GA Group Research Articles

Feasibility and Safety of Endoscopic Submucosal Dissection of Esophageal or Gastric Carcinomas under General Anesthesia

Objective: To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of esophageal or gastric carcinomas under general anesthesia. Subjects and Methods: ESD removal of esophageal or gastric carcinomas was performed in 59 patients under midazolam sedation (control group), and in 46 patients under general anesthesia (GA group). The procedural times, perioperative complications and patient's satisfaction with the procedures were recorded. Results: There was no statistically significant difference in age (65 ±12 vs. 58 ±11), male gender (43.5 vs. 49.2%), types or location or the size of the carcinomas (30 ± 6 vs. 28 ± 7 mm) between the control and GA groups (p > 0.05). The mean procedural time in the GA group was shorter than in the control group (42.5 ± 5.5 vs. 79.0 ± 13.2 min, p = 0.01). The combined gastric perforation and postprocedural bleeding rate in the GA group was lower than in the control group, but the difference did not reach statistical significance (p = 0.06). In the GA group, all patients rated the procedural experience as satisfactory, while in the control group, 38 (64.5%) rated the experience as satisfactory (p = 0.001). Conclusion: ESD under general anesthesia was associated with a shorter procedure time and a high rate of patient's satisfaction with the procedures.

Association of all-trans retinoic acid treatment with the renin-angiotensin aldosterone system expression in glomerulosclerosis rats

All-trans retinoic acid (ATRA), a promising therapeutic agent, has been confirmed in animal experiments as playing a protective role against renal diseases. The renin-angiotensin aldosterone system (RAAS) plays a key role in the pathogenesis of renal diseases, and RAAS inhibitors can prevent the progression of kidney diseases. In our previous study, we found that ATRA could play a protective role against glomerulosclerosis (GS) lesions in rats, and its effect was similar to RAAS inhibitors. However, whether ATRA treatment was associated with RAAS expression was not clear. Six-week-old male Wistar rats were divided into three groups: sham operation group (SHO), glomerulosclerosis model group without treatment (GS) and GS model group treated with ATRA (GA). At the end of 13 weeks, the relevant samples were collected and analyzed. The mRNA and protein expression of angiotensin-converting enzyme 1 (ACE1) in the GS group was notably higher when compared with the SHO group. However, mRNA and protein expression of ACE1 in the ATRA treatment group was markedly down-regulated when compared with the GS group. Angiotensin-converting enzyme 2 (ACE2) expression (mRNA or protein) in the GS group was reduced compared with that in the SHO group, and ATRA markedly increased the mRNA and protein expression of ACE2 compared with the GS group. The levels of protein expression of angiotensin I and angiotensin II were significantly up-regulated in the GS group compared with those in the SHO group, and ATRA reduced their expression in the GA group when compared with the GS group. ATRA is associated with RAAS expression in GS rats, but its detailed mechanism needs to be elucidated by further research.

Short-term outcome of premature neonates admitted to NICU & newborn services at Amirkola children hospital in 2010

Introduction: Improvements in newborn intensive care led to decreased mortality, but increased the morbidity rates of preterm infants. This study have designed to evaluate the short- term outcome in premature infants admitted to NICU at Amirkola Children Hospital(ACH) , northern Iran from Mar20,2010- Mar21,2011 Methods: All the premature infants admitted to NICU and newborn services from Mar20, 2010- Mar21, 2011 entered to the study .Data like Death, NEC, IVH, and ROP were gathered. Gestational of age determined based on New Ballard Score.IVH and NEC diagnosed with brain ultrasonography and radiology. ROP diagnosed by indirect ophthalmoscopic exam made by a retinologist and if it was advanced then referred for therapy. Hearing test done with ABR technique and then if it was failed, referred to repeat ABR and any patients with hearing loss referred for rehabilitation with hearing aid. We followed up patients for hearing loss and blindness until the 2-2.5 years of age. Results: In 159 premature neonates who admitted in this period 63.5% were boy and 36.5% was girl. Seventy nine percent delivered by C/S and 21% through NVD .The most frequent GA group was 34-37 week (56%).The mean CRIB score of the babies was 5.6±2.4. The mortality premature neonates were %9.7. The rate of IVH, NEC and threshold ROP were 9.5%, 3.1%, and 10.3% respectively. We have 1 neonate with blindness and 3 neonates with hearing loss. Conclusion: The finding of this study reveals an improvement in the short-term outcome in premature infants' admitted to NICU at ACH, although there is some distance between the present condition and the real favorable outcome.

42. Laboratory immune parameters of normal humans vary by cytokine receptor polymorphisms

It has been demonstrated that Th1/Th2 cytokine imbalance is correlated with excess psychological stress although there are clearly individual differences in the responses to the same stressor. These differences may derive from cytokine receptor configuration and/or binding affinity, which could be influenced by single nucleotide polymorphisms (SNPs). We categorized differences in immunoregulatory profiles from peripheral blood mononuclear cells of 209 normal volunteers according to various cytokine receptor polymorphisms including T-56C and G-611A of IFNGR1, Q64R of IFNGR2, and Ile50Val, Q576R and S503P of IL4R. Genotyping of each polymorphism was performed by allelic discrimination real-time PCR, and Th1, Th2, Th1/Th2 ratio, and CD3+CD4+CD25hiFoxp3+ cell numbers were also measured using flow cytometry. Results showed that Th1 levels were higher for males than for females in CC group but not in TT and CT groups of T-56C ( p = 0.002) and in AA group but not in GG and GA groups of G-611A ( p = 0.013). In Q64R, Th2 was positively correlated with age in Gln/Arg genotype but not in Gln/Gln ( p = 0.009). For Q576R, Th1/Th2 ratio was lower for Arg/Arg compared to Gln/Gln ( p = 0.035). For S503P, Th1/Th2 ratio decreased with an increase in age for Ser/Ser but not for Ser/Pro ( p = 0.030). We conclude that SNPs from various components of the stress-immune network may be useful for categorizing baseline immune responses to more accurately evaluate immunological components of stress risk in individual subjects.

Effects of a diabetes-specific enteral nutrition on nutritional and immune status of diabetic, obese, and endotoxemic rats

Obese and type 2 diabetic patients present metabolic disturbance-related alterations in nonspecific immunity, to which the decrease in their plasma arginine contributes. Although diabetes-specific formulas have been developed, they have never been tested in the context of an acute infectious situation as can be seen in intensive care unit patients. Our aim was to investigate the effects of a diabetes-specific diet enriched or not with arginine in a model of infectious stress in a diabetes and obesity situation. As a large intake of arginine may be deleterious, this amino acid was given in graded fashion. Randomized, controlled experimental study. University research laboratory. Zucker diabetic fatty rats. Gastrostomized Zucker diabetic fatty rats were submitted to intraperitoneal lipopolysaccharide administration and fed for 7 days with either a diabetes-specific enteral nutrition without (G group, n=7) or with graded arginine supply (1-5 g/kg/day) (GA group, n=7) or a standard enteral nutrition (HP group, n=10). Survival rate was better in G and GA groups than in the HP group. On day 7, plasma insulin to glucose ratio tended to be lower in the same G and GA groups. Macrophage tumor necrosis factor-α (G: 5.0±1.1 ng/2×10⁶ cells·hr⁻¹; GA: 3.7±0.8 ng/2×10⁶ cells·hr⁻¹; and HP: 1.7±0.6 ng/2×10⁶ cells·hr⁻¹; p<.05 G vs. HP) and nitric oxide (G: 4.5±1.1 ng/2×10⁶ cells·hr⁻¹; GA: 5.1±1.0 ng/2×10⁶ cells·hr⁻¹; and HP: 1.0±0.5 nmol/2×10⁶ cells·hr⁻¹; p<.05 G and GA vs. HP) productions were higher in the G and GA groups compared to the HP group. Macrophages from the G and GA groups exhibited increased arginine consumption. In diabetic obese and endotoxemic rats, a diabetes-specific formula leads to a lower mortality, a decreased insulin resistance, and an improvement in peritoneal macrophage function. Arginine supplementation has no additional effect. These data support the use of such disease-specific diets in critically ill diabetic and obese patients.

Analgesia da farmacopuntura com meloxicam ou da aquapuntura preemptivas em gatas submetidas à ovariosalpingohisterectomia

Objetivou-se avaliar o efeito analgésico da farmacopuntura com meloxicam e da aquapuntura preemptivas em gatas submetidas à OSH. Foram utilizados 29 animais considerados sadios após exame clínico e laboratorial com idade de 11,59±6,21 meses e peso de 2,50±0,58kg distribuídos em quatro grupos: aquapuntura (GA; n=7; 0,1ml de solução fisiológica nos acupontos BP6, VB34, F3 e E36 bilaterais), meloxicam (GM; n=8; 0,1mg kg-1 de meloxicam por via subcutânea), farmacopuntura (GMFV; n=7; 0,01mg kg-1 de meloxicam, diluído em 0,8ml de solução fisiológica, distribuído nos acupontos BP6, VB34, F3 e E36 bilaterais) e subdose de meloxicam (GMFF; n=7; 0,01mg kg-1 de meloxicam diluído em solução fisiológica por via SC na região interescapular). Os animais foram submetidos à OSH por meio de técnica cirúrgica minimamente invasiva. Os momentos de avaliação pós-cirúrgica foram 1h, 2h, 6h, 8h, 12h e 24h após o término da cirurgia por avaliador encoberto. Todos os parâmetros avaliados no dia anterior à cirurgia foram considerados como valores basais. Para a avaliação da sedação, utilizou-se a escala analógica visual e o escore do grau de sedação. Para a avaliação da dor, foram utilizadas a escala analógica visual (EAV), a escala descritiva de dor (EDD) e o grau de hiperalgesia com o auxílio dos monofilamentos de Von Frey. O resgate analgésico foi realizado com morfina na dose de 0,2mg kg-1 por via intramuscular (IM), quando a pontuação na EDD ultrapassava 33% da total. A análise estatística foi realizada por meio do programa Sigma-Stat 3.1, utilizando-se a análise de variância paramétrica e não paramétrica e respectivos teste de Tukey e de Dunn para as comparações, com significância de 5% (P&lt;0,05). Não houve diferenças estatísticas na comparação entre os grupos quanto às variáveis fisiológicas, sensibilidade quanto aos monofilamentos de Von Frey, EAV para dor e sedação e EDD. Quatro resgates do grupo GM foram realizados, contra três resgates dos grupos GA e GMFF e dois resgates do grupo GMFV. Os tratamentos apresentaram semelhante eficácia analgésica em gatas submetidas à OSH.

Effect of Anesthetic Methods on Cerebral Oxygen Saturation in Elderly Surgical Patients: Prospective, Randomized, Observational Study

Intraoperative cerebral oxygen desaturation was reported to be associated with postoperative cognitive dysfunction in elderly patients. The effect of the anesthesia method on regional cerebral oxygen saturation (rSO(2)) is still a question under debate. The purpose of this study was to compare the effects of three common anesthesia methods on intraoperative rSO(2) changes in elderly patients. In this prospective randomized clinical trial, 87 patients scheduled for elective transurethral prostatectomy were allocated to receive general inhalational anesthesia (GA group, n = 30), spinal anesthesia (SA group, n = 28), or spinal anesthesia plus sedation with midazolam (SA+S group, n = 29). The numbers of patients showing a decrease in rSO(2) below the baseline value were higher in the SA (92.9 %) and SA+S (100 %) groups than in the GA group (33.3 %). The number of patients with a ≥ 50 % decrease in rSO(2) below baseline was greater in the SA+S (31.0 %) group than in the GA (0 %) or SA (3.6 %) group. During surgery, patients subjected to general anesthesia had higher rSO(2) than those with spinal anesthesia. Blood pressures and heart rates were similar in three groups except 5 and 10 min after anesthesia. Intraoperative SpO(2) was higher in the GA group than in the two spinal anesthesia groups. Spinal anesthesia is associated with more frequent cerebral desaturation than general anesthesia; and it was aggravated when combined with midazolam sedation. The cerebral effects of anesthesia should be considered when managing high-risk elderly patients.

Su1847 Alcohol Consumption and Colorectal Adenoma Risk Among Older Women

[Background] A polymorphism rs7521584 is located between MIR200B and MIR 429. Recently, it has been reported that both miR200 and miR429 target c-myb gene and affect the breast cancer cell growth (Cesi V, et al.: Cell cycle 2011). One of both the miR200s and miR429 targeting genes is RIPK2, coding RICK. RICK is an important molecule for inflammation by transmitting NOD signal. Then, we attempted to clarify the association between chronic gastritis and genomic variation rs7521584G>T in Japanese population. [Materials and Methods] Gastric mucosa samples were obtained from 429 subjects with no malignancies. The rs7521584 genotype was determined by PCR-SSCP method using DNA extracted from obtained gastric mucosa. The degree of gastritis was assessed in 393 cases according to the updated Sydney system, serum pepsinogen (PG) I/II levels were measured in 117 cases. [Results] The mean age of the subjects was 59.7 years old, male/female ratio was 253/176, and H. pylori (HP) positive ratio was 63.6%. The distribution of rs7521584G>T genotype in all subjects was 153GG, 215GT and 61TT (HWE, p=0.31). The atrophic gastritis group (GA group) was defined as atrophy score >0 and metaplasia score >0. Then, the distribution of rs7521584G>T genotype in GA group (n=142) was 51GG, 66GT and 22TT. The rs7521584 minor allele frequencies in GA and non-GA groups were 39.6% and 38.2%, respectively. By logistic regression analysis after adjustment for gender, age and H. pylori (HP) infection status, rs7521584 TT homozygote has a significantly high risk for gastric mucosal atrophy (OR: 2.41, 95%CI: 1.10-5.25, p=0.027). In HP positive subjects, TT homozygote was a more significant risk factor for gastric mucosal atrophy (OR: 3.31, 95%CI: 1.35-8.12, p=0.0089). In addition, in the subjects younger than 60 years old, TT homozygote has also significant risk for gastric mucosal atrophy (OR: 3.15, 95%CI: 1.03-9.61, p=0.044). The serum PG I/II ratio was reversely correlated to the age in TT homozygote (p=0.0084 by ANOVA), whereas there was no correlation between age and PG I/II ratio in G carrier (p=0.092). [Conclusions] Our results suggest that rs7521584, in pre-miR429 and premiR200s gene, TT homozygote is a risk factor for the progression of gastric mucosal atrophy under the influence of HP infection.

Su1846 A Polymorphism Rs7521584 in Pre-Mir429 and Pre-Mir200s Genes is Closely Associated With the Progression of Chronic Gastritis

[Background] A polymorphism rs7521584 is located between MIR200B and MIR 429. Recently, it has been reported that both miR200 and miR429 target c-myb gene and affect the breast cancer cell growth (Cesi V, et al.: Cell cycle 2011). One of both the miR200s and miR429 targeting genes is RIPK2, coding RICK. RICK is an important molecule for inflammation by transmitting NOD signal. Then, we attempted to clarify the association between chronic gastritis and genomic variation rs7521584G>T in Japanese population. [Materials and Methods] Gastric mucosa samples were obtained from 429 subjects with no malignancies. The rs7521584 genotype was determined by PCR-SSCP method using DNA extracted from obtained gastric mucosa. The degree of gastritis was assessed in 393 cases according to the updated Sydney system, serum pepsinogen (PG) I/II levels were measured in 117 cases. [Results] The mean age of the subjects was 59.7 years old, male/female ratio was 253/176, and H. pylori (HP) positive ratio was 63.6%. The distribution of rs7521584G>T genotype in all subjects was 153GG, 215GT and 61TT (HWE, p=0.31). The atrophic gastritis group (GA group) was defined as atrophy score >0 and metaplasia score >0. Then, the distribution of rs7521584G>T genotype in GA group (n=142) was 51GG, 66GT and 22TT. The rs7521584 minor allele frequencies in GA and non-GA groups were 39.6% and 38.2%, respectively. By logistic regression analysis after adjustment for gender, age and H. pylori (HP) infection status, rs7521584 TT homozygote has a significantly high risk for gastric mucosal atrophy (OR: 2.41, 95%CI: 1.10-5.25, p=0.027). In HP positive subjects, TT homozygote was a more significant risk factor for gastric mucosal atrophy (OR: 3.31, 95%CI: 1.35-8.12, p=0.0089). In addition, in the subjects younger than 60 years old, TT homozygote has also significant risk for gastric mucosal atrophy (OR: 3.15, 95%CI: 1.03-9.61, p=0.044). The serum PG I/II ratio was reversely correlated to the age in TT homozygote (p=0.0084 by ANOVA), whereas there was no correlation between age and PG I/II ratio in G carrier (p=0.092). [Conclusions] Our results suggest that rs7521584, in pre-miR429 and premiR200s gene, TT homozygote is a risk factor for the progression of gastric mucosal atrophy under the influence of HP infection.

Su1848 The −449c>G Polymorphism of NFKB1 Gene, Coding Nuclear Factor-Kappa-B, is Associated With the Susceptibility to Ulcerative Colitis

[Background] A polymorphism rs7521584 is located between MIR200B and MIR 429. Recently, it has been reported that both miR200 and miR429 target c-myb gene and affect the breast cancer cell growth (Cesi V, et al.: Cell cycle 2011). One of both the miR200s and miR429 targeting genes is RIPK2, coding RICK. RICK is an important molecule for inflammation by transmitting NOD signal. Then, we attempted to clarify the association between chronic gastritis and genomic variation rs7521584G>T in Japanese population. [Materials and Methods] Gastric mucosa samples were obtained from 429 subjects with no malignancies. The rs7521584 genotype was determined by PCR-SSCP method using DNA extracted from obtained gastric mucosa. The degree of gastritis was assessed in 393 cases according to the updated Sydney system, serum pepsinogen (PG) I/II levels were measured in 117 cases. [Results] The mean age of the subjects was 59.7 years old, male/female ratio was 253/176, and H. pylori (HP) positive ratio was 63.6%. The distribution of rs7521584G>T genotype in all subjects was 153GG, 215GT and 61TT (HWE, p=0.31). The atrophic gastritis group (GA group) was defined as atrophy score >0 and metaplasia score >0. Then, the distribution of rs7521584G>T genotype in GA group (n=142) was 51GG, 66GT and 22TT. The rs7521584 minor allele frequencies in GA and non-GA groups were 39.6% and 38.2%, respectively. By logistic regression analysis after adjustment for gender, age and H. pylori (HP) infection status, rs7521584 TT homozygote has a significantly high risk for gastric mucosal atrophy (OR: 2.41, 95%CI: 1.10-5.25, p=0.027). In HP positive subjects, TT homozygote was a more significant risk factor for gastric mucosal atrophy (OR: 3.31, 95%CI: 1.35-8.12, p=0.0089). In addition, in the subjects younger than 60 years old, TT homozygote has also significant risk for gastric mucosal atrophy (OR: 3.15, 95%CI: 1.03-9.61, p=0.044). The serum PG I/II ratio was reversely correlated to the age in TT homozygote (p=0.0084 by ANOVA), whereas there was no correlation between age and PG I/II ratio in G carrier (p=0.092). [Conclusions] Our results suggest that rs7521584, in pre-miR429 and premiR200s gene, TT homozygote is a risk factor for the progression of gastric mucosal atrophy under the influence of HP infection.

Tu1640 Is ‘Push’ an Effective and Safe Method for Relief of Esophageal Food Bolus Obstruction on Endoscopy?

we investigated subjects who underwent upper gastrointestinal endoscopy at our university since November 2007 until September 2011. We investigated a prevalence of GA by endoscopy and divided into two groups (GA( ) and GA( ) group). Between GA( ) group and GA( ) group, we investigate the characteristics(age, sex, alcohol intake and smoking) and upper gastrointestinal disorder (reflux esophagitis, Barrett’s mucosa, hiatus hernia and atrophic gastritis). A multiple logistic regression was used to assess the clinical characteristic of GA. Result: 582 cases were analyzed in this study. GA was diagnosed in 462 cases (78.4%) endoscopically. (GA( ) group: n 462, M/F 60.1%/39.9%, mean age 63.1 11.5 years, smoking 189(40.8%), alcoholic drinker 227(49.2%). GA( ) group: n 120, M/F 26.9%/73.1%, mean age 58.3 16.3 years, smoking 22(18.1%), alcoholic drinker 23(19.0%)). Between GA( ) and GA( ) group, the prevalence rate of upper gastrointestinal disorder (reflux esophagitis, Barrett’s mucosa, hiatus hernia and atrophic gastritis) were 54.5% vs 18.6%, 70.8% vs 43.6%, 40.2% vs 27.8% and 34.7%vs 39.8%, respectively. By a multiple logistic regression, Age (p 0.05, OR: 1.747 (1.010 95%CI 3.02)), male (p 0.05, OR: 3.334 (1.885 95%CI 5.895)), reflux esophagitis (p 0.05,OR: 3.564 (1.859 95%CI 6.835) and Barrett’s mucosa (p 0.05,OR: 2.757 (1.859 95%CI 4.786)) were associated with GA. Conclusion: It was considered that age, male, reflux esophagitis and Barrett’s mucosa were associated with GA. This result revealed that the GA associated clearly with gastro-esophageal reflux disease.

Waiting Time for Deceased Donor Kidney Allocation in Korea: A Single Center Experience

Background: The kidney recovery rate associated with deceased donors has increased after the establishment of the Korean Network for Organ Sharing (KONOS). And the KONOS organ allocation system gives priority to candidates affiliated with a Hospital based Organ Procurement Organization (HOPO) and/or donor recovery hospital. Regardless of whether or not this organ allocation system is fair, it can make an important impact on the waiting time for an organ transplant. Methods: A total of 157 deceased donor kidney transplantations were performed at Severance Hospital between January 2006 and April 2011. The recipients of these transplantations were retrospectively divided into five groups according to their allocation types; general allocation group (GA, n=54), HOPO priority group (HP, n=65), zero antigen mismatching group (ZM, n=23), marginal donor allocation group (MD, n=7), and the combined organ transplant allocation group (CT, n=8). The five groups were assessed in terms of their waiting time for organ allocation, cold ischemia time, and post-transplant graft outcome. Results: Mean waiting time for organ allocation of the HP group (69.5±27.4 months) was significantly shorter than for the GA group (90.0±34.0 months)(P<0.05). However, the degree of HLA mismatching was not different between each group. The cold ischemia time for the HP group (301.5±133.9 min) was significantly shorter than all other groups, except for the ZM group. There were no differences between groups in terms of acute rejection episodes, delayed graft function events or graft survival rates. Conclusions: Our retrospective analysis of the kidney allocation pattern showed that there were disparities in distribution by priority of allocation. We should make a consensus within the Korean transplant society in order to further develop the allocation system to decease donor kidney transplantation time.

All-trans retinoic acid treatment is associated with prohibitin expression in renal interstitial fibrosis rats.

This study was performed to investigate the association of prohibitin with renal interstitial fibrosis (RIF) lesion and to explore the association of all-trans retinoic acid (ATRA) treatment with prohibitin expression in RIF rats. Rats were divided into three groups: the sham operation group (SHO), the model group subjected to unilateral ureteral obstruction (UUO), and the model group treated with ATRA (GA). Renal tissues were collected at 14 and 28 days after surgery, and the relevant indicators were detected. In comparison with the SHO group, the RIF index in the UUO group was markedly elevated (p < 0.01), and the RIF index in the GA group was alleviated compared with that in the UUO group (p < 0.01). Compared with the SHO group, the expression of prohibitin (protein or mRNA) in the UUO group was significantly reduced (each p < 0.01). Prohibitin expression in the GA group was markedly increased when compared with that in the UUO (p < 0.01). The expression of TGF-β1 (protein and mRNA), protein expressions of Col-IV, fibronectin, α-SMA and cleaved Caspase-3, ROS generation and cell apoptosis index in the UUO group were markedly higher than those in the SHO group (all p < 0.01), and their expressions in the GA group were markedly down-regulated compared to those in the UUO group (all p < 0.01, respectively). The protein expression of prohibitin was negatively correlated with the RIF index, protein expression of TGF-β1, Col-IV, fibronectin, α-SMA or cleaved Caspase-3, ROS generation and the cell apoptosis index (each p < 0.01). In conclusion, lower expression of prohibitin is associated with the RIF, and ATRA treatment is associated with increased prohibitin, which can prevent the progression of RIF.

BaGa2GeX6(X=S, Se): New mid-IR nonlinear optical crystals with large band gaps

New middle infrared nonlinear optical crystals of BaGa2GeX6(X=S, Se) have been synthesized. The structures of both BaGa2GeS6 and BaGa2GeSe6 were found to be isomorphous exhibiting a three-dimensional framework constructed by the parallel alignment of Ga or Ge tetrahedron groups along the c-aix. The ultraviolet transmittance spectrum indicates the short-wavelength absorption edges of BaGa2GeS6 and BaGa2GeSe6 are 380nm and 440nm, respectively. The IR transmittance spectrum shows that the absorption edge of the BaGa2GeS6 crystal is 13.7μm. Second-harmonic generation of the powder samples was measured with a 2.05μm laser using the Kurtz and Perry technique, which showed that BaGa2GeS6 and BaGa2GeSe6 are phase-matched materials, and their measured SHG coefficient is ∼2.1 and ∼3.5 times as large as the coefficient of AgGaS2, or 26.3pm/V and 43.7pm/V.

The differential impact of two anesthetic techniques on cortisol levels in Nigerian surgical patients

Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immunologic, and metabolic alterations. The aim was to compare the effects on the stress response by isoflurane-based intratracheal general anesthesia (ITGA) and bupivacaine-based epidural anesthesia (EA), using cortisol as a biochemical marker. Following the approval of the Hospital Ethical Board, informed written consent from patients recruited into this study was obtained. One group received general anesthesia with relaxant technique (group A) while the other group had bupicaine epidural anesthesia with catheter placement for top-ups (group B) for their surgeries. Both groups were assessed for plasma cortisol levels - baseline, 30 minutes after skin the start of surgery and at skin closure. There was no statistically significant difference in the baseline mean heart rate, mean arterial pressure (mean MAP) and the mean duration of surgery between the two groups; the baseline mean plasma cortisol level was 88.70 ± 3.85 ng/ml for group A and 85.55 ± 2.29 ng/ml for group B, P=0.148. At 30 minutes after the start of surgery the plasma cortisol level in the GA group was 361.60 ± 31.27 ng/ml while it was 147.45 ± 22.36 ng/ml in the EA group, showing a significant difference, P=0.001. At skin closure the mean plasma cortisol value of 384.65 ± 48.04 ng/ml recorded in the GA group was found to be significantly higher than the value of 140.20 ± 10.74 ng/ml in the GA group, P<0.002. Using plasma cortisol as a measure, bupivacaine-based epidural anesthesia significantly reduces the stress response to surgical stimuli when compared with isoflurane-based tracheal general anesthesia.

Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

Near-Infrared Spectroscopy Assessment of Cerebral Oxygen Metabolism in the Developing Premature Brain

Little is known about cerebral blood flow, cerebral blood volume (CBV), oxygenation, and oxygen consumption in the premature newborn brain. We combined quantitative frequency-domain near-infrared spectroscopy measures of cerebral hemoglobin oxygenation (SO2) and CBV with diffusion correlation spectroscopy measures of cerebral blood flow index (BFix) to determine the relationship between these measures, gestational age at birth (GA), and chronological age. We followed 56 neonates of various GA once a week during their hospital stay. We provide absolute values of SO2 and CBV, relative values of BFix, and relative cerebral metabolic rate of oxygen (rCMRO2) as a function of postmenstrual age (PMA) and chronological age for four GA groups. SO2 correlates with chronological age (r=−0.54, P value ⩽0.001) but not with PMA (r=−0.07), whereas BFix and rCMRO2 correlate better with PMA (r=0.37 and 0.43, respectively, P value ⩽0.001). Relative CMRO2 during the first month of life is lower when GA is lower. Blood flow index and rCMRO2 are more accurate biomarkers of the brain development than SO2 in the premature newborns.

Incidencia y evolución de membrana hialina en menores de 35 semanas según crecimiento intrauterino

ABSTRACTIncidence and evolution of hyaline membrane in newborns under 35 weeks of gestational age according intrauterine growthIntroduction: It is thought that intrauterine growth restriction induces respiratory maturation. The information varies if the studies consider analysis based on birth weight or gestational age. Objective: The goal of this stu-dy is to compare the incidence and evolution of hyaline membrane disease (HMD) between small and adequate premature babies under 35 weeks of gestational age (< 35 wGA) based on data in the literature. Patients and Methods: Two databases were created and analyzed: a) 2 022 newborns < 35 wGA admitted to the Service, whose incidence of HMD was calculated, and b) 733 newborns < 35 wGA with HMD and treated with sur-factant, to describe the evolution. Results: Analysis of GA group shows a higher incidence of HMD (35.2%) among small for GA, and less (29.1%) among those who are not small for GA (p: 0.026). If a subset is formed for the newborns < 1 500 g in brithweight, those small for gestational age have a lower incidence (47.5%) than those adequate for GA (60.7%). Logistic regression analysis for discharge with oxygen of newborns with HMD shows association with lower z score for birthweight, corticosteroid use and oxygen dependence at 36 weeks.

All-trans retinoic acid can regulate the expressions of gelatinases and apolipoprotein E in glomerulosclerosis rats

Apolipoprotein E (apoE) is an important plasma protein in cholesterol homeostasis and plays a key role in the pathogenesis of glomerulosclerosis (GS). Gelatinases include matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9). The abnormal expressions of gelatinases are implicated in the pathogenesis of extracellular matrix accumulation. All-trans retinoic acid (ATRA) is an import biological agent which can play a protective role against GS. We performed this investigation to explore whether ATRA could regulate the expressions of gelatinases and apoE in the glomerulus of GS rats. 120 Wistar rats were randomly divided into three groups: sham operation group (SHO), glomerulosclerosis model group without treatment (GS) and GS model group treated with ATRA (GA). The GS disease was established by uninephrectomy and adriamycin injection. At the end of 9 and 13weeks, the relevant samples were collected and determined. Compared with GS group at 9/13weeks, values of 24-hour urine total protein, 24-hour urine excretion for albumin, blood urea nitrogen, serum creatinine and glomerulosclerosis index, and protein expressions of apoE, transforming growth factor-βl (TGF-β1), α-smooth muscle actin, collagen-IV and fibronectin in glomerulus and mRNA expressions of apoE and TGF-β1 in renal tissue were significantly down-regulated by ATRA (each P<0.01). However, the expressions of MMP-2 and MMP-9 (mRNA, protein and activity) were enhanced in GA group than those in GS group. In conclusion, gelatinases are associated with apoE expression, and ATRA can increase the gelatinases expressions and reduce the accumulation of apoE in glomerulus of GS rats, but the detailed mechanism needs to be elucidated in the future.

The effect on improvement of recovery and pain scores of paravertebral block immediately before breast surgery

Objectives Paravertebral block (PVB) has the potential to reduce postoperative pain after breast surgery. The aim of the study was to investigate whether PVB performed immediately before surgery could affect the postoperative morbidities in terms of pain and emesis, and improve the quality of recovery (QoR) in patients after surgery for breast cancer. Methods Postoperative data were collected prospectively from two groups of patients undergoing unilateral breast surgery during the study period of 1 month. Forty consecutive patients received either solely general anesthesia (GA group, n = 25) or GA plus ultrasound-guided PVB (GA + PVB group, n = 15) for the surgery. Pain scores and areal distribution of pain were compared between the two groups 1 hour and 6 hours postoperatively and on the midmorning of postoperative Day 1 (POD1). The QoR scores were compared between the two groups 6 hours postoperatively and on the midmorning of POD1. Incidence of postoperative nausea and vomiting and doses of analgesics and narcotics given were also compared. Results Pain scores at rest were significantly lower in the GA + PVB group at all designated time points [1 hour ( p < 0.0001), 6 hours ( p < 0.0001), and on midmorning of POD1 ( p = 0.041)]. Pain scores with movements was also significantly lower at all time points in the GA + PVB group (1 hour, p < 0.0001; 6 hours, p < 0.0001; midmorning of POD1, p = 0.0012). Areal distribution of pain at rest and with movement was wider in the GA group 1 hour and 6 hours postoperately but was identical to that of GA+ PVB group on the mid-morning of POD1 [1 hour postoperatively at rest ( p < 0.0001), with movement ( p < 0.0001); 6 hours postoperatively at rest ( p = 0.0018), with movement ( p = 0.0048)]. The QoR scores were significantly higher in the GA + PVB group at 6 hours ( p < 0.0001) and on midmorning of POD1 ( p = 0.0079). The incidences of postoperative nausea and vomiting were significantly lower in the GA + PVB group ( p = 0.0004). Doses of postoperative analgesics and narcotics were significantly less in the GA + PVB group ( p < 0.0001 and p = 0.001, respectively). Time to first request for analgesics was significantly longer in the GA + PVB group ( p = 0.0002). Conclusions PVB given before surgery in combination with GA could provide better postoperative analgesia and better QoR than did GA alone in patients undergoing surgery for unilateral breast cancer.