Lactated Ringer Solution Research Articles

Order Substitutions and Education for Balanced Crystalloid Solution Use in an Integrated Health Care System and Association With Major Adverse Kidney Events

Trials comparing balanced crystalloids with normal saline have yielded mixed results regarding reductions in kidney complications and mortality for hospitalized patients receiving intravenous fluids. To evaluate the association of a multifaceted implementation program encouraging the preferential use of lactated Ringer solution with patient outcomes and intravenous fluid-prescribing practices in a large, multilevel health care system. This type 2 hybrid implementation and comparative effectiveness study enrolled all patients 18 years or older who received 1 L or more of intravenous fluids while admitted to an emergency department and/or inpatient unit at 1 of 22 hospitals in Idaho and Utah between November 1, 2018, and February 29, 2020. An interrupted time series analysis was used to assess study outcomes before and after interventions to encourage use of lactated Ringer solution. Implementation program combining order set modification, electronic order entry alerts, and sequential clinician-targeted education to encourage prescribing of lactated Ringer solution instead of normal saline. The primary implementation outcome was the patient-level proportion of intravenous fluids that was balanced crystalloids. The primary effectiveness outcome was the incidence of major adverse kidney events (MAKE30)-a composite of new persistent kidney dysfunction, new initiation of dialysis, and death-at 30 days. Among 148 423 patients (median [IQR] age, 47 [30-67] years; 91 302 women [61%]), the proportion of total fluids received that was lactated Ringer solution increased from 28% to 75% in the first week vs the last week of the study (immediate implementation effect odds ratio [OR], 3.44; 95% CI, 2.79-4.24). The estimated MAKE30 absolute risk reduction was 2.2% (95% CI, 1.3%-3.3%) based on interrupted time series analysis showing a decrease in the week-on-week trend for MAKE30 (OR difference, 0.03; 95% CI, 0.03-0.03, P < .001). The immediate postimplementation OR for MAKE30 was 0.88 (95% CI, 0.76-1.01), with a decrease in persistent kidney dysfunction (OR, 0.80; 95% CI, 0.69-0.93) and mortality (OR, 0.78; 95% CI, 0.65-0.93) but not dialysis (OR, 1.00; 95% CI, 0.76-1.32). In this comparative effectiveness study, an implementation program was associated with an increase in the proportion of fluids administered as lactated Ringer solution compared with normal saline and was associated with a reduction in MAKE30 events among patients treated in a large integrated health care system.

MO662: Effects of Blood Contact with Haemodialysis Membrane on the Kidney in a Rat Extracorporeal Perfusion Model

Abstract BACKGROUND AND AIMS A microcirculatory disturbance was found to occur during hemodialysis in an organ such as the brain or heart, which was recently considered to lead to functional impairment of these organs. Decrease in blood volume due to water removal during hemodialysis and the reaction of blood vessels with activated leukocytes and platelets that have come in contact with the dialysis membrane may cause the microcirculatory disturbance of the organs. Residual renal function decline after initiation of hemodialysis is well-known, but the mechanism has not yet been fully understood. In the present study, we focused on the effects of leucocytes and platelets activated by contact with the dialysis membrane and aimed to clarify the effects of blood contact with the dialysis membrane on the kidney. METHOD Male Sprague–Dawley rats weighing 397.4 ± 38.6 g were used for the experiment. We compared three experimental groups; the sham group, in which only puncture and infusion of Ringer's lactate solution were performed; the extracorporeal perfusion alone group, in which extracorporeal perfusion was performed only through a blood circuit; and the dialyzer group, in which extracorporeal perfusion was performed through a blood circuit and dialyzer. Blood was withdrawn from the femoral artery and returned to the femoral vein. The blood flow rate was 0.5–1.0 mL/min, the perfusion time was 4-h and no water removal was performed. During the perfusion experiment, arterial pressure and percutaneous arterial oxygen saturation (SpO2) were measured and at the end of perfusion, serum interleukin-6 (IL-6), a marker of inflammation and urinary kidney injury molecule-1 (KIM-1), a marker of kidney injury, were measured. After completing the perfusion experiment, kidneys were removed and morphology was evaluated by a hematoxylin and eosin (HE) staining. RESULTS AND DISCUSSION Arterial pressure during perfusion showed a significant upward trend during the first 2-h in the extracorporeal alone and dialyzer groups, while SpO2 showed a significant downward trend in these groups. Serum IL-6 levels were significantly higher in the extracorporeal perfusion alone group (P &amp;lt; .05, n = 8) and the dialyzer group (P &amp;lt; .01, n = 6) than in the sham group (n = 7). Urinary KIM-1 level in the dialyzer group was significantly higher than that in normal rats (P &amp;lt; .01, n = 7). Glomerular congestion was observed in the kidney only in the dialyzer group from the HE staining. There was a significant correlation between the increase in arterial pressure and the decrease in SpO2, suggesting that peripheral circulatory disturbance due to peripheral vasoconstriction occurred in the extracorporeal perfusion alone and the dialyzer groups. In addition, extracorporeal perfusion through the dialyzer caused high levels of IL-6 in serum and KIM-1 in urine, suggesting that systemic inflammatory and kidney injury have occurred. These reactions may contribute to the progression of residual renal dysfunction due to dialysis treatment, especially for the patients after the initiation of hemodialysis. CONCLUSION Extracorporeal perfusion and blood contact with a dialyzer caused systemic inflammation and the microcirculatory disturbance of kidneys, resulting in glomerular congestion and kidney injury in a rat extracorporeal perfusion model.

Rhabdomyolysis, myoglobinuric nephrosis, and crystalline nephropathy in a captive bottlenose dolphin.

A 5-y-old female bottlenose dolphin (Tursiops truncatus) from an aquarium in Japan had clinical signs of anorexia, vomiting, and bradykinesia. Enrofloxacin and lactated Ringer solution were administered for treatment of bacterial infection and for rehydration. Elevations of creatine kinase and aspartate aminotransferase activities were detected on day 4 of treatment, indicating that rhabdomyolysis had developed on day 3. On day 5, serum creatinine and urea concentrations increased and remained high throughout the remaining treatment; the dolphin died on day 16. Postmortem examination revealed massive necrosis of the longissimus dorsi muscles. Histologic examination revealed extensive necrosis of skeletal myofibers, multifocal renal tubular necrosis with intratubular casts and crystals, and suppurative bronchopneumonia. The renal casts labeled positively with anti-myoglobin antibody; expression of aquaporin-1 was decreased in renal tubules compared to normal kidney tissue. To our knowledge, this description of clinicopathologic findings of rhabdomyolysis leading to acute kidney injury with concomitant crystalline nephropathy has not been reported previously in a bottlenose dolphin.

Anti-scarring effect of sodium hyaluronate at filtration pathway after filtering surgery in rabbits.

To investigate the anti-scarring effect of sodium hyaluronate (HA) at filtration pathway after filtering surgery in a rabbit model. Fifteen healthy adult New Zealand white rabbits were selected for trabeculectomy in both eyes. The right eyes were used as HA group with 0.1 mL HA injected into the anterior chamber at the end of the operation; the left eyes were used with 0.1 mL sodium lactate Ringer's solution (RS) injected into the anterior chamber as RS group. Intraocular pressure (IOP), filtering blebs morphology, inflammatory reaction and complications were observed at the 7, 60, and 90d after surgery. One day after surgery, the IOP of HA and RS groups were 12.75±1.92 and 10.50±1.59 mm Hg (P=0.005). At the 7th day postoperative, the filtering blebs of each group were functional type and TGF-β expression was significantly difference in both groups (0.10±0.01 vs 0.14±0.02, P=0.024). After 60d of the operation, all filtering blebs were scarring and alpha-smooth muscle actin (α-SMA) expression was significantly difference in both groups (0.40±0.04 vs 0.35±0.02, P=0.032). α-SMA positive cells were mainly distributed in the junction of conjunctiva and sclera and around the blood vessels. The collagen volume fraction (CVF) of HA and RS group was (75.49±7.01)% and (79.93±5.35)% (P=0.044). On the 90th day after the operation, CVF was (82.57±5.19)% and (88.08±1.75)% in HA and RS groups (P=0.036). There was no α-SMA positive cell in HA group, while a few positive cells were observed in RS group (P=0.000). HA has effect of anti-scar and anti-inflammation on filtration pathway after filtering surgery within 3mo by inhibiting fibroblast proliferation and collagen deposition.

Development of an Electrodeposited Graphene Quantum Dot Electrode for the Electrochemical Detection of C‐Reactive Protein (CRP) Biomarker

AbstractC‐reactive protein (CRP) is a potential cardiac biomarker whose levels fluctuate in response to cardiac diseases. In particular, the severity of cardiovascular disease can be associated with the level of CRP, emphasizing the necessity for a highly sensitive biosensor capable of detecting CRP at ultralow levels in a short period of time. In this study, we used a facile pyrolysis method to synthesize graphene quantum dots (GQDs) with a diameter of 2.2 nm. Then, to fabricate the Au/GQDs/anti‐CRP electrode, GQDs were electrodeposited successfully on the surface of the bare Au electrode to provide a nano‐interfaced matrix platform for effective anti‐CRP immobilization. Cyclic voltammetry was used to investigate the contact between anti‐CRP and CRP in the Fe(CN)63−/4− as a mediator. The recorded current signal from differential pulse voltammetry measurements shows that the associative interaction between the anti‐CRP and CRP is efficiently induced. Furthermore, the Figureure of merits of the developed sensor, including the sensory response of &lt;50 s with a high sensitivity of 58 μA ng−1 mL−1 cm−2 and a low detection capability of 0.104 ng mL−1 (n=3), suggests that it is a potential candidate for point‐of‐care testing. And the fabricated Au/GQDs/anti‐CRP biosensor were used to sense CRP in an artificial serum (ringer lactate) solution.

Development and Evaluation of a Serum Transfusion Process in the Thorny Devil Stick Insect (Eurycantha calcarata)

The thorny devil stick insect (Eurycantha calcarata) is a common invertebrate maintained under human care. Blood (hemolymph) transfusions are a widely used therapeutic tool in other species, but investigation in terrestrial arthropods remains scarce. Study objectives were development and evaluation of a serum transfusion process in the thorny devil stick insect. Twenty-five clinically healthy adult insects (9.9–23.0 g) were enrolled and baseline body weights were collected. Hemolymph collection was not successful in males, thus, all were recipient only (n = 12, MR). Females were divided into donor (n = 4, FD) or donor and recipient (n = 9, FDR) groups. Females were manually restrained and up to 1 mL of hemolymph was collected from the abdominal segment caudal to the proximal hindlimb using an 18 g hypodermic needle and passive collection via gravity. Hemolymph was quantified, centrifuged, and the serum separated. Insects were then injected superficially at the lateral aspect of the abdomen with 0.01 mL/g FD serum (MR), lactated Ringer's solution (LRS) equal to collected hemolymph volume (FD), or a combination of FDR serum and LRS equal to collected hemolymph volume (FDR). Response to stimulation, surface temperature, and righting reflex and mortality were serially assessed for up to 24 h and 7 days, respectively, following injection. In FD, median (range) injected LRS dose was 0.04 (0.03–0.06) mL/g. In FDR, median (range) injected serum, LRS, and combined serum and LRS dose was 0.03 (0.02–0.04), 0.01 (0–0.04), and 0.04 (0.02–0.06) mL/g, respectively. A mild temperature increase (maximum +2.9°C) (MR n = 10, FD n = 3, FDR n = 8) and delayed righting reflex (MR n = 4, FD n = 3, FDR n = 7) occurred in a subset of insects following injection. Two deaths occurred at 2 min (n = 1, FDR) and 96 h (n = 1, FD) post-injection. This is the first report of serum transfusions in thorny devil stick insects, and while largely successful, minor to severe transfusion reactions may occur.

Effects of different crystalloid resuscitation on renal function in septic shock rabbits under the guidance of pulse indicator continuous cardiac output

To study the effect of different crystalloid resuscitation on renal function in septic shock rabbits, and to provide a theoretical basis for the choice of crystalloid for clinical fluid resuscitation. Thirty-six healthy male New Zealand white rabbits were divided into six groups by random number table: control group, model group, and four crystalloid groups including normal saline (NS) group, lactate Ringer solution (LR) group, acetate Ringer solution (AR) group, and sodium potassium magnesium calcium glucose injection (SPMCG) group, with 6 rabbits in each group. Rabbits were infused with Escherichia coli lipopolysaccharide (LPS) 500 μg/kg via the marginal ear vein (infused at a constant speed within 20 minutes), and then continued to infuse in an increase of 300 μg/kg every 10 minutes, the maximum dose was 2 mg/kg, until the mean arterial pressure (MAP) dropped to 60% of the basal value, the septic shock model was considered to be successfully reproduced. The rabbits in the control group were not injected with LPS, and other operations were the same as in the model group. Different crystalloid groups were given crystal solution immediately after modeling for resuscitation (predetermined fluid volume 60 mL/kg, transfusion within 3 hours). The volume stress test was performed every hour to guide the fluid volume, and the stroke volume index increase rate (ΔSVI) < 15% was the end point of resuscitation. The control group and the model group were given NS 4 mL×kg-1×h-1 to maintain the physiological requirement. All groups were given tracheotomy and mechanical ventilation, and the hemodynamic changes were monitored by pulse-indicated continuous cardiac output (PiCCO). The dynamic changes of hemodynamic indexes, arterial blood gas analysis, electrolytes, blood glucose and renal function biomarkers were monitored before modeling, immediately after modeling and 3, 6, and 12 hours after resuscitation. (1) Hemodynamic indicators: after modeling, the MAP in the model group and the four fluid resuscitation groups decreased significantly, the cardiac index (CI) increased, and the systemic vascular resistance index (SVRI), global end-diastolic volumn index (GEDVI) decreased. After different crystalloid resuscitation at different time points, MAP, SVRI, and GEDVI increased in the four crystalloid groups. (2) Arterial blood gas analysis, electrolytes, blood glucose: blood lactic acid (Lac) in the model group and the four fluid resuscitation groups increased after model success. After fluid resuscitation, the Lac of each crystalloid group began to decrease and reached to the lowest at 12 hours. Compared with the LR, AR and SPMCG groups, the pH value decreased in the NS group at 6 hours and 12 hours of fluid resuscitation (6 hours: 7.29±0.00 vs. 7.40±0.02, 7.35±0.02, 7.37±0.02; 12 hours: 7.27±0.02 vs. 7.38±0.02, 7.39±0.02, 7.35±0.01; all P < 0.05). After fluid resuscitation, blood Cl- levels at 3, 6, and 12 hours in the NS group were significantly higher than those in the LR, AR and SPMCG groups (mmol/L: 113.4±0.6 vs. 101.4±3.6, 108.0±1.1, 106.0±0.8 at 3 hours; 115.1±2.0 vs. 101.1±2.7, 109.0±2.2, 105.3±0.6 at 6 hours; 116.9±0.1 vs. 104.2±4.4, 107.6±1.7, 108.7±0.6 at 12 hours; all P < 0.05). There was no significant difference in blood glucose at each time point among the four crystalloid groups. (3) Biomarkers of renal function: blood and urine neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cys C) were significantly increased in the model group and four fluid resuscitation groups. After fluid resuscitation, blood, urine NGAL and Cys C decreased. There was no significant difference in blood, urine NGAL and Cys C at all the time points among the different fluid resuscitation groups. In the rabbit model of septic shock induced by Escherichia coli LPS, hyperchloremia and acidosis occurred after NS resucitation, but did not occur during the recovery of LR, AR and SPMCG. There was no difference in the effects of different crystalloid resuscitation on renal function in septic shock rabbits.

P33. PEG-FUSION TO RESTORE ELECTROPHYSIOLOGICAL CONTINUITY AND FUNCTION AFTER NERVE TRANSECTION

PURPOSE: In this study, we tested whether Polyethylene glycol (PEG)-fusion repair of peripheral nerves could improve electrophysiological and behavioral functions in a large animal (swine) model of nerve repair. METHODS: The median and ulnar nerves were both sharply transected above the elbow in Yorkshire pigs (n=2). The median nerve was irrigated with hypotonic calcium-free saline and methylene blue, then repaired with 9-0 sutures in standard fashion. PEG was applied directly to the coaptation site for 1-2min, followed by a final wash with Lactated Ringers solution. Electrophysiological testing of compound action potentials (CAPs) and compound muscle action potentials (CMAPs) was performed to measure if PEG resulted in the re-establishment of electrical connectivity between proximal and distal nerve segments. RESULTS: Electrophysiological testing demonstrated the absence of CAPs or CMAPs after the nerve was repaired with sutures and re-establishment of CAP and CMAPs after application of PEG. Follow up studies 14 days post-operatively showed continual maintenance of CAPs in both pigs, and CMAPs in 1 of 2 pigs, suggesting axonal survival and maintenance of neuromuscular innervation. CONCLUSION: PEG-fusion successfully re-established electrophysiological function after median nerve transection in swine, showing that PEG-fusion can be accomplished in larger animal models. Swine could be a particularly useful model for PEG-fusion of long nerve defects (>3cm) that are not possible in small animal models.

Laparoscopic sclerotherapy for an endometrioma in 10 steps

To present 10 consecutive, standardized, and reproducible surgical steps for laparoscopic sclerotherapy of an endometrioma. Step-by-step video demonstration of the technique. Local institutional review board approval was not required for this video because patients cannot be identified. Endometriosis Center. Women with an endometrioma >50 mm with deep endometriosis lesions, symptomatic, and wishing to conceive. Ethanol sclerotherapy for an endometrioma may be performed following 10 steps. Step 1 takes place preoperatively and consists of a rigorous selection of the patient to eliminate malignant tumors. Step 2 consists of the preparation of the material by preparing the required volume of alcohol. Step 3 consists of an exploration of the peritoneal cavity to eliminate the presence of peritoneal carcinosis. Step 4 is the puncture of the cyst, which may be direct via a 5 mm trocar or after the intraabdominal opening of the cyst; then aspiration of its contents in Step 5. Step 6 is flushing the cyst with a Ringer's lactate solution. In Step 7, the surgeon fills the cavity with a 96% alcohol solution. Step 8 consists of exposure for 10 to 15 minutes while the surgeon continues to operate. In Step 9, the surgeon extracts out all the alcohol from the cyst and cleans the peritoneal cavity. Step 10 consists of removal of the area not exposed to alcohol to treat this portion and obtain a histologic diagnosis. Description of 10 successive surgical steps. A video presenting 10 surgical steps to perform sclerotherapy of an endometrioma during endometriosis surgery. Laparoscopic sclerotherapy for an endometrioma is a rapid and accessible method. The standardization of this technique by this 10-step video should allow the surgeon to consider it as an alternative to cystectomy to preserve the ovarian reserve.

Effects of Thymosin β4 on Myocardial Apoptosis in Burned Rats.

The aim of this study was to investigate the effects of thymosin β4 on myocardial apoptosis following burns. Fifty healthy Sprague Dawley (SD) rats were randomly divided into the normal control group, resuscitation group the low-dose Tβ4 (thymosin β4) group (2g), the medium-dose Tβ4 group (6g), and the high-dose Tβ4 group (18g). The rats were immersed in 95°C hot water for 18 seconds, and then the model of 30% body surface area (TBSA) III° scald was established. The resuscated rats were injected with lactate Ringer's solution for antishock rehydration, while the Tβ4 treatment group was injected with lactate Ringer's solution for antishock rehydration, and the animals were sacrificed 6 h after scald. The degree of histopathological damage was observed by HE (hematoxylin and eosin) staining. Western blot was used to detect STAT1 and STAT3 protein expression levels. Real-time PCR was used to detect mRNA expressions of STAT1 and STAT3. The results showed that the apoptosis rate of the resuscitation group was significantly higher than that of the control group (P < 0.01). Compared with the resuscitation group, the apoptosis rate of thymosin β4 in the treatment group was significantly reduced (P < 0.01). Compared with the normal control group, the expression of STAT1 protein was increased and the expression of STAT3 protein was decreased in model group rats after ischemia and reperfusion. Compared with the model group, the expression of STAT1 protein decreased and the expression of STAT3 protein increased after ischemia-reperfusion in the thymosin β4 treatment group. Thymosin β4 may protect the myocardium by downregulating STAT1 and upregulating STAT3 expression and inhibiting myocardial apoptosis induced by ischemia and reperfusion after severe scald injury.

484 The Role of Plasma Derived Purified Exosome Product (PEP) for Improved Locomotor Recovery in Spinal Cord Injured Rats

INTRODUCTION: Preclinical studies indicate that mesenchymal stem cell-derived secretomes exert immunomodulatory and neuroprotective effects in various spinal cord injury models. Exosomes as one of the secretomes, have been shown to successfully aid wound healing for the skin and following myocardial infarction. However, the effects of human plasma-derived purified exosomal products (PEP) on spinal cord injury (SCI) have not been explored to this date. METHODS: Twenty-four female rats were randomly divided into five groups. These included 2 control groups for the I.V or I.T injected PEP groups and a sham group. Groups were subject to a T9 laminectomy, followed by a moderate contusion SCI. After 24 hours, lactated ringer solution or PEP was injected through I.V or IT routes. Rats were assessed weekly for a total period of 10 weeks by an open field Basso, Beattie, and Bresnahan (BBB) motor score and a postmortem quantification of external scaring, neuronal regeneration, cavity volume, and glial scarring was carried out at the end of the follow-up period. RESULTS: Animals treated with I.V PEP or IT PEP had significant improvement within the first-week post-injury (1.05±1.2 vs. 2.16±3.15) and (1.08±3.5 vs. 4.5±0.083) respectively, with sustained improvement in BBB score at 10 weeks (11±1.16 vs. 13.8±1.90), (11.3±1.4 vs. 14±1.16). CONCLUSION: Our preliminary results suggest that I.V or IT PEP injection without immunosuppression might provide beneficial effects initially following traumatic SCI.

Abstract No.: ABS2482: A comparative study to evaluate the effect of melatonin on blood loss after elective Caesarean section: a randomised double blind study.

Background & Aims:Postpartum hemorrhage (PPH) being a cause for one-third of obstetric deaths, its prevention helps decreasing blood loss at caesarean section. Melatonin acts on MT1 and MT2 receptors in the myometrium, and similarities between melatonin and oxytocin signaling could lead to increased contractility.Severe pre-eclampsia (n=19)Mild pre-eclampsia (n=16)Healthy controls (n=35) P Mean ONSD (mm) Mean±SD5.36±0.324.71±0.354.24±0.38<0.0001, S vs M: <0.0001, S vs H: <0.0001, M vs H: <0.0001LUSS score Median (IQR)11 (4.5-16)1 (0-4.25)0 (0-1.5)<0.0001, S vs M: 0.0008, S vs H: <.0001, M vs H: 0.107Methods:After obtaining informed-written-consent, patients were randomly allocated to 2 groups, of 30 each to receive either melatonin 3mg (group M3), or placebo (group P) orally, 1h before spinal-anaesthesia. Patient was preloaded with 10ml/kg ringer-lactate solution. In operating-room, standard monitoring was connected. Oxygen was delivered at 4L/min. SAB was administered, and motor-blockade determined using modified-Bromage-scale. After delivery, injection oxytocin was given. Haemoglobin values were determined before and 12h after surgery. Blood-loss (ml) was measured-as a) the difference between the weight of used materials before and after the surgery and b) the volume of suction after placental delivery. The sedation score assessment was done. Neonatal Apgar score and birth weight were noted.Results:There was significant difference between group M and group P in total blood loss with mean 1357.17 and 1440 and standard deviation 162.82 and 170.31 respectively with p=0.029539.Conclusion:The use of melatonin 3mg orally as premedication in pregnant patients undergoing cesarean section under spinal anaesthesia could statistically decrease the amount of blood loss after caesarean section.Group MGroup P P MeanSDMean SDTotal blood loss1357.17162.821440170.310.029539Pre Op Hb11.260.8711.820.920.1633Post Op Hb10.250.8411.490.890.084116Difference of Hb1.0060.410.920.420.029539

Comparison of the Hemodynamic Changes in Normotensive and Severe Preeclamptic Pregnant Woman Posted For Cesarean Section under Spinal Anaesthesia

Background: Spinal anesthesia is widely considered a technique of choice for cesarean delivery. But due to fear of sudden and extensive sympathetic blockade, spinal anesthesia may not be considered safe in severe preeclampsia. Objectives: The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), incidence of hypotension, phenyl ephrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Material and Methods: A total of 35 severe pre-eclamptic (BP &gt; 160/110 mmHg) 3(Group A) and 35 healthy parturients (group B), meeting the inclusion criteria were included in the study. After preloading with 10 ml/kg of ringer lactate (RL) solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Heart rate and blood pressure were recorded before spinal anesthesia and thereafter at 3 minute intervals upto 60 minutes. Hypotension was defined as MAP LESS,THAN 30% of the baseline or a decrease in SBP to LESS THAN 100 mm Hg over the same time interval and was treated with 50 mcg phenylephrine intravenously (i.v). Apgar score was noted 1 and 5 min after birth. Results: The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients (55.6% vs. 34.1%). The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P LESS THAN 0.0001) than that of pre-eclamptic group (48.3 ± 35). The total doses of IV Phenylephrine for treating hypotension were significantly lower among the preeclamptic patients (72 mcg in preeclamptic patients versus 188 mcg in normotensive patients) (P LESS THAN 0.05). There was no statistical difference in the neonatal outcome and Apgar score in the study groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.

Comparison of the Hemodynamic Changes in Normotensive and Severe Preeclamptic Pregnant Woman Posted For Cesarean Section under Spinal Anaesthesia

Background: Spinal anesthesia is widely considered a technique of choice for cesarean delivery. But due to fear of sudden and extensive sympathetic blockade, spinal anesthesia may not be considered safe in severe preeclampsia. Objectives: The aim of the present study was to compare the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), incidence of hypotension, phenyl ephrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing cesarean section under spinal anesthesia. Material and Methods: A total of 35 severe pre-eclamptic (BP &gt; 160/110 mmHg) 3(Group A) and 35 healthy parturients (group B), meeting the inclusion criteria were included in the study. After preloading with 10 ml/kg of ringer lactate (RL) solution spinal anesthesia was administered with 12.5 mg of hyper baric bupivacaine. Heart rate and blood pressure were recorded before spinal anesthesia and thereafter at 3 minute intervals upto 60 minutes. Hypotension was defined as MAP LESS,THAN 30% of the baseline or a decrease in SBP to LESS THAN 100 mm Hg over the same time interval and was treated with 50 mcg phenylephrine intravenously (i.v). Apgar score was noted 1 and 5 min after birth. Results: The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients (55.6% vs. 34.1%). The minimum SBP, DBP, and MAP recorded were lower in normotensive, and the difference between two groups was statistically significant. The mean phenylephrine requirement in the normotensive group (151.1 ± 70) was significantly greater (P LESS THAN 0.0001) than that of pre-eclamptic group (48.3 ± 35). The total doses of IV Phenylephrine for treating hypotension were significantly lower among the preeclamptic patients (72 mcg in preeclamptic patients versus 188 mcg in normotensive patients) (P LESS THAN 0.05). There was no statistical difference in the neonatal outcome and Apgar score in the study groups. Conclusion: Pre-eclamptics experienced less hypotension following subarachnoid block (SAB) than normotensives and required less phenylephrine with comparable fetal Apgar scores.

Effectiveness of Ozone Therapy in The Treatment of Endometritis in Mares

Endometritis is defined as inflammation of the endometrium that may be acute or chronic, infectious, or non-infectious. Endometritis is an important cause of subfertility in mares. Considering the antimicrobial characteristics, immune-stimulating ability, and low cost of ozone (O3) therapy, we aimed to evaluate the effectiveness of intrauterine O3 therapy as an alternative treatment for endometritis in mares. Twenty-five mares with a known reproductive history of uterine infection and inflammation were allocated into three groups: Group 1 (control; n = 7), uterine lavage with Ringer's lactate solution; Group 2 (O3-gas; n = 9), uterine lavage with Ringer's lactate solution followed by uterine insufflation with O2-O3 gas mixture containing 40 µg O3 mL−1 for 10 minute; and Group 3 (O3-oil; n = 9), uterine infusion of ozonized sunflower oil. Uterine inflammation was evaluated through a uterine cytological examination (cytobrush) and uterine culture (swab) for microbiological content before and after all treatments. In assessments of uterine cytology, the average number of neutrophils/field changed from 9.14 ± 3.02 to 7.71 ± 3.59 in the control group, from 10.67 ± 3.84 to 2.89 ± 3.59 in the O3-gas group, and from 6.44 ± 2.79 to 6.55 ± 7.18 in the O3-oil group post-treatment. The pre- and post-treatment findings in the mares treated with ozonized gas were significantly different (P < .05), unlike the findings for the mares in the control and O3-oil groups. All mares (25/25) showed a positive uterine culture before treatment. After treatment, the percentage of mares showing positive culture results was 57%, 11%, and 22% in the control, O3-gas, and O3-oil groups, respectively. Our results showed the effectiveness of two groups (O2-O3 gas mixture and ozonized sunflower oil) for the treatment of uterine infections in mares. Thus, direct intrauterine O3 gas infusion has been shown to be effective in treating endometritis in mares, reducing both inflammation and uterine infection.

Trichlorfon for Treatment of Cutaneous Habronemosis - Evaluation of Intravenous Regional Perfusion in the Distal Equine Limbs

Background: Equine cutaneous habronemiasis is common in the distal regions of the limbs. Organophosphates, applied systemically, one previously used treatment, which is highly effective, but currently in disuse, due to the risks of intoxica-tion. Regional perfusion is a potential technique for distal limb wounds, since, in addition to being used in low doses, it prevents systemic circulation of the drug and possible intoxication, and has a lower treatment cost. The current work aimed to perform clinical, laboratory, and venography evaluations of the use of trichlorfon in regional intravenous perfusion, as a possible form of treatment for cutaneous habronemosis in the distal region of equine limbs.Materials, Methods &amp; Results: Twelve horses were used, divided into two groups, with the left thoracic limb (LTL) being the test limb, and the right thoracic limb (RTL) the control limb. At moment zero (M0), distal radiography and venography were performed. The tourniquet was then loosened and after five minutes, at moment one (M1), the tourniquet was repositioned for 1.25 mg/kg (G1) and 5.5mg/kg (G2) trichlorfon injections into the left thoracic limb, diluted in 20 mL of Ringer's lactate solution, and 20 mL of Ringer's lactate solution was applied to the right thoracic limb. The tourniquet was maintained for 30 minutes after infusion in both groups. At moment two (M2), four days later, blood tests, radiography, and venography were repeated. Every day between M0 and M2, physical examinations were performed, including measurement of the pastern, fetlock, and coronet band, and a lameness examination. There were no significant alterations in clinical parameters, behavior, and appetite. In the blood cell count, there was an increase in leukocytes on D4 in G2, although remaining within the reference values for the species. The biochemical tests showed no alterations. There were no changes in the circumferences evaluated and 4 horses from G2 presented lameness in the LTL and one in the RTL. In the venograms, one G2 animal was noticed to be hypoperfused in all LTL plexuses. Discussion: The use of trichlorfon in regional perfusion at a dose of 1.25 mg/kg demonstrated safety, with no clinical, laboratory, and lameness changes in any of the animals. At the highest dose (5.5 mg/kg), individual reactions were observed, such as different degrees of lameness, swelling, and heat in foot. Serial venographies document the response to treatment used, it was decided to perform the second venography 4 days after the trichlorfon perfusion and the first initial venography evaluation, following the recommendations for the repetition time of the examination and evaluation of the use of the drug. The evaluation of radiographic images of venography, in a grading system created considering the range of contrast in five regions by the three examiners experienced in podiatry and the analysis of radiographic images of limbs of horses, without having participated in the previous procedures was important for the reliability of the assessment. The areas of hypoperfusion observed in the venography were not related to trichlorfon perfusion. It is essential that the application of trichlorfon be performed correctly, intravenously, to avoid reactions such as necrosis, pain, edema, erythema, lameness, and even more severe inflammatory reactions, such as phlegmon and thrombophlebitis. Although a small number of animals were used in this study, trichlorfon regional perfusion of equine limbs, at a dose of 1.25 mg/kg may be a technique appears to be inert to hoof vascularization.

H12‐(ADP)‐liposomes for hemorrhagic shock in thrombocytopenia: Mesenteric artery injury model in rabbits

BackgroundDamage control resuscitation improves patient outcomes after severe hemorrhage and coagulopathy. However, effective hemostasis methods for these critical situations are lacking. ObjectiveWe evaluated the hemostatic efficacy of fibrinogen γ‐chain (HHLGGAKQAGDV, H12)‐coated, adenosine‐diphosphate (ADP)‐encapsulated liposomes (H12‐[ADP]‐liposomes) in thrombocytopenic rabbits with hemorrhagic shock. MethodsAcute thrombocytopenia (80%) was induced in rabbits that also received mesenteric vessel injury, leading to hemorrhagic shock. Five minutes after injury, subjects received intravenous bolus injection with H12‐(ADP)‐liposomes (20 mg/kg), followed by isovolemic transfusion with stored red blood cells (RBCs)/platelet poor plasma (PPP) (RBC:PPP = 1:1 [vol/vol]), or lactated Ringer solution every 5 min to compensate blood loss. One group received H12‐(phosphate buffered saline [PBS]) liposomes followed by RBC/PPP. Additional groups were received isovolemic transfusion with RBC/platelet rich plasma (PRP) (RBC:PRP = 1:1 [vol/vol]), RBC/PPP, PPP alone, or lactated Ringer solution. ResultsTreatment with H12‐(ADP)‐liposomes followed by RBC/PPP transfusion and RBC/PRP transfusion effectively stopped bleeding in all thrombocytopenic rabbits. In contrast, three of 10 rabbits treated with RBC/PPP failed hemostasis, and no rabbits receiving lactated Ringer solution stopped bleeding or survived. Twenty‐four hours after hemorrhage, 80% of rabbits receiving H12‐(ADP)‐liposome followed by RBC/PPP transfusion survived and 70% of rabbits receiving RBC/PRP transfusion also survived, although RBC/PPP‐transfused rabbits showed 40% survival. Rabbits receiving H12‐(ADP)‐liposomes followed by lactated Ringer solution showed a transient hemostatic potential but failed to survive. H12‐(PBS)‐liposomes showed no beneficial effect on hemostasis. Neither the PPP group nor the lactated Ringer group survived. ConclusionH12‐(ADP)‐liposome treatment followed by RBC/PPP may be effective in lethal hemorrhage after mesenteric vessel injury in coagulopathic rabbits.

Biodegradable properties of AZ31-0.5Ca magnesium alloy

ABSTRACT In this work, the effect of Ca addition on the microstructure, mechanical properties, electrochemical corrosion and biocompatibility of AZ31 Mg alloy was investigated. Scanning electron microscopy and electron probe microanalyzer were used to analyse microstructural characteristics of both alloys. Open circuit potential , potentiodynamic polarisation and electrochemical impedance spectroscopy techniques were carried out in Ringer lactate solution at 37 ± 1°C to determine the mechanism of corrosion and rate of deterioration of AZ31 and AZ31-0.5Ca. The results revealed that addition of Ca significantly enhanced the corrosion resistance of AZ31 (20.21 mpy and 10.08 mpy for AZ31 and AZ31-0.5Ca, respectively), which was attributed to the presence of second phase particles. the cell viability and biocompatibility of the both alloys were determined by performing the cytotoxicity test after 24 h, 48 h and 72 h incubation in L929 and MC3T3-E1 cell extract. Both the alloys demonstrated adequate cell viability and biocompatibility.

Effect of heparin sodium on postoperative inflammation after adult cataract surgery

To evaluate the effect of use of ringer lactate solution supplemented with heparin sodium in patients undergoing cataract surgery.In a prospective, double-blind, interventional study, 200 patients were included and were randomized to undergo cataract surgery using ringer lactate solution with or without 10 IU/ml heparin. All patients underwent phacoemulsification with hydrophobic acrylic foldable intraocular lens (IOL) implantation. The severity of anterior chamber inflammation and amount of pigment deposition of IOL was assessed by slit lamp biomicroscopy on day 1, 7, 28 and after 8 weeks postoperatively. Mean age in treatment and control group was 63.0± 11.5 years and 65.1±12.7 years respectively. A significant reduction in the severity of inflammatory cellular activity (p=0.001), flare (p=0.001) and pigment deposition on IOL (p=0.001) was noted on day 1 in the heparin treated group compared to the control group. However, no significant difference was observed in the amount of inflammatory activity as well as IOL pigment deposition beyond 1 week postoperatively. The inflammatory activity resolved almost completely in both the groups by the end of 8 weeks postoperatively. : Our study showed the beneficial effect of addition of heparin to irrigating solution during cataract surgery. Heparin treated eyes demonstrated a reduction in the early postoperative inflammation and IOL pigment deposition. The anti-inflammatory effect was observed in the early postoperative period.

Women with a history of preeclampsia have preserved sensory nerve-mediated dilatation in the cutaneous microvasculature.

What is the central question of this study? Are sensory nerve-mediated vasodilatation and the NO-dependent contribution to that response attenuated in the cutaneous microvasculature of women who have had preeclampsia? What is the main finding and its importance? Women who have had preeclampsia demonstrate attenuated microvascular endothelium-dependent dilatation compared to women with a history of uncomplicated pregnancy. However, there are no differences in sensory nerve-mediated vasodilatation between groups. This suggests that the neurogenic response is not altered following preeclampsia, and that the NO-dependent vasodilatation of the neurogenic response is not related to endothelium-dependent NO-mediated dilatation in these women. Women who have had preeclampsia (PE) demonstrate microvascular endothelial dysfunction, mediated in part by reduced nitric oxide (NO)-dependent mechanisms. Localized heating of the skin induces a biphasic vasodilatation response: a sensory nerve-mediated initial peak, followed by a sustained endothelium-dependent plateau. We have previously shown that the endothelium-dependent plateau is attenuated in PE. However, it is unknown if the sensory nerve-mediated initial peak is similarly attenuated. Therefore, the purpose of this study was to examine the effect of PE history on sensory nerve-mediated vasodilatation and the NO-dependent contribution to that response. We hypothesized that PE would have an attenuated initial peak and a reduced NO-dependent contribution to that response compared to women with a history of normotensive pregnancy (healthy controls, HC). Nine HC (31±4years) and nine PE (28±6years) underwent a standard local heating protocol (42°C; 0.1°Cs-1 ). Two intradermal microdialysis fibres were placed in the skin of the ventral forearm for the continuous local delivery of lactated Ringer solution alone (control) or 15-mM NG -nitro-l-arginine methyl ester for nitric oxide synthase (NOS) inhibition. Red blood cell flux was measured at each site by laser Doppler flowmetry (LDF). Cutaneous vascular conductance was calculated (CVC=LDF/mean arterial pressure) and normalized to maximum (%CVCmax ; 28-mM SNP + local heat 43°C). There were no differences in the initial peak between groups (HC: 79±8 vs. PE: 80±10%CVCmax ; P=0.936). NOS inhibition attenuated the initial peak in both HC (57±18% CVCmax ; P=0.003) and PE (54±10%CVCmax ; P=0.002). However, there were no differences in the NO-dependent portion of the initial peak (HC: 23±16 vs. PE: 24±9%; P=0.777). The local heating plateau (HC: 99±4 vs. PE: 88±7%CVCmax ; P=0.001) and NO contribution to the plateau (HC: 31±9 vs. PE: 17±14%; P=0.02) were attenuated in PE. There was no relation between NO-dependent dilatation in the initial peak and NO-dependent dilatation in the plateau across groups (R2 =0.005; P=0.943). Women who have had PE demonstrate attenuated microvascular endothelium-dependent dilatation. However, there are no differences in sensory nerve-mediated vasodilatation following PE, suggesting that the NO-dependent vasodilatation of the neurogenic response is not related to endothelium-dependent NO-mediated dilatation in these women.