KA Group Research Articles

Kaolin loaded gelatin sponges for rapid and effective hemostasis and accelerated wound healing

Severe trauma with massive active blood loss, including liver and spleen rupture, arterial bleeding and pelvic fracture, will lead disability, malformation and even death. Therefore, it is very important to develop new, fast and efficient hemostatic materials. In this study, a novel Gelatin/Kaolin (GE/KA) composite sponge was developed. Meanwhile, to further investigate the effect of kaolin content on sponge properties, we prepared four types of sponges: GE/5% KA, GE/10% KA, GE/15% KA and GE/20% KA. The results of coagulation test in vitro showed that compared to the other groups, there were more activated adhered platelets and red blood cells on the surface of GE/15% KA. The results of hemostasis test in vivo showed that compared to other experimental groups, the GE/15% KA group had significantly less hemostasis time (liver hemostasis model: 69.50 ± 2.81 s; femoral artery hemostasis model: 75.17 ± 3.06 s) and bleeding volume (liver hemostasis model: 219.02 ± 10.39 mg; femoral artery hemostasis model: 948.00 ± 50.69 mg), and was similar to the commercial hemostasis material group. Additionally, the material properties of the sponge were characterized and its biocompatibility was verified as well through cell experiments and in vivo embedding experiments. All these results indicate that the optimal content of kaolin is 15%, which provides a theoretical basis for subsequent research. All in all, the novel GE/KA composite sponge prepared in this study can be used as a multifunctional hemostatic wound dressing for the treatment of complex wounds under various trauma scenes.

DOP78 Does KONO-S anastomosis reduce recurrence in Crohn's disease compared to conventional ileocolonic anastomosis ? A nationwide propensity score-matched study from GETAID Chirurgie Group (KoCoRICCO study).

Abstract Background The ileocolonic anastomosis is the main site of postoperative recurrence in Crohn's disease. In 2003, Kono et al. described a new operative technique that could reduce the rate of postoperative recurrence (Kono-S anastomosis). Recently, a randomized monocenter study showed a significant decrease in endoscopic recurrence rate at 6 and 18 months (22.2% vs 62.8% and 25% vs 67.4%), as well as a decrease in clinical recurrence (Luglio. AnnSurg 2020). Nevertheless, the level of evidence remains too low to establish practice recommendations. The KoCoRICCO study aimed to compare outcomes between both techniques in two nationwide prospective cohorts. Methods Adult patients with Crohn's disease requiring ileocolonic resection with Kono-S anastomosis (KA Group) were prospectively included in 7 french referral centers between 2020 and 2022. Patients with conventional side-to-side anastomosis (CA Group) were enrolled from a previously publish nationwide cohort (Maggiori et al. Ann Surg 2019). Comparisons between two groups were performed for postoperative morbidity in the overall population. To deal with confounding factors distributed inequally among groups, a propensity score analysis was performed in patients with available endoscopic follow-up to compare recurrence at first endoscopy in a matched 1:2 ratio population. Parameters involved in the propensity score were: sex, active smoking, history of bowel resection, penetrating and anoperineal disease, preop and postop biological therapy. Results A total of 432 patients with ileocolonic anastomosis were enrolled, of whom 155 (35.9%) had a Kono-S anastomosis (Figure 1). Before matching both groups were unbalanced for preoperative, intraoperative and postoperative characteristics. Severe surgical morbidity according to Dindo-Clavien was 4.6% and 7.6% in the KA and CA groups, respectively (p<0.0001). In patients with available endoscopic follow-up, 61 patients in the KA group were matched with 122 in the CA group with the use of the propensity score. In the matched population, mean delay between surgery and endoscopic assessment was 7.4 months (SD ±3.0) and not statistically different between both groups. Endoscopic recurrence ≥ i2 was found in 29 patients (47.5%) and 54 patients (44.3%) in the KA group and CA group, respectively (p=0.6745). In unconditionnal logistic regression, Kono-S anastomosis was not associated with a lower risk of endoscopic recurrence: OR = 1.141 (95% CI 0.616-2.114, p=0.5147). Conclusion Kono-S could be associated with reduced severe morbidity compared to a conventional side-to-side anastomosis in Crohn's disease but does not seem to reduce the risk of endoscopic recurrence. A longer follow-up is mandatory to assess a potential benefit on surgical recurrence.

Low protein diet supplemented with ketoacids on muscle wasting in chronic kidney disease: A clinical trial.

AimNutrition is an important part of the care of patients with chronic kidney disease (CKD). However, there is limited clinical research on the skeletal muscle nutrition of patients with CKD. We carried out this study to find out whether a low-protein diet supplemented with ketoacids (LPD + KA) could improve muscle wasting in patients with CKD.MethodsPatients were enrolled in this non-blind, parallel-group, randomized trial assessing the nutritional status of CKD, randomly assigned to either the LPD + KA group or conventional LPD group. Blood samples such as Hemoglobin, Cystatin C, Creatinine, BUN, Albumin, Pre- Albumin, Glycerin Trilaurate, and Cholesterol were measured at baseline and every 3 months. The parameters of skeletal muscle and other body composition were assessed before and after dietary intervention for 12 months.ResultsA total of 58 patients with CKD completed the study and were available for further analysis. The hemoglobin and albumin were observed to be markedly improved in the LPD + KA group during the follow-up as compared to baseline. Body mass index and total body water index of both groups were increased upon follow-up but the increase in the LPD + KA group was comparatively higher. Moreover, an increase in body fat%, skeletal muscle mass index, and appendicular skeletal muscle mass index was observed in both groups between baseline and follow-up, but it was statistically insignificant.ConclusionThis study did not find a significant improvement of KAs on muscle wasting, and a long time or more indices study may need to find the effects of the LPD + KA diets.Clinical trial registration[www.ClinicalTrials.gov], identifier [NCT02568020].

The Morphology of a Kinematically Aligned Distal Femoral Osteotomy Is Different from That Obtained with Mechanical Alignment and Could Have Implications for the Design of Total Knee Arthroplasty.

Background: Kinematically aligned total knee arthroplasty (KA-TKA) may lead to a different pattern of osteotomy from mechanically aligned total knee arthroplasty (MA-TKA). This paper aims to analyze the effects of KA and MA on the morphology of the distal femoral osteotomy surface. Methods: Computed tomography scans of 80 TKA candidates were reconstructed into 3D models. The measurement of bone morphology was performed after the distal femur cut according to two different alignment techniques. The aspect ratio, trapezoidicity ratio, and asymmetry ratio of the distal femur were assessed. Results: The aspect ratio and the asymmetry ratio in the KA group was significantly lower than that in the MA group in the general population (p < 0.001). The trapezoidicity ratio in the KA group was significantly higher than that in the MA group in the general population (p < 0.001). Conclusions: It was found that KA-TKA and MA-TKA presented different morphologies of the distal femoral osteotomy surface, and this difference was also influenced by gender. The surgery pattern of KA-TKA and MA-TKA and gender should be considered when surgeons choose femoral prostheses.

Homology analysis and clinical infection characteristics of hypervirulent Klebsiella pneumonia

Objective: The hvKP phenotype strains were screened from the sensitive and multi-drug resistant Klebsiella pneumoniae, and the distribution and homology of their clinical infection characteristics were compared. Methods: A total of 158 Klebsiella pneumoniae strains isolated from clinical infection specimens in the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2018 were retrospectively collected. The string test (ST) was used to screen the hvKP infection, and a total of 65 were screened. The number of patients included 51 males and 14 females, with an average age of 56 years. The composition ratio of Klebsiella pneumoniae was analyzed for clinical infection related information. Matrix assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) was used to identify the hypervirulent Klebsiella pneumoniae and establish a new database, and bio-tree cluster analysis and principal component analysis were carried out for all strains that met the experimental conditions by using analysis software and the homology of protein level was obtained. Results: A total of 65 strains hvKP were screened, 62 of which were susceptible strains and 3 were multi-drug resistant strains. The main diseases of infected patients were diagnosed as hepatobiliary disease, encephalopathy and liver abscess. The basic diseases of the population were mainly diabetes and hypertension. Dendrogram cluster analysis divided hvKP into 3 groups at a distance of 550 from the horizontal line; principal component analysis found that some strains were closely related, and the Kc group with the largest proportion was mainly related to hepatobiliary diseases. Ka group was mainly related to infection after surgery. Conclusions: HvKP was highly invasive and the clinical manifestations of infection were diverse. The infected patients were mostly elderly patients with weakened immunity. The rapid homology analysis of MALDI-TOF MS mass spectrometry has important clinical significance for the rapid screening of hvKP infection.

Anchor-Based Femoral Fixation for Physeal-Sparing Medial Patellofemoral Ligament Reconstruction: A Time-Zero Biomechanical Comparison With Tenodesis Screw Fixation

Background: Open physes and trochlear/notch geometries in pediatric patients limit the safe corridor for femoral interference screw graft fixation during medial patellofemoral ligament (MPFL) reconstruction. Accordingly, interest is increasing in anchor-based fixation, but biomechanical validation is deficient. Purpose: To compare anchor-based and tenodesis screw femoral fixation of MPFL grafts in a time-zero biomechanical model. Study Design: Controlled laboratory study. Methods: Twenty-seven fresh-frozen porcine distal femurs were potted for testing in an electromechanical load frame, while bovine tendons were used for MPFL grafts. Reconstructions were performed with 1 of 3 femoral fixation strategies: 4.5-mm biocomposite double-loaded threaded anchor (DLA group), 3.9-mm biocomposite knotless threaded anchor (KA group), or traditional 7 × 23–mm biocomposite tenodesis screw (TS group). For testing, femoral specimens were oriented and secured in the mechanical testing apparatus such that actuator tensile pull re-created the normal MPFL trajectory. Specimens underwent 10 cycles of 5- to 15-N loading at 1-Hz preconditioning, followed by 1000 cycles of 10- to 50 N-loading at 1 Hz. After cyclic loading, all specimens were loaded to failure at 305 mm/min. The average cyclic construct stiffness, displacement, and load-to-failure data between the 3 groups were compared using analysis of variance (ANOVA) with the significance level set at P < .05. Results: Average cyclic construct stiffnesses were comparable across groups per repeated-measures ANOVA analysis: 68.3 ± 6.3, 71.4 ± 6.4, and 74.3 ± 7.9 N/mm for TS, DLA, and KA groups, respectively (at cycle 1000). Average construct displacements at cycles 100 and 1000 were significantly less in the anchor versus tenodesis screw groups per ANOVA and Tukey post hoc analysis: 7.7 ± 4.2 mm for the TS group versus 3.7 ± 0.4 and 4.3 ± 0.6 mm for the DLA and KA groups, respectively (at cycle 1000). There was no significant difference in ultimate failure loads between the anchor and tenodesis screw groups, but 3 of 9 TS constructs failed at loads below the average failure load of the native MPFL. Conclusion: Compared with the tenodesis group, anchor-based fixation produced constructs with equivalent cyclic stiffnesses, improved load-displacement characteristics, and had less failure load variability in the porcine cadaveric model. Clinical Relevance: Femoral fixation of the MPFL graft with a single anchor (4.5 or 3.9 mm threaded) is a viable alternative to traditional tenodesis screw fixation.

Comparison of Sedation with Dexmedetomidine Alfentanil Versus Ketamine-Alfentanil in Patients Undergoing Closed Reduction of Nasal Fractures.

ObjectivesTo compare the sedative effects of dexmedetomidine alfentanil versus ketamine-alfentanil in patients undergoing closed reduction of nasal fractures on the basis of intraoperative hemodynamic changes, satisfaction of patients and surgeons, and the adverse effects.MethodsSixty patients with ASA class 1 or 2 were randomized to either of two groups, a dexmedetomidine alfentanil group (DA group; n = 30) or a ketamine-alfentanil group (KA group; n = 30). Hemodynamic parameters, oxygenation status, adverse events, the satisfaction of patients and surgeons, and postoperative pain scores by visual analog scale (VAS) were recorded at specific time intervals during the trial.ResultsSystolic blood pressure was significantly lower in the DA group than in the KA group from T1 min to T15 min. The duration of the recovery ward stay was longer in the DA group; however, two groups were similar in terms of total anesthesia time and awakening time. Likewise, two groups were similar in terms of the patient and surgeon’s satisfaction, pain scores, and the occurrence of adverse effects.ConclusionsBoth sedation methods were safely performed, and dexmedetomidine-alfentanil is as effective as ketamine-alfentanil in patients undergoing short-term operations such as nasal fracture corrections.

P1672IMPACT OF ISLET TRANSPLANTATION VERSUS INSULIN ALONE AFTER KIDNEY TRANSPLANTATION IN TYPE 1 DIABETES PATIENTS

Abstract Background and Aims In patients with type 1 diabetes and end-stage renal disease, kidney transplantation improves both quality of life and survival. When simultaneous kidney-pancreas transplantation appears too invasive, or after failure of the pancreatic graft, an islet after kidney transplantation (IAK) may be considered to restore a stable endocrine function. The aim of our work was to assess the impact of islet transplantation on kidney transplantation outcomes versus insulin alone. Method In this retrospective parallel-arm cohort study in Lille, we included all type 1 diabetes patients who received a kidney graft from 2000 to 2017, followed by an islet transplantation after kidney (IAK) or not (kidney alone, KA). The primary study endpoint was the change of renal function (estimated glomerular filtration rate, eGFR). Secondary endpoints were glycemic control-related markers, such as HBA1c. Results During the period of study, 14 patients were included in the KA group versus 15 in the IAK group (including 5 after failure of a simultaneous pancreatic graft) were enrolled. At baseline, kidney donor sex, BMI, cause of death, cold ischemia time and recipient sex, waiting time on dialysis, type of dialysis, and number of previous kidney transplantation, were similar between the two groups. Yet, there were significant differences between KA and IAK, considering donor age (resp. 56.0±15.0 vs 35.2±13.7 years, p&amp;lt;0.001), use of perfusion machine (resp. 7 vs 0, p= 0.002), recipient age (resp. 55.7±5.7 vs 42.1±6.1, p&amp;lt;0.001), and recipient BMI (24.7± 1.8 vs 21.9±2.5 k/m? p=0.004). In IAK, the median (IQR) time between islet and kidney transplantation was 21.8 months (19.0 – 29.4). eGFR was not significantly different at baseline (IAK: 57.8±17.7 vs KA: 48.9±21.4 ml/min, p=0.22) but the decrease was significantly lower up to 5 years in the IAK group (IAK: 0.05±1.99 ml/min/year vs KA: -2.42±3.43 ml/min/year, p=0.03). HBA1c was similar at baseline in both groups (IAK: 7.8±1.6% versus KA: 7.9±1.1%, p=0.31), but significantly lower in the IAK group up to 5 years (IAK: 6.6±0.97% versus KA: 7.8±1.12%, p&amp;lt;0.001). Conclusion In patients with type 1 diabetes and a functioning kidney graft, IAK was associated with a better glucose control and a slower decrease of eGFR than standard insulin therapy. Our results suggest that IAK should be proposed to type 1 diabetes patients with a functional kidney graft.

Hyperoside alleviates epilepsy-induced neuronal damage by enhancing antioxidant levels and reducing autophagy

Ethnopharmacological relevanceHypericum perforatum L. (genus Hypericum, family Hypericaceae), a plant commonly used in traditional Chinese medicine, is believed to confer a wide range of benefits, including fever reduction, detoxification, calming, and pain relief via decoctions of its stems and leaves. Hyperoside (HYP), a natural compound extracted from Hypericum perforatum L., has been shown to demonstrate a wide array of bioactivities including antioxidative, anti-inflammatory, and anti-apoptotic effects. In this study, we investigated the effects of HYP on epilepsy-induced neuronal damage in mice and the associated regulatory factors. Aim of the studyThis study examined the potential therapeutic use of HYP for the treatment of neuronal damage in a mouse model of epilepsy and explored the relationships of the potential neuroprotective effects of HYP pretreatment with antioxidant levels and autophagy. Materials and methodsICR mice were randomly divided into six groups: sham group, sham-HYP group, KA group, KA-HYP group, KA-HYP-DDC group and KA-CQ group. Immunohistochemical staining was used to assess changes in NeuN, IBA-1, and GFAP expression in the CA3 region of the hippocampus. Immunofluorescence staining was used to assess the effects of HYP on the number of autophagosomes that accumulated in neurons in the hippocampal CA3 region. The levels of SOD1, SOD2, LC3I/II, Beclin1, and PI3K/AKT and MAPK signaling-related proteins were detected by Western blot. ResultsPretreatment with 50 mg/kg HYP protected against epilepsy-induced neuronal damage in the hippocampal CA3 region. Additionally, HYP enhanced antioxidant levels and reduced the levels of autophagy-related proteins via the PI3K/AKT and MAPK pathways. ConclusionHYP protected the hippocampal CA3 region against epilepsy-induced neuronal damage via enhancing antioxidant levels and reducing autophagy. The mechanism of action may be related to the maintenance of antioxidant levels and the suppression of autophagy via the PI3K/Akt and MAPK pathways.

Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years.

To study and identify the determinants of the impact on pain, function, and quality of life of a prosthetic replacement surgery after 5 years of survival in patients with osteoarthritis (OA) of the lower limb. In total, 626 osteoarthritic patients from a University Hospital, divided in 2 groups (according to surgical site), were prospectively followed for 5 years after hip (n = 346) or knee (n = 280) replacement. Validated specific Western Ontario and McMaster Universities Arthritis Index (WOMAC) and generic (SF-36 and EQ) instruments assessing quality of life were used prior to surgery and yearly, thereafter. We defined a good outcome as a clinically relevant improvement in WOMAC greater than or equal to the minimally important difference (MID). Regressions showed the relationships among preoperative, perioperative, and postoperative measures and the evolution of WOMAC scores after 5 years (percent change). We also examined any predictors of good outcomes. The beneficial effect on quality of life observed during the first year after hip and knee arthroplasty (HA and KA) was maintained for up to 5 years. More than 3/4 of the patients in our study experienced a good outcome (86.04% in HA group and 79.91% in KA group). Both the good outcome and the 5-year change in WOMAC are predicted by preoperative (i.e., radiological severity, comorbidities, disability, and level of education), perioperative (i.e., length of hospital stay and place of discharge), and postoperative (i.e., complications) variables in the two groups. Joint arthroplasty is a highly valuable therapeutic strategy for hip or knee OA patients who do not respond to pharmacological management. These results represent a step towards the collection of robust, scientifically sound data that will facilitate the completion of health economic analyses in the field of OA. • This study reports the long term outcomes of hip and knee replacement surgery in late-stage OA.• We identified pre-, per-, and post-operative determinants which contribute to a greater improvement in pain and function, hence increasing patients' satisfaction.• These results could contribute to select an OA population which has a high probability to get an optimal benefit from total joint replacement.

Anticonvulsive and neuroprotective effects of aqueous and methanolic extracts of Anacyclus pyrethrum root in kainic acid-induced-status epilepticus in mice

PurposeEpilepsy is a chronic neurological disorder characterized by spontaneous and recurrent seizures. The currently available synthetic antiepileptic drugs have a limited efficacy and are associated with a wide range of side effects. In Ayurveda, Anacyclus pyrethrum root (APR) has been used as a traditional antiepileptic remedy. The aim of the present study is to evaluate the anticonvulsive and neuroprotective effects of aqueous and methanol extracts of Anacyclus pyrethrum root (AEAPR and MEAPR) on experimental model of status epilepticus (SE). MethodsTwenty four male mice were divided into four groups. The control and KA groups had free access to tap water for 5 days before the intraperitoneal injection of distillated water or kainic acid (KA; 30 mg/kg), respectively. In the treated groups, mice received extracts solutions MEAPR and AEAPR in drinking water at the concentration of 5 g/l for 5 days. At the fifth day, animals received intraperitoneal injection of KA. The behavioral changes latency of seizures, the number of wet dog shakes (WDS) and the mortality were observed over 6 h. Thereafter, the mice were sacrificed for immunohistochemical studies. ResultsPretreatment with MEAPR and AEAPR decreases significantly the frequency of WDS (32.5% and 43.9%, p < 0.01; respectively), and increases considerably the latent period (77.9% and 91.9%, p<0.01; respectively) between the injection of the KA and the appearance of the SE as compared to the KA group. The duration and severity of seizure in the MEAPR or AEAPR-pretreated groups were significantly lower (p < 0.01 and p < 0.05 or p < 0.01; respectively) than those in the KA group. These behavioral results were confirmed by the immunohistochemical study at the level of the hippocampus, in which the c-FOS and GFAP expression of both MEAPR and AEAPR-treated animals largely reduced (p < 0.001) the number of labelled cells with respect to the group, which received the KA alone. ConclusionOur results showed that the MEAPR and AEAPR have anticonvulsive effect and putative neuroprotective effect against seizures induced by KA. Further studies are required to identify its active ingredients responsible for the observed effects.

Compound \u03b1-keto acid tablet supplementation alleviates chronic kidney disease progression via inhibition of the NF-kB and MAPK pathways

BackgroundKeto-analogues administration plays an important role in clinical chronic kidney disease (CKD) adjunctive therapy, however previous studies on their reno-protective effect mainly focused on kidney pathological changes induced by nephrectomy. This study was designed to explore the currently understudied alternative mechanisms by which compound α-ketoacid tablets (KA) influenced ischemia–reperfusion (IR) induced murine renal injury, and to probe the current status of KA administration on staving CKD progression in Chinese CKD patients at different stages.MethodsIn animal experiment, IR surgery was performed to mimic progressive chronic kidney injury, while KA was administrated orally. For clinical research, a retrospective cohort study was conducted to delineate the usage and effects of KA on attenuating CKD exacerbation. End-point CKD event was defined as 50% reduction of initial estimated glomerular filtration rate (eGFR). Kaplan–Meier analysis and COX proportional hazard regression model were adopted to calculate the cumulative probability to reach the end-point and hazard ratio of renal function deterioration.ResultsIn animal study, KA presented a protective effect on IR induced renal injury and fibrosis by attenuating inflammatory infiltration and apoptosis via inhibition of nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways. In clinical research, after adjusting basic demographic factors, patients at stages 4 and 5 in KA group presented a much delayed and slower incidence of eGFR decrease compared to those in No-KA group (hazard ratio (HR) = 0.115, 95% confidence interval (CI) 0.021–0.639, p = 0.0134), demonstrating a positive effect of KA on staving CKD progression.ConclusionKA improved IR induced chronic renal injury and fibrosis, and seemed to be a prospective protective factor in end stage renal disease.

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

BackgroundKinematically aligned (KA) total knee arthroplasty (TKA) has emerged as an alternative approach to the intraoperative alignment targets of mechanically aligned (MA) TKA. While the clinical outcomes of the two philosophies have been investigated, further investigation is required to quantify exactly how the two philosophies differ in their approach to correcting the deformities encountered in osteoarthritic knees such as fixed flexion deformities (FFD) and coronal malalignment. The aim of this paper was to compare MA and KA philosophies in TKA in terms of the intra-operative correction of FFD and coronal malalignment and quantify the way in which each philosophy achieves a well-balanced knee that can reach full extension. MethodsA retrospective review of prospective data collected from 210 consecutive TKAs performed by a single surgeon between March 2015 and May 2017 was undertaken. MA and KA cases were compared in terms of pre-operative patient deformity and characteristics, intraoperative steps taken to correct FFD (including bony resections, soft tissue releases and components used) and postoperative alignment achieved. ResultsOne hundred twenty MA and 90 KA TKAs were analysed. There was no significant difference in terms of patient age, gender and preoperative coronal and sagittal deformity between the two cohorts. KA TKAs were able to achieve the same degree of sagittal correction as MA TKAs with less total bony resection (16.7 mm vs. 18.9 mm, p < 0.0001), less soft tissue releases (10% vs. 49.2%, p < 0.0001). This was achieved with a difference in component alignment. The femur was in more valgus (−2.5 vs. −0.03°, p < 0.0001), the tibia in more varus (2.3 vs. 0.3°, p < 0.0001), and the overall alignment slightly more varus in the KA group (1.1 vs. 0.4°, p = 0.007), without significant difference in the proportion of patients within three degrees of a neutral axis. ConclusionThis study shows that using a kinematic alignment philosophy in total knee arthroplasty results in the achievement of extension range-of-motion and soft tissue balance goals with less bone resection and less soft tissue release. This allows for bone stock preservation and minimization of trauma due to soft tissue release. Further study is required to correlate these results with patient reported outcomes and determine their clinical significance. Level of evidenceIII — retrospective cohort study.

Sub-anaesthetic bolus dose of intravenous ketamine for postoperative pain following caesarean section

Background: Effective postoperative analgesia following Caesarean Section is important because parturients are at a higher risk for thromboembolic events due to immobility, increased likelihood of developing postpartum depression (PPD) following inadequate pain control which also can interrupt breastfeeding. Ketamine at sub anesthetic doses has been considered to reduce postoperative pain and analgesic consumption following caesarean section. Aims: The aim of this study was to evaluate the efficacy of sub anesthetic doses of ketamine on post caesarean analgesia. Material and Methods: This randomized double blind, placebo controlled study was conducted on 108 parturients, divided into three groups (36 in each group);Group C- received 2 ml of 0.9% normal saline; Group Ka- received 0.15 mg/kg of ketamine (2 ml) and Group Kb- 0.3 mg/kg of ketamine (2 ml) after 5 min of delivery. Postoperatively VAS score, consumption of rescue analgesic in 24 h and adverse effects were recorded. Statistical analysis was done with Analysis of variance (ANOVA) for continuous variables and Chi-square test for categorical scale. P values less than 0.05 were considered significant. Results: Postoperative VAS scores were significantly higher in control group while the time to the first analgesic requirement was significantly prolonged in Ka group (5.44 ± 1.45 h) and Kb group (6.18 ± 1.61 h) as compared to the control group (4.97 ± 1.48 h). The total number of doses and total dose of rescue analgesic (tramadol) required in 24 hours was significantly less in the Ka group (194.44 ± 53.15 mg) and Kb group (152.78 ± 50.63 mg) as compared to group C (136.11 ± 48.71 mg. Conclusion: Administration of sub-anesthetic doses (0.15 mg/kg and 0.3 mg/kg) of intravenous ketamine enhanced postoperative analgesia and reduced the total rescue analgesic consumption in first 24 h following CS. Ketamine 0.3 mg/kg also increased the time to first postoperative rescue analgesic request.

Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties.

Objective To measure and identify the determinants of the outcomes after hip/knee arthroplasty (HA/KA) in patients with osteoarthritis during the first postsurgical year. Design In this prospective observational study, we evaluated the preoperative and postoperative (3, 6, and 12 months) outcomes of 626 patients who underwent HA (346 with median age 65 years, 59% female) or KA (280 with median age 66.5 years, 54% female) between 2008 and 2013. Generic and specific tools were used to measure health-related quality of life (HRQoL) and utility. Good outcome was defined as an improvement in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) greater than or equal to the minimal important difference (MID). Regressions were performed to evaluate the relationship between preoperative and postoperative measures and evolution of WOMAC/good outcome. Results We observed an almost systematic improvement of all parameters for up to 12 months, but especially at the 3-month follow-up. The low number of comorbidities and the absence of postoperative complications were the common determinants of improvement of WOMAC total score after 12 months. Other parameters (background of the joint, preoperative function and length of hospital stay in KA group; place of discharge in HA group) affected the evolution of WOMAC scores. 87.09% of HA and 73.06% of KA patients experienced a good outcome. A small number of comorbidities, a worse preoperative function, a shortened hospital stay (KA only), and an absence of early postoperative complications (HA only) significantly predicted a good outcome. Conclusions Intermediate HRQoL following HA or KA improved quickly from preoperative levels for all instruments. More than 70% of patients achieved a good outcome defined as improved pain, stiffness and disability and the predictors are slightly close.

Sub-classifying the languages of the Lower Volta Valley: Towards redefining Kwa

AbstractThis paper is concerned with defining the genetic position of the Ghana-Togo Mountain (GTM) languages, formerly known as theTogorestsprachen, later the Central Togo languages, in relation to what are currently known as the Kwa languages. It explores the possible genetic relationship of the languages now referred to as “Ghana-Togo Mountain” languages to the Potou-Tano languages, as an initial step towards defining their relationship towards all the languages of the area. Probably nobody today questions that the languages are all related, all being classifiable as Niger-Congo, but the problem is, how are they related? The paper does not conclusively prove that GTM languages belong to the family denoted by the node label “Potou-Tano”, but evidence adduced makes it seem very likely. It also shows that on the basis of several sound shifts it is reasonable to regard GTM as a genetic group within Potou-Tano. There is no clear evidence that the NA group of GTM is any more closely related to Tano than the KA group. An obvious next step is a proper comparison of the Tano and GTM noun class systems.

Preferred Hip Strategy During Landing Reduces Knee Abduction Moment in Collegiate Female Soccer Players.

Hip-focused interventions are aimed to decrease frontal plane knee loading related to anterior cruciate ligament injuries. Whether a preferred hip landing strategy decreases frontal plane knee loading is unknown. To determine if a preferred hip landing strategy during a drop vertical jump (DVJ) is utilized during a single-leg landing (SLL) task and whether differences in frontal plane knee loading are consistent between a DVJ and an SLL task. Descriptive laboratory study. Research laboratory. Twenty-three collegiate, female soccer players. Participants were dichotomized into a hip (HIP; n = 9) or knee/ankle (KA; n = 14) strategy group based on the percentage distribution of each lower extremity joint relative to the summated moment (% distribution) during the DVJ. Separate 1-way analysis of variances examined the differences in joint-specific % distribution and external knee abduction moment between the HIP and KA groups. The HIP group had significantly greater % distribution of hip moment and less % distribution of knee moment compared with the KA group during the DVJ and SLL. External knee abduction moment was also significantly less in the HIP group compared with the KA group during the DVJ. Female soccer athletes who land with a preferred hip strategy during a DVJ also land with a preferred hip strategy during an SLL. The preferred hip strategy also resulted in less external knee abduction moments during the DVJ. Targeting the neuromuscular control of the hip extensor may be useful in reducing risk of noncontact anterior cruciate ligament injuries.

VEGF expression and new blood vessel after dental X-ray irradiation on fractured tooth extraction wound

Background: Dental X-ray has an important role in dentistry. Complication case such as tooth fracture extraction requires this examination to determine the appropriate treatment measures. Dental X-ray can also cause a negative impact to the body at cellular and even molecular level. Purpose: The aim of this study was to evaluate the decrease of vascular endothelial growth factor (VEGF) expression and new blood vessels number caused by dental X-ray irradiation on fractured tooth extraction wound on day 3 and 7 after extraction. Method: We used 30 wistar rats which was randomly divided into 6 groups. Each rat’s central insisive of left mandible was fractured and then extracted after or without X-ray irradiation. Group KA and KB were control groups without irradiation. Group P1 A and P1 B were treatment groups with 0.08 mSv irradiation dose. Group P2 A and P2 B were treatment groups with 0.16 mSv irradiation dose. The subject from group KA, P1 A, and P2 A were sacrficed and sockets were collected at day 3. The subject from group KB, P1 B, and P2 B were sacrficed and sockets were collected at day 7. Socket were processed and painted with hematoxylin eosin and immunohistochemistry, then observed with a microscope. Data processing was performed with SPSS 16 through one way anova test and post hoc Tukey test HS. Result: The lowest means expression of VEGF and the number of new blood vessels on the day 3 was found in P2 A group, and the highest found in the KA group. The lowest means expression of VEGF and the number of new blood vessels on the day 7 was found in P2 B group, and the highest found in the KB group. Conclusion: Dental X-ray irradiation dose of 0.08 mSv and 0.16 mSv causes decrease of VEGF expression and new blood vessels in the wound fractured tooth extraction in day 3 and day 7 post-extraction.

Effects of Low-Protein Diets Supplemented with Ketoacid on Expression of TGF-β and Its Receptors in Diabetic Rats.

TGF-β 1 has been recognized as a key mediator in DN. This study aimed to observe the effects of low-protein diets supplemented with ketoacid on mRNA and protein expression of TGF-β and TβRI and t TβRII receptors in the renal tissue of diabetic rats. A diabetes model was established in 72 male SD rats. They were then equally randomized to three groups: NPD group, LPD group, and LPD + KA group. Additional 24 male SD rats receiving normal protein diets were used as the control. Eight rats from each group were sacrificed at weeks 4, 8, and 12 after treatment, from which SCr, BUN, serum albumin, and 24 h urinary protein excretion were collected. The expressions of TGF-β 1, TβRI, and TβRII in LPD and LPD + KA groups were significantly lower than those in NPD group and lower in LPD + KA group than those in LPD group. Low-protein diets supplemented with ketoacid have been demonstrated to provide a protective effect on the renal function as represented by reduced SCr, BUN, and urinary protein excretion, probably through downregulating the gene expression of TGF-β 1 and its receptors in LPD + KA group.

Effects of neuropeptide Y gene transfection on seizure in rat and the expression of phosphorylated Tau protein in the rat hippocampus

Objective To discuss the effect of gene transfection of rAAV2/1-NPY- EGFP on KA-induced rat seizures, EEG and the expression of hippocampal phosphorylated Tau protein. Methods Altogether 72 healthy male Wistar adult rats were randomly divided into three groups : control group, KA group and NPY group(n=24). The epileptic models were established by the injection of KA 2 μl (0.4 μg/μl) five times to the right side of the hippocampus CA3 area every three days. rAAV2/1-NPY-EGFP group, in which 10 μl of rAAV2/1-NPY-EGFP (titer 5×1011 v. g./ml) was injected to the lateral ventricle in successful rats chronic model, while KA group was injected with an equal dose of saline. The control group was injected with an equal dose of saline both in the hippocampal CA3 area and the lateral ventricle. The seizure situation, the onset latency and EEG were observed at 2 weeks and 4 weeks after vector injection. Then the expression of phosphorylated Tau protein in hippocampus were detected with Western blotting. Results (1) Scale and latency of each seizure onset in rats of rAAV2/1-NPY-EGFP group (12.13±8.06)had no significant difference at 2 weeks(P>0.05) compared with KA group(12.10±8.07). The scale of seizure in rats of rAAV2/1-NPY-EGFP group(6.06±3.78) significantly reduced at 4 weeks(P<0.05). Latency of seizure onset (79.06±8.83min) significantly increased at 4 weeks(P<0.05), EEG epileptic discharge frequency and wave amplitude decreased (P<0.05) at 4 weeks.The control group had no seizures. (2) Compared with the control group, the expression of phosphorylated Tau protein in KA group and NPY group significantly increased(P <0.05) at 2 weeks and 4 weeks, and the expression of phosphorylated Tau protein in the NPY group (1.15±0.16 RQ value) at 4 weeks significantly decreased (P <0.05) compared with the KA group(1.87±0.23 RQ value). Conclusion rAAV2/1-NPY-EGFP gene transfection significantly reduces scale of seizure onset and prolongs latency of seizure onset in KA-induced rat model. rAAV2/1-NPY-EGFP gene transfection may play anti-epileptic and neuroprotective effects through inhibiting the expression of phosphorylated Tau protein in hippocampus of KA-induced epileptic rat model. Key words: Neuropeptide Y; Epilepsy; Gene transfection; Phosphorylated Tau protein