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2,335,900 |
Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials.
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This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor.</AbstractText>Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data.</AbstractText>Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min (P</i>=0.002), 30 min (P</i>=0.01), and 120 min (P</i>=0.02) after block and at the moment of fetal disengagement (P</i>=0.0002), decreased mean arterial pressure of 120 min (P</i>=0.01), heart rate of 30 min (P</i>=0.003), 60 min (P</i> < 0.00001), and 120 min (P</i> < 0.00001) after block, blood loss (P</i>=0.02), and the incidence of nausea/vomiting (P</i>=0.006), and increased the incidence of maternal bradycardia (P</i>=0.04). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block (P</i> < 0.00001) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting (P</i>=0.002), increased the incidence of maternal bradycardia (P</i>=0.04), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different.</AbstractText>Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.</AbstractText>Copyright © 2021 Nijuan Li et al.</CopyrightInformation>
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2,335,901 |
Inhibition of the hERG potassium channel by phenanthrene: a polycyclic aromatic hydrocarbon pollutant.
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The lipophilic polycyclic aromatic hydrocarbon (PAH) phenanthrene is relatively abundant in polluted air and water and can access and accumulate in human tissue. Phenanthrene has been reported to interact with cardiac ion channels in several fish species. This study was undertaken to investigate the ability of phenanthrene to interact with hERG (human Ether-à-go-go-Related Gene) encoded Kv11.1 K<sup>+</sup> channels, which play a central role in human ventricular repolarization. Pharmacological inhibition of hERG can be proarrhythmic. Whole-cell patch clamp recordings of hERG current (I<sub>hERG</sub>) were made from HEK293 cells expressing wild-type (WT) and mutant hERG channels. WT I<sub>hERG1a</sub> was inhibited by phenanthrene with an IC<sub>50</sub> of 17.6 ± 1.7 µM, whilst I<sub>hERG1a/1b</sub> exhibited an IC<sub>50</sub> of 1.8 ± 0.3 µM. WT I<sub>hERG</sub> block showed marked voltage and time dependence, indicative of dependence of inhibition on channel gating. The inhibitory effect of phenanthrene was markedly impaired by the attenuated inactivation N588K mutation. Remarkably, mutations of S6 domain aromatic amino acids (Y652, F656) in the canonical drug binding site did not impair the inhibitory action of phenanthrene; the Y652A mutation augmented I<sub>hERG</sub> block. In contrast, the F557L (S5) and M651A (S6) mutations impaired the ability of phenanthrene to inhibit I<sub>hERG</sub>, as did the S624A mutation below the selectivity filter region. Computational docking using a cryo-EM derived hERG structure supported the mutagenesis data. Thus, phenanthrene acts as an inhibitor of the hERG K<sup>+</sup> channel by directly interacting with the channel, binding to a distinct site in the channel pore domain.
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2,335,902 |
The minor pilin PilV provides a conserved adhesion site throughout the antigenically variable meningococcal type IV pilus.
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<i>Neisseria meningitidis</i> utilizes type IV pili (T4P) to adhere to and colonize host endothelial cells, a process at the heart of meningococcal invasive diseases leading to meningitis and sepsis. T4P are polymers of an antigenically variable major pilin building block, PilE, plus several core minor pilins that initiate pilus assembly and are thought to be located at the pilus tip. Adhesion of <i>N. meningitidis</i> to human endothelial cells requires both PilE and a conserved noncore minor pilin PilV, but the localization of PilV and its precise role in this process remains to be clarified. Here, we show that both PilE and PilV promote adhesion to endothelial vessels in vivo. The substantial adhesion defect observed for <i>pilV</i> mutants suggests it is the main adhesin. Consistent with this observation, superresolution microscopy showed the abundant distribution of PilV throughout the pilus. We determined the crystal structure of PilV and modeled it within the pilus filament. The small size of PilV causes it to be recessed relative to adjacent PilE subunits, which are dominated by a prominent hypervariable loop. Nonetheless, we identified a conserved surface-exposed adhesive loop on PilV by alanine scanning mutagenesis. Critically, antibodies directed against PilV inhibit <i>N. meningitidis</i> colonization of human skin grafts. These findings explain how <i>N. meningitidis</i> T4P undergo antigenic variation to evade the humoral immune response while maintaining their adhesive function and establish the potential of this highly conserved minor pilin as a vaccine and therapeutic target for the prevention and treatment of <i>N. meningitidis</i> infections.
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2,335,903 |
Continuous Lumbar Plexus Block under the Guidance of the "Shamrock Method" Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients.
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To explore the effect of continuous lumbar plexus block guided by the "Shamrock method" on postoperative analgesia and hemodynamics in elderly patients after total knee arthroplasty (TKA).</AbstractText>From January 2020 to December 2020 in our hospital, 98 patients who underwent TKA were selected. Using the random number table method, the patients were divided into two groups: a continuous lumbar plexus block group (group L), with 49 patients, and a continuous femoral nerve block group (group F), with 49 patients. The onset time and maintenance time of motor and sensory nerve blocks in patients were recorded. A visual analogue scale (VAS) was applied to assess the pain severity at 6, 12, 24, and 48 h after the operation. The VAS score (FVAS) was applied to evaluate the pain severity of the patients during 24 and 48 h after the operation and knee joint functional exercise. The levels of hemodynamic indexes such as heart rate, mean arterial pressure, and oxyhemoglobin saturation and the levels of hemorheological indexes such as plasma viscosity, high and low whole blood shear viscosity, fibrinogen, and hematocrit were detected and compared between the two groups immediately after the operation and at 12 h and 48 h after the operation, respectively. The incidence of adverse reactions induced by anesthesia was counted.</AbstractText>The onset time of motor and sensory nerve blocks in group L was lower than that in group F, and the maintenance time was higher than that in group F (P</i> < 0.05). The VAS scores of 6, 12, 24, and 48 h after operation in group L were significantly lower than those in group F (P</i> < 0.05). The FVAS scores of group L at 24 and 48 h after operation were significantly lower than those of group F (P</i> < 0.05). The heart rates of the patients in the two groups were higher at 12 h and 48 h after operation than those immediately after operation (P</i> < 0.05). The heart rates at 12 h and 48 h after operation in group L were lower than those in group F (P</i> < 0.05). The plasma viscosity, high whole blood shear viscosity, and low whole blood shear viscosity in the group L at 12 h and 48 h after operation were lower than those in group F (P</i> < 0.05). There was no significant difference in the incidence of local anesthetic poisoning, nausea, vomiting, urinary retention, pruritus, and other adverse reactions between the two groups (P</i> > 0.05).</AbstractText>The "Shamrock method" ultrasound-guided continuous lumbar plexus block in elderly patients after TKA has good analgesic effect, stable hemodynamics, little influence on hemorheology, and good safety. It is of great value to enhance the surgical effect and promote postoperative rehabilitation.</AbstractText>Copyright © 2021 Jinpei Xue et al.</CopyrightInformation>
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2,335,904 |
Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial.
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Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique.</AbstractText>This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure.</AbstractText>The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate.</AbstractText>Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.</AbstractText>Copyright © 2021 Journal of Dental Anesthesia and Pain Medicine.</CopyrightInformation>
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2,335,905 |
Systemic lupus erythematosus and pregnancy: A retrospective single-center study of 215 pregnancies from Portugal.
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Systemic lupus erythematosus (SLE) is a life-threatening disorder that affects women at reproductive age. We evaluate the clinical impact of pregnancy in a cohort of Portuguese SLE patients and the risk factors associated with maternal and fetal adverse outcomes.</AbstractText>A retrospective observational study that included all pregnant women with SLE managed at a Portuguese tertiary hospital, between January 1993 and December 2019. Baseline maternal information was collected, and maternal-fetal and neonatal outcomes were evaluated. Disease activity before and during pregnancy was assessed.</AbstractText>We included 215 pregnancies from 143 patients. Lupus nephritis was present in 20.0% and antiphospholipid syndrome (APS) in 21.9% of the cases. Preconception consultation was performed in 86.9% of the pregnancies, and 92.5% of the patients had no or low disease activity at conception. During gestation, 79.6% of the patients were under treatment, and hydroxychloroquine (HCQ) was the most commonly used drug (63.7%). Low-dose acetylsalicylic acid (ASA) was prescribed at conception in 87.9% of the patients. The live birth rate was 84.2%. An adverse pregnancy outcome (APO) occurred in 41.4% of the pregnancies. A miscarriage rate of 15.3% and a preterm delivery rate of 15.4% were found. Preeclampsia and fetal growth restriction complicated 13.1% and 14.0% of the gestations, respectively. Neonatal lupus occurred in 7.1% of the newborns, and there were 2 cases of congenital heart block. Significant risk factors for the development of AOP were disease activity at conception, lupus flare, hypocomplementemia, positivity for lupus anticoagulant, and APS. The use of ASA was significantly associated with a reduced incidence of miscarriage. An SLE flare was diagnosed in 16.3% of the cases. We identified as risk factors for lupus flares the presence of active disease at conception, a previous history of lupus nephritis, and the use of chronic medication. HCQ use during pregnancy was associated with a significant reduction of flare incidence during pregnancy and postpartum.</AbstractText>Pregnancy in an SLE patient is associated with an increased incidence of adverse obstetric outcomes. Good disease control before pregnancy and adequate treatment, especially with HCQ, is crucial to achieving the best obstetric results.</AbstractText>
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2,335,906 |
Anaesthesia in PROstate Biopsy Pain Obstruction Study: A Study Protocol for a Multicentre Randomised Controlled Study Evaluating the Efficacy of Perineal Nerve Block in Controlling Pain in Patients Undergoing Transperineal Prostate Biopsy.
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<b>Introduction:</b> Transperineal prostate biopsy is as effective as the transrectal biopsy in detecting prostate cancer and has a lower risk of infection. However, concerning the procedural pain of the transperineal route, a higher level of anaesthesia is needed, which prevents this approach from being widely used. Although several methods of local anaesthesia to relieve pain during transperineal biopsy have been described, few well-designed trials have been conducted to assess the efficacy of local anaesthesia. <b>Methods:</b> This is a prospective, multicentre, randomised controlled study in men suspected of having prostate cancer and planning to undergo transperineal prostate biopsy. The aim of this trial is to determine whether the perineal nerve block and periprostatic block relieve pain to different extents in men undergoing transperineal biopsy. The main inclusion criteria are men aged between 18 and 80 years old, a prostate-specific antigen (PSA) level of 4-20 ng/ml, or/and suspicious rectal examination findings. A sample size of 190 participants, accounting for a 10% loss, is required. All participants will be randomly allocated at a ratio of 1:1 to the perineal nerve block (<i>n</i> = 95) and periprostatic block groups (<i>n</i> = 95). The primary outcome will be the level of the worst pain experienced during the transperineal prostate biopsy procedure, which will be measured by a numerical rating scale (NRS). The key secondary outcomes will include the pain severity score at 1, 6, and 24 h after prostate biopsy. <b>Results:</b> The primary outcome is the level of the worst pain experienced during the prostate biopsy procedure. The main secondary outcomes are as follows: (1) Post-biopsy pain severity score at 1, 6, and 24 h after the prostate biopsy; (2) Changes in blood pressure, heart rate and breathing rate during the biopsy procedure; (3) External manifestations of pain during biopsy; (4) Anaesthesia satisfaction; (5) The detection rate for clinically significant prostate cancer and any prostate cancer. <b>Conclusion:</b> Anaesthesia in PROstate biopsy Pain Obstruction Study (APROPOS) is randomised controlled trial aiming to determine the efficacy of the perineal nerve block in controlling pain in patients undergoing prostate biopsy <i>via</i> the transperineal approach. <b>Clinical Trial Registration:</b> www.ClinicalTrials.gov, identifier: NCT04501055.
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2,335,907 |
Postoperative Pain Management: Efficacy of Caudal Tramadol in Pediatric Lower Abdominal Surgery: A Randomized Clinical Study.
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One of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations.</AbstractText>In this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdominal surgery.</AbstractText>In this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal analgesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemodynamic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups.</AbstractText>No considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05).</AbstractText>In this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.</AbstractText>Copyright © 2021, Author(s).</CopyrightInformation>
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2,335,908 |
Utility of conventional clinical risk scores in a low-risk COVID-19 cohort.
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Several specific risk scores for Coronavirus disease 2019 (COVID-19) involving clinical and biochemical parameters have been developed from higher-risk patients, in addition to validating well-established pneumonia risk scores. We compared multiple risk scores in predicting more severe disease in a cohort of young patients with few comorbid illnesses. Accurately predicting the progression of COVID-19 may guide triage and therapy.</AbstractText>We retrospectively examined 554 hospitalised COVID-19 patients in Singapore. The CURB-65 score, Pneumonia Severity Index (PSI), ISARIC 4C prognostic score (4C), CHA2</sub>DS2</sub>-VASc score, COVID-GRAM Critical Illness risk score (COVID-GRAM), Veterans Health Administration COVID-19 index for COVID-19 Mortality (VACO), and the "rule-of-6" score were compared for three performance characteristics: the need for supplemental oxygen, intensive care admission and mechanical ventilation.</AbstractText>A majority of patients were young (≤ 40 years, n = 372, 67.1%). 57 (10.3%) developed pneumonia, with 16 (2.9% of study population) requiring supplemental oxygen. 19 patients (3.4%) required intensive care and 2 patients (0.5%) died. The clinical risk scores predicted patients who required supplemental oxygenation and intensive care well. Adding the presence of fever to the CHA2</sub>DS2</sub>-VASc score and 4C score improved the ability to predict patients who required supplemental oxygen (c-statistic 0.81, 95% CI 0.68-0.94; and 0.84, 95% CI 0.75-0.94 respectively).</AbstractText>Simple scores including well established pneumonia risk scores can help predict progression of COVID-19. Adding the presence of fever as a parameter to the CHA2</sub>DS2</sub>-VASc or the 4C score improved the performance of these scores in a young population with few comorbidities.</AbstractText>© 2021. The Author(s).</CopyrightInformation>
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2,335,909 |
Reversal Activity and Toxicity of Heparin-Binding Copolymer after Subcutaneous Administration of Enoxaparin in Mice.
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Uncontrolled bleeding after enoxaparin (ENX) is rare but may be life-threatening. The only registered antidote for ENX, protamine sulfate (PS), has 60% efficacy and can cause severe adverse side effects. We developed a diblock copolymer, heparin-binding copolymer (HBC), that reverses intravenously administered heparins. Here, we focused on the HBC inhibitory activity against subcutaneously administered ENX in healthy mice. BALB/c mice were subcutaneously injected with ENX at the dose of 5 mg/kg. After 110 min, vehicle, HBC (6.25 and 12.5 mg/kg), or PS (5 and 10 mg/kg) were administered into the tail vein. The blood was collected after 3, 10, 60, 120, 360, and 600 min after vehicle, HBC, or PS administration. The activities of antifactors Xa and IIa and biochemical parameters were measured. The main organs were collected for histological analysis. HBC at the lower dose reversed the effect of ENX on antifactor Xa activity for 10 min after antidote administration, whereas at the higher dose, HBC reversed the effect on antifactor Xa activity throughout the course of the experiment. Both doses of HBC completely reversed the effect of ENX on antifactor IIa activity. PS did not reverse antifactor Xa activity and partially reversed antifactor IIa activity. HBC modulated biochemical parameters. Histopathological analysis showed changes in the liver, lungs, and spleen of mice treated with HBC and in the lungs and heart of mice treated with PS. HBC administered in an appropriate dose might be an efficient substitute for PS to reverse significantly increased anticoagulant activity that may be connected with major bleeding in patients receiving ENX subcutaneously.
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2,335,910 |
Modern Rotational Radiation Techniques with Volumetric Modulated Arc Therapy or Helical Tomotherapy for Optimal Sparing of the Lung and Heart in Left-Breast Cancer Radiotherapy Plus Regional Nodal Irradiation: A Comparative Dosimetric Analysis.
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For advanced breast cancer with lymph node involvement, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. However, an extensive RT volume is associated with normal organ exposure, which increases the toxicity and affects patient outcomes. Modern arc RT techniques can improve normal organ sparing compared with conventional techniques. The aim of this study was to explore the optimal technique for left-breast RT with RNI.</AbstractText>We retrospectively reviewed patients receiving RT with RNI for left-breast cancer. We used modern arc RT techniques with either volumetric-modulated arc therapy (VMAT) or helical tomotherapy (HT) with a novel block technique, and compared differences in dosimetry parameters between the two groups. Subgroup analysis of RNI with or without internal mammary node (IMN) volume was also performed.</AbstractText>A total of 108 eligible patients were enrolled between 2017 and 2020, of whom 70 received VMAT and 38 received HT. The median RT dose was 55 Gy. No significant differences were found regarding the surgery, RT dose, number of fractions, target volume, and RNI volume between the VMAT and HT groups. VMAT reduced the heart mean dose more than HT (3.82 vs. 5.13 Gy, p</i> < 0.001), as well as the cardiac parameters of V5-V20, whole-lung mean dose, lung parameters of V5-V20, and contralateral-breast and esophagus mean dose. In the subgroup analysis of RNI with IMNs, the advantage of VMAT persisted in protecting the heart, lung, contralateral breast, and esophagus. HT was beneficial for lowering the thyroid mean dose. For RNI without IMN, VMAT improved the low-dose exposure of the heart and lung, but HT was similar to VMAT in terms of heart, whole-lung, and contralateral-breast mean dose.</AbstractText>For patients with left-breast cancer receiving adjuvant RT with RNI, VMAT reduced the exposure dose to the heart, lung, contralateral breast, and esophagus compared with HT. VMAT was superior to HT in terms of normal organ sparing in the patients who underwent RNI with IMN irradiation. Considering the reduction in normal organ exposure and potential toxicity, VMAT is the optimal technique for patients receiving RNI when deep inspiration breath-hold is not available.</AbstractText>
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2,335,911 |
Comparison of epidural, spinal, and saddle block for holmium laser enucleation of prostate (HoLEP): A prospective randomized, comparative study.
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Holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostate hypertrophy. The aim of the present study was to compare regional anesthesia methods for HoLEP operation and to determine the optimal technique.</AbstractText>Sixty patients with American Society of Anesthesiologists scores of I-III were randomly allocated into 3 groups. Patients in group E received an epidural block with 75 mg of bupivacaine plus 50 μg of fentanyl. In group S, 15 mg of bupivacaine and 50 μg fentanyl were used for spinal anesthesia. In group SA, patients received saddle block with 15 mg of bupivacaine and 50 μg of fentanyl.</AbstractText>Time to T10 dermatome block and to maximal level block were longest in group E (P < .05), and maximal sensorial block level was higher in group E than group SA (P < .05). There was a significant difference in postoperative motor block, but no difference in systolic blood pressure and heart rate.</AbstractText>Among 3 techniques, saddle block might be preferable in HoLEP because an adequate sensorial level was achieved with lower motor block and stable hemodynamics.</AbstractText>Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.</CopyrightInformation>
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2,335,912 |
Effectiveness of Suprascapular Nerve Block in the Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-Analysis.
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<b>Purpose:</b> We aimed to investigate the effectiveness of suprascapular nerve block (SSNB) in patients with hemiplegic shoulder pain (HSP). <b>Background:</b> SSNB is widely used in various shoulder pains, but whether it is effective in HSP remains unknown. <b>Methods:</b> PubMed, Cochrane Library, and Embase databases were searched to identify potential citations. Randomized controlled trials meeting the eligible criteria were included in our analysis. The primary endpoint was Visual Analog Scale (VAS) with a maximum value of 100 and a minimum value of 0. Secondary endpoints were passive range of motion (PROM) that pain starts, and the PROM mainly included abduction, flexion, and external rotation. In addition, the upper extremity Fugl-Meyer assessment (FMA) was also included in our secondary endpoints. <b>Results:</b> Eight studies with 281 patients were included in our analysis. For VAS, there was no obvious difference between SSNB group and control group regardless of the follow-up period (<4 weeks or ≥4 weeks), which were -6.62 (-15.76, 2.53; <i>p</i> = 0.16) and 1.78 (-16.18, 19.74; <i>p</i> = 0.85). For shoulder function, the PROM of abduction, flexion, and external rotation was similar between groups. However, motor function indicator FMA is lower in SSNB control than that in control group, with a mean difference (and 95% CI) of -2.59 (-4.52, -0.66; <i>p</i> = 0.008). <b>Conclusion:</b> SSNB is an effective way for HSP patients. <b>Systematic Review Registration:</b> Registration ID: CRD42021252429.
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2,335,913 |
Fetal Congenital Heart Block Associated With Maternal Primary Systemic Lupus Erythematosus and Sjogren's Syndrome.
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Congenital heart block is a grave condition reported in 0.5% of 100 live births. Systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) are chronic autoimmune and inflammatory condition, which affects multiple systems. The association of SLE and SS with pregnancy has been seen in the past. Usually, it shows anti-Ro/SSA and anti-Ro/SSB auto-antibodies in maternal serum, which is proportional to fetal Outcome. In this report, we present a case of a 29-year-old female gravida 4, para one and aborta 3, with a history of polycystic ovarian disease and multiple abortions. At 20 weeks of gestation, her antenatal examination revealed fetal bradycardia and heart block, which further led to SLE and SS diagnosis in her. She was treated with steroids to prevent further fetal complications. The patient delivered a healthy neonate at 38 weeks of gestation. The neonate eventually received a cardiac pacemaker and is now on regular follow-up.
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2,335,914 |
Music-Assisted Training for Dart Throwing Novices: Post-Training Effects on Heart Rate and Performance Accuracy.
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While previous research has suggested that lowering athletes' heart rates can enhance sports performance, it is unknown whether slow-paced music might induce a lower heart rate and thereby improve some types of motor performance. In this study, we investigated the effects of different types of music during dart-throw training on both heart rate and dart-throwing performance in 45 (<i>M</i> age = 19.7, <i>SD</i> = 0.31 years) novice dart throwers who were randomly assigned to either a Slow Music Group (SMG), a Fast Music Group (FMG), or a Control Group (CG). All participants completed three dart-throwing blocks - Pre-Test, Practice, and Post-Test. During the Practice block, participants practiced dart-throwing with either slow-paced, fast-paced or no music according to their assigned group. We recorded the participants' heart rates and total dart-throwing accuracy scores during Pre-Test and Post-Test. Music-assisted dart-throw training with slow-paced music was effective in significantly inhibiting a performance-related increase in heart rate and was associated with the greatest dart throwing improvement after training.
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2,335,915 |
Glycolysis Inhibition Alleviates Cardiac Fibrosis After Myocardial Infarction by Suppressing Cardiac Fibroblast Activation.
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<b>Objective:</b> To explore the role of glycolysis in cardiac fibroblast (CF) activation and cardiac fibrosis after myocardial infarction (MI). <b>Method:</b> <i>In vivo</i>: 2-Deoxy-D-glucose (2-DG), a glycolysis inhibitor, was injected into the abdominal cavity of the MI or sham mice every day. On the 28th day, cardiac function was measured by ultrasonic cardiography, and the hearts were harvested. Masson staining and immunofluorescence (IF) were used to evaluate the fibrosis area, and western blot was used to identify the glycolytic level. <i>In vitro</i>, we isolated the CF from the sham, MI and MI with 2-DG treatment mice, and we also activated normal CF with transforming growth factor-β1 (TGF-β1) and block glycolysis with 2-DG. We then detected the glycolytic proteins, fibrotic proteins, and the concentrations of lactate and glucose in the culture medium. At last, we further detected the fibrotic and glycolytic markers in human fibrotic and non-fibrotic heart tissues with masson staining, IF and western blot. <b>Result:</b> More collagen and glycolytic protein expressions were observed in the MI mice hearts. The mortality increased when mice were treated with 2-DG (100 mg/kg/d) after the MI surgery (Log-rank test, <i>P</i> < 0.05). When the dosage of 2-DG declined to 50 mg/kg/d, and the treatment was started on the 4th day after MI, no statistical difference of mortality between the two groups was observed (Log-rank test, <i>P</i> = 0.98). The collagen volume fraction was smaller and the fluorescence signal of α-smooth muscle actin (α-SMA) was weaker in mice treated with 2-DG than PBS. <i>In vitro</i>, 2-DG could significantly inhibit the increased expression of both the glycolytic and fibrotic proteins in the activated CF. <b>Conclusion:</b> Cardiac fibrosis is along with the enhancement of CF activation and glycolysis. Glycolysis inhibition can alleviate cardiac fibroblast activation and cardiac fibrosis after myocardial infarction.
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2,335,916 |
Effect Analysis of Epidural Anesthesia with 0.4% Ropivacaine in Transforaminal Endoscopic Surgery.
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Epidural anesthesia used in percutaneous endoscopic lumber discectomy (PELD) has the risk of complete neurotactile block. Patients cannot timely respond to the operator when the nerve is touched by mistake, so the potential risk of nerve injury cannot be avoided. According to pharmacodynamics, with the decrease of local anesthetic concentration, the nerve tactile gradually recovered; however, the analgesic effect also gradually weakened. Therefore, it is necessary to explore an appropriate concentration of local anesthetics that can keep the patients' nerve touch without pain. By comparing the advantages and disadvantages of 0.4% ropivacaine epidural anesthesia, local anesthesia and intravenous anesthesia on intraoperative circulation fluctuation, the incidence of salvage analgesia and the incidence of nerve non-touch, the feasibility of using low concentration epidural anesthesia in PELD to obtain enough analgesia and avoid the risk of nerve injury was confirmed.</AbstractText>153 cases of intervertebral foramen surgery from October 2017 to January 2020 were selected and divided into local anesthesia group (LA group), 0.4% ropivacaine epidural anesthesia group (EA group), and intravenous anesthesia group (IVA group) according to different anesthesia methods. The changes of blood pressure and heart rate, the incidence of rescue analgesia and nerve root non-touch were compared among the three groups.</AbstractText>The difference of map peak value among the three groups was statistically significant (P</i> < 0.001); pairwise comparison showed that the map peak value of the LA group was higher than that of the EA group (P</i> < 0.001) and IVA group (P</i> < 0.001), but there was no statistical significance between the EA group and IVA group. The difference of HR peak value among the three groups was statistically significant; pairwise comparison showed that the HR peak value of the LA group was higher than that of the EA group (P</i> < 0.001) and IVA group (P</i> < 0.001), but there was no statistical significance between the EA group and IVA group. There was significant difference in the incidence of intraoperative hypertension among the three groups (P</i> < 0.05); pairwise comparison showed that the incidence of intraoperative hypertension in the EA group was lower than that in the LA group (P</i> < 0.05), while there was no significant difference between the IVA group, EA group, and LA group. There was significant difference in the incidence of rescue analgesia among the three groups (P</i> < 0.01); pairwise comparison showed that the incidence of rescue analgesia in the EA group was lower than that in the LA group (P</i> < 0.05) and IVA group (P</i> < 0.05), but there was no significant difference between the LA group and IVA group. Due to the different analgesic mechanisms of the three anesthesia methods, local anesthesia and intravenous anesthesia do not cause the loss of nerve tactile, while the incidence of nerve tactile in 0.4% ropivacaine epidural anesthesia is only 2.4%, which is still satisfactory.</AbstractText>Epidural anesthesia with 0.4% ropivacaine is a better anesthesia method for PELD. It not only has a low incidence of non-tactile nerve, but also has perfect analgesia and more stable intraoperative circulation.</AbstractText>Copyright © 2021 Bingwei Hu et al.</CopyrightInformation>
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2,335,917 |
TRK inhibitors block NFKB and induce NRF2 in TRK fusion-positive colon cancer.
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Tropomyosin receptor kinase (TRK) fusion is one of the oncogenic driver causes of colon cancer, and tropomyosin 3-neurotrophic receptor tyrosine kinase 1 (TPM3-NTRK1) fusion has been detected in the KM12SM cell line. In the present study, we investigated anticancer mechanisms in the KM12SM cell line using three different form of dovitinib (dovitinib (free base), dovitinib lactate (mono acid), and dovitinib dilactic acid (diacid)) and four TRK inhibitors (LOXO-101, entrectinib, regorafenib, and crizotinib). Exposure of TRK inhibitors at concentrations of 10 nM resulted in the apoptosis of KM12SM cells, whereas regorafenib had no effect. Treatment with all inhibitors except regorafenib also significantly increased the expression levels of the genes nuclear factor-erythroid 2-related factor 2 (NRF2) and glutamyl cysteine ligase catalytic subunit (GCLC) in KM12SM. These drugs significantly reduced expression of the phosphorylated proteins NFκB and COX-2 in the KM12SM cell line, and significantly attenuated KM12SM cell migration, according to a Transwell migration assay. Together, these results suggest that TRK inhibitors block products of carcinogenesis by negatively regulating the NFκB signaling pathway and positively regulating the antioxidant NRF2 signaling pathway.
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2,335,918 |
A prospective, randomized, single-blinded, crossover trial to investigate the effect of a wearable device in addition to a daily symptom diary for the Remote Early Detection of SARS-CoV-2 infections (COVID-RED): a structured summary of a study protocol for a randomized controlled trial.
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It is currently thought that most-but not all-individuals infected with SARS-CoV-2 develop symptoms, but the infectious period starts on average 2 days before the first overt symptoms appear. It is estimated that pre- and asymptomatic individuals are responsible for more than half of all transmissions. By detecting infected individuals before they have overt symptoms, wearable devices could potentially and significantly reduce the proportion of transmissions by pre-symptomatic individuals. Using laboratory-confirmed SARS-CoV-2 infections (detected via serology tests [to determine if there are antibodies against the SARS-CoV-2 in the blood] or SARS-CoV-2 infection tests such as polymerase chain reaction [PCR] or antigen tests) as the gold standard, we will determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the following two algorithms to detect first time SARS-CoV-2 infection including early or asymptomatic infection: • The algorithm using Ava bracelet data when coupled with self-reported Daily Symptom Diary data (Wearable + Symptom Data Algo; experimental condition) • The algorithm using self-reported Daily Symptom Diary data alone (Symptom Only Algo; control condition) In addition, we will determine which of the two algorithms has superior performance characteristics for detecting SARS-CoV-2 infection including early or asymptomatic infection as confirmed by SARS-CoV-2 virus testing.</AbstractText>The trial is a randomized, single-blinded, two-period, two-sequence crossover trial. The study will start with an initial learning phase (maximum of 3 months), followed by period 1 (3 months) and period 2 (3 months). Subjects entering the study at the end of the recruitment period may directly start with period 1 and will not be part of the learning phase. Each subject will undergo the experimental condition (the Wearable + Symptom Data Algo) in either period 1 or period 2 and the control condition (Symptom Only Algo) in the other period. The order will be randomly assigned, resulting in subjects being allocated 1:1 to either sequence 1 (experimental condition first) or sequence 2 (control condition first). Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence.</AbstractText>The trial will be conducted in the Netherlands. A target of 20,000 subjects will be enrolled. Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence. This results in approximately 6500 normal-risk individuals and 3500 high-risk individuals per sequence. Subjects will be recruited from previously studied cohorts as well as via public campaigns and social media. All data for this study will be collected remotely through the Ava COVID-RED app, the Ava bracelet, surveys in the COVID-RED web portal and self-sampling serology and PCR kits. More information on the study can be found in www.covid-red.eu . During recruitment, subjects will be invited to visit the COVID-RED web portal. After successfully completing the enrolment questionnaire, meeting eligibility criteria and indicating interest in joining the study, subjects will receive the subject information sheet and informed consent form. Subjects can enrol in COVID-RED if they comply with the following inclusion and exclusion criteria: Inclusion criteria: • Resident of the Netherlands • At least 18 years old • Informed consent provided (electronic) • Willing to adhere to the study procedures described in the protocol • Must have a smartphone that runs at least Android 8.0 or iOS 13.0 operating systems and is active for the duration of the study (in the case of a change of mobile number, the study team should be notified) • Be able to read, understand and write Dutch Exclusion criteria: • Previous positive SARS-CoV-2 test result (confirmed either through PCR/antigen or antibody tests; self-reported) • Current suspected (e.g. waiting for test result) COVID-19 infection or symptoms of a COVID-19 infection (self-reported) • Participating in any other COVID-19 clinical drug, vaccine or medical device trial (self-reported) • Electronic implanted device (such as a pacemaker; self-reported) • Pregnant at the time of informed consent (self-reported) • Suffering from cholinergic urticaria (per the Ava bracelet's user manual; self-reported) • Staff involved in the management or conduct of this study INTERVENTION AND COMPARATOR: All subjects will be instructed to complete the Daily Symptom Diary in the Ava COVID-RED app daily, wear their Ava bracelet each night and synchronize it with the app each day for the entire period of study participation. Provided with wearable sensor and/or self-reported symptom data within the last 24 h, the Ava COVID-RED app's underlying algorithms will provide subjects with a real-time indicator of their overall health and well-being. Subjects will see one of three messages, notifying them that no seeming deviations in symptoms and/or physiological parameters have been detected; some changes in symptoms and/or physiological parameters have been detected and they should self-isolate; or alerting them that deviations in their symptoms and/or physiological parameters could be suggestive of a potential COVID-19 infection and to seek additional testing. We will assess the intraperson performance of the algorithms in the experimental condition (Wearable + Symptom Data Algo) and control conditions (Symptom Only Algo). Note that both algorithms will also instruct to seek testing when any SARS-CoV-2 symptoms are reported in line with those defined by the Dutch national institute for public health and the environment 'Rijksinstituut voor Volksgezondheid en Milieu' (RIVM) guidelines.</AbstractText>The trial will evaluate the use and performance of the Ava COVID-RED app and Ava bracelet, which uses sensors to measure breathing rate, pulse rate, skin temperature and heart rate variability for the purpose of early and asymptomatic detection and monitoring of SARS-CoV-2 in general and high-risk populations. Using laboratory-confirmed SARS-CoV-2 infections (detected via serology tests, PCR tests and/or antigen tests) as the gold standard, we will determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the following two algorithms to detect first-time SARS-CoV-2 infection including early or asymptomatic infection: the algorithm using Ava bracelet data when coupled with the self-reported Daily Symptom Diary data and the algorithm using self-reported Daily Symptom Diary data alone. In addition, we will determine which of the two algorithms has superior performance characteristics for detecting SARS-CoV-2 infection including early or asymptomatic infection as confirmed by SARS-CoV-2 virus testing. The protocol contains an additional twenty secondary and exploratory objectives which address, among others, infection incidence rates, health resource utilization, symptoms reported by SARS-CoV-2-infected participants and the rate of breakthrough and asymptomatic SARS-CoV-2 infections among individuals vaccinated against COVID-19. PCR or antigen testing will occur when the subject receives a notification from the algorithm to seek additional testing. Subjects will be advised to get tested via the national testing programme and report the testing result in the Ava COVID-RED app and a survey. If they cannot obtain a test via the national testing programme, they will receive a nasal swab self-sampling kit at home, and the sample will be tested by PCR in a trial-affiliated laboratory. In addition, all subjects will be asked to take a capillary blood sample at home at baseline (between month 0 and 3.5 months after the start of subject recruitment), at the end of the learning phase (month 3; note that this sampling moment is skipped if a subject entered the study at the end of the recruitment period), period 1 (month 6) and period 2 (month 9). These samples will be used for SARS-CoV-2-specific antibody testing in a trial-affiliated laboratory, differentiating between antibodies resulting from a natural infection and antibodies resulting from COVID-19 vaccination (as vaccination will gradually be rolled out during the trial period). Baseline samples will only be analysed if the sample collected at the end of the learning phase is positive, or if the subject entered the study at the end of the recruitment period, and samples collected at the end of period 1 will only be analysed if the sample collected at the end of period 2 is positive. When subjects obtain a positive PCR/antigen or serology test result during the study, they will continue to be in the study but will be moved into a so-called COVID-positive mode in the Ava COVID-RED app. This means that they will no longer receive recommendations from the algorithms but can still contribute and track symptom and bracelet data. The primary analysis of the main objective will be executed using the data collected in period 2 (months 6 through 9). Within this period, serology tests (before and after period 2) and PCR/antigen tests (taken based on recommendations by the algorithms) will be used to determine if a subject was infected with SARS-CoV-2 or not. Within this same time period, it will be determined if the algorithms gave any recommendations for testing. The agreement between these quantities will be used to evaluate the performance of the algorithms and how these compare between the study conditions.</AbstractText>All eligible subjects will be randomized using a stratified block randomization approach with an allocation ratio of 1:1 to one of two sequences (experimental condition followed by control condition or control condition followed by experimental condition). Based on demographics, medical history and/or profession, each subject will be stratified at baseline into a high-risk and normal-risk group within each sequence, resulting in approximately equal numbers of high-risk and normal-risk individuals between the sequences.</AbstractText><AbstractText Label="BLINDING (MASKING)" NlmCategory="UNASSIGNED">In this study, subjects will be blinded to the study condition and randomization sequence. Relevant study staff and the device manufacturer will be aware of the assigned sequence. The subject will wear the Ava bracelet and complete the Daily Symptom Diary in the Ava COVID-RED app for the full duration of the study, and they will not know if the feedback they receive about their potential infection status will only be based on the data they entered in the Daily Symptom Diary within the Ava COVID-RED app or based on both the data from the Daily Symptom Diary and the Ava bracelet.</AbstractText><AbstractText Label="NUMBERS TO BE RANDOMIZED (SAMPLE SIZE)" NlmCategory="UNASSIGNED">A total of 20,000 subjects will be recruited and randomized 1:1 to either sequence 1 (experimental condition followed by control condition) or sequence 2 (control condition followed by experimental condition), taking into account their risk level. This results in approximately 6500 normal-risk and 3500 high-risk individuals per sequence.</AbstractText>Protocol version: 3.0, dated May 3, 2021. Start of recruitment: February 19, 2021. End of recruitment: June 3, 2021. End of follow-up (estimated): November 2021 TRIAL REGISTRATION: The Netherlands Trial Register on the 18th</sup> of February, 2021 with number NL9320 ( https://www.trialregister.nl/trial/9320 ) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.</AbstractText>© 2021. The Author(s).</CopyrightInformation>
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2,335,919 |
A scintigraphy study of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler in patients with moderate-to-very severe chronic obstructive pulmonary disease.<Pagination><StartPage>261</StartPage><MedlinePgn>261</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">261</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1186/s12931-021-01813-w</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Triple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β<sub>2</sub>-agonists (ICS/LAMA/LABA) is recommended for patients with chronic obstructive pulmonary disease (COPD) with continued symptoms or exacerbations, despite treatment with LAMA/LABA or ICS/LABA. The pulmonary, extrathoracic, and regional lung deposition patterns of a radiolabeled ICS/LAMA/LABA triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate (BGF 320/18/9.6 μg), delivered via a single Aerosphere metered dose inhaler (MDI) were previously assessed in healthy volunteers and showed good deposition to the central and peripheral airways (whole lung deposition: 37.7%). Here, we report the findings assessing BGF in patients with moderate-to-very severe COPD.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">This phase I, single-dose, open-label gamma scintigraphy imaging study (NCT03906045) was conducted in patients with moderate-to-very severe COPD. Patients received two actuations of BGF MDI (160/9/4.8 μg per actuation) radiolabeled with technetium‑99‑pertechnetate, not exceeding 5 MBq per actuation. Immediately following each inhalation, patients performed a breath-hold of up to 10 s, then exhaled into an exhalation filter. Gamma scintigraphy imaging of the anterior and posterior views of the lungs and stomach, and a lateral head and neck view, were performed immediately after exhalation. The primary objective of the study was to assess the pulmonary deposition of BGF. Secondary objectives assessed the deposited dose of radiolabeled BGF in the oropharyngeal and stomach regions, on the actuator, and on the exhalation filter in addition to regional airway deposition patterns in the lungs.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The mean BGF emitted dose deposited in the lungs was 32.1% (standard deviation [SD] 15.6) in patients with moderate-to-very severe COPD, 35.2% (SD 12.8) in patients with moderate COPD, and 28.7% (SD 18.4) in patients with severe/very severe COPD. Overall, the mean normalized outer/inner ratio was 0.55 (SD 0.19), while the standardized central/peripheral ratio was 2.21 (SD 1.64).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Radiolabeled BGF 320/18/9.6 μg was efficiently delivered and deposited throughout the entire lung, including large and small airways, in patients with moderate-to-very severe COPD, with similar deposition in patients with moderate COPD and patients with severe/very severe COPD.</AbstractText><AbstractText Label="TRIAL REGISTRATION" NlmCategory="BACKGROUND">ClinicalTrials.gov, NCT03906045. Registered 8 April 2019, https://clinicaltrials.gov/ct2/show/NCT03906045.</AbstractText><CopyrightInformation>© 2021. The Author(s).</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Usmani</LastName><ForeName>Omar</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Asthma Lab, National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, South Block, Royal Brompton Campus, Sydney St, Chelsea, London, SW3 6NP, UK. [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roche</LastName><ForeName>Nicolas</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Respiratory Medicine, Hôpital Cochin (AP-HP), University of Paris, Cochin Institute, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wahab</LastName><ForeName>Ezanul</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Simbec Research Ltd, Merthyr Tydfil, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Israel</LastName><ForeName>Samuel</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Simbec Research Ltd, Merthyr Tydfil, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jenkins</LastName><ForeName>Martin</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>AstraZeneca, Cambridge, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Trivedi</LastName><ForeName>Roopa</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>AstraZeneca, Durham, NC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dorinsky</LastName><ForeName>Paul</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>AstraZeneca, Durham, NC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aurivillius</LastName><ForeName>Magnus</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>AstraZeneca, Gothenburg, Sweden.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><DataBankList CompleteYN="Y"><DataBank><DataBankName>ClinicalTrials.gov</DataBankName><AccessionNumberList><AccessionNumber>NCT03906045</AccessionNumber></AccessionNumberList></DataBank></DataBankList><PublicationTypeList><PublicationType UI="D017426">Clinical Trial, Phase I</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>10</Month><Day>07</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Respir Res</MedlineTA><NlmUniqueID>101090633</NlmUniqueID><ISSNLinking>1465-9921</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D058666">Adrenergic beta-2 Receptor Agonists</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D001993">Bronchodilator Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D003287">Contrast Media</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D005938">Glucocorticoids</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D018727">Muscarinic Antagonists</NameOfSubstance></Chemical><Chemical><RegistryNumber>A0730CX801</RegistryNumber><NameOfSubstance UI="D013670">Sodium Pertechnetate Tc 99m</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="C000722808">budesonide-glycopyrrolate-formoterol fumarate drug combination</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000280" MajorTopicYN="N">Administration, Inhalation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058666" MajorTopicYN="Y">Adrenergic beta-2 Receptor Agonists</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001993" MajorTopicYN="Y">Bronchodilator Agents</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003287" MajorTopicYN="N">Contrast Media</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005938" MajorTopicYN="Y">Glucocorticoids</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008168" MajorTopicYN="Y">Lung</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D036501" MajorTopicYN="N">Metered Dose Inhalers</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018727" MajorTopicYN="Y">Muscarinic Antagonists</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011237" MajorTopicYN="N">Predictive Value of Tests</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D029424" MajorTopicYN="Y">Pulmonary Disease, Chronic Obstructive</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011877" MajorTopicYN="N">Radionuclide Imaging</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020127" MajorTopicYN="N">Recovery of Function</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013670" MajorTopicYN="N">Sodium Pertechnetate Tc 99m</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Budesonide</Keyword><Keyword MajorTopicYN="N">Formoterol fumarate</Keyword><Keyword MajorTopicYN="N">Gamma scintigraphy</Keyword><Keyword MajorTopicYN="N">Glycopyrronium</Keyword><Keyword MajorTopicYN="N">Pulmonary deposition</Keyword></KeywordList><CoiStatement>OU reports academic grants from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline; and personal fees from Aerocrine, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Mundipharma, NAPP, Prosonix Ltd, Sandoz, Takeda, and Zentiva NR reports grants and personal fees from Boehringer Ingelheim, Novartis, and Pfizer; and personal fees from AstraZeneca, Chiesi, Cipla, GlaxoSmithKline, Mundipharma, Sanofi, Teva, Trudell, and Zambon. EW and SI declare that they have no competing interests. MJ, RT, PD, and MA are employees of, and hold stock and/or stock options in, AstraZeneca.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>3</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>7</Month><Day>28</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>10</Month><Day>8</Day><Hour>5</Hour><Minute>41</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>10</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>2</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34620167</ArticleId><ArticleId IdType="pmc">PMC8496011</ArticleId><ArticleId IdType="doi">10.1186/s12931-021-01813-w</ArticleId><ArticleId IdType="pii">10.1186/s12931-021-01813-w</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Global Initiative for Chronic Obstructive Lung Disease. 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<b><i>Objective:</i></b> Aortic stenosis (AS) is characterized by narrowing of the aortic valve opening, resulting in peak blood flow velocity that induces high wall shear stress (WSS) across the valve. Severe AS leads to heart failure and death. There is no treatment available for AS other than valve replacement. Platelet-derived transforming growth factor beta 1 (TGF-β1) partially contributes to AS progression in mice, and WSS is a potent activator of latent TGF-β1. N-acetylcysteine (NAC) inhibits WSS-induced TGF-β1 activation <i>in vitro</i>. We hypothesize that NAC will inhibit AS progression by inhibiting WSS-induced TGF-β1 activation. <b><i>Approach:</i></b> We treated a cohort of <i>Ldlr(-/-)Apob(100/100)</i> low density lipoprotein receptor (LDLR) mice fed a high-fat diet with NAC (2% in drinking water) at different stages of disease progression and measured its effect on AS progression and TGF-β1 activation. <b><i>Results:</i></b> Short-term NAC treatment inhibited AS progression in mice with moderate and severe AS relative to controls, but not in LDLR mice lacking platelet-derived TGF-β1 (TGF-β1<sup>platlet-KO</sup>-LDLR). NAC treatment reduced TGF-β signaling, p-Smad2 and collagen levels, and mesenchymal transition from isolectin B<sub>4</sub> and CD45-positive cells in LDLR mice. Mechanistically, NAC treatment resulted in plasma NAC concentrations ranging from 75.5 to 449.2 ng/mL, which were sufficient to block free thiol labeling of plasma proteins and reduce active TGF-β1 levels without substantially affecting reactive oxygen species-modified products in valvular cells. <b><i>Conclusions:</i></b> Short-term treatment with NAC inhibits AS progression by inhibiting WSS-induced TGF-β1 activation in the LDLR mouse model of AS, motivating a clinical trial of NAC and/or other thiol-reactive agent(s) as a potential therapy for AS.
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Interoceptive sensibility predicts the ability to infer others' emotional states.<Pagination><StartPage>e0258089</StartPage><MedlinePgn>e0258089</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">e0258089</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0258089</ELocationID><Abstract><AbstractText>Emotional sensations and inferring another's emotional states have been suggested to depend on predictive models of the causes of bodily sensations, so-called interoceptive inferences. In this framework, higher sensibility for interoceptive changes (IS) reflects higher precision of interoceptive signals. The present study examined the link between IS and emotion recognition, testing whether individuals with higher IS recognize others' emotions more easily and are more sensitive to learn from biased probabilities of emotional expressions. We recorded skin conductance responses (SCRs) from forty-six healthy volunteers performing a speeded-response task, which required them to indicate whether a neutral facial expression dynamically turned into a happy or fearful expression. Moreover, varying probabilities of emotional expressions by their block-wise base rate aimed to generate a bias for the more frequently encountered emotion. As a result, we found that individuals with higher IS showed lower thresholds for emotion recognition, reflected in decreased reaction times for emotional expressions especially of high intensity. Moreover, individuals with increased IS benefited more from a biased probability of an emotion, reflected in decreased reaction times for expected emotions. Lastly, weak evidence supporting a differential modulation of SCR by IS as a function of varying probabilities was found. Our results indicate that higher interoceptive sensibility facilitates the recognition of emotional changes and is accompanied by a more precise adaptation to emotion probabilities.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Hübner</LastName><ForeName>Amelie M</ForeName><Initials>AM</Initials><Identifier Source="ORCID">0000-0002-0564-2286</Identifier><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Trempler</LastName><ForeName>Ima</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Otto-Creutzfeldt-Center for Cognitive and Behavioural Neuroscience, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gietmann</LastName><ForeName>Corinna</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schubotz</LastName><ForeName>Ricarda I</ForeName><Initials>RI</Initials><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Otto-Creutzfeldt-Center for Cognitive and Behavioural Neuroscience, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>10</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS One</MedlineTA><NlmUniqueID>101285081</NlmUniqueID><ISSNLinking>1932-6203</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004644" MajorTopicYN="N">Emotions</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005149" MajorTopicYN="Y">Facial Expression</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006240" MajorTopicYN="Y">Happiness</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006339" MajorTopicYN="N">Heart Rate</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D065812" MajorTopicYN="N">Interoception</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011930" MajorTopicYN="N">Reaction Time</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012677" MajorTopicYN="N">Sensation</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>12</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>9</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>10</Month><Day>6</Day><Hour>17</Hour><Minute>23</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>10</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>11</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34613976</ArticleId><ArticleId IdType="pmc">PMC8494315</ArticleId><ArticleId IdType="doi">10.1371/journal.pone.0258089</ArticleId><ArticleId IdType="pii">PONE-D-20-39386</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Craig A. 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Emotional sensations and inferring another's emotional states have been suggested to depend on predictive models of the causes of bodily sensations, so-called interoceptive inferences. In this framework, higher sensibility for interoceptive changes (IS) reflects higher precision of interoceptive signals. The present study examined the link between IS and emotion recognition, testing whether individuals with higher IS recognize others' emotions more easily and are more sensitive to learn from biased probabilities of emotional expressions. We recorded skin conductance responses (SCRs) from forty-six healthy volunteers performing a speeded-response task, which required them to indicate whether a neutral facial expression dynamically turned into a happy or fearful expression. Moreover, varying probabilities of emotional expressions by their block-wise base rate aimed to generate a bias for the more frequently encountered emotion. As a result, we found that individuals with higher IS showed lower thresholds for emotion recognition, reflected in decreased reaction times for emotional expressions especially of high intensity. Moreover, individuals with increased IS benefited more from a biased probability of an emotion, reflected in decreased reaction times for expected emotions. Lastly, weak evidence supporting a differential modulation of SCR by IS as a function of varying probabilities was found. Our results indicate that higher interoceptive sensibility facilitates the recognition of emotional changes and is accompanied by a more precise adaptation to emotion probabilities.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Hübner</LastName><ForeName>Amelie M</ForeName><Initials>AM</Initials><Identifier Source="ORCID">0000-0002-0564-2286</Identifier><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Trempler</LastName><ForeName>Ima</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Otto-Creutzfeldt-Center for Cognitive and Behavioural Neuroscience, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gietmann</LastName><ForeName>Corinna</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schubotz</LastName><ForeName>Ricarda I</ForeName><Initials>RI</Initials><AffiliationInfo><Affiliation>Department of Psychology, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Otto-Creutzfeldt-Center for Cognitive and Behavioural Neuroscience, University of Muenster, Muenster, Germany.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>10</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS One</MedlineTA><NlmUniqueID>101285081</NlmUniqueID><ISSNLinking>1932-6203</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004644" MajorTopicYN="N">Emotions</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005149" MajorTopicYN="Y">Facial Expression</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006240" MajorTopicYN="Y">Happiness</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006339" MajorTopicYN="N">Heart Rate</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D065812" MajorTopicYN="N">Interoception</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011930" MajorTopicYN="N">Reaction Time</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012677" MajorTopicYN="N">Sensation</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>12</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>9</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>10</Month><Day>6</Day><Hour>17</Hour><Minute>23</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>10</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>11</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34613976</ArticleId><ArticleId IdType="pmc">PMC8494315</ArticleId><ArticleId IdType="doi">10.1371/journal.pone.0258089</ArticleId><ArticleId IdType="pii">PONE-D-20-39386</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Craig A. 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Frontiers in psychology, 9, 798. doi: 10.3389/fpsyg.2018.00798</Citation><ArticleIdList><ArticleId IdType="doi">10.3389/fpsyg.2018.00798</ArticleId><ArticleId IdType="pmc">PMC5985305</ArticleId><ArticleId IdType="pubmed">29892247</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">34612503</PMID><DateRevised><Year>2021</Year><Month>10</Month><Day>06</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1930-613X</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Oct</Month><Day>06</Day></PubDate></JournalIssue><Title>Military medicine</Title><ISOAbbreviation>Mil Med</ISOAbbreviation></Journal><ArticleTitle>Lyme Carditis With Complete Heart Block Successfully Treated With Oral Doxycycline.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">usab420</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1093/milmed/usab420</ELocationID><Abstract>Lyme disease is a vector-borne infection that can affect multiple different organ systems. Lyme carditis represents one of these sequelae and is defined by acute onset of high-grade atrioventricular block in the presence of laboratory-confirmed infection. Current guidelines recommend patients with Lyme carditis be admitted for close cardiac monitoring and intravenous antibiotics therapy. Our case illustrates an active duty male who was initially diagnosed with Lyme disease after initially reporting symptoms including headache, fever, eye pain, and rash, with subsequent development of exercise intolerance 6 weeks later. An electrocardiogram (ECG) obtained at that time was misinterpreted as first-degree heart block, and he was initiated on oral doxycycline therapy and referred to cardiology. On follow-up to cardiology clinic, the prior ECG was reviewed and interpreted as complete heart block. A repeat ECG showed resolution of the heart block, and exercise stress testing showed chronotropic competence. This case illustrates the resolution of complete heart block in Lyme carditis with oral doxycycline, suggesting this antibiotic as a possible alternative treatment agent.
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A Computational Framework for Pre-Interventional Planning of Peripheral Arteriovenous Malformations.
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Peripheral arteriovenous malformations (pAVMs) are congenital lesions characterised by abnormal high-flow, low-resistance vascular connections-the so-called nidus-between arteries and veins. The mainstay treatment typically involves the embolisation of the nidus, however the complexity of pAVMs often leads to uncertain outcomes. This study aims at developing a simple, yet effective computational framework to aid the clinical decision making around the treatment of pAVMs using routinely acquired clinical data.</AbstractText>A computational model was developed to simulate the pre-, intra-, and post-intervention haemodynamics of a patient-specific pAVM. A porous medium of varying permeability was employed to simulate the sclerosant effect on the nidus haemodynamics. Results were compared against clinical data (digital subtraction angiography, DSA, images) and experimental flow-visualization results in a 3D-printed phantom of the same pAVM.</AbstractText>The computational model allowed the simulation of the pAVM haemodynamics and the sclerotherapy-induced changes at different interventional stages. The predicted inlet flow rates closely matched the DSA-derived data, although the post-intervention one was overestimated, probably due to vascular system adaptations not accounted for numerically. The nidus embolization was successfully captured by varying the nidus permeability and increasing its hydraulic resistance from 0.330 to 3970 mmHg s ml-1</sup>. The nidus flow rate decreased from 71% of the inlet flow rate pre-intervention to 1%: the flow completely bypassed the nidus post-intervention confirming the success of the procedure.</AbstractText>The study demonstrates that the haemodynamic effects of the embolisation procedure can be simulated from routinely acquired clinical data via a porous medium with varying permeability as evidenced by the good qualitative agreement between numerical predictions and both in vivo and in vitro data. It provides a fundamental building block towards a computational treatment-planning framework for AVM embolisation.</AbstractText>© 2021. The Author(s).</CopyrightInformation>
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2,335,922 |
Use of Outpatient-Derived COVID-19 Convalescent Plasma in COVID-19 Patients Before Seroconversion.
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Transfusion of COVID-19 convalescent plasma (CCP) containing high titers of anti-SARS-CoV-2 antibodies serves as therapy for COVID-19 patients. Transfusions early during disease course was found to be beneficial. Lessons from the SARS-CoV-2 pandemic could inform early responses to future pandemics and may continue to be relevant in lower resource settings. We sought to identify factors correlating to high antibody titers in convalescent plasma donors and understand the magnitude and pharmacokinetic time course of both transfused antibody titers and the endogenous antibody titers in transfused recipients.</AbstractText>Plasma samples were collected up to 174 days after convalescence from 93 CCP donors with mild disease, and from 16 COVID-19 patients before and after transfusion. Using ELISA, anti-SARS-CoV-2 Spike RBD, S1, and N-protein antibodies, as well as capacity of antibodies to block ACE2 from binding to RBD was measured in an in vitro</i> assay. As an estimate for viral load, viral RNA and N-protein plasma levels were assessed in COVID-19 patients.</AbstractText>Anti-SARS-CoV-2 antibody levels and RBD-ACE2 blocking capacity were highest within the first 60 days after symptom resolution and markedly decreased after 120 days. Highest antibody titers were found in CCP donors that experienced fever. Effect of transfused CCP was detectable in COVID-19 patients who received high-titer CCP and had not seroconverted at the time of transfusion. Decrease in viral RNA was seen in two of these patients.</AbstractText>Our results suggest that high titer CCP should be collected within 60 days after recovery from donors with past fever. The much lower titers conferred by transfused antibodies compared to endogenous production in the patient underscore the importance of providing CCP prior to endogenous seroconversion.</AbstractText>Copyright © 2021 Wirz, Röltgen, Stevens, Pandey, Sahoo, Tolentino, Verghese, Nguyen, Hunter, Snow, Singh, Blish, Cochran, Zehnder, Nadeau, Pinsky, Pham and Boyd.</CopyrightInformation>
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2,335,923 |
Neuromodulation of innate immunity by remote ischaemic conditioning in humans: Experimental cross-over study.
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Experimental animal studies on the mechanisms of remote ischaemic conditioning (RIC)-induced cardioprotection against ischaemia/reperfusion injury demonstrate involvement of both neuronal and humoral pathways. Autonomic parasympathetic (vagal) pathways confer organ protection through both direct innervation and/or immunomodulation, but evidence in humans is lacking. During acute inflammation, vagal release of acetylcholine suppresses CD11b expression, a critical β2-integrin regulating neutrophil adhesion to the endothelium and transmigration to sites of injury. Here, we tested the hypothesis that RIC recruits vagal activity in humans and has an anti-inflammatory effect by reducing neutrophil CD11b expression. Participants (age:50 ​± ​19 years; 53% female) underwent ultrasound-guided injection of local anaesthetic within the brachial plexus before applying 3 ​× ​8 min cycles of brachial artery occlusion using a blood pressure cuff (RIC<sup>block</sup>). RIC was repeated 6 weeks later without brachial plexus block. Masked analysers quantified vagal activity (heart rate, heart rate variability (HRV)) before, and 10 ​min after, the last cycle of RIC. RR-interval increased after RIC (reduced heart rate) by 40 ​ms (95% confidence intervals (95%CI):13-66; n ​= ​17 subjects; <i>P</i> ​= ​0.003). RR-interval did not change after brachial plexus blockade (mean difference: 20 ​ms (95%CI:-11 to 50); <i>P</i> ​= ​0.19). The high-frequency component of HRV was reduced after RIC<sup>block</sup>, but remained unchanged after RIC (<i>P</i> ​< ​0.001), indicating that RIC preserved vagal activity. LPS-induced CD16<sup>+</sup>CD11b<sup>+</sup> expression in whole blood (measured by flow cytometry) was reduced by RIC (3615 median fluorescence units (95%CI:475-6754); <i>P</i> = 0.026), compared with 2331 units (95%CI:-3921 to 8582); <i>P</i> = 0.726) after RIC<sup>block</sup>. These data suggest that in humans RIC recruits vagal cardiac and anti-inflammatory mechanisms via ischaemia/reperfusion-induced activation of sensory nerve fibres that innervate the organ undergoing RIC.
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2,335,924 |
MiR-218-5p Mediates Myocardial Fibrosis after Myocardial Infarction by Targeting CX43.
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Myocardial fibrosis after myocardial infarction (MI) has been considered a core factor in the deterioration of cardiac function. Previous studies have shown that miRNA plays an important role in various pathophysiological processes of the heart. However, the role of miRNA in myocardial fibrosis regulation after MI remains unclear. In the present study, we documented that miR-218-5p was significantly decreased in myocardial fibroblasts after MI.</AbstractText>The miRNA expression profiles of MI were downloaded from GEO Datasets. The expression of a fibrosis-related gene in vivo and in vitro was analyzed by RT-PCR, western blotting, and immunohistochemical staining.</AbstractText>Total 7 up- and 9 downregulated common miRNAs were found in the two profiles. Among these common genes, miR-218-5p was downregulated in the MI mice. MiR-218-5p mediated the myocardial fibrosis in vivo and in vitro. Mechanistically, we found that GJA1 (CX43) may be the target of miR218-5p, and overexpressed CX43 can partly block the function of miR-218-5p in fibrosis inhibition.</AbstractText>Our results suggested that miR-218-5p plays an important role in myocardial fibrosis after MI by targeting CX43. Thus, miR-218-5p promises to be a potential diagnosis and treatment of myocardial fibrosis after MI.</AbstractText>Copyright© Bentham Science Publishers; For any queries, please email at [email protected].</CopyrightInformation>
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2,335,925 |
Direct interaction between ABCA1 and HIV-1 Nef: Molecular modeling and virtual screening for inhibitors.
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HIV-1 infection impairs cellular cholesterol efflux by downmodulating the cholesterol transporter ABCA1, leading to metabolic co-morbidities like cardio-vascular disease. The main mechanism of this effect is impairment by the HIV-1 protein Nef of the ABCA1 interaction with the endoplasmic reticulum chaperone calnexin, which leads to a block in ABCA1 maturation followed by its degradation. However, ABCA1 is also downmodulated by Nef delivered with the extracellular vesicles, suggesting involvement of a direct Nef:ABCA1 interaction at the plasma membrane. Here, we present an optimized model of the Nef:ABCA1 interaction, which identifies interaction sites and provides an opportunity to perform a virtual screening for potential inhibitors. Interestingly, the predicted sites on Nef involved in the ABCA1 interaction overlap with those involved in the interaction with calnexin. The compounds previously shown to block Nef:calnexin interaction were among the top ranking ligands in docking simulations with ABCA1-interacting sites on Nef, suggesting the possibility that both interactions can be inhibited by the same chemical compounds. This study identifies a series of compounds for potential development as inhibitors of Nef-mediated co-morbidities of HIV infection.
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2,335,926 |
A prospective observational study on the feasibility of subumbilical laparoscopic procedures under epidural anesthesia in sedated spontaneously breathing infants with a natural airway.
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Laparoscopic procedures are usually performed under general anesthesia with a secured airway including endotracheal intubation or supraglottic airways.</AbstractText>This is a prospective study of the feasibility of subumbilical laparoscopic procedures under epidural anesthesia in sedated, spontaneous breathing infants with a natural airway.</AbstractText>We consecutively enrolled 20 children <3 years old with nonpalpable testes scheduled for diagnostic laparoscopy with or without an ensuing orchidopexy, inguinal revision, or Fowler-Stephens maneuver. Inhalational induction for venous access was followed by sedation with propofol and ultrasound-guided single-shot epidural anesthesia via the caudal or thoracolumbar approach using 1.0 or 0.5 ml kg-1</sup> ropivacaine 0.38%, respectively. The primary outcome measure was block success, defined as no increase in heart rate by >15% or other indicators of pain upon skin incision.</AbstractText>Of the 20 children (median age: 10 months; IQR: 8.3-12), 17 (85%) were anesthetized through a caudal and 3 (15%) through a direct thoracolumbar epidural, 18 (90%) underwent a surgical procedure and 2 (10%) diagnostic laparoscopy only. Five patients (25%) received block augmentation using an intravenous bolus of fentanyl (median dose: 0.9 µg kg-1</sup> ; IQR: 0.8-0.95) after the initial prick test and before skin incision. There was no additional need for systemic pain therapy in the operating theater or recovery room. No events of respiratory failure or aspiration were observed.</AbstractText>In experienced hands, given our success rate of 100%, epidural anesthesia performed in sedated spontaneously breathing infants with a natural airway can be an alternative strategy for subumbilical laparoscopic procedures.</AbstractText>© 2021 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.</CopyrightInformation>
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2,335,927 |
The Way forward for the Origin of Life: Prions and Prion-Like Molecules First Hypothesis.
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In this paper the hypothesis that prions and prion-like molecules could have initiated the chemical evolutionary process which led to the eventual emergence of life is reappraised. The prions first hypothesis is a specific application of the protein-first hypothesis which asserts that protein-based chemical evolution preceded the evolution of genetic encoding processes. This genetics-first hypothesis asserts that an "RNA-world era" came before protein-based chemical evolution and rests on a singular premise that molecules such as RNA, acetyl-CoA, and NAD are relics of a long line of chemical evolutionary processes preceding the Last Universal Common Ancestor (LUCA). Nevertheless, we assert that prions and prion-like molecules may also be relics of chemical evolutionary processes preceding LUCA. To support this assertion is the observation that prions and prion-like molecules are involved in a plethora of activities in contemporary biology in both complex (eukaryotes) and primitive life forms. Furthermore, a literature survey reveals that small RNA virus genomes harbor information about prions (and amyloids). If, as has been presumed by proponents of the genetics-first hypotheses, small viruses were present during an RNA world era and were involved in some of the earliest evolutionary processes, this places prions and prion-like molecules potentially at the heart of the chemical evolutionary process whose eventual outcome was life. We deliberate on the case for prions and prion-like molecules as the frontier molecules at the dawn of evolution of living systems.
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2,335,928 |
Is a Block of the Femoral and Sciatic Nerves an Alternative to Epidural Analgesia in Sheep Undergoing Orthopaedic Hind Limb Surgery? A Prospective, Randomized, Double Blinded Experimental Trial.
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Peripheral nerve blocks are commonly used in human and veterinary medicine. The aim of the study was to compare the analgesic efficacy of a combined block of the femoral and sciatic nerves with an epidural injection of ropivacaine in experimental sheep undergoing orthopaedic hind limb surgery. Twenty-five sheep were assigned to two groups (peripheral nerve block; sciatic and femoral nerves (P); epidural analgesia (E)). In group P 10 mL ropivacaine 0.5% was injected around the sciatic and the femoral nerves under sonographic guidance and 10 mL NaCl 0.9% into the epidural space while in group E 10 mL ropivacaine 0.5% was injected into the epidural space and 10 mL NaCl 0.9% to the sciatic and the femoral nerves. During surgery, heart rate, respiratory rate and mean blood pressure were used as indicators of nociception. In the postoperative phase, nociception was evaluated every hour by use of a purposefully adapted pain score until the animal showed painful sensation at the surgical site. The mean duration of analgesia at the surgical wound was 6 h in group P and 8 h in group E. Mean time to standing was 4 h in group P and 7 h in group E. In conclusion time to standing was significantly shorter in group P while the duration of nociception was comparable in both groups. The peripheral nerve block can be used as an alternative to epidural analgesia in experimental sheep.
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2,335,929 |
Real-World Experience in Toxicity with Bevacizumab in Indian Cancer Patients.
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<b>Background</b> Bevacizumab, a humanized monoclonal antibody, known to block the binding of all known vascular endothelial growth factor-A isomers to their receptors, is used in solid cancers, especially in advanced settings where its role is proven to be stronger than localized stages. Furthermore, various studies have suggested that adding bevacizumab to first-line standard therapy in advanced solid cancers, such as colorectal cancer, lung cancer, ovarian cancer, renal cancer, and breast cancer, significantly prolongs progression-free survival, overall survival, and response rates. However, this ability is limited and variable in cancer subtype. The toxicity profile of bevacizumab is outspread, ranging from mild gastrointestinal side effects, proteinuria to life-threatening hemorrhagic tendency, ischemic thromboembolism, and intestinal perforation. However, it has never been studied in Indian subset of patients till date. <b>Materials and Methods</b> We performed an institutional retrospective study of 41 patients with a pathologically proven ovarian, colorectal, lung, mesothelioma, melanoma, round cell tumors, and GBMs who received bevacizumab (2.5 mg/kg/week [5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks]) with or without chemotherapy, between January 2016 and January 2019 at our center in North India. <b>Results</b> Forty-one patients, including 12 (29) advanced ovarian cancer, 12 (29) colon cancer, 10 (24) rectal cancer, 1 (2) appendicular cancer, 1 (2) mesothelioma, 1 (2) melanoma, 1 (2) desmoplastic round cell tumor, and 3 (7) GBM, were treated with bevacizumab. The incidence of arterial thrombus and hemorrhage was 2 and 10%, respectively, whereas venous thrombus and fistula were not seen and not related to age. No fatal adverse event was recorded. The global incidence of severe (grade 3/4) arterial hypertension (HTN) was 49%. It was safely managed in all cases, and no grade 4 (life-threatening complication) occurred. The incidence of severe HTN was significantly higher in elderly patients than in younger ones (72 vs. 40%), proteinuria was found to be more frequent in the younger age group as compared with older age group (7 vs. 3%). Also to note, the incidence of congestive heart failure and subacute intestinal obstruction was found in 5% of patients, wherein all four patients belonged to the older subgroup. Furthermore, Grade 3 hypersensitivity reaction was found in one patient in the younger subgroup which warranted immediate termination of bevacizumab.
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2,335,930 |
Network Meta-analysis of First-Line Systemic Treatment for Patients With Metastatic Colorectal Cancer.
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To assess the relative efficacy and safety of first-line systemic therapies in patients with metastatic colorectal cancer.</AbstractText>A comprehensive literature review was conducted including MEDLINE, Embase, and the Cochrane Central Registry of Controlled Trials for phase II or III randomized controlled trials (RCTs) published up to and including July 15, 2019. We included RCTs in which at least 1 intervention was either chemotherapeutic agents (such as fluorouracil, irinotecan, or oxaliplatin) or antibodies targeting angiogenesis (such as bevacizumab) or agents that act on the epidermal growth factor receptor pathway (such as cetuximab and panitumumab) or studies reported at least one of the following outcomes: overall survival (OS), progression-free survival (PFS), and/or Grade 3 + adverse events (AEs). Using a random effect model, we performed a Bayesian network meta-analysis to analyze the probability of optimal therapeutic regime obtained from direct comparisons with indirect evidences. We estimated hazard ratios for OS and PFS.</AbstractText>A total of 30 RCTs comprising 12,146 mCRC patients with 25 different treatment strategies were included. The triple combination FOLFOXIRI [fluorouracil, leucovorin, oxaliplatin, and irinotecan] plus bevacizumab provided significant survival benefits with improved OS over all other treatments. The network meta-analysis also indicated a significant advantage of using FOLFOXIRI plus bevacizumab in comparison to other treatment strategies for PFS. Besides, FOLFOXIRI plus bevacizumab was associated with the well-tolerated adverse events.</AbstractText>Our study supported the use of FOLFOXIRI plus bevacizumab as the best first-line regimen and potentially effective and safe strategy for the management of patients with mCRC.</AbstractText>
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2,335,931 |
Thoracic Paravertebral Nerve Block with Ropivacaine and Adjuvant Dexmedetomidine Produced Longer Analgesia in Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Trial.
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This study evaluated the postoperative analgesic effect of ultrasound-guided single-point thoracic paravertebral nerve block (TPVB) combined with dexmedetomidine (DEX) in patients undergoing video-assisted thoracoscopic lobectomy.</AbstractText>Sixty adult patients of the American Society of Anesthesiologists (ASA) I-III were randomly assigned into three groups (n</i> = 20 each). G group: patients received routine general anesthesia; PR group: patients received 0.5% ropivacaine; and PRD group: patients received 0.5% ropivacaine with 1 μ</i>g/kg DEX. TPVB was performed in the T5 space before surgery, and then, general anesthesia induction and video-assisted thoracoscopic lobectomy were performed. Analgesics were administered through the patient-controlled analgesia (PCA) device intravenously. The background infusion of each PCA device was set to administer 0.02 μ</i>g/kg/h sufentanil, with a lockout time of 15 min, and a total allowable volume is 100 ml.</AbstractText>Compared to PR and G groups, the total sufentanil consumption after operation, the times of analgesic pump pressing, the pain score, and the incidence of postoperative nausea or vomiting in the PRD group were significantly reduced (p</i> < 0.05). Also, the duration of first time of usage of the patient-controlled analgesia (PCA) was longer. The heart rate (HR) and mean arterial pressure (MAP) during operation were lower in the PRD group as compared with the other two groups in most of the time. However, hypotension and arrhythmia occurred in three groups with no statistically significant difference.</AbstractText>A small volume of TPVB with ropivacaine and DEX by single injection produced longer analgesia in patients undergoing video-assisted thoracoscopic lobectomy, reduced postoperative opioids consumption, and the incidence of side effects.</AbstractText>Copyright © 2021 Jun Zha et al.</CopyrightInformation>
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2,335,932 |
Analysis of bupivacaine and ropivacaine-related cardiac arrests in regional anesthesia: A systematic review of case reports.
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Regional anesthesia as a component of multimodal analgesia protocols has become more and more a part of modern perioperative pain management. The widespread adoption of ultrasound guidance in regional anesthesia has surely played an important role in that growth and it has significantly improved patient safety, decreased the incidence of block failure, cardiac arrest, and reduced complication rates. The objective of this systematic review is to extract, analyze, and synthesize clinical information about bupivacaine and ropivacaine related cardiac arrest that we might have a clearer picture of the clinical presentation. The literature search identified 268 potentially relevant publications and 22 relevant case reports were included in the review. Patients' demographics, types of regional anesthesia, hypotension, heart rhythm disorders, seizures, cardiac arrest, fatal outcome, recommendations and limitations on prevention and treatment of bupivacaine and ropivacaine related cardiac arrest are analyzed and discussed in the systematic review. Both bupivacaine and ropivacaine-induced local anesthetic toxicity can result in cardiac arrest. Lipid emulsion, telemetry, local anesthetic toxicity resuscitation training appears to be promising in improvement of survival but more research is needed. Improvement and encouragement of reporting the local anesthetic toxicity are warranted to improve the quality of information that can be analyzed in order to make more precise conclusion.
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2,335,933 |
An Observational Study on Arrhythmia During Cesarean Section Under Spinal Anesthesia: Incidence, Risk Factors, and Effects on Immediate Post-delivery Neonatal Outcome.
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Various types of arrhythmia have been reported during cesarean section under spinal anesthesia. But the possible causative factors and the effects of arrhythmia on immediate post-delivery neonatal outcome are not well established.</AbstractText>This prospective observational study was conducted over a period of one year in a tertiary care hospital on women undergoing cesarean section under spinal anesthesia. The objectives of the study were to determine the incidence of arrhythmia, its types, the possible factors influencing arrhythmia, and the immediate post-delivery neonatal outcome. Data collected were analyzed using Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY).</AbstractText>In our study, the incidence of arrhythmia was 31.9% during cesarean section under spinal anesthesia; and sinus bradycardia was the most common type. Arrhythmia occurred more in women with hypotension, when maximum block height was above T4</sub> level and dose of intrathecal hyperbaric bupivacaine was more than 2.2 mL (P value <0.05). Also, uterine manipulation led to sudden bradycardia and transient cardiac asystole in two patients which was preceded by subjective symptoms of pain and discomfort. None of the neonates required cardiopulmonary resuscitation or neonatal intensive care unit admission within an hour of birth. APGAR (Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration) scores at 1 and 5 minutes were similar in all the newborns born to mothers with or without arrhythmia.</AbstractText>The occurrence of arrhythmia during cesarean section under spinal anesthesia, though very common, is rarely life-threatening. Keeping maximum level of block height between T4</sub> and T6,</sub> using lower possible drug dose to provide adequate level of sensory block, prompt management of hypotension, and strict monitoring during uterine manipulation may reduce the overall incidence of arrhythmia. Intraoperative arrhythmia, however, does not adversely affect the immediate post-delivery neonatal outcome.</AbstractText>Copyright © 2021, Dev et al.</CopyrightInformation>
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2,335,934 |
Complete heart block in patients infected with SARS-CoV-2: A case series from a developing country.
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Coronavirus Disease 19 (COVID-19) has led to a global pandemic and has been the center of attention across the entire medical community. This novel virus was initially thought to affect primarily the respiratory system, but now it is evident that it has a multitude of effects on the human body. Our point of interest is to establish the effect of COVID-19 infection on the conducting system of the heart. We present a case series of four patients who developed complete heart block (CHB) shortly after being infected with COVID-19 without any previous known risk factors of complete heart block. There have only been a few previous case reports on the occurrence of CHB in COVID-19 patients highlighting the importance and the need of our case series to the literature of cardiovascular outcomes in COVID-19 patients. Our case series highlight that COVID-19 can indeed affect the conduction system of the heart and cause CHB in patients who then recovered spontaneously further elucidating the transient nature of cardiovascular effects caused by the novel virus.
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2,335,935 |
Robust neuromorphic coupled oscillators for adaptive pacemakers.
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Neural coupled oscillators are a useful building block in numerous models and applications. They were analyzed extensively in theoretical studies and more recently in biologically realistic simulations of spiking neural networks. The advent of mixed-signal analog/digital neuromorphic electronic circuits provides new means for implementing neural coupled oscillators on compact, low-power, spiking neural network hardware platforms. However, their implementation on this noisy, low-precision and inhomogeneous computing substrate raises new challenges with regards to stability and controllability. In this work, we present a robust, spiking neural network model of neural coupled oscillators and validate it with an implementation on a mixed-signal neuromorphic processor. We demonstrate its robustness showing how to reliably control and modulate the oscillator's frequency and phase shift, despite the variability of the silicon synapse and neuron properties. We show how this ultra-low power neural processing system can be used to build an adaptive cardiac pacemaker modulating the heart rate with respect to the respiration phases and compare it with surface ECG and respiratory signal recordings from dogs at rest. The implementation of our model in neuromorphic electronic hardware shows its robustness on a highly variable substrate and extends the toolbox for applications requiring rhythmic outputs such as pacemakers.
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2,335,936 |
An adaptive cryptosystem on a Finite Field.
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Owing to mathematical theory and computational power evolution, modern cryptosystems demand ingenious trapdoor functions as their foundation to extend the gap between an enthusiastic interceptor and sensitive information. This paper introduces an adaptive block encryption scheme. This system is based on product, exponent, and modulo operation on a finite field. At the heart of this algorithm lies an innovative and robust trapdoor function that operates in the Galois Field and is responsible for the superior speed and security offered by it. Prime number theorem plays a fundamental role in this system, to keep unwelcome adversaries at bay. This is a self-adjusting cryptosystem that autonomously optimizes the system parameters thereby reducing effort on the user's side while enhancing the level of security. This paper provides an extensive analysis of a few notable attributes of this cryptosystem such as its exponential rise in security with an increase in the length of plaintext while simultaneously ensuring that the operations are carried out in feasible runtime. Additionally, an experimental analysis is also performed to study the trends and relations between the cryptosystem parameters, including a few edge cases.
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2,335,937 |
Effect of thoracic paravertebral block on intraoperative hypotension and postoperative pain in patients undergoing breast cancer surgery under general anesthesia: a retrospective study.
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To retrospectively compare the effects of general anesthesia (GA) and thoracic paravertebral block (TPVB) combined with general anesthesia on the incidence of hypotension and postoperative pain in breast cancer (BC) surgery.</AbstractText>We retrospectively collected the medical records of patients who underwent BC surgery under general anesthesia from January 2018 to December 2020, and divided them into 2 groups according to the patient's anesthesia management method: GA group (Group G) and TPVB combined with GA group (Group T). During the operation, the use of boosting drugs and ephedrine, amount of fluid infusion, amount of bleeding, and operation time of the 2 participant groups were recorded, as well as the pain score in the resting state.</AbstractText>During anesthesia, the bispectral index (BIS) value of Group G was significantly lower than that of Group T, the use of sufentanil and the use rate of ephedrine were significantly higher than that of Group T, and the difference was statistically significant (P<0.05). At the T4 time point, the blood pressure [systolic blood pressure/diastolic blood pressure (SBP/DBP)] of Group G was higher than that of Group T; at time point T3, the blood pressure (SBP/DBP) of Group G was lower than that of Group T. At the T4 time point, the heart rate of G group was higher than that of Group T, and the heart rate of G group was lower than that of Group T at the time points T2 and T3. The difference between the 2 groups was statistically significant. The change trend of the visual analogue scale (VAS) scores of the 2 participant groups was basically the same when they were resting peacefully, and there were statistical differences in the VAS scores at 1, 2, 4, and 8 h after surgery (P<0.05).</AbstractText>When TPVB is combined with GA, there is a lower incidence of hypotension, more stable circulatory state, and better postoperative analgesic effect.</AbstractText>
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2,335,938 |
Initiation and termination of reentry-like activity in rat cardiomyocytes cultured in a microelectrode array.
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Cardiac reentry is a lethal arrhythmia associated with cardiac diseases. Although arrhythmias are reported to be due to localized propagation abnormalities, little is known about the mechanisms underlying the initiation and termination of reentry. This is primarily because of a lack of an appropriate experimental system in which activity pattern switches between reentry and normal beating can be investigated. In this study, we aimed to develop a culture system for measuring the spatial dynamics of reentry-like activity during its onset and termination. Rat cardiomyocytes were seeded in microelectrode arrays and purified with a glucose-free culture medium to generate a culture with a heterogeneous cell density. Reentry-like activity was recorded in purified cardiomyocytes, but not in the controls. Reentry-like activity occurred by a unidirectional conduction block after shortening of the inter-beat interval. Furthermore, reentry-like activity was terminated after propagation with a conduction delay of less than 300 ms, irrespective of whether the propagation pattern changed or not. These results indicate that a simple purification process is sufficient to induce reentry-like activity. In the future, a more detailed evaluation of spatial dynamics will contribute to the development of effective treatment methods.
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2,335,939 |
Machine Learning Identification of Pro-arrhythmic Structures in Cardiac Fibrosis.
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Cardiac fibrosis and other scarring of the heart, arising from conditions ranging from myocardial infarction to ageing, promotes dangerous arrhythmias by blocking the healthy propagation of cardiac excitation. Owing to the complexity of the dynamics of electrical signalling in the heart, however, the connection between different arrangements of blockage and various arrhythmic consequences remains poorly understood. Where a mechanism defies traditional understanding, machine learning can be invaluable for enabling accurate prediction of quantities of interest (measures of arrhythmic risk) in terms of predictor variables (such as the arrangement or pattern of obstructive scarring). In this study, we simulate the propagation of the action potential (AP) in tissue affected by fibrotic changes and hence detect sites that initiate re-entrant activation patterns. By separately considering multiple different stimulus regimes, we directly observe and quantify the sensitivity of re-entry formation to activation sequence in the fibrotic region. Then, by extracting the fibrotic structures around locations that both do and do not initiate re-entries, we use neural networks to determine to what extent re-entry initiation is predictable, and over what spatial scale conduction heterogeneities appear to act to produce this effect. We find that structural information within about 0.5 mm of a given point is sufficient to predict structures that initiate re-entry with more than 90% accuracy.
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2,335,940 |
Meal-time glycaemia in adults with type 1 diabetes using multiple daily injections vs insulin pump therapy following carbohydrate-counting education and bolus calculator provision.
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To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), following diabetes education.</AbstractText>Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00-10:00hrs; lunch 11:00-15:00hrs; dinner 17:00-21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9-10.0 mmol/L was the primary outcome.</AbstractText>MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00-24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis).</AbstractText>After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps.</AbstractText>Copyright © 2021 Elsevier B.V. All rights reserved.</CopyrightInformation>
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2,335,941 |
Effects of a blend of live yeast and organic minerals or monensin on performance of dairy cows during the hot season.
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The objective of this study was to evaluate the effects of feed additives on intake and digestibility of nutrients, milk yield and composition, feeding behavior, and physiological parameters of dairy cows during the hot season. Forty Holstein cows were assigned to a randomized block design experiment with a 2 × 2 factorial treatment arrangement to evaluate (1) control diet without inclusion of additives; (2) monensin (MON), 20 mg/kg diet dry matter sodium monensin (Rumensin; Elanco); (3) Milk Sacc+ (MS+), inclusion of 40 g/cow per d of Milk Sacc+ (a blend of live yeast and organic minerals, Alltech); and (4) combination of MON and MS+. The average temperature-humidity index throughout the experimental period was 73 ± 2.84 (standard deviation). The experiment lasted 11 wk, including 2 preliminary weeks for covariate adjustments. Cows fed MS+ increased dry matter intake (% body weight), milk yield, 3.5% fat-corrected milk, and solids yield, and cows fed MON had greater milk urea nitrogen content in comparison with counterparts. Feeding MS+ increased the intake of feed particles with size between 8 and 19 mm and decreased the intake of particles shorter than 4 mm compared with other treatments. Rumination time (min/d) and chewing time (min/kg of neutral detergent fiber) were lower for cows fed MS+. Physiologic parameters (i.e., heart and respiratory rates, and body temperature) were not affected by the treatments. Overall, the use of monensin did not differ from control, and Milk Sacc+ improved performance of cows.
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2,335,942 |
Hydroxychloroquine plus azithromycin early treatment of mild COVID-19 in an outpatient setting: a randomized, double-blinded, placebo-controlled clinical trial evaluating viral clearance.
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Hydroxychloroquine has shown potential to block viral replication of SARS-CoV-2 in some in vitro studies. This randomised, double-blinded, placebo controlled clinical trial evaluated the efficacy of hydroxychloroquine plus azithromycin (HCQ/AZT) in reducing viral loads in patients with early and mild SARS-CoV-2 infection.</AbstractText>A single-centre randomised placebo-controlled clinical trial was conducted with outpatients with early and mild SARS-CoV-2 infection. Inclusion criteria were: patients aged 18-65 years with symptoms suggestive of COVID-19 for < 5 days, no significant comorbidities, and positive nasopharyngeal/oropharyngeal swab screening tests (POCT-PCR). Randomised patients received either hydroxychloroquine for 7 days plus azithromycin for 5 days or placebo. The primary endpoint was viral clearance within a 9-day period. Secondary endpoints included viral load reduction, clinical evolution, hospitalization rates, chest computed tomography evolution, and adverse effects.</AbstractText>From 107 potential trial participants, 84 were enrolled following predetermined criteria. Statistical analyses were performed on an intention-to-treat (N = 84) and per-protocol (PP) basis (N = 70). On the PP analysis, the treatment (N = 36) and placebo (N = 34) groups displayed similar demographic characteristics. At 95% CI, no statistically significant between-group differences were found in viral clearance rates within 9 days following enrolment (P = 0.26).</AbstractText>This randomised, double-blinded, placebo-controlled clinical trial evaluating outpatients with early and mild COVID-19 showed that viral clearance rates within a 9-day period from enrolment did not change with HCQ/AZT treatment compared with placebo, although no major cardiovascular events were observed in participants without comorbidities. Secondary outcomes were also not significantly improved with HCQ/AZT treatment compared with placebo. These findings do not support use of HCQ/AZT in this setting.</AbstractText>Copyright © 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.</CopyrightInformation>
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2,335,943 |
On the physiology of interruption after unexpectedness.
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We tested whether surprise elicits similar physiological changes as those associated with orienting and freezing after threat, as surprise also involves a state of interruption and attention for effective action. Moreover, because surprise is primarily driven by the unexpectedness of an event, initial physiological responses were predicted to be similar for positive, neutral, and negative surprises. Results of repetition-change studies (4 + 1 in Supplemental Materials) showed that surprise lowers heart rate (Experiments 1-4) and increases blood pressure (Experiment 4). No effects on body movement (Experiment 2) or finger temperature (Experiment 4) were found. When unexpected stimuli were presented more often (making them less surprising) heart rate returned to baseline, while blood pressure remained high (Experiment 4). These effects were not influenced by stimulus valence. However, second-to-second analyses within the first (surprising) block showed a tendency for a stronger increase in systolic blood pressure after negative vs. positive surprise.
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2,335,944 |
Toxicity of oleate-based amino protic ionic liquids towards Escherichia coli, Danio rerio embryos and human skin cells.
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Protic ionic liquids (PILs) have been widely employed with the label of "green solvents'' in different sectors of technology and industry. The studied PILs are promising for corrosion inhibition and lubrication applications in industry. Industrial use of the PILs can transform them in wastes, due to accidental spill or drag in water due to washing, that can reach water bodies. In addition, the handling of the product by the workers can expose them to accidental contact. Thus, the aim of this work is to evaluate the toxicity of PILs 2-hydroxyethylammonium oleate (2-HEAOl), N-methyl-2-hydroxyethylammonium oleate (m-2HEAOl) and bis-2-hydroxyethylammonium oleate (BHEAOl) towards Escherichia coli, zebrafish embryos, model organisms that can be present in water, and human skin cells. This is the first work reporting toxicity results for these PILs, which constitutes its novelty. Results showed that the studied PILs did not inhibit E. coli bacterial growth but could cause human skin cells death at the concentrations of use. LC<sub>50</sub> values for zebrafish eggs were 40.21 mg/L for 2HEAOl, 12.92 mg/L for BHEAOl and 32.74 mg/L for m-2HEAOl, with sublethal effects at lower concentrations, such as hatching retarding, low heart rate and absence of free swimming.
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2,335,945 |
Effects on newborns of applying bupivacaine combined with different doses of fentanyl for cesarean section.
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The choice of anesthesia for cesarean section is very important.</AbstractText>To compare the effects of applying bupivacaine combined with different doses of fentanyl on newborns after cesarean section.</AbstractText>We randomly divided one hundred and twenty patients undergoing cesarean section into the following 4 groups: group B (bupivacaine group), group BF10 (bupivacaine combined with 10 µg fentanyl), group BF30 (bupivacaine combined with 30 µg fentanyl) and group BF50 (bupivacaine combined with 50 µg fentanyl). The heart rate, mean arterial pressure, block plane fixation time and sensory block time were recorded. Umbilical artery blood was then collected immediately after fetal delivery for blood gas analysis and qualitative detection of fentanyl. Additionally, data on the neonatal 1-min and 5-min Apgar scores, results of umbilical artery blood gas analysis and qualitative detection of fentanyl in umbilical artery blood were recorded.</AbstractText>Although the mean arterial pressure decreased in all four groups at 3 min after anesthesia, the percentage of the decrease was less than 20% of the baseline. In addition, there were no significant differences in the 1-min or 5-min Apgar scores or the umbilical artery blood gas analysis among the four groups (P</i> > 0.05). Moreover, the concentration of fentanyl in umbilical artery blood was qualitatively detected using an ELISA kit, and the results in the four groups were negative.</AbstractText>Bupivacaine combined with fentanyl spinal anesthesia is effective in cesarean section.</AbstractText>©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.</CopyrightInformation>
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2,335,946 |
Theoretical Investigation of the Mechanism by which A Gain-of-Function Mutation of the TRPM4 Channel Causes Conduction Block.
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In the heart, TRPM4 is most abundantly distributed in the conduction system. Previously, a single mutation, 'E7K', was identified in its distal N-terminus to cause conduction disorder because of enhanced cell-surface expression. It remains, however, unclear how this expression increase leads to conduction failure rather than abnormally enhanced cardiac excitability. To address this issue theoretically, we mathematically formulated the gating kinetics of the E7K-mutant TRPM4 channel by a combined use of voltage jump analysis and ionomycin-perforated cell-attached recording technique and incorporated the resultant rate constants of opening and closing into a human Purkinje fiber single-cell action potential (AP) model (Trovato model) to perform 1D-cable simulations. The results from TRPM4 expressing HEK293 cells showed that as compared with the wild-type, the open state is much preferred in the E7K mutant with increased voltage-and Ca<sup>2+</sup>-sensitivities. These theoretical predictions were confirmed by power spectrum and single channel analyses of expressed wild-type and E7K-mutant TRPM4 channels. In our modified Trovato model, the facilitated opening of the E7K mutant channel markedly prolonged AP duration with concomitant depolarizing shifts of the resting membrane potential in a manner dependent on the channel density (or maximal activity). This was, however, little evident in the wild-type TRPM4 channel. Moreover, 1D-cable simulations with the modified Trovato model revealed that increasing the density of E7K (but not of wild-type) TRPM4 channels progressively reduced AP conduction velocity eventually culminating in complete conduction block. These results clearly suggest the brady-arrhythmogenicity of the E7K mutant channel which likely results from its pathologically enhanced activity.
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2,335,947 |
Gray Ramus Communicans Nerve Block for Acute Pain Control in Vertebral Compression Fracture.
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<i>Background and Objectives</i>: The current options for acute pain control of vertebral compression fracture include hard brace, vertebroplasty, early surgery, and analgesic injection. We hypothesize that the gray ramus communicans nerve block (GRNB) controls the acute pain experienced during vertebral compression fractures. This study assessed the time course of pain control after injection and evaluated the risk factors affecting pain control failure. <i>Materials and methods:</i> Sixty-three patients (24 male, 66.19 ± 15.17 y) with a thoracolumbar vertebral fracture at the T10-L5 spine, who presented to our hospital from November 2018 to October 2019, were included in this retrospective cohort study. GRNB was performed within 1 week of the trauma. The patients were followed up on days 3, 14, 30, 90, and 180 and assessed with the serial visual analog scale (VAS, resting and motion), Oswestry Low Back Disability (ODI) questionnaire, and Roland-Morris Disability Questionnaire (RDQ). The failure group was defined by the need for an additional block or cement injection after a single GRNB. The failure group's risk factors, such as body mass index, initial thoracolumbar injury classification and severity score, Kummel's disease, age, bone marrow density (BMD), and underlying disease, were analyzed. <i>Results</i>: The motion VAS score improved from preoperative to three months post-procedure, but the resting VAS was affected by the procedure for only three days. The quality of life index improved at postoperative six months. A lower BMD was the only risk that affected treatment failure in the logistic regression analysis (<i>p</i> = 0.0038). <i>Conclusion</i>: The effect of GRNB was maintained even at three months after trauma based on motion VAS results. The only risk factor identified for GRNB failure was lower BMD.
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2,335,948 |
Search for a Functional Genetic Variant Mimicking the Effect of SGLT2 Inhibitor Treatment.
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SGLT2 inhibitors (SGLT2i) block renal glucose reabsorption. Due to the unexpected beneficial observations in type 2 diabetic patients potentially related to increased natriuresis, SGLT2i are also studied for heart failure treatment. This study aimed to identify genetic variants mimicking SGLT2i to further our understanding of the potential underlying biological mechanisms. Using the UK Biobank resource, we identified 264 SNPs located in the <i>SLC5A2</i> gene or within 25kb of the 5' and 3' flanking regions, of which 91 had minor allele frequencies >1%. Twenty-seven SNPs were associated with glycated hemoglobin (HbA1c) after Bonferroni correction in participants without diabetes, while none of the SNPs were associated with sodium excretion. We investigated whether these variants had a directionally consistent effect on sodium excretion, HbA1c levels, and <i>SLC5A2</i> expression. None of the variants met these criteria. Likewise, we identified no common missense variants, and although four SNPs could be defined as 5' or 3' prime untranslated region variants of which rs45612043 was predicted to be deleterious, these SNPs were not annotated to <i>SLC5A2</i>. In conclusion, no genetic variant was found mimicking SGLT2i based on their location near <i>SLC5A2</i> and their association with sodium excretion or HbA1c and <i>SLC5A2</i> expression or function.
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2,335,949 |
Profiling Human <i>CD55</i> Transgene Performance Assist in Selecting Best Suited Specimens and Tissues for Swine Organ Xenotransplantation.
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Xenotransplantation of pig organs receives substantial attention for being comparable to human's. However, compatibility constraints involving hyper-acute rejection (HAR) still block clinical applications. Transgenesis of human complement regulatory proteins has been proposed to overcome xenorejection. Pigs expressing human-<i>CD55</i> have been widely tested in experimental surgery. Still, no standardized method has been developed to determine tissue expression of human decay-accelerating factor (DAF), <i>hCD55's</i> product, or to predict the ability to overpass HAR. Here we describe objective procedures addressing this need. Organs and tissues from five <i>hCD55</i> transgenic pigs were collected and classified according to their xenotransplantation value. The ability to overcome HAR was assessed by classical complement pathway hemolysis assays. Quantitative PCR mRNA expression and Western blot protein level studies were performed. Real-time cytotoxicity assays (RTCA) on fibroblast cultures exposed to baboon and human sera informed on longer-term rejection dynamics. While greater <i>hCD55</i>/DAF expression correlated with better performance, the results obtained varied among specimens. Interestingly, the individual with highest mRNA and protein levels showed positive feedback for <i>hCD55</i> transcript after challenge with human and baboon sera. Moreover, <i>hCD55</i> expression correlated to DAF levels in the liver, lung and intestine, but not in the heart. Moreover, we found significant correlations among valuable and non-valuable tissues. In sum, the methodology proposed allows us to characterize the <i>hCD55</i> transgene functioning and performance. Moreover, the correlations found could allow us to predict <i>hCD55</i>/DAF expression in surrogate tissues, thus eliminating the need for direct biopsies, resulting in preservation of organ integrity before xenotransplantation.
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2,335,950 |
The Interplay of Mitochondrial Oxidative Stress and Endoplasmic Reticulum Stress in Cardiovascular Fibrosis in Obese Rats.
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We have evaluated the role of mitochondrial oxidative stress and its association with endoplasmic reticulum (ER) stress activation in the progression of obesity-related cardiovascular fibrosis. MitoQ (200 µM) was orally administered for 7 weeks to male Wistar rats that were fed a high-fat diet (HFD, 35% fat) or a control diet (CT, 3.5% fat). Obese animals presented cardiovascular fibrosis accompanied by increased levels of extracellular matrix proteins and profibrotic mediators. These alterations were associated with ER stress activation characterized by enhanced levels (in heart and aorta vs. CT group, respectively) of immunoglobulin binding protein (BiP; 2.1-and 2.6-fold, respectively), protein disulfide-isomerase A6 (PDIA6; 1.9-fold) and CCAAT-enhancer-binding homologous protein (CHOP; 1.5- and 1.8-fold, respectively). MitoQ treatment was able to prevent (<i>p</i> < 0.05) these modifications at cardiac and aortic levels. MitoQ (5 nM) and the ER stress inhibitor, 4-phenyl butyric acid (4 µM), were able to block the prooxidant and profibrotic effects of angiotensin II (Ang II, 10<sup>-6</sup> M) in cardiac and vascular cells. Therefore, the data show a crosstalk between mitochondrial oxidative stress and ER stress activation, which mediates the development of cardiovascular fibrosis in the context of obesity and in which Ang II can play a relevant role.
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2,335,951 |
Analgesic and Sedative Effects of Epidural Lidocaine-Xylazine in Elective Bilateral Laparoscopic Ovariectomy in Standing Mule Mares.
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The purpose of this study was to determine the analgesic efficacy and safety of epidural lidocaine-xylazine administration in standing mules undergoing elective bilateral laparoscopic ovariectomy in order to suppress unwanted behaviour. Eight mule mares were sedated with intramuscular 0.05 mg/kg acepromazine followed by 1.3 mg/kg of xylazine and 0.02 mg/kg of butorphanol intravenously. Sedation was maintained by a constant rate infusion of 0.6 mg/kg/h of xylazine. The paralumbar fossae were infiltrated with 30 mL of 2% lidocaine. Epidural anaesthesia was performed at the first intercoccygeal space with 0.2 mg/kg of lidocaine and 0.17 mg/kg of xylazine. After 15 min, bilateral laparoscopic ovariectomy was performed. Heart rate, respiratory rate, rectal temperature, invasive arterial blood pressure, degree of analgesia, sedation and ataxia were evaluated during surgery. The laparoscopic ovariectomy was successfully completed in all animals. Sedation and analgesia were considered satisfactory in six out of the eight mules. In conclusion, caudal epidural block allowed surgery to be easily completed in six out of eight. The animals did not show any signs of discomfort associated with nociception and were mostly calm during the procedures, however additional studies are needed to establish epidural doses of xylazine and lidocaine that result in reliable abdominal pain control in mules for standing ovariectomy.
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2,335,952 |
Non-immune hydrops fetalis: Two case reports.
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Fetal hydrops is a serious condition difficult to manage, often with a poor prognosis, and it is characterized by the collection of fluid in the extravascular compartments. Before 1968, the most frequent cause was the maternal-fetal Rh incompatibility. Today, 90% of the cases are non-immune hydrops fetalis. Multiple fetal anatomic and functional disorders can cause non-immune hydrops fetalis and the pathogenesis is incompletely understood. Etiology varies from viral infections to heart disease, chromosomal abnormalities, hematological and autoimmune causes.</AbstractText>A 38-year-old pregnant woman has neck lymphoadenomegaly, fever, cough, tonsillar plaques at 14 wk of amenorrhea and a rash with widespread itching. At 27.5 wk a fetal ultrasound shows signs of severe anemia and hydrops. Cordocentesis is performed with confirmation of severe fetal anemia and subsequent fetal transfusion. The karyotype is 46, XX, array-comparative genome hybridization (CGH) negative, and infectious tests are not conclusive. In the following days there is a progressive improvement of the indirect signs of fetal anemia. At 33.6 wk, for relapse of severe fetal anemia, further fetal transfusions are necessary and an urgent cesarean section is performed. On the day 12 of life, for the detection of anemia, the newborn is subjected to transfusion of concentrated red blood cells and begins treatment with erythropoietin. Later there is a normalization of blood chemistry values and the baby does not need new transfusions. A 29-year-old pregnant woman, with Sjogren's syndrome and positive Anti-Ro/SSA antibodies, is subjected to serial fetal ecocardio for branch block. At 26.5 wk there is a finding of fetal ascites. Infectious disease tests on amniotic fluid are negative as well as quantitative fluorescent polymerase chain reaction, Array CGH. At cordocentesis Hb is 1.3 mmol/L, consequently fetal transfusion is performed. Also in this case, due to continuous episodes of relapse of fetal anemia with consequent transfusions, at 29.4 wk a cesarean section is performed. On day 9 of life, a treatment with erythropoietin is started in the newborn, but the baby needs three blood transfusions. The search for autoantibodies in the baby found SS-A Ro60 positive, SSA-Ro52 positive and SS-B negative. The hemoglobin values normalized after the disappearance of maternal autoantibodies.</AbstractText>An attempt to determine the etiology of hydrops should be made at the time of diagnosis because the goal is to treat underlying cause, whenever possible. Even if the infectious examinations are not conclusive, but the pregnancy history is strongly suggestive of infection as in the first case, the infectious etiology must not be excluded. In the second case, instead, transplacental passage of maternal autoantibodies caused hydrops fetalis and severe anemia. Finally, obstetric management must be aimed at fetal support up to an optimal timing for delivery by evaluating risks and benefits to increase the chances of survival without sequelae.</AbstractText>©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.</CopyrightInformation>
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2,335,953 |
<i>En bloc</i> procurement of porcine abdominal multiple organ block for <i>ex situ</i> normothermic machine perfusion: a technique for avoiding initial cold preservation.
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Normothermic machine perfusion (NMP) is a technique that maintains organs ex situ</i> with normal metabolism, and organ function can be better preserved. The study of multiple-organ NMP is rarely reported. Multiple organ block (MOB) is a self-perfusing system for maintaining multiple organs ex situ</i>, and porcine MOBs have been successfully preserved for 18 to 37 h. Due to the above context, we conceived to maintain abdominal multiple organ block (AMOB) ex situ</i> utilizing NMP technology.</AbstractText>AMOBs were procured from Ba-Ma miniature pigs through en bloc</i> procurement surgery. The process of cold preservation was eliminated between the procurement and machine perfusion, and a few minutes of warm ischemia emerged. Autologous whole blood was collected during procurement surgery as a perfusate component in the beginning.</AbstractText>The median time of procurement surgery was approximately 220 min, and the median time of warm ischemia was 300 sec. Cases 1 and 2 suffered from repeated hypotension during the procurement surgery, and case 2 exhibited hemorrhage. After improved and optimized procurement processes, the vital signs of cases 3 to 5 remained stable during procurement. In the NMP phase, the flow increased slowly in cases 1 and 2 and did not remain stable even after continuous infusion of a high-dose vasodilator. The lactic acid level rapidly increased, and the levels of ALT and AST were obviously higher than those in cases 3 to 5. In contrast, the flow rate increased smoothly in cases 3 to 5. The lactic acid level remained stable during the first 10 h of perfusion.</AbstractText>AMOB procurement from heart-beating pigs for NMP without initial cold preservation is technically feasible.</AbstractText>2021 Annals of Translational Medicine. All rights reserved.</CopyrightInformation>
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2,335,954 |
Adrenal crisis and acute exacerbation of interstitial lung disease after thymoma needle biopsy: a case report and literature review.
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Thymoma is the most common paraneoplastic syndrome-associated tumor. It is related to a variety of autoimmune diseases including myasthenia gravis, systemic lupus erythematosus, and hypogammaglobulinemia. Only a few reports of thymoma associated with Addison's disease have been reported to date. Herein, we report a novel case of thymoma complicated with autoimmune Addison's disease and interstitial lung disease. The patient developed adrenal crisis with persistent hypotensive shock and heart block after needle biopsy. Acute exacerbation of the interstitial lung disease was also observed, accompanied by severe respiratory failure. After treatment with glucocorticoids, somatostatin, and temporary pacemaker implantation, the patient's condition improved, and the thymoma had shrunk in size. Finally, he underwent transsternal extended thymectomy and lymph node dissection. Hydrocortisone was given intravenously before surgery, on the operation day and after the surgery. The operation was uneventful, and no hypotension or fever occurred. Cortisol and ACTH were still obviously abnormal at 1 month post-surgery. The clinical manifestations of Addison's disease and interstitial lung disease are hidden and can be easily overlooked. However, in the postoperative period, Addison's disease can lead to adrenal crisis developing, which can progress to life-threatening shock, arrhythmia, and acute respiratory failure. Therefore, clinicians should be aware of this phenomenon and consider a regimen combining proactive glucocorticoid replacement therapy with somatostatin to preserve the life of such patients.
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2,335,955 |
Clinical outcomes of upgrade to versus de novo cardiac resynchronization therapy in mild heart failure patients with atrioventricular block.<Pagination><StartPage>6</StartPage><EndPage>14</EndPage><MedlinePgn>6-14</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jjcc.2021.07.012</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0914-5087(21)00195-7</ELocationID><Abstract><AbstractText Label="BACKGROUND">Indication for de novo cardiac resynchronization therapy (CRT) has been recommended in mild heart failure (HF) patients with left ventricular (LV) ejection fraction (LVEF) <50% and atrioventricular block (AVB). In contrast, the indication of CRT upgrade from right ventricular pacing (RVP) has been limited to severe HF patients with LVEF≤35% and AVB. This study examined LV volumetric responses and clinical outcomes in mild HF patients with AVB who underwent CRT upgrade, compared with those of de novo CRT patients.</AbstractText><AbstractText Label="METHODS">This retrospective study focused on patients with CRT due to AVB, mild HF at New York Heart Association class II and LVEF<50%. A total of 58 patients were divided into two groups: (1) 27 patients with CRT upgrade from RVP>40% (Upgrade group, UG), and (2) 31 patients with de novo CRT implantation (De novo group, DG). The echocardiographic assessment was performed at baseline and six months after CRT. The study endpoint was a combined endpoint with total mortality, HF hospitalization, or ventricular tachyarrhythmia events.</AbstractText><AbstractText Label="RESULTS">At six months after CRT, the LV end-systolic volume (LVESV) was significantly reduced in both groups (from 144.3±39.4 mL to 111.1±33.5 mL in UG, p<0.01; from 134.5±36.6 mL to 123.5±45.6 mL in DG, p<0.05); however, a significant improvement in LVEF was obtained in UG but not in DG (from 31.7±6.8% to 39.7±8.5% in UG, p<0.01; from 34.2±7.3% to 36.0±9.7% in DG, p=0.15). Consequently, the changes in LVESV and LVEF were significantly greater in UG than in DG. During the follow-up of 989 days, the survival rate for the composite events were similar between both groups (p=0.18).</AbstractText><AbstractText Label="CONCLUSIONS">LV reverse remodeling was significantly greater in UG than DG, and the incidence of clinical composite events at mid-term follow-up was equivalent between UG and DG. CRT upgrade could be an acceptable indication in mild HF patients dependent on RVP.</AbstractText><CopyrightInformation>Copyright © 2021. Published by Elsevier Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kanai</LastName><ForeName>Miwa</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yagishita</LastName><ForeName>Daigo</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shoda</LastName><ForeName>Morio</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ejima</LastName><ForeName>Koichiro</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Clinical Research Division for Heart Rhythm Management, Tokyo Women's Medical University, Tokyo, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hagiwara</LastName><ForeName>Nobuhisa</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>08</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>J Cardiol</MedlineTA><NlmUniqueID>8804703</NlmUniqueID><ISSNLinking>0914-5087</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D054537" MajorTopicYN="Y">Atrioventricular Block</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058406" MajorTopicYN="Y">Cardiac Resynchronization Therapy</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006333" MajorTopicYN="Y">Heart Failure</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013318" MajorTopicYN="N">Stroke Volume</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Atrioventricular block</Keyword><Keyword MajorTopicYN="N">Cardiac resynchronization therapy</Keyword><Keyword MajorTopicYN="N">Heart failure</Keyword><Keyword MajorTopicYN="N">Left ventricular ejection fraction</Keyword><Keyword MajorTopicYN="N">Mortality</Keyword><Keyword MajorTopicYN="N">Upgrade</Keyword></KeywordList><CoiStatement>Declaration of Competing Interest D. Yagisihta, M. Shoda, and K.Ejima belong to an endowed department established by contributions from Medtronic Japan, Boston Scientific, Biotronik, and Abbott Medical. The other authors do not have grants, conflicts, or relationships with industry.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>5</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>7</Month><Day>12</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>7</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>8</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>3</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>8</Month><Day>24</Day><Hour>5</Hour><Minute>42</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34426046</ArticleId><ArticleId IdType="doi">10.1016/j.jjcc.2021.07.012</ArticleId><ArticleId IdType="pii">S0914-5087(21)00195-7</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM" IndexingMethod="Automated"><PMID Version="1">34424247</PMID><DateCompleted><Year>2021</Year><Month>10</Month><Day>15</Day></DateCompleted><DateRevised><Year>2021</Year><Month>10</Month><Day>15</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1940-087X</ISSN><JournalIssue CitedMedium="Internet"><Issue>174</Issue><PubDate><Year>2021</Year><Month>Aug</Month><Day>05</Day></PubDate></JournalIssue><Title>Journal of visualized experiments : JoVE</Title><ISOAbbreviation>J Vis Exp</ISOAbbreviation></Journal>Surgery and Sample Processing for Correlative Imaging of the Murine Pulmonary Valve.
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The underlying causes of heart valve related-disease (HVD) are elusive. Murine animal models provide an excellent tool for studying HVD, however, the surgical and instrumental expertise required to accurately quantify the structure and organization across multiple length scales have stunted its advancement. This work provides a detailed description of the murine dissection, en bloc staining, sample processing, and correlative imaging procedures for depicting the heart valve at different length scales. Hydrostatic transvalvular pressure was used to control the temporal heterogeneity by chemically fixing the heart valve conformation. Micro-computed tomography (µCT) was used to confirm the geometry of the heart valve and provide a reference for the downstream sample processing needed for the serial block face scanning electron microscopy (SBF-SEM). High-resolution serial SEM images of the extracellular matrix (ECM) were taken and reconstructed to provide a local 3D representation of its organization. µCT and SBF-SEM imaging methods were then correlated to overcome the spatial variation across the pulmonary valve. Though the work presented is exclusively on the pulmonary valve, this methodology could be adopted for describing the hierarchical organization in biological systems and is pivotal for the structural characterization across multiple length scales.
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2,335,956 |
Effects of canagliflozin on serum potassium in people with diabetes and chronic kidney disease: the CREDENCE trial.
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Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin-aldosterone system, particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium‒glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain.</AbstractText>The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and <3.5 mmol/L, respectively) and change in serum potassium. At baseline, the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin-angiotensin system blockade. The incidence of investigator-reported hyperkalaemia or initiation of potassium binders was lower with canagliflozin than with placebo [occurring in 32.7 vs. 41.9 participants per 1000 patient-years; hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.64-0.95, P = 0.014]. Canagliflozin similarly reduced the incidence of laboratory-determined hyperkalaemia (HR 0.77, 95% CI 0.61-0.98, P = 0.031), with no effect on the risk of hypokalaemia (HR 0.92, 95% CI 0.71-1.20, P = 0.53). The mean serum potassium over time with canagliflozin was similar to that of placebo.</AbstractText>Among patients treated with renin-angiotensin-aldosterone system inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia.</AbstractText>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].</CopyrightInformation>
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2,335,957 |
A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy.
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This study sought to investigate the effects of transversus thoracic muscle plane-pectoral nerves (TTP-PECS) block combined with propofol anesthesia on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy.</AbstractText>A total of 115 patients who underwent radical mastectomy for breast cancer at our hospital from January 2019 to January 2021 were selected as the study subjects. The patients were allocated to the control group (n=57) or observation group (n=58) using a random number method. The control group was given simple general anesthesia, and the observation group was given TTP-PECS block combined with propofol anesthesia. The recovery time, pain [visual analogue scoring (VAS)] scores, and incidences of adverse reactions were compared between the 2 groups. Hemodynamic indicators [i.e., heart rate (HR), mean arterial pressure (MAP)], stress indicators [i.e., blood glucose (GLU), epinephrine (E), cortisol (Cor)], and the cellular immune function ofthe2 groups before anesthesia (T0), at the end of operation (T1), 1day after operation (T2) and 3days after operation (T3) were recorded.</AbstractText>The spontaneous respiration recovery time, time to full wakefulness and the extubation time of the observation group were shorter than those of the control group (P<0.05). The observation group had lower VAS scores than the control group at 2, 8, 12, and 24 h after operation (P<0.05). The levels of MAP, HR, GLU, E and Cor in the observation group at T1, T2, and T3 were lower than those in the control group (P<0.05). Compared to the control group, the observation group had increased cluster of differentiation (CD)3+</sup>, CD4+</sup>, and CD4+</sup>/CD8+</sup> cells (P<0.05), but there were no significant differences in CD8+</sup> and natural killer (NK) cells between the 2 groups (P>0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (8.62% vs.</i> 24.56%) (P<0.05).</AbstractText>TTP-PECS block combined with propofol anesthesia can relieve pain, shorten the recovery time, stabilize the hemodynamic level, and alleviate the stress responses of patients undergoing radical mastectomy with a slight suppression of cellular immune function and high safety.</AbstractText>Chinese Clinical Trial Registration Center ChiCTR2100048438.</AbstractText>2021 Gland Surgery. All rights reserved.</CopyrightInformation>
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2,335,958 |
Complete Heart Block as a Clinical Feature in Critically Ill Coronavirus Disease 2019 (COVID-19) Patients: A Case Series of Three Cases.
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<i>Background</i>. Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. However, there have been very few reports on complete heart block (CHB) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of critically ill COVID-19 patients complicated by CHB. <i>Case Summary</i>. We present three cases of new-onset CHB in critically ill COVID-19 patients. Patient 1 is a 41-year-old male with well-documented history of Familial Mediterranean Fever (FMF) who required mechanical ventilator support for acute hypoxic respiratory failure from severe COVID-19 pneumonia. He developed new-onset CHB without a hemodynamic derangement but subsequently had acute coronary syndrome complicated by cardiogenic shock. Patient 2 is a 77-year-old male with no past medical history who required intubation for severe COVID-19 pneumonia acute hypoxic respiratory failure. He developed CHB with sinus pause requiring temporary pacing but subsequently developed multiorgan failure. Patient 3 is 36-year-old lady 38 + 2 weeks pregnant, gravida 2 para 1 with no other medical history, who had an emergency Lower Section Caesarean Section (LSCS) as she required intubation for acute hypoxic respiratory failure. She exhibited new-onset CHB without hemodynamic compromise. The CHB resolved spontaneously after 24 hours. <i>Discussion</i>. COVID-19-associated CHB is a very rare clinical manifestation. The potential mechanisms for CHB in patients with COVID-19 include myocardial inflammation or direct viral infiltration as well as other causes such as metabolic derangements or use of sedatives. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and hemodynamic instability.
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2,335,959 |
Increasing nausea and vomiting of pregnancy is associated with sex-dependent differences in early childhood growth: the GUSTO mother-offspring cohort study.
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Nausea and vomiting of pregnancy (NVP) is common and underlying mechanisms are poorly understood. Longer-term offspring outcomes are also not well documented. This study aimed to determine if NVP, even in milder forms, is associated with adverse pregnancy and childhood growth outcomes.</AbstractText>In the GUSTO prospective mother-offspring cohort, women with singleton pregnancies (n = 1172) recruited in first trimester responded to interviewer-administered questions at 26-28 weeks' gestation about earlier episodes of NVP since becoming pregnant. Pregnancy outcomes were obtained from medical records. Offspring height and weight measured at 15 time-points between birth to 72 months (m) were standardised for age and sex.</AbstractText>58.5% (n = 686) reported mild-moderate vomiting (mNVP), 10.5% (n = 123) severe vomiting (sNVP) and 5.7% (n = 67) severe vomiting with hospitalisation (shNVP). There was no difference in odds of gestational diabetes, hypertensive disorders of pregnancy, labour induction or caesarean section after adjustment for covariates. sNVP was associated with late preterm delivery [34+ 0</sup>-36+ 6</sup> weeks', adjusted OR = 3.04 (95% CI 1.39,6.68)], without increased odds of neonatal unit admission. Compared with no NVP, boys born to mothers with sNVP were longer at birth [adjusted β = 0.38 standard deviations (SDs) (95% CI 0.02,0.73)], remained taller [0.64 SDs (0.23,1.04) at 72 m] and heavier [0.57 SDs (0.05,1.08) at 60 m] without differences in BMI. Conversely, girls born to mothers with shNVP were lighter from 48 m [- 0.52 SDs (- 1.00, - 0.03)] onwards with lower BMI [- 0.61 SDs (- 1.12,-0.09)]. Conditional growth modelling revealed significant sex-divergence in weight-gain at birth-3 m, 6-9 m and 4-5 years.</AbstractText>Severe NVP was associated with late preterm delivery, and both mild-moderate and severe NVP associated with sex-dependent differences in early childhood growth. Boys whose mothers had NVP were taller and heavier from birth with faster growth in the first year, whereas, girls had poorer weight gain and were lighter by 48 m. As even milder severities of NVP could have long-term impact on offspring growth, further research is needed to determine mechanisms involved and implications on future health.</AbstractText>Clinicaltrials.gov identifier NCT01174875 .</AbstractText>© 2021. The Author(s).</CopyrightInformation>
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2,335,960 |
Minimum effective volume of 0.2% ropivacaine for ultrasound-guided axillary brachial plexus block in preschool-age children.
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Ultrasound-guided axillary brachial plexus block is increasingly used in preschool-age patients. However, the minimum effective volume of local anaesthetics has not been determined. With ethical committee approval and written informed consent from the guardians of all paediatric patients, we studied 27 consecutive patients aged 3 to 6 years who were scheduled for hand surgery. After general anaesthesia, eligible patients received a set volume of ultrasound-guided axillary brachial plexus block. We determined the volume of 0.2% ropivacaine for consecutive patients from the preceding patient's outcome. The initial volume was 0.4 ml/kg. The testing interval was set at 0.05 ml/kg, and the lowest volume was 0.1 ml/kg. The following conditions were defined as a successful block: no heart rate changes, body movement, or ventilatory disorders during the operation; no use of fentanyl in the PACU; and a postoperative sensory block score < 3. The sequences of positive and negative blocks in consecutive patients were recorded. Using probit regression analysis, the 50% effective volume was 0.185 ml/kg (95% CI 0.123-0.234), and the 95% effective volume was 0.280 ml/kg (95% CI 0.232-0.593). EV50 and EV95 values of 0.2% ropivacaine for ultrasound-guided axillary brachial plexus block were 0.185 ml/kg and 0.280 ml/kg, respectively.
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2,335,961 |
FA-GAN: Fused attentive generative adversarial networks for MRI image super-resolution.
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High-resolution magnetic resonance images can provide fine-grained anatomical information, but acquiring such data requires a long scanning time. In this paper, a framework called the Fused Attentive Generative Adversarial Networks(FA-GAN) is proposed to generate the super- resolution MR image from low-resolution magnetic resonance images, which can reduce the scanning time effectively but with high resolution MR images. In the framework of the FA-GAN, the local fusion feature block, consisting of different three-pass networks by using different convolution kernels, is proposed to extract image features at different scales. And the global feature fusion module, including the channel attention module, the self-attention module, and the fusion operation, is designed to enhance the important features of the MR image. Moreover, the spectral normalization process is introduced to make the discriminator network stable. 40 sets of 3D magnetic resonance images (each set of images contains 256 slices) are used to train the network, and 10 sets of images are used to test the proposed method. The experimental results show that the PSNR and SSIM values of the super-resolution magnetic resonance image generated by the proposed FA-GAN method are higher than the state-of-the-art reconstruction methods.
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2,335,962 |
Cox-sMBPLS: An Algorithm for Disease Survival Prediction and Multi-Omics Module Discovery Incorporating <i>Cis</i>-Regulatory Quantitative Effects.
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The development of high-throughput techniques has enabled profiling a large number of biomolecules across a number of molecular compartments. The challenge then becomes to integrate such multimodal Omics data to gain insights into biological processes and disease onset and progression mechanisms. Further, given the high dimensionality of such data, incorporating prior biological information on interactions between molecular compartments when developing statistical models for data integration is beneficial, especially in settings involving a small number of samples.</AbstractText>We develop a supervised model for time to event data (e.g., death, biochemical recurrence) that simultaneously accounts for redundant information within Omics profiles and leverages prior biological associations between them through a multi-block PLS framework. The interactions between data from different molecular compartments (e.g., epigenome, transcriptome, methylome, etc.) were captured by using cis</i>-regulatory quantitative effects in the proposed model. The model, coined Cox-sMBPLS, exhibits superior prediction performance and improved feature selection based on both simulation studies and analysis of data from heart failure patients.</AbstractText>The proposed supervised Cox-sMBPLS model can effectively incorporate prior biological information in the survival prediction system, leading to improved prediction performance and feature selection. It also enables the identification of multi-Omics modules of biomolecules that impact the patients' survival probability and also provides insights into potential relevant risk factors that merit further investigation.</AbstractText>Copyright © 2021 Vahabi, McDonough, Desai, Cavallari, Duarte and Michailidis.</CopyrightInformation>
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2,335,963 |
Cardiac Arrest After Interscalene Block Before Arthroscopic Shoulder Surgery: A Case Report.
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A 42-year-old previously healthy woman developed profound hypotension, bradycardia, and asystolic cardiac arrest requiring cardiopulmonary resuscitation after an interscalene block before being placed in the beach-chair position for shoulder arthroscopy.</AbstractText>Activation of the Bezold-Jarisch reflex, a vagally mediated reflex leading to hypotensive bradycardic episodes, is a rare but devastating complication of shoulder arthroscopy when performed with the combination of interscalene blocks and the beach-chair position. Our case shows that the Bezold-Jarisch reflex may occur in patients before placement in the beach-chair position and may even lead to extreme reactions in healthy patients including asystolic cardiac arrest.</AbstractText>Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.</CopyrightInformation>
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2,335,964 |
Cellular therapy for myocardial ischemia using a temperature-responsive biodegradable injectable polymer system with adipose-derived stem cells.
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Adipose-derived stem cell (AdSC) has been attracting attention as a convenient stem cell source. Not only AdSC can differentiate into various tissue cells, but it can also accelerate cell proliferation, anti-inflammation, and angiogenesis by secreting paracrine factors. Studies have demonstrated AdSC treatment of ischemic heart. However, an improvement in the remaining live AdSCs administered at the injected site while maintaining paracrine factor secretion is desired to achieve effective regenerative medicine. We previously reported the ABA-type tri-block copolymer of poly(ɛ-caprolactone-<i>co</i>-glycolic acid) and poly(ethylene glycol) (tri-PCG), exhibiting temperature-responsive sol-to-gel transition as biodegradable injectable polymer (IP) systems. Moreover, we recently reported that the biodegradable temperature-triggered chemically cross-linked gelation systems exhibited longer gel state durations using tri-PCG attaching acryloyl groups and a polythiol derivative. In this study, we explored this IP-mediated AdSC delivery system. We investigated the cell viability, mRNA expression, and cytokine secretion of AdSCs cultured in the physical or chemical IP hydrogels. Both of these IP hydrogels retained a certain number of viable cells, and RT-PCR and ELISA analyses revealed that mRNA expression and secretion of vascular endothelial growth factor of the AdSCs cultured in the chemical hydrogel were higher than the physical hydrogel. Moreover, AdSCs injected with the chemical hydrogel into ischemic heart model mice showed longer retention of the cells at the injected site and recovery from the ischemic condition. The results mean that the IP system is a promising candidate for a stem cell delivery system that exhibits the recovery of cardiac function for myocardial infarction treatment.
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2,335,965 |
Effects of esketamine combined with ultrasound-guided nerve block on cognitive function in children with lower extremity fractures.
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To explore the effect and complications of esketamine combined with ultrasound-guided nerve block in children with lower extremity fractures.</AbstractText>120 children with fractures of lower extremities were included into the observation group (OG) and control group (CG) according to the specific anesthesia method. The OG was given esketamine combined with ultrasound-guided nerve block, and the CG was given ultrasound-guided nerve block combined with general anesthesia. Serum norepinephrine (NE), epinephrine (E), renin (R), mean arterial pressure (MAP), heart rate (HR), oxyhemoglobin saturation (SpO2</sub>) and respiration rate (RR) were measured before, at 10, 20, and 30 min after anesthesia. The incidence of clinical complications and the anesthetic effects were compared between the two groups. The mini-mental state examination (MMES) scale was performed to evaluate the cognitive function of children in the two groups before and after surgery.</AbstractText>At 10 min and 20 min after anesthesia, the CG showed higher MAP and HR than the OG (P</i><0.05); however, RR and SpO2</sub> showed no difference between the two groups (P</i>>0.05). At 30 min after anesthesia, HR and MAP were not significantly different between the two groups (P</i>>0.05); NE, E, and R showed no significant difference before surgery (P</i>>0.05), which were higher in CG than those in the OG after surgery (P</i><0.05). The success rate of nerve block and anesthesia were 91.67% and 85.00%, respectively in the OG, which were higher than 88.33% and 83.33% in the CG (P</i>>0.05). The OG had a complication rate of 8.33%, significantly lower than that of 20.00% in the CG (P</i><0.05).</AbstractText>Esketamine combined with ultrasound-guided nerve block anesthesia was superior to ultrasound-guided nerve block combined with general anesthesia in children with lower extremity fractures, with fewer compilations.</AbstractText>AJTR Copyright © 2021.</CopyrightInformation>
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2,335,966 |
Isolated Cardiac Sarcoidosis with High-Grade Heart Block: Utilization of New Diagnostic Guidelines.
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Cardiac sarcoidosis can present with heart failure and conduction disease. This is a case of a 58-year-old male who presented for dyspnea, edema, and varying degrees of heart block. Using new updated diagnostic guidelines and multimodal cardiac imaging, he was diagnosed with isolated cardiac sarcoidosis.
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2,335,967 |
TGR5 Expression Is Associated with Changes in the Heart and Urinary Bladder of Rats with Metabolic Syndrome.
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Adipose-derived cytokines may contribute to the inflammation that occurs in metabolic syndrome (MetS). The Takeda G protein-coupled receptor (TGR5) regulates energy expenditure and affects the production of pro-inflammatory biomarkers in metabolic diseases. Etanercept, which acts as a tumor necrosis factor (TNF)-α antagonist, can also block the inflammatory response. Therefore, the interaction between TNF-α and TGR5 expression was investigated in rats with high-fat diet (HFD)-induced obesity. Heart tissues isolated from the HFD-induced MetS rats were analyzed. Changes in TGR5 expression were investigated with lithocholic acid (LCA) as the agonist. Betulinic acid (BA) was used to activate TGR5 in urinary bladders. LCA was more effective in the heart tissues of HFD-fed rats, although etanercept alleviated the function of LCA. STAT3 activation and higher TGR5 expression were observed in the heart tissues collected from HFD-fed rats. Thus, cardiac TGR5 expression is promoted by HFD through STAT3 activation in rats. Moreover, the urinary bladders of female rats fed a HFD showed a low response, which was reversed by etanercept. Relaxation by BA in the bladders was more marked in HFD-fed rats. The high TGR5 expression in HFD-fed rats was characterized using a mRNA assay, and the increased cAMP levels were found to be stimulated by BA in the isolated bladders. Therefore, TGR5 expression increases with a HFD in both the hearts and urinary bladders. Collectively, cytokine-medicated TGR5 activation was observed in the hearts and urinary bladders of rats.
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2,335,968 |
Evidence that toxin resistance in poison birds and frogs is not rooted in sodium channel mutations and may rely on "toxin sponge" proteins.
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Many poisonous organisms carry small-molecule toxins that alter voltage-gated sodium channel (NaV) function. Among these, batrachotoxin (BTX) from Pitohui poison birds and Phyllobates poison frogs stands out because of its lethality and unusual effects on NaV function. How these toxin-bearing organisms avoid autointoxication remains poorly understood. In poison frogs, a NaV DIVS6 pore-forming helix N-to-T mutation has been proposed as the BTX resistance mechanism. Here, we show that this variant is absent from Pitohui and poison frog NaVs, incurs a strong cost compromising channel function, and fails to produce BTX-resistant channels in poison frog NaVs. We also show that captivity-raised poison frogs are resistant to two NaV-directed toxins, BTX and saxitoxin (STX), even though they bear NaVs sensitive to both. Moreover, we demonstrate that the amphibian STX "toxin sponge" protein saxiphilin is able to protect and rescue NaVs from block by STX. Taken together, our data contradict the hypothesis that BTX autoresistance is rooted in the DIVS6 N→T mutation, challenge the idea that ion channel mutations are a primary driver of toxin resistance, and suggest the possibility that toxin sequestration mechanisms may be key for protecting poisonous species from the action of small-molecule toxins.
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2,335,969 |
Neonatal Outcomes in Pregnant Women with Systemic Lupus Erythematosus: A 13-Year Experience in Southern Thailand.
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The purpose of the study was to determine the clinical features of NLE and to compare the neonatal outcomes between newborns born to pregnant women with SLE and healthy pregnant women.</AbstractText>We conducted a retrospective cohort analysis between 2007 and 2019 in a tertiary referral hospital in Thailand. A total of 118 pregnant women with SLE with 132 neonates compared with 264 randomly selected healthy pregnant women.</AbstractText>The median (interquartile range) gestational age and birth weight of 132 neonates born to women with SLE were 37 (35-38) weeks and 2687 g (2045-3160 g), respectively. The clinical features of NLE infants were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. Moreover, logistic regression analysis found that neonates born to women with SLE increased the risk of preterm birth [odd ratio (OR) 8.87, 95% confidence interval (95% CI) 4.32-18.21, p < 0.001], low birth weight (OR 10.35, 95% CI 5.08-21.08, p < 0.001), birth asphyxia (OR 2.91, 95% CI 1.26-6.73, p = 0.011) and NICU admission (OR 4.26, 95% CI 2.44-7.42, p < 0.001). SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE.</AbstractText>The major clinical features of NLE patients were hematologic and hepatobiliary abnormalities in our study. Pregnancies with SLE dramatically increased the risk of preterm delivery and neonatal complications.</AbstractText>Neonatal lupus erythematosus (NLE) is the consequence of the transplacental passage of autoantibodies to newborns during pregnancy. The clinical features of NLE infants in our study were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. We also compared the neonatal outcomes between 118 pregnant women with SLE and 264 randomly selected healthy pregnant women. Our study found that the neonates born to women with SLE increased the risk of preterm birth, low birth weight, birth asphyxia and NICU admission. Moreover, SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE.</AbstractText>© The Author(s) [2021]. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].</CopyrightInformation>
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2,335,970 |
Efficacy of Dexmedetomidine Versus Morphine as an Adjunct to Bupivacaine in Caudal Anesthesia for Pediatric Thoracic Surgeries: A Randomized Controlled Trial.
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Caudal anesthesia is an effective method of pain management, which can be successfully employed to minimize post-thoracotomy pain in pediatric patients. However, its main disadvantage is the short postoperative analgesic period, which can be prolonged by the concurrent administration of one of many adjuvants.</AbstractText>This prospective randomized, blinded study aimed to compare the efficacy of dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal anesthesia for thoracic surgeries in pediatric patients.</AbstractText>Fifty patients were randomly allocated into two equal groups. To achieve caudal epidural block anesthesia, the patients in group M (n = 25) were administered morphine and bupivacaine, while group D (n = 25) received a mixture of dexmedetomidine and bupivacaine. The primary outcome of this study was the postoperative analgesic duration achieved. The secondary outcomes included morphine administration in the first 24 hours following caudal block anesthesia, the face, legs, activity, cry, consolability (FLACC) scale scores, and adverse effects, including vomiting, itching, bradycardia, hypotension, and respiratory depression.</AbstractText>The results showed that patients who had received dexmedetomidine achieved a longer postoperative analgesia as compared to those who had received morphine (P < 0.001). Postoperatively, the heart rate, blood pressure, pain score, and mean consumption of morphine were lower in group D as compared to the group M. There was no significant difference in the adverse effects between the two groups.</AbstractText>The use of dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during pediatric thoracic surgeries induced better and prolonged postoperative analgesia as compared to morphine.</AbstractText>Copyright © 2021, Author(s).</CopyrightInformation>
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2,335,971 |
Role of microRNA-129 in cancer and non-cancerous diseases (Review).
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An increasing number of studies indicate that microRNAs (miRNAs/miRs) are involved in diverse biological signaling pathways and play important roles in the progression of various diseases, including both oncological and non-oncological diseases. These small non-coding RNAs can block translation, resulting in a low expression level of target genes. miR-129 is an miRNA that has been the focus of considerable research in recent years. A growing body of evidence shows that the miR-129 family not only functions in cancer, including osteosarcoma, nasopharyngeal carcinoma, and ovarian, prostate, lung, breast and colon cancer, but also in non-cancerous diseases, including heart failure (HF), epilepsy, Alzheimer's disease (AD), obesity, diabetes and intervertebral disc degeneration (IVDD). It is therefore necessary to summarize current research progress on the role of miR-129 in different diseases. The present review includes an updated summary of the mechanisms of the miR-129 family in oncological and non-oncological diseases. To the best of our knowledge, this is the first review focusing on the role of miR-129 in non-cancerous diseases such as obesity, HF, epilepsy, diabetes, IVDD and AD.
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2,335,972 |
Effects of a nurse-led eHealth cardiac rehabilitation programme on health outcomes of patients with coronary heart disease: A randomised controlled trial.
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The uptake of and adherence to cardiac rehabilitation remain suboptimal despite its apparent health benefits in modifying risk factors and slowing disease progression. eHealth refers to the use of information and communication technologies for health-related purposes. It is a promising approach for improving participation in cardiac rehabilitation by enabling instant contact, hypermedia information delivery, technology-monitored functionalities and individualised progress monitoring.</AbstractText>To evaluate the effects of a nurse-led eHealth cardiac rehabilitation (NeCR) system on health behaviours, cardiac self-efficacy, anxiety and depression, health-related quality of life, risk parameters and unplanned use of care services for people with coronary heart disease.</AbstractText>A single-blinded randomised controlled trial design was used.</AbstractText>The study randomly assigned 146 patients hospitalised for coronary heart disease to receive either the NeCR intervention or the usual care. Underpinned by social cognitive theory, the intervention commenced before hospital discharge with an in-person session by the nurse to identify individualised self-care needs, set goals and develop an action plan to enhance behavioural risk factor modification and orientate the patient to the use of the information and communication technology platform for cardiac rehabilitation. After discharge, the e-platform helped patients gain knowledge of disease management and monitor goal attainment for health behavioural changes. The nurse provided feedback on the patients' goal attainment and lifestyle modifications on a weekly basis in a small group format through the WeChat platform, thus also mobilising peer influence. Data for lifestyle behaviours, physiological risk parameters and clinical outcomes were collected at baseline and at 6 and 12 weeks post-intervention.</AbstractText>At 6 weeks post-intervention, participants in the intervention group showed significant improvement in the number of steps/day (β = 2628.48, p = .022), the number of minutes/week sitting (β = -640.30, p = .006) and their health-promoting lifestyle profile (β = 25.17, p < .001) compared with the control group. Improvements in the number of steps/day (β = 2520.00, p = .006), the number of minutes/week sitting (β = -719.73, p = .004) and health-promoting lifestyle (β = 16.09, p < .001) were sustained until the 12-week post-intervention endpoint. Moreover, participants showed significantly greater improvement in self-efficacy (β = 0.61, p = .005) and health-related quality of life (mean difference = 0.56, p < .001) than the control group at the study endpoint.</AbstractText>The findings of this study demonstrate the effectiveness of the NeCR intervention in modifying behavioural risk factors and improving health-related quality of life. These findings also provide insights into the application of eHealth nursing interventions to enhance the rehabilitation of patients with coronary heart disease.</AbstractText>ChiCTR1800020411.</AbstractText>Copyright © 2021. Published by Elsevier Ltd.</CopyrightInformation>
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2,335,973 |
Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study.
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Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS.</AbstractText>In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay.</AbstractText>No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0-2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1-2). Mean post-operative length of stay was 4.17 ± 2.50 days.</AbstractText>Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.</AbstractText>© 2021. The Author(s).</CopyrightInformation>
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2,335,974 |
Resolvin D1 reduces expression and secretion of cytokines and monocyte adhesion triggered by Angiotensin II, in rat cardiac fibroblasts.
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Cardiac fibroblasts (CF) play an important role in the healing process and in pathological remodeling of cardiac tissue. As sentinel cells in the heart, they respond to inflammatory stimuli, expressing cytokines and cell adhesion proteins, which ultimately lead to increased recruitment of monocytes and enhancement of the inflammatory response. Angiotensin II (Ang II) triggers an inflammatory response, leading to cardiac tissue remodeling. On the other hand, RvD1 has been shown to contribute to the resolution of inflammation; however, its role in Ang II-treated CF has not been addressed until now. The present research aimed to study the effect of RvD1 on cytokine levels, cell adhesion proteins expression in a model of Ang II-triggered inflammatory response. CF from adult Sprague Dawley rats were used to study mRNA and protein levels of MCP-1, IL-6, TNF-a, IL-10, ICAM-1 and VCAM-1; and adhesion of spleen mononuclear cells to CF after Ang II stimulation. Our results show that Ang II increased IL-6, MCP-1 and TNF-a mRNA levels, but only increased IL-6 and MCP-1 protein levels. These effects were blocked by Losartan, but not by PD123369. Moreover, RvD1 was able to prevent all Ang II effects in CF. Additionally, RvD1 reduced the intracellular Ca<sup>2+</sup> increase triggered by Ang II, indicating that RvD1 acts in an early manner to block Ang II signaling. Conclusion: our findings confirm the pro-resolutive effects of inflammation by RvD1, which at the cardiovascular level, could contribute to repair damaged cardiac tissue.
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2,335,975 |
Evaluation of neuraxial administration of bupivacaine in bearded dragons (Pogona vitticeps).
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To assess the success rate, onset, duration and extent of motor/sensory block following neuraxial injection of two dosages of bupivacaine in bearded dragons (Pogona vitticeps).</AbstractText>Prospective, randomized, blinded, crossover experimental study.</AbstractText>A total of 10 adult bearded dragons (0.3 ± 0.1 kg).</AbstractText>After sedation with alfaxalone (15 mg kg-1</sup> subcutaneously), neuraxial injections were performed with 1 or 2 mg kg-1</sup> bupivacaine hydrochloride (0.5%, treatments BUP-1 and BUP-2, respectively) in a randomized treatment sequence with a 7 day washout period. If the initial bupivacaine injection was not successful within 10 minutes, a second injection was performed at the same dose. Mechanical stimulation of limbs, 25%, 50%, 75% of the trunk's length and cloacal tone were assessed.</AbstractText>Success rate following the first neuraxial injection was 95%, which increased to 100% after the second injection. Motor/sensory block were noted by 5 minutes after the injection of bupivacaine at either dose. BUP-2 was associated with more cranial spread. The median (range) duration of cloacal tone loss was longer following treatment BUP-2 [120 (75-225) minutes] than followed treatment BUP-1 [83 (25-135) minutes; p = 0.03]. Duration of pelvic limb motor block was comparable between both doses, lasting a median of 68 minutes in both treatments (p = 0.94). There was a transient, not clinically relevant increase from baseline in heart rate in treatment BUP-1 only. No significant difference from baseline in respiratory rate was noted in either treatment; however, two animals in treatment BUP-2 became apneic (10-20 minutes).</AbstractText>Bupivacaine (1 mg kg-1</sup>) is recommended for neuraxial anesthesia in bearded dragons. In treatment BUP-2, extensive cranial spread resulted in apnea and motor block of the thoracic limb in several animals; therefore this dose is not recommended.</AbstractText>Copyright © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,335,976 |
Anti-nociceptive Effects of Dexmedetomidine Infusion Plus Modified Intercostal Nerve Block During Single-port Thoracoscopic Lobectomy: A Double-blind, Randomized Controlled Trial.
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Multimodal general anesthesia based on modified intercostal nerve block (MINB) has been found as a novel method to achieve an intraoperative opioid-sparing effect. However, there is little information about the effective method to inhibit visceral nociceptive stress during single-port thoracoscopic surgery.</AbstractText>To investigate whether a low-dose dexmedetomidine infusion followed by MINB might be an alternative method to blunt visceral stress effectively.</AbstractText>Double-blind, randomized control trial.</AbstractText>Affiliated hospital from March 2020 through September 2020.</AbstractText>Fifty-four patients were randomized (1:1), 45 patients were included to receive dexmedetomidine with a 0.4 microgram/kg bolus followed by 0.4 microgram/kg/h infusion (group Dex) or saline placebo (group Con). During the operation, an additional dose of remifentanil 0.05-0.25 microgram/kg/min was used to keep mean arterial pressure (MAP) or heart rate (HR) values around 20% below baseline values. The primary outcome was to evaluate remifentanil consumption. Secondary outcomes included intraoperative hemodynamics, the first time to press an analgesia pump, and adverse effects.</AbstractText>Remifentanil consumption during surgery was markedly decreased in the Dex group than in the Con group (0 [0-0] versus 560.0 [337.5-965.0] microgram; P = 0.00). MAP and HR in the Con group during the first 5 minutes after visceral exploration was significantly higher than in the Dex group (P < 0.05). Time to first opioid demand was significantly prolonged (P = 0.04) and postoperative length of stay was shortened slightly in the Dex group (P = 0.05).</AbstractText>This study was limited by the measurement of nociception.</AbstractText>This study demonstrates that low-dose dexmedetomidine infusion combined with MINB might be an effective alternative method to blunt visceral stress in patients undergoing single-port thoracoscopic lobectomy. Furthermore, the analgesic effect of MINB was significantly prolonged after dexmedetomidine infusion.</AbstractText>
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2,335,977 |
Comparison of analgesic efficacy of the conventional approach and mid-transverse process to pleura approach of the paravertebral block in video-assisted thoracoscopy surgeries: A randomised controlled trial.
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The paravertebral block (PVB) is an effective alternative to thoracic epidural analgesia for post-operative analgesia in thoracic surgeries. Despite the use of ultrasound in PVB, the search for a safer approach continues. This study was conducted to compare the analgesic efficacy of conventional and mid-transverse process to the pleura (MTP) approach of the PVB.</AbstractText>Forty patients aged between 18-60 years, posted for video-assisted thoracoscopic surgery, were enroled for this study. Patients were randomised into two groups using a random number table, and group allocation was done by the sealed opaque envelope method. One group received PVB by conventional approach (group CP). In contrast, patients in the other group (group MP) received PVB by the mid-transverse process to pleura (MTP) approach before induction of general anaesthesia under ultrasound guidance. The study's primary aim was to compare analgesic consumption in the first 24 hours. Secondary aims were comparing the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, haemodynamic parameters such as heart rate (HR), oxygen saturation (SpO2</sub>), and non-invasive blood pressure (NIBP), patient satisfaction scores, and complications observed. Data were analysed using Statistical Package for the Social Sciences version 23.</AbstractText>Demographic parameters, block performance time, and dermatomal distribution were comparable in both groups. We did not find any statistical difference in the analgesic consumption in the first 24 hours (P</i> = 0.38), VAS at rest or on movement, complication rates, and patient satisfaction scores between the groups.</AbstractText>The MTP approach of the PVB is as effective as the conventional thoracic paravertebral approach for post-operative analgesia in video-assisted thoracoscopic surgeries.</AbstractText>Copyright: © 2021 Indian Journal of Anaesthesia.</CopyrightInformation>
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2,335,978 |
Transient Complete Heart Block Following Femoral Arterial Sheath Removal: An Extreme Case of Vasovagal Reflex Syndrome.
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<b>How to cite this article:</b> Kodliwadmath A, Walia R, Ola R, Sharma P. Transient Complete Heart Block Following Femoral Arterial Sheath Removal: An Extreme Case of Vasovagal Reflex Syndrome. Indian J Crit Care Med 2021;25(7):825-827.
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2,335,979 |
Oral acetaminophen as an adjunct to continuous epidural infusion and patient-controlled epidural analgesia in laboring parturients: a randomized controlled trial.
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Intravenous acetaminophen is safe and effective as an adjunct to labor analgesia with combined spinal-epidural (CSE) analgesia and patient-controlled epidural analgesia (PCEA). Oral acetaminophen is a much cheaper and safe option but has not been studied as an adjunct to labor analgesia till date. The aim of the present study is to evaluate the effect of oral acetaminophen as an adjunct in patients receiving local anesthetic-opioid combination using CSE analgesia.</AbstractText>In this ethically approved randomized double-blind placebo-controlled trial, 60 consenting parturients were randomly allocated to two groups of 30 each: acetaminophen (who received oral acetaminophen 1 g) or placebo, 45 min before the procedure. CSE was administered as per hospital protocol. All the patients received continuous epidural infusion (CEI) of levobupivacaine 0.1% and fentanyl 2 mcg/mL at 5 ml/h and PCEA boluses of 5 mL of the same drug with a lockout interval of 15 min if needed. The primary outcome was hourly mean consumption of levobupivacaine and fentanyl mixture (mL/h). Secondary outcomes included pain score, sensory and motor block, hemodynamic parameters of mother, duration of the second stage of labor, mode of delivery, maternal satisfaction, Apgar scores, fetal heart rate, and adverse effects.</AbstractText>The mean drug consumption per hour was significantly less in the acetaminophen group than in the placebo group (7.66 mL/h, SD 2.01 vs. 9.01 mL/h, SD 2.83; p = 0.04). The requirement for bolus was also significantly less in the acetaminophen group than in the placebo group (median 2.5, IQR 3 vs. median 3.5, IQR 2; p = 0.04).</AbstractText>The use of 1 g of oral acetaminophen could be a cheap, safe, and effective adjunct to CEI plus PCEA in labor analgesia.</AbstractText>© 2021. Japanese Society of Anesthesiologists.</CopyrightInformation>
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2,335,980 |
A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): a randomised controlled trial.
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To investigate superiority of a telerehabilitation programme for COVID-19 (TERECO) over no rehabilitation with regard to exercise capacity, lower limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL) and dyspnoea.</AbstractText>Parallel-group randomised controlled trial with 1:1 block randomisation.</AbstractText>Three major hospitals from Jiangsu and Hubei provinces, China.</AbstractText>120 formerly hospitalised COVID-19 survivors with remaining dyspnoea complaints were randomised with 61 allocated to control and 59 to TERECO.</AbstractText>Unsupervised home-based 6-week exercise programme comprising breathing control and thoracic expansion, aerobic exercise and LMS exercise, delivered via smartphone, and remotely monitored with heart rate telemetry.</AbstractText>Primary outcome was 6 min walking distance (6MWD) in metres. Secondary outcomes were squat time in seconds; pulmonary function assessed by spirometry; HRQOL measured with Short Form Health Survey-12 (SF-12) and mMRC-dyspnoea. Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up).</AbstractText>Adjusted between-group difference in change in 6MWD was 65.45 m (95% CI 43.8 to 87.1; p<0.001) at post-treatment and 68.62 m (95% CI 46.39 to 90.85; p<0.001) at follow-up. Treatment effects for LMS were 20.12 s (95% CI 12.34 to 27.9; p<0.001) post-treatment and 22.23 s (95% CI 14.24 to 30.21; p<0.001) at follow-up. No group differences were found for lung function except post-treatment maximum voluntary ventilation. Increase in SF-12 physical component was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24 to 6.35; p=0.004) at post-treatment and 2.69 (95% CI 0.06 to 5.32; p=0.045) at follow-up.</AbstractText>This trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and physical HRQOL.</AbstractText>ChiCTR2000031834.</AbstractText>© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
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2,335,981 |
Monitored Anesthetic Care Combined with Scalp Nerve Block in Awake Craniotomy: An Effective Attempt at Enhanced Recovery After Neurosurgery.
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Enhanced recovery after surgery has been attempted in neurosurgery at a greater rate. However, concern exists regarding the feasibility of using enhanced recovery after neurosurgery (ERANS). How to manage available resources to safely perform ERANS and improve clinical outcomes has been the subject of much debate and discussion.</AbstractText>Owing to the paucity of data available on the use of ERANS protocols, we performed the present feasibility study. We studied the outcomes of the protocols used within a tertiary referral neurosurgery center. Data from patients who had undergone awake craniotomy within an ERANS protocol were prospectively recorded in our institution from September 2017 to December 2018. We also evaluated the safety and effectiveness of the novel ERANS protocol.</AbstractText>A total of 20 patients (mean age, 49.5 ± 17.8 years) were included in the present study. Intraoperative hypertension, hypotension, and bradycardia were present in 4 (20%), 1 (5%), and 1 (5%) patient, respectively. The postoperative morbidities included epilepsy in 1 (5%), pain in 3 (15%), and nausea or vomiting in 2 (10%). No significant changes had occurred in the mean arterial pressure, heart rate, blood glucose, or lactic acid level throughout the procedure. The median length of intensive care unit stay and postoperative hospital stay were 1 and 9.5 days, respectively. No 30-day readmissions or reoperations occurred during the present study.</AbstractText>Applying an ERANS protocol was feasible, associated with a low incidence of complications, and acceptable intensive care unit and postoperative hospital lengths of stay. The findings from the present study might provide a new approach for the further research of ERANS.</AbstractText>Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,335,982 |
Effects of fadolmidine, an α<sub>2</sub> -adrenoceptor agonist, as an adjuvant to spinal bupivacaine on antinociception and motor function in rats and dogs.
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α<sub>2</sub> -Adrenoceptor agonists such as clonidine and dexmedetomidine are used as adjuvants to local anesthetics in regional anesthesia. Fadolmidine is an α<sub>2</sub> -adrenoceptor agonist developed especially as a spinal analgesic. The current studies investigate the effects of intrathecally administered fadolmidine with a local anesthetic, bupivacaine, on antinociception and motor block in conscious rats and dogs. The antinociceptive effects of intrathecal fadolmidine and bupivacaine alone or in combination were tested in the rat tail-flick and the dog's skin twitch models. The durations of motor block in rats and in dogs were also assessed. In addition, the effects on sedation, mean arterial blood pressure, heart rate, respiratory rate and body temperature were evaluated in telemetrized dogs. Concentrations of fadolmidine in plasma and spinal cord were determined after intrathecal and intravenous administration in rats. Co-administration of intrathecal fadolmidine with bupivacaine increased the magnitude and duration of the antinociceptive effects and prolonged motor block without hypotension. The interaction of the antinociceptive effect was synergistic in its nature in rats. Concentration of fadolmidine in plasma was very low after intrathecal dosing. Taken together, these studies show that fadolmidine as an adjuvant to intrathecal bupivacaine provides enhanced sensory-motor block and enables a reduction of the doses of both drugs. The results indicate that co-administration of fadolmidine with intrathecal bupivacaine was able to achieve an enhanced antinociceptive effect without hypotension and could thus represent a suitable combination for spinal anesthesia.
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2,335,983 |
Reducing Auditory Nerve Excitability by Acute Antagonism of Ca<sup>2+</sup>-Permeable AMPA Receptors.
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Hearing depends on glutamatergic synaptic transmission mediated by α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs). AMPARs are tetramers, where inclusion of the GluA2 subunit reduces overall channel conductance and Ca<sup>2+</sup> permeability. Cochlear afferent synapses between inner hair cells (IHCs) and auditory nerve fibers (ANFs) contain the AMPAR subunits GluA2, 3, and 4. However, the tetrameric complement of cochlear AMPAR subunits is not known. It was recently shown in mice that chronic intracochlear delivery of IEM-1460, an antagonist selective for GluA2-lacking AMPARs [also known as Ca<sup>2+</sup>-permeable AMPARs (CP-AMPARs)], before, during, and after acoustic overexposure prevented both the trauma to ANF synapses and the ensuing reduction of cochlear nerve activity in response to sound. Surprisingly, baseline measurements of cochlear function before exposure were unaffected by chronic intracochlear delivery of IEM-1460. This suggested that cochlear afferent synapses contain GluA2-lacking CP-AMPARs alongside GluA2-containing Ca<sup>2+</sup>-impermeable AMPA receptors (CI-AMPARs), and that the former can be antagonized for protection while the latter remain conductive. Here, we investigated hearing function in the guinea pig during acute local or systemic delivery of CP-AMPAR antagonists. Acute intracochlear delivery of IEM-1460 or systemic delivery of IEM-1460 or IEM-1925 reduced the amplitude of the ANF compound action potential (CAP) significantly, for all tone levels and frequencies, by > 50% without affecting CAP thresholds or distortion product otoacoustic emissions (DPOAE). Following systemic dosing, IEM-1460 levels in cochlear perilymph were ~ 30% of blood levels, on average, consistent with pharmacokinetic properties predicting permeation of the compounds into the brain and ear. Both compounds were metabolically stable with half-lives >5 h <i>in vitro</i>, and elimination half-lives <i>in vivo</i> of 118 min (IEM-1460) and 68 min (IEM-1925). Heart rate monitoring and off-target binding assays suggest an enhanced safety profile for IEM-1925 over IEM-1460. Compound potency on CAP reduction (IC<sub>50</sub> ~ 73 μM IEM-1460) was consistent with a mixture of GluA2-lacking and GluA2-containing AMPARs. These data strongly imply that cochlear afferent synapses of the guinea pig contain GluA2-lacking CP-AMPARs. We propose these CP-AMPARs may be acutely antagonized with systemic dosing, to protect from glutamate excitotoxicity, while transmission at GluA2-containing AMPARs persists to mediate hearing during the protection.
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2,335,984 |
A Reversible Low Frequency Alternating Current Nerve Conduction Block Applied to Mammalian Autonomic Nerves.
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Electrical stimulation can be used to modulate activity within the nervous system in one of two modes: (1) Activation, where activity is added to the neural signalling pathways, or (2) Block, where activity in the nerve is reduced or eliminated. In principle, electrical nerve conduction block has many attractive properties compared to pharmaceutical or surgical interventions. These include reversibility, localization, and tunability for nerve caliber and type. However, methods to effect electrical nerve block are relatively new. Some methods can have associated drawbacks, such as the need for large currents, the production of irreversible chemical byproducts, and onset responses. These can lead to irreversible nerve damage or undesirable neural responses. In the present study we describe a novel low frequency alternating current blocking waveform (LFACb) and measure its efficacy to reversibly block the bradycardic effect elicited by vagal stimulation in anaesthetised rat model. The waveform is a sinusoidal, zero mean(charge balanced), current waveform presented at 1 Hz to bipolar electrodes. Standard pulse stimulation was delivered through Pt-Black coated PtIr bipolar hook electrodes to evoke bradycardia. The conditioning LFAC waveform was presented either through a set of CorTec<sup>®</sup> bipolar cuff electrodes with Amplicoat<sup>®</sup> coated Pt contacts, or a second set of Pt Black coated PtIr hook electrodes. The conditioning electrodes were placed caudal to the pulse stimulation hook electrodes. Block of bradycardic effect was assessed by quantifying changes in heart rate during the stimulation stages of LFAC alone, LFAC-and-vagal, and vagal alone. The LFAC achieved 86.2±11.1% and 84.3±4.6% block using hook (N = 7) and cuff (N = 5) electrodes, respectively, at current levels less than 110 µA<sub>p</sub> (current to peak). The potential across the LFAC delivering electrodes were continuously monitored to verify that the blocking effect was immediately reversed upon discontinuing the LFAC. Thus, LFACb produced a high degree of nerve block at current levels comparable to pulse stimulation amplitudes to activate nerves, resulting in a measurable functional change of a biomarker in the mammalian nervous system.
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2,335,985 |
[Comparison of the post-operative analgesic effect of ultrasound-guided serratus anterior plane block combined with pectoral nerves block Ⅰ and thoracic paravertebral block in radical mastectomy].
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<b>Objective:</b> To investigate the serratus anterior plane block combined with pectoral nerves block I can produce a non-inferior analgesic effect compared with thoracic paravertebral block for radical mastectomy. <b>Methods:</b> From October 2020 to February 2021, Sixty-four patients of Beijing Tongren Hospital, Capital Medical University scheduled for radical mastectomy with general anesthesia,were divided into two groups (<i>n</i> = 32 each) using a random number table method: thoracic paravertebral block group (TPVB group) and serratus anterior plane block combined with pectoral nerves block I group (S&P group). All patients received patient controlled intravenous analgesia (PCIA) postoperatively. The numerical rating scale (NRS) at post anesthesia care unit (PACU), 4, 8, 12, 24, 48 h after operation were compared between the two groups. Sufentanil cumulative dosage of PCIA in 24 h and 48 h, first press time after operation, total press times, the dosage of propofol, remifentanil and vasoactive drugs during operation, intraoperative blood pressure and heart rate, the operation time of block and adverse effects were all compared. Non-inferiority could be claimed if the difference of sufentanil cumulative dosage in 24 h between S&P group and TPVB group is higher than the negative value (-3.8) of the non-inferiority effect. <b>Results:</b> There was no significant difference in postoperative NRS at PACU, 4, 8, 12, 24, 48 h after operation, first press time after operation, total press times, propofol and remifentanil dosage, sufentanil cumulative dosage of PCIA in 24 h and 48 h, and adverse effects (all <i>P</i>>0.05). The sufentanil cumulative dosage of PCIA in 24 h of S&P group and of TPVB group were (15.8±4.7) μg and (15.2±3.2) μg. The 95% confidence interval (<i>CI</i>) of the difference between S&P group and of TPVB group was -1.478 to 2.694, and the lower limit was greater than non-inferiority margin -3.8. The mean arterial pressure of TPVB patients after induction and at the beginning of the operation were (63±7) mmHg and (70±7) mmHg, which were significantly lower than the (77±5) mmHg and (79±8) mmHg at the same time in the combination group (both <i>P</i><0.05). The frequency of vasoactive drugs usage in TPVB group was 56.3%, which was statistically significant higher than the 18.8% in S&P group (<i>P</i><0.01). Nerve block time in TPVB group was 10 (9, 11) min, which was significantly longer than 8 (6, 10) min in S&P group (<i>P<</i>0.01). <b>Conclusion:</b> The serratus anterior block combined with pectoral nerves block I can produce a non-inferior analgesic effect compared with thoracic paravertebral block for radical mastectomy, and the intraoperative hemodynamics is more stable and the block time is shorter than that of thoracic paravertebral block for radical mastectomy.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>L L</ForeName><Initials>LL</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xi</LastName><ForeName>C H</ForeName><Initials>CH</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yin</LastName><ForeName>Y</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lei</LastName><ForeName>G Y</ForeName><Initials>GY</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Y</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Du</LastName><ForeName>Y J</ForeName><Initials>YJ</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wei</LastName><ForeName>Z</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hu</LastName><ForeName>C H</ForeName><Initials>CH</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>G Y</ForeName><Initials>GY</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>chi</Language><GrantList CompleteYN="Y"><Grant><GrantID>ZYLX202103</GrantID><Agency>Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support</Agency><Country/></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</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></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000700" MajorTopicYN="N">Analgesics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001943" MajorTopicYN="Y">Breast Neoplasms</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008408" MajorTopicYN="N">Mastectomy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015409" MajorTopicYN="N">Mastectomy, Radical</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009407" MajorTopicYN="Y">Nerve Block</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010149" MajorTopicYN="N">Pain, Postoperative</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013900" MajorTopicYN="Y">Thoracic Nerves</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018084" MajorTopicYN="N">Ultrasonography, Interventional</DescriptorName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="chi"><b>目的：</b> 探讨前锯肌阻滞联合胸肌Ⅰ型阻滞对比胸椎旁阻滞在乳腺癌根治术术后镇痛的非劣效应。 <b>方法：</b> 选择2020年10月至2021年2月首都医科大学附属北京同仁医院全身麻醉下因乳腺癌行乳腺癌根治术患者64例，采用随机数字表法分为两组（<i>n</i> = 32）：胸椎旁阻滞组（TPVB组）、前锯肌阻滞联合胸肌Ⅰ型阻滞组（联合组）。术后给予患者自控静脉镇痛（PCIA）。比较两组患者在麻醉后恢复室（PACU）以及术后4、8、12、24、48 h各时间点的静息疼痛评分（NRS），术后24 、48 h舒芬太尼用量，患者PCIA首次按压时间及按压次数，术中丙泊酚、瑞芬太尼、血管活性药用量，术中血压、心率、阻滞操作时间，术后恶心、呕吐等不良反应发生率。若联合组与TPVB组术后24 h舒芬太尼总量差值的95%置信区间下限高于非劣效应界值负值（-3.8）时，即认为联合组非劣效于TPVB组。 <b>结果：</b> 两组患者在PACU以及术后4、8、12、24、48 h各时间点NRS评分，PCIA首次按压时间及按压次数，术中全身麻醉药用量及术后24、48 h舒芬太尼用量比较差异均无统计学意义（均<i>P></i>0.05）；联合组与TPVB组术后24 h舒芬太尼总量分别为（15.8±4.7）、（15.2±3.2） μg，差值的95%置信区间为-1.478~2.694，其下限高于非劣效性界值负值；TPVB患者诱导后及手术开始时的平均动脉压（MAP）为（63±7）、（70±7） mmHg（1 mmHg=0.133 kPa），显著低于联合组的（77±5）、（79±8） mmHg，差异均有统计学意义（均<i>P<</i>0.05）；TPVB组和联合组使用血管活性药比率分别为56.3%和18.8%，TPVB使用血管活性药更频繁，差异有统计学意义（<i>P</i><0.01）；TPVB组神经阻滞时间为10（9，11） min，联合组为8（6，10） min，联合组操作时间更短，差异有统计学意义（<i>P<</i>0.01）。 <b>结论：</b> 前锯肌阻滞联合胸肌Ⅰ型阻滞在乳腺癌根治术后具有相对于胸椎旁阻滞的镇痛非劣效应，且术中血流动力学更平稳，操作时间更短。.
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2,335,986 |
The effectiveness of a nurse-led home-based heart failure self-management programme (the HOM-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial.
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Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons.</AbstractText>A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235).</AbstractText>A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline.</AbstractText>Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up.</AbstractText>The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore.</AbstractText>Copyright © 2021. Published by Elsevier Ltd.</CopyrightInformation>
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2,335,987 |
Effect of aromatherapy with Melissa essential oil on stress and hemodynamic parameters in acute coronary syndrome patients: A clinical trial in the emergency department.
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Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department.</AbstractText>In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t-test, and post-hoc Tukey's test.</AbstractText>Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05).</AbstractText>Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions.</AbstractText>Copyright © 2021 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,335,988 |
Low prevalence of anti-SSA (anti-Ro) and anti-SSB (anti-La) autoantibodies in female patients with rheumatoid arthritis with a wish to conceive.
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Guidelines advise to test for anti-Sjögren's-syndrome-related antigen A (anti-SSA) and anti-Sjögren's-syndrome-related antigen B (anti-SSB) antibodies in all patients with rheumatoid arthritis (RA) who wish to conceive. Our objective was to determine the prevalence and titres of anti-SSA and anti-SSB autoantibodies in patients with RA with a wish to conceive or pregnant.</AbstractText>Patients were derived from two large cohorts on RA and pregnancy (PARA cohort and PreCARA cohort). In addition, to determine the clinical relevance of searching for anti-SSA and anti-SSB in patients with RA, we studied the prevalence of the maternal diagnosis of RA in the French national registry of neonatal lupus syndrome (NLS) and congenital heart block (CHB).</AbstractText>26 out of 647 patients with RA had detectable anti-SSA and/or anti-SSB. Anti-SSA was detected in 25 out of 647 patients (3.9%) (Ro-52, n=17; Ro-60, n=19), anti-SSB in 7 out of 647 (1.1%). Thirteen women had a titre of >240 units/mL of anti-SSA antibodies. The prevalence of anti-SSA and/or anti-SSB was higher in rheumatoid factor (RF)-positive patients compared with RF-negative patients (5.1% vs 1.6%, p=0.04). No cases of CHB and/or NLS in the offspring were observed. In the French national register, the prevalence of RA in mothers with SSA related CHB was 1.5%.</AbstractText>Anti-SSA and anti-SSB have a low prevalence in patients with RA who wish to conceive. Especially for RF-negative patients, the current advise to test for anti-SSA and anti-SSB should be reconsidered.</AbstractText>© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
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2,335,989 |
An Integrative Genomic Strategy Identifies sRAGE as a Causal and Protective Biomarker of Lung Function.
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There are few clinically useful circulating biomarkers of lung function and lung disease. We hypothesized that genome-wide association studies (GWAS) of circulating proteins in conjunction with GWAS of pulmonary traits represents a clinically relevant approach to identifying causal proteins and therapeutically useful insights into mechanisms related to lung function and disease.</AbstractText>Can an integrative genomic strategy using GWAS of plasma soluble receptor for advanced glycation end-products (sRAGE) levels in conjunction with GWAS of lung function traits identify putatively causal relations of sRAGE to lung function?</AbstractText>Plasma sRAGE levels were measured in 6,861 Framingham Heart Study participants and GWAS of sRAGE was conducted to identify protein quantitative trait loci (pQTL), including cis-pQTL variants at the sRAGE protein-coding gene locus (AGER). We integrated sRAGE pQTL variants with variants from GWAS of lung traits. Colocalization of sRAGE pQTL variants with lung trait GWAS variants was conducted, and Mendelian randomization was performed using sRAGE cis-pQTL variants to infer causality of sRAGE for pulmonary traits. Cross-sectional and longitudinal protein-trait association analyses were conducted for sRAGE in relation to lung traits.</AbstractText>Colocalization identified shared genetic signals for sRAGE with lung traits. Mendelian randomization analyses suggested protective causal relations of sRAGE to several pulmonary traits. Protein-trait association analyses demonstrated higher sRAGE levels to be cross-sectionally and longitudinally associated with preserved lung function.</AbstractText>sRAGE is produced by type I alveolar cells, and it acts as a decoy receptor to block the inflammatory cascade. Our integrative genomics approach provides evidence for sRAGE as a causal and protective biomarker of lung function, and the pattern of associations is suggestive of a protective role of sRAGE against restrictive lung physiology. We speculate that targeting the AGER/sRAGE axis may be therapeutically beneficial for the treatment and prevention of inflammation-related lung disease.</AbstractText>Published by Elsevier Inc.</CopyrightInformation>
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2,335,990 |
Local anesthetic volume in ultrasound-guided interscalene block and opioid consumption during shoulder arthroscopic surgery: A retrospective comparative study.
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Interscalene block (ISB) is commonly performed for regional anesthesia in shoulder surgery. Ultrasound-guided ISB enables visualization of the local anesthetic spread and a reduction in local anesthetic volume. However, little is known about the appropriate local anesthetic dose for surgical anesthesia without sedation or general anesthesia. The purpose of our study was to evaluate the appropriate local anesthetic volume by comparing intraoperative analgesics and hemodynamic changes in ISB in arthroscopic shoulder surgery.Overall, 1007 patients were divided into groups 1, 2, and 3 according to the following volume of local anesthetics: 10-19, 20-29, and 30-40 mL, respectively. The use of intraoperative analgesics and sedatives, and the reduction in intraoperative maximum blood pressure and heart rate were compared through retrospective analysis.Fentanyl was used in 55.6% of patients in group 1, which was significantly higher than in those groups 2 and 3 (22.3% and 30.7%, respectively); furthermore, it was also higher than those in groups 2 and 3 in dose-specific comparisons (P < .05). The percent of the maximum reduction in intraoperative systolic blood pressure and heart rate in group 3 was significantly higher than those in groups 1 and 2. Ephedrine administration was lower in group 2 than that in other groups (P < .05). The incidence of hypotensive bradycardic events was lowest (9.1%) at the local anesthetic volume of 24 mL as revealed by the quadratic regression analysis (R2 = 0.313, P = .003).Decreasing the local anesthetic volume to less than 20 mL for ultrasound-guided ISB as the sole anesthesia increases the opioid consumption during shoulder arthroscopic surgery. Local anesthetics >30 mL or increased opioid consumption with <20 mL of local anesthetics could increase the risk of cardiovascular instability intraoperatively. Our findings indicate that 24 mL of local anesthetic could be used to lower the incidence of hypotensive bradycardic events.
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2,335,991 |
Antifibrotic Effects of (-)-Epicatechin on High Glucose Stimulated Cardiac Fibroblasts.
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Cardiac fibrosis is one of the hallmarks of a diabetic cardiomyopathy. When activated, cardiac fibroblasts (CFs) increase the production of extracellular matrix proteins. Transforming growth factor (TGF)-<i>β</i>1 is known to mediate cardiac fibrosis through the SMAD pathway. High glucose (HG = 25 mM) cell culture media can activate CFs using TGF-<i>β</i>1. There is a need to identify effective antifibrotic agents. Studies in animals indicate that treatment with (-)-epicatechin (Epi) appears capable of reducing myocardial fibrosis. Epi binds to G-protein coupled estrogen receptor (GPER) and activates downstream pathways. We evaluated the potential of Epi to mitigate the development of a profibrotic phenotype in HG stimulated CFs. CF primary cultures were isolated from young male rats and were exposed for up to 48 h HG media and treated with vehicle or 1 <i>μ</i>M Epi. Relevant profibrotic end points were measured by the use of various biochemical assays. HG exposure of CFs increased TGF-<i>β</i>1 protein levels by ∼15%, fibronectin ∼25%, urea levels ∼60%, proline incorporation ∼70%, and total collagen ∼15%. Epi treatment was able to significantly block HG induced increases in TGF-<i>β</i>1, fibronectin, urea, proline, and total collagen protein levels. GPER levels were reduced by HG and restored in CFs treated with Epi an effect associated with the activation (<i>i.e.</i>, phosphorylation) of c-Src. Epi treatment also reverted SMAD levels. Altogether, results demonstrate that CFs cultured in HG acquire a profibrotic phenotype, which is blocked by Epi an effect, likely mediated at least, in part, by GPER effects on the SMAD/TGF-<i>β</i>1 pathway.
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2,335,992 |
Coordinated changes in gene expression kinetics underlie both mouse and human erythroid maturation.
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Single-cell technologies are transforming biomedical research, including the recent demonstration that unspliced pre-mRNA present in single-cell RNA-Seq permits prediction of future expression states. Here we apply this RNA velocity concept to an extended timecourse dataset covering mouse gastrulation and early organogenesis.</AbstractText>Intriguingly, RNA velocity correctly identifies epiblast cells as the starting point, but several trajectory predictions at later stages are inconsistent with both real-time ordering and existing knowledge. The most striking discrepancy concerns red blood cell maturation, with velocity-inferred trajectories opposing the true differentiation path. Investigating the underlying causes reveals a group of genes with a coordinated step-change in transcription, thus violating the assumptions behind current velocity analysis suites, which do not accommodate time-dependent changes in expression dynamics. Using scRNA-Seq analysis of chimeric mouse embryos lacking the major erythroid regulator Gata1, we show that genes with the step-changes in expression dynamics during erythroid differentiation fail to be upregulated in the mutant cells, thus underscoring the coordination of modulating transcription rate along a differentiation trajectory. In addition to the expected block in erythroid maturation, the Gata1-chimera dataset reveals induction of PU.1 and expansion of megakaryocyte progenitors. Finally, we show that erythropoiesis in human fetal liver is similarly characterized by a coordinated step-change in gene expression.</AbstractText>By identifying a limitation of the current velocity framework coupled with in vivo analysis of mutant cells, we reveal a coordinated step-change in gene expression kinetics during erythropoiesis, with likely implications for many other differentiation processes.</AbstractText>
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2,335,993 |
Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial.
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Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations.</AbstractText>In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery.</AbstractText>In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups.</AbstractText>The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05).</AbstractText>In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.</AbstractText>Copyright © 2021, Author(s).</CopyrightInformation>
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2,335,994 |
Comparison of Spinal Versus Epidural Analgesia for Vaginal Delivery: A Randomized Double Blinded Clinical Trial.
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Recently, one of the problems in developing countries is pregnant women who insist on cesarean section for fear of painful vaginal delivery. There are various methods to reduce labor pain, including medical and non-medical methods. Neuraxial analgesia is classified as one of the best ways to reduce labor pain. Epidural analgesia is a classic and popular procedure to decrease labor pain. Nevertheless, other methods, such as spinal or combined spinal-epidural analgesia, is more effective compared with the epidural.</AbstractText>In this study, we investigated a single intrathecal versus epidural injection in pregnant women during childbirth.</AbstractText>In our research, after obtaining informed consent, the patients were randomly assigned to two equal groups: epidural and spinal. Each group contained 50 parturient women in advanced labor. In the epidural group, 2.5 mL isobaric bupivacaine 0.5%, sufentanil (0.2 mcg/mL), and 7 mL saline 0.9% were injected by an 18-gauge Tuohy needle at the L4-5 or L5-S1 intervertebral space, and in the spinal group, 0.5 mL isobaric bupivacaine 0.5%, 2.5 mcg sufentanil, and 0.5 mL saline 0.9% were injected by a 25-gauge pencil-point Quincke needle at the L4-5 or L5-S1 intervertebral spaces. For pain intensity, the visual analog scale (VAS) was used at serial intervals, and other variables, such as the onset and duration of analgesia, hypotension, neonatal APGAR score, fetal heart rate (FHR) changes, and other variables were examined.</AbstractText>The mean time to onset analgesic effect was 4.6 min in the spinal group compared with 12.5 minutes in the epidural (P < 0.001). Duration of analgesia was 121 minutes in the spinal group compared with 104 min in the epidural group (P < 0.001). The time to reach the maximum block was 8.4 min in the spinal group vs. 22.2 min in the epidural group (P < 0.001). The duration of the second and third gestation stages was the same in both groups.</AbstractText>Spinal analgesia is short and easy to perform and does not require advanced equipment and technical experience. Spinal analgesia can be a good option for labor analgesia and leads to achieving a lower pain score than epidural analgesia.</AbstractText>Copyright © 2021, Author(s).</CopyrightInformation>
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2,335,995 |
Intrathecal nalbuphine <i>vs</i>. buprenorphine as an adjuvant in lower limb orthopedic surgeries: a prospective randomized controlled study.
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This study aimed to compare the efficacy of intrathecal nalbuphine and buprenorphine as an adjuvant to heavy bupivacaine (0.5%) for spinal anesthesia in lower limb orthopedic surgeries to improve the quality of spinal anesthesia (onset, duration, and side effects) and prolongation of postoperative analgesia. Sixty patients were recruited into this single-centered, double-blinded, hospital-based, prospective, comparative study conducted in 2017-2018. They were randomly and equally (n = 30) allocated into two groups: nalbuphine group which received 0.5 mL (0.8 mg) of nalbuphine with 3 mL of heavy (0.5%) hyperbaric bupivacaine and buprenorphine group which received 0.5 mL (60 mg) of buprenorphine with 3 mL of heavy hyperbaric bupivacaine. Intraoperatively, onset and duration of blockade (motor and sensory), and time for first dose of rescue analgesia were recorded in both groups at regular intervals. Heart rate, blood pressure, Visual Analogue Scale score and side effects were also recorded postoperatively for 12 hours. The demographic parameters, time of onset of sensory block and motor block, and duration of motor block were comparable between nalbuphine and buprenorphine groups. The duration of sensory block in the buprenorphine group was longer than in the nalbuphine group. Time to the first dose of rescue analgesia was delayed in buprenorphine group as compared to nalbuphine group. In both groups maximum patients achieved maximum height of sensory block at 90 minutes. There were significant differences in the mean heart rate and blood pressure between buprenorphine and nalbuphine groups. Nalbuphine group patients achieved a Visual Analogue Scale score > 4 earlier as compared to buprenorphine group. Few side effects were observed in both groups. Intrathecal buprenorphine is a better adjuvant to 0.5% bupivacaine in the spinal anesthesia for lower limb orthopedic surgeries, as it provides longer sensory block and delayed administration of first dose of rescue analgesia with negligible side-effects. The study was approved by Institutional Ethics Committee of Krishna Institute of Medical Sciences (approval number: KIMSDU/IEC/03/2017) on November 23, 2017.
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2,335,996 |
3,4-Difluorobenzocurcumin Inhibits Vegfc-Vegfr3-Erk Signalling to Block Developmental Lymphangiogenesis in Zebrafish.
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Lymphangiogenesis, the formation of new lymphatic vessels from pre-existing vasculature, plays critical roles in disease, including in cancer metastasis and chronic inflammation. Preclinical and recent clinical studies have now demonstrated therapeutic utility for several anti-lymphangiogenic agents, but optimal agents and efficacy in different settings remain to be determined. We tested the anti-lymphangiogenic property of 3,4-Difluorobenzocurcumin (CDF), which has previously been implicated as an anti-cancer agent, using zebrafish embryos and cultured vascular endothelial cells. We used transgenic zebrafish labelling the lymphatic system and found that CDF potently inhibits lymphangiogenesis during embryonic development. We also found that the parent compound, Curcumin, does not inhibit lymphangiogenesis. CDF blocked lymphatic and venous sprouting, and lymphatic migration in the head and trunk of the embryo. Mechanistically, CDF impaired VEGFC-VEGFR3-ERK signalling in vitro and in vivo. In an in vivo pathological model of Vegfc-overexpression<i>,</i> treatment with CDF rescued endothelial cell hyperplasia. CDF did not inhibit the kinase activity of VEGFR3 yet displayed more prolonged activity in vivo than previously reported kinase inhibitors. These findings warrant further assessment of CDF and its mode of action as a candidate for use in metastasis and diseases of aberrant lymphangiogenesis.
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2,335,997 |
Effect of β-blockers on the risk of COPD exacerbations according to indication of use: the Rotterdam Study.
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Observational studies report a reduction of COPD exacerbations in patients treated with β-blockers. In contrast, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (BLOCK COPD) randomised controlled trial which excluded COPD patients with cardiovascular conditions showed an increase in COPD exacerbations. It is unclear whether this discrepancy could be explained by underlying cardiovascular comorbidity. We examined whether the association between use of β-blockers and risk of COPD exacerbations differed between patients with and without a cardiovascular indication for β-blockers use. Within the Rotterdam Study, we followed COPD subjects until the first COPD exacerbation, or end of follow-up. Cardiovascular indication for β-blockers use was defined as a history of hypertension, coronary heart disease, atrial fibrillation and/or heart failure at baseline. The association between β-blockers use and COPD exacerbations was assessed using Cox proportional hazards models adjusted for age, sex, smoking, incident cardiovascular disease (<i>i.e.</i> heart failure, hypertension, atrial fibrillation and/or coronary heart disease during follow-up), respiratory drugs and nitrates. In total, 1312 COPD patients with a mean age of 69.7±9.2 years were included. In patients with a cardiovascular indication (n=755, mean age of 70.4±8.8 years), current use of cardioselective β-blockers was significantly associated with a reduced risk of COPD exacerbations (HR 0.69, 95% CI 0.57-0.85). In contrast, in subjects without a cardiovascular indication (n=557, mean age of 68.8±9.7 years), current use of cardioselective β-blockers was not associated with an altered risk of COPD exacerbations (HR 0.94, 95% CI 0.55-1.62). Use of cardioselective β-blockers reduced the risk of exacerbations in COPD patients with concomitant cardiovascular disease. Therefore, the potential benefits of β-blockers might be confined to COPD patients with cardiovascular disease.
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2,335,998 |
Notes on Indian wolf spiders: I. Genus Evippa Simon, 1882 (Araneae: Lycosidae, Evippinae).
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Indian wolf spider species of the genus Evippa Simon, 1882 based on the type material available in the National Zoological Collection, Zoological Survey of India, Kolkata are revised. One new synonymy is recognised: Evippa mandlaensis Gajbe, 2004 syn. nov. is synonymised with Wadicosa fidelis (O. Pickard-Cambridge, 1872). All the type material examined are imaged and supplementary descriptions for Evippa shivajii Tikader Malhotra, 1980, Evippa sohani Tikader Malhotra, 1980, and Evippa solanensis Tikader Malhotra, 1980 are provided.
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2,335,999 |
Ultrasound-guided retrolaminar block versus ilioinguinal nerve block for postoperative analgesia in children undergoing inguinal herniotomy: A randomized controlled trial.
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Ultrasound-guided retrolaminar block (RLB) is a new, safe and technically easy nerve block. To our knowledge, no studies have evaluated its analgesic efficacy in pediatric patients. This study aimed to compare the postoperative analgesic efficacy of RLB and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy.</AbstractText>Superiority, prospective, randomized, double-blinded, controlled study.</AbstractText>Operating rooms and wards of Mansoura University Children's Hospital, Egypt.</AbstractText>Sixty-five patients aged 2 to 6 years undergoing unilateral inguinal herniotomy were enrolled.</AbstractText>In the ultrasound-guided RLB group (n = 30), we injected 0.5 mL/kg bupivacaine 0.25% into the retrolaminar space between the lamina of T12 and the paraspinal muscles and in ultrasound-guided INB group (n = 30), 0.5 mL/kg bupivacaine 0.25% was injected for INB.</AbstractText>The primary outcome measure was the number of patients requiring ibuprofen as rescue analgesia and the secondary outcome measures were intraoperative hemodynamic changes and the postoperative FLACC (Face, Legs, Activity, Cry, Consolability) score.</AbstractText>The number of patients who needed rescue analgesia in the first postoperative 24 h was significantly lower (P = 0.023) in the RLB group [5 (16%)] than the INB group [13 (43%)]. The mean (SD) arterial blood pressure and heart rate were significantly higher (P < 0.001) during sac traction in the INB group [74.07 (2.99), 97.33 (6.98)] than the RLB group [67.73 (3.55), 90.79 (5.13)]. The postoperative FLACC scores at 4, 6, 12, and 24 h were significantly lower (P < 0.05) in the RLB group than in the INB group.</AbstractText>Retrolaminar block is superior to ilioinguinal nerve block in providing postoperative analgesia in pediatric patients undergoing unilateral inguinal herniotomy.</AbstractText>Copyright © 2021 Elsevier Inc. All rights reserved.</CopyrightInformation>
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