Group Rs Research Articles

A comparative evaluation of dexamethasone and MgSO4 as an adjuvant to ropivacaine in transversus abdominis plane block for post operative analgesia in patients undergoing elective cesarean section, a triple blinded randomised controlled trial

: In regional blocks, dexamethasone and magnesium sulphate (MgSO4) have been used as an adjunct to local anesthesia. But more research needs to be done on each one's effectiveness. This study aims to assess the efficacy of dexamethasone 4mg and MgSO4 150mg as an adjunct to ropivacaine 0.375% in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing cesarean section under subarachnoid block (SAB).: Ninety patients undergoing cesarean section under SAB belonging to American Society of Anesthesiologists physical status I or II, were recruited and randomised in three groups. Each group comprised of 30 patients. Group RS received 20ml 0.375% ropivacaine with 2 ml normal saline, Group RD received 20ml 0.375% ropivacaine with 4 mg dexamethasone and Group RM received 20ml 0.375% ropivacaine with 150 mg MgSO4.Time to first analgesic request, VAS score at rest and movement, patient satisfaction score, hemodynamic parameters and side effects were recorded in each group post-TAP block for 24 hours. Time to first analgesic request was significantly longer in group RD (814.0± 277.3 min) compared to group RM (606.5 ± 279.9 min) and group RS (545.5 ± 254.3 min) (p = 0.001). The mean value of tramadol requirement was statistically higher in Group RS compared to Group RD and Group RM (p<0.001). The mean differences in VAS score at rest and movement at 6 & 8 h was significantly lower in dexamethasone and MgSO4 compared to control group p=0.001. The addition of dexamethasone to ropivacaine in TAP block significantly prolonged the duration of analgesia, reducing the need for systemic analgesia with minimal side effects.

Preceptorship Program and Recruitment Process on Improving the Behavior of Professional Nurses in the Inpatient Room of Hospital C Jakarta

Aims: The unprofessional behavior of nurses makes nursing services not provide positive values, which can be influenced by the absence of preceptorship for nurses. The research conducted in June – August 2022 aims to assess the effect of preceptorship program and recruitment process to improve professional nurse behavior. Design: Quasi-experimental study, with intervention group preceptorship program RS Cinta Kasih Tzu Chi and control group RS Mentari. Samples of intervention and control groups were 35 respondents each, using total sampling technique. Data collection tools are questionnaires and pretest - posttest data collection is carried out 4 days after the questionnaires are distributed. Method: Data analysis using Wilcoxon test, Chi-square test and multivariate logistic regression test. Results: The results showed that the behavior of professional nurses increased. There are differences in the behavior of nurses in the intervention and control groups (p value= 0.000). There is the relationship between the recruitment process and an increase in the behavior of nurses (p value = 0.001). Working period (p value = 0.017) and preceptorship program (p value = 0.006) have an effect on increasing the behavior of professional nurses. Conclusion: It is hoped that RS C will hold a preceptorship program and establish regulations, policies, guidelines and guidelines on the application of the preceptorship method to changes in the behavior of professional nurses. Nurses understand and instill the behavior of professional nurses starting from themselves, colleagues, and patient care.

18F-FluorThanatrace (18F-FTT) positron emission tomography (PET/CT) in prostate cancer measures in vivo PARP-1 expression and is associated with adverse clinicopathologic features.

5030 Background: We performed the first clinical trial to evaluate expression of PARP-1, the target of PARP-inhibitors (PARPi), in prostate cancer (PC) using 18F-FluorThanatrace (18F-FTT), a novel radiopharmaceutical that selectively measures PARP-1 expression with PET/CT. Approvals for PARPi in metastatic castrate resistant prostate cancer (mCRPC) have improved clinical outcomes in men with homologous recombination deficient (HRD) associated PC. Patient selection using genetic biomarkers such as HRD and PARP-1 IHC are insufficient PARPi biomarkers. We report the first trial of assessment of PARP-1 expression in men with prostate cancer. Methods: Men with localized PC with planned prostatectomy were included. Patients were required to have 2+ biopsy cores with > 50% involvement, OR > 1cm dominant prostate lesion on MRI. Men received a single pre-operative [18F]FTT scan. [18F]FTT is. Patients received a single injection of 8-12 mCi [18F]FTT and underwent 60 minutes dynamic scanning and static scan at 90 minutes post-injection. Ex vivo IHC, autoradiography, and germline/somatic genomic testing was performed after surgical removal. The study was approved by the University of Pennsylvania IRB (UPCC #13817, ClinicalTrials.gov, NCT03334500). Results: 30 men consented for participation (29 with presurgical MRI) from 6/2019 to 12/2020. Mean PSA was 9.8 ng/mL (range 2.35 – 60). Gleason Grade (GG) groups included: GG 1 (n = 1), GG 2 (n = 10), GG 3 (n = 5), GG 4 (n = 7), and GG 5 (n = 7). Stages included: pT2 (n = 12), pT3a (n = 10), pT3b (n = 8). Two patients had pN1 disease (cN0 by MRI). Mean injected dose was 10.32 mCi (range 7.52 – 11.62). There were no serious adverse events noted for any patient. Of patients with presurgical MRI, a range of uptake on the PET/CT correlated to the dominant lesion on MRI. The mean and median SUVMax of all lesions was 3.52 and 3.46, respectively (range 1.03 – 6.56). Both patients cN0 on MRI, had those nodes identified on the [18F]FTT scan. SUVMax was significantly associated with increasing Gleason Grade group Rs = 0.37298, p (2-tailed) = 0.04. SUVMax was significantly associated with Decipher scores (GenomeDx Biosciences, San Diego, CA) Rs = 0.63077, p (2-tailed) = 0.02. Ex vivo IHC showed PARP1 localization to the dominant region on the MRI. Ex vivo autoradiography using [I125]KX1, a FTT analogue, and correlation to genomic HRD (DDR aberrations and HRD scores) is underway. Conclusions: [18F]FTT detects in vivo PARP-1 expression in prostate cancer and SUVMax is associated with higher Gleason Grade groups and Decipher scores, This tracer may be used as an imaging biomarker for PARP-1 expression in men with prostate cancer, the target of PARPi. A follow-up study to assess change in [18F]FTT uptake before and after administration of PARPi in men with mCRPC is underway to test [18F]FTT as a biomarker PARPi (UPCC #08821). Clinical trial information: NCT03334500.

Effect of caudally administered clonidine on sevoflurane induced emergence agitation-A randomized trial.

Background and Aims:Emergence agitation (EA) is an unpleasant problem encountered in children following anesthesia with Sevoflurane. We studied the effectiveness of caudal epidural block (CEB) with ropivacaine 0.2% and clonidine two microgram per kilogram (mcg/kg) on the incidence of EA, with respiratory depression and hemodynamic variables as secondary end points.Material and Methods:Ninety children aged one to eight years undergoing infra umbilical surgeries were randomly allocated into two groups. Group RS: Ropivacaine 0.2% one ml/kg + . Saline one ml and Group RC: Ropivacaine 0.2% one ml/kg + Clonidine two mcg/kg made to one ml. They were then administered general anesthesia with endotracheal intubation followed by CEB using test drugs. Post surgery, EA was evaluated by Modified Richmond Agitation Scale at 15-minute intervals for one hour. The results were then analyzed using mean and standard deviation (SD), Chi square test, and Independent t test.Results:EA was significantly lower in group RC when compared to group RS (P < 0.0001). Group RC had 12 (28.5%) children with EA at 15 minutes compared to 35 (83.3%) children in Group RS. At 30 minutes, it was seen in five (11.3%) and 27 (64.2%) children in group RC and RS, respectively. No significant respiratory depression was noted in both groups. A significant decrease in heart rate was seen in Group RC (P < 0.001) but was not significant clinically. No adverse events were recorded in both the groups.Conclusion:Addition of clonidine (2mcg/kg) to ropivacaine 0.2% offers an advantage over 0.2% ropivacaine alone in decreasing the incidence of sevoflurane induced EA in children undergoing lower abdominal surgery without any adverse effects.

Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial.

Sufentanil combined with ropivacaine is commonly used for epidural labor analgesia, but it may cause some adverse effects. Dexmedetomidine is suitable for long-term and short-term intraoperative sedation and analgesia, and it can reduce the use of the opioid sufentanil. This study compared the efficacy and safety of dexmedetomidine and sufentanil combined with ropivacaine for epidural labor analgesia. A randomized, triple-blinded, controlled trial was performed for epidural labor analgesia. All included parturient women were randomized 1:1 by computer to receive ropivacaine combined with dexmedetomidine (group RD) or sufentanil (group RS) from October 2020 to February 2021. The primary outcomes were the pain relief of parturient women assessed by the visual analog scale (VAS) score, and the physical status of newborns assessed by the neonatal behavioral neurological assessment (NBNA) score and Apgar score. Secondary outcomes included the duration of labor stages and adverse reactions of parturient women and newborns. A total of 160 parturient women were included in this study, with 80 in each group. The VAS scores were lower in both groups after the injection of analgesics (in 120 min; RD: 2.6±1.0 vs. RS: 2.5±0.8; P=0.489), and there was no significant difference. The newborns' NBNA (RD: 39.9±0.4 vs. RS: 39.8±0.5; P=0.368) and Apgar scores (RD: 9.8±0.7 vs. RS: 9.7±0.8; P=0.424) were higher than normal standard (NBNA >37; Apgar >7) in both groups, and there were also no significant differences. No differences in parturient women's demographic characteristics, vital signs, Ramsay Sedation Scale (RSS) values, blood loss, duration of labor stages (first and second stages), onset time of analgesia, and dose of analgesics were found between the 2 groups (all P>0.05). The incidence of adverse reactions in parturient women and newborns was low in both groups. Dexmedetomidine or sufentanil combined with ropivacaine for epidural labor analgesia had similar analgesic effects in clinical practice. Chinese Clinical Trial Registry ChiCTR2000038702.

Addition of low-dose sufentanil to ropivacaine for reducing shivering and visceral traction pain during cesarean section.

ObjectiveTo investigate the efficacy of low-dose sufentanil for preventing shivering and visceral traction pain during cesarean section under spinal anesthesia.MethodsThis was a prospective, randomized, controlled study. A total of 112 full-term parturients who underwent elective caesarean delivery were randomly divided into two groups. Group R received 0.75% isobaric ropivacaine intrathecally and group RS received 0.75% isobaric ropivacaine plus 5 µg sufentanil intrathecally.ResultsThere were no significant differences in the maximum sensory block time, motor block time, duration of the surgery, and heart rate, mean arterial pressure, and blood oxygen saturation before and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the surgery between the two groups. Shivering was significantly more common in group R (n = 30) than in group RS (n = 8). The incidence of visceral traction pain in group R (46.43%) was significantly higher than that in group RS (14.29%). There was no significant difference in the newborns’ Apgar scores between the groups.ConclusionAdding low-dose sufentanil to ropivacaine can significantly reduce the incidence of shivering and visceral traction pain after spinal anesthesia.

Does sugammadex suppress allergic inflammation due to rocuronium in animal model of rat?

There are a few reports in the literature about the successful use of sugammadex in the treatment of hypersensitivity reactions caused by rocuronium; however, the pathophysiological mechanism is still unknown. This study aims to investigate the changes caused by rocuronium in the lung and the effect of sugammadex on these changes with biochemical, light microscopic and immunohistochemical parameters on a rat model. For the study, 28-male Sprague-Dawley rats were randomly divided, seven of each, into four groups. Group C (control) received only 0. 9 % NaCl without any drug. Group R received rocuronium alone 1mg/kg. Group S received sugammadex alone 96 mg/kg. Group RS received rocuronium 1mg/kg and sugammadex 96 mg/kg. After 24 h later, the animals were sacrificed and their tissues were removed. Biochemical (IgE/CRP), light microscopic and immunohistochemical findings were recorded. Immunoglobulin E and CRP levels, peribronchial, alveolar septal lymphocytic infiltration, thickening of the alveolar membranes and bleeding sites in Group R were significantly higher than all the other groups. In Group RS, while these parameters were significantly lower than that of Group R and Group S, it was significantly higher than that of Group C. Total mast cells and tryptase-positive mast cells counts were significantly higher in Group R than in all other groups. In Group RS, these parameters were statistically lower than that of Group R and Group S, but higher than that of Group C. This study shows that allergic inflammatory changes due to rocuronium in the lungs of rats are reduced with sugammadex. These results support cases of anaphylaxis due to rocuronium which improved with sugammadex.

Morin-5'-Sulfonic Acid Sodium Salt (NaMSA) Attenuates Cyclophosphamide-Induced Histological Changes in Genitourinary Tract in Rats-Short Report.

Cyclophosphamide (CPX) exerts toxicity in the urogenital system. The current study was designed to evaluate the effect of morin-5′-sulfonic acid sodium salt (NaMSA) on CPX-induced urogenital toxicity in rats. NaMSA (100 mg/kg/daily) and CPX (15 mg/kg/daily) alone or in combination and 0.9% NaCl (as a control) were given intragastrically for 10 days. Testes and epididymes from male and urinary bladders from male and female rats were evaluated histologically. In testes and epididymes, morphological changes and relative decrease in sperm count were assessed. In urinary bladders edema, hemorrhage and urothelium erosions were described by 0–2 points scoring system. Reproductive score (RS—in total 6 points) and urinary bladder score (BS—in total 6 points) were thereafter calculated. In CPX-receiving group RS (2.7) and BS (3.3) were significantly higher than in the control (0.5 and 0.25 for RS and BS, respectively). Co-administration of NaMSA reversed most of the morphological changes, which was reflected by lower RS and BS score (0.5 and 1.2 for RS and BS, respectively). The preliminary findings suggest that NaMSA may attenuate CPX-induced histological changes in rat urogenital tract.

Validation of computerized reflective function: A replication study

Objective: The Reflective Function (RF) Scale is the original validated measure of mentalizing, applied to Adult Attachment Interview (AAI) transcripts. This study aimed to replicate the preliminary validation of Computerized RF (CRF), a computerized text analysis measure of RF. Methods: 49 women with borderline personality disorder (BPD; n = 20) and without (n = 29) completed diagnostic interviews and the AAI. AAIs were scored by certified coders using the RF Scale, and by computerized text analysis software using CRF dictionaries. Results: CRF significantly correlated with RF. The frequency of High CRF words had moderate-to-strong correlations with RF in the total sample (rs = .47), BPD group (rs = .61), and non-BPD group (rs = .41). Adding the frequency of Low CRF words to create a proportion of High and Low CRF words, and applying CRF to AAIs trimmed to include only items that “demand” RF, both produced significant, but not stronger, correlations with RF. Conclusion: CRF is an efficient alternative to the RF Scale that can estimate mentalization. Near average levels, neither RF nor CRF significantly differentiated between groups, indicating mentalizing deficits may not always be present, detectable, or defining in BPD samples. While more research is needed, CRF is a valid assessment of RF when codable text is available.

Use of dual layered stents in endovascular treatment of extracranial stenosis of the internal carotid artery: one year results of a patient-based meta-analysis of 4 clinical studies

Abstract Background Small sized clinical studies evaluating one year outcomes of CAS performed with two available DLS, Roadsaver® (RS) and CGuard® (CG), have been published. Purpose To evaluate one year safety and efficacy of dual layered mesh covered carotid stent systems (DLS) for carotid artery stenting (CAS). Methods We performed an individual patient-level meta-analysis including studies enrolling more than 100 CAS with DLS. Primary endpoint was the death and stroke rate; secondary endpoints were restenosis and in-stent thrombosis rates at one year. Results Patients were divided in two groups according to DLS (RS N=250; CG N=306). At one year, 11 patients died (1.97%), 7 patients in the group RS (2.8%) and 4 patients in the CG one (1.31%), 10 strokes occurred, 4 in the group RS (1.6%) and 6 in the CG one (1.96%). Overall death and stroke rate was 3.77% (N=21), 11 events in the group RS (4.4%) and 10 in the CG group (3.27%). Symptomatic status was the only predictor of death and or stroke. At one year restenosis occurred in 12 patients (2.1%), 10 in the group RS (4%) and 2 in the CG one (0.65%) (p=0.007). In stent thrombosis occurred in 1 patient (0.18%) of the group CG (0.32%). RS use was the only independent restenosis predictor. Conclusions This study suggests that DLS use for CAS is associated to a low one year death and stroke rate and specific DLS stent use could affect restenosis rate. Funding Acknowledgement Type of funding source: None

Comparative Assessment of the Shaping and Cleaning Abilities of M-Pro and Revo-S versus ProTaper Next Rotary Ni-Ti Systems: An In Vitro study

Objective: The aim of the present study was to compare the canal transportation, centering ratio, debris and smear layer score after using 3 rotary Ni-Ti systems, Revo-S (RS; Micro-Mega, Besancon Cedex, France) and ProTaper Next (PTN; Dentsply Tulsa Dental Specialties, Tulsa, OK) and M-Pro system( Guangdong, China, Mainland). Material and methods: Thirty nine mesiobuccal root canals of extracted lower first molars with 20˚ to 45˚ angle of curvature and were divided randomly into 3 groups of 13 samples each: group RS, group M-Pro and group PTN. Root canal transportation and centering ratio were evaluated at 3, 6 and 9 mm from apex using i-CAT CBCT (Hatfield, pennsylvania ,USA) before and after preparation.Thirteen Roots from each group were split longitudinally using diamond disc, by making a groove on buccal and lingual side of root without reaching the lumen of the canal.The root halves were examined under Scan Electron Microscope (SEM) by magnification x 1000 and x 4000 for debris and smear layer respectively The significance level was set at P ≤ 0.05. Results: There was no statistically significant difference in canal transportation, canal centering ratio, debris and smear layer score between the three tested groups. Conclusion: From the obtained results and within the limitations of this study, the following could be concluded:M-Pro Nickel Titanium rotary system had a negligible effect on root canal transportation which was similar to the ProTaper Next and Revo-S systems and no system was able to clean the root canal system completely.

Efficacy and Safety of Neuromuscular Blockade in Overweight Patients Undergoing Nasopharyngeal Surgery.

BackgroundAdequate muscle relaxation and rapid recovery of neuromuscular function are essential in the perioperative period. We therefore compared various anesthetic regimens of neuromuscular blockers and antagonists administered to overweight patients undergoing nasopharyngeal surgery.Material/MethodsThis prospective, randomized, double-blind study was conducted in overweight patients undergoing nasopharyngeal surgery. We randomly assigned 102 patients into 3 groups (each n=34) treated with various muscle relaxant agents and antagonists: rocuronium and sugammadex (Group RS), rocuronium and neostigmine (Group RN), and cisatracurium and neostigmine (Group CN). Then, we compared the efficacy and safety indexes of the 3 groups.ResultsOnset times of muscular relaxation in Group RS and Group RN (110 s and 120 s) were shorter than in Group CN (183 s). Time from administration of antagonist to recovery of the TOF ratio to 0.9 was shorter in Group RS (3.3 min) than in other groups (20.7 min and 19.1 min, respectively). The incidence of postoperative residual curarization (PORC) was significantly lower in Group RS (5.9%) than in the other 2 groups (both 41.2%). The hemodynamic parameter changes before extubation were significantly higher in Group RN and Group CN than in Group RS. The postoperative pain scores were lowest in Group RS.ConclusionsFor overweight patients undergoing nasopharyngeal surgery, the use of rocuronium with sugammadex had the shortest onset time of neuromuscular relaxation, accelerated the reversion of neuromuscular blockade, effectively reduced the occurrence of PORC, relieved postoperative pain, and maintained hemodynamic stability before extubation. The combination of rocuronium and sugammadex may be the best anesthetic regimen for overweight patients undergoing nasopharyngeal surgery.

1678-P: Insulin Peptide Reactive T-Cells May Reflect Disease Activity in Ketosis-Prone Type 2 Diabetes

Ketosis-prone type 2 diabetes with autoantibody negative and beta cell function positive group (KPD) is recognized as atypical diabetes characterized by the onset of disease at a relatively young age, obesity, sudden onset of ketosis and a transient decrease in insulin secretion. Previously we have reported that insulin peptide reactive T cells are detected in KPD patients (2017, ADA meeting). In this study, we examined the correlation between insulin peptide reactive T cells and clinical background such as C-peptide, HbA1c, and HLA types especially focusing on class I region to assess the significance of insulin peptide reactive T cells detected in KPD subjects. Peripheral blood was obtained from enrolled subjects with informed consent, and stimulated with insulin peptides (insulin B9-23, B10-24, B11-25, B12-26) for 24 hours, then interferon (IFN)-gamma spots were counted. Maximum spots more than 2.5 were considered as positive based on the data from control subjects. Seven out of 21 (33.3%) KPD participants (21 males, 0 females, mean age 40.3 years) showed positive result, and this frequency was similar to that in acute-onset type 1 diabetes (17 out of 50; 34.0%) (22 males, 28 females, mean age 44.5 years); these results were consistent with our previous observation. Only 1 out of 35 (2.9%) showed positive result in controls (26 males, 9 females, mean age 61.8 years). In KPD participants, serum C-peptide level was significantly lower in the ELISpot positive group than in the negative group (1.40±0.55 ng/mL vs. 2.35±0.76 ng/mL; p &amp;lt;0.05). Moreover, there was a significant positive correlation between the spot number and HbA1c at onset in the positive group (rs= 0.6232, (p &amp;lt;0.05 by Spearman correlation test). Furthermore, HLA A*02:01 or A*24:02 positive rate was significantly higher in the ELISpot positive group (n=7) than the negative group (n=14) (86% vs. 36%; p &amp;lt;0.05). These findings suggest that insulin peptide reactive IFN-gamma-producing T cells may reflect disease activity of KPD. Disclosure A. Satomura: None. S. Suzuki: None. A. Haisa: None. Y. Oikawa: None. A. Shimada: Advisory Panel; Self; Astellas Pharma Inc. Speaker’s Bureau; Self; Eli Lilly Japan K.K., Novo Nordisk Inc., Sanofi-Aventis.

Study of Efficacy of Sevoflurane with Rocuronium during Induction in Neurosurgical Patients

Background: Rocuronium provides good intubating conditions but large doses causes prolongation of its duration of action, making it unsuitable for short surgical procedures. Aims: We assessed the efficacy of sevoflurane with rocuronium during induction in terms of reducing the onset time for intubation, evaluating intubating conditions and haemodynamic responses during intubation.Subjects and Methods:This prospective, randomised, double-blind study was conducted in 40 adult patients undergoing lumbar disc operations under general anaesthesia were randomly allocated into two equal groups namely Group R (received 0.8 mg/kg of rocuronium) and Group RS (received 0.8 mg/kg of rocuronium and 2% sevoflurane during induction).Results:The two groups were comparable with respect to age, sex, weight and ASA grade. The time for loss of thumb adduction was 101.4 ± 11.2 s in Group R compared with 61.04 ± 5.4 s in Group RS P &lt; 0.001]. The onset time of intubation was significant P &lt; 0.001]. Significant differences in heart rate and mean arterial pressure were seen immediately after intubation, at 1 and 3 min after intubation (P &lt; 0.05) between the two groups. The mean intubation score was comparable in both the groups is insignificant[P = 0.11].Conclusion:Rocuronium 0.8 mg/kg along with 2% sevoflurane provides rapid sequence intubation during anaesthesia in neurosurgical patients.

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial.

Opioids and α2-agonists have been used as epidural adjuvants in local anesthetics for a long time, but the effect of the combination of opioids and α2-agonists as epidural adjuvants is not completely understood. In the present study, the combination of dexmedetomidine (Dex) and sufentanil as adjuvants to ropivacaine for epidural labor analgesia was investigated. A total of 108 parturient women receiving labor epidural analgesia were randomly divided into three groups: i) Group RD received 0.1% ropivacaine + 0.5 µg/ml Dex; ii) Group RS received 0.1% ropivacaine + 0.5 µg/ml sufentanil; and iv) Group RDS received 0.1% ropivacaine + 0.25 µg/ml Dex + 0.25 µg/ml sufentanil. Patients received a 10 ml loading dose followed by a maintenance by patient controlled epidural analgesia. The visual analog scale scores, onset time, local anesthetic requirements, motor blockage and adverse effects were recorded. Group RDS displayed an improved labor analgesia effect compared with Groups RD and RS. Group RDS displayed a shorter onset time compared with Groups RD and RS, and a reduced local anesthetic requirement compared with Group RS. The motor blockage in Groups RDS and RS was significantly lower compared with Group RD, and the incidence of pruritus in Groups RDS and RD was lower compared with Group RS. In conclusion, the combined use of 0.25 µg/ml Dex and 0.25 µg/ml sufentanil as adjuvants to 0.1% ropivacaine for epidural labor analgesia displayed an improved analgesia effect compared with the use of either 0.5 µg/ml sufentanil or 0.5 µg/ml Dex alone. The present study was registered with the Chinese Clinical Trial Registry Center on 23 February, 2018 (registration no. ChiCTR-IOR-1800014943).

Comparison of emergence agitation between succinylcholine and rocuronium-sugammadex in adults following closed reduction of a nasal bone fracture: a prospective randomized controlled trial

BackgroundSugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia.MethodsForty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each n = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared.ResultsThe incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7; P = .006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4; P = .045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3; P = .001).ConclusionSuccinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture.Trial registrationCRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).

Comparison of effects of different labor analgesia regimens on perinatal mental state of parturients

Objective To compare the effects of sufentanil mixed with ropivacaine and ropivacaine alone for peripartum analgesia on perinatal mental state of parturients. Methods Three hundred and eighty-nine primiparous acquiring labor analgesia in our hospital from April 2016 to April 2019, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, at ≥37 weeks of gestation, aged 25-45 yr, were divided into 2 groups using a random number table method: ropivacaine group (R group, n=193) and ropivacaine mixed with sufentanil group (RS group, n=196). Epidural labor analgesia was performed with 1.5% ropivacaine in group R. Epidural labor analgesia was performed with 1% ropivacaine mixed with 0.5 μg/ml sufentanil in group RS.The Edinburgh depression scale (EPDS), multidimensional social support perception scale (MSPSS) and breast-feeding self-brief scale (BSES) were used to evaluate the maternal psychological status at 30 min after labor analgesia induction and 42 days after delivery. Results One hundred and sixty-one patients completed the study in group RS and 157 patients in group R. Compared with group RS, the EPDS score was significantly decreased, and the BSES score was increased at 42 days after delivery (P 0.05). Conclusion Compared with epidural labor analgesia with ropivacaine, epidural labor analgesia with sufentanil mixed with ropivacaine has a marked adverse effect on the perinatal mental state of parturients. Key words: Analgesia, obstetrical; Depression, postpartum

Physical fitness and psycho-cognitive performance in the young and middle-aged workforce with primarily physical versus mental work demands

AimThe purpose of this study was to examine physical fitness and psycho-cognitive performance and their associations in young and middle-aged workers with primarily physical versus mental work demands.Subjects and methodsHealthy young and middle-aged workers (73 men, age = 33 ± 7 years; 75 women, age = 35 ± 9 years) were recruited from German small-to-medium-sized enterprises (< 250 employees) and classified into groups with primarily mental (MD) or physical demands (PD) at work. Participants were tested for cardiorespiratory fitness, trunk flexor/extensor muscular endurance, handgrip strength, balance, leg muscle power, perceived stress, cognitive performance, and work ability.ResultsNinety-four workers were allocated to the MD (53% females) and 54 to the PD (46% females) groups. The MD group showed significantly better balance, trunk extensor muscular endurance, and cognitive performance (p < 0.035, 0.35 ≤ d ≤ 0.55) and less stress compared with the PD group (p < 0.023, d = 0.38). Group-specific Spearman rank correlation analysis (rS) revealed significant small-to-medium-sized correlations between physical fitness and cognitive performance (− 0.205 ≤ rS ≤ 0.434) in the MD and PD groups. Significant small-to-medium-sized correlations were found for physical fitness and stress/work ability (0.211 ≤ rS ≤ 0.301) in the MD group only. Further, associations of trunk extensor muscular endurance and work ability were significantly higher in the MD group (rS = 0.240) compared with the PD group (rS = − 0.141; z = 2.16, p = 0.031).ConclusionsMD workers showed better physical fitness measures (balance, trunk extensor muscular endurance) and cognitive performance and lower levels of perceived stress compared with PD workers. Small-to-medium-sized associations between physical fitness and psycho-cognitive performance measures indicate that gains in physical fitness may at least partly contribute to psycho-cognitive performance and/or vice versa, particularly in MD workers.

Evaluation of left ventricular systolic function and synchronicity in patients with maintenance hemodialysis by layer-specific strain

Objective To explore the systolic function and synchronicity of left ventricle (LV) in patients with maintenance hemodialysis(MHD) by layer-specific strain. Methods Forty-three patients with MHD and 48 healthy controls were studied. Three consecutive cardiac cycles two-dimensional dynamic images including standard LV apical two-chamber, long-axis and four-chamber views and LV short-axis views at the levels of basal, middle and apical were acquired. A quantitative software called EchoPAC was used to analyze longitudinal strain(LS) and circumferential strain(CS) of these six dynamic images and peak strain dispersion(PSD) was automatic computed by the software. The difference of these parameters between the two groups and the correlation between PSD and other parameters were studied. Results Parameters of global layer-specific strain: compared with the control group, global LS and CS of subendocardial, midmyocardial, epicardial and full-thickness myocardium layers were decreased in the MHD group (P 0.05). Parameters of synchronicity: PSD of MHD group was larger than that of control group(t=6.094, P<0.001). PSD was positively correlated with longitudinal strain of full-thickness (GLS) in MHD group (rs=0.478, P=0.039). Conclusions Layer-specific strain can noninvasively and accurately quantitate left ventricular systolic function and synchronicity in patients with MHD. Key words: Echocardiography; Renal dialysis; Ventricular function, left; Layer-specific strain

Профилактика перипроцедурного повреждения почек нагрузочными дозами статинов при плановых чрескожных коронарных вмешательствах

To compare the effect of loading doses of atorvastatin and rosuvastatin on the value of the acute kidney injury and acute inflammatory response to elective percutaneous coronary interventions. An open prospective comparative study included 68 patients referred for elective percutaneous coronary intervention (PCI). At baseline, all patients had been taking statins for a long time as a standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of 80 mg of atorvastatin (As) 12 hours before the intervention with saving this dose for 2-6 days. The second group included 35 patients treated with rosuvastatin (Rs) 40 mg / day in the same manner. The levels of creatinine and cystatin C in the blood were determined at baseline and 12, 24, 48 and 72 hours after the intervention. HsCRP level was determined at baseline and 72 hours after PCI. AKI was diagnosed in 5 patients (7.94 %): 4 patients (12.1 %) in group As and 1 patient (3.3 %) in group Rs (p = 0.36). The increase of serum creatinine level in the group As patients was 43.4 % higher than one in the Rs group patients (p = 0.024). The decrease of glomerular filtration rate (GFR) in group As was 15.5 % higher than one in group Rs (p = 0.09). Initially, the level of cystatin C in the groups did not differ (698.9 (560.2-869.6) ng / ml in group As vs 759.5 (673.8-899.9) ng/ml in group Rs, p = 0.75). Significant intergroup differences were found in the level of serum cystatin C 12 hours after PCI (718.3 (555.6-839.6) ng/ml in group As vs 470.6 (378.2-689.4) ng/ml in the Rs group, p = 0.007) that persisted 24 hours after the intervention (732.1 (632.3-887) ng/ml vs 526.4 (357.4-802.7) ng/ml, respectively, p = 0.02). From the second day after PCI, intergroup differences in serum cystatin C disappeared. The level of hsCRP significantly increased 72 hours after the intervention in group As (1.65 (0.9-4) mg/l at baseline vs 4.55 (1.6-8.7) mg/l 72 hours after PCI, p = 0.01). The level of hsCRP did not change significantly at the same time in the Rs group (2.8 (0.8-6.8) mg/l at baseline vs 2.75 (1.5-6.5) mg/l 72 hours after PCI, p = 0.16). The loading dose of rosuvastatin better prevents periprocedural kidney injury in PCI and more significantly reduces the overall inflammatory response to intervention compared to the loading dose of atorvastatin.