GA Group Research Articles

CXCL12 rs18011157 polymorphısm in patients wıth non-Hodgkin's lymphoma: Is it associated with poor outcome?

We studied CXCL12-related rs18011157 polymorphism in non-Hodgkin lymphoma (NHL) patients. We also determined the effect of this polymorphism on clinical features and outcome of NHL. We included 90 NHL patients (54 males, 36 females) and 88 healthy controls (54 males, 34 females). CXCL12-related rs18011157 polymorphism was determined by polymerase chain reaction. rs18011157 polymorphism was significantly more frequent in NHL patients with GA genotype than in healthy controls (37.8% vs. 20.5%, P = 0.011). The frequency of patients with initially high lactate dehydrogenase (LDH) level (65.8% vs. 38.5%) and extranodal involvement (61.1% vs. 43.8%) was significantly higher in the GA plus AA genotype groups when considered altogether (P = 0.01 and 0.09). Poor prognostic factors in univariate analysis were the presence of B symptoms, initially high International Prognostic Index (IPI), splenomegaly, nonresponse to first-line therapy, the presence of early relapse, and carrying A allele (GA plus AA genotypes). The independent prognostic factors in multivariate analysis were only early relapse and an initially high IPI score. CXCL12 rs1801157 polymorphism which was found to be associated with extranodal involvement and increased LDH in NHL might be a marker of poor prognosis in patients with GA and AA genotypes. CXCL12-related rs18011517 polymorphism was more frequent in NHL patients: it might be associated with NHL pathogenesis and outcome.

Incomplete resection and linitis plastica are factors for poor survival after extended multiorgan resection in gastric cancer patients

The aim of this retrospective study was to analyze the morbidity, mortality, and survival rates of extended multiorgan resection (EMR) for locally advanced gastric cancer patients compared to gastrectomy alone and a palliative operation. 893 locally advanced gastric cancer patients without distant metastasis had surgery including gastrectomy alone (GA group, n = 798), EMR resection (EMR group, n = 75), and palliative operation (palliative gastrectomy or gastrojejunostomy (PO group, n = 20)). Postoperative mortality and complication rates in the EMR group were significantly higher than in the GA group (2.7% vs 0.4%, P = 0.010 and 25.3% vs 8.1%, P < 0.001, respectively), but similar in the PO group. The median survival time of the EMR group was significantly longer than in the PO group (27 months vs 11 months, P = 0.020), but significantly worse (P = 0.020) than in the GA group (44 months). Incompleteness of resection (R1) and linitis plastica were independent prognostic factors for survival in the EMR group. Three different gastric cancer surgeries led to different postoperative mortality and complication rates. EMR had a better survival rate compared with PO while GA had the longest survival time with the lowest mortality and complication rates.

Oldest lamproites from Peninsular India track the onset of Paleoproterozoic plume-induced rifting and the birth of Large Igneous Province

Potassic and ultrapotassic magmatism from deep lithospheric sources in intra-cratonic settings can be the signal of subsequent voluminous mafic magmatism and the formation of Large Igneous Provinces (LIPs) triggered by mantle plumes. Here we report for the first time, precise zircon U–Pb age data from a suite of lamproites in the Bastar Craton of central India that mark the onset of Paleoproterozoic rifting and culminating in the formation of extensive mafic dyke swarms as the bar codes of one of the major LIP events during the Precambrian evolution of the Indian shield. The lamproites from the Nuapada field occur as dismembered dykes and are composed of phenocrysts and microphenocrysts of altered olivine together with microphenocrysts of phlogopite and magnetite within a groundmass of chlorite and calcite with accessory rutile, apatite and zircon. The rocks compositionally correspond to olivine phlogopite lamproite and phlogopite lamproite. Geochemical features of the lamproites correlate with their counterparts in Peninsular India and other similar suites elsewhere in the world related to rift settings, and also indicate OIB-like magma source. The associated syenite shows subduction-related features, possibly generated in a post-collisional setting. Magmatic zircon grains with high Th/U ratios in the syenite from the Nuapada lamproite form a coherent group with an upper intercept age of 2473±8Ma representing the timing of emplacement of the magma. Zircon grains in three lamproite samples yield four distinct age groups at ca. 2.4Ga, 2.2Ga, 2.0Ga and 0.8Ga. The 2.4Ga group corresponds to xenocrysts entrained from the syenite whereas the 2.2Ga group is considered to represent the timing of emplacement of the lamproites. The ca. 2.0Ga zircon grains correlate with the major thermal imprint associated with mafic magmatism and dyke emplacement in southern Bastar and the adjacent Dharwar Cratons. A few young zircon grains in the syenite and lamproites show a range of early to middle Neoproterozoic ages from 879 to 651Ma corresponding to younger thermal event(s) as also represented by granitic veins cutting across these rocks and extensive silicification. Zircon Lu–Hf isotope data suggest magma derivation from a refertilized Paleo-Mesoarchean sub-continental lithospheric mantle, or OIB-type sources. The differences in Hf-isotope composition among the zircon grains from different age groups indicate that the mantle sources of the lamproite are heterogeneous at the regional scale. A combination of the features from geochemical and zircon Hf isotope data is consistent with asthenosphere-lithosphere interaction during the lamproite magma evolution.The timing of lamproite emplacement in central India correlates with the global 2.2Ga record of LIPs. We link the origin of the related mantle plume to the recycling of subducted slabs associated with the prolonged subduction-accretion history prior to the Neoarchean cratonization, as well as the thermal blanket effect of the Earth's oldest supercontinent. Pulsating plumes and continued rifting generated voluminous dyke swarms across the Bastar and Dharwar Cratons, forming part of a major global rifting and LIP event.

ANALGESIC EFFICACY OF ULTRA-SOUND GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK WITH TOTAL ABDOMINAL HYSTERECTOMY

Pre-incisional bilateral Ultra-sound guided transverses abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents for postoperative analgesia. The aim of this study is, assess the effectiveness of Ultra-sound guided TAP block on requirement of intra-operative fentanyl and post-operative analgesia in patients undergoing total abdominal hysterectomy. Subjects and Methods: Eighty patients ASA physical status I and II, were randomly allocated into two groups (40 patients each), group TAP: received bilateral Ultra-sound guided TAP block with 20ml bupivacaine 0.25% in each side and group GA: received Ultra-sound guided TAP with same volume of normal saline. both groups given standardized GA. Intra-operative fentanyl requirements and postoperative pain using visual analogue score (VAS) at 30 min.1, 2, 3, 6, 12 and 24 h post-operatively were assessed and if VAS ≥3, patients received i.v. pethidine as a rescue analgesic and time to first request of analgesia was recorded. Results: Intra-operative fentanyl requirement reduced in TAP group compared to GA group; it was 100.4±21.6 and150.3±24.3 mcg respectively. Time to the first analgesic request was also reduced in TAP group compared to GA group; it was112.5±5.4 min.vs.23.4 ± 2.3 min respectively. VAS at most post-operative measurement points and pethidine requirement were reduced in TAP group compared to GA group; (41.7 and 92.3 mg respectively).There were no recorded complications attributed to the TAP block procedure. All TAP group patients were highly satisfied with their postoperative analgesic regimen. Conclusion: TAP block provides effective intra and postoperative analgesia, prolongs time to the first analgesic request and reduces total intra and postoperative analgesic consumption with minimal PONV after total abdominal hysterectomy.

Anesthesia-Related Outcomes for Endovascular Stroke Revascularization: A Systematic Review and Meta-Analysis.

There is currently controversy on the ideal anesthesia strategy during mechanical thrombectomy for acute ischemic stroke. We performed a systematic review and meta-analysis of studies comparing clinical and angiographic outcomes of patients undergoing general anesthesia (GA group) and those receiving either local anesthesia or conscious sedation (non-GA group). A literature search on anesthesia and endovascular treatment of acute ischemic stroke was performed. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome at 90 days (modified Rankin Score≤2), symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, and time to groin puncture. Twenty-two studies (3 randomized controlled trials and 19 observational studies), including 4716 patients (1819 GA and 2897 non-GA) were included. In the nonadjusted analysis, patients in the GA group had higher odds of death (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.45) and respiratory complications (OR, 1.70; 95% CI, 1.22-2.37) and lower odds of good functional outcome (OR, 0.58; 95% CI, 0.48-0.64) compared with the non-GA group. There was no difference in procedure time between the 2 primary comparison groups. When adjusting for baseline National Institutes of Health Stroke Scale, GA was still associated with lower odds of good functional outcome (OR, 0.59; 95% CI, 0.29-0.94). When considering studies performed in the stent-retriever/aspiration era, there was no significant difference in good neurological outcome rates (OR, 0.84; 95% CI, 0.67-1.06). Acute ischemic stroke patients undergoing intra-arterial therapy may have worse outcomes when treated with GA as compared with conscious sedation/local anesthesia. However, major limitations of current evidence (ie, retrospective studies and selection bias) indicate a need for adequately powered, multicenter randomized controlled trials to answer this question.

Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures

Category: Ankle, Trauma Introduction/Purpose: This prospective study aimed to evaluate the usefulness of ultrasound (US)-guided nerve block (NB) for emergency external fixation of lower leg fractures, by investigating real time before the operation and the clinical result according to the anesthesia method (US-guided NB or general anesthesia [GA]). Methods: From June 2014 to April 2016, 40 patients who underwent emergency surgery for external fixator application were enrolled in this study. We performed a randomized trial for US-guided NB and GA. We measured the lead time before the start of the operation after the decision to perform emergency surgery in both groups. Results: The US-guided NB group comprised 17 men and 3 women with a median age of 55.6 (33–77) years. Twelve of these patients had conditions such as diabetes mellitus, hypertension, and kidney-related diseases. Fracture types 42, 43, and 44 in the AO classification were observed in 3, 12, and 5 cases, respectively. The average time taken to emergency operation was 4.3 (2– 6.25) h. However, in the GA group, the average time taken to emergency operation was 9.4 (3–14) h. In the US-guided NB group, no cases of anesthesia failure and unstable vital signs during the operation occurred. Moreover, there were no postoperative complications related to the anesthesia method, such as aggravation of the general condition. Conclusion: Emergency external fixation with US-guided NB in patients with lower-extremity trauma can be implemented in less time regardless of preoperative preparation, which is a requirement in GA.

Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures (AO 42, 43, 44)

The present randomized controlled trial evaluated the usefulness of ultrasound (US)-guided nerve block (NB) for emergency external fixation of lower leg fractures, by investigating the time required before surgery and the clinical results stratified by the anesthesia method (US-guided NB or general anesthesia [GA]). From June 2014 to April 2016, 40 patients who had undergone emergency surgery for external fixator application were enrolled in the present study. We measured the lead time before the start of surgery after the decision to perform emergency surgery in both groups. The US-guided NB group included 17 males (85%) and 3 females (15%), with a mean age of 55.6 (range 33 to 77) years. Of these 20 patients, 12 (60%) had comorbidities such as diabetes mellitus, hypertension, and kidney-related disease. Fracture type 42, 43, and 44 in the AO classification were observed in 3 (15%), 12 (60%), and 5 (25%) cases, respectively. The mean interval before emergency surgery was 4.3 (range 2 to 6.25) hours in the US-guided NB group. In the GA group (n = 20 patients), the mean interval before emergency surgery was 9.4 (range 3 to 14) hours, and this difference was statistically significant (p < .001). In the US-guided NB group, no cases of anesthesia failure or unstable vital signs occurred during surgery. Also, no postoperative complications related to the anesthesia method, such as aggravation of the general condition, developed. In contrast, 1 case of postoperative atelectasis occurred in the GA group. Emergency external fixation with US-guided NB in patients with lower extremity trauma can be implemented in less time, regardless of the preoperative preparation, which is a requirement for GA.

THE EFFECTIVENESS OF NEURAXIAL ANESTHESIA TECHNIQUES IN DIABETIC FOOT SURGERY

Introduction. Common is considered that surgical procedures in patients with diabetes mellitus (DM) must be performed at a stable level of blood glucose and at a stable hemodynamic. Aim. Determine effective anesthesia technique for diabetic foot (DF).surgery. Materials and methods. 30 patients (59.5 (53; 67) yr old, 16 female and 14 male) with DM and DF surgery were included in a retrospective study. Spinal anesthesia was used in 10 patients (SA group). In the presence of contraindications to spinal anesthesia we used the blockade of the sciatic nerve (SNB group, 10 patients), or general anesthesia with tracheal intubation (GA group, 10 patients). Data are presented as median (25th, 75th percentile). Results. In the SA group mean arterial pressure (MAP) decreased from baseline by more than 20% in 80% of patients, in the SNB group - in 30% (p = 0,03) and in the GA group - in 60% of patients (ns). The median of maximum decrease in MAP during anesthesia was 25 (20; 27)% for the SA group, 16 (13; 22)% for the SNB group (p = 0,03) and 21 (15; 24)% for the GA group (ns). Infusion volume was lower In SNB group than in the SA group (500 (500; 750) vs 1500 (1500; 2000) ml, p

Comparison of Short-Term Complications of General and Spinal Anesthesia for Primary Unilateral Total Knee Arthroplasty.

PurposeTo compare the occurrences of perioperative complications of two anesthetic techniques (general anesthesia [GA] and spinal anesthesia [SA] in patients undergoing primary unilateral total knee arthroplasty (TKA).Materials and MethodsPatients who underwent unilateral primary TKA due to osteoarthritis from January 2005 to January 2014 were retrospectively reviewed. They were divided into two groups: GA (n=490) and SA (n=746). The operation duration, length of perioperative stay in the operation room and occurrences of adverse events in postoperative 30 days (mean, 29.7±3.1 days) were compared. Before multivariate linear or logistic regression analysis, different baseline characteristics were adjusted in the statistical models.ResultsThere were significant intergroup differences in mean age (GA, 68.4±7.2 years; SA, 70.7±7.5 years; p<0.001) and mCCI (GA, 3±1.4; SA, 3.2±1.5; p<0.001). The GA group required longer preoperative room time (+9.4 minutes; p<0.001), postoperative room time (+12.7 minutes; p<0.001), and postoperative hospital stay (+2.5 days; p=0.001) and had more surgical site infections (5 [1%] vs. 0 [0%]; p=0.005) and blood transfusion (205 [41.8%] vs. 262 [35.1%]; p=0.01). No differences in operative duration and other adverse events were identified.ConclusionsWe should cautiously consider that GA may be associated with slightly increased preoperative and postoperative room times, postoperative hospital stay, transfusion and surgical site infection rates in primary unilateral TKA.

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation. In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77). The demographic characteristics and echocardiographic parameters between the two groups were similar (P>0.05). Two (2.6%) of patients were moved from BIS-guided sedation to general anesthesia for surgical reasons. Procedures were significantly shorter in the SED group than in the GA group ((127.10±44.43) min vs. (165.90±71.62) min, P=0.004). Patients in the SED group lost less blood and received significantly fewer red blood cells and catecholamines than those in the GA group (5.19% vs. 22.22%, P=0.017 and 67.53% vs. 97.22%, P<0.001). The length of hospital stay was significantly shorter and there were fewer pulmonary complications in the SED group than in the GA group. Thirty-day mortality was similar between the two groups. BIS-guided sedation is a feasible and safe approach for transfemoral TAVI. The anesthesiologist should choose the best anesthetic method according to the team's experience.

The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study.

BackgroundEpidural use can provide a better short-term outcome and protect patients from the postoperative development of tumour recurrence and metastases. In this study, we sought to assess the effects of intra- and postoperative anaesthesia and analgesia choice on outcome after gastric cancer resection, searched for evidence of interaction between intra-and postoperative epidural use and outcomes of gastric cancer patients.MethodsFour thousand two hundred and eighteen cases of gastric cancer were identified from the Records of Hospital Patients. Patients who received only general anesthesia (GA group) or epidural anesthesia combined with general anesthesia (EGA group), were administered patient-controlled intravenous or epidural analgesia for 72-120 hours postoperatively. Flatus time, length of stay in hospital, incidence of nausea and vomiting, and visual analogue scale (VAS ) scores were collected for evaluating the short-outcome of the patients. A Kaplan-Meier log-rank test was used for a univariable analysis, and Cox proportional hazards regressions were used for a multivariable analysis of the survival time in both groups.ResultsThe VAS scores and incidence of nausea and vomiting in the EGA group were lower than the GA group. There was a significant association between intra-and postoperative epidural use and improved survival.ConclusionsThese results indicated that epidural anaesthesia combined with general anaesthesia and patient-controlled epidural analgesia may be associated with the improved overall survival in gastric cancer patients who underwent resection.

Embryological Results of Couples Undergoing ICSI-ET Treatments with Males Carrying the Single Nucleotide Polymorphism rs175080 of the MLH3 Gene.

Human MLH3 (hMLH3) gene has been suggested to play a role in the DNA mismatch repair mechanism, while it may also be associated with abnormal spermatogenesis and subsequently male infertility. The aim of the present study was to investigate possible relationships between the single nucleotide polymorphism (SNP) rs175080 in the MLH3 gene of males and the embryological results in couples undergoing intracytoplasmatic sperm injection-embryo transfer (ICSI-ET) treatments. A total of 132 men volunteered for the study and gave written informed consent. All couples were subjected to ICSI-ET treatments in the years 2010 to 2012. The couples were divided into three groups according to the genotype of their husbands: the wild type GG (n = 28), the heterozygotic type GA (n = 72) and the mutant type AA (n = 32). Significantly lower sperm concentration and progressive motility were observed in the AA group as compared to the other two groups (Concentration: 14.57 ± 4.9 mil/mL in AA, 38.3 ± 5.4 mil/mL in GA and 41.03 ± 6.8 mil/mL in GG, p < 0.05, mean ± standard error of the mean—SEM). However, significantly better embryological results (mean score of embryo quality–MSEQ) were found in the AA (8.12 ± 0.5) and the GA group (7.36 ± 0.4) as compared to the GG group (5.82 ± 0.7), (p < 0.05). Clinical pregnancy rate was significantly higher in the AA genotype group (43.8%) and the GA group (30.6%) than in the GG group (14.3%), (p < 0.05). Live birth rate was not different. It is suggested for the first time that the deteriorating effect of the mutant type on sperm characteristics does not impact on embryo development after fertilization in vitro.

Glycyrrhetinic acid alleviates radiation-induced lung injury in mice

Radiation-induced lung injury (RILI) is a common complication of thoracic radiotherapy, but efficacious therapy for RILI is lacking. This study ascertained whether glycyrrhetinic acid (GA; a functional hydrolyzed product of glycyrrhizic acid, which is extracted from herb licorice) can protect against RILI and investigated its relationship to the transforming growth factor (TGF)-β1/Smads signaling pathway. C57BL/6 mice were divided into four groups: a control group, a GA group and two irradiation (IR) groups. IR groups were exposed to a single fraction of X-rays (12 Gy) to the thorax and administered normal saline (IR + NS group) or GA (IR + GA group). Two days and 17 days after irradiation, histologic analyses were performed to assess the degree of lung injury, and the expression of TGF-β1, Smad2, Smad3 and Smad7 was recorded. GA administration mitigated the histologic changes of lung injury 2 days and 17 days after irradiation. Protein and mRNA expression of TGF-β1, Smad2 and Smad3, and the mRNA level of Smad7, in lung tissue were significantly elevated after irradiation. GA decreased expression of TGF-β1, Smad2 and Smad3 in lung tissue, but did not increase Smad7 expression. GA can protect against early-stage RILI. This protective effect may be associated with inhibition of the TGF-β1/Smads signaling pathway.

The efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery

Background Ultrasound (U/S)-guided rectus sheath block is an effective analgesic technique in elective pediatric laparoscopic surgical procedures. The aim of the study was to evaluate the efficacy of rectus sheath block for pain management following laparoscopic orchiopexy surgery. Patients and methods A total of 50 patients undergoing elective laparoscopic orchiopexy were allocated randomly into two groups: the U/S-guided rectus sheath block group (the REC group) and the general anesthesia-only group (the GA group), in which no rectus sheath block was performed. All patients received the same general anesthetic technique. In the REC group, patients received bilateral U/S-guided rectus sheath block, using 0.4 ml/kg of 0.25% bupivacaine, and morphine (0.1 mg/kg) was administered for rescue analgesia postoperatively and its total dose was recorded. Pain was measured by means of Children’s Hospital of Eastern Ontario Pain Scale score. Hospital stay and the incidence of respiratory depression or vomiting were recorded. Results In all, 50 patients completed the study. The total dose of morphine used over 24 h was significantly lower in the REC group. Children’s Hospital of Eastern Ontario Pain Scale scores were significantly lower in the REC group during the first 3 h postoperatively, and the incidence of vomiting, respiratory depression, and oxygen saturation in the postanesthesia care unit showed no significant difference between the study groups. Hospital stay was significantly shorter in the REC group compared with the GA group. Conclusion U/S-guided rectus sheath block is an effective analgesic technique with morphine-sparing effect after laparoscopic orchiopexy surgery.

Efficacy of Indomethacin in Pharmacological Closure of PDA in Preterm Neonates: A Prospective Study from Tertiary Care Centre in Rural India

Background: Patent ductusarteriosus (PDA) is a fetal shunt necessary for intrauterine survival of the baby, however its closure at birth occurs as pulmonary vascular resistance drops and lungs get expanded for participating in ventilation. However, PDA remains patent in a large proportion of preterm babies and by day -7, 87% of babies <24 wk gestation have a PDA which hinders in ventilation and causes ductal steal to vital organs. Hence, we aimed to study pharmacological closure of ductus in preterm babies. Aims and Objectives: 1) To study the efficacy of COX inhibitor, Indomethacin in ductal closure in preterm babies <34 wk gestation. 2) To compare the symptomatology of PDA in different groups of preterm babies <34 wk GA. Methods: A Hospital-based prospective study was conducted in tertiary care NICU.A total of 104 consecutive, eligible preterm babies <34 wk with echocardiographically documented PDA. Indomethacin (COX inhibitor) was administered orally in a dose of 0.2 mg/kg 12 h for 3 doses and the babies underwent Echo study in first 48 h, after2 days, 7days, and weekly thereafter till PDA closure. A second cycle of indomethacin was repeated if PDA did not respond to the initial treatment. Results: 75/104 (72%) PDAs closed with indomethacin while 13(12.5%) did not respond, and 16(15.38%) showed a reduction in the calibre of PDA. 26–30 wk group showed a brisk response to ductal closure with indomethacin within 108.1±12.44 h, and a mean no. of cycles of indomethacin of 0.98±5.75. Conclusion: With indomethacin we achieved 72% (75/104) closure rates. The best response to indomethacin was noted in 30–32 wk GA group, while maximum nonresponders were in 32–34 wk; suggesting as gestation increases, response to PG inhibitors decreases. KEYWORDS: Patent ductusarteriosus, Cyclo-oxygenase, Indomethacin, Preterm Neonates, PG inhibitors, Ductus arteriosus, Ductal flow.

Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

To compare the effects of a single-dose interscalene block and general anesthesia (SISB/GA) with the effects of GA only in the early postoperative period after arthroscopic rotator cuff repair by evaluating subjective pain visual analog scale scores and objective pain-related stress biomarkers. Patients refractory to conservative treatment of the affected shoulder were enrolled in this prospective, randomized endpoint study. Patients diagnosed with a rotator cuff tear (1-4cm) based on magnetic resonance imaging were included. Exclusion criteria were small (<1cm) and massive (>4cm) rotator cuff tears. Thirty-one patients each were randomized into the SISB/GA and GA treatment groups. Preoperative pain scores were measured at 6:00 AM on the day of surgery, measured again at 1 and 6hours postoperatively, and then every 6hours until 3days postoperatively. Blood sampling was performed to evaluate the stress biomarkers insulin, dehydroepiandrosterone sulfate, and fibrinogen preoperatively at 6:00 AM on the day of surgery and postoperatively at 18, 42, and 66hours (6:00 AM on postoperative days 1-3). Pain scores were significantly decreased in the SISB/GA group (2.50 ± 0.94) versus the GA group (3.82 ± 1.31) on the day of surgery (P < .001), and especially at 6hours postoperatively (SISB/GA: 2.42 ± 1.43; GA: 4.23 ± 2.17; P < .001). Insulin was decreased significantly in the SISB/GA group (10.55 ± 7.92 μU/mL) versus the GA group (20.39 ± 25.60 μU/mL) at 42hours postoperatively (P= .048). There was no significant change in dehydroepiandrosterone sulfate or fibrinogen over time (P> .05). After arthroscopic rotator cuff repair, an SISB effectively relieved pain on the day of surgery without any complications. In addition, insulin levels were significantly reduced at 42hours postoperatively. Level I, prospective randomized controlled trial.

Pathways for the Reactions Between Neurotoxic Organophosphorus Compounds and Oximes or Hydroxamic Acids

To obtain mechanistic insight into the recently demonstrated detoxification ability of β‐cyclodextrin derivatives containing substituents with oxime or hydroxamic acid residues, analogous glucose derivatives with the same substituents were treated with cyclosarin (GF), tabun (GA), and O‐ethyl S‐[2‐(diisopropylamino)ethyl] methylphosphonothioate (VX) in (Tris)‐HCl buffer (0.1 m, pH 7.40), and the different reaction pathways were studied by 31P NMR spectroscopy and mass spectrometry. Consistent with previous reports, the oxime is phosphonylated by GF, which is followed by elimination of O‐cyclohexyl methylphosphonate to afford a nitrile. Reaction of the hydroxamic acid with GA depends on whether the nitrogen atom of the hydroxamic acid bears a substituent or not. The unsubstituted hydroxamic acid affords a stable phosphate ester lacking the cyanide and the dimethylamino group of GA. If the hydroxamic acid is methylated, the initially formed phosphorylated product undergoes a number of transformations, including cleavage of the C–N bond of the hydroxamic acid. Reaction of the hydroxamic acid with VX involves a Lossen rearrangement. These investigations thus show that all investigated nucleophiles are irreversibly modified upon reaction with nerve agents under the chosen conditions, which indicates that cyclodextrins with oximes or hydroxamic acid as substituents are unlikely to afford catalytic nerve‐agent scavengers.

Efficacy of switching therapy of luteinizing hormone–releasing hormone analogue for advanced prostate cancer

This study was conducted to determine the efficacy of switching therapy with a second-line luteinizing hormone–releasing hormone (LHRH) analogue after prostate-specific antigen (PSA) progression for advanced prostate cancer. We enrolled 200 patients, from December 2005 to September 2013, with nodal positive, metastatic prostate cancer or disease progression after definite treatment receiving continuous LHRH analogue therapy with monthly depot leuprorelin(sc) acetate 3.75 mg/vial (LA) or goserelin acetate(sc) 3.6 mg/vial (GA). If the patients had castration-resistant prostate cancer, the treatment choice of switching therapy (from LA to GA or from GA to LA) prior to starting chemotherapy was given. The LH, testosterone level, and PSA change were recorded. The records showed that there were 127 patients receiving LA as initial ADT therapy, whereas the other 73 patients were in GA therapy. A total of 92 patients received LHRH analogue switching therapy (54 patients switched from LA to GA and 38 switched from GA to LA). The effect of LH and testosterone reduction prior to and after switching therapy was comparable between the two groups, and increased PSA level after 3 months of treatment was seen in both groups (median PSA: 15.7–67.7 ng/mL in the LA to GA group; 15.2–71.4 ng/mL in the GA to LA group). This study concluded that switching therapy for patients with PSA progression after ADT has no efficacy of further PSA response.

General Anesthesia Versus Local Anesthesia in Stereotactic Biopsies of Brain Lesions: A Prospective Randomized Study

Stereotactic biopsy of brain lesions with unknown entities is a common neurosurgical procedure to obtain tumor tissue. Pathologists can then provide an exact diagnosis on which further therapy, such as resection, radiotherapy, or chemotherapy, can be based. These procedures can be performed under local or general anesthesia. In this prospective study, we aim to show whether stress levels are higher for patients who undergo stereotactic biopsy under local or general anesthesia. Between January 2013 and December 2014, we screened 157 patients. Of these, 43 were included and evaluated in this study. Twenty-one patients gave their written consent and were randomized for either local or general anesthesia. A Post Traumatic Stress Score (PTSS) questionnaire was filled out by the patients preoperatively and postoperatively. Also, patients who did not agree to randomization had an opportunity to fill out the PTSS questionnaire. Twenty-two patients agreed only to fill out the stress-level questionnaire but refused randomization. These patients were evaluated as a subgroup. Scores achieved in the PTSS were compared by using the Fisher exact test. Among the randomized patients, 9 underwent the procedure under local anesthesia and 12 under general anesthesia. Median PTSS was 24 preoperatively in the patients who received local anesthesia versus 20 among the patients with general anesthesia (P= 0.37; Fisher exact test). Postoperatively, PTSS was 29.5 in median for patients with local anesthesia versus 23 for patients with general anesthesia (P= 0.30; Fisher exact test). Postoperatively, the PTSS showed a median increase of 5.5 points in the LA and 3 points in the GA group (P= 0.87; Fisher exact test). P values of 0.05 and lower were considered statistically significant. The willingness of patients to undergo randomization in this setting was low (13.3%). Within this highly selective group of patients, there was no significant difference for stress levels in patients who underwent stereotactic biopsy under local anesthesia versus general anesthesia. However, median values indicate a trend for higher stress-level values for patients undergoing local anesthesia.

Thoracic Epidural Versus General Anaesthesia for MRM Surgeries

Background : General anaesthesia is still the preferred technique amongst many practitioners for oncologic breast surgeries. However the TEA technique has a lot of advantages over the conventional GA technique. Objective: We attempted to evaluate the two techniques of anaesthesia for MRM surgeries. Materials and Method: Sixty ASA I-II patients undergoing MRM were randomly assigned to two study groups of 30 patients each. In the TEA group (group T), an epidural catheter was inserted at T7-T8 level, and 8-10 ml of 0.5% bupivacaine was titrated and administered. GA (group G) was induced with 2mg/kg of propofol and was maintained with Isoflurane, intermittent inj. Vecuronium and 70% N2O in oxygen. The authors evaluated the adequacy of anesthesia, surgical condition, post anesthetic recovery, post anesthetic analgesia and patients' satisfaction. Results: The intra operative haemodynamics was comparable in between the two groups. The incidence of nausea and vomiting was significantly lower in the TEA group (16.5% in group T and 39.6% in group G , P = 0.02). The mean immediate VAS score was also lower in TEA group ( group T =2.4 , group G =5.8,P = 0.001). Aldrete recovery score was 9/10 in 1 st hr in a significant proportion in the TEA group (89.1% in group T v/s 59.4% in group G , P = 0.003). Patient satisfaction was significantly higher. The surgeons were however satisfied with both the methods. Conclusion: Use of thoracic epidural technique as a sole anaesthetic technique for MRM surgeries provides adequate operating conditions, better side effect profile, better pain management and patient satisfaction.