Group LE Research Articles

Treatment results in the different surgery of intradural extramedullary tumor of 122 cases.

Study DesignA retrospective study of intradural extramedullary tumor.ObjectiveTo compare the treatment results in the different surgeries of spinal intradural extramedullary tumor.MethodsThe study retrospectively reviewed 122 patients. The minimally invasive surgery (MIS) group was divided into Group A (hemilaminectomy + tumor microscopic excision) and Group B (laminectomy + tumor microscopic excision + pedicle screw fixation). Meanwhile, the non-MIS group was divided into Group C (hemilaminectomy + tumor excision), Group D (laminectomy + tumor excision), and Group E (laminectomy + tumor excision + pedicle screw fixation). In order to study postoperative spinal stability, we simultaneously divided all of the subjects into three categories, namely Group HE: hemilaminectomy + tumor excision; Group LE: laminectomy + tumor excision; and Group LEPSF: laminectomy + tumor excision + pedicle screw fixation.ResultsThe MIS group exhibited fewer postoperative complications (p<0.05), better short-term clinical efficacy (p<0.05) and less non-surgical cost (p<0.05) than in non-MIS group. The rate of postoperative spinal instability in hemilaminectomy was lower than in laminectomy in a single spinal segment (p<0.05). The rate of postoperative spinal instability in laminectomy + pedicle screw fixation was lower than in hemilaminectomy and laminectomy in two or more spinal segments (p<0.05).ConclusionIn the case of appropriate surgical indications, minimally invasive surgery for intradural extramedullary tumor is a useful method that can successfully produce good clinical results and reduce non-surgical cost. In addition, pedicle screw fixation helps avoid spinal postoperative instability.

Development and validation of a quality of life assessment tool for use in kennelled dogs (Canis familiaris)

There is currently no objective and validated quality of life assessment tool available to assess the quality of life of domestic dogs in kennels. This study aimed to develop a validated scoring system to assess the quality of life of dogs kennelled in rehoming centres. Objective animal-based measures of welfare and quality of life, identified from the scientific literature, were included in the scoring system to indicate negative and positive quality of life. Each item was scored using a binary system to minimise subjectivity in scoring. Dogs were recruited from 13 rehoming centres into four different treatment groups: group NS consisted of dogs that had newly arrived at the shelter and received a standard husbandry routine; group NE consisted of dogs that had newly arrived at the shelter and received an enrichment programme; group LS consisted of dogs that had been in the centre for more than 30 days and received a standard husbandry routine; and group LE consisted of dogs that had been in the shelter for more than 30 days and received an enrichment programme. Inter-observer reliability of each item was established and internal consistency of the entire score was assessed: seven unreliable items were removed and the scoring system was refined. 26.7% (ICC1=0.267) of the variation in quality of life scores was explained by rehoming centre group membership, and rehoming centre groups could reliably be differentiated in terms of quality of life scores (ICC2=0.832). Therefore, quality of life scores varied between rehoming centres but other factors must exist to explain the remaining 73.3% of the variation in quality of life scores. The addition of an enrichment programme and later recruitment onto the study increased quality of life scores by 0.035±0.027 (SE) and 0.086±0.027 (SE), respectively. These increases represent an 8.27% and a 20.33% improvement on the overall (across all treatment groups) mean QoL score (0.423). Evidence of good content, construct and criterion validity was established, however, internal consistency was found to be poor, indicating that the reliability of the score could be improved.

Mesohepatectomy versus extended hemihepatectomy for centrally located hepatocellular carcinoma

Extended hemihepatectomy is usually recommended to treat large centrally located hepatocellular carcinoma (HCC). However, the morbidity and mortality are high because of the postoperative liver failure. Mesohepatectomy is seldom used because of its technical complexity. This study aimed to evaluate the short-term and long-term curative effect of mesohepatectomy. From January 2002 to September 2008, a total of 198 consecutive patients with centrally located HCC underwent hepatectomy in our department. According to the surgical procedures, they were divided into mesohepatectomy (group M, n=118), extended right hemihepatectomy (group RE, n=47) and extended left hemihepatectomy (group LE, n=33) groups. The surgical techniques, clinical pathological characteristics and outcomes were compared between group M, group RE and group LE. The operative time of group M was significantly longer than that of the other two groups (P<0.05); however the total bilirubin on postoperative day 3 in group M was the lowest among the three groups (P<0.01). In group M, the number of the patients whose resection margin achieving 1 cm was significantly lower than that of the other two groups (P<0.05). The mortality rates in groups M, RE and LE were 2.5%, 8.5% and 3.0%, respectively (P>0.05). The morbidity rate in group M was significantly lower than that in group RE (37.3% vs 55.3%, P=0.034), but not in group LE (37.3% vs 24.2%, P=0.163). The biliary leakage tended to be more common in group M (10.2%, P>0.05). The incidence of postoperative liver failure in group M was significantly lower than that in group RE (1.7% vs 10.6%, P=0.032), but not in group LE (1.7% vs 6.1%, P=0.208). The 1-, 3- and 5-year tumor-free survival rates and the overall survival rates after mesohepatectomy were 53.4%, 30.5% and 16.9% and 67.8%, 45.5% and 28.9%, respectively. Mesohepatectomy is a safe and effective technique for centrally located HCC patients. Compared with extended right hemihepatectomy, mesohepatectomy can retain residual liver volume to the maximum limit and reduce postoperative liver failure rate. But no significant advantage was found compared mesohepatectomy to extended left hemihepatectomy.

Gromwell (Lithospermum erythrorhizon) Supplementation Enhances Epidermal Levels of Ceramides, Glucosylceramides, β-Glucocerebrosidase, and Acidic Sphingomyelinase in NC/Nga Mice

We have previously reported that dietary gromwell (Lithospermum erythrorhizon; LE) prevents the development of atopic dermatitis (AD) with increased epidermal levels of total ceramide (Cer), the major lipid maintaining epidermal barrier. In this study, we investigated whether the increased level of total Cer induced by dietary LE would be related to the altered metabolism of glucosylceramide (GlcCer) and sphingomyelin (SM), two major precursor lipids in Cer generation. NC/Nga mice, an animal model of AD, were fed a control diet (group CA: atopic control) or a diet with 70% ethanol LE extracts (1% in diet; group LE) for 10 weeks. Individual species of Cer, GlcCer, and SM were analyzed by high-performance thin layer chromatography. In the epidermis of group CA, total Cer (including Cer2 and Cer5-7) and total GlcCer (including GlcCer-B/C/D) were significantly reduced; these levels in group LE were increased to levels similar to the normal control group of BALB/c mice (group C). In addition, protein expressions and activities of β-glucocerebrosidase (β-GlcCer'ase) and acidic sphingomyelinase (aSMase), enzymes for GlcCer or SM hydrolysis, respectively, were increased in group LE. However, alterations of Cer1, Cer3/4, GlcCer-A, and all SM species (including SM1-3) were not significant among groups C, CA, and LE. Dietary gromwell increases GlcCer-B/C/D, and further enhances the generation of Cer2 and Cer5-7 with high protein expressions and activities of β-GlcCer'ase and aSMase.

Effects of emulsified isoflurane preconditioning on expression of platelet-activating factor and its receptor in brain during focal cerebral ischemia-reperfusion in rats

Objective To investigate the effects of emulsified isoflurane preconditioning on the expression of platelet-activating factor (PAF) and PAF receptor during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-two healthy adult male SD rats weighing 250-300 g were randomly divided into 4 groups ( n =8each):group sham operation (group S); group I/R; group emulsified isoflurane preconditioning( group EI) and group lipid emulsion (group LE).Focal cerebral I/R was induced by 2 h occlusion of middle cerebral artery followed by reperfusion in groups I/R,EI and LE.8％ emulsified isoflurane 10.5 ml/kg and 30％ lipid emulsion 10.5 ml/kg were injected intraperitoneally at 24 h before cerebral ischemia in groups EI and LE respectively.The neurologic deficit score (NDS) (0 =no deficit,4 =unable to control) was evaluated at 12 h of reperfusion.Venous blood samples were collected for measurement of plasma PAF concentration.The animals were then sacrificed and their brains removed for determination of infarct size (by TTC staining) and PAF receptor expression in hippocampus and cerebral cortex (by Western blot).Results Focal cerebral I/R significantly increased NDS,the infarct size,plasma PAF concentration and PAF receptor expression in cerebral cortex and hippocampus in group I/R as compared with group S.Emulsified isoflurane preconditioning significantly attenuated the focal cerebral I/R induced above changes in group EI as compared with group I/R,but there was no significant difference between groups I/R and LE.Conclusion Emulsified isoflurane preconditioning can attenuate focal cerebral I/R injury by inhibiting PAF and PAF receptor expression. Key words: Isoflurane; Fat emulsions, intravenous; Reperfusion injury; Platelet activating factor; Receptors, cell surface; Brajn

Effect of emulsified isoflurane preconditioning on postsynaptic density protein 95 activation in brain during focal cerebral ischemia-reperfusion injury in rats

Objective To investigate the effect of emulsified isoflurane preconditioning on postsynaptic density protein 95 (PSD95) activation in brain during focal cerebral ischemia-reperfusion (I/R)injury in rats.Methods Thirty-two pathogen-free male SD rats weighing 280-300 g were randomly divided into 4 groups (n =8each): sham operation group(group S),group I/R,emulsified isoflurane group(group EI) and lipid emulsion group(group LE).Focal cerebral I/R was induced by middle cerebral artery occlusion for 2 h followed by reperfusion.8％ emulsified isoflurane 10.5 ml/mg or 30％ lipid emulsion 10.5 ml/mg was injected intraperitoneally at 24h before I/R in groups EI and LE respectively.The neurologic deficit score (NDS) was evaluated at 6 h of reperfusion and then 4 rats were sacrificed,and brains were removed for determination of phosphorylatied PSD95 (pPSD95) expression in ischemia cortex and hippocampus by Western blot.Four rats were sacrificed at 24 h of reperfusion and then their brains were removed for determination of infarct volume percentage.Results NDS,infarct volume percentage and pPSD95 expression in ischemia cortex and hippocampus were higher in groups I/R,EI and LE than in group S( P ＜ 0.01 ).NDS,infarct volume percentage and pPSD95 expression in ischemia cortex and hippocampus were lower in group EI than in group I/R( P ＜ 0.05).There was no significant difference in NDS,infarct volume percentage and pPSD95 expression between groups I/R and LE(P ＞ 0.05).Conclusion Emulsified isoflurane preconditioning can attenuate focal cerebral I/R injury in rats by inhibiting PSD95 activation in brain. Key words: Isoflurane ; Fat emulsions, intravenous ; Membrane proteins; Reperfusion injury ; Brain; Ischemic preconditioning

The effect of combined ephedrine and lidocaine pretreatment on pain and hemodynamic changes due to propofol injection

Objectives Injection pain and hypotension are two main adverse effects of propofol that discourage uniform acceptation. The aim of this study was to compare the effect of ephedrine-lidocaine combination with lidocaine and ephedrine alone on injection pain and hemodynamic changes caused by propofol injection. Methods One hundred and sixty five patients were randomly allocated to five groups to receive either lidocaine 0.5 mg/kg (Group L) alone, ephedrine 30 μg/kg (Group E30) alone, ephedrine 70 μg/kg (Group E70) alone, lidocaine 0.5 mg/kg-ephedrine 30 μg/kg Group LE, or 2 mL saline (Group S). One minute after the respective study solution was given propofol 2 mg/kg was injected. Face pain scale and verbal rating scale were then evaluated. The mean arterial blood pressure (MAP) and heart rate (HR) were recorded before injection of the test solution, just before the intubation, and 1 minute after intubation. Results Patients in the Group L and Group LE showed significantly smaller pain scores compared with the saline group (Group S) [95% confidence interval (CI) 0.50–1.50; p = 0.003 and 95% CI 1.000–1.500; p = 0.004, respectively). The pain scores in Group E30 and Group E70 failed to show a significant difference with that of the Group S ( p = 0.193 and p = 0.184, respectively). The changes of MAP before and after propofol injection between the Group L versus Group E30, Group E70, and Group LE were found to be significant (95% CI 5.27–14.49; p = 0.000), (95% CI 4.72–16.39; p = 0.001), and (95% CI 5.94–16.47; p = 0.001), respectively. The HR changes, before and after propofol injection, tended to be smaller in ephedrine groups than in Group L and Group S ( p < 0.05). Conclusion Pretreatment with combination of small-dose ephedrine and lidocaine could reduce the incidence and intensity of propofol-induced pain and also result in more stable hemodynamic profile, but however, the combination of two drugs failed to work better in further reduction of pain.

Combined spinal epidural and epidural volume extension: Interaction of patient position and hyperbaric bupivacaine

Background:Previous trials have documented failure of block augmentation with epidural volume extension, when applied after the intrathecal injection of hyperbaric bupivacaine was made in sitting position. However, there is no study comparing the effect of change in patient position during block performance, on the results of epidural volume extension.Materials and Methods:The study was conducted in two parts in American Society of Anesthesiologists physical status I or II parturients scheduled for elective cesarean section under regional anesthesia. In the first part, 28 patients were randomized to one of the two groups, depending on whether epidural volume extension was applied following the block in sitting (group SE) or lateral position (group LE) (n=14 each). In the second part of the study another 28 patients were recruited and randomized to receive the block in sitting (group S) or lateral (group L) position (n=14 each), without epidural volume extension. All patients received combined spinal epidural block using needle-through-needle technique with intrathecal injection of 9 mg hyperbaric bupivacaine (0.5%) and 10 μg fentanyl. Epidural volume extension was performed using 5 ml normal saline in groups SE and LE.Results:In the first part of the study, the maximum sensory block level was higher in group LE vs. SE (P<0.05). In the second part of the study, no significant difference was seen in the maximum sensory level between group S and group L (P>0.05).Conclusions:If epidural volume extension is being applied with intention of rapid extension of sensory block when hyperbaric bupivacaine has been injected intrathecally, the combined spinal epidural block should be performed in lateral position rather than in the sitting position.

Effect of 8% emulsified isoflurane postconditioning on focal cerebral ischemia-reperfusion injury in rats

Objective To investigate the effect of postconditioning with 8 % emulsified isoflurane (EI) on focal cerebral ischemia-reperfusion (I/R) injury in rats. Methods Forty-eight male SD rats weighing 260-300 g were randomly divided into 6 groups ( n = 8 each): group Ⅰ sham operation (group S); group Ⅱ I/R; group Ⅲ,Ⅳ, Ⅴ 3 different doses of EI (group L-EI, M-EI, H-.EI) and group Ⅵ lipid emulsion (group LE). Right middle cerebral artery occlusion (MCAO) was induced by inserting a nylon thread 0.24 mm in diameter into right internal carotid artery. The thread was threaded cranially until resistance was met. MCAO was maintained for 2 h followed by 24 h reperfusion in group Ⅱ-Ⅵ. In group Ⅲ-Ⅴ EI 3.5, 7.0 and 10.5 ml/kg were injected intraperitoneally (IP) immediately before reperfusion respectively. In group LE 30% lipid emulsion 10.5 ml/kg was given instead of EI. The neurologic deficit was assessed and scored (0 = normal, 4 = unable to move and unconscious). The animals were then killed and infarct size was measured. Results IP 8% emulsified isoflurane 7.0 and 10.5 ml/kg injected before reperfusion significantly reduced neurologic deficit scores and infarct size in group M-EI and H-EI as compared with group I/R. Conclusion Postconditioning with 8% emulsified isoflurane can protect the brain against focal cerebral I/R injury. Key words: Isoflurane; Lipid emulsions, intravenous; Reperfusion injury; Brain; Ischemic postconditioning

Variation of human milk oligosaccharides in relation to milk groups and lactational periods

Human milk oligosaccharides, representing the third largest fraction of human milk, have been assigned important protective functions for newborns acting as bifidogenic substrates or as inhibitory agents towards pathogens. Using high-pH anion-exchange chromatography and an enzyme test kit, twenty oligosaccharides and lactose were determined in milk samples of German women from days 3 to 90 postpartum. Twenty-two secretor mothers with Lewis blood group Le(a-b+) synthesised all twenty oligosaccharides, and could be assigned to milk group 1. Five non-secretor mothers (Le(a+b-)) produced all oligosaccharides with the exception of α1,2-fucosylated compounds (milk group 2), whereas three secretor mothers with blood type Le(a-b-) lacked α1,4-fucosyloligosaccharides, corresponding to milk group 3. Secretor women of milk groups 1 and 3 synthesised significantly higher amounts of total neutral oligosaccharides and of several total core structures (e.g. lacto-N-tetraose) than non-secretor women. Generally, these oligosaccharides significantly decrease during the first 3 months postpartum. By comparing fucosyloligosaccharides within and among the three milk groups, insight into their biosynthesis could be gained. Six acidic oligosaccharides without fucose residues were detected in milk samples of all mothers. Regression analysis confirmed that total acidic oligosaccharides declined threefold during the study period. Milk samples corresponding to the three milk groups exhibited significant qualitative and quantitative differences during the first 3 months of lactation. It can be assumed that particularly milk of non-secretor women (milk group 2) exerts a modified biological protection in the babies in comparison with milks of secretors (groups 1 and 3).

Plant polyphenols associated with vitamin E can reduce plasma lipoperoxidation in dairy cows given n-3 polyunsaturated fatty acids

Diets rich in n-3 polyunsaturated fatty acids (PUFA) improve the nutritional value of ruminant products but also increase the risk of lipoperoxidation in plasma and tissues. The relative effectiveness of dietary antioxidants such as vitamin E (vit E) given alone or with plant extracts rich in polyphenols (PERP) containing rosemary, grape, citrus, and marigold was investigated in the plasma of mid-lactation dairy cows given diets enriched in 18:3 n-3. For a 30-d period, the animals were given a maize silage-based diet (control group C, n=6) or the same basal diet supplemented with extruded linseed rich in 18:3 n-3 [50g of oil/kg of diet dry matter (DM); group L, n=6], extruded linseed+vit E (375 international units/kg of diet DM; 7,500 IU/cow per day; group LE, n=6), or extruded linseed+vit E+PERP (10g/kg of diet DM; group LEP, n=5). Plasma susceptibility to lipoperoxidation was evaluated using in vitro parameters of conjugated diene formation (lag phase and maximum oxidation rate). Plasma indicators of lipoperoxidation and antioxidant status were analyzed in the 4 experimental groups as well as the fatty acid (FA) composition of total plasma lipids. At d 30, group L significantly increased plasma cholesterol esters (+57%) and phospholipids (+35%) compared with group C. It also increased plasma n-3 PUFA (4.7-fold increase) to the detriment of n-6 PUFA (−30%), leading to a higher peroxidizability index (+20%). Plasma in vitro lipoperoxidation was higher in group L (rich in 18:3 n-3) than in group C. Vitamin E alone had no effect on lipoperoxidation, whereas vit E in association with PERP lowered lipoperoxidation by increasing the resistance time against peroxidation (+47%) and by decreasing the oxidation rate (−48%) compared with group L at d 30. Surprisingly, in vivo plasma lipoperoxidation estimated by the plasma level of the major lipoperoxidation product (malondialdehyde) was not significantly increased in group L. This study shows, for the first time, that PERP supplied in association with vit E were able to reduce lipoperoxidation in lactating cows given a diet rich in 18:3 n-3, thereby helping to protect cows against the deleterious consequences of lipoperoxidation and potentially ensuring antioxidant potential for 18:3 n-3–enriched dairy products.

Oral supplementation of Lithospermum erythrorhizon prevents the development of atopic dermatitis with reducing ceramide degradation in the epidermis of NC/Nga mice

Lithospermum erythrorhizon Sieb. et Zucc. (LE) is widely used in the treatment of abnormal skin conditions, but its systemic efficacy, especially in atopic dermatitis (AD), is not clear. To examine the systemic efficacy of LE on the clinical manifestation of AD-like skin lesions, NC/Nga mice, a murine model of AD, were fed a control diet (group CA: atopic control) or a diet with a 70% ethanol extract from 5% LE (group LE) for 10 weeks. In group LE, the clinical manifestation of AD-like skin lesions was prevented as the level of serum IgE, epidermal hyperproliferation, and the number and duration of scratching episodes, which were greater in group CA, were significantly reduced to a similar level of the normal control group of BALB/c mice (group C). In addition, the level of ceramides, the major lipid maintaining the epidermal barrier, in the epidermis of group LE was increased, and was inversely associated with a decreased protein level of ceramidase, an enzyme of ceramide degradation. However, the mRNA and the protein levels of serine palmitoyl transferase (enzyme for de novo ceramide synthesis) in groups C, CA and LE did not differ. It was demonstrated that oral supplementation with LE extract prevented the development of atopic dermatitis with reducing ceramide degradation coupled with a low expression of ceramidase protein.

Oral supplementation of gromwell (Lithospermum erythrorhizon) extract prevents the development of atopic dermatitis with reducing ceramide degradation in the epidermis of NC/Nga mice

Abstract Gromwell (Lithospermum erythrorhizon) is widely used in the treatment of abnormal skin condition, but its systemic efficacy, especially in atopic dermatitis (AD), is not clear. To examine the systemic efficacy of gromwell on the clinical manifestation of AD‐like skin lesions, NC/Nga mice, a murine model of AD, were fed control diet (group CA: atopic control) or diet with 70% ethanol extracts from 5% gromwell (Group LE) for 10 wks. In group LE, the clinical manifestation of AD‐like skin lesion was prevented as the level of serum IgE, epidermal hyperproliferation, and the number and duration of scratching episode, which were greater in group CA, were significantly reduced to the similar level of normal control group of BALB/c mice. In addition, the level of ceramides, the major lipid maintaining epidermal barrier, in the epidermis of group LE was increased, which was inversely associated with a decreased protein level of ceramidase, an enzyme of ceramide degradation. However, mRNA and protein levels of serine palmitoyl transferase (enzyme for de novo ceramide synthesis) in groups C, CA and LE did not differ. We demonstrate that oral supplementation of gromwell extracts prevents the development of atopic dermatitis with reducing ceramide degradation coupled with a low expression of ceramidase protein.

The role of the antioxidants lycopene and vitamin E in the prevention of halothane-induced hepatotoxicity

The aim of this study was to examine the effects of lycopene and vitamin E on halothane-induced hepatotoxicity. Thirty-five male albino Wistar rats were studied. The control group (group C) did not receive any treatment. Rats in group H were exposed to 1.5% halothane (in 50% oxygen/50% air) for 2 h on days 10 and 13. Group L received 25 mg/kg/day lycopene, group E received 100 IU/kg/day vitamin E and group LE received lycopene and vitamin E for 13 days. Similar to group H, groups L, E and LE were exposed to halothane. Total antioxidant capacity (TAC), total oxidant level (TOL) and sulfhydryl=thiol groups (SH) were measured. Histopathological examinations were carried out using light microscopy, and histopathological findings were graded on a scale of 0-6. There were no significant differences among the groups in TAC, TOL and SH values (P > 0.05). Liver injury was observed in the four treatment groups; the mean degree of damage was more severe in group H compared to groups E, L and LE: 2.14 +/- 0.37, 1.50 +/- 0.54, 0.85 +/- 0.69 and 0.83 +/- 0.75, respectively. This study found that both lycopene and vitamin E reduce halothane-induced hepatotoxicity, although the effect of vitamin E was not statistically significant.

Local infiltration of epinephrine-containing lidocaine with bicarbonate reduces superficial bleeding and pain during labor epidural catheter insertion: a randomized trial

Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain. After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n=20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lidocaine 1.5% with epinephrine 1:200000, and group LEB: lidocaine 1.5% with epinephrine 1:200000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anesthetic infiltration and epidural catheter movement during labor. Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular disturbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6+/-2.2 vs. 2.6+/-1.8; P=0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor. Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.

Epinephrine in Local Anesthetic Cancels Increase in Tongue Mucosal Blood Flow after Stellate Ganglion Block in Rabbit

The goal of this study was to compare oral mucosal blood flow and duration of anesthetic action after stellate ganglion block (SGB) using lidocaine, with or without epinephrine, and discuss the effect of epinephrine on SGB. Duration of anesthetic action was defined as elapsed time from finish of injection to recovery of common carotid blood flow (CCBF) to within+/-5% of respective control value. Male Japan White rabbits were anesthetized with isoflurane and mechanically ventilated. Common carotid blood flow and tongue mucosal tissue blood flow (TMBF) were measured with an ultrasound flowmeter and laser Doppler flowmeter, respectively. End-tidal partial pressure of carbon dioxide (ETCO(2)) and hemodynamic variables were continuously monitored, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). For SGB, the tip of the needle was placed on the left transverse process of the cervical vertebra, 1-2 mm caudal to the cricoid cartilage. Either 0.1 ml of 1% lidocaine (Group L) or 1% lidocaine containing 10 mug/ml epinephrine (Group LE) was injected for SGB. There were no differences in values at immediately before SGB and at the time when maximal change in CCBF was observed after SGB for ETCO(2), HR, SBP, DBP or MAP in either group. CCBF showed a significant increase in Group L after SGB. In contrast, CCBF only showed a slight increase in Group LE. TMBF showed a significant increase in Group L after SGB, but not in Group LE. No differences in time required for maximal effect were observed between the two groups. In contrast, duration of anesthetic action in Group LE was significantly longer than that in Group L. Addition of epinephrine to local anesthetic solutions is not suitable for SGB, as it may not facilitate an increase in tissue blood flow, which is the primary objective of SGB.

The Effect of Combined Ephedrine and Lidocaine Pretreatment on Tracheal Intubation Condition and Maximum Neuromuscular Block after Rocuronium Administration

Background: Rocuronium is a nondepolarizing muscle relaxants used for trying rapid-sequence intubation due to its relatively rapid onset of action and low side effects. Methods to further reduce the onset time of a muscle relaxant include increasing the dose of muscle relaxant, pretreatment for potentiating neuromuscular block of the muscle relaxants or increasing the cardiac output and muscle blood flow. The purpose of this study was to examine the pretreatment effect of combined lidocaine and ephedrine, as a pretreatment, on the onset time and intubation conditions of rocuronium-induced neuromuscular block in adults. Methods: Sixty ASA physical stati 1 and 2 patients were randomly allocated to four groups. Normal saline 10 ml was administered to Group NS prior to induction, lidocaine (1.5 mg/kg) to Group L, ephedrine (70μg/kg) to Group E, and combined lidocaine (1.5 mg/kg) and ephedrine (70μg/kg) to Group LE. Anesthesia was induced with propofol (2.0 mg/kg) and rocuronium (0.6 mg/kg). Intubation was performed 45 seconds after the administration of rocuronium and the intubation conditions then evaluated. The change in the mean arterial pressure and heart rate were checked and compared during the peri-induction periods. Results: There were no differences in the hemodynamics between the four groups. The intubation conditions were graded as good to excellent in 33.3, 53.3, 66.7 and 93.3% of patients in NS, L, E and LE groups, respectively. The intubation conditions in group LE were significantly better than those in group NS (P ＜ 0.05). Conclusions: The above results demonstrated that pretreatment with a combination of ephedrine and lidocaine, following rocuronium, improves the tracheal intubation conditions. (Korean J Anesthesiol 2007; 53: 325～31)

Lectinochemical studies on the affinity of Anguilla anguilla agglutinin for mammalian glycotopes

Anguilla anguilla agglutinin (AAA) is a fucose-specific lectin found in the serum of the fresh water eel. It is suggested to be associated with innate immunity by recognizing disease-associated cell surface glycans, and has been widely used as a reagent in hematology and glycobiology. In order to gain a better understanding of AAA for further applications, it is necessary to elucidate its binding profile with mammalian glycotopes. We, therefore, analyzed the detailed carbohydrate specificity of AAA by enzyme-linked lectinosorbent assay (ELLSA) with our extended glycan/ligand collection and lectin-glycan inhibition assay. Among the glycans tested, AAA reacted well with nearly all human blood group A h (GalNAcα1→3[ lFucα1→2]Gal), B h (Galα1→3[ lFucα1→2]Gal) , H lFucα1→2Gal) and Le b (Fucα1→2Galβ1→3[Fucα1→4]GlcNAc) active glycoproteins (gps), but not with blood group Le a (Galβ1→3[Fucα1→4]GlcNAc) substances, suggesting that residues and optimal density of α1-2 linked lFuc to Gal at the non-reducing end of glycoprotein ligands are essential for lectin-carbohydrate interactions. Blood group precursors, Galβ1-3GalNAc ( T), GalNAcα1-Ser/Thr ( Tn) containing glycoproteins and N-linked plasma gps, gave only negligible affinity. Among the mammalian glycotopes tested, A h, B h and H determinants were the best, being about 5 to 6.7 times more active than lFuc, but were weaker than p-nitrophenylαFuc indicating that hydrophobic environment surrounding the lFuc moiety enhance the reactivity. The hierarchy of potency of oligo- and monosaccharides can be ranked as follows: p-nitrophenyl-αFuc > A h, B h and H > lFuc > lFucα1→2Galβ1→4Glc (2′-FL) and Galβ1→4[ lFucα1→3]Glc (3′-FL), while LNDFH I ( Le b hexa-), Le a, Le x (Galβ1→4[Fucα1→3]GlcNAc), and LDFT (gluco-analogue of Le y ) were inactive. From the present observations, it can be concluded that the combining site of AAA should be a small cavity-type capable of recognizing mainly H/crypto H and of binding to specific polyvalent ABH and Le b glycotopes.

The Effects of Exogenous Epinephrine on a Convulsive Dose of Lidocaine: Relationship with Cerebral Circulation

In order to understand why exogenous epinephrine decreases the convulsive dose of lidocaine, the authors investigated cerebral circulation and plasma lidocaine concentrations in Wistar rats under general anesthesia. In the first experiment, baseline evaluations of each rat's electroencephalogram (EEG), mean arterial pressure (MAP), regional cerebral blood flow (r-CBF), cerebrospinal fluid (CSF) pressure, and cerebral perfusion pressure (CPP) were made. The rats were then assigned to one of three groups: Group L (n=6) received intravenous lidocaine (5 mg/kg/min); Group LE (n=6) received intravenous lidocaine (5 mg/kg/min) and epinephrine (2.5 kg/kg/min); and Group E (n=5) received intravenous epinephrine (2.5 microg/kg/min). Cumulative doses of lidocaine at the onset of EEG spike activity in Groups L and LE were compared. Blood-brain barrier (BBB) permeability was evaluated by observing extravasation of Evans blue (EB) dye. In the second experiment, additional rats were allocated to two treatment groups: Group L' (n=6) received intravenous lidocaine (5 mg/kg/min); Group LE' (n=6) received intravenous lidocaine (5 mg/kg/min) and epinephrine (2.5 microg/kg/min). Brain tissue oxygen partial pressure (PtO2) was monitored during infusion, and arterial and sagittal sinus blood samples were obtained immediately after the onset of EEG spike activity to determine plasma lidocaine concentration. The convulsive dose of lidocaine was significantly decreased when lidocaine was administered with epinephrine (Group L: 61.5+/-5.3 mg/kg (mean+/-SD); Group LE: 30.1+/-4.0 mg/kg) (p < 0.05), but there were no significant differences in plasma lidocaine concentration among these groups. R-CBF, CSF pressure, and CPP immediately before EEG spike activity were higher in Group LE than in Group L. Neither decreased PtO2 nor extravasation of EB was observed in rats treated with epinephrine and lidocaine, excluding cerebral ischemia and BBB breakdown from possible mechanisms by which epinephrine decreased the convulsive dose of lidocaine. None of the rats in Group E exhibited EEG findings suggestive of a preconvulsive state, ruling out a convulsive effect of epinephrine itself. The results suggest that an increase in lidocaine supply to the brain caused by increased CBF causes the low cumulative dose of lidocaine at the onset of convulsion in rats given lidocaine plus epinephrine.

Life cycle analysis of the newspaper le monde

On behalf of the French press group Le MONDE, four newspapers have been examined in a Life Cycle Assessment study. The products were the newspaper actually produced and sold in 1995, two other 1995 versions with reduced amounts of unsold circulation and an improved version manufactured under adequate management control and using paper, inks, printing plates and packaging material with lower environmental impacts. Results include the following • An improved distribution, reducing the unsold circulation by 40% and 80%, does not reduce significantly the relative effect score of the different environmental impacts because the effects of the internal management are predominant. • The development of an improved version of Le MONDE depends more on managerial will than on technical decisions. • The use of vegetal inks improves significantly the air quality inside the printing plant as well as the photochemical oxidant potential.