Group RP Research Articles

Comparison of hypotension between propofol and remimazolam-propofol combinations sedation for day-surgery hysteroscopy: a prospective, randomized, controlled trial

BackgroundA combination of remimazolam and propofol could produce more stable sedation. A good medication regimen should consider not only efficacy but also safety, especially hypotension. The aim of the current study was to compare the incidence and amount of hypotension by propofol versus remimazolam-propofol combinations in day-surgery hysteroscopy.MethodsPatients were randomly assigned to receive either propofol (Group P, n = 125) or remimazolam-propofol combinations (Group RP, n = 125) at a 1:1 ratio. Intravenous injection of sufentanil 0.1ug/kg were administered before sedative medication. In group P, a bolus of 2.5 mg/kg propofol was administered. In group RP, intravenous anesthesia was commenced with 0.125 mg/kg remimazolam and 1 mg/kg propofol. After loss of consciousness, propofol was maintained at 6 mg/kg/h. The primary outcomes were the incidence and amount of hypotension during surgery. Hypotension was defined as a MAP less than 65mmHg for at least 1 min. The amount of hypotension was assessed by time-weighted average intraoperative MAP under a threshold of 65 mmHg. The secondary outcomes were various anesthesia related parameters and some adverse events.ResultsIn group P, 25 patients (20.0%) experienced hypotension during hysteroscopy compared with 9 patients (7.2%) in group RP, for a difference of 12.8% (RR 2.778, 95%CI [1.352–5.709]). The combination of remimazolam and propofol resulted in significantly lower TWA (Time Weighted Average) threshold 0.14 (0.10–0.56) mmHg in group RP compared to 0.31 (0.15–0.67) mmHg in group P. The total dose of propofol was nearly double in group P compared to group RP. A significantly higher frequency of injection pain and low oxygen saturation was observed in the group P than that of the group RP. Hiccup was observed only in group RP. The incidences of body movement, bradycardia and vomiting were no significant difference between groups.ConclusionThe incidence and amount of hypotension by remimazolam-propofol combinations was significantly less than that by propofol sedation in day-surgery hysteroscopy. The optimization of medication regimen would attenuate the harm of hypotension and contribute to patients’ rapid recovery in day surgery.Trial registration Chinese Clinical Trial Registry, ChiCTR2400079888 (date: 15/01/2024),

Investigation into the application of remimazolamin conjunction with low-dose propofolfor pediatricfiberoptic bronchoscopy.

This study delves into the effectiveness of combining remimazolam with low-dose propofol in pediatric fiberoptic bronchoscopy. Ninety children scheduled for fiberoptic bronchoscopy in our hospital were enrolled as research participants. Based on the intraoperative anesthetic drug regimen, the children were divided into three groups: group R (remimazolam 0.2-0.4mg/kg), group P (propofol 1-3mg/kg), and group RP (remimazolam0.2mg/kg, propofol 0.5mg/kg). Immediately post-anesthesia, group P exhibited lower blood pressure and heart rate (HR) compared to both group R and group RP (P < 0.05). As bronchoscope approached the glottis and epiglottis, group P continued to display lower blood pressure and HR compared to group R and group RP (P < 0.05). During lavage, group P maintained lower blood pressure and HR compared to both the R and RP groups (P < 0.05). Immediately post-anesthesia, group P demonstrated lower SpO2 compared to the R and RP groups (P < 0.05).During lavage, group P maintained lower SpO2 than group R and group RP (P < 0.05). In comparison with group R and group PR, group P showed shortened induction and recovery times (P < 0.05). The one-time entry success rate into the microscope was higher in group R than in group P, with the RP group showing an intermediate decreased (P < 0.05). Moreover, the cough score in R group was higher than in the P and RP groups (P < 0.05). Furthermore, the satisfaction rates of the RP group exceeded those of the R and P groups (P < 0.05). Remimazolam combined with low-dose propofol effectively balances the strengths and weaknesses of remimazolam and propofol, ensuring more stable hemodynamics, a lower incidence of adverse reactions, and optimal surgical conditions in pediatric fiberoptic bronchoscopy.

Comparative Study of 0.5% Bupivacaine, 0.5% Ropivacaine, and 0.75% Ropivacaine With Fentanyl as a Continuous Intraoperative Epidural Infusion on Post-operative Analgesia.

Introduction Persistent postoperative pain leads to impaired patient recovery and delays in discharge of patients. The aim was to compare the efficacy of 0.5% bupivacaine to two varying concentrations of ropivacaine, specifically 0.5% and 0.75%, along with fentanyl as a continuous epidural infusion in providing adequate pain relief for patients subjected to infraumbilical surgeries. Materials and methods A prospective randomized comparative study was carried out on 150 patients and was divided into three groups, namely group B, group R, and group RP. Group B indicates (0.5% bupivacaine), group R means (0.5% ropivacaine),and finally, group RP means (0.75% ropivacaine); the three groups had 50 patients each. Group B was administered an epidural infusion of bupivacaine at a concentration of 0.5%, group R was given 0.5% ropivacaine, and group RP was treated with 0.75% ropivacaine; all three groups included 40 mcg fentanyl. The duration of the motor and sensory blockade and the time needed for the first rescue analgesia after the stoppage of epidural infusion were assessed in all three groups.The data were statistically analyzed using the ANOVA, "post hoc Tukey," and chi-square tests. Results Comparison of the duration of motor and sensory blockade among all three groups showed that group RP (0.75% ropivacaine with 2 mcg/cc fentanyl)had the longest duration of 328.8 and 406 minutes, and the difference was statistically significant (p < 0.001). Comparison of the time of stoppage of epidural infusion to the requirement of first rescue analgesia showed that the group that received 0.75% ropivacaine with 40 mcg fentanyl had the highest value of 258.6 minutes and was statistically significant (p < 0.001). Conclusion Epidural intraoperative infusion of 0.75% ropivacaine with fentanyl offers better postoperative pain relief as compared to both 0.5% bupivacaine and 0.5% ropivacaine with fentanyl.

Improved quality of life with fremanezumab in Japanese and Korean patients with episodic and chronic migraine: Results of two multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trials.

To evaluate quality of life (QoL) endpoints from two 12-week trials investigating fremanezumab efficacy and safety in Japanese/Korean patients with chronic (CM) or episodic (EM) migraine. Migraine is a leading cause of disability and affects QoL considerably, interfering with work and daily activities, social and family life, and emotional wellbeing. This planned exploratory analysis used data from two multicenter, randomized, double-blind, placebo-controlled, parallel-group studies in which Migraine-Specific QoL (MSQoL; Role Function-Restrictive [RR], Role Function-Preventive [RP], and Emotional Function [EF] domains) scores and Patient Global Impression of Change (PGIC) scores were pre-specified QoL outcomes in individuals receiving monthly or quarterly fremanezumab or placebo. In both trials, MSQoL was assessed at baseline, and MSQoL and PGIC at Weeks 4, 8, and 12. PGIC responders had a score of ≥5 points, indicating significant improvement. Mean baseline MSQoL scores were similar across groups in both CM (N = 565; RR, 60.3-61.5; RP, 78.5-80.0; EF, 69.0-71.4) and EM (N = 353; RR, 68.6-71.1; RP, 83.1-85.7; EF, 76.7-81.9) trials. In the CM trial, all three MSQoL domains improved in both fremanezumab groups at 12 weeks compared with placebo: least squares mean (LSM) and standard error (SE) change from baseline, p versus placebo (quarterly; monthly; placebo): RR 14.9 (1.3), p = 0.030; 15.1 (1.4), p = 0.020; 11.6 (1.3); RP 8.9 (1.1), p = 0.007; 8.6 (1.1), p = 0.013; 5.4 (1.1); EF 13.3 (1.5), p < 0.001; 12.5 (1.5), p = 0.003; 7.5 (1.5). In the EM trial, RR/EF domains improved in both fremanezumab groups compared with placebo: LSM change from baseline, p versus placebo (quarterly; monthly; placebo): RR 16.3 (1.4), p = 0.003; 16.4 (1.3), p = 0.002; 11.6 (1.4); EF 13.0 (1.3), p < 0.001; 11.5 (1.2), p = 0.004; 7.4 (1.3); RP improved in the quarterly group RP 8.6 (1.1), p = 0.010; 7.6 (1.1), p = 0.066; 5.4 (1.1). The proportion of PGIC responders at Week 12 was greater in the monthly and quarterly fremanezumab groups compared with the placebo group in the CM (96/182 [52.7%] and 98/180 [54.4%] vs. 68/179 [38.0%]; p < 0.05) and EM trial (81/118 [68.6%] and 86/113 [76.1%] vs. 38/111 [34.2%]; p < 0.001). Patients with EM/CM receiving monthly or quarterly fremanezumab, for a duration of 12 weeks, showed significant improvements in their QoL.

Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial.

Remimazolam tosilate (RT) is a new short-acting γ-aminobutyric acid A (GABAA) receptors agonist. However, its optimal use mode and dosage still remain unclear. This study aimed to examine the safety and effectiveness of the combination of RT and propofol in gastroscopy. This was a prospective, single-blind, randomized, multicenter, parallel-group study. All eligible 256 patients were randomized into the following 3 groups. Patients were anesthetized with propofol (Group P), RT (Group R) or the combination of RT and propofol (Group RP). The primary efficacy endpoints were: body movement score; satisfaction of gastroscopy doctors; success rate of sedation and effects on sleep status. Sedation induction time, time to be fully alert and adverse events were also recorded. The probability of complete immobility was lower in group R (33.73%) than in group P (86.67%) and RP (83.13%). The rate of doctors' satisfaction was much lower in group R (28.92%) than in group P (77.78%) and RP (72.29%). The success rate of sedation and sleep outcome score has no difference in the three groups. The time to adequate sedation was longer in group RP (77.27 ± 18.63s) than in group P (64.47 ± 24.36s), but much shorter than that in group R (102.84 ± 46.43s). The time to be fully alert was shorter in group R (6.30 ± 1.52min) and RP (6.54 ± 1.13min) than in group P (7.87 ± 1.08min). The proportion of sedative hypotension was significantly higher in group P (41.11%) than in group R (1.20%) and group RP (3.61%) (p < 0.001). The incidence of respiratory depression was much higher in group P (17.78%) than in group R (no patient) and group RP (1.2%). The incidence of adverse events was lower in groups R (4.82%) and RP (9.64%) than in group P (31.11%). The combination of RT and propofol takes effect quickly, makes patients alert quickly, provides a sufficient depth of sedation, reduces body movement, does not inhibit circulation and respiratory function, does not affect sleep, and is the preferred mode for gastroscopy doctors and anesthesiologists.

Comparison of Analgesic Effect of Clonidine as an Adjuvant with Different Concentration of Ropivacaine (0.35% and 0.2%) in Thoracic Paravertebral Block among Modified Radical Mastectomy Patients: A Randomised Double Blinded Clinical Study

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 µg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020, clinical study, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groupsRP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 ml+Clonidine (1 µg/kg) and 0.2% Ropivacaine 19 ml+Clonidine(1 µg/kg) diluted upto total 20 ml with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p&lt;0.05 was considered statistically significant. Results: Mean duration of analgesia was prolonged in clonidine groups RC and LDRC (811.5±110.99 and 753±119.76 min, respectively) as compared to group RP (400.125±108.13 min), although no statistically significant difference was noted between group RC and LDRC. Similar observations were noted when total dose of rescue analgesic in group RC (82.50±7.21 mg) and LDRC (99.38±35.57 mg) was compared to group RP (142.50±53.169 mg) as well as when total number of rescue analgesic doses in group RC (1.10±0.496) and group LDRC (1.32±0.474) were compared to group RP (1.92±0.694). Visual Analogue Scale (VAS) was noted at rest, cough, movement at 0, 4, 8, 12, 24 hours and showed a statistically significant difference between ropivacaine group RP and ropivacaine clonidine groups. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in lower pain scores, prolong duration of analgesia and reduce postoperative requirement of rescue analgesics. Both lower (0.2%) and higher (0.35%) concentrations of ropivacaine provide equally effective postoperative analgesia.

Comparison of efficacy of fascia iliaca compartment block using ropivacaine versus ropivacaine with dexmedetomidine versus ropivacaine with dexamethasone for acute pain relief in patients with femoral fractures: A prospective randomized controlled study

Context: Landmark-guided fascia iliaca compartment block (FICB) has been used in operation theater to facilitate patient position before administration of subarachnoid block, but its utilization is yet to be explored in the accident and emergency department for acute pain relief in patients with femoral fractures. Aims: The study aims to compare dexmedetomidine and dexamethasone as adjuvants to ropivacaine for FICB for onset and duration of analgesia. Settings and Designs: This was a prospective randomized controlled study performed in Mahatma Gandhi Memorial Medical College, Indore. Subjects and Methods: Ninety patients with femoral factures were allocated into three groups, and each group received 15 ml of study drug; (i) ropivacaine with dexmedetomidine (RD) group (0.2% ropivacaine with 50 μg dexmedetomidine), (ii) ropivacaine with dexamethasone (RM) group (0.2% ropivacaine with 4 mg dexamethasone), and (iii) ropivacaine alone (RP) group (0.2% ropivacaine). Patients were assessed for onset, duration of analgesia, and need for rescue analgesic. Severity of pain was assessed using Numerical Rating Scale (NRS) score. Statistical Analysis Used: Comparison of means of three groups was done using One-Way ANOVA and pair-wise comparisons using post hoc Tukey's test. Results: The onset of analgesia was earlier in Group RD at 4.38 min followed by Group RM at 4.45 min and Group RP at 7.86 min, whereas the duration of analgesia was longer in Group RD at 725 min followed by Group RM at 594 min and Group RP at 275 min. NRS Score was comparable before application of FICB. After the block, the mean NRS score in Group RD was 3.83, in Group RM was 5.30, and in Group RP was 7.93. Conclusions: FICB is an effective alternative to intravenous opioids and nonsteroidal anti-inflammatory drugs for acute pain relief in patients with femoral fractures, and dexmedetomidine and dexamethasone can be used as adjuvants to ropivacaine as they both enhance quality of block.

Curage lombo-aortique et cancers gynécologiques pelviens : cœlioscopie rétroperitonéale ou transpéritonéale ?

IntroductionPara-aortic lymphadenectomy plays a fundamental role in the surgical management of pelvic gynecological cancers. Two laparoscopic approaches exist: the transperitoneal (TP) and the extraperitoneal (EP). The aim of this study was to compare these 2 approaches in terms of surgical outcomes, specially the number of removed lymph nodes according to the surgical technique, and morbidity. Materials and methodA single-center retrospective study was carried out at the Lariboisiere University Hospital between January 2011 and March 2020 including all patients who underwent para-aortic lymphadenectomy for the management of a pelvic gynecological cancer (cervix, endometrium, ovary). Univariate and multivariate analysis (logistic regression) were performed to compare the TP and the EP groups. Results143 patients were included: 74 in the TP group and 69 in the RP group. The total duration of surgery was 220.8minutes in the TP group and 166.4minutes in the EP group (P<0.001 in multivariate analysis). No significant difference between groups were found in the average total number of lymph nodes removed but there was a statistically significant difference in the average latero-aortic number of lymph nodes removed: 8.5 lymph nodes in the TP group and 11.3 lymph nodes in the group RP (P<0.001 in multivariate analysis). There was no difference between groups in peri and postoperative morbidity. ConclusionEP para-aortic lymphadenectomy reduces duration of surgery and increases the average latero-aortic number of lymph nodes removed with same morbidity compared to TP para-aortic lymphadenectomy, this confirming its preferred indication in endometrial and in cervical cancers.

Abstract 14625: Clinical Outcomes of Autologous Stem Cell Patch Implantation for Heart Failure Patients With Non-ischemic Dilated Cardiomyopathy

Background: Although pre-clinical researches proved that cardiac regenerative therapy with autologous skeletal stem cell (SSC) patch implantation healed non-ischemic dilated cardiomyopathy (NIDCM) animal model by anti-fibrotic effect and preservation of cytoskeletal proteins in distressed myocytes, its clinical effectiveness for NIDCM has not been clearly elucidated. We hypotheses SSC patch implantation for NIDCM is feasible, safe and have therapeutic efficacy and we aim to identify the predictor of responder of this treatment in NIDCM patients Methods: Twenty-four NIDCM patients with ejection fraction less than 35% underwent SSC patch transplantation (average: 3.9±0.4х10 8 cells) via the left thoracotomy without concomitant procedures. We identified thirteen responders (Group RP) and eleven non-responders (Group NR) using the combined indicator of major cardiac adverse event and incidence of heart failure event. Results: In Group RP, symptoms, exercise capacity and cardiac performance were improved postoperatively (NYHA functional class; 2.5±0.5 to 1.9±0.3, p&lt;0.05, six-minute walk test; 471(370-541) to 525(425-555)m, p&lt;0.05, LVSWI; 31.1(22.7-35.5) to 32.8(28-38.5)g/m 2 /beat, p=0.21). However, such improvement was not observed in Group NR. Overall survival rate was 90.9±8.7% at 5 years, which was superior to estimated survival rate using Seattle heart failure model (SHFM) of 70.9±5.4% in Group RP. However overall and estimated survival rate using SHFM was similar in Group NR (47.7±21.6% and 56.3±8.1%). Preoperative histological analysis demonstrated significant low level of hypertrophy of myocyte and interstitial fibrosis and high expression of histone methylation-related molecules in Group RP compared with Group NR. Multivariate regression model with BNP, PCWP and expression of histone H3 lysine 4 trimethylation (H3K4me3) strongly predicted the responder (BNP: OR 0.96, PCWP: OR, 0.58, H3K4me3; OR, 1.35, AUC in ROC, 0.96, p&lt;0.001). Conclusions: This clinical trial demonstrated that SSC patch implantation might promise functional recovery and good clinical outcome in selected NIDCM patients with preoperatively preserved diastolic function and ability of protein synthesis in myocytes.

Random-pattern versus perforator-based adipocutaneous skin paddles for postoperative monitoring of free muscle flaps—a comparative retrospective cohort study

Free microvascular muscle flaps represent well-established reconstructive options for complex soft tissue defects. However, due to their lack of cutaneous capillary beds, they are difficult to monitor postoperatively. To this end, random and axial-pattern adipocutaneous skin paddles are often included. The objective of the study was to compare the impact of random-pattern versus perforator-based adipocutaneous skin paddles on operative efficacy and muscle flap safety. Between August 2014 and July 2016, a total of 120 free muscle flaps were included in this retrospective monocentric cohort study. Based on their skin-paddle type, they were either grouped into a 'perforator-based' (group Pb) or 'random-pattern' (group Rp) cohort. The electronic medical records and operative reports of all patients were subsequently reviewed and patient, defect, and flap characteristics of both groups were compared. The effect of the competing skin paddle types on the overall operative time, incidences of flap loss or microvascular complications, and total length of hospital stay were then assessed. Group Pb comprised 72 flaps, whereas 48 flaps constituted group Rp. Patient, defect, and flap characteristics were similar between both groups. Groups Pb and Rp were comparable regarding patient age (group Pb: 61 (10-90) vs. Rp: 59 (13-81), p = 0.556), ASA (American Society of Anesthesiologists) class (group Pb: 3 (1-4) vs. Rp 3 (1-3), p = 0.977), and comorbidities, summarized by the Charlson comorbidity index (CCI; group Pb: 1 (0-4 vs. Rp: 1 (0-5), p = 0.295). Both types of monitoring skin paddles were equally reliable. There was no significant difference in the mean operation time between both groups (group Pb: 373 ± 122 min vs. Rp: 342 ± 84 min, p = 0.124). In-patient treatment after flap surgery and total length of hospital stay were significantly shorter in group Pb (group Pb: 24 ± 10 days vs. Rp: 32 ± 17 days, p = 0.002 and group Pb: 39 ± 15 vs. Rp: 48 ± 24, p = 0.022). Perforator-based skin paddles are a reliable tool for postoperative perfusion monitoring of free muscle flaps and help avoid additional surgical interventions as opposed to their random-pattern counterparts. Thus, the overall and postoperative length of hospital stay is significantly reduced.

Comparison between the composite heavy weight prolene mesh versus the prolene soft mesh for the reduction in post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernias

Background: Globally, inguinal hernia is the most common type of hernia, comprising of approximately 75% of all abdominal wall hernias.Aim of the study was to compare the heavyweight composite polypropylene mesh versus the prolene soft mesh for the reduction of post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernia.Methods: This study was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum attached to KLE University’s J.N.M.C Belgaum.Results: Male preponderance was seen with 96.67% of patients in group SP and all (100%) patients in group RP were males. The mean age in group SP was 51.93±18.73 years compared to 49.50±14.03 years in group RP (p=0.571). The mean duration of the disease was 12.67±9.85 months in group SP whereas in group RP it was 15.10±8.98 months (p=0.321). The mean pulse rate in group SP and RP (79.60±5.64 vs 82.37±5.46 /min; p=0.059), systolic blood pressure (120.33±9.99 vs 124.33±11.94 mmHg; p=0.165) and diastolic blood pressure (73.73±6.76 vs 75.80±8.59 mmHg; p=0.305) were comparable. Right position was noted in 56.67% of patients in group SP compared to 50% of patients in group RP (p=0.673).Conclusions: Prolene soft mesh (lightweight macro-porous polypropylene mesh) significantly reduced the post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernia as compared to heavyweight composite polypropylene mesh.

The Role of Testosterone in Amplifying the Effect of a Phosphodiesterase Type 5 Inhibitor After Pelvic Irradiation

BackgroundAfter radiotherapy, the risk of hypogonadism increases, and the incidence of erectile dysfunction increases with time. AimWe investigated the effect of testosterone and a phosphodiesterase type 5 inhibitor (PDE5I) on erectile tissue after radiotherapy. Methods12 male Wistar rats were assigned to each of 5 groups (group C: control; group R: radiation; group RPT: radiation, testosterone, and a PDE5I; group RP: radiation and a PDE5I; and group RT: radiation and testosterone). A 12.5 Gy/fraction dose was administered to the rectum in groups R, RPT, RP, and RT. Udenafil (20 mg/kg) was administered daily via nasogastric tubes in group RPT and group RP for 4 weeks starting 1 day after radiotherapy. Testosterone enanthate (25 mg/kg, IM) was administered immediately after radiotherapy in group RT and group RPT. 6 rats from each group were used to evaluate endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and NOX2, and cavernosal pressure was evaluated in the other 6 rats in each group. OutcomeTestosterone enhanced the effect of PDE5I on penile tissue after radiotherapy by amplifying the nitric oxide synthase activity. ResultseNOS mRNA expression increased in response to either testosterone replacement or PDE5I administration after radiotherapy. nNOS mRNA expression did not significantly increase in response to testosterone replacement, but testosterone significantly enhanced the effect of PDE5I on nNOS mRNA expression. Testosterone significantly amplified the effect of PDE5I on both eNOS and nNOS protein expression. Both testosterone and PDE5I reduced NOX2 protein expression. The intracavernosal pressure during electrical stimulation showed that testosterone alone did not significantly enhance erectile function. Clinical TranslationClinicians should consider both hypoxic tissue damage and hypogonadism during and after radiation, and the combination of testosterone and PDE5I could be more beneficial for preserving erectile tissue than either individual treatment. Strengths & LimitationsThis study describes the role of testosterone in amplifying the effect of a PDE5I on pelvic radiotherapy-induced hypogonadism. However, we did not show the time-dependent effects of testosterone and PDE5I. ConclusionsDespite the fact that the intracavernosal pressure during electrical stimulation did not significantly increase with testosterone replacement after radiotherapy, important changes in nitric oxide synthase activity and superoxide regulation might have amplifying effects on erectile tissue. Therefore, we recommend that physicians monitor testosterone levels and should not hesitate to combine testosterone and PDE5I in cases of radiation-induced hypogonadism if testosterone replacement is not contraindicated.Lee DS, Sohn DW. The Role of Testosterone in Amplifying the Effect of a Phosphodiesterase Type 5 Inhibitor After Pelvic Irradiation. J Sex Med 2020;17:1268–1279.

PRODUKTIVITAS PADI PADA MUSIM PENGHUJAN DAN MUSIM KEMARAU DI WILAYAH DESA CIREBON GIRANG (Rice Productivity in The Rainy and Dry Seasons in The Cirebon Village Area)

This research aims to determine the appropriate rice cultivation and cropping patterns in the rainy and dry seasons and to find out the analysis of rice farming in the rainy and dry seasons. The time of the research is from January to April 2019. The research location was in the village of Cirebon Girang, Talun District, Cirebon. The method used in this research is descriptive qualitative. The results showed that rice cultivation in the rainy and dry seasons experienced differences especially in fertilization, different plant disturbing organisms, different cropping patterns from the two farmer groups, as well as the highest farming business analysis in the Talun Makmur Rainy Season Farmer group Rp. 22,772,885 and the lowest farming business is the Tanjung Makmur farmer group. Rainy season Rp. 17,044,044. While the large profits obtained in the Talun Makmur Rainy season farmers group of Rp. 24,718,667.

Effect of Silicon dioxide coating of acrylic resin surfaces on Candida albicans adhesion.

Acrylic resin has been used in the manufacture of prostheses, however, in the oral cavity, this material starts to retain microorganisms capable of causing gingival inflammation due its porosities. The aim of this study was to evaluate the influence of the use of silicon dioxide as a coating layer applied onto acrylic resin, on the adhesion of Candida albicans (Ca). After the incubation period in Sabouraud Dextrose Broth, a total of 1 ml of the Ca suspension was added to plate wells, each well containing a specimen of acrylic resin. The adhesion ability of Ca on acrylic resin was determined by counting colonies. Three groups (n = 6) of acrylic resin were assessed: with polishing (RP); without polishing (RW); with polishing and coating layer of silicon dioxide (RPC). Ca deposited on the surface of the acrylic resin was also observed using Scanning Electron Microscopy (SEM). Statistical assessment by Kruskal-Wallis and Student-Newman-Keuls Method were done (α = 2%). There was significant difference among the groups. The RPC group showed the lowest growth, with an average of 5.59 Log CFU/cm 2 ; there was a statistically significant difference in relation to group RW, which presented a growth of 6.07 Log CFU/cm 2 and to group RP with 5.91 Log CFU/cm 2 (p < 000.1). SEM images demonstrated that in the RP and RPC group, the surface of the resin had greater regularity, and smaller number of microorganisms. The application of silicon dioxide coating on acrylic resin appears to be a promising alternative, and its use can help in reducing the adhesion of Ca in prostheses.

Cost of Illness Diabetes Melitus Tipe 2 dan Komplikasinya pada Peserta Jaminan Kesehatan Nasional (JKN) di Rawat Jalan Rumah Sakit Condong Catur Yogyakarta

Type 2 diabetes mellitus is a chronic disease that requires lifelong therapy and high service costs so that the use of antidiabetic drugs affects the patient's therapeutic costs. The purpose of this study was to determine the cost of outpatient type 2 diabetes mellitus therapy for National Health Insurance (JKN) participants in Condong Catur Hospital Yogyakarta. The research method used is observational. The parameters measured are calculating the average direct medical costs (drug costs, doctor's examination and consultation fees, laboratory costs, medical treatment costs), and comparison between the costs of oral drugs, insulin, oral and insulin. The results of normality tests with Shapiro-Wilk (microvascular, microvascular and macrovascular), Kolmogorrov-Smirnov (macrovascular) p0.05 indicate that data are not normally distributed, the results of the Kruskal Wallis test of the three groups (microvascular, macrovascular, microvascular and microvascular) show that differences are not normally distributed significant (p = 0.001).The results showed that the microvascular group therapy costs Rp 3,164,733.58 per month, the macrovascular group Rp 9,984,566.85 per month, the microvascular and macrovascular groups Rp 11,260,372.39 per month. The cost of therapy is based on the microvascular group drug Rp. 408,567.78 per month, the macrovascular group Rp. 1,245,987.48 per month, the microvascular and macrovascular groups Rp. 1,786,270.68 per month so that statistically from the three complications groups show significant differences p = 0,001 (p 0,005). The difference in the difference between the total real costs and the total INA-CBG's rates, the microvascular group Rp -38,741.14 per patient, the macrovascular group Rp -10,914.03 per patient, while in the microvascular and macrovascular group Rp 3,272.90 per patient shows that from to three groups of complications were not significantly different p = 0.207 (p 0.005). Statistically it can be concluded that the cost of therapy based on antidiabetic drugs in the three groups of complications shows a significant difference. There is no significant difference in the difference between the real costs in the three groups of complications

Continuous Adductor Canal Block used for postoperative pain relief after medial Unicondylar Knee Arthroplasty: a randomized, double-blind, placebo-controlled trial

BackgroundPeripheral nerve block and local infiltration analgesia (LIA) provide good analgesia after knee replacement. This study evaluated the additional analgesic efficacy of continuous adductor canal block (ACB) added to single-dose LIA after medial unicondylar knee arthroplasty (UKA). We hypothesized ACB would lower pain scores and facilitate postoperative ambulation.MethodsForty-six patients were enrolled into this double-blind, randomized, placebo-controlled trial. UKA was performed and all patients received single-dose LIA intraoperatively. Patients were randomized into two groups: Group RP receiving 0.2% ropivacaine or Group Con receiving normal saline. A flow at 6 mL/h was administered for 48 h through a catheter in the adductor canal. Primary outcome was movement pain score at 24 h using the numeric rating scale (NRS-11). Secondary outcomes included serial postoperative pain scores, rate of patients with NRS>3 at rest and movement within 24 and 48 h postoperatively, time to breakthrough pain, quadriceps motor strength, ambulated distance, catheter related infection and patient satisfaction.ResultsForty-two patients were analyzed. Pain scores with movement at 24 h postoperatively were significantly lower in Group RP than that in Group Con (3 vs. 5 NRS, P<0.001). Compared with Group Con, breakthrough pain occurred later in Group RP (18.5 vs 10.0 h, P = 0.002), serial pain scores at rest and with movement and rate of patients with NRS>3 with movement after surgery were significantly lower. Quadriceps motor strength was equivalent, however, ambulated distance on postoperative day 1 and 2 in Group Con was significant less (19.7 vs 37.3 m, P = 0.046; 33.4 vs 59.5 m, P = 0.002).ConclusionsContinuous adductor canal block added to single-dose LIA offered better analgesia and facilitated ambulation without motor weakness after medial UKA.Trial registrationClinical Trial Registration: ChiCTR-IOR-16008720; Registered 25 June 2016.

Reveromycin A Inhibits Bone Loss in Ovariectomized Mice

Background and objectives: Reveromycin A inhibits bone metastasis of lung cancer cells in natural killer cell-depleted immunodeficient mice with increasing apoptosis of osteoclasts. This knowledge suggests that reveromycin A is a potent inhibitor for osteoclasts in vivo. To determine the activity of bone loss in acute estrogen deficiency, we studied ovariectomized mice treated with reveromycin A. Materials and Methods: Eight-week-old female C57BL/6 mice were either ovariectomized or sham-operated. Reveromycin A was continuously administered for the first 2 weeks (Group RA) or the last 2 weeks (Group RP) using a subcutaneous mini osmotic pump. Mice were sacrificed 4 weeks after surgery. Inhibition was detected by images as well as serum carboxyterminal telopeptide of type I collagen (CTX). Results: BMD reduction in the RA group was significantly inhibited and was comparable with that in the sham group. In contrast, the RP group failed to inhibit BMD reduction. The plasma CTX level at the 28th day of the experiment was significantly increased in the RP and OVX groups compared with that in the sham group, while the increase was inhibited in the RA group. Morphometric analysis revealed that absorption of trabecular bone was strongly inhibited in the RA group. Conclusion: The inhibitory effects of reveromycin A administered immediately after ovariectomy was the most effective at the early phase of bone loss than at the later stage. A new reagent that inhibits bone loss in acute estrogen deficiency might be a new tool to experimentally study osteoporosis and may have clinical implications.

COST-EFFECTIVENESS ANALYSIS OF CEFTRIAXONE AND NON-CEFTRIAXONE ON TYPHOID FEVER PATIENTS

Objective: This study aimed to evaluate the cost-effectiveness of ceftriaxone and non-ceftriaxone therapies in patients with typhoid fever.Methods: The applied method was a cost-effectiveness analysis. Data were retrospectively collected, and sampling was performed using totalsampling based on medical records and hospital information systems. Subjects were limited to patients diagnosed with typhoid fever and usingceftriaxone or non-ceftriaxone antibiotics. A total of 15 patients were investigated, comprising 10 patients on ceftriaxone and five patients using nonceftriaxoneantibiotics. Effectiveness was evaluated by the length of hospitalization. The cost was a median of total costs, consisting of the cost of thedrug, concomitant drugs, medical equipment, laboratory tests, doctor, health-care services, and hospitalization.Results: The results showed the effectiveness of ceftriaxone (3.80±0.789 days) did not differ with the non-ceftriaxone drugs (3.40±1.635 days).However, the total cost of ceftriaxone (Rp 1,929,355) was less than that of non-ceftriaxone antibiotics (Rp 2,787,003). The average cost-effectivenessratio of ceftriaxone group (Rp 507,725/effectiveness) was lower compared to the non-ceftriaxone (Rp 819,707/effectiveness).Conclusions: This study results showed that ceftriaxone was more cost-effective than non-ceftriaxone antibiotics.

Effect of parecoxib combined with ropivacaine for incision infiltration on agitation during recovery from anesthesia in patients undergoing abdominal hepatectomy

Objective To evaluate the effect of parecoxib combined with ropivacaine for incision infiltration on agitation during recovery from anesthesia in patients undergoing abdominal hepatectomy. Methods Forty patients of both sexes, aged 35-64 yr, with body mass index of 18-24 kg/m2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, undergoing elective partial hepatectomy, were divided into parecoxib sodium group (group P) and parecoxib sodium plus ropivacaine group (group RP) with 20 cases in each group. Parecoxib sodium 40 mg was intravenously injected at 30 min before operation in group P. Parecoxib sodium 40 mg was intravenously injected at 30 min before operation, and incision infiltration was performed with 0.5% ropivacaine 20 ml at the end of surgery in group RP.Patient-controlled intravenous analgesia was performed at the end of surgery in both groups.The development of agitation, respiratory depression and nausea and vomiting was recorded within 30 min after operation.Blood samples were collected from the radial artery immediately before induction (T0), at the end of surgery (T1) and at removal of extubation (T2) for determination of plasma cortisone (Cor) concentrations (by radio-immunity method), plasma epinephrine (E) and norepinephrine (NE) concentrations (by enzyme-linked immunosorbent assay) and blood glucose (using a blood gas analyzer). Results Compared with the baseline at T0, the plasma concentrations of Cor, Glu, E and NE were significantly increased at T1, 2 in two groups (P>0.05). The incidence of agitation and plasma concentrations of Cor, Glu, E and NE were significantly lower at T1, 2 in group RP than in group P (P<0.05). No patients developed nausea and vomiting and respiratory depression in two groups. Conclusion Parecoxib combined with ropivacaine for incision infiltration can decrease the occurrence of agitation during recovery from anesthesia, which is related to inhibiting stress responses of patients undergoing abdominal hepatectomy. Key words: Cyclooxygenase 2 inhibitors; Amides; Anesthesia recovery period; Dysphoria

Dexmedetomidine facilitates extubation in children who require intubation and respiratory support after airway foreign body retrieval: a case-cohort analysis of 57 cases.

This study aimed to investigate whether dexmedetomidine had sedative weaning advantage for extubation after airway foreign body (FB) removal in children. A retrospective case-cohort comparison study with total of 57 critical children who required mechanical ventilation after rigid bronchoscopy was performed. After tracheal intubation, group D (received dexmedetomidine 1µg/kg over 10min, followed by an infusion of 0.8µg/kg/h), and group RP (received remifentanil-propofol 6-10µg/kg/h and 1-3mg/kg/h, respectively). The primary outcome was successful extubation rate on first weaning trial. The minor outcomes included weaning time, emergency agitation, coughing score and the incidence of respiratory adverse complications on emergency. All 57 patients were included in the analysis, with 30 patients in group D and 27 controlled cases in group RP. The success rate of first weaning trial in the D group was 96.7 vs 77.8% in the RP group, risk ratio (RR) 1.56, 95% CI [0.78-1.98]. Time for resuming spontaneous breathing after termination infusion was shorter in the D group (median 8min, IQR 15min) vs RP group (median 12min, IQR 19min, P = 0.02, RR 0.56, 95% CI 0.14-6.57). In mechanical ventilation of pediatric patients following rigid bronchoscopy, in comparison to remifentanil-propofol, dexmedetomidine is proved to have high success rate for weaning strategy. WHAT IS ALREADY KNOWN?: Remifentanil is proved to be effective for weaning in ICU patients. Dexmedetomedine can provide similar rates of smooth extubation for pediatric patients who underwent airway surgery. WHAT THIS ARTICLE ADDS?: Invasive ventilation is used for patients with severe comorbidity after airway surgery, but the correct strategy for pediatric extubation after removal of airway foreign body remains unclear. For these patients with short-term mechanical ventilation, dexmedetomedine may improve the extubation rate, when compared with remifentanil-propofol.