Drug Induction Research Articles

Anesthetic Preferences for Cardiac Anesthesia: A Survey of the Society of Cardiovascular Anesthesiologists.

Volatile anesthetics have been historically preferred for cardiac anesthesia, but the evidence for their superiority to intravenous agents is mixed. We conducted a survey to better understand the current state of practice and the rationale behind provider preferences for anesthesia for cardiac surgery with cardiopulmonary bypass. We hypothesized that anesthetic preference would vary considerably among surveyed providers without a clear majority, as would the rationale behind those preferences. Email invitations were sent to members of the Society of Cardiovascular Anesthesiologists, who were asked to identify the anesthetics or sedatives they typically prefer to administer during induction, prebypass, bypass, postbypass, and postoperative periods and why they prefer those agents. Members' beliefs regarding the importance of anesthetics on postoperative outcomes were also assessed. Invitations were sent on 2 separate dates to 3328 and 3274 members, of whom 689 (21%) responded. The median (interquartile range [IQR]) respondent age was 45 (37-56) years, 79% were men, and 75% were fellowship trained. The most frequently chosen drug for induction was propofol (80%). Isoflurane was the most frequently selected primary agent for the prebypass (57%), bypass (62%), and postbypass periods (50%). Sevoflurane was the second most frequently selected (30%; 17%, and 24%, respectively). Propofol was the third most frequently selected agent for the bypass (14%) and postbypass periods (17%). Ease of use was the most frequently selected reason for administering isoflurane and sevoflurane for each period. During bypass, the second most frequently selected rationale for using isoflurane and sevoflurane was institutional practice. A total of 76% responded that the perfusionist typically delivers the bypass anesthetic. Ischemic preconditioning, organ protection, and postoperative cognitive function were infrequently selected as rationales for preferring the volatile anesthetics. Most respondents (73%) think that anesthetics have organ-protective properties, especially isoflurane (74%) and sevoflurane (59%), and 72% believed that anesthetic choice contributes to patient outcome. The median (IQR) agreement (0 = strongly disagree to 100 = strongly agree) was 72 (63-85) for the statement that "inhaled anesthetics are an optimal maintenance anesthetic for cardiac surgery." In a survey of cardiac anesthesiologists, a majority of respondents indicated that they prefer volatile anesthetics for maintenance of anesthesia, that anesthetic selection impacts patient outcomes, and that volatile anesthetics have organ-protective properties. The members' rationales for preferring these agents possibly reflect that practical considerations, such as ease of use, effectiveness, and institutional practice, also influence anesthetic selection during cardiac surgery in addition to considerations such as organ protection.

A comparison of supraglottic airway devices versus endotracheal intubation for use in rabbit anaesthesia

PICO question
 In domestic rabbits undergoing anaesthesia, how does the use of supraglottic airway devices compare to endotracheal intubation for ease of use in achieving a patent airway and maintaining a stable anaesthesia?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Five papers were reviewed to answer this clinical question including four randomised controlled trials, one of which was a randomised crossover trial and one peer-reviewed conference proceeding
 Strength of evidence
 Moderate
 Outcomes reported
 There is evidence to support that supraglottic devices were easier and faster to insert than endotracheal tubes and were used effectively to achieve and maintain a patent airway and anaesthesia. They were however, more easily displaced and took up more space in the oral cavity. Evidence also supports endotracheal intubation can be used to effectively achieve a patent airway and maintain a stable anaesthesia however, can result in more damage to tracheal mucosa when attempted blindly and required higher doses of induction drugs to use
 Conclusion
 Based on current available evidence, endotracheal intubation is an excellent option for maintaining a patent airway and anaesthesia in rabbit patients as it is a tried and tested method, however, can cause tracheal damage if conducted blindly. Supraglottic airways devices can be used as an alternative where endotracheal intubation is unsuccessful. They can also be used where speed of obtaining a patent airway is imperative such as in an emergency as they may be easier and faster to apply, especially in inexperienced practitioners without the necessary equipment for safe endotracheal intubation. Supraglottic devices are unsuitable for procedures that require access to the oral cavity and / or patient movement, due to the size and easier loss of seal during movement potentiating risk of aspiration. Both supraglottic devices and endotracheal intubation are superior to face masks which evidence shows have more leakage, dead space and increased risk of hypercapnia
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

The influence of anaesthetic choice on seizure duration of electroconvulsive therapy; etomidate versus methohexital

BackgroundMany of the anaesthetic drugs used for electroconvulsive therapy have anticonvulsant properties and may influence efficacy of electroconvulsive therapy. With this study we aim to provide more information on the effect of etomidate and methohexital on seizure duration. We explore the relationship between induction drug, motor and electroencephalography seizure duration. Moreover, we study the relationship of seizure duration and number of therapies.MethodsIn this retrospective study we collected data from patient records from 2005 until 2016. Inclusion criteria were the use of etomidate and/or methohexital and documentation of dosage, electroconvulsive therapy dosage and seizure duration. Exclusion criteria were missing data on either induction drug, dosage or seizure duration.ResultsThirty seven patients were analysed. The mean age was 52 years and seventy six percent were female. Most patients were suffering from affective disorders (81%). Motor and electroencephalography seizure duration were analysed in 679 and 551 electroconvulsive therapies, respectively. Compared to methohexital, motor and electroencephalography seizures under etomidate were 7 and 13 s longer, respectively. Furthermore, there was a negative association between seizure duration and number of treatment and a negative association between seizure duration and electroconvulsive therapy dosage.ConclusionsThis study demonstrates significant longer motor and electroencephalography seizure duration using etomidate compared to methohexital. Etomidate might therefore increase the effectiveness of electroconvulsive therapy. Moreover, we observed a negative association between seizure duration, number of treatment and electroconvulsive therapy dosage. With this study we contribute to the available literature comparing methohexital and etomidate as induction agents for electroconvulsive therapy.

Visual Disturbances Due to Use of Different Synthetic Drugs for the Ovulation Induction among Females with Infertility Issues

Visual Disturbances Due to Use of Different Synthetic Drugs for the Ovulation Induction among Females with Infertility Issues

The Success of Ovulation Induction with Letrozole and Gonadotropins in Obese and Nonobese Women: A Study from a Tertiary Center.

Background Letrozole, an aromatase inhibitor, is suggested as a first-line drug for ovulation induction in women with polycystic ovary syndrome (PCOS) especially in obese women. Letrozole has also been used in women with unexplained infertility with similar rates of success to clomiphene. However, literature on letrozole and gonadotropins in obese and nonobese women is sparse. Hence, this study was done to assess the success of ovulation induction (OI) with letrozole plus follicle stimulating hormone (FSH) in obese (BMI ≥ 30 kg/m2) and nonobese women (BMI < 30 kg/m2). Methods A retrospective descriptive cohort study was conducted involving 135 women who underwent OI with letrozole plus follicle stimulating hormone therapy and either timed intercourse or intrauterine insemination. The data was collected from the hospital information system, including the age, body mass index, the type of infertility, number of induction cycles with letrozole, number of gonadotropin injections, and the pregnancy occurrence following treatment. SPSS was used to analyze the data. Results There were 135 women who used FSH injections along with letrozole. Of this, 28.5% obese women got pregnant compared to 29.2% nonobese women, but this did not attain statistical significance (P = 0.75). About 70% of obese women and 57% on nonobese women had polycystic ovarian syndrome. The median number of FSH injections was six, and the interquartile range was 3 to 11. Conclusion Of the 135 women undergoing letrozole and FSH, there was almost an equal probability of pregnancy in the obese group (BMI ≥ 30 kg/m2) and nonobese women.

Reduction of greenhouse gases emission through the use of tiletamine and zolazepam

Isoflurane is an anaesthetic gas widely used in both human and veterinary medicine. All currently used volatile anaesthetics are ozone-depleting halogenated compounds. The use of total intravenous anaesthesia (TIVA) allows to induce the effect of general anaesthesia by administering drugs only intravenously without the use of anaesthetic gases. This allows you to create a protocol that is safe not only for the patient, but also for doctors and the environment. However, so far, no anaesthetic protocol based on induction of anaesthesia with tiletamine-zolazepam without the need to maintain anaesthesia with anaesthetic gas has been developed. Our study showed that the use of this combination of drugs for induction does not require the use of additional isoflurane to maintain anaesthesia. Thanks to Dixon's up-and-down method we proved that with the induction of anaesthesia with tiletamine-zolazepam at a dose of 5 mg/kg the use of isoflurane is not needed to maintain anaesthesia in minimally invasive surgical procedures. Until now, this dose has been recommended by the producer for more diagnostic than surgical procedures or for induction of general anaesthesia. The maintenance was required with anaesthetic gas or administration of another dose of the tiletamine-zolazepam. The results obtained in this study will allow for a significant reduction in the consumption of isoflurane, a gas co-responsible for the deepening of the greenhouse effect, having a negative impact on patients and surgeons. These results are certainly the first step to achieving a well-balanced and safe TIVA-based anaesthetic protocol using tiletamine-zolazepam, the obvious goal of which will be to maximize both the safety of the patient, people involved in surgical procedures, and the environment itself. Being aware of the problem of the greenhouse effect, we are committed to reducing the consumption of anaesthetic gases by replacing them with infusion agents.

Ondansetron versus ramosetron in controlling propofol induced pain

Background: Propofol, a widely used drug for induction, often causes local pain when administered into a peripheral vein. The present study compared the efficacy of ondansetron and ramosetron in controlling propofol‑induced pain in 80 patients. Materials &amp; Methods: 80 patients of both genders posted for surgery under general anaesthesia were randomized using lottery method and divided into 2 groups of 40 each. Group I received 4 mg of ondansetron and group II received 0.3 mg of ramosetron. Each group had 40 patients. All the pre-treatment drugs were made into 2 ml volume with normal saline and given 1 minute before injection of propofol and applying manual occlusion at midarm level. Pain during injection of propofol was recorded in a four point pain rating scale. Results: Group I received ondansetron and group II received ramosetron. Both the groups were comparable in relation to demographic profile and ASA status.The difference was not significant (P&gt; 0.05).

Impact of systemic therapy regimen on survival of PCNSL.

2070 Background: Primary CNS Lymphoma (PCNSL) is a rare and often fatal disease. Treatment includes multi-agent systemic therapy with a backbone of high-dose methotrexate (HD-MTX). Despite multiple drug and radiotherapy combinations for induction and consolidation treatment there remains no clear standard of care. The purpose of this analysis is to evaluate how varying treatment approaches impacted clinical outcomes at our institution. Methods: Data retrospectively collected for 95 consecutive patients with PCNSL pathologically confirmed from 2002 to 2021. Primary endpoint was OS with secondary endpoints of PFS and LC. Progression based on RANO criteria. Kaplan-Meier analyses, Log-rank test and Cox proportional hazard models used for time to event endpoints. MVA by backward selection applying an alpha of 0.2 for associations with 1st line chemo agents, number of cycles of HD-MTX (&gt;6 or 0-5), size of enhancing tumor at presentation, CSF cytology, type of surgery (biopsy, STR, or GTR), and use of WBRT. Results: Most patients had KPS &gt;70 (64.2%), were HIV negative (89.5%), and had no history of solid organ transplant (95.8%). Diagnosis was made by biopsy (73.7%) or resection (GTR 13.7%, STR 12.6%). 54.3% had &lt;14 cc contrast-enhancing tumor volume (median 12.6 cc, range 0.5 - 67.8 cc) and 48.6% had single enhancing lesion. Of the 62 patients treated first line with at least 1 cycle of HD-MTX, 61.3% were treated with HD-MTX + Rituximab (R) and 33.9% with HD-MTX + R + temozolomide (TMZ). With or after induction HD-MTX, 1-3 patients received one or a combination of cytarabine, thiotepa, procarbazine, vincristine, carmustine, or ASCT. Of the 60 patients with evaluable CSF, 30.0% had positive cytology. IT chemotherapy (ITc) was administered to 12 patients (5 with + cytology, 4 with - cytology, 3 with unknown cytology). WBRT for consolidation after chemotherapy used for 3 patients and as monotherapy for 9 patients. 2-year OS and PFS rate was 50.1% (95% CI 38.6%-60.5%) and 38.5% (95% CI 27.9%-49.0%). On MVA, &gt; 6 cycles of MTX was associated with superior OS, PFS, and LC. For patients receiving any chemotherapy, addition of R was associated with inferior OS while ITc was associated with improved OS, PFS, and LC (Table). There was no OS association on MVA with TMZ, GTR, consolidation WBRT, or size or number of initial lesions (p&gt;0.05). Conclusions: Completion of induction HD-MTX and use of ITc was associated with better outcomes in this population. Incorporation of R into 1st line therapy was associated with worse OS. Survival remained poor throughout the study period, underscoring importance of further innovation. [Table: see text]

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Tracheal Intubation in Emergency Departments in China: A National Cross-Sectional Survey.

BackgroundTracheal intubation is a necessary but risky procedure performed in emergency departments (EDs) around the world. Relatively high morbidity has been encountered in Chinese EDs, which has raised concerns about peri-intubation ED management. This study aimed to investigate intubation procedures and identify any areas for improvement in Chinese EDs.MethodsThis was a questionnaire-based survey lasting 1 month (March 2021) in 41 tertiary-care hospital EDs in mainland China. The primary outcome was complications associated with intubation. Secondary outcomes were the first-pass success rate and blood pressure variations during intubation. Univariate and binary logistic regression analyses were used to find possible risk factors for first-pass intubation failure.ResultsIn total, 1,020 replies were analyzed out of 1,080 surveys submitted (94.4% response rate). Most patients were elderly men with severe medical conditions like cardiac arrest (24.8%). In total, 97.2% of patients were given preoxygenation, and 48.1% received some form of pretreatment. Induction drugs (e.g., etomidate and ketamine) were less often used: 39.9% of intubations used sedatives, 5.5% used analgesics, and only 5.3% used muscle relaxants. The overall first-pass intubation success rate was 85.7% and was accompanied by a 19.8% adverse event rate. A marked decrease in blood pressure after intubation was also identified.ConclusionThis survey found an 85.7% tracheal intubation first-pass success rate (which is relatively high compared to other countries) and a 19.8% adverse event rate (which is also relatively high). Given the very low rate of using induction medications (5.3% used muscle relaxants), future education should focus on induction drugs and traditional intubation techniques.

A Study of Comparison of Effectiveness of Letrozole (5mg) Versus Clomiphene Citrate (100 Mg) by Using Injection Human Placental Extract (HPE) for Ovulation Induction among Infertile Women

Aim &amp; Objective: To compare the efficacy of letrozole and clomiphene citrate (CC) by using injection of Human placental extract (HPE) for ovulation induction in infertile women. Introduction: Human placental extract (HPE) is a product of aqueous extraction from the biochemically enriched fresh human placenta which contains nucleotides, amino acids, peptides and vitamins in natural form. It is available as 2 ml ampule. Each ml. is derived from 0.1 gm. of fresh human placenta. Injection of HPE is used in infertility treatment for its anti-inflammatory property, due to which tubal inflammation is decreased and tubal motility increases which is useful for fertility. This is the hypothetical theory behind use of Injection of HPE for infertility treatment in infertile women. Clomiphene citrate has been traditionally used as drug of the choice for treatment of women with infertility. In the last decade, an aromatase inhibitor, letrozole has emerged as an alternative ovulation induction (OI) agent in anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to clomiphene citrate therapy and this is confirmed by literatures. Background: Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause. HPE is a product of aqueous extraction from the biochemically enriched fresh human placenta which contains nucleotides, amino acids, peptides and vitamins in natural form. HPE injection- properties: • Specific anti – inflammatory • Tissue repair–wound healing • Immunomodulatory • Melanopoetic • Debridement action It is useful in ovulation induction among infertile women who are infertile due to pelvic inflammatory disease (PID) or due to polycystic ovary syndrome (PCOS) because of its anti-inflammatory property which leads to reduction in tubal inflammation and increased tubal motility. Clomiphene citrate is considered as the first line of treatment for anovulatory dysfunction for a various reason, however Clomiphene citrate has some drawbacks like multi-follicular ovulation and Peripheral anti-estrogenic effect are areas of concern and desire for an effective alternative is need of the hour. An aromatase inhibitor, letrozole, was introduced into infertility practice in the year 2000 and is regarded as a second line option, particularly in women with clomiphene resistance and it has found acceptance in various clinical situations and the indications for its use have expanded. Design: Randomized double blind study. Setting: Scientific Research Institute, Surendranagar, Gujarat, India and a private practice setting. Patients &amp; Methods: The study included 100 women who presented with infertility and were having polycystic ovary syndrome (PCOS). The study participants were divided into 2 groups of 50 each. With these injections, 1 group was given clomiphene citrate (100 mg daily) and another group was given; letrozole (5 mg daily), started from day 3 to day 5 of the menstruation cycle and continued up to 5 consecutive days. Both the groups have received Estradiol Valerate 4 mg. on the 12th day of menstruation until 16th day of menstruation; with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. Selected participants were of age between 20 to 39 years, had normal uterine cavity and had intercourse with male partner with a sperm concentration of at least 14 million per millilitre; and during the study the women and their partners agreed to have regular periodical intercourse with the intent of successful conception. The live birth of baby during the treatment period was the primary outcome. Second Outcome Measures: Follicular growth, endometrial thickness, pregnancy outcome. Results: Women who received Letrozole had more cumulative live births than those women who had received Clomiphene Citrate, (38 out of 50 [76%] vs. 29 out of 50 [58%]) after giving Injection of HPE with these ovulation induction drugs, without significant differences in overall congenital anomalies, with letrozole, as compared to clomiphene, the cumulative ovulation rate was higher. Clomiphene was associated with more numbers of episodes of hot flushes while letrozole was associated with fatigue and dizziness. Rates of other adverse effects were almost similar between these 2 groups. A significant difference in the follicular and endometrial development was evident between these 2 groups. Conclusion: Treatment with Injection of HPE with 2 ovulation induction drugs, Letrozole &amp; Clomiphene Citrate - as compared to clomiphene, letrozole - an aromatase inhibitor, was associated with higher live-birth and ovulation rates in infertile women. The results of the study demonstrated that letrozole is non inferior to clomiphene citrate in the maintenance of endometrial thickness.

Ten-year follow-up after mitoxantrone induction for early highly active relapsing-remitting multiple sclerosis: An observational study of 100 consecutive patients

BackgroundSix monthly courses of mitoxantrone were approved in France in 2003 for patients with highly active multiple sclerosis (MS). ObjectiveTo report the 10-year clinical follow-up and safety of mitoxantrone as an induction drug followed by maintenance therapy in patients with early highly active relapsing–remitting MS (RRMS) and an Expanded Disability Status Scale (EDSS) score<4, 12months prior to mitoxantrone initiation. MethodsIn total, 100 consecutive patients with highly active RRMS from the Rennes EDMUS database received monthly mitoxantrone 20mg combined with methylprednisolone 1g for 3 (n=75) or 6months (n=25) followed by first-line disease-modifying drug (DMD). The 10-year clinical impact was studied through clinical activity, DMD exposure, and adverse events. ResultsTwenty-four percent were relapse-free over 10years and the mean annual number of relapses was 0.2 at 10years. The mean EDSS score remained significantly improved for up to 10years, changing from 3.5 at mitoxantrone initiation to 2.7 at 10years. The probability of disability worsening and improvement from mitoxantrone initiation to 10years were respectively 27% and 58%, and 13% converted to secondary progressive MS. Patients only remained untreated or treated with a first-line maintenance DMD for 6.5years in average. In our cohort, mitoxantrone was generally safe. No leukemia was observed and six patients developed neoplasms, including 4 solid cancers. ConclusionMonthly mitoxantrone for 3 or 6months, followed by maintenance first-line treatment, may be an attractive therapeutic option for patients with early highly active RRMS, particularly in low-income countries.

Assessing the Rate of Successful Induction of labor Following Intra-Vaginal Administration of Misoprostol

Introduction: The use of prostaglandin preparations with or without oxytocin infusion is widely recognized and accepted as a standard method of induction of labor. It has been shown to reduce induction time and the risk of failed induction. But the use of prostaglandin E2 is quite expensive and is not available in many developing countries. In such cases, misoprostol can also be used as an induction agent. The aim of the study was to assess the rate of successful induction of labor following intra-vaginal administration of misoprostol. Methods: This open clinical trial study was conducted at the Department of Obstetrics and Gynaecology, North East Medical College Hospital, Sylhet, Bangladesh. The study duration was 1 year and was conducted with a total of 100 patients who were admitted with term pregnancy and unfavorable cervix in the study hospital, fulfilling the inclusion and exclusion criteria. Result: Bishop’s score was significantly raised after 6 hours vaginal misoprostol [4.63 (SD ± 1.17) VS 5.82 (SD ± 1.60); p&lt;0.001]. The mean induction to vaginal delivery time was 14.6 (SD ± 4.6) hours (range 6 to 23 hours); the induction to vaginal delivery time was&lt;12 hours in 44.3% and 12-24 hours in 55.7% cases. The mode of delivery was vaginal in most of the cases (70.0%) and cesarean section was in 30.0% of cases. Fetal distress was the most frequent indication of cesarean section (63.3%), followed by arrested labor (20.0%) and failed induction (16.7%). The maternal obstetric complication was postpartum hemorrhage (3.0%) without any ruptured uterus, tachysystole, hypertonus uterus, or hyperstimulation. The maternal side-effects were nausea or vomiting (5.0%), diarrhea (2.0%), and fever (1.0%). Fetal outcomes were, normal baby (65.0%), APGAR score &lt;7 at 1 min (27.0%), resuscitation needed (27.0%), neonatal unit admission (13.0%), meconium passage (8.0%) and intrauterine Fetal death (diagnosed before induction) (8.0%). Conclusion: Vaginal misoprostol seems to be a promising drug for labor induction with a high rate of success. Possible advantages of misoprostol may be the availability, ease of administration, well tolerability, and most notably its dual action in cervical ripening and labor induction. However, future studies focusing on dosing regimens and routes of application are needed.

Procedural Sedation Using Two Different Proportions of Ketamine-Propofol Combination in Short Gynecological Procedures: A Randomized Controlled Trial.

Background: Procedural sedation with a combination of propofol and ketamine for short-duration surgeries is a convenient technique of anesthesia as it has a faster recovery avoiding the side effects of general anesthesia. The aim of this study was to compare the sedative and analgesic effects of two different proportions of ketamine and propofol combination in patients undergoing short gynecological procedures.Methods: A randomized double-blind study was conducted in 140 patients posted for elective gynecological procedures with a duration equal to or less than 30 minutes. After premedication of all participants, sedation was induced with bolus administration (0.1 mL/kg) of the study drugs to achieve desired Ramsay sedation score (RSS) of 6, followed by infusion at 0.3 mL/kg/h (Group A, ketamine:propofol in the ratio of 1:4 and Group B, ketamine:propofol in the ratio of 1:2). The adequacy of sedation, volume of drug to induce the patient, time to achieve desired RSS, time for first bolus dose, the total volume of the drugs, hemodynamic variables, awakening time, and side effects were observed.Results: The incidence of movement of lower extremities was found to be significantly lower in the higher concentration ketamine group (Group B, P - 0.028). The volume of a drug for induction and the duration to reach RSS of 6 were significantly lower in Group B with P-values of 0.002 and <0.001, respectively. Hemodynamic variables, awakening time, and side effects were not statistically significant between the two groups.Conclusion: Ketamine-propofol combination in the ratio 1:2 provides better sedation and analgesia with no increased side-effects compared to ketamine-propofol in the ratio 1:4 for short outpatient gynecological procedures.

Cell-cell death communication by signals passing through non-aqueous environments: A reply

The effects of the emission of low intensity light from cells and organelles, known as biophotons, or ultraweak photon emission, are not well understood and subject to debate. Potapovich & Kostyuk recently proposed that the induction of oxidative stress generates non-chemical death signals which can induce cell death in neighbouring, chemically isolated cells (termed detector cells). Given the significance of these results, here we attempt to replicate their findings. We found treatment of “inductor cells” with duroquinone dissolved in ethanol does indeed induce significant cell death in neighbouring “detector” cells relative to distant control cells (64.53 % ± 14.42 vs 99.72 % ± 6.09 cell viability), closely reproducing their original results. However, this was no longer true if the induction drug was dissolved in a less volatile solvent, suggesting that their original findings may have been a result of volatile solvent-based transmission as opposed to light-based non-chemical signalling.

Controlling the Uterus

<h3>Abstract:</h3> Eliminating and easing pain in childbirth has long been considered a major obstetric achievement. But what about the ability to control the uterus and when childbirth happens? Why have augmentation and induction drugs not been central to historical analysis of medicalization of childbirth in the United States? Our understanding of how birth became medicalized is complicated when augmentation drugs are the central analytical lens. At the turn of the twentieth century, the emerging field of endocrinology and hormone-based therapies influenced the growing authority and professionalization of medicine and introduced the chemical manipulation of childbirth. This article explores two main points: first, the development of chemical interventions, like ergot and oxytocin, used to start and hasten labor; and second, how different drug categories pushed the boundaries of what was and was not “natural.” These drugs were valuable tools that helped solve public health concerns of maternal and fetal health outcomes, further entrenched women’s reliance on male physicians, and illustrate the complexities of how childbirth became a medical event in the United States.

Outcome of Oxytocin on Haemodynamic Change During Caesarean Section under Spinal Anaesthesia

Background: Oxytocin is generally used in obstetric exercise as a uterotonic drug for induction and augmentation of labor and stays the drug of desire for facilitating uterine contractions all through vaginal and operative delivery. It is now spreading up to far-flung areas. The infusion method of oxytocin is protected in the caesarean area beneath spinal anaesthesia. Objective: This is to evaluate the hemodynamic modifications precipitated by oxytocin given as an I/V bolus or infusion to limit uterine bleeding in cesarean section. Methods: This prospective, interventional learning was once carried out at the Department of Anaesthesiology, Abdul Malek Ukil Medical College &amp; Hospital, Noakhali, Bangladesh, from January to December 2020. A whole range of fifty sufferers ASA grade I had been selected. Thirty affected people in every group. In crew A, the parturient acquired oxytocin 5IU of I/V in bolus, and in team B, infusion of oxytocin 5IU diluted with 5ml everyday saline given I/V over two min by way of the use of infusion pump. Systolic and diastolic BP, MAP, coronary heart rate, uterine bleeding have been recorded every 1 min. The learning about duration used to be started out simply earlier than oxytocin is given, and it used to be persisted for an additional 10 min. Results: In our study, every group had n=25. All outcomes are expressed as mean± standard deviation. The studied groups became statistically matched for age, gestational age, weight, coronary heart rate, systolic and diastolic blood pressure, suggesting arterial pressure. The implied distinction of all hemodynamic parameters at 2 to 5 minutes of oxytocin administration has been statistically significant (p&lt;0.05). Conclusion: Oxytocin remains the first-line uterotonic after vaginal and caesarean delivery. The hemodynamic changes were more marked in the I/V bolus of oxytocin than infusion technique. Recent research elucidates the therapeutic range of oxytocin during caesarean delivery and receptor desensitization. A slower injection of oxytocin can effectively minimize cardiovascular side effects and equally effectively reduce blood loss without compromising the therapeutic benefits. Evidence-based protocols for preventing and treating uterine atony during cesarean delivery are recommended.

A Comparative Study of the Effect of Anesthesia Induction with the Use of Four Drug Combinations Including "Propofol," "Etomidate-Propofol," "Thiopental," and "Midazolam-Thiopental" on Hemodynamic Changes during the Insertion of Laryngeal Mask in Eye Surgery.

Background:This study aimed to compare the efficacies of four anesthetic induction drugs (thiopental, propofol, midazolam-thiopental, and etomidate-propofol) on cardiovascular response during laryngeal mask airway (LMA) placement in eye surgery.Materials and Methods:The present clinical trial study included 128 patients who were candidates for ophthalmic surgery in four groups. Patients in the first group were given a combination of midazolam (0.04 mg/kg) with thiopental (2.5 mg/kg) (Group T + M). We administered propofol alone (2.5 mg/kg) to patients in the second group (Group P). The third group received a combination of etomidate (0.1 mg/kg) with propofol (1 mg/kg) (ET + P group) and patients in the fourth group received thiopental drug (5 mg/kg) alone (Group T). Then, the stability of patients' hemodynamic parameters before anesthesia was evaluated and compared immediately after anesthesia, 1, 3, and 5 min after LMA placement.Results:There was no significant difference between the four groups in changes in oxygen saturation level (P > 0.05). Furthermore, the difference between decreased systolic blood pressure and diastolic blood pressure over time was not significant in 5 min in both Groups T + M and T (P > 0.05). In addition, the stability of these two groups was higher than the other two groups (P < 0.05) and the most unstable group was Group P. The changes pulse ratein the P group were significant (P < 0.05).Conclusion:According to the results of the current study, thiopental and Midazolam can be used as an effective induction compound to facilitate LMA insertion with higher hemodynamic stability compared to propofol alone, propofol and etomidate, and thiopental alone.

Smart Lipid-Based Nanosystems for Therapeutic Immune Induction against Cancers: Perspectives and Outlooks.

Cancer immunotherapy, a promising and widely applied mode of oncotherapy, makes use of immune stimulants and modulators to overcome the immune dysregulation present in cancer, and leverage the host’s immune capacity to eliminate tumors. Although some success has been seen in this field, toxicity and weak immune induction remain challenges. Liposomal nanosystems, previously used as targeting agents, are increasingly functioning as immunotherapeutic vehicles, with potential for delivery of contents, immune induction, and synergistic drug packaging. These systems are tailorable, multifunctional, and smart. Liposomes may deliver various immune reagents including cytokines, specific T-cell receptors, antibody fragments, and immune checkpoint inhibitors, and also present a promising platform upon which personalized medicine approaches can be built, especially with preclinical and clinical potentials of liposomes often being frustrated by inter- and intrapatient variation. In this review, we show the potential of liposomes in cancer immunotherapy, as well as the methods for synthesis and in vivo progression thereof. Both preclinical and clinical studies are included to comprehensively illuminate prospects and challenges for future research and application.

Evaluation of Treatment Response in Lupus Nephritis

Objectives: To evaluate the effectiveness of the treatment reflected by the rate of response to therapy at 6 months and 12 months of follow-up respectively. Methods: We retrospectively analyzed clinical, laboratory data, treatment regimens, the type of response and relapse rate of 51 patients diagnosed with LN between January 2017 and February 2020. Results:47.06% of the patients underwent renal biopsy, classes III and IV being the most common lupus nephritis types (totaling 35.3% of biopsied patients). All induction therapy choices analyzed in the study- CYC, Glucocorticoids (GCs) and MMF- proved effective at reducing the proteinuria of the patients (p=0.001, p=0.012 and p=0,019 respectively. The 12 months evaluation demonstrated an ascending trend of the complete response, starting from 27.45% at 6 months and almost doubling at 1 year (56.86%). Almost half of patients (49.02%) did not relapse, while most of them (27.45%) had only 1 relapse. Analyzing the risk of relapse for each induction drug used, CYC had the highest rate of recurrence (62.07%). The use of MMF as a maintenance drug associated the lowest degree of recurrence. Conclusions: Both CYC and MMF as induction therapy are significantly effective in reducing proteinuria. The complete response was more frequently identified as an endpoint at 12 months of follow-up.