i>0.05）。P组镇痛90 min、停药时的VAS评分分别为（2.7±0.6）、（2.9±0.7）分，明显高于D组的（2.4±0.6）、（2.5±0.6）分，差异均有统计学意义（<i>t=</i>2.500、3.068，均<i>P<</i>0.05）。 <b>结论：</b> 采用硬脊膜穿破硬膜外阻滞技术行分娩镇痛较传统硬膜外技术能提供快速、有效的镇痛效果，镇痛药物用量少，且对母婴无不良影响。.
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2,334,509 |
Postoperative pain management for circumcision; Comparison of frequently used methods.
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To determine the ideal method for postoperative pain management after circumcision by comparing the most frequently used different methods like; dorsal penile block, caudal epidural block, subcutaneous ring block, intravenous paracetamol and intravenous tramadol HCl.</AbstractText>Between May 1st</sup> 2015 to May 1st</sup> 2016, 500 children between 2-10 year old were circumcised at the department of pediatric surgery of Istanbul Medipol University Health Care Practice & Research Center Sefakoy Hospital. Five groups were formed according to postoperative analgesia methods which were planned to be compared; Group-I. penile block, Group-II. Caudal epidural block, Group-III. subcutaneous ring block, Group-IV as intravenous paracetamol and Group-V as intravenous tramadol HCl. In order to evaluate the postoperative pain levels of children, Children's Hospital Eastern Ontario Pain Scale (CHEOPS) was filled at 30, 60, 120, 180 minutes after circumcision by a researcher who does not know which method was applied.</AbstractText>No significant difference is found between the groups (p>0.05). In the statistical analysis, no significant difference was found in the effect of analgesia methods on CHEOPS scores between 30, 60, 120 and 180 minutes (p>0.05). In parallel with this result, no significant difference was found in the effect of heart beat rates and respiration rate averages between 30, 60, 120 and 180 minutes (p>0.05).</AbstractText>It has been shown that none of the five method has any superiority in reducing pain after circumcision and that all five methods can be used. However, we think that side effects of regional anesthesia and systemic analgesic applications should not be ignored.</AbstractText>Copyright: © Pakistan Journal of Medical Sciences.</CopyrightInformation>
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2,334,510 |
Measures of Poor Sleep Quality Are Associated With Higher Energy Intake and Poor Diet Quality in a Diverse Sample of Women From the Go Red for Women Strategically Focused Research Network.
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Background Poor sleep increases cardiovascular disease risk, and diet likely contributes to this relationship. However, there are limited epidemiological data on the relationship between measures of sleep quality and habitual dietary patterns. This study examined these associations in a diverse sample of women. Methods and Results Baseline data from 495 participants in the AHA Go Red for Women prospective cohort study (age: 20-76 years; 61% racial/ethnic minority) were examined. Sleep quality and sleep-onset latency were measured using the Pittsburgh Sleep Quality Index (PSQI) and insomnia using the Insomnia Severity Index. The validated Block Brief Food Frequency Questionnaire was used to assess diet quantity and quality. Linear regression models adjusted for confounding variables tested relationships between sleep and diet variables. Results showed that higher PSQI scores, indicative of poorer sleep quality, were associated with lower unsaturated fat intake (β=-0.14, <i>P</i><0.05) and higher food weight (β=14.9, <i>P</i>=0.02) and added sugars consumed (β=0.44, <i>P</i>=0.04). Women with sleep-onset latency >60 minutes had higher intakes of food by weight (β=235.2, <i>P<</i>0.01) and energy (β=426, <i>P</i><0.01), and lower intakes of whole grains (β=-0.37, <i>P</i>=0.01) than women with sleep-onset latency ≤15 minutes. Greater insomnia severity was associated with higher food weight (β=9.4, <i>P</i>=0.02) and energy (β=17, <i>P</i>=0.01) consumed and lower total (β=-0.15, <i>P</i>=0.01) and unsaturated fat intakes (β=-0.11, <i>P</i><0.01). Conclusions Poor sleep quality was associated with greater food intake and lower-quality diet, which can increase cardiovascular disease risk. Future studies should test whether promoting sleep quality could augment efforts to improve cardiometabolic health in women.
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2,334,511 |
Novel Predictors of New Persistent Left Bundle Branch Block After SAPIEN 3 Transcatheter Aortic Valve Replacement.<Pagination><StartPage>1141</StartPage><EndPage>1143</EndPage><MedlinePgn>1141-1143</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jcin.2019.10.053</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S1936-8798(19)32313-1</ELocationID><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Zaid</LastName><ForeName>Syed</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Ahmad</LastName><ForeName>Hasan</ForeName><Initials>H</Initials></Author><Author ValidYN="Y"><LastName>Kaple</LastName><ForeName>Ryan</ForeName><Initials>R</Initials></Author><Author ValidYN="Y"><LastName>Undemir</LastName><ForeName>Cenap</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Lansman</LastName><ForeName>Steven L</ForeName><Initials>SL</Initials></Author><Author ValidYN="Y"><LastName>Dangas</LastName><ForeName>George D</ForeName><Initials>GD</Initials></Author><Author ValidYN="Y"><LastName>Sharma</LastName><ForeName>Samin K</ForeName><Initials>SK</Initials></Author><Author ValidYN="Y"><LastName>Kini</LastName><ForeName>Annapoorna</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Tang</LastName><ForeName>Gilbert H L</ForeName><Initials>GHL</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016422">Letter</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>02</Month><Day>12</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>JACC Cardiovasc Interv</MedlineTA><NlmUniqueID>101467004</NlmUniqueID><ISSNLinking>1936-8798</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001024" MajorTopicYN="N">Aortic Valve Stenosis</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002037" MajorTopicYN="N">Bundle-Branch Block</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000209" MajorTopicYN="Y">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006350" MajorTopicYN="Y">Heart Valve Prosthesis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011474" MajorTopicYN="N">Prosthesis Design</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D065467" MajorTopicYN="N">Transcatheter Aortic Valve Replacement</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName><QualifierName UI="Q000295" MajorTopicYN="Y">instrumentation</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>10</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2019</Year><Month>10</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>10</Month><Day>29</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>2</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>11</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>2</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32061602</ArticleId><ArticleId IdType="doi">10.1016/j.jcin.2019.10.053</ArticleId><ArticleId IdType="pii">S1936-8798(19)32313-1</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedBookArticle><BookDocument><PMID Version="1">31643625</PMID><ArticleIdList><ArticleId IdType="bookaccession">NBK548302</ArticleId></ArticleIdList><Book><Publisher><PublisherName>National Institute of Diabetes and Digestive and Kidney Diseases</PublisherName><PublisherLocation>Bethesda (MD)</PublisherLocation></Publisher><BookTitle book="livertox">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury</BookTitle><PubDate><Year>2012</Year></PubDate><BeginningDate><Year>2012</Year></BeginningDate><Medium>Internet</Medium></Book><ArticleTitle book="livertox" part="Transplant_Drugs">Transplant Agents
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Solid organ transplantation has been made possible by the development of potent immunosuppressive agents which block cellular rejection adequately for survival of the transplanted organ and induction of at least partial tolerance. The first regimens that were found to successfully prevent cellular rejection consisted of high doses of corticosteroids and an immunosuppressive antimetabolite such as azathioprine, 6-mercaptopurine or cyclophosphamide. These combinations allowed for the initial successes in renal, liver, lung and heart transplantation in the 1950s and 1960s. However, acute and chronic rejection as well as complications of high dose corticosteroid therapy remained major problems. The subsequent introduction of the calcineurin inhibitors, cyclosporine and tacrolimus in the 1980s placed organ transplantation on a solid basis, leading to its acceptance as the standard of care for end-stage kidney, liver, heart and lung disease. The further addition of the newer, more specific antiproliferative and immunosuppressive agents–mycophenolate mofetil (1995) and sirolimus (1999)–have further improved the management of patients after solid organ transplantation. All of these agents are associated with mild liver test abnormalities that occur early during therapy or shortly after transplantation and that resolve rapidly with dose modification. While these potent immunosuppressive agents all have some degree of liver toxicity, clinically significant injury is rare and has invariably been mild and rapidly reversible with dose modification or switching to another agent. These agents are often used in patients with underlying liver disease or who are receiving multiple potentially hepatotoxic drugs, so that their role in causing hepatic injury is not always clear. The following drugs used to prevent transplant rejection are discussed separately. The references regarding the hepatotoxicity and safety of these agents are given together below. References updated: 17 February 2020
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2,334,512 |
Comparing the prophylactic effects of oral gabapentin, pregabalin, and celecoxib on postoperative pain management in orthopedic surgery of the lower extremity: A double-blind randomized controlled trial.
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Lower extremity pain after orthopedic surgery is so frequent that has led to many treatment modalities. This study aims to compare the prophylactic effects of oral gabapentin, pregabalin, and celecoxib on reducing postsurgical pain of the lower extremity orthopedic surgery.</AbstractText>In a double-blind randomized controlled trial, 120 patients were randomly divided into four groups using block design randomization. 1 h before spinal anesthesia, the studied groups received 300 mg oral gabapentin; 75 mg oral pregabalin; 200 mg oral celecoxib; and starch as placebo. The severity of postoperative pain (using visual analog scale), mean arterial pressure, heart rate, opioid consumption dose, and drug side effects were recorded for six times (each 60 min up to two times and then every 6 h for the next four times). Chi-square, one-way analysis of variance (ANOVA), and ANOVA repeated measure tests were used for statistical analysis.</AbstractText>Significant reduction of pain severity was observed only at the first time measurement between pregabalin and placebo groups (P</i>: 0.014). Patients in the pregabalin group required lower dose of opioid compared to placebo group during admission in surgical ward. There were no significant differences concerning pain reduction, opioid administration, and side effects between pregabalin, gabapentin, and celecoxib groups.</AbstractText>Taking 75 mg oral pregabalin before lower extremity orthopedic surgery can attenuate postoperative pain, especially during the 1st</sup> h postoperation as well as less opioid consumption and much more patients' satisfaction.</AbstractText>Copyright: © 2020 Journal of Research in Medical Sciences.</CopyrightInformation>
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2,334,513 |
Effect of Scalp Nerve Block with Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy: A Randomized, Double Blinded Study.
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Scalp nerve block with ropivacaine has been shown to provide perioperative analgesia. However, the best concentration of ropivacaine is still unknown for optimal analgesic effects. We performed a prospective study to evaluate the effects of scalp nerve block with varied concentration of ropivacaine on postoperative pain and intraoperative hemodynamic variables in patients undergoing craniotomy under general anesthesia. Eighty-five patients were randomly assigned to receive scalp block with either 0.2% ropivacaine, 0.33% ropivacaine, 0.5% ropivacaine, or normal saline. Intraoperative hemodynamics and post-operative pain scores at 2, 4, 6, 24 hours postoperatively were recorded. We found that scalp blockage with 0.2% and 0.33% ropivacaine provided adequate postoperative pain relief up to 2 h, while administration of 0.5% ropivacaine had a longer duration of action (up to 4 hour after craniotomy). Scalp nerve block with varied concentration of ropivacaine blunted the increase of mean arterial pressure in response to noxious stimuli during incision, drilling, and sawing skull bone. 0.2% and 0.5% ropivacaine decreased heart rate response to incision and drilling. We concluded that scalp block using 0.5% ropivacaine obtain preferable postoperative analgesia compared to lower concentrations. And scalp block with ropivacaine also reduced hemodynamic fluctuations in craniotomy operations.
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2,334,514 |
Ryanodine receptor modulation by caffeine challenge modifies Na<sup>+</sup> current properties in intact murine skeletal muscle fibres.
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We investigated effects of the ryanodine receptor (RyR) modulator caffeine on Na<sup>+</sup> current (I<sub>Na</sub>) activation and inactivation in intact loose-patch clamped murine skeletal muscle fibres subject to a double pulse procedure. I<sub>Na</sub> activation was examined using 10-ms depolarising, V<sub>1</sub>, steps to varying voltages 0-80 mV positive to resting membrane potential. The dependence of the subsequent, I<sub>Na</sub> inactivation on V<sub>1</sub> was examined by superimposed, V<sub>2</sub>, steps to a fixed depolarising voltage. Current-voltage activation and inactivation curves indicated that adding 0.5 and 2 mM caffeine prior to establishing the patch seal respectively produced decreased (within 1 min) and increased (after ~2 min) peak I<sub>Na</sub> followed by its recovery to pretreatment levels (after ~40 and ~30 min respectively). These changes accompanied negative shifts in the voltage dependence of I<sub>Na</sub> inactivation (within 10 min) and subsequent superimposed positive activation and inactivation shifts, following 0.5 mM caffeine challenge. In contrast, 2 mM caffeine elicited delayed negative shifts in both activation and inactivation. These effects were abrogated if caffeine was added after establishing the patch seal or with RyR block by 10 μM dantrolene. These effects precisely paralleled previous reports of persistently (~10 min) increased cytosolic [Ca<sup>2+</sup>] with 0.5 mM, and an early peak rapidly succeeded by persistently reduced [Ca<sup>2+</sup>] likely reflecting gradual RyR inactivation with ≥1.0 mM caffeine. The latter findings suggested inhibitory effects of even resting cytosolic [Ca<sup>2+</sup>] on I<sub>Na</sub>. They suggest potentially physiologically significant negative feedback regulation of RyR activity on Na<sub>v</sub>1.4 properties through increased or decreased local cytosolic [Ca<sup>2+</sup>], Ca<sup>2+</sup>-calmodulin and FKBP12.
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2,334,515 |
Locally optimized correlation-guided Bayesian adaptive regularization for ultrasound strain imaging.
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Ultrasound strain imaging utilizes radio-frequency (RF) ultrasound echo signals to estimate the relative elasticity of tissue under deformation. Due to the diagnostic value inherent in tissue elasticity, ultrasound strain imaging has found widespread clinical and preclinical applications. Accurate displacement estimation using pre and post-deformation RF signals is a crucial first step to derive high quality strain tensor images. Incorporating regularization into the displacement estimation framework is a commonly employed strategy to improve estimation accuracy and precision. In this work, we propose an adaptive variation of the iterative Bayesian regularization scheme utilizing RF similarity metric signal-to-noise ratio previously proposed by our group. The regularization scheme is incorporated into a 2D multi-level block matching (BM) algorithm for motion estimation. Adaptive nature of our algorithm is attributed to the dynamic variation of iteration number based on the normalized cross-correlation (NCC) function quality and a similarity measure between pre-deformation and motion compensated post-deformation RF signals. The proposed method is validated for either quasi-static and cardiac elastography or strain imaging applications using uniform and inclusion phantoms and canine cardiac deformation simulation models. Performance of adaptive Bayesian regularization was compared to conventional NCC and Bayesian regularization with fixed number of iterations. Results from uniform phantom simulation study show significant improvement in lateral displacement and strain estimation accuracy. For instance, at 1.5% lateral strain in a uniform phantom, Bayesian regularization with five iterations incurred a lateral strain error of 104.49%, which was significantly reduced using our adaptive approach to 27.51% (p   <  0.001). Contrast-to-noise (CNR <sub>e</sub> ) ratios obtained from inclusion phantom indicate improved lesion detectability for both axial and lateral strain images. For instance, at 1.5% lateral strain, Bayesian regularization with five iterations had lateral CNR <sub>e</sub> of  -0.31 dB which was significantly increased using the adaptive approach to 7.42 dB (p   <  0.001). Similar results are seen with cardiac deformation modelling with improvement in myocardial strain images. In vivo feasibility was also demonstrated using data from a healthy murine heart. Overall, the proposed method makes Bayesian regularization robust for clinical and preclinical applications.
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2,334,516 |
Effects of utilizing cotton byproducts in a finishing diet on beef cattle performance, carcass traits, fecal characteristics, and plasma metabolites.
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Increased cotton production in the Southwestern United States has increased the availability of cotton byproducts for use in cattle diets. The objective of this experiment was to evaluate the inclusion of cotton byproducts in feedlot finishing diets on the performance, carcass traits, fecal characteristics, and plasma metabolites of steers. Crossbred beef steers (n = 64; BW = 318 ± 12.3 kg) were assigned to 1 of 2 experimental treatments in a randomized complete block design (8 pens per treatment; 4 steers per pen). Treatments included a control (CON) diet, which included prairie hay, Sweet Bran, rolled corn, and a corn steep and molasses-based liquid fat supplement, and a cotton byproduct (CTN) diet, which included cotton gin trash, whole cottonseed, rolled corn, and water. Both diets contained urea and dry supplement. Over the entire feeding period, DMI (P = 0.04) was greater for CTN steers than CON steers with no difference in the gain to feed ratio (P = 0.86) between treatments. The CTN steers tended to have heavier final BW (P = 0.09) and greater overall average daily gain (P = 0.08). The CTN steers had heavier hot carcass weight (P = 0.02) and greater fat thickness (P = 0.03) than CON steers, but marbling score and rib eye area were not different between treatments (P ≥ 0.64). Steers fed the CON diet tended to have a lower yield grade (P = 0.07), less kidney, pelvic and heart fat (P = 0.09), and decreased dressing percentage (P = 0.10) than CTN steers. Liver scores did not differ (P ≥ 0.17) between treatments. Fecal consistency scores were decreased for CTN steers on day 56 (P = 0.03) and fecal pH tended to be greater for the CTN steers on day 28 (P = 0.09) compared with CON steers, but neither differed during other periods (P ≥ 0.18). A treatment × day interaction (P = 0.04) was detected for plasma urea nitrogen (PUN) concentrations, where PUN concentrations differed between treatments only on days 28 and 56. On both days 28 and 56, CTN steers had lower PUN concentrations (P = 0.03, P = 0.002, respectively). No treatment × day interaction was detected for plasma glucose or lactate concentrations. A day effect was observed for both metabolites (P < 0.01). Results from this experiment suggest that cotton byproducts can be effectively used as a source of fiber, fat, and protein in feedlot rations without adverse effects on performance or carcass characteristics.
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2,334,517 |
Intravenous Fentanyl 4 μg per kg Administered before Scalp Pin Application is Inferior to Scalp Block in Preventing Hemodynamic Changes.
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Application of scalp pins for craniotomy surgeries is a noxious stimulus, causing tachycardia and hypertension, resulting in increased cerebral blood flow and elevated intracranial pressure, hence measures to attenuate this will have beneficial role.</AbstractText>The aim is to compare the effectiveness of scalp block (SB) to 4 μg.kg-1</sup> intravenous (i.v) fentanyl in attenuating hemodynamic response to scalp pin application in patients who underwent elective craniotomy under general anesthesia.</AbstractText>The study design involves prospective, randomized study conducted at Tertiary care center/hospital.</AbstractText>Forty-four American Society of Anesthesiologists physical status Classes l and II patients were randomly allocated into the following groups: Group-SB (n</i> = 22) received SB using 0.25% injection bupivacaine and Group-F (n</i> = 22) received 1 μg.kg-1</sup> i.v fentanyl. Patient's heart rate (HR) and mean arterial pressure (MAP) were recorded from the application of pins till 60 min and rescue analgesic/anesthetic agents and their dosage were noted. Statistical analysis was performed comparing HR and MAP changes to application of scalp pins.</AbstractText>Software developed by the Centre for Disease Control, Atlanta, namely Epidemiological Information Package 2010 was used to derive statistical variables.</AbstractText>Patients were comparable in age, gender, hypertension as comorbidity, baseline HR, and MAP. Significant rise in HR was noted in Group-F till 20th</sup> min compared to Group-SB. MAP was high from application of pins till 60th</sup> min in Group-F compared to Group-SB. Requirement of rescue analgesics/anesthetics was high in Group-F compared to Group-SB.</AbstractText>SB effectively attenuates hemodynamic response to application of scalp pins in patients undergoing elective craniotomy and reduces requirement of rescue analgesic and/or anesthetics.</AbstractText>Copyright: © 2019 Anesthesia: Essays and Researches.</CopyrightInformation>
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2,334,518 |
A Comparative Study of Tramadol and Clonidine as an Additive to Levobupivacaine in Caudal Block in Pediatric Patients Undergoing Perineal Surgeries.
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Caudal block is a simple, safe procedure with fewer side effects to provide intraoperative and postoperative analgesia in pediatric patients. Many drugs were used as an additive to local anesthetics in caudal block. All these drugs had their own side effects.</AbstractText>In this study, we compare the effects of tramadol and clonidine as an additive to levobupivacaine in caudal block in children undergoing perineal surgeries regarding hemodynamic changes, analgesic effects, and side effects.</AbstractText>This is a prospective, double-blind randomized, controlled study, conducted in Department of Paediatric Surgery, at King George's Medical University, Lucknow, Uttar Pradesh during 2017-2018.</AbstractText>After informed consent and ethical clearance from institutional ethics committee, King Georges Medical University, Lucknow. Total 66 patients aged 1-10 year, planned for perineal surgery were randomly allocated according to computer-generated random number, into three groups. Group I - 0.25% levobupivacaine (1 mL.kg-1</sup>) alone, Group II - 0.25% levobupivacaine (1 mL.kg-1</sup>) with tramadol 1 mL.kg-1</sup>, and Group III - 0.25% levobupivacaine (1 mL.kg-1</sup>) with clonidine 1 μg.kg-1</sup>. Perioperative pain was the primary outcome. Hemodynamic parameters: heart rate, mean arterial pressure, and peripheral oxygen saturation were recorded. Postoperative pain assessed by Children and Infants Postoperative Pain Scale (CHIPPS), sedation by Ramsay sedation score and requirement of rescue analgesia were recorded at predetermined time intervals.</AbstractText>The values were represented in number (%) and mean ± standard deviation. Comparison of quantitative variables between the study groups was done using ANOVA test and Mann-Whitney U-test. Categorical data were analyzed using Chi-square test.</AbstractText>Postoperative analgesic effect was significantly longer in levobupivacaine with clonidine group as compared to tramadol with levobupivacaine group and levobupivacaine alone group.</AbstractText>Clonidine in a dose of 1 μg.kg-1</sup> when added to levobupivacaine in caudal block significantly prolongs the duration of analgesia as compared to tramadol with levobupivacaine and levobupivacaine alone without any clinically significant side effects. Thus, it is better to add additive like clonidine to enhance the effect of analgesia.</AbstractText>Copyright: © 2019 Anesthesia: Essays and Researches.</CopyrightInformation>
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2,334,519 |
[Analysis of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope].
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<b>Objective:</b> To investigate the efficacy and safety of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope. <b>Methods:</b> One hundred patients undergoing radical resection of lung cancer under thoracoscope in Affiliated Cancer Hospital of Zhengzhou University from March to September in 2019, were randomly divided into control group (group C) and sugammadex group (group S). All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion of propofol and remifentanil, and intermittent intravenous injection of the neuromuscular block of rocuronium. During the operation, the bispectral index (BIS) was used to monitor the depth of anesthesia, and the neuromuscular block was assessed with TOF. Single-lung mechanical ventilation and double-lumen endotracheal intubation were carried out, and patient-controlled analgesia after operation were enforced. Patients in group C received neostigmine (2 mg) combined with atropine (0.5-1.0 mg) after thoracic closure, while patients in group S received sugammadex (2 mg/kg) at TOF count (≥2) after thoracic closure, and then double-lumen endotracheal tubes were extubated according to extubation indications. At these time points: T(0) (immediate before anesthesia induction), T(1) (immediate before tracheal intubation), T(2) (immediately after thoracic closure), T(3) (1 h after operation), T(4) (6 h after operation), T(5) (24 h after operation), T(6)(48 h after operation), the heart rate(HR) and mean arterial pressure (MAP) were recorded, QT interval (V3 ECG) were measured and calculated, indicators of liver function [alanine transaminase (ALT), aspartate transaminase(AST)], renal function [blood urea nitrogen (BUN), creatinine (Cre)] and clotting function [thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB)] were detected. The duration of operation, postoperative conditions within 48 hours after operation(the time of tracheal tube extubation, respiratory suppression/dysfunction, allergy, nausea and vomiting, itching of skin, abnormal sensation), pathological types and the postoperative hospital stay were recorded. <b>Results:</b> There were no significant differences of the age, sex ratio, body mass index (BMI), American Society of Anesthesiologists (ASA) grading ratio, duration of operation, pathological types and the postoperative hospital stay, HR, MAP and QT interval between two groups (all <i>P></i>0.05). There were no remarkable differences of the levels of serum histamine, ALT, AST, BUN, Cre, TT, PT, APTT and FIB before and after administration of neuromuscular blockade antagonists (neostigmine or Sugammadex) in the same group patients (all <i>P></i>0.05), also no significant differences between group C and group S at the same time points (all <i>P></i>0.05). Average time of tracheal tube extubation in group S [(3.7±1.3) min] was sharply shorter than that in group C [(14.5±4.4) min, <i>t=</i>2.266, <i>P<</i>0.05)]. There were no patients with allergy, skin itching, sensory abnormality in these two groups. There were no significant difference of the incidence of postoperative nausea and vomiting between these two groups. There were 5 patients with respiratory depression in group C and no respiratory depression patient in group S, the difference was statistically significant between these two groups (χ(2)=5.263, <i>P<</i>0.05). <b>Conclusion:</b> Sugammadex is effective for antagonizing the neuromuscular blockade of rocuronium in patients with radical resection of lung cancer under thoracoscope, and can shorten the time of tracheal tube extubation after surgery.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ba</LastName><ForeName>Y F</ForeName><Initials>YF</Initials><AffiliationInfo><Affiliation>Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>Y N</ForeName><Initials>YN</Initials><AffiliationInfo><Affiliation>Medical Department, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003,China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>He</LastName><ForeName>S H</ForeName><Initials>SH</Initials><AffiliationInfo><Affiliation>Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Li</LastName><ForeName>H M</ForeName><Initials>HM</Initials><AffiliationInfo><Affiliation>Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>H R</ForeName><Initials>HR</Initials><AffiliationInfo><Affiliation>Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhu</LastName><ForeName>J P</ForeName><Initials>JP</Initials><AffiliationInfo><Affiliation>Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xing</LastName><ForeName>W Q</ForeName><Initials>WQ</Initials><AffiliationInfo><Affiliation>Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Li</LastName><ForeName>C S</ForeName><Initials>CS</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and perioperative medicine, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450003,China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>201702242</GrantID><Agency>Medical Science and Technology Research Project of Henan Province</Agency><Country/></Grant><Grant><GrantID>182102410015</GrantID><Agency>International Cooperation Research Project on Scientific and Technology of Henan Province</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Yi Xue Za Zhi</MedlineTA><NlmUniqueID>7511141</NlmUniqueID><ISSNLinking>0376-2491</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000732">Androstanols</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D002800">Cholinesterase Inhibitors</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D003473">Neuromuscular Nondepolarizing Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D047408">gamma-Cyclodextrins</NameOfSubstance></Chemical><Chemical><RegistryNumber>361LPM2T56</RegistryNumber><NameOfSubstance UI="D000077122">Sugammadex</NameOfSubstance></Chemical><Chemical><RegistryNumber>3982TWQ96G</RegistryNumber><NameOfSubstance UI="D009388">Neostigmine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000732" MajorTopicYN="N">Androstanols</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000037" MajorTopicYN="N">antagonists & inhibitors</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002800" MajorTopicYN="N">Cholinesterase Inhibitors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008175" MajorTopicYN="N">Lung Neoplasms</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009388" MajorTopicYN="N">Neostigmine</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019148" MajorTopicYN="N">Neuromuscular Blockade</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003473" MajorTopicYN="N">Neuromuscular Nondepolarizing Agents</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="Y">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000077122" MajorTopicYN="N">Sugammadex</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="Y">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D020708" MajorTopicYN="N">Thoracoscopes</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D047408" MajorTopicYN="Y">gamma-Cyclodextrins</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨舒更葡糖钠用于胸腔镜肺癌根治术患者拮抗肌松药作用的有效性和安全性。 <b>方法：</b> 本研究为前瞻性研究。选取2019年3至9月在郑州大学附属肿瘤医院拟行胸腔镜肺癌根治术患者100例，随机数字表法分为对照组（C组）、舒更葡糖钠组（S组）。两组患者均进行静脉靶控输注丙泊酚和瑞芬太尼、静脉推注罗库溴铵进行麻醉诱导和维持，脑电双频指数（BIS）监测麻醉深度，肌松监测仪（TOF）检测肌松，双腔导管气管内插管，单肺机械通气，术后患者自控镇痛（PCA）。C组患者在关闭胸腔后且有自主呼吸时静脉推注新斯的明（2 mg）联合阿托品（0.5~1.0 mg）逆转肌松药作用；S组在关闭胸腔后TOF计数≥2时（无论有无自主呼吸）静脉推注舒更葡糖钠（2 mg/kg）；两组患者均参照拔管指征拔除气管导管。检测麻醉诱导前即刻（T(0)）、气管插管前即刻（T(1)）、关闭胸腔后即刻（T(2)）、术后1 h（T(3)）、术后6 h（T(4)）、术后24 h（T(5)）、术后48 h（T(6)）患者平均动脉压，心率，V3导联心电图的QT间期，血清谷丙转氨酶（ALT），谷草转氨酶（AST），肾功能[血尿素氮（BUN）、血肌酐（Cre）]和凝血功能[血浆凝血酶时间（TT）、血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）]，并记录患者的手术时间、气管导管拔除时间、术后48 h内呼吸抑制、呼吸功能障碍、过敏、恶心呕吐、皮肤瘙痒、感觉异常的发生率，以及术后病理分型、术后住院天数等情况。 <b>结果：</b> 两组患者年龄、性别、体质指数（BMI）、美国麻醉医师协会（ASA）分级、手术时间、术后病理分型、术后住院天数差异均无统计学意义（均<i>P></i>0.05）；两组患者心率、血压和QT间期差异均无统计学意义（均<i>P></i>0.05）；两组患者在应用肌松拮抗剂前后血清组胺、肝功能指标（ALT和AST）、肾功能指标（BUN和Cre）差异均无统计学意义（均<i>P></i>0.05），相同时间点两组间血清组胺、肝功能指标、肾功能指标差异均无统计学意义（均<i>P></i>0.05）；两组患者在应用肌松拮抗剂前后出/凝血功能指标（TT、PT、APTT和FIB）差异均无统计学意义（均<i>P></i>0.05），相同时间点两组间出/凝血功能指标差异均无统计学意义（均<i>P></i>0.05）；S组患者术后气管导管拔管时间为（3.7±1.3）min，短于C组患者的（14.5±4.4）min，差异有统计学意义（<i>t=</i>2.266，<i>P<</i>0.05）；两组术后48 h内均无呼吸功能障碍、过敏、皮肤瘙痒和感觉异常患者，术后恶心呕吐发生率两组差异无统计学意义（<i>P></i>0.05）；术后48 h内C组呼吸抑制患者5例，S组无呼吸抑制患者，差异有统计学意义（χ(2)=5.263，<i>P<</i>0.05）。 <b>结论：</b> 肺癌根治术患者术毕应用舒更葡糖钠拮抗罗库溴铵的肌松作用是有效的，可以缩短术后气管导管拔管时间。.
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2,334,520 |
Fungal infection in a post-renal transplant patient with <i>Diaporthe</i>.
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Post-renal transplant fungal infections continue to be a major cause of mortality and morbidity. Universally reported fungi are Candida, especially Candida albicans, Cryptococcus, Aspergillus, Trichophyton rubrum and Pityriasis versicolor. Here, we report a case of infection caused by a rare fungus Diaporthe. It is an endophyte reported as plant pathogens and infrequently in humans and mammals. The patient was a renal transplant recipient on immunosuppressant. He had hypothyroidism and diagnosed with permanent pacemaker due to a complete heart block. The patient was treated with itraconazole (200 mg) successfully.
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2,334,521 |
A randomized double-blind comparison of the double-space technique versus the single-space technique in combined spinal-epidural anesthesia for cesarean section.
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Combined spinal-epidural anesthesia (CSEA) can be performed with either a single-space technique or a double-space technique for cesarean section. We performed a double-blind randomized controlled study to compare the effect of the double-space technique with that of the single-space technique on sensory block level and side effects.</AbstractText>Parturients undergoing elective cesarean section under regional anesthesia were randomized to receive CSEA with either the double-space technique (double group, n = 20) or the single-space technique (single group, n = 20). In the double group, an epidural catheter was inserted at the L1-2 interspace, and dural puncture was performed at the L3-4 interspace. In the single group, the procedure was performed at the L3-4 interspace using the needle-through-needle technique.</AbstractText>There were no differences in time to readiness or intraoperative level of sensory block between the two groups. The postoperative sensory level was maintained at a higher level in the double group than in the single group (1 h postoperatively, P = 0.029; 6 h postoperatively, P = 0.016). There was no difference between the two groups in terms of side effects. The parturient satisfaction scores 48 h postoperatively were significantly different between groups (9.5 in the double group vs. 8 in the single group, P = 0.004).</AbstractText>We conclude that there were no differences in intraoperative variables between the double-space technique and the single-space technique for CSEA. However, double-space CSEA for cesarean section may be beneficial for controlling postoperative pain and improving parturient satisfaction.</AbstractText>The study was retrospectively registered at https://cris.nih.go.kr under the trial ID KCT0002514. Date of registration: October 27, 2017.</AbstractText>
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2,334,522 |
Canalicular system reorganization during mouse platelet activation as revealed by 3D ultrastructural analysis.
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The canalicular system (CS) has been defined as: <b>1)</b> an inward, invaginated membrane connector that supports entry into and exit from the platelet; <b>2)</b> a static structure stable during platelet isolation; and <b>3)</b> the major source of plasma membrane (PM) for surface area expansion during activation. Recent analysis from STEM tomography and serial block face electron microscopy has challenged the relative importance of CS as the route for granule secretion. Here, We used 3D ultrastructural imaging to reexamine the CS in mouse platelets by generating high-resolution 3D reconstructions to test assumptions 2 and 3. Qualitative and quantitative analysis of whole platelet reconstructions, obtained from immediately fixed or washed platelets fixed post-washing, indicated that CS, even in the presence of activation inhibitors, reorganized during platelet isolation to generate a more interconnected network. Further, CS redistribution into the PM at different times, post-activation, appeared to account for only about half the PM expansion seen in thrombin-activated platelets, <i>in vitro</i>, suggesting that CS reorganization is not sufficient to serve as a dominant membrane reservoir for activated platelets. In sum, our analysis highlights the need to revisit past assumptions about the platelet CS to better understand how this membrane system contributes to platelet function.
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2,334,523 |
Functional analysis of molecular and pharmacological modulators of mitochondrial fatty acid oxidation.
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Fatty acid oxidation (FAO) is a key bioenergetic pathway often dysregulated in diseases. The current knowledge on FAO regulators in mammalian cells is limited and sometimes controversial. Previous FAO analyses involve nonphysiological culture conditions or lack adequate quantification. We herein described a convenient and quantitative assay to monitor dynamic FAO activities of mammalian cells in physiologically relevant settings. The method enabled us to assess various molecular and pharmacological modulators of the FAO pathway in established cell lines, primary cells and mice. Surprisingly, many previously proposed FAO inhibitors such as ranolazine and trimetazidine lacked FAO-interfering activity. In comparison, etomoxir at low micromolar concentrations was sufficient to saturate its target proteins and to block cellular FAO function. Oxfenicine, on the other hand, acted as a partial inhibitor of FAO. As another class of FAO inhibitors that transcriptionally repress FAO genes, antagonists of peroxisome proliferator-activated receptors (PPARs), particularly that of PPARα, significantly decreased cellular FAO activity. Our assay also had sufficient sensitivity to monitor upregulation of FAO in response to environmental glucose depletion and other energy-demanding cues. Altogether this study provided a reliable FAO assay and a clear picture of biological properties of potential FAO modulators in the mammalian system.
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2,334,524 |
Is it feasible "scoop and run while playing" resuscitation on a rescue water craft? A randomized simulation study with lifeguards.
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Response time is a predictive factor for survival of drowning victims and lifesaving. Rescue Water Craft (RWC) are lifeboats very common in lifeguards operations. The aim of this study was to analyze the feasibility of providing effective mouth-to-mouth ventilations and/or cardiopulmonary resuscitation (CPR) on the RWC while sailing at different speeds.</AbstractText>A quasi-experimental cross-over block design was used to test during one minute efforts the effectiveness of Mouth to Mouth ventilation (MM-only) and CRP, at the beach and sailing at two diferents speeds 5 knots(kn) and 10 kn with calm sea. Quality CPR reference were 2015 ERC guidelines.</AbstractText>The data obtained from 13 lifeguards were included, that means that 78 resuscitation test were completed. The MM-only performance skills reached 69.7% ± 40.4 for 5 kn and 60.0% ± 41.8 for 10 kn (p = .59). For full CPR, performance was 74.4% ± 24.2 and 68.5% ± 23.9 respectively. Quality of MM and CPR decreased, not significantly, while sailing at 5 kn and 10 kn [(Q-MM; 5 kn: 59.9% ± 37.8 vs. 10 kn: 43.2% ± 41.4, p = .42)(Q-CPR; 5 kn: 64.8% ± 21.2 and 10 kn: 60.6% ± 21.0, p = .44)]. MM-only and CC variables were significantly worse on RJS when compared with resuscitation at the beach (p < .05). A trend for better results by lifeguards previously training on RJS was observed.</AbstractText>Resuscitation techniques on board of a RWC are feasible and therefore they could be an option for lifeguards when their training, sea conditions, distance and the victim's characteristics allow it. CPR maneuvers may be highly effective at 10 kn, both for MM-only and CPR, however, the quality of the ventilations dramatically worsen with increasing speed.</AbstractText>Copyright © 2019 Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,334,525 |
Early Season Hormonal and Biochemical Changes in Division I Field Hockey Players: Is Fitness Protective?
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Walker, AJ, McFadden, BA, Sanders, DJ, Bozzini, BN, Conway, SP, and Arent, SM. Early season hormonal and biochemical changes in Division I field hockey players: is fitness protective? J Strength Cond Res 34(4): 975-981, 2020-The purpose was to evaluate changes in hormonal and biochemical markers as a result of the accumulated stress of the initial 4-week training block in field hockey players. Women's Division I field hockey players (N = 22; Mage = 19.7 ± 1.1 years) performed testing before the start of preseason (A1) that included body composition (%BF), vertical jump, and V[Combining Dot Above]O2max. Blood draws were conducted at A1 to assess creatine kinase (CK), iron (Fe), hemoglobin (HGB), hematocrit (HCT), percent saturation (%sat), total cortisol (TCORT), free cortisol (FCORT), interleukin-6 (IL-6), sex hormone-binding globulin (SHBG), prolactin (PRL), vitamin D (vitD), and thyroxine (T3). Blood draws were repeated 4 weeks later (A2). Athletes were monitored during this training block, which included 2 weeks of preseason and the first 2 weeks of the season, using heart rate monitors to determine energy expenditure (Kcal) and training load. There were significant disruptions in TCORT, FCORT, T3, CK, Fe, and SHBG (p < 0.05) from A1 to A2. V[Combining Dot Above]O2max accounted for 31% (p < 0.05) of the variance in TCORT and %BF accounting for an additional 20.1% (p < 0.05). V[Combining Dot Above]O2max accounted for 32.7% (p < 0.05) of the variance in FCORT. %BF accounted for 48.9% (p < 0.05) of the variance in T3. Kcal was positively correlated with V[Combining Dot Above]O2max (p < 0.05) and negatively correlated with %BF (p < 0.05). Athletes with higher V[Combining Dot Above]O2max and lower %BF may be capable of a higher work output and therefore more likely to experience increased physiological disruptions during intense training. The high-volume nature of preseason and differences in athlete fitness capabilities require coaches to manage players at an individual level to maintain athlete readiness.
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2,334,526 |
[Effect of Aromatherapy on Menopausal Symptoms, Heart Rate Variability, and Sleep Quality in Women].
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Studies have shown that aromatherapy improve health problems related to anxiety, depression, heart rate variability (HRV), and sleep. However, the effect of aromatherapy in women who suffer from menopausal syndrome and its specific effects on HRV and sleep quality are unknown.</AbstractText>This study designed an aromatherapy intervention and evaluated its effect on menopausal syndrome, HRV, and sleep quality in women.</AbstractText>This double-blinded randomized controlled trial was conducted at a medical center hospital. A total of 84 participants who met the study criteria were randomly assigned using permuted block randomization. The experimental group received a 20-min inhalation of essential oil and the control group received a 20-min inhalation of sweet almond oil every night for 4 weeks. Posttest data was collected at 2 weeks after completion of the intervention. Data were collected using the Green Menopausal Symptom Scale, HRV device, and Pittsburgh Sleep Quality Index.</AbstractText>After adjusting for age, the results of the generalized estimation equations (GEE) showed that all outcomes were significantly different in both the experimental group and the control group (p < .05) for the interaction effect of group and time, and that the outcome of sleep quality on the 2nd week in the control group was not significantly different (p < .066).</AbstractText><AbstractText Label="CONCLUSIONS / IMPLICATIONS FOR PRACTICE" NlmCategory="CONCLUSIONS">This study supports that the 4-week aromatherapy intervention improves menopausal symptoms, the activity of autonomic nervous systems, and sleep quality in women with no adverse side effects. In the future, this intervention may be applied in outpatient departments to promote the health of menopausal women.</AbstractText>
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2,334,527 |
Comparison of peribulbar block and general anaesthesia in mechanical vitrectomy: a prospective observational study.
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Vitrectomy surgery is a common procedure for the treatment of several types of ophthalmologic conditions. It can be performed under regional anaesthesia with peribulbar block (PB) or general anaesthesia (GA). There are no evidence-based recommendations on the optimal anaesthesia strategy for this procedure. The aim of this study was to compare the advantages of PB and GA for vitrectomy surgery.</AbstractText>A prospective observational study was conducted on adults submitted for mechanical vitrectomy between January 2017 and December 2017. Demographic and perioperative data were collected, namely ASA physical status, median arterial pressure, heart rate, postoperative opioid consumption, postoperative nausea and vomiting, times of induction, surgery, recovery, and hospital stay and costs considering medication and material needed. Statistical analysis was performed using SPSS v.25, with chi-square, Fisher and Mann-Whitney U tests, according to the type of variables analysed.</AbstractText>We included 179 patients submitted for mechanical vitrectomy: 91 (51%) with PB and 88 (49%) under GA. Patients submitted to PB were older (69.0 vs. 64.5 years, p=.006) and presented with higher ASA physical status (p=.001). For haemodynamic outcomes, patients submitted to PB presented with less variation of median arterial pressure (-3.0 vs. -13.5mmHg, p=.000) and with no significant differences in heart rate (-2.0 vs. -3.0 bpm, p=.825). In the postoperative period, the PB group presented with decreased need of postoperative analgesia (0.0 vs. 5.0, p=.026) and a lower incidence of nausea and vomiting (1.0 vs. 12.0, p=.001). Times related to anaesthesia and surgery were better in PB group, with shorter induction time (10.0 vs. 11.0min, p=.000), surgery time (56.5 vs. 62.0min, p=.001), recovery time (10.0 vs. 75.5min, p=.000), and hospital stay (2.0 vs. 3.0 days, p=.000). When analysing costs, PB was less expensive than GA (4.65 vs. 12.09 euros, p=.021) CONCLUSION: PB is a reliable and safe alternative to GA for patients undergoing mechanical vitrectomy, permitting good anaesthesia and akinesia conditions during surgery, better haemodynamic stability, and less postoperative complications, especially in older patients and those with more comorbidities.</AbstractText>Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.</CopyrightInformation>
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2,334,528 |
A multicentre study of 244 pregnancies in undifferentiated connective tissue disease: maternal/fetal outcomes and disease evolution.
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To investigate fetal/perinatal and maternal outcomes from a large multicentre cohort of women diagnosed with UCTD.</AbstractText>This multicentre retrospective cohort study describes the outcomes of 224 pregnancies in 133 consecutive women with a diagnosis of UCTD, positive for ANA and aged <45 years old at study inclusion.</AbstractText>Of the 224 pregnancies analysed, 177 (79%) resulted in live births, 45 (20.1%) in miscarriages (defined as pregnancy loss before 12 weeks' gestation), 2 (0.9%) in stillbirths (pregnancy loss after 20 weeks' gestation) and 6 (2.7%) cases showed intrauterine growth restriction. Miscarriages and stillbirths were strongly associated with the presence of aPL and ENA antibodies (P < 0.05). Maternal pregnancy complications were as follows: 5 (2.2%) cases developed pre-eclampsia, 11 (4.9%) cases gestational hypertension and 12 (5.4%) cases gestational diabetes. Joint involvement represented the most frequent clinical manifestation of the cohort (57.9%), followed by RP (40.6%), photosensitivity (32.3%) and haematological manifestations (27.1%). The rate of disease evolution of our cohort from a diagnosis of UCTD to a diagnosis of definite CTD was 12% within a mean time of 5.3 ± 2.8 years. With a total follow-up after first pregnancy of 1417 patient-years, we observed the evolution to a defined CTD in one out of every 88 patient- years.</AbstractText>In our multicentre cohort, women with UCTD had a live birth rate of 79%. Women with UCTD should be referred to specialist follow-up when planning a pregnancy. ENA profiling and aPL testing should be mandatory in this setting, and further therapeutic approaches and management should be planned accordingly.</AbstractText>© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].</CopyrightInformation>
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2,334,529 |
Super-resolution of cardiac magnetic resonance images using Laplacian Pyramid based on Generative Adversarial Networks.
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Cardiac magnetic resonance imaging (MRI) can assist in both functional and structural analysis of the heart, but due to hardware and physical limitations, high-resolution MRI scans is time consuming and peak signal-to-noise ratio (PSNR) is low. The existing super-resolution methods attempt to resolve this issue, but there are still shortcomings, such as hallucinate details after super-resolution, low precision after reconstruction, etc. To dispose these problems, we propose the Laplacian Pyramid Generation Adversarial Network (LSRGAN) in order to generate visually better cardiovascular ultrasound images so as to aid physician diagnosis and treatment.</AbstractText>In order to address the problem of low image resolution, we used the Laplacian Pyramid to analyze the high-frequency detail features of super-resolution (SR) reconstruction of images with different pixel sizes. To eliminate gradient disappearance, we implemented the least squares loss function as the discriminator, we introduce the residual-dense block (RDB) as the basic network building unit is used to generate higher quality images. The experimental results show that the LSRGAN can effectively avoid the illusion details after super-resolution and has the best reconstruction quality. Compared with the state-of-the-art methods, our proposed algorithm generates higher quality super-resolution images that comes with higher peak signal-to-noise ratio and structural similarity (SSIM) scores.</AbstractText>We implemented a novel LSRGAN network model, which solves reduces insufficient resolution and hallucinate details of MRI after super-resolution. Our research presents a superior super-resolution method for medical experts to diagnose and treat myocardial ischemia and myocardial infarction.</AbstractText>Copyright © 2020. Published by Elsevier Ltd.</CopyrightInformation>
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2,334,530 |
Rehabilitation Intervention for Individuals With Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study.
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To investigate feasibility of recruitment, tablet use in intervention delivery, and use of self-report outcome measures and to analyze the effect of Energy Conservation plus Problem-Solving Therapy versus Health Education interventions for individuals with heart failure-associated fatigue.</AbstractText>This feasibility study was a block-randomized controlled trial involving 23 adults, blinded to their group assignment, in a rural southern area in the United States. Individuals with heart failure and fatigue received the interventions for 6 weeks through videoconferencing or telephone. Participants were taught to solve their fatiguerelated problems using energy conservation strategies and the process of Problem-Solving Therapy or educated about health-related topics.</AbstractText>The recruitment rate was 23%. All participants completed the study participation according to their group assignment, except for one participant in the Energy Conservation plus Problem-Solving Therapy group. Participants primarily used the tablet (n=21) rather than the phone (n=2). Self-report errors were noted on Activity Card Sort (n=23). Reported fatigue was significantly lower for both the Energy Conservation plus Problem-Solving Therapy (p=0.03, r=0.49) and Health Education (p=0.004, r=0.64) groups. The Health Education group reported significantly lower fatigue impact (p=0.019, r=0.48). Participation was significantly different in low-physical demand leisure activities (p=0.008; r=0.55) favoring the Energy Conservation plus Problem-Solving Therapy group.</AbstractText>The recruitment and delivery of the interventions were feasible. Activity Card Sort may not be appropriate for this study population due to recall bias. The interventions warrant future research to reduce fatigue and decrease participation in sedentary activities (Clinical Trial Registration number: NCT03820674).</AbstractText>
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2,334,531 |
Temporal registration: a new approach to manage the incomplete recovery of the longitudinal magnetization in the Modified Look-Locker Inversion Recovery sequence (MOLLI) for T1 mapping of the heart.
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To correct with post-processing effects of incomplete recovery of the longitudinal magnetization before a new inversion pulse in the Modified Look-Locker Inversion recovery sequence (MOLLI) sequence.</AbstractText>We model such effects as a temporal shift ([Formula: see text]) of the signal of the Look-Locker block following next inversion pulses. After using the following equation [Formula: see text], a temporal registration of [Formula: see text] is applied to the signal of the affected block to adjust the sampling time of the recovery signal and correct the underlying effect on quantitative T1. To test our approach, simulations, phantoms, and five volunteers' data were used while applying different MOLLI sampling schemes at different heart rates and compared to the reference three-parameter fit.</AbstractText>The temporal registration of the affected signals allows to reach higher accuracy on long T1 when compared to the reference three parameters fit (10.15 vs 22.12% for T1 = 1785 ms; 8.22 vs 14.65% for T1 = 1278 ms), and lower average variation in case of rest-period deletion (62 vs 231 ms).</AbstractText>The proposed approach leads to more accurate T1 in case of incomplete recovery. It is less sensitive to parameters affecting the recovery such as the rest period or the sampling scheme; and, therefore, supports multi-center studies with different MOLLI protocols.</AbstractText>
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2,334,532 |
Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study.
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For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks.</AbstractText>Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 µg/kg dexmedetomidine (maximum volume 4 mL/side).</AbstractText>The modified children's hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P</i> < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P</i> < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P</i> = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects.</AbstractText>Addition of dexmedetomidine 0.5 µg/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.</AbstractText>
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2,334,533 |
Early experience with erector spinae plane blocks in children.
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An erector spinae plane block is a relatively new regional anesthetic technique. Apart from case reports and small series, the literature regarding pediatric use is limited.</AbstractText>Our objective was to determine the efficacy of the erector spinae plane block in children by measuring the heart rate response to incision. Secondary objectives included feasibility, safety, opioid consumption, and pain scores. Furthermore, we reviewed this block in children published since 2016.</AbstractText>Case Series; Level of evidence, IV.</AbstractText>With Institutional Review Board approval, a retrospective chart review was conducted on all patients who received erector spinae plane block for surgery between October 2017 and May 2019 at a single institution. Blocks were performed under anesthesia, using ultrasound guidance prior to surgical incision. Block details and hemodynamic and analgesic data were collected. In addition, a PubMed literature review was conducted to identify all erector spinae plane block related publications in patients ≤18 years of age.</AbstractText>About 164 patients, 2 days-19.4 years, weighing 2.3-94.7 kg, received erector spinae plane blocks. For more than 79% of single injection blocks, placement time was ≤10 minutes. Using a heart rate increase of <10% at skin incision as criterion, 70.1% of patients had a successful block. Only 20% required long-acting opioids intraoperatively. In a subset of infants who underwent gastrostomy surgery using a dose of 0.5 mL/kg, a local anesthetic spread of at least five dermatomes (0.1 mL/kg/dermatome) was achieved. Per the literature review, 33 publications described erector spinae plane block in 128 children. No complications were reported.</AbstractText>Erector spinae plane blocks are relatively easy to perform in children with no complications reported to date. The efficacy of the block for a broad spectrum of surgeries, involving incisions from T1 to L4, is encouraging.</AbstractText>© 2019 John Wiley & Sons Ltd.</CopyrightInformation>
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Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy. A prospective randomised trial.
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Thoracic paravertebral block (TPVB) provides effective analgesia in breast surgery. Recently, use of erector spinae plane block (ESPB) in controlling post-operative pain has proved effective. This study aimed to compare the effect of ESPB with TPVB in post-mastectomy acute pain control.</AbstractText>A prospective, randomised double-blinded study enrolled 70 adult female patients, scheduled for modified radical mastectomy. Patients were randomised into two groups, receiving 20 ml of 0.25% bupivacaine: group I (TPVB) and group II (ESPB). Post-operative 24 h morphine consumption, intra-operative fentanyl consumption, time of the first request for analgesia and post-operative visual analogue scale (VAS), heart rate (HR), mean blood pressure (MBP) and complications were recorded.</AbstractText>Post-operative 24 h morphine consumption and time of the first request for analgesia were comparable between both groups (P</i> = 0.32 and 0.075, respectively). There was no significant difference in the intra-operative fentanyl consumption. There was also no significant difference in VAS between both groups over the 24 h of study. Four patients in group I developed pneumothorax with no significant differences between both groups (P</i> = 0.114). Incidence of nausea and vomiting was comparable between both groups. All patients displayed a stable haemodynamic profile.</AbstractText>Both TPVB and ESPB can be effectively used in controlling post-mastectomy pain and reduce intra-operative and post-operative opioid consumption.</AbstractText>Copyright: © 2019 Indian Journal of Anaesthesia.</CopyrightInformation>
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2,334,535 |
Pterostilbene Attenuates Fructose-Induced Myocardial Fibrosis by Inhibiting ROS-Driven Pitx2c/miR-15b Pathway.
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Excessive fructose consumption induces oxidative stress and myocardial fibrosis. Antioxidant compound pterostilbene has cardioprotective effect in experimental animals. This study is aimed at investigating how fructose drove fibrotic responses via oxidative stress in cardiomyocytes and explored the attenuation mechanisms of pterostilbene. We observed fructose-induced myocardial hypertrophy and fibrosis with ROS overproduction in rats. Paired-like homeodomain 2 (Pitx2c) increase, microRNA-15b (miR-15b) low expression, and p53 phosphorylation (p-p53) upregulation, as well as activation of transforming growth factor-<i>β</i>1 (TGF-<i>β</i>1)/drosophila mothers against DPP homolog (Smads) signaling and connective tissue growth factor (CTGF) induction, were also detected in fructose-fed rat hearts and fructose-exposed rat myocardial cell line H9c2 cells. The results from <i>p53</i> siRNA or <i>TGF-β1</i> siRNA transfection showed that TGF-<i>β</i>1-induced upregulation of CTGF expression and p-p53 activated TGF-<i>β</i>1/Smads signaling in fructose-exposed H9c2 cells. Of note, Pitx2c negatively modulated miR-15b expression <i>via</i> binding to the upstream of the miR-15b genetic loci by chromatin immunoprecipitation and transfection analysis with pEX1-Pitx2c plasmid and <i>Pitx2c</i> siRNA, respectively. In H9c2 cells pretreated with ROS scavenger N-acetylcysteine, or transfected with miR-15b mimic and inhibitor, fructose-induced cardiac ROS overload could drive Pitx2c-mediated miR-15b low expression, then cause p-p53-activated TGF-<i>β</i>1/Smads signaling and CTGF induction in myocardial fibrosis. We also found that pterostilbene significantly improved myocardial hypertrophy and fibrosis in fructose-fed rats and fructose-exposed H9c2 cells. Pterostilbene reduced cardiac ROS to block Pitx2c-mediated miR-15b low expression and p-p53-dependent TGF-<i>β</i>1/Smads signaling activation and CTGF induction in high fructose-induced myocardial fibrosis. These results firstly demonstrated that the ROS-driven Pitx2c/miR-15b pathway was required for p-p53-dependent TGF-<i>β</i>1/Smads signaling activation in fructose-induced myocardial fibrosis. Pterostilbene protected against high fructose-induced myocardial fibrosis through the inhibition of Pitx2c/miR-15b pathway to suppress p-p53-activated TGF-<i>β</i>1/Smads signaling, warranting the consideration of Pitx2c/miR-15b pathway as a therapeutic target in myocardial fibrosis.
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2,334,536 |
The Intriguing Role of Interleukin 13 in the Pathophysiology of Asthma.
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Approximately 5-10% of asthmatic patients worldwide suffer from severe asthma. Experimental and clinical studies have demonstrated that IL-13 is an important cytokine in chronic airways inflammation. IL-13 is involved in Th2 inflammation and has been identified as a possible therapeutic target in the treatment of asthma. Two different human monoclonal antibodies (mAbs) anti-IL-13 (tralokinumab and lebrikizumab) block binding and signaling of IL-13 to its receptors, IL-13Rα1 and IL-13Rα2. Several randomized, double-blind, placebo-controlled multicenter studies have evaluated the safety and efficacy of tralokinumab and lebrikizumab in the treatment of adult patients with severe asthma, but all have failed to meet their primary endpoints. No serious adverse events related to the treatment with these anti-IL-13 mAbs have been reported in these studies. These negative clinical results contrast with positive findings from blocking IL-13 signaling in experimental models of asthma, raising doubts about the transferrable value of some models. Interestingly, dupilumab, a mAb which blocks both IL-4 and IL-13 signaling reduces exacerbation rates and improves lung function in severe asthmatics. These results suggest that IL-4 and IL-13 share some, but not all functional activities in airway inflammation. Tralokinumab might show efficacy in a highly selected cohort of asthmatics characterized by overexpression of IL-13.
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2,334,537 |
Feasibility of non-intubated anesthesia and regional block for thoracoscopic surgery under spontaneous respiration: a prospective cohort study.
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Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.
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2,334,538 |
Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study.
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There is no consensus on the optimal anesthesia method for intertrochanteric fracture surgeries in elderly patients. Our study aimed to compare the hemodynamics and perioperative outcomes of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway (LMA) and nerve block for intertrochanteric fracture surgeries in elderly patients.</AbstractText>This is a retrospective study of 75 patients aged > 60 years scheduled for intertrochanteric fracture surgeries with general anesthesia with intubation (n = 25), combined spinal-epidural anesthesia (n = 25), and general anesthesia with LMA and nerve block (n = 25). The intraoperative hemodynamics were recorded, and the maximum variation rate was calculated. Postoperative analgesic effect was evaluated using the visual analog scale (VAS). Postoperative cognitive status was assessed using the Mini-Mental State Exam (MMSE).</AbstractText>The maximum variation rate of intraoperative heart rate, systolic blood pressure, diastolic blood pressure differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 2 h, 4 h, 6 h, and 8 h also differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 24 h were significantly lower in the general anesthesia with LMA/nerve block group than the general anesthesia with intubation group and the combined spinal-epidural anesthesia group. The MMSE scores postoperative 15 min and 45 min differed significantly between the three groups (general anesthesia with intubation < combined spinal-epidural anesthesia < general anesthesia with LMA and nerve block). The MMSE scores postoperative 120 min in the general anesthesia with intubation group were the lowest among the three groups. There was no significant difference in the incidence of respiratory infection postoperative 24 h, 48 h, and 72 h between the three groups.</AbstractText>Compared to general anesthesia with intubation and combined spinal-epidural anesthesia, general anesthesia with LMA and nerve block had better postoperative analgesic effect and less disturbances on intraoperative hemodynamics and postoperative cognition for elderly patients undergoing intertrochanteric fracture surgeries.</AbstractText>
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2,334,539 |
Access to Primary Care Physicians and Mortality in Washington State: Application of a 2-Step Floating Catchment Area.
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To measure access to primary care physicians (PCPs) using a 2-step floating catchment area and explore the associations between access to PCPs and mortality related to all-causes, cancers, and heart disease in Washington State.</AbstractText>An ecological study employing generalized linear regression models of access to PCPs and mortality rates in 4,761 block groups in Washington State in 2015. To measure access to PCPs, we used a 2-step floating catchment area approach, taking into account area-level population, supply of PCPs, and travel time between PCPs, as well as area-level population with a distance decay function.</AbstractText>A 1-unit increase in PCP access score was associated with a reduction of 4.2 all-cause deaths per 100,000 people controlling for socioeconomic characteristics. A 1-unit increase in PCP access score was associated with a reduction of 2.7 cancer deaths and a reduction of 2.1 heart disease deaths per 100,000 people controlling for socioeconomic characteristics.</AbstractText>Better access to PCPs was associated with lower mortality from all-causes, cancers, and heart disease. The 2-step floating catchment area approach can help with the identification of PCP shortage areas, the development of rural residency programs, and the expansion of the physician workforce in Washington State and other regions.</AbstractText>© 2019 National Rural Health Association.</CopyrightInformation>
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2,334,540 |
Glycans in drug discovery.
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Glycans are key players in many biological processes. They are essential for protein folding and stability and act as recognition elements in cell-cell and cell-matrix interactions. Thus, being at the heart of medically relevant biological processes, glycans have come onto the scene and are considered hot spots for biomedical intervention. The progress in biophysical techniques allowing access to an increasing molecular and structural understanding of these processes has led to the development of effective therapeutics. Indeed, strategies aimed at designing glycomimetics able to block specific lectin-carbohydrate interactions, carbohydrate-based vaccines mimicking self- and non-self-antigens as well as the exploitation of the therapeutic potential of glycosylated antibodies are being pursued. In this mini-review the most prominent contributions concerning recurrent diseases are highlighted, including bacterial and viral infections, cancer or immune-related pathologies, which certainly show the great promise of carbohydrates in drug discovery.
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2,334,541 |
Oral Bruton tyrosine kinase inhibitors block activation of the platelet Fc receptor CD32a (FcγRIIA): a new option in HIT?
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Activation of the platelet Fc-receptor CD32a (FcγRIIA) is an early and crucial step in the pathogenesis of heparin-induced thrombocytopenia type II (HIT) that has not been therapeutically targeted. Downstream FcγRIIA Bruton tyrosine kinase (BTK) is activated; however, its role in Fc receptor-induced platelet activation is unknown. We explored the potential to prevent FcγRIIA-induced platelet activation by BTK inhibitors (BTKi's) approved (ibrutinib, acalabrutinib) or in clinical trials (zanubrutinib [BGB-3111] and tirabrutinib [ONO/GS-4059]) for B-cell malignancies, or in trials for autoimmune diseases (evobrutinib, fenebrutinib [GDC-0853]). We found that all BTKi's blocked platelet activation in blood after FcγRIIA stimulation by antibody-mediated cross-linking (inducing platelet aggregation and secretion) or anti-CD9 antibody (inducing platelet aggregation only). The concentrations that inhibit 50% (IC50) of FcγRIIA cross-linking-induced platelet aggregation were for the irreversible BTKi's ibrutinib 0.08 µM, zanubrutinib 0.11 µM, acalabrutinib 0.38 µM, tirabrutinib 0.42 µM, evobrutinib 1.13 µM, and for the reversible BTKi fenebrutinib 0.011 µM. IC50 values for ibrutinib and acalabrutinib were four- to fivefold lower than the drug plasma concentrations in patients treated for B-cell malignancies. The BTKi's also suppressed adenosine triphosphate secretion, P-selectin expression, and platelet-neutrophil complex formation after FcγRIIA cross-linking. Moreover, platelet aggregation in donor blood stimulated by sera from HIT patients was blocked by BTKi's. A single oral intake of ibrutinib (280 mg) was sufficient for a rapid and sustained suppression of platelet FcγRIIA activation. Platelet aggregation by adenosine 5'-diphosphate, arachidonic acid, or thrombin receptor-activating peptide was not inhibited. Thus, irreversible and reversible BTKi's potently inhibit platelet activation by FcγRIIA in blood. This new rationale deserves testing in patients with HIT.
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2,334,542 |
Target-controlled infusion of dexmedetomidine effect-site concentration for sedation in patients undergoing spinal anaesthesia.
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Dexmedetomidine has been a preferred sedative for patients undergoing regional anaesthesia and is mostly administered via conventional zero-order infusion. Recently, a pharmacokinetic-pharmacodynamic (PKPD) model of dexmedetomidine has been published, but no external validation has been reported in clinical trials. We aimed to administer target-controlled infusion (TCI) of dexmedetomidine at the effect-site concentration (Ce) to patients undergoing spinal anaesthesia and investigate the relationship between dexmedetomidine Ce and the sedative effects.</AbstractText>Forty-five patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. After confirmation of sensory block level, we initiated effect-site TCI of dexmedetomidine using Colin's model and assessed sedation levels using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale and bispectral index (BIS) with each stepwise increase in the dexmedetomidine Ce. We used a non-linear mixed-effects model to determine the PD relationships between the dexmedetomidine Ce and sedation level.</AbstractText>The dexmedetomidine Ce associated with 50% probability (Ce50</sub> ) of the MOAA/S scale ≤4, 3 and 2 was 0.57, 0.89 and 1.19 ng/mL, respectively. Mean dexmedetomidine Ce when BIS decreased ≤70 was 0.99 ± 0.15 ng/mL. As dexmedetomidine Ce increased, the MOAA/S scale decreased significantly (correlation coefficient [r] = -.832, P < .0001). BIS decreased significantly with increasing dexmedetomidine Ce (r = -.811, P < .0001) and decreasing MOAA/S scale (r = .838, P < .0001). The most common side effects were hypertension (26.67%) and bradycardia (20%).</AbstractText>We applied effect-site TCI of dexmedetomidine in patients undergoing spinal anaesthesia for the first time. Dexmedetomidine Ce correlated significantly with MOAA/S scale and BIS, and was 0.89 and 1.19 ng/mL for moderate and deep sedation, respectively.</AbstractText>© 2019 John Wiley & Sons Ltd.</CopyrightInformation>
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2,334,543 |
Emergent airway management outside of the operating room - a retrospective review of patient characteristics, complications and ICU stay.
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Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward.</AbstractText>We retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained.</AbstractText>336 intubations were performed in 275 patients during the six-month period. The majority of intubations (n = 196, 58%) occurred in an ICU setting, and the rest 140 (42%) occurred on a normal floor or in a remote location. The mean admission ASA status was 3.6 ± 0.5, age 60 ± 16 years, and BMI 30 ± 9 kg/m2</sup>. Chest X-rays performed immediately after intubation showed main stem intubation in 3.3% (n = 9). Two immediate (within 20 min after intubation) intubation related cardiac arrest/mortality events were identified. The 30-day in-hospital mortality was 31.6% (n = 87), the overall in-hospital mortality was 37.1% (n = 102), the mean hospital stay was 22 ± 20 days, and the mean ICU-stay was 14 days (13.9 ± 0.9, CI 12.1-15.8) with a 7.3% ICU-readmission rate.</AbstractText>Patients requiring emergent airway management are a high-risk patient population with multiple comorbidities and high ASA scores on admission. Only a small number of intubation-related complications were reported but ICU length of stay was high.</AbstractText>
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2,334,544 |
Awakening the regenerative potential of the mammalian retina.
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As with all glial cells, the major role of retinal Müller glia (MG) is to provide essential neuronal support. However, the MG of some non-mammalian species have the additional ability to generate new retinal neurons capable of sight restoration. Unfortunately, mammalian MG do not possess this ability. However, if we could understand the reasons why, we may be able to devise strategies to confer regenerative potential. The recent discovery that the Hippo signaling pathway acts as an intrinsic block to mammalian MG proliferation, along with reports of adeno-associated virus (AAV)-based MG reprogramming and functional photoreceptor differentiation, may indicate a watershed moment in the field of mammalian retinal regeneration. However, as researchers delve deeper into the cellular and molecular mechanisms, and further refine MG reprogramming strategies, we should recall past misinterpretations of data in this field and proceed with caution. Here, we provide a summary of these emerging data and a discussion of technical concerns specific to AAV-mediated reprogramming experiments that must be addressed in order for the field to move forward.
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2,334,545 |
Pregnancy control in patients with systemic lupus erythematosus/antiphospholipid syndrome. Part 2: Pregnancy follow-up.
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In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology set up a working group for the preparation of three consensus documents.</AbstractText>Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology.</AbstractText>This second document contains the recommendations regarding the management of pregnancy in women with SLE and APS, including complications such as lupus activity, congenital heart block, thrombotic and obstetric manifestations of APS and placental vascular disease.</AbstractText>These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with SLE/APS during pregnancy.</AbstractText>Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.</CopyrightInformation>
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2,334,546 |
Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair.
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Interscalene brachial plexus block (ISB) is one of the most commonly used regional blocks in relieving postoperative pain after arthroscopic rotator cuff repair. Dexmedetomidine (DEX) is an alpha 2 agonist that can enhance the effect of regional blocks. The aim of this study was to compare the effects of DEX combined with ISB with ISB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair.</AbstractText>Fifty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single center, double-blinded randomized controlled trial study. Twenty-five patients were randomly allocated to group 1 and received ultrasound-guided ISB using a mixture of 1 ml (100 μg) of DEX and 8 ml of 0.75% ropivacaine preemptively. The other 25 patients were allocated to group 2 and underwent ultrasound-guided ISB alone using a mixture of 1 ml of normal saline and 8 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were checked within 48 h postoperatively. The plasma interleukin (IL)-6, -8, -1β, cortisol, and substance P levels were also measured within 48 h, postoperatively.</AbstractText>Group 1 showed a significantly lower mean VAS score and a significantly higher mean SAT score than group 2 at 1, 3, 6, 12, and 18 h postoperatively. Compared with group 2, group 1 showed a significantly lower mean plasma IL-6 level at 1, 6, 12, and 48 h postoperatively and a significantly lower mean IL-8 level at 1, 6, 12, 24, and 48 h postoperatively. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (12.7 h > 9.4 h, p = 0.006).</AbstractText>Ultrasound-guided ISB with DEX in arthroscopic rotator cuff repair led to a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h postoperatively than ISB alone. In addition, ISB with DEX showed lower mean plasma IL-6 and IL-8 levels than ISB alone within 48 h postoperatively, with delayed rebound pain.</AbstractText>I.</AbstractText>2013-112, ClinicalTrials.gov Identifier: NCT02766556.</AbstractText>
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2,334,547 |
S-nitrosylation of connexin43 hemichannels elicits cardiac stress-induced arrhythmias in Duchenne muscular dystrophy mice.
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Patients with Duchenne muscular dystrophy (DMD) commonly present with severe ventricular arrhythmias that contribute to heart failure. Arrhythmias and lethality are also consistently observed in adult Dmdmdx mice, a mouse model of DMD, after acute β-adrenergic stimulation. These pathological features were previously linked to aberrant expression and remodeling of the cardiac gap junction protein connexin43 (Cx43). Here, we report that remodeled Cx43 protein forms Cx43 hemichannels in the lateral membrane of Dmdmdx cardiomyocytes and that the β-adrenergic agonist isoproterenol (Iso) aberrantly activates these hemichannels. Block of Cx43 hemichannels or a reduction in Cx43 levels (using Dmdmdx Cx43+/- mice) prevents the abnormal increase in membrane permeability, plasma membrane depolarization, and Iso-evoked electrical activity in these cells. Additionally, Iso treatment promotes nitric oxide (NO) production and S-nitrosylation of Cx43 hemichannels in Dmdmdx heart. Importantly, inhibition of NO production prevents arrhythmias evoked by Iso. We found that NO directly activates Cx43 hemichannels by S-nitrosylation of cysteine at position 271. Our results demonstrate that opening of remodeled and S-nitrosylated Cx43 hemichannels plays a key role in the development of arrhythmias in DMD mice and that these channels may serve as therapeutic targets to prevent fatal arrhythmias in patients with DMD .
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2,334,548 |
Multiple poloxamers increase plasma membrane repair capacity in muscle and nonmuscle cells.
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Various previous studies established that the amphiphilic tri-block copolymer known as poloxamer 188 (P188) or Pluronic-F68 can stabilize the plasma membrane following a variety of injuries to multiple mammalian cell types. This characteristic led to proposals for the use of P188 as a therapeutic treatment for various disease states, including muscular dystrophy. Previous studies suggest that P188 increases plasma membrane integrity by resealing plasma membrane disruptions through its affinity for the hydrophobic lipid chains on the lipid bilayer. P188 is one of a large family of copolymers that share the same basic tri-block structure consisting of a middle hydrophobic propylene oxide segment flanked by two hydrophilic ethylene oxide moieties [poly(ethylene oxide)<sub>80</sub>-poly(propylene oxide)<sub>27</sub>-poly(ethylene oxide)<sub>80</sub>]. Despite the similarities of P188 to the other poloxamers in this chemical family, there has been little investigation into the membrane-resealing properties of these other poloxamers. In this study we assessed the resealing properties of poloxamers P181, P124, P182, P234, P108, P407, and P338 on human embryonic kidney 293 (HEK293) cells and isolated muscle from the <i>mdx</i> mouse model of Duchenne muscular dystrophy. Cell membrane injuries from glass bead wounding and multiphoton laser injury show that the majority of poloxamers in our panel improved the plasma membrane resealing of both HEK293 cells and dystrophic muscle fibers. These findings indicate that many tri-block copolymers share characteristics that can increase plasma membrane resealing and that identification of these shared characteristics could help guide design of future therapeutic approaches.
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2,334,549 |
Microfiber-shaped building-block tissues with endothelial networks for constructing macroscopic tissue assembly.
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We describe a microfiber-shaped hepatic tissue for <i>in vitro</i> macroscopic tissue assembly, fabricated using a double coaxial microfluidic device and composed of cocultured Hep-G2 cells and human umbilical vein endothelial cells (HUVECs). The appropriate coculture conditions for Hep-G2 cells and HUVECs in the microfiber-shaped tissue were optimized by changing the thickness of the core and the cell ratio. The HUVEC networks were formed in the microfiber-shaped tissue following culture for 3 days. Using this microfiber-shaped tissue as a building block, two types of macroscopic assembled tissues were constructed-parallel and reeled tissues. In both tissue types, the connection of the HUVEC network across the adjacent microfiber-shaped tissues was established after 2 days, because the calcium alginate shell of the microfiber-shaped tissue was enzymatically removed. Our approach could facilitate the generation of complex and heterogeneous macroscopic tissues mimicking the major organs including the liver, kidney, and heart for the treatment of critically ill patients.
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2,334,550 |
Cross-Modal Conflict Increases With Time-on-Task in a Temporal Discrimination Task.
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The modality appropriateness hypothesis argues that the auditory modality is preferred over the visual modality in tasks demanding temporal operations; hence, we predicted that responses to visual stimuli would be more sensitive to the detrimental effect of Time-on-Task. We used a bimodal temporal discrimination task. The factors were durational congruency between the modalities and the direction of modality-transmission. Participants needed to decide the duration of the cued stimulus (visual or auditory). The first five blocks of the task lasted about 1.5 h without rest [Time-on-Task (ToT) period]. The participants then had a 12-min break followed by an additional block of trials. Subjective fatigue, reaction time, error rates, and electrocardiographic data were recorded. In the visual modality, we found an enhanced congruency effect as a function of ToT. The cost of attentional shifting was higher in the auditory modality, but remained constant, suggesting that processing of auditory stimuli is robust against the effects of fatigue. Performance did not improve after the break, indicating that the effects of fatigue could not be overcome by taking a brief break. The heart rate variability (HRV) data showed that vagal inhibition increased with ToT, but this increase was not associated with the changes in performance.
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2,334,551 |
Stereoselective neurochemical, behavioral, and cardiovascular effects of α-pyrrolidinovalerophenone enantiomers in male rats.
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The synthetic cathinone α-pyrrolidinovalerophenone (α-PVP) continues to be abused despite being banned by regulatory agencies. The abused formulation of α-PVP is a racemic mixture consisting of two enantiomers, S-α-PVP and R-α-PVP. In this study, we investigated the neurochemical, behavioral, and cardiovascular effects of racemic α-PVP and its enantiomers in male rats. Racemic α-PVP blocked the uptake of both dopamine and norepinephrine ex vivo, but did not block the uptake of serotonin (5-HT), at their respective transporters. S-α-PVP was slightly more potent than racemic α-PVP, while R-α-PVP was 10 to 20 times less potent at blocking dopamine and norepinephrine uptake. In microdialysis studies, racemic and S-α-PVP increased extracellular dopamine levels in the nucleus accumbens, but not levels of 5-HT. Racemic and S-α-PVP also increased locomotor activity. When tested at the same doses, S-α-PVP produced larger effects than racemic α-PVP. R-α-PVP also increased extracellular dopamine levels and locomotor activity, but only at 30 times higher doses than S-α-PVP. Racemic and S-α-PVP were self-administered by rats at 0.03 mg/kg/injection, whereas R-α-PVP was self-administered at a 10 times higher dose. Dose-effect determinations following acquisition suggested that R-α-PVP was at least 30 times less potent than S-α-PVP. Finally, racemic and S-α-PVP increased blood pressure and heart rate at doses approximately 30 times less than was required for R-α-PVP to produce similar effects. These results show that the neurochemical, behavioral, and cardiovascular effects of racemic α-PVP most likely reflect the actions of S isomer.
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2,334,552 |
New synonymies and transfers in Castianeira Keyserling, 1879 (Araneae, Corinnidae, Castianeirinae) from India.
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Indian species in the castianeirine genus Castianeira Keyserling, 1879 (Corinnidae) are partly revised based on type materials deposited in the National Zoological Collection, Zoological Survey of India, Kolkata. Two new synonyms are recognized: Castianeira himalayensis Gravely, 1931 syn. nov. is synonymised with Corinnomma severum (Thorell, 1877), and Castianeira bengalensis Biswas, 1984 syn. nov. with the liocranid species Oedignatha scrobiculata Thorell, 1881. Castianeira albopicta Gravely, 1931 is considered as a nomen dubium. Castianeira adhartali Gajbe, 2003 and Castianeira indica Tikader, 1981 are transferred to Oedignatha Thorell, 1881 (Liocranidae). The taxonomic status of both Castianeira tinae Patel Patel, 1973 and Castianeira quadrimaculata Reimoser, 1934 is discussed. All the examined type materials are illustrated, and the current status of the type material of each species is discussed.
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Coexistence of increased arterial stiffness and interatrial block in overweight subjects.<Pagination><StartPage>e12724</StartPage><MedlinePgn>e12724</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">e12724</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1111/anec.12724</ELocationID><Abstract><AbstractText Label="BACKGROUND">Interatrial block (IAB) is an electrical conduction delay between the right and left atrium and is associated with some cardiovascular disorders. Arterial stiffness is a useful prognostic marker for cardiovascular events. In the present study, we aimed to investigate the coexistence of increased arterial stiffness and IAB in overweight subjects.</AbstractText><AbstractText Label="METHODS">A total of 110 overweight people were enrolled (56 subjects with IAB, and 54 age- and gender-matched subjects without IAB) into the study. Surface 12-lead standard ECGs were recorded. I.E.M. Mobil-O-Graph ambulatory blood pressure monitor device was used to assess the arterial stiffness.</AbstractText><AbstractText Label="RESULTS">The mean age of the patients was 54.1 ± 11.5 years, and 53.6% were male. PWV and Aix were significantly higher in IAB (+) group than IAB (-) group (9.34 ± 1.5 vs. 7.86 ± 1.3, p < .001; 29.18 ± 11.2 vs. 22.75 ± 10.4, p < .001, respectively), and also, positive linear correlation was observed between arterial stiffness parameters and P-wave duration (r = .758 for PWV; r = .682 for Aix, respectively).</AbstractText><AbstractText Label="CONCLUSION">The present study is the first to focus on evaluating the relationship between the presence of IAB and arterial stiffness in overweight subjects. If there is a coexistence of increased arterial stiffness and IAB in overweight subjects, it should be considered as requiring clinically closer follow-up.</AbstractText><CopyrightInformation>© 2019 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals, LLC.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Dogdus</LastName><ForeName>Mustafa</ForeName><Initials>M</Initials><Identifier Source="ORCID">0000-0002-3895-1923</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Training and Research Hospital, Usak University, Usak, Turkey.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cinier</LastName><ForeName>Goksel</ForeName><Initials>G</Initials><Identifier Source="ORCID">0000-0001-5064-1816</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Kackar State Hospital, Rize, Turkey.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>11</Month><Day>10</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Ann Noninvasive Electrocardiol</MedlineTA><NlmUniqueID>9607443</NlmUniqueID><ISSNLinking>1082-720X</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000074021" MajorTopicYN="N">Interatrial Block</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D050177" MajorTopicYN="N">Overweight</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000503" MajorTopicYN="Y">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D059289" MajorTopicYN="N">Vascular Stiffness</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">clinical</Keyword><Keyword MajorTopicYN="N">epidemiology/clinical trials</Keyword><Keyword MajorTopicYN="N">noninvasive techniques-electrocardiography</Keyword></KeywordList><CoiStatement>The authors declare that there is no conflict of interest.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>8</Month><Day>28</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2019</Year><Month>9</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>9</Month><Day>29</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>11</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>6</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>11</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31707766</ArticleId><ArticleId IdType="pmc">PMC7358844</ArticleId><ArticleId IdType="doi">10.1111/anec.12724</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Abel, E. 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JAMA, 292, 2471–2477. 10.1001/jama.292.20.2471</Citation><ArticleIdList><ArticleId IdType="doi">10.1001/jama.292.20.2471</ArticleId><ArticleId IdType="pubmed">15562125</ArticleId></ArticleIdList></Reference><Reference><Citation>Willum‐Hansen, T. , Staessen, J. A. , Torp‐Pedersen, C. , Rasmussen, S. , Thijs, L. , Ibsen, H. , & Jeppesen, J. (2006). Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation, 113, 664–670. 10.1161/CIRCULATIONAHA.105.579342</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.105.579342</ArticleId><ArticleId IdType="pubmed">16461839</ArticleId></ArticleIdList></Reference><Reference><Citation>Wu, J. T. , Wang, S. L. , Chu, Y. J. , Long, D. Y. , Dong, J. Z. , Fan, X. W. , … Yang, C. K. (2016). Usefulness of a combination of interatrial block and a high CHADS2 score to predict new onset atrial fibrillation. International Heart Journal, 57, 580–585. 10.1536/ihj.15-505</Citation><ArticleIdList><ArticleId IdType="doi">10.1536/ihj.15-505</ArticleId><ArticleId IdType="pubmed">27593538</ArticleId></ArticleIdList></Reference><Reference><Citation>Zebekakis, P. E. , Nawrot, T. , Thijs, L. , Balkestein, E. J. , van der Heijden‐Spek, J. , Van Bortel, L. M. , … Staessen, J. A. (2005). Obesity is associated with increased arterial stiffness from adolescence until old age. Journal of Hypertension, 23, 1839–1846. 10.1097/01.hjh.0000179511.93889.e9</Citation><ArticleIdList><ArticleId IdType="doi">10.1097/01.hjh.0000179511.93889.e9</ArticleId><ArticleId IdType="pubmed">16148607</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">31707423</PMID><DateRevised><Year>2019</Year><Month>11</Month><Day>22</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1432-136X</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2019</Year><Month>Nov</Month><Day>09</Day></PubDate></JournalIssue><Title>Journal of comparative physiology. B, Biochemical, systemic, and environmental physiology</Title><ISOAbbreviation>J Comp Physiol B</ISOAbbreviation></Journal>Can´t beat the heat? Importance of cardiac control and coronary perfusion for heat tolerance in rainbow trout.
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Coronary perfusion and cardiac autonomic regulation may benefit myocardial oxygen delivery and thermal performance of the teleost heart, and thus influence whole animal heat tolerance. Yet, no study has examined how coronary perfusion affects cardiac output during warming in vivo. Moreover, while β-adrenergic stimulation could protect cardiac contractility, and cholinergic decrease in heart rate may enhance myocardial oxygen diffusion at critically high temperatures, previous studies in rainbow trout (Oncorhynchus mykiss) using pharmacological antagonists to block cholinergic and β-adrenergic regulation showed contradictory results with regard to cardiac performance and heat tolerance. This could reflect intra-specific differences in the extent to which altered coronary perfusion buffered potential negative effects of the pharmacological blockade. Here, we first tested how cardiac performance and the critical thermal maximum (CT<sub>max</sub>) were affected following a coronary ligation. We then assessed how these performances were influenced by pharmacological cholinergic or β-adrenergic blockade, hypothesising that the effects of the pharmacological treatment would be more pronounced in coronary ligated trout compared to trout with intact coronaries. Coronary blockade reduced CT<sub>max</sub> by 1.5 °C, constrained stroke volume and cardiac output across temperatures, led to earlier cardiac failure and was associated with reduced blood oxygen-carrying capacity. Nonetheless, CT<sub>max</sub> and the temperatures for cardiac failure were not affected by autonomic blockade. Collectively, our data show that coronary perfusion improves heat tolerance and cardiac performance in trout, while evidence for beneficial effects of altered cardiac autonomic tone during warming remains inconclusive.
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ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison.
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Syncope is a commonly encountered and challenging problem in medical practice. Presentations are variable, and the causal mechanism often remains elusive even after extensive (and often expensive) evaluation. Clinical practice guidelines have been developed to help guide the multidisciplinary approach necessary to diagnose and manage the broad spectrum of patients presenting with syncope. The American College of Cardiology/American Heart Association, in collaboration with the Heart Rhythm Society, published its first syncope guidelines in 2017. The European Society of Cardiology released the fourth iteration of its syncope guidelines in 2018. This review highlights the differences and congruencies between the 2 sets of recommendations, their implications for clinical practice, the remaining gaps in understanding, and areas of future research.
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Associations of Circadian Eating Pattern and Diet Quality with Substantial Postpartum Weight Retention.
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Besides food quantity and quality, food timing and frequency may contribute to weight regulation. It is unclear if these factors during pregnancy can influence maternal weight retention after childbirth. We thus aimed to examine the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months in an Asian cohort. We assessed circadian eating pattern and diet quality of 687 women using 24-h dietary recalls at 26-28 weeks' gestation. We calculated PPWR by subtracting maternal weight in the first trimester from weight at 18-month postpartum and defined substantial PPWR as ≥5 kg weight retention. Multivariable binary logistic regression was performed. Overall, 16% of women had substantial PPWR. After the confounders adjustment, night eating, defined by greater night-time caloric intake (odds ratio 1.95; 95% confidence interval 1.05, 3.62), and lower diet quality, classified by median score of the Healthy Eating Index (1.91; 1.17, 3.10), were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night fasting duration and number of eating episodes. In conclusion, alignment of eating time with day-night cycles and diet quality during pregnancy may play a role in PPWR, with possible implications for long-term obesity risk.
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Development of a nanomedicine-loaded hydrogel for sustained delivery of an angiogenic growth factor to the ischaemic myocardium.
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The 5-year mortality rate for heart failure borders on 50%. The main cause is an ischaemic cardiac event where blood supply to the tissue is lost and cell death occurs. Over time, this damage spreads and the heart is no longer able to pump efficiently. Increasing vascularisation of the affected area has been shown to reduce patient symptoms. The growth factors required to do this have short half-lives making development of an efficacious therapy difficult. Herein, the angiogenic growth factor Vascular Endothelial Growth Factor (VEGF) is complexed electrostatically with star-shaped or linear polyglutamic acid (PGA) polypeptides. Optimised PGA-VEGF nanomedicines provide VEGF encapsulation of > 99% and facilitate sustained release of VEGF for up to 28 days in vitro. The star-PGA-VEGF nanomedicines are loaded into a percutaneous delivery compliant hyaluronic acid hydrogel. Sustained release of VEGF from the composite nano-in-gel system is evident for up to 35 days and the released VEGF has comparable bioactivity to free, fresh VEGF when tested on both Matrigel<sup>®</sup> and scratch assays. The final star-PGA-VEGF nanomedicine-loaded hydrogel is biocompatible and provides sustained release of bioactive VEGF. Therefore, we report the development of novel, self-assembling PGA-VEGF nanomedicines and their incorporation into a hyaluronic acid hydrogel that is compatible with medical devices to enable minimally invasive delivery to the heart. The final star-PGA-VEGF nanomedicine-loaded hydrogel is biocompatible and provides sustained release of bioactive VEGF. This formulation provides the basis for optimal spatiotemporal delivery of an angiogenic growth factor to the ischaemic myocardium.
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Complete Heart Block: A Rare Complication of Takotsubo Syndrome.
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Takotsubo syndrome was believed to be a rare acute cardiac event until recently with takotsubo cardiomyopathy being its most commonly recognized and often the diagnostic feature. Its diagnosis is becoming increasingly common with varied clinical manifestations most of whom have favorable clinical outcomes, yet it can be associated with life-threatening complications. We report a case of takotsubo syndrome leading to complete heart block which is a unique complication of an otherwise self-resolving disease.
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Pooled summary of native T1 value and extracellular volume with MOLLI variant sequences in normal subjects and patients with cardiovascular disease.
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T1 mapping by cardiac magnetic resonance (CMR) allows detection of abnormal myocardium. A number of myocardial abnormalities affects the signal captured in T1 mapping. We performed a systematic review and meta-analysis of native T1 and extracellular volume (ECV) in subjects with and without cardiac disease (1) to determine the normal ranges of T1 values and ECV by sequences as well as parameters influencing them, and (2) to summarize the differences in T1 values and ECV of the diseases relative to the normal ranges. Three databases (EMBASE, SCOPUS, and MEDLINE) were systematically searched for native T1 time and ECV. Only human studies with a sample size of ≥ 20 subjects were included. A random effect model was used to pool data. The 69 selected articles included 1954 healthy subjects and 3186 with disease. T1 of normal healthy was different among MOLLI variants: in 1.5T sequences, ShMOLLI had the shortest (944 ms [95% confidence interval 925, 963]), followed by MOLLI 3(3)3(3)5 flip-angle 50°, 967 [959, 975] and flip-angle 35°, 969 [951, 988]. 3T had longer T1 than 1.5T by approximately 100-200 ms. ECV of the normal healthy was consistent among the studies (ranging from 25 to 27%), irrespective of subjects' factors, sequences, vendors, and contrast type. Many diseases demonstrated longer native T1 than normal subjects, but T1 was shorter in Fabry disease and iron overload. In contrast, all disease states showed either normal or increased ECV. Diagnostic accuracy of native T1 time was minimally affected by the difference in the sequences. ECV is less influenced by methodology than T1 time among normal subjects. Different myocardial diseases are associated with shorter or longer T1 times, whereas ECV is consistently increased independent of the underlying pathophysiology.
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An Integrated Pipeline for Combining <i>in vitro</i> Data and Mathematical Models Using a Bayesian Parameter Inference Approach to Characterize Spatio-temporal Chemokine Gradient Formation.
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All protective and pathogenic immune and inflammatory responses rely heavily on leukocyte migration and localization. Chemokines are secreted chemoattractants that orchestrate the positioning and migration of leukocytes through concentration gradients. The mechanisms underlying chemokine gradient establishment and control include physical as well as biological phenomena. Mathematical models offer the potential to both understand this complexity and suggest interventions to modulate immune function. Constructing models that have powerful predictive capability relies on experimental data to estimate model parameters accurately, but even with a reductionist approach most experiments include multiple cell types, competing interdependent processes and considerable uncertainty. Therefore, we propose the use of reduced modeling and experimental frameworks in complement, to minimize the number of parameters to be estimated. We present a Bayesian optimization framework that accounts for advection and diffusion of a chemokine surrogate and the chemokine CCL19, transport processes that are known to contribute to the establishment of spatio-temporal chemokine gradients. Three examples are provided that demonstrate the estimation of the governing parameters as well as the underlying uncertainty. This study demonstrates how a synergistic approach between experimental and computational modeling benefits from the Bayesian approach to provide a robust analysis of chemokine transport. It provides a building block for a larger research effort to gain holistic insight and generate novel and testable hypotheses in chemokine biology and leukocyte trafficking.
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Global Sensitivity Analysis of Ventricular Myocyte Model-Derived Metrics for Proarrhythmic Risk Assessment.
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Multiscale computational models of the heart are being extensively investigated for improved assessment of drug-induced torsades de pointes (TdP) risk, a fatal side effect of many drugs. Model-derived metrics such as action potential duration and net charge carried by ionic currents (<i>qNet</i>) have been proposed as potential candidates for TdP risk stratification after being tested on small datasets. Unlike purely statistical approaches, model-derived metrics are thought to provide mechanism-based classification. In particular, <i>qNet</i> has been recently proposed as a surrogate metric for early afterdepolarizations (EADs), which are known to be cellular triggers of TdP. Analysis of critical model components and of the ion channels that have major impact on model-derived metrics can lead to improvements in the confidence of the prediction. In this paper, we analyze large populations of virtual drugs to systematically examine the influence of different ion channels on model-derived metrics that have been proposed for proarrhythmic risk assessment. We demonstrate <i>via</i> global sensitivity analysis (GSA) that model-derived metrics are most sensitive to different sets of input parameters. Similarly, important differences in sensitivity to specific channel blocks are highlighted when classifying drugs into different risk categories by either <i>qNet</i> or a metric directly based on simulated EADs. In particular, the higher sensitivity of <i>qNet</i> to the block of the late sodium channel might explain why its classification accuracy is better than that of the EAD-based metric, as shown for a small set of known drugs. Our results highlight the need for a better mechanistic interpretation of promising metrics like <i>qNet</i> based on a formal analysis of models. GSA should, therefore, constitute an essential component of the <i>in silico</i> workflow for proarrhythmic risk assessment, as an improved understanding of the structure of model-derived metrics could increase confidence in model-predicted risk.
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2,334,561 |
Paradoxical effects of continuous high dose gabapentin treatment on autonomic dysreflexia after complete spinal cord injury.
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Spinal cord injury (SCI) can have profound effects on the autonomic and cardiovascular systems, notably with injuries above high-thoracic levels that result in the development of autonomic dysreflexia (AD) characterized by volatile hypertension in response to exaggerated sympathetic reflexes triggered by afferent stimulation below the injury level. Pathophysiological changes associated with the development of AD include sprouting of both nociceptive afferents and ascending propriospinal 'relay' neurons below the injury, as well as dynamic changes in synaptic inputs onto sympathetic preganglionic neurons. However, it remains uncertain whether synapse formation between sprouted c-fibers and propriospinal neurons contributes to the development of exaggerated sympathetic reflexes produced during AD. We previously reported that once daily treatment with the anti-epileptic and neuropathic pain medication, gabapentin (GBP), at low dosage (50 mg/kg) mitigates experimentally induced AD soon after injections, likely by impeding glutamatergic signaling. Since much higher doses of GBP are reported to block the formation of excitatory synapses, we hypothesized that continuous, high dosage GBP treatment after SCI might prevent the formation of aforementioned aberrant synapses and, accordingly, reduce the incidence and severity of AD. Adult female rats implanted with aortic telemetry probes for hemodynamic monitoring underwent T4-transection SCI and immediately received 100 mg/kg (i.p.) of GBP and then every six hours (400 mg/kg/day) for 4-weeks after injury. We assessed daily body weight, mean arterial pressure, heart rate, frequency of spontaneous AD, and hemodynamic changes during colorectal distension (CRD) to establish whether high dose GBP treatment prophylactically mitigates both AD and associated aberrant synaptic plasticity. This regimen significantly reduced both the absolute blood pressure reached during experimentally induced AD and the time required to return to baseline afterwards. Conversely, GBP prevented return to pre-injury body weights and paradoxically increased the frequency of spontaneously occurring AD. While there were significant decreases in the densities of excitatory and inhibitory pre-synaptic markers in the lumbosacral dorsal horn following injury alone, they were unaltered by continuous GBP treatment. This indicates distinct mechanisms of action for acute GBP to mitigate induced AD whereas chronic GBP increases non-induced AD frequencies. While high dose prophylactic GBP is not recommended to treat AD, acute low dose GBP may hold therapeutic value to mitigate evoked AD, notably during iatrogenic procedures under controlled clinical conditions.
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2,334,562 |
Pregnancy and Systemic Lupus Erythematosus.
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As SLE onset is often in young adulthood, pregnancy is common and is usually successful. Pregnancy, though, is considered high-risk due to a combination of maternal (lupus flare, diabetes, pre-eclampsia) and fetal (miscarriage, intrauterine fetal demise, preterm birth, intrauterine growth restriction, congenital heart block) risks. Pregnancy should be planned for a time of good control of SLE (on allowable medications). The antimalarial hydroxychloroquine should be continued. The only permitted immunosuppressive drugs are azathioprine and tacrolimus. Of the antiphospholipid antibodies, only the lupus anticoagulant has been associated with adverse pregnancy outcomes in the largest prospective multicenter study, Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus (PROMISSE). Management of antiphospholipid syndrome in pregnancy is low molecular weight heparin and aspirin, although only 75% of pregnancies are successful.
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2,334,563 |
Salivary dysbiosis and the clinical spectrum in anti-Ro positive mothers of children with neonatal lupus.
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Mothers giving birth to children with manifestations of neonatal lupus (NL) represent a unique population at risk for the development of clinically evident pathologic autoimmunity since many are asymptomatic and only become aware of anti-SSA/Ro positivity (anti-Ro+) based on heart block in their fetus. Accordingly, we hypothesized that the microbiome in saliva is associated with the development of autoreactivity and in some cases the progression in health status from benign to overt clinical disease including Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE). The study comprised a clinical spectrum of anti-Ro+ mothers, all of whom gave birth to a child with NL: 9 were asymptomatic or had an undifferentiated autoimmune disease (Asym/UAS) and 16 fulfilled criteria for SS and/or SLE. Microbial diversity was reduced across all levels from kingdom to species for the anti-Ro+ mothers vs healthy controls; however, there were no significant differences between Asym/UAS and SS/SLE mothers. Relative abundance of Proteobacteria and more specifically class Betaproteobacteria decreased with clinical severity (healthy controls < Asym/UAS < SS/SLE). These ordered differences were maintained through the taxonomic hierarchy to three genera (Lautropia, Comamonas, and Neisseria) and species within these genera (L. mirabilis, N. flavescens and N. oralis). Biometric analysis comparing von Willebrand Factor domains present in human Ro60 with L. mirabilis proteins support the hypothesis of molecular mimicry. These data position the microbiome in the development of anti-Ro reactivity and subsequent clinical spectrum of disease.
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2,334,564 |
Childhood Obesity and the Food Environment: A Population-Based Sample of Public School Children in New York City.
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This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes.</AbstractText>A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school students were used. BMI z scores were calculated, student obesity or obesity/overweight was determined using Centers for Disease Control and Prevention growth charts, and these data were combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examined using neighborhood (census tract) fixed effects.</AbstractText>Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types.</AbstractText>Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity.</AbstractText>© 2019 The Obesity Society.</CopyrightInformation>
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2,334,565 |
Clinical analysis of different anesthesia methods for pulmonary infection after perioperative operation.
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The purpose is to explore the effect of different anesthesia methods on pulmonary infection after the operation. 120 patients who underwent surgery from January 2015 to August 2018 were selected in three groups: group A (n=40), group B (n=40), and group C (n=40). Group A was given inhalation anesthesia, group B was given total intravenous anesthesia, and group C was given epidural block combined with general anesthesia. In addition to lung imaging examination, the postoperative parameters of patients such as leukocyte count and mean arterial pressure were recorded. Through image analysis, the case of pulmonary infection after epidural block combined with general anesthesia was 1, while that of inhalation anesthesia and intravenous injection was 7 and 8. In terms of the fluctuation of heart rate and mean arterial pressure, patients in group C had lower levels of heart rate and mean arterial pressure, while patients in groups A and B had higher levels of these parameters. There was no significant difference between inhalation anesthesia and intravenous injection for pulmonary infection after the operation. Thus, it can be concluded that the negative effects of epidural block combined with general anesthesia are much less than those of the other two anesthesia methods, which has the smallest effect on pulmonary infection after the operation. Therefore, the epidural block combined with general anesthesia has the smallest effect on pulmonary infection after the operation. This study is of great significance, and more anesthesia methods can be further studied in subsequent works.
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2,334,566 |
Estimating the effect of calorie menu labeling on calories purchased in a large restaurant franchise in the southern United States: quasi-experimental study.
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To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction.</AbstractText>Quasi-experimental longitudinal study.</AbstractText>Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018.</AbstractText>104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period.</AbstractText>Primary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census).</AbstractText>The analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81).</AbstractText>A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.</AbstractText>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</CopyrightInformation>
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2,334,567 |
Real world experience on treatment, outcome and toxicity of crizotinib in patients with anaplastic lymphoma kinase positive advanced non-small cell lung cancer.
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Crizotinib has been the standard treatment for patients with anaplastic lymphoma kinase (ALK)-rearranged advanced non-small cell lung cancer (NSCLC). It demonstrated superior progression-free survival (PFS) and higher objective response rates (ORRs) vs.</i> chemotherapy in previously treated and untreated patients with ALK-positive advanced NSCLC. This retrospective analysis reports real-world experience in treatment outcome and toxicity of crizotinib in this group of patients, with a focus on the cardiac toxicity and its management.</AbstractText>Twenty-two patients diagnosed with ALK-positive NSCLC, either by immunohistochemistry (IHC) or fluorescence in situ</i> hybridization (FISH), treated at Johns Hopkins Singapore International Medical Centre (JHSIMC) and Tan Tock Seng Hospital (TTSH) in Singapore, were identified and followed for a median of 18 months. Data were collected and analyzed for baseline demographics, PFS, ORR, duration of response, toxicity and overall survival (OS).</AbstractText>Clinical profile of patients included in the study was similar with clinical trials on crizotinib. Most patients were young of mean age 42, non-smokers and with good performance status. Fifty-nine percent had prior chemotherapy. Fifty percent of patients had brain metastases (BM), either de novo</i> or on progression. ORR of crizotinib was 64% with median total duration of treatment of 8.5 months (range, 2-73+</sup> months). Median PFS for patients treated with first-line crizotinib was 15 months. Most patients with BM had brain radiation. Median time for intracranial progression from the start of crizotinib was 11 months. Those with stable or responding extracranial disease continued crizotinib after radiotherapy to the brain. Median duration of response in this group of patients was 14 months (range, 2-31 months). Median OS among patients treated with upfront crizotinib was not reached, with 7 out of 11 patients still alive at the time of data analysis (n=11, range, 1-73+</sup>). Toxicity was manageable with moderate rate of grade 3 or worse toxicity (n=7, 31.8%). Three patients had grade 3-4 neutropenia. Eighteen percent (n=4) of patients developed cardiotoxicities such as bradycardia, prolonged QTc interval and complete heart block. One patient who developed complete heart block required pacemaker insertion. Two patients are long term responders who have been on crizotinib for 68+</sup> and 73+</sup> months.</AbstractText>This retrospective analysis of a real-world experience confirms the therapeutic benefit of crizotinib in advanced ALK-positive NSCLC. Our data showed crizotinib is tolerable and effective, comparable with literature report. Occasional serious cardiac toxicity requires attention.</AbstractText>2019 Journal of Thoracic Disease. All rights reserved.</CopyrightInformation>
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2,334,568 |
High Effectiveness in Actions of Carfilzomib on Delayed-Rectifier K<sup>+</sup> Current and on Spontaneous Action Potentials.
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Carfilzomib (CFZ, Kyprolis<sup>®</sup>) is widely recognized as an irreversible inhibitor of proteasome activity; however, its actions on ion currents in electrically excitable cells are largely unresolved. The possible actions of CFZ on ionic currents and membrane potential in pituitary GH<sub>3</sub>, A7r5 vascular smooth muscle, and heart-derived H9c2 cells were extensively investigated in this study. The presence of CFZ suppressed the amplitude of delayed-rectifier K<sup>+</sup> current (<i>I</i> <sub>K(DR)</sub>) in a time-, state-, and concentration-dependent manner in pituitary GH<sub>3</sub> cells. Based on minimal reaction scheme, the value of dissociation constant for CFZ-induced open-channel block of <i>I</i> <sub>K(DR)</sub> in these cells was 0.33 µM, which is similar to the IC<sub>50</sub> value (0.32 µM) used for its efficacy on inhibition of <i>I</i> <sub>K(DR)</sub> amplitude. Recovery from <i>I</i> <sub>K(DR)</sub> block by CFZ (0.3 µM and 1 µM) could be well fitted by single exponential with 447 and 645 ms, respectively. The M-type K<sup>+</sup> current, another type of K<sup>+</sup> current elicited by low-threshold potential, was slightly suppressed by CFZ (1 µM). Under current-clamp condition, addition of CFZ depolarized GH<sub>3</sub> cells, broadened the duration of action potentials as well as raised the firing frequency. In A7r5 vascular smooth muscle cells or H9c2 cardiac cells, the CFZ-induced inhibition of <i>I</i> <sub>K(DR)</sub> remained efficacious. Therefore, our study led us to reflect that CFZ or other structurally similar compounds should somehow act on the activity of membrane K<sub>V</sub> channels through which they influence the functional activities in different types of electrically excitable cells such as endocrine, neuroendocrine cells, smooth muscle cells, or heart cells, if similar <i>in vivo</i> findings occur.
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2,334,569 |
Glucose-Sensitive Nanoparticles Based On Poly(3-Acrylamidophenylboronic Acid-Block-N-Vinylcaprolactam) For Insulin Delivery.
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Compared with random copolymers, block copolymerization is easier to prepare for nanoparticles with core-shell structure, and they will have better glucose sensitivity and higher insulin loading.</AbstractText>In our study, insulin-loaded poly (3-acrylamidophenylboronic acid-block-N-vinyl caprolactam) p(AAPBA-b-NVCL) nanoparticles were successfully prepared and were glucose-sensitive, which could effectively lower the blood sugar levels within 72 hrs.</AbstractText>The polymer of p(AAPBA-b-NVCL) was produced by reversible addition-fragmentation chain transfer polymerization based on different ratios of 3-acrylamidophenylboronic acid (AAPBA) and N-vinylcaprolactam (NVCL), and its structure was discussed by Fourier transform infrared spectroscopy and 1H-nuclear magnetic resonance . Next, the polymer was manufactured into the nanoparticles, and the characteristics of nanoparticles were detected by dynamic light scattering, lower critical solution temperature, and transmission electron microscopy. After that, the cell and animal toxicity of nanoparticles were also investigated.</AbstractText>The results demonstrated that p(AAPBA-b-NVCL) was successfully synthesized, and can be easily self-assembled to form nanoparticles. The new nanoparticles included monodisperse submicron particles, with the size of the nanoparticle ranged between 150 and 300nm and are glucose- and temperature-sensitive. Meanwhile, insulin can be easily loaded by p(AAPBA-b-NVCL) nanoparticles and an effective sustained release of insulin was observed when the nanoparticles were placed in physiological saline. Besides, MTT assay revealed that cell viability was more than 80%, and mice demonstrated no negative impact on blood biochemistry and heart, liver, spleen, lung, and kidney after intraperitoneal injection of 10 mg/kg/d of nanoparticles. This suggested that the nanoparticles were low-toxic to both cells and animals. Moreover, they could lower the blood sugar level within 72h.</AbstractText>Our research suggested that these p(AAPBA-b-NVCL) nanoparticles might have the potential to be applied in a delivery system for insulin or other hypoglycemic proteins.</AbstractText>© 2019 Wu et al.</CopyrightInformation>
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2,334,570 |
A Pilot Study to Evaluate the Acceptability of Using a Smart Pillbox to Enhance Medication Adherence Among Primary Care Patients.
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Smart pillboxes that remind patients to take medication may help avoid unintended non-adherence to medication regimens. To better understand the implementation potential of smart pillboxes among patients with chronic diseases, this study aimed to explore patients' acceptability to use such devices and its associated factors. Five-hundred primary care patients aged 40 years or older were randomly recruited from a government-funded primary care clinic in Hong Kong. Patients were asked (i) if they needed to take medication daily, (ii) how many daily oral medications they needed to take on average, (iii) if they had ever missed a dose by accident, and (iv) if they were willing to use a smart pillbox for free to remind them to take medication. Out of the 344 participants included in the analysis who needed to take daily oral medication, 49.1% reported having previously missed a dose by accident, and 70.6% were willing to use a smart pillbox for free. A multiple logistic regression model found that male patients (adjusted odds ratio (aOR): 0.59) and patients with hypertension (aOR: 0.56) were less likely to have previously missed a dose by accident. Patients who needed to take a greater number of daily medications (aOR: 1.16), who had previously missed a dose by accident (aOR: 2.44), with heart disease (aOR: 3.67) and with a high monthly income (aOR: 2.30) were more willing to use a smart pillbox, while older patients (aOR: 0.95) were less willing to do so. Primary care patients who reported missing a dose by accident were 2.4 times as likely to want to use a smart pillbox while those with heart disease were almost 4 times as likely to want to use a smart pillbox. Further studies such as those evaluating the willingness to pay for smart pillboxes and randomised control trials to evaluate the effectiveness of smart pillboxes in enhancing medication adherence should be conducted to provide more evidence about the implementation potential of such devices.
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2,334,571 |
Nearly fatal ventricular arrhythmia following pacemaker implantation in a young female with complete heart block.
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This case concerns a 24-year-old female who developed malignant ventricular tachyarrhythmia a few weeks after pacemaker implantation for complete heart block. Apparently, right ventricular pacing caused significant repolarization abnormalities in both native and paced rhythms with marked QT prolongation and substantial electrical instability. This case highlights other intriguing phenomena in the puzzle of cardiac repolarization and how pacing therapy may alter this complex process providing arrhythmic substrate in vulnerable subjects. Though such arrhythmic events are clinically rare, vulnerable patients or with suspected myocardial disease that may cause QT prolongation should be carefully followed in the course of pacing therapy.
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2,334,572 |
"A PCMH mind and a PCMH heart": Patient, faculty, and learner perspectives on collaborative care in an interprofessional team-based training programme.
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<AbstractText Label="RATIONALE, AIMS, AND OBJECTIVES" NlmCategory="OBJECTIVE">Providing high-quality primary care in patient-centred medical homes (PCMHa) requires competencies that can only be provided by interprofessional (IP) education. The benefits of collaborative training have been documented for learners, but less is known about the perceptions of the clinical professionals who train the learners or the patients receiving IP primary care. This investigation compared stakeholder attitudes about IP education, training, and providing collaborative care prior to developing a new IP training programme.</AbstractText>We conducted five focus groups at a large general internal medicine training practice. Learner and faculty groups included participants from medicine, psychology, pharmacy, and physician assistant professions; three patient groups were held to obtain perspectives on receiving health care from IP trainees. We used inductive analysis to identify themes across the three stakeholder groups.</AbstractText>We identified seven convergent themes across all three stakeholder groups: (a) team engagement, (b) technology in care delivery, (c) cost of care, (d) involving patients in learning, (e) time constraints, (f) scope of practice, and (g) autonomy/interdependence. Each group emphasized the need to define and communicate team members' roles. Learners anticipated high-quality IP interactions, and patients noted the benefits of receiving care from well-supervised trainees. Faculty struggled to navigate the training needs of diverse learner groups and to integrate PCMH mandates focused on documentation with authentic patient-centred care.</AbstractText>This is the first reported data comparing perceptions about IP training and care across these three stakeholder groups. Results suggest the need to clarify scope of practice, define professional roles, and bridge gaps between teaching PCMH principles and subsequently providing high-quality health care. Results inform faculty development needs in learning ways to train learners across professions and outline ways to structure interactions with patients.</AbstractText>© 2019 John Wiley & Sons, Ltd.</CopyrightInformation>
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2,334,573 |
Gallstone ileus managed with enterolithotomy.
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Although gallstone disease is classically associated with the inflammatory sequela of cholecystitis, other presentations include gallstone ileus, Mirizzi syndrome, Bouveret syndrome and gallstone ileus. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocaecal valve. It represents an uncommon complication of cholelithiasis, accounting for 1%-4% of all cases of mechanical bowel obstruction and 25% of all cases in individuals aged >65 years. It has a female predilection. Clinical presentation depends on the site of the obstruction. Diagnosis can prove challenging with the diagnosis rendered in 50% of cases intraoperatively. The authors present the case of a 79-year-old woman with a 10-day history of abdominal pain, nausea, vomiting and episodes of loose stools. An abdominal radiograph showed mildly distended right small bowel loops. Further investigation with a CT of the abdomen and pelvis demonstrated small bowel obstruction secondary to a 3.3 cm calculus within the small bowel. She underwent a laparotomy and a 5.0×2.5 cm gallstone was evident, causing complete obstruction. An enterolithotomy was performed. Her postoperative course was complicated by Mobitz type II heart block requiring pacemaker insertion. This paper will provide an overview of the clinical presentation, investigations and management of gallstone ileus. It provides a cautionary reminder of considering gallstone ileus in the differential diagnosis in elderly patients presenting with bowel obstruction and a history of gallstone disease.
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2,334,574 |
Time-Course Transcriptome Analysis for Drug Repositioning in <i>Fusobacterium nucleatum</i>-Infected Human Gingival Fibroblasts.
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<i>Fusobacterium nucleatum</i> (<i>F. nucleatum</i>) is a crucial periodontal pathogen and human gingival fibroblasts (GFs) are the first line of defense against oral pathogens. However, the research on potential molecular mechanisms of host defense and effective treatment of <i>F. nucleatum</i> infection in GFs remains scarce. In this study, we undertook a time-series experiment and performed an RNA-seq analysis to explore gene expression profiles during the process of <i>F. nucleatum</i> infection in GFs. Differentially expressed genes (DEGs) could be divided into three coexpression clusters. Functional analysis revealed that the immune-related signaling pathways were more overrepresented at the early stage, while metabolic pathways were mainly enriched at the late stage. We computationally identified several U.S. Food and Drug Administration (FDA)-approved drugs that could protect the <i>F. nucleatum</i> infected GFs via a coexpression-based drug repositioning approach. Biologically, we confirmed that six drugs (etravirine, zalcitabine, wortmannin, calcium D-pantothenate, ellipticine, and tanespimycin) could significantly decrease <i>F. nucleatum</i>-induced reactive oxygen species (ROS) generation and block the Protein Kinase B (PKB/AKT)/mitogen-activated protein kinase signaling pathways. Our study provides more detailed molecular mechanisms of the process by which <i>F. nucleatum</i> infects GFs and illustrates the value of the cogena-based drug repositioning method and the potential therapeutic application of these tested drugs in the treatment of <i>F. nucleatum</i> infection.
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2,334,575 |
The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial.
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Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it.</AbstractText>One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60 ml of 0.2% ropivacaine in combination with low (0.25 μg/kg), medium (0.50 μg/kg) or high dose (1.0 μg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block (n = 25). The primary outcomes were stress marker levels during the operation.</AbstractText>One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine, interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner (P < 0.05), accompanied with decreased anesthetic and opioid consumption during the operation (P < 0.05), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine (P < 0.05).</AbstractText>The addition of dexmedetomidine at the dose of 0.5 μg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response with limited impact on blood pressure and heart rate in patients undergoing laparoscopy gynecological surgery.</AbstractText>This study was registered at www.chictr.org.cn on November 6th, 2016 (ChiCTR-IOR-16009753).</AbstractText>
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2,334,576 |
Efficacy of Epidural Dexamethasone Combined with Intrathecal Nalbuphine in Lower Abdominal Oncology Operations.
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Dragging pain during lower abdominal surgeries under intrathecal anesthesia is a common problem. Epidural steroid seemed to be effective in reducing intra and postoperative pain. Kappa receptor agonist like nalbuphine helps in reduction of visceral pain. Hence, this study was designed to detect the efficacy of epidural steroid dexamethasone with intrathecal Kappa opioid as a sole anesthetic technique in patients subjected to lower abdominal oncology operations.</AbstractText>Patients were randomly allocated into two groups; epidural placebo group-control group (Group P) - Intrathecal injection of 20 μg fentanyl followed by intrathecal injection of (15 mg) of hyperbaric bupivacaine 0.5%, then (epidural injection placebo 15 mL volume of sterile saline 0.9%). Epidural dexamethasone group-study group (Group D) - Intrathecal injection of 0.6 mg nalbuphine followed by intrathecal injection of (15 mg) of hyperbaric bupivacaine 0.5% then (epidural injection of 8 mg dexamethasone in 15 mL total volume using sterile saline 0.9%).</AbstractText>Group D recorded significantly longer times to 1st</sup> analgesic request, sensory regression to S1</sub> and modified bromage Score 0 with significant lower number of patients that had abdominal dragging pain in comparison with Group P. Visual analog score in the first four postoperative hours, total postoperative nalbuphine dose in 1st</sup> 24 h and incidence of nausea and vomiting were significantly lower in Group D. Heart rate and mean arterial pressure were comparable in both groups. Postoperative headache incidence was comparable in both groups. Both patient and surgeon satisfaction were significantly higher in Group D compared to Group P.</AbstractText>Combined epidural dexamethasone with intrathecal nalbuphine as a sole anesthetic technique during lower abdominal oncology operations could be an efficient anesthetic technique that offered better block characteristics, with more analgesia and as a result it gained better patient and surgeon satisfaction.</AbstractText>Copyright: © 2019 Anesthesia: Essays and Researches.</CopyrightInformation>
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2,334,577 |
Fascia Iliaca Block as an Anesthetic Technique for: Acute Lower Limb Ischemia.
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The purpose of this study is to evaluate the efficacy of preoperative fascia iliaca block (FIB) as a sole anesthetic technique in transfemoral thromboembolectomy of unilateral acute lower limb ischemia compared to unilateral spinal anesthesia (SA) as a primary outcome. Hemodynamic variation, postoperative pain score, and the first demand for analgesia with the total postoperative analgesic required in the 1st</sup> postoperative day were considered as the secondary outcome.</AbstractText>This prospective randomized controlled study included two groups of patients aged between 40 and 70 years, who underwent transfemoral thrombectomy for acute unilateral lower limb ischemia. Patients in the spinal group (SA) (n</i> = 56): underwent unilateral SA using 10 mg bupivacaine 0.5% and patients in the group FIB (n</i> = 56): received FIB with 30 mL of 0.25% bupivacaine. Sensory block was evaluated over the incisional area with 3-point scale. If the sensory block did not reach zero grade after 30 min, the patient received general anesthesia.</AbstractText>The incidence of the successful block was 100% in the SA group compared to 80.35% in the FIB group. There was a significant decrease in recorded heart rate and mean blood pressure within the SA group at 3, 10, and 20 min and 3, 20, and 45 min, respectively. Values of visual analog scale decreased significantly in SA group compared to that of the FIB group immediately and 1 h postoperative. However, the time for the first postoperative analgesic requirement and morphine consumption was comparable between the groups.</AbstractText>Preoperative FIB could be considered as a promising alternative anesthetic technique to SA with better hemodynamic parameters in patients undergoing transfemoral thrombectomy for acute lower limb ischemia. It could be also due to limited precautions considered the first choice over SA for patients on perioperative anticoagulants.</AbstractText>Copyright: © 2019 Anesthesia: Essays and Researches.</CopyrightInformation>
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2,334,578 |
Comparison between Position Change after Low-Dose Spinal Anesthesia and Higher dose with Sitting Position in Elderly Patients: Block Characteristics, Hemodynamic Changes, and Complications.
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Large numbers of patients are presenting for surgeries with aging-related pre-existing conditions that make them at higher risks of adverse outcomes. Hemodynamic instability due to high sympathetic nerve block largely limits the use of conventional dose spinal anesthesia in high risk elderly patients.</AbstractText>We aimed to compare the hemodynamic stability and the block characteristics in low dose spinal anesthesia (5 mg) with immediate position change into supine position versus higher dose of spinal anesthesia (10 mg) with maintaining patient position in sitting position for 3 minutes after the block in elderly high risk population.</AbstractText>This study was a prospective randomized controlled double-blinded clinical study.</AbstractText>This study was carried on 70 patients of American Society of Anesthesiologists physical status classes I, II, and III aged 50 years old and above, who were scheduled for elective knee and below knee orthopedic surgeries expected to last for 40-60 minutes under spinal anesthesia. Patients were randomly allocated into two groups: group (A) Sitting group n= 35 patients that received 10 mg hyperbaric bupivacaine 0.5% in 2 mL volume intrathecal at level lumbar (L4-5</sub>) in sitting position and remained in this position for 3 minutes before turning supine. And, group (B) Supine group n</i> = 35 patients received 5 mg (low dose) intrathecal hyperbaric bupivacaine in 2 mL volume (1 mL hyperbaric bupivacaine 0.5% diluted with 1 ml sterile distilled water) at L4-5</sub> in sitting position then turned supine immediately. The injection will be in the midline over 30 seconds by 25 gauge(G) Quincke needle. We measured the changes of mean arterial blood pressure, heart rate, O2</sub> saturation and the incidence of hypotension and bradycardia intraoperatively as a primary outcome. Also, we measured the characteristics and the duration of the sensory and motor blocks, the duration required till return of bladder function and the satisfaction levels of both the patients and the surgeons as secondary outcomes.</AbstractText>Student's t</i>-test and Chi-square test were used for analysis.</AbstractText>As regards hemodynamics, mean arterial blood pressure and heart rate were significantly lower in group A compared to group B; P</i>-value <0.05, during the intraoperative period, while MABP and HR were significantly decreasing in group A during the initial intraoperative period at 5 min, 10 min, 15 min, 20 min, 25 min, 30 min and 35 min, but in group B these parameters were statistically insignificant throughout the whole procedure P</i>-value >0.05. As regards oxygen saturation, there were no significant differences between both groups or within the same group during the whole intraoperative period. Comparing sensory and motor blocks, sensory block was significantly higher and motor block was significantly dense in group A compared to group B during the first intraoperative period at 5 min, 10 min, 15 min, 20 min and 25 minutes. The recovery times from sensory and motor blocks were significantly longer in group A compared to group B (P</i>-value <0.001). Also, the void recovery time was significantly longer in group A (129.29 ± 5.87 min) compared to group B (114.77 ± 8.24 min). In group B, patient satisfaction was significantly better (25 excellent/ 10 good) compared to group A (10 excellent/25 good). Also, surgeon satisfaction was statistically significantly better in group B (23 excellent/12 good) compared to group A (14 excellent/21 good). As regards side effects, in group A, 3 patients had to receive ephedrine due to significant reduction in MABP while no patients in group B had significant hypotension or bradycardia throughout the intra operative period.</AbstractText>We concluded that the use of small dose of heavy bupivacaine 0.5% (5 mg) with immediate patient position changing to supine position provided good spinal block characteristics in elderly population without any hemodynamic side effects, also with better patient and surgeon satisfaction levels compared to higher doses of heavy bupivacaine (10 mg) even if we maintained patient position in the sitting position for 3 min after the block.</AbstractText>Copyright: © 2019 Anesthesia: Essays and Researches.</CopyrightInformation>
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2,334,579 |
Cell atlas of the foetal human heart and implications for autoimmune-mediated congenital heart block.
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Investigating human heart development and applying this to deviations resulting in disease is incomplete without molecular characterization of the cell types required for normal functioning. We investigated foetal human heart single-cell transcriptomes from mid-gestational healthy and anti-SSA/Ro associated congenital heart block (CHB) samples.</AbstractText>Three healthy foetal human hearts (19th to 22nd week of gestation) and one foetal heart affected by autoimmune-associated CHB (21st week of gestation) were subjected to enzymatic dissociation using the Langendorff preparation to obtain single-cell suspensions followed by 10× Genomics- and Illumina-based single-cell RNA-sequencing (scRNA-seq). In addition to the myocytes, fibroblasts, immune cells, and other minor cell types, previously uncharacterized diverse sub-populations of endothelial cells were identified in the human heart. Differential gene expression analysis revealed increased and heterogeneous interferon responses in varied cell types of the CHB heart compared with the healthy controls. In addition, we also identified matrisome transcripts enriched in CHB stromal cells that potentially contribute to extracellular matrix deposition and subsequent fibrosis.</AbstractText>These data provide an information-rich resource to further our understanding of human heart development, which, as illustrated by comparison to a heart exposed to a maternal autoimmune environment, can be leveraged to provide insight into the pathogenesis of disease.</AbstractText>© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.</CopyrightInformation>
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2,334,580 |
Dealing with saturated and unsaturated fatty acid metabolism for anticancer therapy.
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Although saturated fatty acid (FA) (SFA) and monounsaturated FA (MUFA) are synthesized in cancer cells from acetyl-CoA, polyunsaturated FAs (PUFAs) are necessarily obtained from diet. Depending on concentrations and metabolism, these different FAs may support tumor proliferation but also exert growth inhibitory effects. The mutual interplay between them also requires to integrate the FA oxidation component that may be concomitant with FA synthesis is cancer cells.</AbstractText>New molecular mechanisms driving FA synthesis, lipotoxicity and anti-inflammatory activity of eicosanoids in mouse and human cancers were recently elicited. To block or take advantage of the above represent attractive perspectives of treatments to fight cancer progression.</AbstractText>The various enzymatic reactions leading to SFA synthesis represent as many targets to prevent tumor growth. Ironically excess SFAs are per-se toxic for cancer cells and the introduction of a double bound to form MUFA is actually limiting lipotoxicity in cancer cells. Blocking stearoyl-CoA desaturase therefore represents another attractive modality. By contrast, dietary PUFAs may exert direct cytotoxic effects by promoting apoptosis or by generating anti-inflammatory eicosanoids. Altogether, these data point out the intricate relationship between SFA, MUFA and PUFA at the heart of the metabolism of proliferating cancer cells.</AbstractText>
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2,334,581 |
Analgesia nociception index and hemodynamic changes during skull pin application for supratentorial craniotomies in patients receiving scalp block versus pin-site infiltration: A randomized controlled trial.
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Noxious stimulation such as skull pin insertion for craniotomy elicits a significant hemodynamic response. Both regional analgesic techniques (pin-site infiltration [PSI] and scalp block [SB]), and systemic strategies (opioids, alpha-2 agonists, anesthetics, and beta-blockers) have shown to attenuate this response. Analgesia Nociception Index (ANI) provides objective information about the magnitude of nociception and adequacy of analgesia. This study compared ANI and hemodynamic changes in patients receiving local anesthetic SB versus PSI during skull pin application for craniotomy.</AbstractText>Sixty adult patients scheduled for elective supratentorial tumor surgery were randomly allocated to receive local anesthetic SB or PSI for skull pin insertion after the induction of anesthesia. Data regarding heart rate (HR), blood pressure (BP), and ANI were collected every minute for 5 min after the skull pin insertion beginning from the baseline.</AbstractText>A significant difference was observed in ANI values between the SB (higher ANI) and the PSI groups during skull pin insertion, P</i> < 0.001 and P</i> = 0.003 for ANIi and ANIm, respectively. Similarly, a significant difference was seen in HR and BP both within and between the two groups during skull pin insertion (P</i> < 0.001 for both). The magnitude and duration of change were smaller in the SB group compared with the PSI group for the parameters studied. A strong negative linear correlation was noted between ANI and hemodynamic parameters.</AbstractText>The changes in HR, BP, and ANI were significantly less with local anesthetic SB compared with PSI during skull pin insertion in patients undergoing supratentorial craniotomy.</AbstractText>Copyright: © 2019 Saudi Journal of Anesthesia.</CopyrightInformation>
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2,334,582 |
A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation.
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Investigate nociception differences in dogs undergoing enucleation administered bupivacaine either via preoperative retrobulbar block (pRB) or intraoperative splash block (iSB).</AbstractText>Prospective, randomized, double-masked, clinical comparison study. Dogs undergoing unilateral enucleation were randomized to two groups: one received bupivacaine pRB and saline iSB of the same volume, and the other received saline pRB and bupivacaine iSB. The following intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end-tidal CO2</sub> (EtCO2</sub> ); systolic, mean, and diastolic arterial blood pressure (SAP, MAP, and DAP respectively); inspired end-tidal isoflurane concentration (EtISOIns), and expired end-tidal isoflurane concentration (EtISOExp). Pain scores were recorded pre- and postoperatively. Analgesic rescue was documented. Surgical hemorrhage and postoperative bruising and swelling were graded subjectively by the surgeon (HDW) and study coordinator (AEZ).</AbstractText>A significant (P = .0399) increase from baseline in overall mean heart rate was recorded in iSB bupivacaine patients (n = 11) compared with pRB bupivacaine patients (n = 11), with no significant differences in other intraoperative physiologic parameters, or pain scores. More analgesic rescue events occurred in iSB bupivacaine patients compared to pRB bupivacaine patients. A near-significant increase in intraoperative bleeding (P = .0519), and a significant increase in bruising (P = .0382) and swelling (P = .0223) was noted in the iSB bupivacaine group.</AbstractText>Preoperative retrobulbar block bupivacaine is more effective than an iSB bupivacaine at controlling both intraoperative and postoperative nociception in dogs undergoing enucleation. Additionally, iSB causes more postoperative bruising and swelling and may be associated with increased intraoperative hemorrhage.</AbstractText>© 2019 American College of Veterinary Ophthalmologists.</CopyrightInformation>
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2,334,583 |
Association of Social Jetlag With Sleep Quality and Autonomic Cardiac Control During Sleep in Young Healthy Men.
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Social jetlag (SJL), the difference in sleep timing between work and free days is a consequence of the discrepancy between the individual's circadian rhythm and the social clock. SJL is considered a chronic stress factor and has been linked to various health problems. In this field study, we examined for the first time the association between SJL and cardiac regulation during sleep. 33 healthy young men aged 20-26 years participated in the study. The median SJL was used as a cut-off value to assign the participants into two groups with either lower or higher SJL. As a marker of autonomic control we analyzed heart rate variability (HRV) and addressed intra-individual differences between workdays and free days. In subjects with higher SJL, pNN50, an indicator of vagal activity was lower in the first 3 h of sleep on workday as compared to free day (day × sleep block × group, <i>p</i> = 0.015), indicating a more adaptable regulation on free days, when subjects slept according to their own preference. However, in subjects with lower SJL, no HRV differences were found between the two nights. SJL showed correlation with the free day-workday differences of both pNN50 and another vagal index, RMSSD in the first 2 h of sleep (<i>p</i> = 0.023 and 0.047, respectively). In subjects with higher SJL, a different HF power on workdays and free days (<i>p</i> = 0.031) also indicated that a shift in sleep timing is accompanied by an altered parasympathetic activity in the first few hours of sleep. Furthermore, subjective sleep quality on workdays was negatively associated with SJL (<i>p</i> = 0.02), and subjects with higher SJL reported worse sleep quality on workday than on free day (<i>p</i> = 0.027). Taken together, our data call attention on the potential effect of SJL on sleep quality and vagal activity during sleep.
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2,334,584 |
Adipokines disrupt cardiac differentiation and cardiomyocyte survival.
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The role of adipose tissue in the pathophysiology of cardiovascular disease remains a major subject of research. The objective of the present study was to dissect the molecular mechanisms that regulate the survival and differentiation of cardiac cells in an obese environment.</AbstractText>We isolated murine/human cardiac cells from adult hearts of control and obese mice/subjects and analyzed the communication between cardiac cells and adipocytes in vitro, as well as the effects on their main functions such as survival and differentiation.</AbstractText>We found that the presence of visceral or subcutaneous adipocytes in the environment of cardiomyocytes or cardiac precursors provoked apoptosis or blocked differentiation, respectively, and these effects were mediated by secreted adipokines. Remarkably, cardiac precursors changed their fate and differentiated into mature adipocytes, contributing to the overall increase in adipose cell content. Inhibiting the adipokines TNF-α, visfatin, or HMGB1 could block the deleterious effects of adipokines on cardiac cells.</AbstractText>Our findings demonstrate that mouse and human visceral adipose tissue contributes negatively to the homeostasis and regeneration of the heart. Moreover, our results suggest that blocking the action of certain adipokines might enhance cardiac differentiation and survival.</AbstractText>
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2,334,585 |
Dysregulation of Hyaluronan Homeostasis During White Matter Injury.
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Although the extra cellular matrix (ECM) comprises a major proportion of the CNS parenchyma, new roles for the ECM in regeneration and repair responses to CNS injury have only recently been appreciated. The ECM undergoes extensive remodeling following injury to the developing or mature CNS in disorders that -include perinatal hypoxic-ischemic cerebral injury, multiple sclerosis and age-related vascular dementia. Here we focus on recently described mechanisms involving hyaluronan (HA), which negatively impact myelin repair after cerebral white matter injury. Injury induced depolymerization of hyaluronan (HA)-a component of the neural ECM-can inhibit myelin repair through the actions of specific sizes of HA fragments. These bioactive fragments selectively block the maturation of late oligodendrocyte progenitors via an immune tolerance-like pathway that suppresses pro-myelination signaling. We highlight emerging new pathophysiological roles of the neural ECM, particularly of those played by HA fragments (HAf) after injury and discuss strategies to promoter repair and regeneration of chronic myelination failure.
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2,334,586 |
Two males with sick sinus syndrome in a family with 0.6 kb deletions involving major domains in MECP2.
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Mutations in methyl-CpG-binding protein 2 (MECP2) in males can lead to various phenotypes, ranging from neonatal encephalopathy to intellectual disability. In this study, using Nord's method of next-generation sequencing in three siblings, we identified a 0.6 kb deletion involving the transcriptional repression domain (TRD). Two males and one female had intellectual disability and apnea, but none met the criteria of Rett syndrome. Both males had sick sinus syndrome and severe tracheomalacia that resulted in early death. The mother, with skewed X-inactivation, had no symptoms. Therefore, this mutation is pathological for both males and females, resulting in sick sinus syndrome and severe tracheomalacia with strong reproducibility in males. Deletions involving major domains in MECP2 can result in a severe phenotype, and deletion of the TRD domain can cause severe autonomic nervous system dysregulation in males in these cases.
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2,334,587 |
Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial.
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The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy.</AbstractText>In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted.</AbstractText>The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively).</AbstractText>The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.</AbstractText>
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2,334,588 |
Therapeutic apheresis during pregnancy: A single center experience.
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Therapeutic apheresis (TA) represents a treatment option for pre-existing conditions or diseases occurring during gestation. Although pregnancy is not a contraindication per se, due to the lack of evidence-based guidelines and presumed risk of maternal/fetal adverse events there is a general resistance to its application.</AbstractText>Between January 2005 and August 2017, at the Apheresis Unit of the University Hospital of Padua 936 TA procedures were performed during 57 pregnancies in 48 patients: 813 Plasma Exchange sessions, 119 Immunoadsorptions, 4 Red Blood Cell exchanges. The treated disease were as follows: antiphospholipid syndrome (18 patients), autoimmune congenital heart block (18), myasthenia gravis (3), Rh alloimmunization (2), systemic sclerosis (1), suspected autoimmune encephalitis (1), severe hypertriglyceridaemia (1), post partum hemolytic-uremic syndrome (1), sickle cell disease (1), lupus nephritis (1) and thrombotic thrombocytopenic purpura (1).</AbstractText>In the time period considered the apheresis sessions applied to pregnant women were 7.1% of the total (n = 13.251). The median age at the first treatment was 33 years. The median week of gestation (WG) at the beginning of treatments was 21. Twenty (2.1%) sessions were complicated by adverse events, none requiring or prolonging hospitalization. There were 50 live births, 5 spontaneous abortions and 2 voluntary terminations of pregnancy. Median WG at delivery was 35 and caesarean section was performed in 46 cases.</AbstractText>Our data showed that TA in pregnancy is well tolerated. Close collaboration between clinician, obstetrician and TA specialist is crucial to ensure a good outcome of high-risk pregnancies.</AbstractText>Copyright © 2019 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,334,589 |
No effect of triheptanoin on exercise performance in McArdle disease.
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To study if treatment with triheptanoin, a 7-carbon triglyceride, improves exercise tolerance in patients with McArdle disease. McArdle patients have a complete block in glycogenolysis and glycogen-dependent expansion of tricarboxylic acid cycle (TCA), which may restrict fat oxidation. We hypothesized that triheptanoin metabolism generates substrates for the TCA, which potentially boosts fat oxidation and improves exercise tolerance in McArdle disease.</AbstractText>Double-blind, placebo-controlled, crossover study in patients with McArdle disease completing two treatment periods of 14 days each with a triheptanoin or placebo diet (1 g/kg/day). Primary outcome was change in mean heart rate during 20 min submaximal exercise on a cycle ergometer. Secondary outcomes were change in peak workload and oxygen uptake along with changes in blood metabolites and respiratory quotients.</AbstractText>Nineteen of 22 patients completed the trial. Malate levels rose on triheptanoin treatment versus placebo (8.0 ± SD2.3 vs. 5.5 ± SD1.8 µmol/L, P < 0.001), but dropped from rest to exercise (P < 0.001). There was no difference in exercise heart rates between triheptanoin (120 ± SD16 bpm) and placebo (121 ± SD16 bpm) treatments. Compared with placebo, triheptanoin did not change the submaximal respiratory quotient (0.82 ± SD0.05 vs. 0.84 ± SD0.03), peak workload (105 ± SD38 vs. 102 ± SD31 Watts), or peak oxygen uptake (1938 ± SD499 vs. 1977 ± SD380 mL/min).</AbstractText>Despite increased resting plasma malate with triheptanoin, the increase was insufficient to generate a normal TCA turnover during exercise and the treatment has no effect on exercise capacity or oxidative metabolism in patients with McArdle disease.</AbstractText>© 2019 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.</CopyrightInformation>
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2,334,590 |
Use of antenatal fluorinated corticosteroids in management of congenital heart block: Systematic review and meta-analysis.
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To evaluate outcomes of fluorinated corticosteroids, with or without other medications, for treatment of congenital heart block in-utero.</AbstractText>A search was conducted through MEDLINE, EMBASE, WEB OF SCIENCE and SCOPUS from inception to October 2017. Only comparative studies are considered eligible. Outcomes include fetal death, downgrade of heart block, neonatal death, need for neonatal pacing, fetal and maternal complications. Random effects model was used.</AbstractText>Out of 923 articles, 12 studies were eligible. Compared to no treatment, there was no significant difference in incidence of fetal death (OR 1.10, 95%CI 0.65-1.84), neonatal death (OR 0.98, 95%CI 0.41-2.33), or need for pacing (OR 1.46, 95%CI 0.78-2.74). Heart block downgrade was significantly higher in treatment group (9.48%vs.1.76%, OR 3.27, 95%CI 1.23-8.71).</AbstractText>antenatal fluorinated corticosteroids do not improve fetal/neonatal morbidity or mortality of congenital heart block and are associated with higher incidence of fetal and maternal complications.</AbstractText>
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2,334,591 |
Cardiac Rehabilitation Availability and Density around the Globe.
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Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.</AbstractText>A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.</AbstractText>CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35-1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04-1.06), and significantly lower with private (OR = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) funding compared to hybrid sources.Median capacity (i.e., number of patients a program could</i> serve annually) was 246/program (Q25-Q75 = 150-390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally.</AbstractText>CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.</AbstractText>
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2,334,592 |
Efficacy of Bilateral Erector Spinae Plane Block in Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.
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Regional analgesia continues to evolve with the introduction of ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB) is a novel technique gaining recent acceptability as a perioperative modality of analgesia in various thoracic and abdominal surgeries. However, literature on the use of ESPB in pediatric cardiac surgery is limited.</AbstractText>A prospective, randomized, single-blind, comparative study.</AbstractText>Single-institution tertiary referral cardiac center.</AbstractText>Eighty children with acyanotic congenital heart disease undergoing cardiac surgery through midline sternotomy.</AbstractText>The subjects were allocated randomly into 2 groups: ESPB (group B, n = 40) received ultrasound-guided bilateral ESPB at the level of T3</sub> transverse process and control (group C, n = 40) receiving no block.</AbstractText>The postoperative pain was assessed using Modified Objective Pain Scores (MOPS) which were evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours after extubation. Group B demonstrated significantly reduced MOPS as compared with group C until the 10th postoperative hour (p < 0.0001), with comparable MOPS at the 12th hour. The consumption of postoperative rescue fentanyl was also significantly less in group B in comparison to group C (p < 0.0001) with a longer duration to first rescue dose requirement in group B. In addition, the group B showed lower postoperative sedation scores and intensive care unit stay in contrast to group C.</AbstractText>Ultrasound-guided bilateral ESPB presents a simple, innovative, reliable, and effective postoperative analgesic modality for pediatric cardiac surgeries contemplated through a midline sternotomy.</AbstractText>Copyright © 2019 Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,334,593 |
Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial.
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Combination nicotine replacement therapy shows additive cessation benefits. We aimed to find out the effectiveness of combining nicotine patches with an e-cigarette (with and without nicotine) on six-month smoking abstinence.</AbstractText>We did a pragmatic, three-arm, parallel-group trial in New Zealand in adult smokers who were e-cigarette naive and motivated to quit smoking. Participants were recruited from the general population using national media advertising. Participants were randomly assigned (1:4:4), with the use of stratified block randomisation, to receive 14 weeks (2 weeks before the agreed quit date) of 21 mg, 24h nicotine patches, patches plus an 18 mg/L nicotine e-cigarette, or patches plus a nicotine-free e-cigarette. We advised participants to use one patch daily, with e-cigarette use as and when necessary or desired. Participants and researchers were masked to e-liquid nicotine content. We offered 6 weeks of telephone-delivered behavioural support. The primary outcome was exhaled carbon monoxide (CO)-verified continuous smoking abstinence 6 months after the agreed quit date. Primary analysis was by intention to treat, with sensitivity analysis by per protocol, treatment adherence, varying CO cutoffs, and complete case analysis. This paper presents the main analyses and is registered with ClinicalTrials.gov, NCT02521662.</AbstractText>Between March 17, 2016 and Nov 30, 2017, 1124 people were assigned to nicotine patches (patches only group, n=125), patches plus a nicotine e-cigarette (patches plus nicotine e-cigarette group, n=500), or patches plus a nicotine-free e-cigarette (patches plus nicotine-free e-cigarette group, n=499). 62 (50%) of 125 participants in the patches only group withdrew or were lost to follow-up by 6 months compared with 161 (32%) of 500 in the patches plus nicotine e-cigarette group and 162 (33%) of 499 in the patches plus nicotine-free e-cigarette group. 35 (7%) participants in the patches plus nicotine e-cigarette group had CO-verified continuous abstinence at 6 months compared with 20 (4%) in the patches plus nicotine-free e-cigarette group (risk difference [RD] 2·99 [95% CI 0·17-5·81]), and three (2%) people in the patches only group (RD 4·60 [1·11-8·09]). 18 serious adverse events occurred in 16 people in the patches plus nicotine e-cigarette group compared with 27 events in 22 people in the patches plus nicotine-free e-cigarette group and four events in three people in the patches only group. In the patches plus nicotine e-cigarette group, two life-threatening serious adverse events were reported (two separate heart attacks in the one participant). In the patches plus nicotine-free e-cigarette group, one death occurred (accidental drug overdose) and one life-threatening serious adverse event (heart attack). No significant between-group differences were noted for serious adverse events, and none were treatment-related.</AbstractText>Combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation over and above that obtained from using patches plus a nicotine-free e-cigarette (or patches alone), with no indication of any serious harm in the short-term. Future e-cigarette trials should focus on their use alone or in combination with usual smoking cessation support, given issues with differential loss to follow-up and withdrawal if a usual care group is used as a comparator.</AbstractText>Health Research Council of New Zealand.</AbstractText>Copyright © 2020 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,334,594 |
Extrapolating Survival Data Using Historical Trial-Based a Priori Distributions.
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To show how clinical trial data can be extrapolated using historical trial data-based a priori distributions.</AbstractText>Extrapolations based on 30-month pivotal multiple myeloma trial data were compared with 75-month data from the same trial. The 30-month data represent a typical decision-making scenario where early results from a clinical trial are extrapolated. Mature historical trial data with the same comparator as in the pivotal trial were incorporated in 2 stages. First, the parametric distribution selection was based on the historical trial data. Second, the shape parameter estimate of the historical trial was used to define an informative a priori distribution for the shape of the 30-month pivotal trial data. The method was compared with standard approaches, fitting parametric distributions to the 30-month data with noninformative prior. The predicted survival of each method was compared with the observed survival (ΔAUC) in the 75-month trial data.</AbstractText>The Weibull had the best fit to the historical trial and the log-normal to the 30-month pivotal trial data. The ΔAUC of the Weibull with informative priors was considerably smaller compared with the standard Weibull. Also, the predicted median survival based on the Weibull with informative priors was more accurate (melphalan and prednisone [MP] 40 months, and bortezomib [V] combined with MP [VMP] 62 months) than based on the standard Weibull (MP 45 months and VMP 72 months) when compared with the observed median (MP 41.3 months and VMP 56.4 months).</AbstractText>Extrapolation of clinical trial data is improved by using historical trial data-based informative a priori distributions.</AbstractText>Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,334,595 |
Linking the metabolic syndrome and obesity with vitamin D status: risks and opportunities for improving cardiometabolic health and well-being.
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The global death toll from noncommunicable diseases is exceptionally high, reported to cause 71% of global deaths worldwide. Metabolic syndrome risk factors, especially excessive adiposity and obesity, are at the heart of the problem resulting in increased co-morbidities such as cardiometabolic diseases and cancer, increased health costs, poorer quality of life, and shortened survival. Vitamin D<sub>3</sub> can positively reverse many of these adverse effects and outcomes through blocking signaling mechanisms that predispose to cardiometabolic and metastatic disease. As an affordable natural agent, vitamin D<sub>3</sub> can be used to counteract obesity-induced inflammation, block early adipogenesis, enhance glucose uptake, counteract hyperleptinemia, ameliorate insulin resistance, and reduce hypertension. This is supported by data from in vitro, in vivo and epidemiological studies and clinical trials. We propose that everyone in general and obese patients in particular consider raising 25-hydroxyvitamin D levels through UVB exposure and/or supplemental vitamin D<sub>3</sub> intake to reduce cardiometabolic and metastatic disease and increase longevity.
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2,334,596 |
Impact of Specimen Characteristics on PD-L1 Testing in Non-Small Cell Lung Cancer: Validation of the IASLC PD-L1 Testing Recommendations.
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Molecules targeting programmed cell death 1 or its ligand programmed death ligand 1 (PD-L1) revolutionized the treatment of patients with NSCLC. The only approved biomarker for predicting treatment response is the PD-L1 tumor proportion score (TPS) determined by immunohistochemistry. According to International Association for the Study of Lung Cancer recommendations, specimens that include fewer than 100 tumor cells or are older than 3 years should not be used for PD-L1 testing and the reliability of cell blocks has yet to be validated.</AbstractText>This retrospective study included 1249 consecutive patients with NSCLC who were tested for PD-L1 (using the clone 22C3) between September 2016 and April 2017. The associations between the presence of suboptimal characteristics (specimens with <100 tumor cells, specimens older than 3 years, or cell blocks) and PD-L1 TPS were examined by using a multinomial logistic regression.</AbstractText>Specimens from 35.5% of the patients had at least one suboptimal characteristic. For patients with a PD-L1 TPS of higher than 50%, there was a significantly higher probability that they had a specimen with more than 100 tumor cells (OR = 1.97, p = 0.008) and a more recent block (within 30 days versus after >3 years) (OR = 2.46, p = 0.023). There was no statistical difference in PD-L1 TPS between cell blocks and tissue specimens (biopsy OR = 0.99 [p = 0.996] and surgery OR = 0.73 [p = 0.302]).</AbstractText>Our results suggest that specimens containing fewer than 100 tumor cells or older than 3 years may lead to an underestimation of PD-L1 status. Our findings also provide support for the use of cell blocks for PD-L1 testing, although further research is needed.</AbstractText>Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,334,597 |
Maternal night-time eating and sleep duration in relation to length of gestation and preterm birth.
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<AbstractText Label="BACKGROUND & AIMS">Maternal metabolic disturbance arising from inappropriate meal timing or sleep deprivation may disrupt circadian rhythm, potentially inducing pregnancy complications. We examined the associations of maternal night-time eating and sleep duration during pregnancy with gestation length and preterm birth.</AbstractText>We studied 673 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal energy intake by time of day and nightly sleep duration were assessed at 26-28 weeks' gestation. Based on 24-h dietary recall, night-eating was defined as consuming >50% of total energy intake from 1900 to 0659 h. Short sleep duration was defined as <6 h night sleep. Night-eating and short sleep were simultaneously analyzed to examine for associations with a) gestation length using multiple linear regression, and b) preterm birth (<37 weeks' gestation) using logistic regression.</AbstractText>Overall, 15.6% women engaged in night-eating, 12.3% had short sleep and 6.8% delivered preterm. Adjusting for confounding factors, night-eating was associated with 0.45 weeks shortening of gestation length (95% CI -0.75, -0.16) and 2.19-fold higher odds of delivering preterm (1.01, 4.72). Short sleep was associated with 0.33 weeks shortening of gestation length (-0.66, -0.01), but its association with preterm birth did not reach statistical significance (1.81; 0.76, 4.30).</AbstractText>During pregnancy, women with higher energy consumption at night than during the day had shorter gestation and greater likelihood of delivering preterm. Misalignment of eating time with day-night cycles may be a contributing factor to preterm birth. This points to a potential target for intervention to reduce the risk of preterm birth. Observations for nightly sleep deprivation in relation to gestation length and PTB warrant further confirmation.</AbstractText>Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</CopyrightInformation>
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2,334,598 |
Comparison of hemodynamic changes of magnesium sulfate and dexmedetomidine for an axillary brachial plexus block.
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Axillary brachial plexus block is used for anesthesia in hands and forearm surgery. The aim of this study was to compare the hemodynamic changes of magnesium sulfate and dexmedetomidine in axillary block.</AbstractText>This randomized, double-blind clinical trial was conducted on 99 patients undergoing a forearm and hand surgery at the Vali-Asr Hospital. Patients were divided into three groups. Dexmedetomidine group consisted of lidocaine 1.5% plus 0.5 μg/kg dexmedetomidine, magnesium sulfate group included lidocaine 1.5% plus 100 mg magnesium sulfate, and the control group received lidocaine 1.5% with normal saline. The final volume was divided into 35 groups in three groups. Blood pressure, heart rate, and oxygen saturation were measured every 5 minutes during surgery, and data were analyzed by SPSS 23.</AbstractText>There was a statistically significant difference between the three groups in terms of the mean blood pressure during surgery (P</i> < 0.05). At all times, blood pressure in the dexmedetomidine group was lower as compared to the other two groups. But in the 20th</sup> and 25th</sup> minutes, there was a relative increase in blood pressure. There was a significant difference between the three groups in terms of heart rate during surgery in minutes 20, 25, 65-100, and 110-120 (P</i> < 0.05).</AbstractText>The final result showed that the blood pressure and heart rate of the dexmedetomidine group patients at different times were less than the other two groups.</AbstractText>
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2,334,599 |
Sonotherapy in the reduction of anxiety and postoperative pain in patients with regional anesthesia as a sole technique: randomized, controlled clinical trial.
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To determine if sonotherapy reduces the anxiety level and postoperative pain in adults undergoing outpatient orthopedic surgery under regional anesthesia.</AbstractText>A randomized, double-blind, placebo-controlled study in 80 adult patients undergoing orthopedic surgery, 40 received intervention with sonotherapy and 40 did not receive it. Pain, anxiety in the preoperative period, immediate postoperative, high, 24 and 48 hours later were measured. Hemodynamic parameters were measured in four moments.</AbstractText>No significant differences were found between the two groups in the pain scales neither anxiety. A significant reduction of the systolic blood pressure was observed after the application of sonotherapy and in recovery. There was no difference in other hemodynamic variables such as heart rate, respiratory rate, arterial oxygen saturation or diastolic blood pressure between groups, however, the observed changes in some of them occurred faster in the intervention group.</AbstractText>In adult patients undergoing outpatient orthopaedic surgery under regional anaesthesia, sound therapy is a novel strategy that significantly reduces systolic blood pressure, considered as an indicator of decreased anxiety. However, in our study, no difference could be demonstrated in terms of pain control or the need for additional sedation or analgesia.</AbstractText>Copyright: © 2019 Permanyer.</CopyrightInformation>
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