Faster Onset Time Research Articles

Ultrasound-Guided Lumbar Plexus-Sciatic Nerve Blocks Versus Epidurals for Orthopaedic Surgeries: A Study to Compare the Competency of Novice Anaesthesiology Residents in a High-Volume Level 1 Trauma Centre.

The relative merits of peripheral nerve blocks (PNB) over central neuraxial anaesthesia and the advantages of the above two techniques over general anaesthesia for surgical interventions of the lower limb are well established. The competency of anaesthetic trainees in a high-volume level 1 trauma centre in administering dual ultrasound and nerve stimulator-guided lumbar plexus-sciatic nerve block(DUNLuPS) vs. epidural anaesthesia (EA) was compared by reporting the adequacy of anaesthesia with the two techniques, time taken for the performance of block, time of onset of sensoryblock (TOSB), and time of onset of motor block (TOMB). This prospective, randomized, study enrolled 92 patients aged 18-80 years with lower limb fractures admitted in trauma triage and scheduled for surgery. Thepatients were randomly allocated equally into the EA group and the DUNLuPS group. A total of 20 anaesthesia trainees in the third year of residencywith clinical experience of more than 15 independent lumbar plexus-sciatic nerve blocks were included in the study.A volume of 20 ml of 0.5% ropivacaine was administered in the lumbar plexus (Shamrock technique) but the volume used for sciatic nerve (subgluteal approach) was varied so that the cumulative dose did not exceed 3 mg/kg. For each block, the onset of nerve blockade was assessed every five minutes, and the assessments continued for an additional 30 minutes after the nerve blocks were finished. Clinical characteristics and adequacy of anaesthesia were comparable, i.e., 95.65% and93.47% success in the EA (n = 46) and DUNLuPS (n = 46) groups, respectively. Performance time was significantly more in the DUNLuPS group but followed by significantly less TOSB and TOMB. The time for the first analgesic request was 351.63 ± 148.70 minutes in the DUNLuPS group and 147.60 ± 52.65 minutes in the EAgroup (p < 0.0001). Both EA and DUNLuPS provide effective and comparable intra-operative anaesthesia for orthopaedic lower limb surgeries (OLLS) when administered by residents with more than two years of experience (third year of residency)in ultrasound-guided regional nerve blocks in a high-volume level 1 trauma centre. Statistically significant differences in the block performance characteristicshad no clinical advantage as it was compensated by the faster onset time in the DUNLuPS group. Post-operative pain management was better in the DUNLuPS group, sothe practice and conduct of anaesthesia for trauma patients should focus on the establishment of "block rooms" and timely training of residents in the former so that the advantages can be extended to the patient population.

The contribution of the vascular architecture and cerebrovascular reactivity to the BOLD signal formation across cortical depth.

Assessment of neuronal activity using blood oxygenation level-dependent (BOLD) is confounded by how the cerebrovascular architecture modulates hemodynamic responses. To understand brain function at the laminar level, it is crucial to distinguish neuronal signal contributions from those determined by the cortical vascular organization. Therefore, our aim was to investigate the purely vascular contribution in the BOLD signal by using vasoactive stimuli and compare that with neuronal-induced BOLD responses from a visual task. To do so, we estimated the hemodynamic response function (HRF) across cortical depth following brief visual stimulations under different conditions using ultrahigh-field (7 Tesla) functional (f)MRI. We acquired gradient-echo (GE)-echo-planar-imaging (EPI) BOLD, containing contributions from all vessel sizes, and spin-echo (SE)-EPI BOLD for which signal changes predominately originate from microvessels, to distinguish signal weighting from different vascular compartments. Non-neuronal hemodynamic changes were induced by hypercapnia and hyperoxia to estimate cerebrovascular reactivity and venous cerebral blood volume ( ). Results show that increases in GE HRF amplitude from deeper to superficial layers coincided with increased macrovascular . -normalized GE-HRF amplitudes yielded similar cortical depth profiles as SE, thereby possibly improving specificity to neuronal activation. For GE BOLD, faster onset time and shorter time-to-peak were observed toward the deeper layers. Hypercapnia reduced the amplitude of visual stimulus-induced signal responses as denoted by lower GE-HRF amplitudes and longer time-to-peak. In contrast, the SE-HRF amplitude was unaffected by hypercapnia, suggesting that these responses reflect predominantly neurovascular processes that are less contaminated by macrovascular signal contributions.

One Case of Heavy Chain Deposition Disease Treated with Dara+KD Regimen and Literature Review

Background: Heavy chain deposition disease (HCDD) is a systemic disease caused by the deposition of monoclonal immunoglobulin heavy chains in tissues.It is a rare monoclonal immunoglobulin deposition disease. The mechanism of HCDD is still unclear, which may be related to the deletion of heavy chain constant region 1 and the activation of the Complement system by monoclonal heavy chains. Renal biopsy remains the gold standard for diagnosing HCDD at present. There are significant individual differences in the formation of abnormal heavy chains in HCDD patients, and FLC, M protein, and complement detection have certain reference significance for the evaluation of diagnosis and treatment processes. The chemotherapy scheme represented by Bortezomib has a certain effect. HDM/ASCT and kidney transplantation can be used as second-line treatment for some patients. At present, there is no report on the use of CD38 monoclonal antibody combined with KD regimen. Objective: To explore the efficacy and toxicity of CD38 monoclonal antibody combined with KD regimen in the treatment of heavy chain deposition disease. Methods: The diagnosis, treatment and efficacy of HCDD who hospitalized in the Hematology Department of the First Affiliated Hospital of Sun Yat-sen University was analyzed, and the value of CD38 monoclonal antibody combined with KD regimen in the treatment of HCDD was discussed. The patient was male, 44 years old, due to “depressed edema of both lower limbs and eyelid edema for more than two months”. Results: Heavy chain deposition disease is a rare malignant Plasma cell disease. CD38 monoclonal antibody combined with KD regimen can rapidly alleviate the disease,.This patient got CR and obvious improvement of clinical symptoms after 1 cycle chemotherapy, and has no obvious side effects.We be expected to do 4 cycle chemothetaphy and would do ASCT.until now,this patient has got 3 cycles. Conclusion: Heavy chain deposition disease is a rare malignant Plasma cell disease. CD38 monoclonal antibody combined with KD regimen can rapidly alleviate the disease, with fast onset time, high CR rate, obvious improvement of clinical symptoms, and no obvious side effects.

Tolerability and effectiveness of albuvirtide combined with dolutegravir for hospitalized people living with HIV/AIDS.

Treatment options for hospitalized people living with HIV/AIDS (PLWHA) with opportunistic infections and comorbidities are limited in China. Albuvirtide (ABT), a new peptide drug, is a long-acting HIV fusion inhibitor with limited drug-drug interactions and fast onset time. This single-center, retrospective cohort study investigated the effectiveness and safety of ABT plus dolutegravir (DTG) therapy in a real-world setting. We performed a chart review on the electronic patient records for hospitalized PLWHA using ABT plus DTG between April and December 2020. The clinical outcomes were retrospectively analyzed. Among 151 PLWHA (mean age 47.6 ± 15.9 years), 140 (93%) had at least 1 episode of bacterial and/or fungal infections and 64 (42%) had other comorbidities including syphilis, hepatitis B, and/or hypertension. ABT plus DTG was given to 87 treatment-naïve (TN) and 64 treatment-experienced (TE) PLWHA. Regardless of treatment history, mean HIV-1 RNA levels significantly decreased from 4.32 log10copies/mL to 2.24 log10copies/mL, 2.10 log10copies/mL and 1.89 log10copies/mL after 2, 4 and 8 weeks of treatment, respectively (P < .0001). Compared with baseline mean CD4 + T-cell counts of 122.72 cells/μL, it increased to 207.87 cells/μL (P = .0067) and 218.69 cells/μL (P = .0812) after 4 and 8 weeks of treatment. Except for limited laboratory abnormalities such as hyperuricemia, increased creatinine level, and hyperglycemia observed after treatment, no other clinical adverse events were considered related to ABT plus DTG. Data suggests that ABT plus DTG is safe and effective for critically-ill hospitalized PLWHA. In view of the rapid viral load suppression and restoration of CD4 + count within 8 weeks of treatment, its clinical application warrants further investigation.

Functional insulin aspart/insulin degludec-based microneedles for promoting postprandial glycemic control.

Insulin aspart (IAsp) and insulin degludec (IDeg), as the third generation of insulin, have a faster onset time or a more durable action period, which may simulate the secretion of insulin under physiological conditions. Microneedles (MNs) are transdermal delivery devices that may allow diabetic patients to easily deploy transdermal insulin therapy while considerably reducing injection pain. In this study, we investigated the combination of dissolving MNs with IAsp or IDeg therapy as an alternative to daily multiple insulin injections, aiming to improve glycemic control and patient compliance. Mechanical properties of the MNs, structural stability of insulin encapsulated in the MNs, and transdermal application characteristics were studied to assess the practicality of insulin-loaded MNs for diabetes therapy. In vivo experiments conducted on diabetic rats demonstrated that the IAsp- and IDeg-loaded MNs have comparable blood glucose control abilities to that of subcutaneous injections. In addition, the therapeutic properties of insulin-loaded MNs under diverse dietary conditions and application strategies were further investigated to provide new information to support future clinical trials. Taken together, the proposed MNs have the potential to improve balances between glycemic control, hypoglycemia risk, and convenience, providing patients with simpler regimens. STATEMENT OF SIGNIFICANCE: 1. The fabricated functional insulin-loaded dissolving microneedles closely matched the glucose rise that occurs in response to meals, demonstrating promising alternatives for multiple daily insulin injections. 2. The hypoglycemic properties of insulin microneedles were investigated under diverse dietary conditions and application strategies, yielding new information to support future clinical trials. 3. Molecular dynamics simulations were utilized to study the interactions between the insulin and microneedle matrix materials, providing a strategy for theoretically understanding drug stability as well as the release mechanism of drug-loaded microneedles.

#3508 FUROSEMIDE DECREASES KYNURENIC ACID SYNTHESIS IN RAT KIDNEY IN VITRO

Abstract Background and Aims Loop diuretics are highly potent agents, particularly beneficial in patients with impaired kidney function or heart failure exacerbation. Furosemide, due to fast onset and short time of action, remains the most commonly used drug from this class of diuretics. Inhibition of sodium-potassium-chloride cotransporter (NKCC2) in the thick ascending limb of Henle's loop is the main mechanism of furosemide's action. Other effects of furosemide, like modulation of potassium channels activity or activation of prostaglandin synthesis, were previously described. It was postulated that furosemide may exacerbate kidney injury in a dose dependent manner. Kynurenic acid (KYNA) is a tryptophan derivative synthesized from L-kynurenine (L-KYN) by kynurenine aminotransferases (KATs). KAT I and KAT II are the main KAT isoenzymes. Non-selective antagonism towards ionotropic glutamatergic receptors, as well as activation of aryl hydrocarbon receptors and the α7 nicotinic acetylcholine receptors are known mechanisms of KYNA’s action. KYNA was shown to regulate water and electrolyte balance through natriuretic effect. By some researchers KYNA, together with other tryptophan metabolites, is classified as uremic toxin. We aimed to analyze the influence of furosemide, widely used loop diuretic, on KYNA’s synthesis and the activity of both KATs in rat kidney in vitro. Method The influence of furosemide on KYNA’s production with KAT I and KAT II activity was tested in rat kidney homogenates in vitro after 2 hours incubation in the presence of KYNA precursor L-KYN and furosemide. Diuretic was examined at increasing concentrations: 1 μM, 10 μM, 50 μM, 100 μM, 500 μM and 1 mM. Enzymatic KYNA’s production was measured by high performance liquid chromatography (HPLC) with fluorometric detector. All applicable international, national and institutional guidelines for the care and use of animals were followed. Results Furosemide at 500 μM and 1 mM lowered KYNA formation in kidney homogenates in vitro to 80% (p &amp;lt; 0.05) and 70% (p &amp;lt; 0.05) of control value, respectively. At 1 mM concentration furosemide inhibited kidney KAT I activity in vitro to 38% (p &amp;lt; 0.01) of control value. Similarly, furosemide at 500 μM and 1 mM concentration decreased kidney KAT II activity in vitro to 53% (p &amp;lt; 0.01) and 18% (p &amp;lt; 0.001) of control value, respectively. Conclusion Our study presents a novel mechanism of action of furosemide. Inhibition of KYNA synthesis in the kidney by furosemide may have influence on kidney function.

Neurophysiology of movement inhibition during full body reaching

Our current understanding of response inhibition comes from go/no-go studies that draw conclusions based on the overt movement of single limbs (i.e., a single finger pushing a button). In general, go/no-go paradigms have found that an individual’s ability to correctly inhibit the motor system is indicative of a healthy central nervous system. However, measuring inhibition by an overt behavioral response may lack the sensitivity to conclude whether the motor system is completely inhibited. Therefore, our goal was to use behavioral and neurophysiological measures to investigate inhibition of the motor system during a full-body reaching task. When directly comparing neurophysiological and behavioral measures, we found that neurophysiological measures were associated with a greater number of errors during no-go trials and faster onset times during go trials. Further analyses revealed a negative correlation between errors and onset times, such that the muscles that activated the earliest during go trials also had the greatest number of errors during no-go trials. Together, our observations show that the absence of an overt behavioral response does not always translate to total inhibition of the motor system.

Sedation quality of alfaxalone associated with butorphanol, methadone or pethidine in cats injected into the supraspinatus or the quadriceps muscle.

The aim of this study was to compare the quality of sedation with three different anaesthetic protocols (alfaxalone combined with butorphanol, methadone or pethidine) administered intramuscularly in cats, and to evaluate the influence of the injection site (between supraspinatus and quadriceps muscles) on the onset and quality of sedation. A total of 151 cats were selected for this study. Cats were sedated with alfaxalone (3 mg/kg) combined with either butorphanol (0.3 mg/kg; n = 50), methadone (0.3 mg/kg; n = 53) or pethidine (5 mg/kg; n = 48). The combination was injected intramuscularly into the supraspinatus (n = 79) or quadriceps muscle (n = 72). The data included a scoring system for the quality of sedation and physiological parameters, such as heart rate (HR), respiratory rate, body temperature and occurrence of mydriasis, monitored during the first 30 mins of anaesthesia. The opioid associated with alfaxalone influenced the overall sedation score, the degree of myorelaxation, the occurrence of mydriasis and HR. The overall sedation score was poorer with butorphanol than with methadone (P = 0.008), and butorphanol induced a lower degree of myorelaxation than methadone (P = 0.013). The injection into the supraspinatus showed better qualitative results for sedation and a faster onset time (in about 3 mins) than that into the quadriceps (P <0.001). HR decreased from baseline (P <0.001) and over time (P <0.001), mainly in cats of the butorphanol-supraspinatus and pethidine-quadriceps groups (P = 0.004). The occurrence of mydriasis was lower after butorphanol than after methadone and pethidine (P = 0.025), while the incidence of side effects did not differ among groups. All three protocols provided a good quality of sedation and allowed performing the scheduled procedure. Moreover, the injection into the supraspinatus muscle showed superior results in all the qualitative scores of sedation and quicker onset time than that into the quadriceps muscle.

Unclogged Janus Mesh for Fog Harvesting.

Janus membranes with asymmetric surface wettability have been extensively utilized in various fields, including fog harvesting, because of their novel liquid transport properties. However, Janus membranes have an inherent disadvantage in terms of aerodynamic efficiency in harvesting fog because of the clogged water bridges caused by the small pore size. In the present work, we applied Janus wettability to mesh geometry with systematically varying hole sizes. For a clogged mesh with a small hole size, capillary water transport to the mesh back via the wettability gradient in the direction of fog flow helps harvest more fog by enhancing water drainage, similarly to the Janus membrane. The advantage of the capillary water transport extends to a clog-free mesh with larger hole sizes but more preferably to a Janus mesh with a superhydrophilic back, which presents the highest level of fog-harvesting yield because of the fast shedding frequency and short onset time. In contrast, a Janus mesh with a superhydrophobic front, which also has a wettability gradient along the fog flow, produces a lower fog-harvesting performance, particularly at slow fog speeds, because of the dropwise deposition of large water drops that locally disturb fog flow around a protruding water surface. On the other hand, the other type of Janus mesh with a superhydrophilic front is observed to minimize this disadvantage in the local fog flow by virtue of the filmwise deposition. It is also found that some Janus treatments can help protect mesh holes from clogging up by either forming a thin water meniscus or resisting water transport through the mesh holes.

A comparative study between magnesium sulfate and dexmedetomidine as adjuvants to bupivacaine using ultrasound-guided lumbar-plexus block in lower abdominal surgeries

Background and aim Pain international association of described pain as an unpleasant sensory and emotional practice accompanied with actual or potential tissue injuries. Opioid administrations remain the cornerstone of postoperative pain relief, but it may cause significant side effects, including sedations, nausea, vomiting, and urinary retention. We aimed to compare the efficacy of ultrasound-guided lumbar-plexus block through adding magnesium sulfate and dexmedetomidine (DEX) to bupivacaine on postoperative analgesia and thereafter surgical operation. Patients and methods This prospective, randomized, double-blinded, controlled research was performed on Al-Azhar University Hospitals. A total of 75 cases of both sexes, age between 21 and 65 years, American Society of Anesthesiologists class I– II, were listed for elective lower-abdomen surgical operation underneath general anesthesia. Results Pain scores were decreased significantly in the study groups for 12 and 18 h in BM and BD, respectively, also, there was a significant decrease at 2, 4, 6, 8, and 12 h in the BD group lesser than the BM group postoperatively. The time to the initial analgesic appeal was significantly extended in the BD group (11.9±1 h) than the BM group (10.6±0.7 h). Conclusion Posterior lumbar-plexus block utilizing 22 ml of bupivacaine 0.5% with DEX 1 μg/kg decreases pain score, opioid consumption, prolongs duration of analgesia, better hemodynamics stability, and perfect outcome of cases’ satisfaction postoperatively compared with posterior lumbar-plexus block using 22 ml of bupivacaine 0.5% with magnesium sulfate 150 mg. DEX provides faster onset time and longer periods of MB and extended period of analgesia with smaller consumptions of postoperative rescue analgesia.

Surveillance of pine wilt disease by high resolution satellite

Pine wilt disease caused by the pinewood nematode Bursaphelenchus xylophilus has led to the death of a large number of pine trees in China. This destructive disease has the characteristics of bring wide-spread, fast onset, and long incubation time. Most importantly, in China, the fatality rate in pines is as high as 100%. The key to reducing this mortality is how to quickly find the infected trees. We proposed a method of automatically identifying infected trees by a convolution neural network and bounding box tool. This method rapidly locates the infected area by classifying and recognizing remote sensing images obtained by high resolution earth observation Satellite. The recognition accuracy of the test data set was 99.4%, and the remote sensing image combined with convolution neural network algorithm can identify and determine the distribution of the infected trees. It can provide strong technical support for the prevention and control of pine wilt disease.

Dynamic negativity effects in emotional responding: Onsets, peaks, and influences from repetition.

Emotional responses to aversive stimuli may be more mandatory than emotional responses to appetitive stimuli, and extant theorizing suggests that negative reactions may be more peaked at maximum intensity. Parameters of this type were investigated within two experiments (total N = 198) in which emotional images were presented and re-presented as participants indicated their moment-to-moment feeling changes in response to both appetitive and aversive images. Negative emotional reactions were more detectable, with more definitive onsets and peaks, and peak amplitudes were systematically higher in the context of aversive stimuli. Furthermore, stimulus repetition enhanced negative emotional responding in terms of both faster onset times and more pronounced peak amplitudes. Although behavioral activation and behavioral inhibition motivation modulated the emotional onset and peak reactivity metrics, such individual differences did not interact with the repetition effects that were observed. These results highlight several dynamic negativity effects that distinguish positive versus negative emotional reactivity processes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Fabrication of Fast Responsive and Insensitive-Humidity Sensor Based on Polyaniline-WO3-CuCl2 for Hydrogen Sulfide Detection

Simple and low-cost hydrogen sulfide gas sensors based on polyaniline-copper chloride and polyaniline- tungsten trioxide- copper chloride composites were developed. The sensing film was produced by drop cast of the dispersed composite on top of screen-printed carbon electrodes on a flexible polyethylene terephthalate substrate. A fast onset time of detection of 10 s and 20 s towards 0.1 ppm of hydrogen sulfide were obtained for polyaniline-tungsten trioxide-copper chloride and polyaniline-copper chloride sensors, respectively. The calibration curve displays a good working range between 0.1 and 1 ppm with a limit of detection and limit of quantification of 155 and 512 ppb, respectively. The polyaniline-CuCl2 sensor presented a high response to humidity change. In contrast, the incorporation of tungsten oxide into the polyaniline-CuCl2 composite exhibited significantly improved the response time to target gas from 15 min to 4 min and make it nearly insensitive to humidity changes up to 40 %. Gas-sensing tests show that polyaniline- tungsten trioxide-copper chloride composites exhibit a high and fast response as well as an excellent selectivity to hydrogen sulfide at ppm level in room temperature. The proposed sensors could be used for different industrial applications.

Development of Lidocaine-Loaded Dissolving Microneedle for Rapid and Efficient Local Anesthesia.

Lidocaine is a local anesthetic agent used in the form of injection and topical cream. However, these formulation types have limitations of being either painful or slow-acting, thereby hindering effective and complete clinical performance of lidocaine. Dissolving microneedles (DMNs) are used to overcome these limitations owing to their fast onset time and minimally invasive administration methods. Using hyaluronic acid and lidocaine to produce the drug solution, a lidocaine HCl encapsulated DMN (Li-DMN) was fabricated by centrifugal lithography. The drug delivery rate and local anesthetic quality of Li-DMNs were evaluated using the pig cadaver insertion test and Von Frey behavior test. Results showed that Li-DMNs could deliver sufficient lidocaine for anesthesia that is required to be utilized for clinical level. Results from the von Frey test showed that the anesthetic effect of Li-DMNs was observed within 10 min after administration, thus confirming fast onset time. A toxicity test for appropriate clinical application standard was conducted with a microbial limit test and an animal skin irritation test, showing absence of skin irritation and irritation-related microorganisms. Overall, Li-DMN is a possible alternative drug delivery method for local anesthesia, meeting the requirements for clinical conditions and overcoming the drawbacks of other conventional lidocaine administration methods.

PK-PD Correlation of Erigeron Breviscapus Injection in the Treatment of Cerebral Ischemia-Reperfusion Injury Model Rats.

By measuring the cerebral infarction rate and neurological behavioral score of rats in a sham operation group, an MCAO model control group and an Erigeron breviscapus injection treatment group, we explored the therapeutic effects of Erigeron breviscapus injection on brain tissue and neuroethological injury in rats. Plasma samples were collected at 18 time points after intravenous injection of Erigeron breviscapus. The levels of scutellarin, 4-caffeoylquinic acid, 5-caffeoylquinic acid, 3,5-dicaffeoylquinic acid, 4,5-dicaffeoylquinic acid, chlorogenic acid and isochlorogenic acid B in rat plasma at the various time points were determined by an HPLC method, and drug concentration versus time plots were constructed to estimate the pharmacokinetic parameters. Finally, a PK-PD combined model was used to analyze the relationship between the blood concentration, time and therapeutic effects of the seven active components. The results of the pharmacodynamics studies showed that the cerebral infarction rate of rats in the Erigeron breviscapus injection group decreased significantly at 5min, 10min, 20min, 6h, 8h, 18h, 24h, 32h, 40h and 48h after cerebral ischemia. Abnormal neurological behavior scores were significantly reduced after 4h of cerebral ischemia. The pharmacokinetics results showed that the seven chemical constituents in Erigeron breviscapus injection reached their highest detection value after 5min of cerebral ischemia. The lowest detection values of scutellarin and isochlorogenic acid B appeared after 6h of cerebral ischemia but could not be detected after 8h. The lowest detection values of 5-caffeoylquinic acid and 4,5-dicaffeoylquinic acid were found in the third hour of cerebral ischemia but not after 4h. The lowest detection values of 4-caffeoylquinic acid, 3,5-dicaffeoylquinic acid and chlorogenic acid were found during the second hour of cerebral ischemia but not at the third hour. However, at 18h, 24h, 32h and 40h of cerebral ischemia, the cerebral infarction rates of rats in the Erigeron breviscapus injection group were significantly reduced, with decreased values of 6.22%, 11.71%, 6.92% and 4.96%, respectively, and the effects were stronger than those after 5-20min of cerebral ischemia. The decreased values reached their highest value after 24h of cerebral ischemia. Our results show that the effects of Erigeron breviscapus injection on reducing the cerebral infarct rate in MCAO model rats are characterized by a fast onset and long maintenance time. The 5-min blood concentration in cerebral ischemia was the highest test value, and after this time, the cerebral infarction rate of MCAO rats began to decrease. However, the peak value of the effects lagged behind that of the plasma concentration. The maximum effective time for Erigeron breviscapus injection appeared 24h after cerebral ischemia, which provides a reference for the screening of specific drugs for ischemic stroke, optimal dosing regimens and rational clinical drug use. Graphical Abstract.

Application of dexmedetomidine combined with ropivacaine in axillary brachial plexus block in children and its effect on inflammatory factors

This study aimed to investigate the effect of dexmedetomidine combined with ropivacaine on inflammatory factors in children with axillary brachial plexus block. Ninety patients who underwent upper limb surgery in our hospital from January 2017 to December 2018 were enrolled and divided into groups A and B. Group A (n=40) was treated with ropivacaine as a local anesthetic, and group B (n= 50) was treated with dexmedetomidine combined with ropivacaine as a local anesthetic during surgery. Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Assessment Scale was employed to evaluate the pain behavior of the children. Intravenous blood (3 ml) was taken before surgery (T0), 30 min (T1) and 3 hours after surgery (T2) respectively to detect serum TNF-α (tumor necrosis factor-α), IL-6 (interleukin-6) and IL-1β (interleukin-1β) levels using ELISA. The adverse reactions in the two groups were observed, and the MAP (mean arterial pressure) and HR (heart rate) were compared before anesthesia, 30 min and 1 hour after block. The FLACC score of both groups showed a marked upward trend (p&lt; 0.001), with that of group B being significantly lower than group A (p&lt; 0.001). Group B presented a remarkably shorter onset time than group A, and the analgesic time was significantly longer (p&lt; 0.001). The incidence of adverse reactions in group B was significantly lower than that in group A (p&lt; 0.05). MAP and HR dropped significantly 30 min and 1 h after block (p&lt; 0.05). MAP and HR were significantly lower in group B than those in group A 30 min and 60 min after block (p&lt; 0.05). As to serum levels of TNF-α, IL-6, and IL-1β, both groups presented notably increased ones after block (p&lt; 0.05). The application of dexmedetomidine combined with ropivacaine in upper limb surgery has a faster onset time and longer duration than ropivacaine alone, which is of certain clinical effect.

Development of effective AmB/AmB–αCD complex double loaded liposomes using a factorial design for systemic fungal infection treatment

Amphotericin B (AmB) is a very potent antibiotic which still remains as the gold standard for the treatment of systemic fungal infections. AmB is a member of Biopharmaceutical Classification System Class IV, mainly characterized by its poor solubility and low permeability. In this study, AmB/AmB-α cyclodextrin complex double loaded liposomes (DLLs) were developed using the design of experiments (DoE®) approach to optimize/determine the effects of lipid composition and other parameters on final product properties such as encapsulation efficacy, particle size, polydispersity index, and zeta potential. Experimental design 24 was used for optimization of these properties in which four factors were studied in two levels. DLLs showed much higher physical stability than liposomes loaded only with free AmB by the means of particle size, zeta potential and encapsulation efficiency, in addition exhibited sustained release of AmB over 72 h (26.7%) with faster onset time. On the other hand, fourfold improved antimicrobial efficiency, minimum inhibitory concentration (0.125 µg/ml), and minimum fungicidal concentration (0.5 µg/ml) was determined by DLLs against C. albicans compared to Ambisome®. Dose dependent effects of the DLLs were investigated by cytotoxicity studies on Vero and L-929 cells. No significant cytotoxicity observed for AmB/AmB–αCD complex DLLs and Ambisome at tested concentrations while free AmB caused severe cytotoxicity. Lastly the developed DLLs did not cause an increase in NGAL (an early biomarker for acute kidney toxicity) levels for both Vero and HK-2 cell lines compared to free AmB.

Effect of wrist-ankle acupuncture therapy combined with auricular acupuncture on cancer pain: A four-parallel arm randomized controlled trial

BackgroundCancer pain affects the quality of life of cancer patients; therefore, various methods exist for alleviating the adverse effects caused by cancer pain. Nonpharmacological intervention is regarded as an important means of auxiliary therapy for drug treatment, with acupuncture receiving the most attention; However, there are numerous types of acupuncture therapies, including acupuncture, wrist-ankle acupuncture (WAA) and auricular acupuncture (AA). Previous studies have demonstrated that all types of acupuncture therapy can alleviate cancer pain. However, the effects and pathways of different acupuncture treatments are not similar, and it is unknown whether single therapy or combination therapy has better analgesic effects. This study aimed to examine the effect of WAA therapy combined with AA on cancer pain. DesignA randomized controlled trial. MethodA total of 160 patients were selected and randomly divided into groups A, B, C and D, with 40 patients in each group. Group A received conventional analgesia alone, with opioids administered based on the World Health Organization (WHO) 3-tiered “cancer pain ladder”. Group B received WAA, in addition to the treatment received by group A. Group C received AA, in addition to the treatment received by group A. Group D received WAA combined with AA, in addition to the treatment received by group A. Analgesic effects and analgesic drug use before and 3, 5 and 7 days after treatment were observed in each group. ResultA total of 159 patients were included in the analysis. The verbal rating scale (VRS) and numeric rating scale (NRS) scores for patients who received mono-acupuncture therapy and combination therapy for 1 week were significantly different from those of the control group. Combination therapy had a stronger effect on the VRS score and a faster onset time, based on the NRS score, and the patients who received combination therapy had reduced analgesic drug use. ConclusionWAA combined with AA can more quickly reduce pain symptoms with more lasting analgesic effects and can effectively reduce analgesic drug use.

Comparative study between nerve stimulator guided technique and ultrasound guided technique for supraclavicular nerve block in upper limb surgery- A randomized controlled trial

Background and Aims– Ultrasonography guided supraclavicular block is presumed to have faster onset time and increased the success rates with a reduction of the local anaesthetic dose, and also low down the complication rates. Whether or not the use of USG can improve practitioner’s ability to successfully perform a faster supraclavicular nerve block remains needs to be studied. Hence study proposes to compare nerve stimulator guided technique and ultrasound guided technique for supraclavicular nerve block in upper limb surgery. Methods- 60 adult patients, who were ASA physical status I–II and scheduled for elective upper limb surgery, were studied prospectively. 30 patients in each group to receive a supraclavicular block using either Ultrasound guidance (group U) or Nerve stimulation guidance (group P). Both the groups were injected with inj. Bupivacaine 0.5% 15ml and 2% lignocaine- with epinephrine 1:200000 15ml (total volume, 30 mL). The groups were compared in terms of Onset of sensory and motor block, Block performance time, Block success rate; hemodynamic parameters, and complications. Paired t-test and two-independent samples t-test were used for analysis. A p-value

Randomized controlled clinical trial comparing the efficacy and tolerability of aripiprazole and sodium valproate in the treatment of Tourette syndrome

ObjectiveThis study compared the efficacy and tolerability of sodium valproate and aripiprazole in the treatment of Tourette syndrome (TS).Method24 children and adolescents with a diagnosis of TS from the Jiamusi Central Hospital between January 2014 and August 2017 were randomly divided into sodium valproate group and aripiprazole group according to the order of clinic visits and treated for 10 days. Tic severity was rated using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impressions Scale for tics (CGI-Tics) and the adverse reactions were valued using the Treatment Emergent Symptom Scale (TESS) at baseline and at each follow-up visit.ResultsThe TTS score in the YGTSS scale decreased over time in both groups while the aripiprazole group was significantly higher on the 5th day (p < 0.05) and 10th day (p < 0.05) than the sodium valproate group. There was no significant difference in TESS score between the two groups.ConclusionsThe study indicates that the patients treated with sodium valproate injection have a faster onset time than the patients treated with oral aripiprazole in controlling tics.