Group N3 Research Articles

Temporal dynamics of awakenings from slow-wave sleep in non-rapid eye movement parasomnia.

Non-rapid eye movement parasomnia disorders, also called disorders of arousal, are characterized by abnormal nocturnal behaviours, such as confusional arousals or sleep walking. Their pathophysiology is not yet fully understood, and objective diagnostic criteria are lacking. It is known, however, that behavioural episodes occur mostly in the beginning of the night, after an increase in slow-wave activity during slow-wave sleep. A better understanding of the prospect of such episodes may lead to new insights in the underlying mechanisms and eventually facilitate objective diagnosis. We investigated temporal dynamics of transitions from slow-wave sleep of 52 patients and 79 controls. Within the patient group, behavioural and non-behavioural N3 awakenings were distinguished. Patients showed a higher probability to wake up after an N3 bout ended than controls, and this probability increased with N3 bout duration. Bouts longer than 15 min resulted in an awakening in 73% and 34% of the time in patients and controls, respectively. Behavioural episodes reduced over sleep cycles due to a reduction in N3 sleep and a reducing ratio between behavioural and non-behavioural awakenings. In the first two cycles, N3 bouts prior to non-behavioural awakenings were significantly shorter than N3 bouts advancing behavioural awakenings in patients, and N3 awakenings in controls. Our findings provide insights in the timing and prospect of both behavioural and non-behavioural awakenings from N3, which may result in prediction and potentially prevention of behavioural episodes. This work, moreover, leads to a more complete characterization of a prototypical hypnogram of parasomnias, which could facilitate diagnosis.

Top-down internal communication and its importance for the sustainability of agricultural organizations from the perspective of Tomas Bata´s management philosophy.

The benefits of internal communication not only can be associated with higher performance, but also with increased awareness of the values within an organization, setting and achieving objectives, getting involved in beneficial activities, encouraging employees' personal development and, last but not least, educating and motivating employees to take responsibility. A responsible working environment facilitates effective internal communication, which is in line with the principles of the Bata Management System. The aim of this paper is to evaluate whether setting top-down internal communication is in line with the sustainable principles of Tomas Bata in organizations in the Czech Republic. The article assesses workplace communication and relationships, including social sustainability and social responsibility, focusing on their added value for corporate practice in all areas of business. The study is based on quantitative research in organizations across sectors and qualitative research in agricultural organizations (questionnaire survey n1 = 183; focus group n3 = 5), using the tools of descriptive statistics, logistic regression and cluster analysis. The results have shown that combining methods of top-down communication is crucial for communicating information efficiently, stimulating employees and achieving the organization´s objectives and that Tomas Bata´s philosophy concerning communication setting can be implemented even more easily in the current digital age than it was in the past if organizations are interested. The research contributes to a better understanding of how the Bata Management System can be applied within each organization, how effective communication settings will help prevent conflicts that workers are engaged in, increase their stabilization, and facilitate the application of Bata's sustainable legacy in the international space. Research makes a significant contribution to advancing knowledge of effective communication from the perspective of Bata for the sustainability of agricultural organizations where the principles have not yet been explored. This is evidenced by the zero overlap with previously published articles despite the rapid progress of research and technology.

Synthesis of functionalized sulfonamides as antitubercular agents

Using up-to-date methods for synthesis and analysis, 51 sulfonamides were prepared for use as tools in antitubercular drug discovery. The synthetic efforts were centered on varying substituents at three key structural units implicated in antimicrobial activity, namely the sulfonyl group, nitrogen N1 and nitrogen N4. Procedures were specific to the sites of functionalization. Preliminary biological assessments are included here on selected compounds. The results suggest that the compounds may be useful in the exploration of the likely interactions of sulfa drugs with enzymes found in tuberculosis (dihydropteroate synthase) or its human host (N-acetyltransferase), interactions that result in drug activity or drug de-activation, respectively.

Production performance, egg quality, and uterine gene expression for layers as affected by N-Carbamylglutamate supplementation.

Supplementation of exogenous additives is a strategy to improve laying performance of layers by regulating uterine function. N-Carbamylglutamate (NCG) as an activator for endogenous arginine synthesis has the potential to regulate the laying performance of layers, but its effects have not been fully understood. This study investigated the effects of dietary supplementation of NCG on production performance, egg quality, and uterine gene expression in layers. A total of 360 45-week-old layers with a genetic line of Jinghong No. 1 were used in this study. The experimental period was 14 weeks. All birds were divided into 4 treatments with 6 replicates per treatment and 15 birds per replicate. Dietary treatments were based on a basal diet and supplemented with 0, 0.08, 0.12, or 0.16% NCG to form C, N1, N2, and N3 groups. We found that layers in group N1 had higher egg production rate than those in group C. Egg weight was significantly reduced, while eggshell thickness was significantly improved, by treatment. However, the albumen height and Haugh unit were the lowest in group N3. Based on the above results, groups C and N1 were selected for further transcriptomics analysis of uterine tissue by RNA-seq. More than 7.4 Gb clean reads and 19,882 tentative genes were obtained using the Gallus gallus genome as a reference. Transcriptomics analysis in uterus tissue revealed that 95 differentially expressed genes (DEGs) were upregulated and 127 DEGs were downregulated. Functional annotation and pathway enrichment analysis showed that DEGs in uterine tissue were mainly enriched in glutathione metabolism, cholesterol metabolism, and glycerolipid metabolism, etc. Vitamin A metabolism-related gene, RBP1, nutrient transport-related gene, ALB, protein synthesis-related gene, METTL21C, and calcium transport-related gene, RYR2, CACNB2, RAMP3, and STAC, were significantly regulated by 0.08% NCG supplementation. Therefore, we concluded that NCG supplementation at a dose of 0.08% improved production performance and egg quality of layers by regulating uterus function.

Add-on therapy with different non-steroidal anti-inflammatory agents in the management of non-infectious, non-necrotizing episcleritis

Background: Episcleritis is a common ocular inflammatory disease that can cause red eye. It is usually managed using single or combined topical corticosteroids and topical or oral non-steroidal anti-inflammatory drugs (NSAIDs) as directed by clinical response. However, recurrence is possible. This study aimed to compare the effects of add-on therapies using different topical NSAIDs in the management of treatment-naive, non-infectious, non-necrotizing episcleritis.
 Methods: Seventy-five eyes of 75 patients with non-infectious, non-necrotizing unilateral episcleritis were included in this study. Patients were allocated to one of three groups based on the NSAID used as add-on therapy: topical diclofenac sodium 0.1% (group D), topical nepafenac 0.1% (group N1), and topical nepafenac 0.3% (group N3). The time to symptom disappearance was defined as the recovery time. 
 Results: There were no statistically significant differences in age, sex, initial best-corrected distance visual acuity, and intraocular pressure between groups (all P > 0.05). The mean recovery times of groups D and N1 were comparable (12.86 ± 5.35 days and 11.45 ± 5.42 days, respectively) (P > 0.05). However, the mean recovery time of group N3 was significantly shorter (9.70 ± 3.80 days, P < 0.05). Recurrence was observed in only one patient in group N1 at 3 months, and symptoms resolved when the same medication was reinstituted. Furthermore, we noted no side effects during the follow-up period for any of the treatment modalities. 
 Conclusions: All three topical NSAIDs were effective add-on therapies in the management of non-infectious, non-necrotizing unilateral episcleritis. However, once-daily administration of topical nepafenac 0.3% had a shorter recovery time than topical diclofenac 0.1% and topical nepafenac 0.1%.

Assessment of the effect of two different doses of intranasal nitroglycerine spray on attenuation of haemodynamic stress response to pneumoperitoneum in laparoscopic surgeries: A randomised, double-blinded study.

Background and Aims:The stress response to pneumoperitoneum can be deleterious due to its effects on haemodynamics, thereby increasing the morbidity. We intended to compare different doses of nitroglycerine nasal spray to obtund these responses and to look for any side effects.Methods:After ethical committee clearance and clinical trials registration, 70 patients scheduled for laparoscopic cholecystectomy were recruited. Random allocation was done into two groups by a computer generated randomisation table. Group N4 (n = 35) received 400 μg nitroglycerine and group N8 (n = 35) received 800 μg nitroglycerine with an intranasal spray 2 min prior to pneumoperitoneum. All the haemodynamic parameters were monitored at regular intervals.Results:The heart rate was comparable between the groups except at 6 and 10 min of pneumoperitoneum but showed significant increase from baseline within the groups. Mean arterial pressure (MAP) was statistically significant between the groups, being higher in group N4. Within group N4, MAP was significantly low only at 2 min, 4 min of pneumoperitoneum (101.69 ± 12.34 at baseline versus 93.31 ± 8.07 at 2 min and 97.54 ± 9.07 mm Hg at 4 min) and increased significantly at 30 min of pneumoperitoneum (101.69 ± 12.34 at baseline versus 105.66 ± 12.35 mm Hg) and hence, MAP was observed to be around baseline throughout the rest of intraoperative period. Within group N8, there was a significant decrease in mean, systolic and diastolic blood pressure from baseline at most of the time intervals.Conclusion:800 μg of intranasal nitroglycerine effectively obtunds the hypertensive response associated with pneumoperitoneum as compared to 400 μg without significant side effects.

Alleviation of Myocardial Inflammation in Diabetic Rats by Flavonoid Extract of Helichrysum Arenarium and Its Effect on Damaged Myocardial Cells Induced by High Glucose.

ObjectiveTo investigate the effects of helichrysum arenarium flavonoid extract on high glucose damaged cardiomyocytes and the alleviation of myocardial inflammation in diabetic rats.MethodsThe study was divided into two parts, the first part was a cellular experiment in which a high-glucose cardiomyocyte injury model (H9C2) was established using a high-glucose culture medium, divided into low (group N1, 6.25 μg/mL), medium (group N2, 12.5 μg/mL), high dose group (group N3, 25 μg/mL) of helichrysum arenarium intervention and a model control group. The levels of enzyme activities [creatine kinase (CK) and lactate dehydrogenase (LDH)] in each group of H9c2 cells were measured by Enzyme-linked immunosorbent assay (ELISA), the expression levels of apoptotic proteins (Bax and Bcl-2) by western blot (WB), and the expression levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6)] by RT-qPCR. The second part is animal experiments, after establishing the diabetic rat model, we used helichrysum arenarium flavonoid extract to intervene SD rats, divided into helichrysum arenarium intervention low (group S1, 250 mg/kg), medium (group S2, 500 mg/kg), high dose group (group S3, 1 g/kg), SD rat model group. Hematoxylin-eosin (HE) staining was used to observe myocardial tissue lesions, and Real Time Quantitative PCR (RT-qPCR) method was used to detect inflammatory (TNF-α, IL-1β, and IL-6) infiltration in myocardial tissue.ResultsCellular experiments: The activity levels of enzymes such as CK and LDH and the levels of inflammatory factors such as TNF-α, IL-1β, and IL-6 in damaged cardiac myocytes were significantly decreased after helichrysum arenarium intervention; the expression levels of Bax protein were significantly down-regulated and the expression levels of Bcl-2 protein expression were significantly up-regulated. Animal experiment: HE staining showed that the model group had widened intercellular spaces, interstitial edema and obvious inflammatory cell infiltration in cardiac muscle tissue. After the intervention of helichrysum arenarium, the collagen fibers of rat myocardial cells were significantly reduced and cell degeneration was alleviated. Animal experiment: HE staining showed that the model group had widened intercellular spaces, interstitial edema and obvious inflammatory cell infiltration in cardiac muscle tissue. After the intervention of helichrysum arenarium, the collagen fibers of rat myocardial cells were significantly reduced and cell degeneration was alleviated; the levels of TNF-α, IL-1β, IL-6 and other inflammatory factors in myocardial tissues were significantly decreased.ConclusionThe helichrysum arenarium flavonoid extract can reduce the degree of damage of H9C2 cells induced by high glucose and decrease the cellular inflammatory response, and its mechanism of action may be achieved by regulating the apoptotic factors Bax and Bcl-2. In addition, the extract of helichrysum arenarium can reduce the histopathological damage of myocardium in diabetic rats, decrease the inflammatory response in the tissue, and achieve the effect of myocardial protection.

Evaluation of Activated Carbon Treatment on Overcoming the Interference of Rivaroxaban on the Detection of Functional Lupus Anticoagulant

Objective: The aim of this study was to review the role of activated carbon (AC) in eliminating the interference of rivaroxaban in the detection of lupus anticoagulants (LAs). Methods: Normal pooled plasma was obtained as group N1, group N2 took 1 mL plasma from N1 and added AC, group N3 was prepared by mixing normal plasma with rivaroxaban, and group N3 was treated with AC according to our procedure, as group N4. Plasma from 22 patients was collected before and 6–12 h after rivaroxaban therapy, described as group P1 and group P2, respectively, and 1 mL plasma was taken from group P2 and treated with AC, as group P3. Anti-Xa and diluted Russell’s viper venom time (dRVVT)/silica clotting time (SCT) index in each group were measured and compared. Results: Rivaroxaban concentrations and anti-Xa had high intercorrelations in group N3, and the levels of anti-Xa and dRVVT/SCT index had high intercorrelations. After treatment with AC, influence of rivaroxaban was removed, with LA and coagulation factor assays not influenced. Rivaroxaban administration could affect LA assay results in patients, with all LA results increased. After treatment with AC, results of anti-Xa and LA tests recovered to the level before rivaroxaban therapy. Conclusions: We proposed a reference procedure for the LA detection of patients using rivaroxaban by AC, and activated carbon was proven to be a simple product to eliminate the interference of rivaroxaban.

Clinical Prognostic Factors in Breast Cancer

AbstractBackground: Carcinoma of the breast is the commonestcancer in female and the second most cause of death in cancerrelated deaths.Aim of Study: To overview the different prognostic factors in breast cancer in our patients with breast cancer.Patients and Methods: This retrospective study wasconducted on 100 patients undergoing mastectomy or breastconservative surgery at El-Demerdash University Hospital.Clinico-pathological features including age, weight, familyhistory, axillary lymph node status, tumor size, pathologyresult will be reviewed.Results: Axillary lymph node status shows a significantassociation between the grade of LN and the development ofrecurrence in group N3 patients compared with N, N1 andN2 groups. There is variability in disease-free survival amongthe ER/PR Her2 subtypes within the first 3 years followingdiagnosis after receiving the treatment. While probability offree from disease was best for the ER+, PR +or-/Her2-subtypefollowed by ER-PR-/Her2-(71%) and (50%) respectively. Onthe other hand all patients in subtypes ER+, PR +or-/Her2 +and ER-PR-/her2 + subtypes suffered from recurrence ofdisease.Conclusion: We have found that the extent of nodalinvolvement and hormone receptor expression are very im-portant prognostic and predictive factors in breast cancermanagement and recurrence.

Multispectral optoacoustic tomography of peripheral arterial disease based on muscle hemoglobin gradients-a pilot clinical study.

BackgroundCurrent imaging assessment of peripheral artery disease (PAD) relies on anatomical cross-sectional visualizations of the affected arteries. Multispectral optoacoustic tomography (MSOT) is a novel molecular imaging technique that provides direct and label-free visualizations of soft tissue perfusion and oxygenation.MethodsMSOT was prospectively assessed in a pilot trial in healthy volunteers (group n1=4, mean age 31, 50% male and group n3=4, mean age 37.3, 75% male) and patients with intermittent claudication (group n2=4, mean age 72, 75% male, PAD stage IIb). We conducted cuff-induced ischemia (group n1) and resting state measurements (groups n2 and n3) over the calf region. Spatially resolved mapping of oxygenated (HbO2), deoxygenated (Hb) and total (THb) hemoglobin, as well as oxygen saturation (SO2), were measured via hand-held hybrid MSOT-Ultrasound based purely on hemoglobin contrast.ResultsCalf measurements in healthy volunteers revealed distinct dynamics for HbO2, Hb, THb and SO2 under cuff-induced ischemia. HbO2, THb and SO2 levels were significantly impaired in PAD patients compared to healthy volunteers (P<0.05 for all parameters). Revascularization led to significant improvements in HbO2 of the affected limb.ConclusionsClinical MSOT allows for non-invasive, label-free and real-time imaging of muscle oxygenation in health and disease with implications for diagnostics and therapy assessment in PAD.

Ocular flora in patients undergoing intravitreal injections: antibiotic resistance patterns and susceptibility to antiseptic picloxydine.

To study antibiotic resistance patterns and susceptibility to eye antiseptic picloxydine of conjunctival flora in patients undergoing intravitreal injections (IVIs). Conjunctival swabs were taken in 4 groups of patients, 20 patients in each group (n=80): without IVIs and ophthalmic operations in history (group N1; control group); with the first IVI and antibiotic eye drops Tobrex applied 3d before IVI and 5d after it (group N2); with 20 or more IVIs and repeated courses of antibiotic eye drops (group N3); with the first IVI and antiseptic eye drops Vitabact (picloxydine) applied 3d before IVI and 5d after it (group N4). In groups N2 and N4 swabs were taken at baseline and after the treatment. Efficacy of picloxydine in inhibition of growth of conjunctival isolates susceptible and resistant to antibiotic was studied in vitro. Minimal inhibition concentrations (MIC) were determined with microdilution test. Two of the three patients who had to undergo the IVI procedure showed conjunctiva bacterial contamination. Along with few Staphylococcus aureus and Gram-negative isolates susceptible to most antibiotics, the majority (71%-77%) of causative agents were coagulase-negative Staphylococci (CoNS), 40%-50% of which were multidrug resistant (MDR). Eye disinfection in the operating room and peri-injection courses of Tobrex or Vitabact resulted in total elimination of isolates found at baseline. However, in 10% and 20% of patients, respectively, recolonization of the conjunctiva with differing strains occurred. In patients with repeated IVI and Tobrex/Maxitrol treatment, the conjunctival flora showed high resistance rates: 90% of CoNS were MDR. In the in vitro study, picloxydine showed bactericidal effect against Staphylococci isolates both antibiotic resistant and susceptible with MIC≥13.56 µg/mL. Incubation of bacteria for 15min in Vitabact eye drops, commercially available form of picloxydine, 434 µg/mL, showed total loss of colony forming units of all tested isolates including Pseudomonas aeruginosa. The confirmed efficacy of eye antiseptic picloxydine against conjunctival bacterial isolates and the presence of its commercial form, 0.05% eye drops, convenient for use by patients before and after injection, make this eye antiseptic promising for prophylaxis of IVI-associated infectious complications.

A randomised double-blind dose–response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal–epidural anaesthesia for Caesarean delivery

BackgroundNorepinephrine infusion has been suggested as an effective method for preventing hypotension during spinal anaesthesia for Caesarean delivery. However, optimal dosing regimens for norepinephrine have not been well established. This study aimed to determine the dose–response characteristics of a weight-adjusted fixed-rate infusion of norepinephrine to prevent hypotension during neuraxial anaesthesia for Caesarean delivery. MethodsIn a double-blind, randomised controlled trial, 80 parturients having elective Caesarean delivery received a prophylactic norepinephrine infusion at 0.025 μg kg−1 min−1 (Group N1), 0.05 μg kg−1 min−1 (Group N2), 0.075 μg kg−1 min−1 (Group N3), or 0.10 μg kg−1 min−1 (Group N4), starting immediately after induction of combined spinal–epidural anaesthesia. The primary outcome was non-occurrence of hypotension, defined as a decrease in systolic arterial pressure ≥20% below baseline value or to ≤90 mm Hg, before delivery. Values for 50% effective dose (ED50) and ED90 were calculated using probit regression. ResultsThe incidence of hypotension was 11/20 (55%), 6/20 (30%), 2/20 (10%), and 1/20 (5%) in Groups N1, N2, N3, and N4, respectively (P<0.0001). The ED50 and ED90 (95% confidence interval) of norepinephrine infusions for preventing hypotension were 0.029 (–0.002 to 0.043) and 0.080 (0.065–0.116) μg kg−1 min−1, respectively. The incidence of reactive hypertension increased with increasing norepinephrine dose (P=0.002). Other adverse effects were similar among groups. ConclusionsUnder the conditions of this study, an infusion of norepinephrine 0.08 μg kg−1 min−1 was effective for preventing hypotension in 90% of patients. This information should provide a guide for initiating norepinephrine infusions. Clinical trial registrationChiCTR1900022322 at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/enindex.aspx).

Prophylactic co-administration of two different bolus doses of norepinephrine in spinal-induced hypotension during caesarean section: A prospective randomized double-blinded study

Background: Vasopressors for prophylaxis and treatment of spinal hypotension have grown in popularity in recent years. Norepinephrine is now emerging as one of the feasible options for prevention as well as management of spinal-induced hypotension in caesarean section (CS). The aim of our study was to compare the efficacy of two different doses of norepinephrine as prophylaxis for spinal-induced hypotension during CS. Material and Methods: Total 110 patients were recruited in this prospective randomized double-blind study from December 2017 to June 2019. After fulfilling the inclusion and exclusion criteria, this study was conducted on 90 patients undergoing elective CS under spinal anesthesia, who were assigned into three groups of 30 patients each. Group N6received norepinephrine 6 μg as an intravenous bolus, group N4received norepinephrine 4 μg, and group C received normal saline simultaneously with subarachnoid block. Incidence of hypotension, requirement of rescue doses of norepinephrine, time of first rescue dose, hemodynamic parameters, adverse effects, and neonatal complications were assessed, compared and analyzed. Results: The incidence of post spinal hypotension was 63.33% in group N6, 80% in group N4, and 83.33% in group C (p = 0.155). Total rescue dose requirement of norepinephrine was significantly less in group N6(8.21 ± 2.97 μg) as compared to N4(9.00 ± 3.06 μg) and control group (11.00 ± 4.57 μg).(p = 0.011). The median time to first rescue dose requirement of norepinephrine was significantly delayed in group N6(6[8–4.5] min) and group N4(4[9–2.5] min) as compared to control group (4[5–2] min) (p = 0.004). Conclusion: Prophylactic intravenous bolus dose of 6 μg norepinephrine when co-administered with spinal anesthesia was found to be more effective than 4 μg norepinephrine in terms of decreasing total rescue dose requirement of vasopressor and delaying the time to first rescue dose, without significant change in the incidence of hypotension.

Savitzky-Golay Filter Based Quantitative Dynamic Contrast-Enhanced Ultrasound on Assessing Therapeutic Response in Mice with Hepatocellular Carcinoma

As new drugs are developed in targeted therapy for advanced hepatocellular carcinoma (HCC), an accurate evaluation procedure for the therapeutic efficacy is needed. Current methods use MRI or CT based response evaluation criteria in solid tumors (RECIST) which is unsatisfactory for overlooking the functional response. We propose a new mice model of HCC for assessment of the early response to targeted therapy with contrast-enhanced ultrasound (CEUS). The major technical innovation is analysis of tumor functional characteristics using Savitzky-Golay filter (S-G filter) based CEUS quantification (SGCQ) software. In this study, mice were divided into three groups, including the control group (n1 = 18), sorafenib treatment group (n2 = 18) and lenvatinib treatment group (n3 = 18). SGCQ software specialized in data smoothing was used to quantify the time, enhanced intensity and blood volume related parameters at five different time points within 14 days of therapy. Promising experimental results were obtained. From the analysis, it could detect response as early as 4th day and perfusion time (PT), mean transit time (MTT), area under the curve of tumor/adjacent parenchyma (qAUC), wash-in slope a3, the average time of perfusion (T0) were early predictors. Then, tumors were excised with histopathology performed, CD31 H-score is in correlation with parameters peak intensity (PI), enhanced intensity (EI) and area under the curve of tumor/adjacent parenchyma (qAUC). Moreover, there was no significant difference in efficacy between sorafenib and lenvatinib in both CEUS parameters and histopathology. Finally, the finding of this study proves SGCQ software to be a valid, sensitive and repeatable method for therapeutic evaluation. Quantitative and comparative studies show that sorafenib and lenvatinib, as two first-line targeted drugs, ensure the therapeutic advantages of HCC.

Effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia on inflammatory response in patients undergoing gynecological tumor laparotomy

Objective To evaluate the effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) on inflammatory response in the patients undergoing gynecological tumor laparotomy. Methods One hundred and twenty-five patients, aged 22-64 yr, weighing 50-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparotomy for gynecologic tumors, were divided into 5 groups (n=25 each) by a random number table method: sufentanil 1 μg/ml group (group S), sufentanil 0.75 μg/ml + nalbuphine 0.25 mg/ml group (group N1), sufentanil 0.5 μg/ml + nalbuphine 0.5 mg/ml group (group N2) , sufentanil 0.25 μg/ml + nalbuphine 0.75 mg/ml group (group N3), and nalbuphine 1 mg/ml group (group N4). Postoperative PCA (granisetron 9 mg was added, the PCA solution was diluted to 150 ml in normal saline, a loading dose of 2 ml, background dose of 2 ml/h, a self-controlled dose of 1 ml/time, and a lockout interval of 15 min) was performed.Flurbiprofen 50 mg was intravenously injected for rescue analgesia, maintaining a static visual analog scale score ≤ 4 and a dynamic (cough) visual analog scale score ≤ 6.Venous blood samples were collected from the upper extremity before induction (T1), at 1 h after incision (T2), at the end of operation (T3), and at 24 and 48 h after operation (T4, 5) for determination of serum concentrations of interleukin-6(IL-6), tumor necrosis factor-alpha and IL-10.The effective pressing times of PCIA, requirement for rescue analgesia, development of nausea and vomiting and somnolence, and postoperative anal exhaust time were recorded within 24 h after surgery. Results Compared with group S, the concentrations of IL-6 and tumor necrosis factor-alpha in serum were significantly decreased, and the concentration of IL-10 was increased at T4, 5 in N1 and N2 groups, the anal exhaust time was significantly shortened, and the incidence of nausea and vomiting was decreased in the other groups, the effective pressing times of PCIA and requirement for rescue analgesia were significantly decreased in group N2, and the incidence of somnolence was significantly increased in group N4 (P<0.05). Conclusion Sufentanil 0.5 μg/ml plus nalbuphine hydrochloride 0.5 mg/ml provides good PCIA, effectively reduces inflammatory responses and decreases the occurrence of adverse reactions in the patients undergoing gynecological tumor laparotomy. Key words: Nalbuphine; Sufentanil; Femininity; Neoplasms; Analgesia, patient-controlled; Inflammation

Anxiety-depressive disorders of patients with external genital endometriosis

Aim. To study the prevalence of anxiety and depression in patients with external genital endometriosis and other gynecologic pathology. Methods. The study involved 152 women. The main group consisted of 100 patients with external genital endometriosis diagnosed by laparoscopy and histologically confirmed. The comparison group included 52 women with other gynecologic pathology (infertility, hysteromyoma, ovarian benign tumours). Exclusion criteria were oncology, acute gynecologic and somatic pathology. To determine the prevalence of anxiety and depression in the groups, the hospital anxiety and depression scale was used. Results. In the group pf females with endometriosis 33 (33%) patients had anxiety and 9 (9%) patients - depression. In the comparison group (N2=52), anxiety disorder was revealed in 18 (34.6%) women, and depression - in three patients (5.8%; p 0.05). To study the features of anxiety and depression in patients with different clinical presentation of endometriosis, females with asymptomatic disease (n1=26), infertility (n2=29) and pain syndrome (n3=43) were compared. Analysis of the results demonstrated that significantly more frequently anxiety and depression developed in patients with pain syndrome. The number of women suffering from anxiety in group n3 was 22 (51.2%), in group n2 - 6 (20.7%) and in group n1 - 2 (7.8%). The number of women with depression in group n3 was 8 (18.6%), in group n2 - 1 (3.4%) and in group n1 there were no women with depression. Conclusion. The conducted study showed no significant differences in the prevalence of anxiety and depression among patients with external genital endometriosis and other gynecologic pathology; anxiety and depression develop more frequently in the presence of pain syndrome.

Optimum dose of nalbuphine prepared for patient-controlled intravenous analgesia after caesarean section

Objective To determine the optimum dose of nalbuphine prepared for patient-controlled intravenous analgesia(PCIA)after caesarean section. Methods A total of 100 parturients, aged 22-40 yr, weighing 60-90 kg, of American Society of Anesthesiologists physical statusⅠor Ⅱ, at≥37 weeks of gestation, scheduled for elective caesarean section, were divided into 4 groups(n=25 each)using a random number table: sufentanil 2.0 μg/kg group(group S), nalbuphine 1.5 mg/kg group(group N1), nalbuphine 2.0 mg/kg group(group N2)and nalbuphine 2.5 mg/kg group(group N3). In S, N1, N2 and N3 groups, sufentanil 2.0 μg/kg and nalbuphine 1.5, 2.0 and 2.5 mg/kg were added to PCIA solution, respectively, tropisetron 12 mg was added, and PCIA solution was then diluted to 100 ml in normal saline.The PCA pump was set up to deliver a 1 ml bolus dose with a 10-min lockout interval and background infusion at 2 ml/h after a loading dose of 3 ml.Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ≤4 or during activity(cough)≤6.The highest Ramsay sedation score, requirement for rescue analgesics, the number of unsuccessfully delivered doses, the number of attempts and occurrence of nausea and vomiting, pruritus and somnolence within 48 h after operation were recorded. Results Compared with group S, the number of unsuccessfully delivered doses, the number of attempts and requirement for rescue analgesics were significantly decreased in N2 and N3 groups, the incidence of somnolence and the highest Ramsay sedation scores were increased in group N3(P 0.05). Compared with group N1, the number of unsuccessfully delivered doses, the number of attempts and requirement for rescue analgesics were significantly decreased in N2 and N3 groups, and the incidence of somnolence and the highest Ramsay sedation scores were increased in group N3(P 0.05). Conclusion The optimum dose of nalbuphine prepared for PCIA after caesarean section is 2.0 mg/kg. Key words: Nalbuphine; Caesarean section; Pain, postoperative; Analgesia, patient-controlled

A Comparison of Different Doses of Sufentanil Combined With Flurbiprofen Axetil In Postoperative Analgesia for Children Undergoing Innominate Osteotomy in China

To evaluate the analgesic efficacy of different doses of sufentanil combined with flurbiprofen axetil in children undergoing innominate osteotomy. Ninety children scheduled for elective innominate osteotomy under general anesthesia were enrolled and randomly divided into 3 groups. All the children received 1mg/kg flurbiprofen axetil intravenously before skin incision for pre-emptive analgesia. Patient Controlled Intravenous Analgesia (PCIA) was started at the end of the operation with the following composition: Sufentanil 1.5 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml (Group N1) sufentanil 2.0 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml (Group N2) and sufentanil 2.5 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml (Group N3). FLACC scores and Ramsay sedation scores were recorded at 2, 4 ,8 ,12 ,24 and 36h after the operation;the PCA button press number and side effects were observed and recorded. FLACC scores in group N1 were higher than group N2 and N3 (p&lt;0.05).Ramsay scores in group N1 were lower than group N2 and N3 (p&lt;0.05).There were no significant differences in FLACC scores and Ramsay scores between group N1 and N2 (p&gt; 0.05).The incidence of side effects was significantly higher in group N3 compared with group N1 and N2 (p&lt;0.05). Combined with 1mg/kg flurbiprofen axetil for preemptive analgesia , PCIA with sufentanil 2.0 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml may be an effective postoperative analgesia solution for children undergoing innominate osteotomy ,with less side effects.&#x0D; JCMCTA 2016 ; 27 (2) : 77 - 80

Comparative Study between the Quality Management Indicators, Marker of Major Psychiatric Disorders in Evolution.

Indicators of quality management are represented by: accounting hospitalization days (duration of stay); mortality rate; the rate of nosocomial infections; patients readmitted in 30 days; the percentage patients transferred; inconsistent diagnoses. The hospitalization period is a marker of evolution. The present study reflects comparative data between duration and the number of hospitalisations in patients with major psychiatric disorders. Introduction. Medical Psychiatry as a discipline has developed a specialized approach in the treatment of mental diseases, a phenomenon linked to the progress of knowledge ofpsychopathology and the increasing complexity of methods of diagnosis and treatment. The history of psychiatric patients reflects not only changes in scientific understanding of mental disorder, but also the beliefs of political, social and economic interests of that period [1,2]. Objectives. We analised the duration and number of hospitalisation in patients with schizophrenia, psychotic disorders compared to those with bipolar disorder and major depressive disorder in Psychiatric clinic from Craiova between 2006-2010. Method. Retrospective study during 2006-2010 took into account 8234 patients aged between 20-65 years from the Psychiatric Clinic Craiova constituting four groups: group N1=989 patients belonging to the schizophrenia group; group N2=1222 patients with psychotic disorders, group N3=918 patients with bipolar disorder and group N4=5101 with major depressive disorder.For data processing we used Microsoft Excel (Microsoft Corp., Redmond, WA, USA), together with the suite for MS Excel XLSTAT (Addinsoft SARL, Paris, France) and IBM SPSS Statistics programme 20.0 (IBM Corporation, Armonk, NY, USA). Results. Schizophrenia being defined as a chronic disease was noted that 85.4 % of the patients from the first group received at least two admissions during the trial. Females have better prognosis, having a lower share in the group with multiple hospital admissions. The duration of the stay was longer than two weeks for 61,7% in the N1 group. Group N2 patients, bipolar disorder, have received at least two admissions, the share between the sexes is similar, the duration of hospitalisation not exceeding 7 days for 54,2% of patients with bipolar disorder. Women with more than 14 hospitalisation days had a share of 21.6%. Duration of hospitalization with the N3 group was of maximum two weeks at 71,4%, the group of major depressive disorders N4 had a number of short admissions of 44,4%. Conclusion. Statistically significantly high differences (p =0,000233<0.001) in favor of the schizophrenia and psychotic disorders group compared with the group of disorders of affectivity, in terms of the number and the duration of hospitalizations, marker of the evolution on the long term.

Histological effects of long term administration of piliostigma thonningii stem bark on the liver of adult Wistar rats

The histological effects of long term administration of piliostigma thonningii commonly used for the treatment of dysentery, fever, respiratory ailments, snake bites, hookworm and skin infections on the liver of adult wistar rats was carefully investigated. The rats of both sexes (N=21), with an average weight of 180g were randomly assigned into two test groups (n1 & n2=14) and control group (n3=7). Animals in the test group A received the extract of Piliostigma thonningii stem barks at a single dose of 200mg/kg body weight daily, animals in test group B received a single dose of 400mg/kg body weight daily for twenty eight days through the orogastric tube administration while the control animals received equal volume of distilled water through the same route and for the same period. The rats were fed with grower’s mash obtained from Edo Feeds and Flour Mill Limited, Ewu, Edo state, Nigeria. The rats were sacrificed by cervical dislocation on the twenty nine day of the experiment and the liver was carefully dissected out and quickly fixed in 10% formal saline for further routine histological study. The findings indicated that the liver in the test groups (groups A&B) showed some level of distortion and disruption of the cytoarchitecture with some marked congestion of blood mainly at the central vein of the liver. The presence of perivascular polymorph nuclei cells and congestion of blood in the sinusoidal space of the liver was also observed in the tested groups with that of group B more marked. Long term administration of extract of Piliostigma thonningii stem barks may therefore have an adverse effect on the liver of adult wistar rats. Keywords: Piliostigma thonningii, liver, Wistar rats.