ITM Group Research Articles

Study on quality difference between Belamcanda chinensis (L.) DC and Iris tectorum Maxim. based on chemical chromatogram analysis, biological activity evaluation and in vivo distribution rule

Ethnopharmacological relevanceBelamcanda chinensis (L.) DC. (BC) and Iris tectorum Maxim. (ITM) have been widely used in recent years due to their remarkable curative effects on sore throat, cough and asthma. but they are often misused due to their similar appearance. A comprehensive comparison of the chemical composition, biological activity, pharmacokinetics and tissue distribution between the two active differential components has not been performed. Differences in their specific effects have not been fully elucidated. Aim of the studyThis work aims at differentiating between BC and ITM in terms of appearance, chemical composition, biological activity, pharmacokinetics and tissue distribution. Materials and methodsIn this study, the HPLC-FP method was used to find the differences between the chemical components of BC and ITM. The pharmacological experiments were used to compare the differences in activity, including in vitro anti-inflammatory activity with LPS-induced inflammation model of RAW 264.7 cells, inhibition of AChE activity, and the regulation of isolated small intestinal smooth muscle in mice. The pharmacokinetic and tissue distribution profiles were used to analyze the differences between the two in rats. ResultsThe types of isoflavones in BC and ITM are basically the same, but their contents in ITM is much higher than that in BC. At the same doses, the release of TNF-α, NO, IL-1β and IL-6 from RAW 264.7 cells in the ITM group was lower than that of the BC group, and the in vitro anti-inflammatory activity of ITM was stronger than that of BC. Meanwhile, ITM had stronger inhibition ability to inhibit AChE activity than BC. The BC extract exhibited an inhibitory effect on the isolated small intestinal smooth muscle of mice, and the ITM extract showed stimulatory effect at low concentration and inhibitory effect at high concentration. There were significant differences in drug-time profiles, kinetic parameters and tissue distribution. ConclusionsThere are significant differences in the multidimensional aspects of appearance, chemical composition, biological activity, pharmacokinetics, and tissue distribution between BC and ITM. This study provides a theoretical basis for the quality control, pharmacological efficacy and clinical application of the two herbs.

A Trace Mineral Injection before Joining and Lambing Increases Marking Percentages and Lamb Weights on Diverse Farms in Victoria, Australia.

This study was conducted on five commercial farms across Victoria, Australia, between September 2018 and November 2019, where the TM status of ewes was within normal ranges before joining. Mix breed ewes (n = 1484) were randomly allocated to receive either nil treatment (Control) or two injections of an ITM product containing zinc (40 mg/mL), manganese (10 mg/mL), selenium (3 mg/mL), and copper (10 mg/mL); 0.2 mL per 10 kg BW (Multimin® plus Copper for Sheep, Virbac (Australia) Pty Ltd., Milperra, NSW, Australia) 30 days before the start of joining and 30 days before the start of lambing. Approximately 90 days after joining, pregnancy status and conception rate were determined by ultrasound. The marking rate was determined approximately four weeks after the end of lambing, and lamb weights were determined at weaning (12 weeks after the end of lambing). In all farms, ITM treatment did not affect the conception rate. The average conception rate was 156 ± 11.0% (p > 0.05). The marking rate of ITM ewes was 9% higher than control ewes (95% Confidence Interval 3−21%). Lambs born to ITM ewes were 2.31 kg heavier at weaning than lambs born to control ewes (p < 0.001). Although not significant, ewe mortality across farms was 1.3% lower in the ITM group than in the control group. On average, ewes treated with ITM pre-joining and pre-lambing produced more and heavier lambs that represent an extra AU$ 2338 per 100 ewes net benefit for the producer. These results help to understand strategic TM supplementation for animal health, performance and farm profitability beyond the treatment of clinical deficiencies.

Clinical Profile and Outcomes of COVID-19-Associated Transverse Myelitis: A Case Report and Review of Literature.

The purpose of this study was to evaluate demographics, clinical profiles, and outcomes of transverse myelitis (TM) in the setting of COVID-19 infection (iTM) or vaccination (vTM) and to describe a case of spontaneous resolution of iTM. Of a total of 158 articles that met our search criteria, 30 articles detailing 65 unique cases were included, of which 48 (73.8%) were iTM and 17 (26.2%) were vTM. The mean age of the iTM group was significantly lower as compared with vTM (43 ± 20.3 years vs 56.4 ± 18.6 years; p = 0.02). There were no gender differences between the groups. There were no significant differences in time to symptom onset (9.9 ± 14.3 days in iTM vs 7.6 ± 7.0 days in vTM, p = 0.2) between the groups. There were no significant differences between iTM and vTM in imaging features or laboratory abnormalities. The most common pharmacotherapy that was administered was intravenous (i.v.) corticosteroid (n = 56, 87.5%), followed by oral corticosteroids (n = 20, 31.2%), plasmapheresis (n = 19, 29.7%), and intravenous immunoglobulin (n = 14, 21.9%). Most of the cases reported a good outcome (n = 51, 79.7%) with no significant differences between the groups (77.1% in iTM vs 87.5% in vTM; p = 0.37). There are no significant differences with respect to time to presentation, clinical and radiological features, and in outcomes between iTM and vTM, suggesting a common pathogenesis. Approximately 80% of cases have a good outcome. Hence, early recognition and treatment are important. Our case demonstrates that treatment should be based on the clinical presentation rather than laboratory or imaging features.

The use of intrathecal morphine for acute postoperative pain in lower limb arthroplasty surgery: a survey of practice at an academic hospital

Background and purpose of the studyIntrathecal morphine (ITM) provides optimal postoperative analgesia in patients who are scheduled for total knee and hip operation with spinal anaesthesia. However, the ideal dose at which maximal analgesic effect occurs with minimal side effects is not known. This study aimed to describe the use of two doses of ITM and side effect profile in patients undergoing elective hip and knee arthroplasty.MethodsThis was a prospective, descriptive, and contextual study conducted on patients who had total hip and knee replacement at Chris Hani Baragwanath Academic Hospital from 1 September to 30 November 2020. The sample size consisted of 66 patients who were 18 years and older, American Society of Anaesthesiology (ASA) classification 1–3, patients who had received either 100 mcg or 150 mcg ITM dose under spinal anaesthesia and sent to the ward postoperatively. Visual Analogue Scale (VAS) score was used to assess pain in the first 24 h, consumption of rescue analgesia and reported side effects were documented.ResultsThere was no relationship between age, weight, ASA classification or type of surgery and VAS score classification groups. Patients who received 100 mcg ITM had a higher median VAS pain score 2 (1–5) compared to those who received 150 mcg ITM 1 (0–2), p = 0.01. The need for rescue analgesia between the two groups was marginally less in the 150 mcg ITM group (p = 0.098). There was no difference in the rate of side effects between the 100 mcg ITM group [12 (41%)] and the 150 mcg ITM group [17 (59%)], p = 0.92. Rescue analgesia was marginally different between groups, p = 0.09. There were no real differences in the VAS pain scores between the total knee and total hip surgeries. None of the patients experienced clinically significant respiratory depression.ConclusionThe 150 mcg ITM dose provided good analgesic effects with longer duration of action and comparable side effect profile to the 100 mcg ITM dose. This dose was not associated with development of respiratory depression and can therefore be administered safely to patients who are discharged to the ward postoperatively in a resource constraint environment.

Effects of Mineral Methionine Hydroxy Analog Chelate in Diets on Meat Quality, Muscular Amino Acids and Fatty Acids in Pigs

Background: Organic trace minerals can improve the improve the bioavailability and reduce the environmental pollution, but the effect of organic trace minerals on meat quality of pigs are still unclear. Methods: Adult healthy 33.68 kg pigs (n = 253) were randomly allotted to six dietary treatments, with 6 pens per treatment and 7-8 pigs per pen in a completely randomized design: 1) ITM: inorganic trace minerals with 20, 100, 40 and 60 mg/kg of Cu, Fe, Mn and Zn in sulfate form; 2) T1: ITM was replaced with 20% mineral methionine hydroxy analog chelate (MMHAC); 3) T2: ITM was replaced with 40% MMHAC; 4) T3: ITM was replaced with 60% MMHAC; 5) T4: ITM was replaced with 80% MMHAC; 6) T5: ITM was replaced with 100% MMHAC. Result: In the present study, shoulder fat thickness, the 6th to 7th rib fat thickness (P less than 0.05), the 10th rib fat thickness, the last rib fat thickness and lumbosacral fat thickness tended to decrease with the increase of the MMHAC. In addition, MMHAC increased pH by 1.05~3.68% and reduced drip loss by 5.08~19.77% and cooking loss by 2.67~7.67% compared with the ITM group. Furthermore, MMHAC reduced methionine by 3.51~7.02%, phenylalanine by 1.14~3.41%, arginine by 1.52~3.79% compared with ITM group. Our results showed that MMHAC improved carcass traits, meat quality and meat flavor partly compared with the ITM group.

Effects of the methionine hydroxyl analog chelated microminerals on growth performance, antioxidant status, and immune response of growing-finishing pigs.

This study aimed to investigate the effects of methionine hydroxyl analog chelated microminerals (MHA-M) replacing inorganic microminerals (ITMs) on the growth performance, fecal microminerals concentrations, immune function, and antioxidant status in growing-finishing pigs; 253 pigs (average 33.68 kg body weight) were randomly assigned to six treatments with six replicates each treatment: (1) ITM: a basal diet with Cu, Fe, Mn, and Zn from sulfates providing 20, 100, 40, and 60 mg/kg; (2-6): 1/5MHA-M, 2/5MHA-M, 3/5MHA-M, 4/5MHA-M, and MHA-M was replaced with 20%, 40%, 60%, 80%, and 100% MHA-M. Results showed that the average daily gain (ADG) in the 1/5MHA-M and 2/5MHA-M was greater than other groups in the whole period. Fecal Cu, Fe, Mn, and Zn concentrations had decreased as the intake of trace minerals decreases. The ITM group decreased the fecal Zn concentration on Days 35, 70, and 91, and Fe concentration on Day 70, and increased the Mn concentration on Day 70 compared with MHA-M group. Pigs fed 1/5MHA-M, 2/5MHA-M, and MHA-M had a higher immune function and antioxidant status in serum compared with ITM, 3/5MHA-M, and 4/5MHA-M on Day 35. In conclusion, treatment with 1/5MHA-M and 2/5MHA-M could reduce the excretion of fecal microminerals and improve the immune function and antioxidant capacity compared with the ITM group.

Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis

BackgroundGabapentin and intravenous patient-controlled analgesia (PCA) can reduce postoperative pain scores, postoperative opioid use, and time to completing physical therapy compared to PCA alone after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Gabapentin combined with intrathecal morphine has not been studied. The primary purpose of this retrospective study was to evaluate whether perioperative gabapentin and intrathecal morphine provide more effective pain control than intrathecal morphine alone after PSF for AIS.MethodsPatients aged 11 to 18 years who underwent PSF for AIS were identified. Patients who received intrathecal morphine only (ITM group) were matched by age and sex to patients who received intrathecal morphine and perioperative gabapentin (ITM+GABA group). The ITM+GABA group received gabapentin preoperatively and for up to 2 days postoperatively. Both groups received oxycodone and the same non-narcotic adjuvant medications.ResultsOur final study group consisted of 50 patients (25 ITM, 25 ITM+GABA). The ITM+GABA group had significantly lower mean total oxycodone consumption during the hospitalization (0.798 vs 1.036 mg/kg, P<0.015). While the ITM group had a lower mean pain score between midnight and 8 am on POD 1 (2.4 vs 3.7, P=0.026), pain scores were significantly more consistent throughout the postoperative period in ITM+GABA group. The ITM+GABA group experienced less nausea/vomiting (52% vs 84%, P=0.032) and pruritus (44% vs 72%, P=0.045). Time to physical therapy discharge and length of hospital stay were similar.ConclusionAddition of gabapentin resulted in reduced oral opioid consumption and more consistent postoperative pain scores after PSF for AIS. The patients who received intrathecal morphine and gabapentin also experienced a lower rate of nausea/vomiting and pruritus.Trial registrationAll data was collected retrospectively from chart review, with institutional IRB approval. Trial registration is not applicable.

Effect of advanced chelate technology based trace minerals on growth performance, mineral digestibility, tibia characteristics, and antioxidant status in broiler chickens

BackgroundCompared to the corresponding source of inorganic trace minerals (TM), chelated supplements are characterized by better physical heterogeneity and chemical stability and appear to be better absorbed in the gut due to possibly decreased interaction with other feed components.MethodsThis study was designed in broiler chickens to determine the effects of replacing inorganic trace minerals (TM) with an advanced chelate technology based supplement (Bonzachicken) on growth performance, mineral digestibility, tibia bone quality, and antioxidant status. A total of 625 male 1-day-old broiler chickens were allocated to 25 pens and assigned to 5 dietary treatments in a completely randomized design. Chelated TM (CTM) supplement was compared at 3 levels to no TM (NTM) or inorganic TM. A corn–soy-based control diet was supplemented with inorganic TM at the commercially recommended levels (ITM), i.e., iron, zinc, manganese, copper, selenium, iodine, and chromium at 80, 92, 100, 16, 0.3, 1.2, and 0.1 mg/kg, respectively, and varying concentration of CTM, i.e., match to 25, 50, and 100% of the ITM (diets CTM25, CTM50, and CTM100, respectively).ResultsDiets CTM50 and CTM100 increased average daily gain (ADG), European performance index (EPI), and tibia length compared to the NTM diet (P < 0.05). Broilers fed the CTM100 diet had lowest overall FCR and serum malondialdehyde level and highest EPI, tibia ash, zinc, manganese, and copper contents, and serum total antioxidant capacity (P < 0.05). The apparent ileal digestibilities of phosphorus and zinc were lower in the ITM group compared with the CTM25 and CTM50 groups (P < 0.05). Broiler chickens fed any of the diets, except diet CTM25, exhibited higher serum glutathione peroxidase and superoxide dismutase activities than those fed the NTM diet, where the best glutathione peroxidase activity was found for CTM100 treatment (P < 0.05).ConclusionsThese results indicate that while CTM supplementation to 25 and 50% of the commercially recommended levels could support growth performance, bone mineralization, and antioxidant status, a totally replacing ITM by equivalent levels of CTM could also improve performance index and glutathione peroxidase activity of broiler chickens under the conditions of this study.

EFFECTS OF PREOPERATIVE INTRATHECAL MORPHINE ON POSTOPERATIVE PAD IN LIVING DONOR KIDNEY TRANSPLANTATION RECIPIENTS

Purpose: Postoperative PAD (pain, agitation, and delirium), especially delirium in living donor kidney transplantation (LDKT) recipients is a risk factor for increased morbidity, length of hospital stay, graft failure, and mortality. In its guideline for management of PAD, the American College of Critical Care Medicine emphasizes the importance of postoperative analgesia, and previous studies have shown effective pain control decreases the incidence and severity of postoperative delirium. Intrathecal morphine is a commonly used method of analgesia, but the effect of preoperative intrathecal morphine on postoperative PAD has not been studied in LDKT recipients. The purpose of this study is to evaluate the effects of preoperative intrathecal morphine on postoperative PAD in LDKT recipients. Methods: LDKT recipients in our institution received intrathecal morphine for the purpose of postoperative pain control if not contraindicated. With IRB approval we compared the incidence of PAD between recipients without intrathecal morphine (control group) and with intrathecal morphine (ITM group) who underwent LDKT (Jan. 2014 – Dec. 2018). Primary outcome was the incidence of delirium as detected by CAM-ICU score. Secondary outcomes were pain expressed as NRS, opioid consumption in milligrams equivalent morphine dose, agitation level expressed as RASS, antipsychotic/sedative consumption, length of hospital/ICU stay, and frequency of prolonged (>3days) ICU stays. Results: 339 recipients were included in the analysis with 166 in control group and 173 in ITM group. The incidence of delirium were 4.82% and 1.16% in control group and ITM group, respectively (p=0.046). There were significant differences in the pain and opioid consumption at POD0 and 1 between two groups. However, there were no significant differences in terms of agitation level and antipsychotics/sedative consumption. Also, the length of hospital/ICU stay and frequency of prolonged ICU stay were comparable between two groups. Conclusion: Preoperative intrathecal morphine in LDKT recipients reduced postoperative pain and delirium. Further study is warranted to investigate other risk factors on PAD in the ICU experience of transplantation recipients.

EFFECTS OF THE DIFFERENT ANESTHETIC METHODS ON POSTOPERATIVE HOSPITALIZATION AND USE OF ANALGESIA IN VARICOCELE SURGERY

Objective: The aim of this study was to evaluate the effect of different anesthetic methods used in varicocele surgery on postoperative pain relief needs and duration of hospitalization.Material and Methods: This study included 299 patients operated with varicocele between 2014 and 2018. patients were divided into general anesthesia+local anesthesia (20 ml prilocaine (2%)) skin infiltration [general anesthesia group (Group 1, n=50)], patients only administered spinal anesthesia [spinal anesthesia group (Group 2, n=142)], patients administered spinal anesthesia+TAP block [spinal+TAP block group (Group 3, n=52)] and patients administered spinal anesthesia and intrathecal morphine [spinal+ITM group (Group 4, n=55)].Results: The analgesic use in the general anesthesia group was not different from the spinal anesthesia group (p&amp;gt;0.05), but was different compared to the spinal+TAP group and spinal+ITM group (p&amp;lt;0.05, for both). Postoperative analgesic use is assessed for patients, the general anesthesia group was observed to have significantly shorter time for first analgesic use compared to the other groups (p=0.001). When patients are assessed in terms of the cost of anesthetic method, the highest cost method was in the spinal+TAP group. Conclusion: Despite relatively high cost of administration of spinal anesthesia+TAP block for varicocele surgery, it is an effective and reliable method with lower analgesic requirements and shorter duration of hospital stay.

Organic trace minerals improve eggshell quality by improving the eggshell ultrastructure of laying hens during the late laying period

The objective of this study was to investigate the effects of low inclusion levels of organic trace minerals (iron, copper, manganese, and zinc) on performance, eggshell quality, serum hormone levels, and enzyme activities of laying hens during the late laying period. A total of 405 healthy hens (HY-Line White, 50-week-old) were randomly divided into 3 treatments, with 9 replications per treatment and 15 birds per replication. The dietary treatments included a basal diet supplemented with inorganic trace minerals at commercial levels (CON), a basal diet supplemented with inorganic trace minerals at 1/3 commercial levels (ITM), and a basal diet supplemented with proteinated trace minerals at 1/3 commercial levels (TRT). The trial lasted 56 D (8 wk). Compared with the CON group, the ITM group showed decrease in (P < 0.05) egg production, eggshell strength, eggshell palisade layer, palisade layer ratio, serum estrogen, luteinizing hormone, glycosaminoglycan concentration, and carbonic anhydrase activity and increase in (P < 0.05) egg loss and mammillary layer ratio. However, the TRT group almost kept all the indices close to the CON group (P > 0.05). Furthermore, hens fed with low inclusion levels of organic trace minerals had smaller mammillary knobs (P < 0.05) than those in the CON and ITM groups. In conclusion, hens fed with low inclusion levels of proteinated trace minerals had better performance and eggshell strength than those fed with identical levels of inorganic compounds; organic trace minerals improved eggshell quality by improving the eggshell ultrastructure of laying hens during the late laying period.

Safety and effectiveness of coadministration of intrathecal sufentanil and morphine in hyperbaric bupivacaine-based spinal anesthesia for cesarean section

Subarachnoid block is a widely used technique for cesarean section. Opioids adding to the local anesthetics can improve its quality. In this prospective, randomized, double blind, controlled trial, we compared the effects of coadministration of intrathecal sufentanil and morphine with intrathecal sufentanil and a single administration of subcutaneous morphine. Sixty-four pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned to two groups according to the way of administration of morphine: intrathecal sufentanil (5 microg) plus intrathecal morphine (150 microg) (ITM group), and intrathecal sufentanil (5 microg) plus single administration of 10 mg subcutaneous morphine (SCM group). In both groups, the local anesthetic used was hyperbaric bupivacaine 0.5 percent (10 mg). Both groups received 1 g acetaminophen every 6 hours. In the postoperative period, pain was recorded on a 0-100 visual analog scale (VAS) and intravenous tramadol (100 mg) was administered if VAS score was >40 mm. Collateral effects, such as nausea, itching, respiratory depression, and sedation were assessed. VAS scores at rest and on coughing were significantly higher in the SCM group than in the ITM group between 3 and 24 hours. The mean titrated dose of tramadol consumed was also significantly greater in the SCM group than in the ITM group (p < 0.05). The time to first administration of tramadol was lower in the SCM group versus the ITM group (p < 0.05). The incidence of nausea was significantly lower in the SCM group than in the ITM group (p < 0.05). There was no significant group difference in the incidence of pruritus (p > 0.05). In conclusion, coadministration of sufentanil and morphine into the subarachnoid space was effective and provided longer pain relief than intrathecal sufentanil plus a single injection of subcutaneous morphine, despite a higher incidence of side effects such as nausea and vomiting.

Intrathecal morphine versus epidural ropivacaine infusion for analgesia after Cesarean section: a retrospective study.

BackgroundAnalgesia after Cesarean delivery (CD) requires early ambulation to prevent thromboembolic disease and to facilitate baby care. We retrospectively reviewed anesthesia charts and medical records of patients who underwent CD to compare the efficacy of spinal anesthesia supplemented with intrathecal morphine hydrochloride (ITM) and combined spinal–epidural anesthesia followed by opioid-free epidural analgesia (CSEA-EDA).FindingsAll subjects underwent CD at Nagaoka Chuo General Hospital between February 2012 and January 2013. Patient characteristics, time to first analgesic rescue after CD, and analgesic use after CD were examined. Incidences of postural hypotension, lower extremity numbness/weakness, postoperative nausea/vomiting (PONV), and pruritus were also examined for 48 h after CD. Average time to first analgesic use after CD (ITM 25.13 ± 16.07 h, CSEA-EDA 22.42 ± 16.27 h, p = 0.521) and cumulative probability of rescue analgesic use (p = 0.139 by log-rank test) were comparable between groups. However, average analgesic use within 24 h was lower in the ITM group (0.75 ± 1.05 times) than in the CSEA-EDA group (1.52 ± 1.72 times, p = 0.0497). Numbness or motor weakness in lower extremities only occurred in the CSEA-EDA group, and pruritus only occurred in the ITM group.ConclusionsThe results of this study suggest that ITM is better than CSEA-EDA for anesthesia following CD with regard to pain control. Also, ITM would be advantageous for early ambulation following CD because of lower incidence of numbness and motor weakness in lower extremities compared to CSEA-EDA.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block in comparison with subarachnoid morphine after cesarean section in morbidly obese parturients

Context Cesarean section is one of the most commonly performed surgical procedures. Intrathecal morphine is a popular and effective option for pain management following cesarean section. It is associated with side effects such as nausea, vomiting, pruritus, urinary retention, reactivation of oral herpes, and, rare but life-threatening, respiratory depression. The interest in transversus abdominis plane (TAP) block as a post-cesarean-delivery analgesic modality has surged in the past few years, and many studies have evaluated and compared its efficacy with intrathecal morphine. Aim The aim of the study was to compare spinal morphine and bilateral TAP block in cesarean section in morbidly obese parturients with respect to their postoperative analgesic efficacy and narcotic consumption. Settings and design This was a prospective randomized, double-blinded study. Materials and methods Parturients, 20 years or older, with BMI greater than 35 kg/m 2 , who were scheduled to undergo elective cesarean section were recruited for the study. They were assigned to receive either intrathecal morphine (the ITM group) 0.1 mg or TAP block (the TAP group) using ropivacaine 0.5% 20 ml on each side. The primary outcome was pain on movement, from supine to sitting position. The secondary outcomes were the presence and severity of nausea and pruritus and the presence of respiratory depression. Results We enrolled 60 patients, of whom 59 were analyzed. The numeric rating scale score for pain was less in the ITM group than in the TAP block group, and this difference was statistically significant. Both pruritus and nausea happened in more patients in the ITM group than in the TAP block group, and this difference was statistically significant in both the 8 and 16 h observations. Conclusion In morbidly obese parturients, intrathecal morphine has superior post-cesarean-delivery analgesic efficacy compared with the TAP block.

Intrathecal Morphine Reduces Blood Loss During Idiopathic Scoliosis Surgery

Lesniak, Aleksandra B.; Tremblay, Pierre; Dalens, Bernard J.; Aucoin, Maryse; Mercier, Pierre Author Information

Intrathecal morphine reduces blood loss during idiopathic scoliosis surgery: retrospective study of 256 pediatric cases

This retrospective cohort study was designed to assess the impact of intrathecal morphine compared with no intrathecal morphine on blood loss and on hemodynamic stability during surgery for pediatric idiopathic scoliosis correction. A retrospective review was done of 256 anesthetic charts who underwent scoliosis surgery between January 1993 and February 2012 by the same orthopedic surgeon. 128 patients were operated on before 2003 without intrathecal morphine (NITM group) and 128 were treated later on with intrathecal morphine (ITM group).Primary endpoints were a 20% decrease in blood loss in the ITM group and hemodynamic stability. Both groups were similar for age, girl/boy ratio, weight and duration of surgery. Blood loss was significantly greater in the NITM group: 1793.1±964.3ml vs 655.8±323.0ml (P<0.0001). Overall mean decrease in blood loss was 63.4% between the NITM group and the ITM group. A significantly (P<0.0001) greater number of patients from the NITM group (122) received blood transfusions as compared to the ITM group (30). The volume of blood transfused per patient was significantly greater in the NITM group (701.4±492.5ml) than in the ITM group (293.7±170.9ml) (P<0.0001). Heart rate was stable intra-operatively in both groups. Variation in blood pressure >20% of baseline occurred more frequently in the NITM group (28.1%) than in the ITM group (14.8%) (P=0.01). These data demonstrate that intrathecal morphine in pediatric surgical scoliosis correction significantly decreases intra-operative blood loss and transfusions and enhances blood pressure stability.

Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

Effect of injectable copper, selenium, zinc and manganese on the pregnancy rate of crossbred heifers (Bos indicus × Bos taurus) synchronized for timed embryo transfer

The success of synchronization protocols for timed embryo transfer (TET) depends on various factors such as breed, body condition scores and nutrition (including trace mineral status). In the present study, crossbred heifers were treated with subcutaneous injectable trace minerals (ITM — 100mg zinc, 100mg manganese, 50mg copper and 25mg selenium; Multimin®, Minerthal, Brazil) 17days prior to embryo transfer. Estrus synchronization for TET, conception rate and pregnancy loss were evaluated. Subcutaneous administration of ITM did not increase the number of heifers successfully synchronized compared to non-injected controls [ITM group=82.1% (308/375) versus control=83.1% (375/451); P=0.76]. However, heifers belonging to the ITM group (n=219) had a 1.58 fold and 1.72-fold higher (P=0.005) odds of being pregnant 23 and 48days after TET compared to the control group (n=276; not receiving ITM), respectively. In contrast, treatment with subcutaneous ITM did not significantly lower the pregnancy-loss rate [control group=17.2% (17/99) versus ITM group=10.6% (11/105); P=0.18]. Even though subcutaneous administration of ITM 17days prior to TET did not increase the number of heifers successfully synchronized, a significant increase in the conception rate (embryo survival) at 23 and 48days after TET was noted in heifers of the ITM group.

Efficacy and safety of a single intrathecal methylprednisolone bolus in chronic complex regional pain syndrome

Activated immune cells in the spinal cord may play an important role in the development and maintenance of neuropathic pain, such as occurs in response to peripheral inflammation or tissue injury. Immune activation may therefore serve as a therapeutic target for immune modulating drugs like corticosteroids. This double-blind randomized placebo-controlled parallel-group trial aimed to investigate the efficacy and safety of a single intrathecal administration of 60 mg methylprednisolone (ITM) in chronic patients with complex regional pain syndrome (CRPS). The primary outcome measure was change in pain (pain intensity numeric rating scale; range 0–10) after 6 weeks. With 21 subjects per group the study had a 90% power to detect a clinically relevant difference (⩾2 points). After 21 patients (10 on ITM) were included, the trial was stopped prematurely after the interim analysis had shown that ITM had no effect on pain (difference in mean pain intensity numeric rating scale at 6 weeks 0.3, 95% confidence interval −0.7 to 1.3) or any other outcome measure. We did not find any difference in treatment-emergent adverse events between the ITM and placebo group. We conclude that a single bolus administration of ITM is not efficacious in chronic CRPS patients, which may indicate that spinal immune activation does not play an important role in this phase of the syndrome.

Expression of Rho GDIα in rat osteoblasts intermittently exposed to parathyroid hormone in vitro and in vivo

To investigate the mechanism of the bone-forming effects of intermittent parathyroid hormone (PTH) administration and to search for novel molecules of bone anabolism via the PTH signaling pathway. Primary cultures of rat osteoblasts (ROBs) were divided into an intermittent PTH-treated group (Itm) and a control group (Ctr). Imitating the pharmacokinetics of intermittent PTH administration in vivo, the ROBs in the Itm group were exposed to PTH for 6 h in a 24-h incubation cycle, and the ROBs in the Ctr group were exposed to vehicle for the entire incubation cycle. The cells were collected at 6 h and 24 h of the final cycle, and the proteins in the Itm and Ctr groups were analyzed by two-dimensional electrophoresis (2-DE) coupled with peptide mass fingerprinting and matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) to detect proteins that were differentially expressed. The proteins with the most significant changes in vitro were validated by immunohistochemistry (IHC) in a rat model. The proteomics analysis indicated that a total of 26 proteins were up- or down-regulated in the Itm group compared with the Ctr group at 6 h and 24 h; among these, 15 proteins were successfully identified. These proteins mainly belong to the cytoskeleton and molecular chaperone protein families, and most of these have anti-apoptotic effects in various cells. Rho GDP-dissociation inhibitor alpha (RhoGDIalpha) and vimentin were the most significantly changed proteins. Further studies by IHC showed that the expression of RhoGDIalpha in ROBs was significantly higher in PTH-treated sham-operated rats than in vehicle-treated sham-operated rats, but the difference was not significant between PTH-treated and vehicle-treated OVX rats. Vimentin expression was not changed in either PTH-treated sham-operated rats or PTH-treated OVX rats. Our research suggests that intermittent PTH treatment induces changes in expression of many proteins in ROBs in vitro, and it results in RhoGDIalpha up-regulation in ROBs both in vitro and in vivo when estrogen is present. This up-regulation of RhoGDIalpha may be one of the mechanisms underlying the synergistic bone-forming effect of PTH and estrogen.Acta Pharmacologica Sinica (2009) 30: 1001-1007; doi: 10.1038/aps.2009.60.