Normal Saline Group Research Articles

Effectiveness of Lidocaine with Epinephrine Irrigation in Reducing Acute Pain from Surgical Removal of Mesioangular-Impacted Third Molars

Background: Anesthetic irrigation is an effective treatment for postoperative pain suppression in patients after molar extraction, but exerts a short period of extraction. The study aimed to evaluate the effect of lidocaine with epinephrine irrigation on acute pain relief in healthy volunteers with inferior alveolar nerve block (IANB) injection for the surgical removal of mesioangular (MA)-impacted third molars. Methods: A total of 28 patients (56 samples) with bilateral MA-impacted third molars were recruited. This study was a split-mouth, double-blind, randomized clinical trial. Surgical procedures were conducted over two separate appointments. Each patient randomly received 2% lidocaine with 1:100,000 epinephrine for the irrigation of the extraction site after surgery on one side of the mouth and normal saline solution on the other side. The postoperative visual analog scale (VAS) as a pain indicator was recorded and statistically analyzed for both treatments. Results: The VAS levels at 3 and 4 h after surgery in the lidocaine group were significantly lower than those of the normal saline group. Increases in pain scores were recorded five hours after surgery in both groups. No complications were recorded during this study. Conclusions: Continuous local anesthetic irrigation appears to be effective in reducing acute postoperative pain in patients with IANB for MA-impacted third molar surgery. Clinical Trial Registry: Reference number ISRCTN13866362, Date: 1 October 2024.

Effect of Sub- Chronic Administration of Omeprazole on Hematological and Biochemical Parameters in Fischer Male Rats

Long-term use of proton pump inhibitors (PPIs) is believed to have various potential adverse events. Omeprazole is a part of PPIs most commonly prescribed worldwide; it irreversibly binds to the H+-K+ ATPase enzyme system in the gastric parietal cells to reduce the secretion of H+ ions into the lumen of the stomach. The main objective of the current work is to assess the adverse effects of omeprazole medication on certain hematological and biochemical parameters in rats who were on treatment for three months. We conducted a comparative cross-sectional study between March 2024 and July 2024. 20 male Fischer rats (Albino) aged two months, weighting (200-250g) was obtained from the animal house located in the Libyan center for medical research, in the city of Alzawia, and were enrolled in this study. Rats were divided into two groups, the first group was the control (Normal saline group) (n=10), second was administered 40mg/kg omeprazole via IP route (n=10) once daily. Complete blood count and biochemical parameters were measured for both groups. The treatment group had remarkably significant reductions in the number of red blood cells (RBCs) (p<0.001) and the platelets indices. Omeprazole elevated the cholesterol level (p<0.001) and triglyceride (p<0.001) as well as low-density lipoprotein (p<0.01). However, no impact was found with high density lipoprotein (HDL) (p>0.05). Blood urea levels (p<0.001) were significantly increased in the treatment group treated with omeprazole medication. The results also showed that the treatment group had a significant decline in calcium levels (p<0.001) than that of the control group. Prolonged use of omeprazole might result in adverse effects on hematological profile, particularly RBCs and their indices leading to the development of anemia in patients on this medication. Furthermore, it might result in disturbances in biochemical profile, levels of minerals, and vitamins as consequences of affected absorption.

Efficacy of Ultrasound-Guided Transverse Abdominal Plane Block for Residual Pain After Pulsed Radiofrequency in Abdominal Acute/Subacute Herpes Zoster-Related Pain.

Pulse radiofrequency (PRF) can reduce the persistent pain of herpes zoster (HZ), but some patients still have residual pain and do not achieve satisfactory results. This study aimed to assess the efficacy of PRF combined with transverse abdominal plane (TAP) block for abdominal acute/subacute HZ-related pain. A total of 137 acute/sub-acute HZ patients with successful PRF treatment were recruited from the Pain Department of Wuhan No. 1 Hospital between January 2018 and January 2020. There were two groups: the transversus abdominis plane group (TAP group, n = 64) and the normal saline group (NS group, n = 60). Pain intensity, sleep quality, and quality of life were quantified using the visual analogue scale (VAS), the five-item questionnaire and scoring system, and the 36-item Short Form Health Survey (SF-36) questionnaire, respectively. Follow-up assessments were conducted at baseline, 1 day, 3 months, 6 months, and 12 months after the block therapy. Compared to the NS group, the TAP group showed significantly decreased pain scores 1 day, 3 months, 6 months, and 12 months after block therapy (P < .05). The sleep quality scores were lower in the TAP group than that in the NS group at 6 months (5.0 ± 2.4 vs 6.3 ± 3.7, p = .042), and 12 months after therapy (3.1 ± 1.8 vs 4.1 ± 2.4, p = .031). For quality of life, in comparison to NS group participants, those in the TAP group exhibited significantly higher scores (p < .05) for quality of life at 3 months, 6 months, and 12 months follow-up. There was a significant decrease in the proportion of pregabalin and analgesic medications in the TAP group and NS group at 6 and 12 months after treatment compared to Baseline (p < .001). Furthermore, the results showed that there was a significant difference in VAS, sleep quality scores (SQS), and quality of life between the PRF + TAP group and pharmacological therapies group before and 12 months after treatment (p < .05). The TAP block is a promising complementary treatment for acute/subacute HZ patients who have undergone PRF treatment. Combining PRF with the TAP block has the potential to alleviate HZ-related pain, enhance the patients' quality of life, and improve their sleep quality.

Comparison of Ultrasound-Guided Hydrodissection with Various Volumes of 5% Dextrose for Carpal Tunnel Syndrome: A Prospective Randomized Controlled Double-Blind Trial.

Ideal volume of 5% dextrose (D5W) for median nerve hydrodissection (HD) for treating carpal tunnel syndrome (CTS) is still unknown. This study assessed the efficacy of nerve hydrodissection using varying volumes of D5W for treating mild to moderate CTS. Eighty participants with unilateral mild to moderate CTS were randomized into groups to receive either 5 ml of normal saline (NS), 5 ml of D5W, 10 ml of NS, and 10 ml of D5W, with each group undergoing one session of ultrasound-guided HD. Visual Analogue Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), grip and pinch strength, cross-sectional area (CSA) of median nerve, and electrophysiological assessment were performed at baseline and weeks 4 and 12. In the 10 ml D5W group, VAS scores considerably improved compared with those in the NS groups. Although nerve CSA values decreased in all groups during follow-ups, the 10 mL D5W group showed a statistically significant improvement compared to the NS groups by the 12th week (p ≤ 0.01). Ultrasound-guided median nerve HD with 10 ml D5W was more effective in reducing pain and nerve size than the NS groups at the 12th week.

Effect and mechanism of Donepezil hydrochloride on Alzheimer’s disease

Objective: To explore the effect and mechanism of donepezil hydrochloride on Alzheimer’s disease (AD).Methods: Thirty-six 3-month-old SD rats were selected as the research subjects and randomly divided into a normal control (NC) group and a model group. The model group was given continuous intraperitoneal injection of D-galactose solution (120 mg/kg/d) combined with aluminum trichloride (10 mg/kg/d) by gavage for 60 days. Morris water maze test was conducted to test the learning and memory abilities of the rats, and AD rats were selected. After modeling, AD rats were divided into a normal saline (NS) group and a drug treatment (DT) group. The DT group was given donepezil hydrochloride (1.0 mg/kg) by gavage intervention, and the NC group and the NS group were given equal volumes of physiological saline by gavage. After 4 weeks of intervention, Morris water maze test was conducted to detect the escape latency, the number of platform crossings and residence time in the target quadrant, the rats were euthanized, with serum and hippocampal tissues collected, and hippocampal tissue homogenate (10%) was prepared by using NS. Enzyme linked immunosorbent assay (ELISA) was used to detect the inflammatory and oxidative stress indicators in rat hippocampal tissues and serum, and hematoxylin eosin (HE) staining was used to observe pathological damage in rat hippocampal tissues.Results: Compared with the NC group, the NS group showed a significant increase in escape latency (p &lt; .05), a significant decrease in the number of platform crossings and residence time in the target quadrant (p &lt; .05), and a significant decrease in the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in serum and hippocampal tissues (p &lt; .05). The content of malondialdehyde (MDA) was significantly increased (p &lt; .05), and the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were significantly increased (p &lt; .05). Compared with the NS group, the DT group can significantly reduce the escape latency (p &lt; .05), increase the number of platform crossings and residence time in the target quadrant (p &lt; .05), significantly increase the activities of SOD and GSH-Px in serum and hippocampal tissues and reduce the content of MDA (p &lt; .05) and the levels of IL-6 and TNF-α (p &lt; .05). After intervention with donepezil hydrochloride, the number of neurons in the hippocampus were significantly increased.Conclusions: Donepezil hydrochloride can improve the learning and memory abilities of rats, reduce the levels of oxidative stress and inflammation in the brain and serum, and improve pathological damage in the hippocampus.

Mitochondrial transplantation following cardiopulmonary resuscitation improves neurological function in rats by inducing M2-type MG/MΦ polarization

AimExplore the effects of mitochondrial transplantation (MT) after cardiopulmonary resuscitation (CPR) on the polarization of microglia/macrophages (MG/MΦ) and neurological function.MethodsSeventy-five Sprague-Dawley rats were randomly divided into five groups: sham, normal saline (NS), vehicle, mitochondria (Mito), and non-functional mitochondria (N-Mito) group. Rats in sham group underwent surgical procedures without cardiac arrest, while the other four groups underwent cardiac arrest and CPR, and then received NS, respiration buffer, mitochondrial suspension or non-functional mitochondria, immediately after the restoration of spontaneous circulation (ROSC). The number of mitochondria in the hippocampus, the morphology and structure of mitochondria in MG/MΦ, the phenotype of MG/MΦ, and hippocampal tissue injury, neuroinflammation, and neuronal apoptosis were detected on days 1 and 3 after ROSC. Neurodeficit score (NDS) was performed on days 1, 3, 7, 15 and 30 after ROSC.ResultsCompared with other groups, the number of mitochondria in the hippocampus was increased, and the morphology and structure of mitochondria in MG/MΦ were significantly improved in the Mito group. Our results show higher expression of M2-type markers in MG/MΦ and decreased hippocampal tissue damage in the Mito group. Levels of NSE and S100β in serum, and TNF-α, IL-6 in the hippocampus were decreased, while the levels of TGF-β and IL-10 were increased in the Mito group. Apoptosis rate of neurons in the Mito group was decreased and the NDS of the Mito group was higher than the other groups.ConclusionsExogenous MT can improve neurological function after CPR by promoting the polarization of MG/MΦ to M2-type cells, and this could be a potential method for brain protection after CPR.

Predictors of Post-operative ABG Changes to Pre-operative Levels in Kidney Transplant Patients, a Cross-Sectional Study

Background: Kidney transplant is the treatment of choice for chronic renal failure (CRF), significantly improving patient outcomes. Fluid administration during surgery can lead to the accumulation of acid ions and electrolytes, inducing pH changes from the pre-operative to post-operative period, which may compromise transplant success. The impact of acid-base balance changes on transplant outcomes is crucial, yet research on predictors and arterial blood gas (ABG) changes post-kidney transplant is limited. Understanding ABG changes can enhance perioperative management, early detection of complications, and long-term graft function, thereby optimizing patient care and increasing transplant success rates. Objectives: To assess ABG changes before and after kidney transplant and identify predictors of post-operative acidosis in patients with renal failure through cross-sectional studies. Methods: In a retrospective cohort study, we included 97 patients who had undergone kidney transplant. During surgery, patients received crystalloid fluids, with 49 receiving only normal saline and 48 receiving only Ringer's lactate. Data collection involved the insertion of an arterial line after anesthesia induction, and the first ABG sample was obtained as a pre-operative measure. A post-operative measure was taken at the end of the surgery. Ethical considerations were followed throughout the study. Statistical analysis included paired t-test or Wilcoxon signed-rank test to compare pre- and post-operative ABG measures, with a significance level set at a P-value less than 0.05. Results: Total of 97 patients, which 65 (69.4%) were male and 32 (30.6%) were female and mean age was 38.6 ± 12.2. Variables significantly associated with post-op acidosis were fluid administered (OR: 3.25, 95% CI: 1.45 - 4.58), post-op central venous pressure (CVP) (OR: 2.31, 95% CI: 1.23 - 2.62, p &lt; 0.05), post-op base excess (BE) (OR: 2.16, 95% CI: 1.50 - 2.95, P &lt; 0.05). HCO₃ (P = 0.010), BE (P = 0.002), pH (P = 0.023) were significantly lower in the normal saline group compared to the Ringer's group. Post-op pH and BE was also associated with increased post-op CVP. Post-op acidosis and post-op CVP were significantly associated with post-op BE. Conclusions: Post-operative ABG changes, including decreases in pH and HCO3, are key indicators of transplant outcomes, reflecting graft function and patient stability. These findings highlight the critical need for prompt management of ABG abnormalities to optimize transplant success and minimize complications, making vigilant monitoring a vital part of post-transplant care.

Efficacy of compound sodium acetate Ringer’s solution in early fluid resuscitation for children with septic shock: a preliminary retrospective cohort study

BackgroundThe effectiveness of acetated Ringer’s solution in pediatric shock has received little attention. This study aimed to assess the clinical outcomes of using compound sodium acetate Ringer’s solution (AR) for fluid resuscitation in children with septic shock.MethodsWe retrospectively analyzed the clinical data of children with septic shock admitted to the pediatric intensive care unit of the Affiliated Hospital of Southwest Medical University from December 2019 to January 2023. Based on the resuscitation fluid administered, the participants were categorized into the compound AR and normal saline (NS) groups. We compared blood circulation conditions, internal environment parameters (arterial blood pH, lactic acid, serum sodium, chloride, calcium, magnesium, potassium, and blood glucose), and 28-day clinical outcomes between the two groups.ResultsThis study included 40 children, with 13 and 27 in the compound AR and NS groups, respectively. The two groups showed no significant differences in sex, age, body weight, body mass index, primary inflammation level, or Pediatric Sequential Organ Failure Assessment on admission. Similarly, no significant difference was observed in resuscitation fluid volume administered during the first hour (compound AR group: 250.00 mL [100.00, 390.00]; NS group: 250.00 mL [100.00, 500.00]). The total amount of crystalloid and colloid fluids administered within 24 h, vasoactive drug use, and blood pressure recovery post-resuscitation did not significantly differ between the groups. However, at 6 h post-resuscitation, the compound AR had considerably lower lactate level than the NS group (1.12 vs. 2.20 mmol/L). There were no significant differences in arterial blood pH, serum sodium, chloride, calcium, magnesium, potassium, and blood glucose levels between the groups. After treatment, in the compound AR group, 3 patients died, 2 improved, and 8 were cured. In the NS group, 7 patients died, 8 improved, and 12 were cured. The 28-day treatment outcomes (mortality rate, improvement rate, cure rate, or side effects) showed no significant differences between the groups.ConclusionsCompound AR was as effective as NS as a resuscitation fluid in pediatric septic shock, demonstrating similar intravascular volume restoration and hemodynamic stability maintenance. However, it caused a faster decline in arterial lactate levels without obvious side effects.

“Comparative evaluation of cytotoxicity of three herbal endodontic irrigants at three intervals of time” – An in vitro study

Aim: The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time. Methodology: Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals. Results: The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P &lt; 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity. Conclusion: In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.

Myocardial Protective Effect of Xuebijing Injection on Extracorporeal Membrane Oxygenation Perfused Isolated Langendorff Heart Based on the PI3K/AKT Pathway

Objective: This study aimed to investigate the myocardial protective effect of Xuebijing injection in a model of extracorporeal membrane oxygenation (ECMO) isolated heart perfusion and determine the role of the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway. Methods: To establish an ECMO isolated heart perfusion model, Guangxi Bama miniature pigs were randomly divided into two groups: (1) a normal saline group (NS group), in which 50 mL of normal saline was added to the perfusion solution; and (2) a Xuebijing injection group (XBJI group), in which 10 mL of XBJI was added to the perfusion solution and then continuously pumped at 5 mL/h. Perfusion was maintained for 8 h. The hemodynamic changes, inflammatory response, and myocardial enzyme levels at T0, T2, T4, T6, and T8 were evaluated. The protein expression level of the PI3K/AKT pathway was analyzed by Western blot analysis and Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR). Hematoxylin and eosin staining and transmission electron microscopy were used to observe the pathological morphology and ultrastructure of T8 cardiomyopathy. Results: There was no significant difference in hemodynamics between the two groups. XBJI could reduce serum inflammatory factors and myocardial enzyme levels. XBJI also upregulated the expression of PI3K and AKT mRNA and the phosphorylation levels of PI3K and AKT proteins. The results of pathological and electron microscopy showed that XBJI effectively reduced myocardial cell and mitochondrial damage. Conclusion: XBJI can reduce myocardial inflammation and myocardial cell and mitochondrial damage in isolated heart perfusion. XBJI may play a role in the myocardial protection of ECMO isolated heart perfusion by activating the PI3K/AKT pathway.

Normal saline versus lactated Ringer’s solution for acute pancreatitis resuscitation, an open-label multicenter randomized controlled trial: the WATERLAND trial study protocol

BackgroundSome evidence suggests that fluid resuscitation with lactated Ringer’s solution (LR) may have an anti-inflammatory effect on acute pancreatitis (AP) when compared to normal saline (NS) and may be associated with a decrease in severity, but existing single-center randomized controlled trials showed conflicting results. The WATERLAND trial aims to investigate the efficacy and safety of fluid resuscitation using LR compared to NS in patients with AP.MethodsThe WATERLAND trial is an international multicenter, open-label, parallel-group, randomized, controlled, superiority trial. Patients will be randomly assigned in a 1:1 ratio to receive LR versus NS-based fluid resuscitation for at least 48 h. The primary outcome will be moderately severe or severe AP, according to the revision of the Atlanta classification. The secondary objectives of the WATERLAND trial are to determine the effect of LR versus NS fluid resuscitation on several efficacy and safety outcomes in patients with AP.A total sample of 720 patients, 360 in the LR group and 360 in the NS group, will achieve 90% power to detect a difference between the group proportions of 10%, assuming that the frequency of moderately severe or severe AP in the LR group will be 17%. A loss to follow-up of 10% of patients is expected, so the total sample size will be 396 patients in each treatment arm (792 patients overall). The test statistic used is the two-sided Z test with pooled variance set at a 0.05 significance level.DiscussionThe WATERLAND study aims to improve the early management of AP. Fluid resuscitation is an inexpensive treatment available in any hospital center worldwide. If a better evolution of pancreatitis is demonstrated in one of the treatment arms, it would have important repercussions in the management of this frequent disease.Trial registrationClinicalTrials.gov, NCT05781243. Registration date on January 4, 2023. EudraCT number 2023–000010-18, first posted March 23, 2023.

Impact of Cyclophosphamide on Testis and Sexual Glands of Adult Albino Rats and Probable Recovery After Drug Withdrawal: A Histological and Immunohistochemical study

Background: Cyclophosphamide is a chemotherapy and an immune-suppressive drug which is used for treatment of malignant and immune –related disease. The current work was conducted to evaluate the histological structure of the male gonad and sexual glands during treatment and after discontinuation of cyclophosphamide. Material and Methods: Thirty male albino- rats were classified into three groups. The first one was treated by normal saline, the second and third groups received cyclophosphamide 150 mg/kg intra peritoneal every two days for one week. The third group regarded as recovery group and divided into two subgroups with one- or two-months’ recovery period. At the accomplishment of the work, blood was drowning for hormonal analysis (testosterone) then the animals were sacrificed. The testis, prostate and seminal vesicle were removed and prepare for histological and immunohistochemical staining. Results: The cyclophosphamide treated group (GII) showed reduction of serum testosterone level, the testicular and sexual glands sections revealed atrophic and degenerative changes of their lining epithelium with reduction of their function and changes of their Ki67 expression which indicate abnormal proliferative pattern of the cells. However, the histopathological changes of treated group showed no improvement after one or even two months of drug withdrawal. Conclusion: The present study pointed out the risk of infertility and gonadal toxicity during cyclophosphamide treatment which may be permanent even after termination of the treatment.

The Severity of Wound Infection in Washing the Primary Prep Area with 70% Alcohol and Normal Saline in the Orthopedic Surgery Prepped with Povidone-Iodine: A Randomized Clinical Trial

Background: Despite significant advances in patient treatment, infection remains a complication after surgery. The present study compared the incidence and severity of wound infection with two methods of washing the primary prep area with 70% alcohol and normal saline in patients who are candidates for orthopedic surgery in Kowsar Hospital of Sanandaj, Iran. Methods: This single-blinded randomized clinical trial was conducted on 190 candidates for upper limb orthopedic surgery aged 18 to 65. Patients were randomly assigned to two alcohol and normal saline groups based on the table of random numbers. The primary outcome of this clinical trial was the incidence and severity of wound infection after surgery, which was measured by the standard scale of the Asepsis index. The results were analyzed using SPSS version 23, and statistical values less than 0.05 were considered significant. Results: Patients’ hospitalization duration in the intervention group was (3.02±1.04 days) and in the control group (2.86±1.03 days) showed no significant statistical difference (p=0.297). The frequency of wound infection in the alcohol group was lower than in the normal saline group. this difference was statistically significant (p=0.023). Also, the severity of wound infection in the 70% alcohol group (Mean=5.12, SD=3.19) was lower than in the normal saline group (Mean=7.69, SD=4.12). This difference was statistically significant (p&lt;0.001). Conclusion: The present clinical trial showed that the incidence and severity of wound infection after surgery were lower in the group washing the skin of the surgical area with alcohol compared to the group washing with normal saline.

6844 Comparison of Lactated Ringers and Normal Saline in the Treatment of Diabetic Ketoacidosis

Abstract Disclosure: J.N. Johnson: None. A.T. Drincic: None. K. Nein: None. E. Buddenhagen: None. K. Samson: None. T. Langenhan: None. Background: Current guidelines recommend normal saline (NS) for fluid resuscitation in the management of patients presenting with diabetic ketoacidosis (DKA). However, previous prospective studies have demonstrated improvement in patient specific outcomes, including time to DKA resolution, when balanced crystalloid fluids are used. We hypothesized that the use of LR compared to NS for volume management in DKA will shorten time to DKA resolution, reduce time to DKA associated protocol insulin infusion discontinuation, and result in lower post-intravenous fluid resuscitation chloride values. Methods: We conducted a single institution, retrospective cohort study of patients admitted with the diagnosis of DKA following our institution’s transition from NS to lactated ringers (LR) as the default resuscitative and maintenance fluid in our DKA management protocol. Adult patients admitted with DKA before and after the protocol change were identified. The primary outcome was time from DKA clinical presentation until DKA resolution. The secondary outcome was time to discontinuation of DKA protocol continuous insulin infusion. Results: Of 246 patients meeting inclusion criteria, 119 were stratified to the NS group (pre-protocol change) and 127 to the LR group (post-protocol change). T-test analysis revealed decreased time to DKA resolution in the LR group (mean 17.1 hours; SD 11.02) relative to the NS group (mean 20.6 hours; SD 12.22; p = .02). Duration of DKA protocol continuous intravenous insulin was shorter in the LR group (mean 16.0 hours; SD 8.72) compared to the NS group (mean 21.4 hours; SD 12.50; p = 0.0001). Conclusions: In this retrospective cohort study, protocolized DKA intravenous fluid management with LR resulted in shorter time to resolution of DKA and reduced duration of DKA protocol continuous insulin infusion. Presentation: 6/2/2024

Normal Saline Versus Hypertonic Saline for Airway STENT Maintenance: SALTY STENT Study.

Mucus plugging is a common complication of airway stenting. There is no data or guidance on the best airway hygiene regimen and consequently wide practice variation exists. This single-center, nonblinded, randomized, pilot study aims to evaluate the effectiveness and safety of nebulized 3% saline (3%S) versus normal saline (NS) in reducing the incidence of mucus plugging in adult patients that undergo central airway stent placement. Patients were enrolled immediately after stent placement and randomized to nebulized 3%S or NS (3mL) 3 times a day. Patients were scheduled for surveillance bronchoscopy in 4 to 6 weeks. Unscheduled bronchoscopies due to symptomatic mucus plugging were recorded. From December 2022 to March 2024, 37 patients were screened, and 35 were enrolled. Four in the 3%S and 8 in the NS group did not undergo a surveillance bronchoscopy and were excluded from the final analysis. During surveillance bronchoscopy for the 3%S (n=13) and NS (n=10) groups, obstructive mucus plugging was noted in 7.7% versus 40%, granulation requiring intervention in 7.7% versus 10%, and >25% circumferential biofilm in 0% versus 30%, respectively. In the 3%S versus NS groups, 0% versus 20% of patients required an unscheduled bronchoscopy due to mucus plugging. There were no side effects reported with the daily use of 3%S or NS. Nebulized 3%S is safe and may be equally or more effective than NS in preventing obstructive mucus plugging in patients who undergo airway stenting. A larger blinded randomized controlled trial is necessary to confirm this finding.

Magnesium Sulphate Versus Fentanyl as Adjuncts to Epidural Anaesthesia for Lower Limb Orthopaedic Surgeries: A Comparative Study

Abstract Introduction: Pain relief for lower limb orthopaedic surgeries is achievable with epidural anaesthesia. This study compared the analgesic effects of epidural anaesthesia with magnesium sulphate or fentanyl adjuvant in patients scheduled for elective lower limb orthopaedic surgeries. Patients and Methods: A double-blind randomisation study was carried out on 96 patients categorised into three groups; M, F, and C. All participants received 18 mL of 0.5% bupivacaine plus 1.5 mL of 75 mg magnesium sulphate in Group M or 50 mg of fentanyl in Group F or normal saline in Group C via the lumbar epidural route. Variables including the onset time of sensory and motor blockade, duration of anaesthesia, and time for postoperative Numerical Rating Scale (NRS) score of 3 were summarised using mean, median, standard deviation, and percentages as appropriate. A P value of &lt;0.05 was considered statistically significant. Results: Mean onset time for the sensory blockade at T8 was 23.7 ± 5.3, 20.5 ± 3.4, and 17.9 ± 5.6 min for groups C, F, and M, respectively (P = 0.001). The onset time for the motor blockade (Bromage score 3) was 29.8 ± 4.0, 26.6 ± 3.5, and 24.5 ± 5.3 min in groups C, F, and M, respectively (P = 0.001). The duration of epidural anaesthesia was 121.6 ± 31.5, 145.9 ± 29.6, and 167.0 ± 27.0 min in groups C, F, and M, respectively (P = 0.001). The time to attain an NRS pain score of 3 was 133.2 ± 27.7, 151.8 ± 32.4, and 172.0 ± 30.9 min in groups C, F, and M, respectively (P = 0.001). Conclusion: Magnesium sulphate is better as an epidural adjuvant compared to fentanyl in patients undergoing lower limb orthopaedic surgeries.

Comparative evaluation of antimicrobial efficacy of 0.1% octenidine dihydrochloride, superoxidized solution, ozonated water, 0.1% silver nanoparticle solution, and Q mix™ 2 in 1 in root canals infected with Enterococcus faecalis.

The objective of this study was to compare and evaluate the antimicrobial efficacy of 0.1% octenidine dihydrochloride, superoxidized solution, ozonated water, 0.1% silver nanoparticles (AgNp) solution, and Q mix™ 2 in 1 in root canals infected with Enterococcus faecalis. One hundred and fifty permanent mandibular premolars were inoculated with E. faecalis (0.5 McFarland standards) were incubated at 37°C for 7 days after which preoperative microbial sampling was done and the number of viable E. faecalis cells was obtained as CFU/mL.The specimens were irrigated with 0.1% octenidine dihydrochloride (group 1), Q mix™ 2 in 1 (group 2), super oxidized solution (group 3), 0.1% AgNp solution (group 4), ozonated water (group 5), and normal saline (group 6) during mechanical instrumentation. The final irrigation was followed by microbial sampling and the number of viable E. faecalis cells was obtained as CFU/mL. Data were analyzed by paired t-test and ANOVA with Tukey's post hoc test. Paired t-test showed a statistically significant difference between mean CFU before and after irrigation in groups I, II, III, IV, and V respectively (P < 0.05). Group VI showed no statistically significant difference between CFU before and after irrigation (P = 0.131). The mean bacterial reduction was statistically significant for all the study groups, proving their good antibacterial activity against E. faecalis in root canals whereas 0.1% octenidine dihydrochloride and ozonated water demonstrated relatively higher antimicrobial potential.

Oxidative stress causes liver injury via the damage of redox system and the apoptosis induced by mitochondria of broiler

The aim of this study was conducted to explore the effects of oxidative stress on the redox system, mitochondrial function, and apoptosis in liver of broilers. 144 one-day-old male Ross-308 broilers from the same batch had been prepared in advance and were divided into 3 treatments: normal control group (without intraperitoneal injection), normal saline group (intraperitoneal injection of normal saline), and hydrogen peroxide (H2O2) group (intraperitoneal injection of H2O2) with 6 replicates of 8 chickens each. The experimental period was 42 days. The injection volumes were 1.0 mL/kg of Ross-308 broiler body weight. On the 42nd day of the experimental period, two Ross-308 broilers were randomly selected from each cage, a total of 36 broilers were stunned by electric shock and slaughtered to collect liver samples. The results showed that compared with the non-injection group and the injection of saline group, H2O2 exposure elevated the relative weight of liver and the activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum of Ross-308 broilers (p < 0.05). Meanwhile, compared with the non-injection group and the injection of saline group, the H2O2 exposure increased the levels of reactive oxygen species (ROS), MDA, lipid peroxide (LPO) and protein carbonyl, decreased the activities of total superoxide dismutase (T-SOD), catalase (CAT), total antioxidant capacity (T-AOC) and glutathione peroxidase (GSH-Px) (p < 0.05). Compared with the non-injection group and the injection of saline group, the H2O2 exposure caused microvesicular steatosis and mitochondrial vacuolisation in the liver tissues of broilers. Additionally, after H2O2 exposure, the levels of nuclear factor erythroid 2–related factor 2 (Nrf2) positive cells were reduced and the relative percentage of hepatocyte apoptosis were increased in the liver tissues of broilers (p < 0.05). The conclusion of this study is that the oxidative stress induced by intraperitoneal injection of H2O2 could induce excessive production of ROS in broiler liver, which damage the antioxidant status and mitochondrial function of liver cells, leading to cell apoptosis. HIGHLIGHTS Oxidative stress can cause severe damage to the liver of broilers. Oxidative stress can mainly damage liver antioxidant function Oxidative stress can induce cell apoptosis by damaging mitochondria in the liver of broilers

Hypoxia-Inducible Factor-1α Potentiates Multiterritory Perforator Flap Survival by Augmenting Vascular Endothelial Growth Factor Expression in the Choke II Zone.

Hypoxia-inducible factor-1α (HIF-1α), regulated by prolyl hydroxylase, plays a central role in tissue adaptation to ischemia. This study investigates the impact of HIF-1α on angiogenesis in the Choke II zone of multiterritory perforator flaps. Ninety male Wistar rats were allocated into 3 groups, with 30 rats in each group: the dimethyloxalylglycine (DMOG) group, the 3-(5-hydroxymethyl-2-furyl)-1-benzylindazole (YC-1) group, and the normal saline (NS) group. All rats underwent multiterritory perforator flap surgeries on their dorsal side. Subsequently, they received intraperitoneal injections of DMOG (40 mg/kg), YC-1 (10 mg/kg), and normal saline on postoperative days 1, 2, and 3, respectively. After treatment, angiogenesis in the Choke II zone of the flap on day 7 was observed through transillumination tests and lead oxide/gelatin x-ray angiography. Histological features were determined using hematoxylin and eosin staining, and the expression of HIF-1α and vascular endothelial growth factor (VEGF) in the Choke II region of the flap was assessed via immunohistochemistry and western blotting. Compared to the YC-1 and NS groups, the DMOG group exhibited significant angiogenesis, resulting in a denser vascular network in the Choke II zone of the flap. The DMOG group showed significantly higher microvessel density in the Choke II zone than the YC-1 and NS groups (7.10 ± 0.99 vs 24.30 ± 3.65; 14.30 ± 2.40 vs 24.30 ± 3.65, both P<0.05). Additionally, the DMOG group demonstrated higher expression of VEGF and HIF-1α in the flaps than the other groups (P < 0.05). In summary, HIF-1α enhances the expression of VEGF, promoting angiogenesis in the Choke II zone of the multiterritory perforator flap, thus increasing the survival area.

Is Taurolidine Irrigation Effective in Preventing Surgical Site Infection during Fracture Surgery?

Taurolidine, known for its broad-spectrum antimicrobial properties and low toxicity, has shown promise in reducing infections in various surgical settings. However, it has not been extensively evaluated in orthopedic surgery. This study assessed the efficacy of taurolidine irrigation in reducing surgical site infections in patients undergoing ankle fracture surgery. A retrospective review was conducted for patients >20 years old who underwent ankle fracture surgery between March 2016 and March 2023, with follow-ups exceeding 6 months. Patients were classified into the following two groups: those who underwent normal saline (NS) irrigation and those who underwent taurolidine irrigation. Minor infections were defined as requiring additional oral antibiotics postoperatively, while major infections were characterized by hospitalization or reoperation due to infection within 3 months. Of 844 patients, 688 were included. The taurolidine group (n = 328) had a significant reduction in minor infections (7.3% vs. 22.5%, odds ratio = 0.410, p = 0.028) compared to the NS group (n = 360). Major infections were fewer in the NS group (1.2% vs. 0%, p = 0.051), but the number of cases was too small for reliable analysis. Taurolidine irrigation significantly reduces the occurrence of minor infections in ankle fracture surgeries when compared to normal saline irrigation.