Administration Of Normal Saline Research Articles

Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge.

Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was <0.7, p > 0.05. IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed.

Does Introduction of Normal Saline Tip the Electrolyte Balance in Preeclampsia? [33I

INTRODUCTION: Due to a nationwide shortage of Ringer's lactate, normal saline became the intravenous fluid of choice at our institution in 5/2018. Recent studies have raised concern on safety of administration of normal saline in critically ill patients. We sought to evaluate the impact of normal saline on the outcomes of women with preeclampsia receiving magnesium sulfate. METHODS: Prospective observational study of women with preeclampsia with severe features receiving normal saline. The amount of normal saline administered was calculated and a basic metabolic panel was surveyed approximately 12 hours after initiation of magnesium sulfate prophylaxis. Laboratory analytes were examined according to the amount of intravenous fluid received. RESULTS: From 5/2018 to 7/2018, a total of 124 patients were identified. The mean intravenous fluid volume received was 1.84 ± 0.9 L. Serum creatinine and chloride levels remained unchanged over time and across quartiles of amount of fluid received (p=0.322 and p=0.822, respectively). Incidentally, a significant relationship was found between calcium levels and both the amount of normal saline received (p=0.0003) and concurrent magnesium levels (p<.0001). When testing for interaction between calcium, magnesium, and normal saline, both of the latter contributed to an increased risk of hypocalcemia. CONCLUSION: There does not appear to be a significant consequence to either chloride levels or renal function when utilizing normal saline in women with preeclampsia receiving magnesium sulfate. Coincidentally, calcium levels significantly declined as the amount of intravenous fluid increased, which given the association with magnesium levels is suspected to be a function of magnesium sulfate exposure.

Does Introduction of Normal Saline Tip the Electrolyte Balance in Preeclampsia? [33I

INTRODUCTION: Due to a nationwide shortage of Ringer's lactate, normal saline became the intravenous fluid of choice at our institution in 5/2018. Recent studies have raised concern on safety of administration of normal saline in critically ill patients. We sought to evaluate the impact of normal saline on the outcomes of women with preeclampsia receiving magnesium sulfate. METHODS: Prospective observational study of women with preeclampsia with severe features receiving normal saline. The amount of normal saline administered was calculated and a basic metabolic panel was surveyed approximately 12 hours after initiation of magnesium sulfate prophylaxis. Laboratory analytes were examined according to the amount of intravenous fluid received. RESULTS: From 5/2018 to 7/2018, a total of 124 patients were identified. The mean intravenous fluid volume received was 1.84 ± 0.9 L. Serum creatinine and chloride levels remained unchanged over time and across quartiles of amount of fluid received (p=0.322 and p=0.822, respectively). Incidentally, a significant relationship was found between calcium levels and both the amount of normal saline received (p=0.0003) and concurrent magnesium levels (p<.0001). When testing for interaction between calcium, magnesium, and normal saline, both of the latter contributed to an increased risk of hypocalcemia. CONCLUSION: There does not appear to be a significant consequence to either chloride levels or renal function when utilizing normal saline in women with preeclampsia receiving magnesium sulfate. Coincidentally, calcium levels significantly declined as the amount of intravenous fluid increased, which given the association with magnesium levels is suspected to be a function of magnesium sulfate exposure.

Effect of therapeutic dose of Topiramate on placenta albino rat

The aim of this study is to elucidate the effects of the therapeutic doses of topiramate on the placental structure of albino rats (one of the antiepileptic drugs).This study was conducted over a period of 6 months extending from October 1, 2011 to February 1, 2012. Thirty adult non pregnant female albino rats and 15 male ones of the same strains, weighing 150-200 grams, were purchased from the Animal House of the Faculty of Medicine, Assiut University, Egypt. Thirty pregnant rats were used in this study and were classified in three groups: a) Control Group: consisted of 10 pregnant females with normal saline administration, b) Group one: consisted of 10 pregnant females with therapeutic dose of topiramate oral administration of 50mg /Kg body weight (Study Group I), and (c) Group two: consisted of 10 pregnant females with therapeutic dose of topiramate oral administration of 100mg /Kg body weight (Study Group II).The oral administration was done daily, from day one of pregnancy, for nineteen days of gestation. Light microscopic examination, using Hematoxylin and Eosin (H&amp;E This study revealed that sections which were obtained from the study groups I &amp; II showed multiple lesions that include decidual cells degeneration, hyaline deposition, particularly in decidual site, labyrinth zone and fetal blood vessels, Trophoblastic giant cells and spongiotrophoblasts had cytoplasmic vacuoles, presumably phagosomes, and pyknotic nucleus, the labyrinth layer of group I &amp; II showed distortion of their plate-like architecture, deposition of more fibrinoid material and perivascular fibrosis and expensive areas of congestion and hemorrhagic in all placental layers. Therefore, topiramate induced dose independent structural changes in the placenta. So, it should be used with caution during pregnancy.

Oral immunization of BALB/c mice with Helicobacter pylori lysate combined with dmLT adjuvant for the induction of mucosal and system immune responses

Objective To observe the protective effects of oral immunization with Helicobacter pylori (Hp) lysates in combination with mucosal adjuvant dmLT (double mutant heat-labile toxin) against Hp infection in a BALB/c mouse model and to analyze the features of induced immune responses. Methods BALB/c mice were orally immunized with Hp lysate (Sydney strain 1, SS1 strain) and dmLT adjuvant, and then innoculated with live Hp strains through oral gavage. A control group was set up by oral administration of normal saline (200 μl/mouse). The colonization of Hp strains in the stomachs of mice was measured six weeks after bacterial inoculation. Samples of serum, spleen, mesenteric lymph node (MLN), small intestine, cecum and feces were collected from mice to analyze the features of induced immune responses. Results The colonization of Hp strains in the stomachs of the immunized mice was significantly decreased as compared with that of the control group. Increased specific IgG antibody responses which were predominantly of IgG1 subtype were detected in the serum samples of the immunized mice and the IgG1/IgG2a ratio was significantly higher than that of the control group. Elevated secretory IgA (sIgA) was detected in the samples of small intestine, cecum and feces in the immunization group, especially in the small intestine samples, while no significant change in sIgA secretion was observed in the control group. The percentages of IL-17+ CD4+ T cells in spleen and mesenteric lymph nodes of the immunization group were significantly higher than those of the control group. Conclusions Oral immunization with Hp lysates in combination with adjuvant dmLT induced mucosal and systemic immune responses and enhanced the resistance to Hp colonization in BALB/c mice, which was associated with the significantly increased Th17 immune responses and Th2 polarization. This study provided reference for further evaluation of dmLT as a mucosal adjuvant in the development of recombinant protein vaccines against Hp infection. Key words: Sydney strain 1 lysate; Double mutant heat-labile toxin (dmLT); BALB/c mouse; Immune response; Helicobacter pylori vaccine

Intravenous administration of normal saline may be misinterpreted as a change of end-expiratory lung volume when using electrical impedance tomography

Electrical impedance tomography (EIT) is a noninvasive imaging modality that allows real-time monitoring of regional lung ventilation. The aim of the study is to investigate whether fast saline infusion causes changes in lung impedance that could affect the interpretation of EIT data. Eleven pigs were anaesthetized and mechanically ventilated. A bolus of 500 mL of normal saline was administered rapidly. Two PEEP steps were performed to allow quantification of the effect of normal saline on lung impedance. The mean change of end-expiratory lung impedance (EELI) caused by the saline bolus was equivalent to a virtual decrease of end-expiratory lung volume (EELV) by 227 (188–250) mL and decremental PEEP step of 4.40 (3.95–4.59) cmH2O (median and interquartile range). In contrast to the changes of PEEP, the administration of normal saline did not cause any significant differences in measured EELV, regional distribution of lung ventilation determined by EIT or in extravascular lung water and intrathoracic blood volume. In conclusion, EELI can be affected by the changes of EELV as well as by the administration of normal saline. These two phenomena can be distinguished by analysis of regional distribution of lung ventilation.

Efficacy of phenobarbital for benign convulsions with mild gastroenteritis: A randomized, placebo-controlled trial

ObjectiveThis study was performed to evaluate the efficacy and safety of intravenous phenobarbital (PB) for benign convulsions with mild gastroenteritis (CwG). MethodsA randomized, single-blind, placebo-controlled trial involving patients with CwG was conducted at the Japanese Red Cross Society Himeji Hospital. Patients with CwG who had experienced two or more seizures were eligible. Patients were excluded if any anticonvulsant was used before enrollment. Patients who were allocated to the PB group were administered 10 mg/kg of PB intravenously. Patients who were allocated to the placebo group were administered 20 ml of normal saline. ResultsFrom April 2016 to October 2018, 13 of 24 patients with CwG were randomized (PB group, n = 7; placebo group, n = 6; age, 1–3 years). Five of six patients in the placebo group had seizures after administration of placebo. However, patients in the PB group had no seizures after administration of PB, with a significant difference in efficacy between the two groups (P = 0.005). Five patients who had seizures after administration of normal saline were administered 10 mg/kg of PB, and no patients had a seizure thereafter. No significant differences were found in heart rate, blood pressure, or saturation of percutaneous oxygen between the two groups. ConclusionThis is the first randomized controlled trial to evaluate the efficacy of an anticonvulsant for CwG. Intravenous PB at 10 mg/kg is effective and well tolerated for CwG.

Effect of royal jelly on testicular antioxidant enzymes activity, MDA level and spermatogenesis in rat experimental Varicocele model

Varicocele is one of the most prevalent causes of infertility. It causes induction of oxidative stress, increases lipid peroxidation in the testis and disrupts spermatogenesis cycle. The aim of the study was to investigate the possible protective effects of royal jelly against varicocele induced oxidative stress, biochemical and histological alterations in the experimental varicocele model in rat. Twenty-one adult Wistar rats were divided into three groups. The control group (I), Varicocele and administration of normal saline (II), varicocele and treatment with RJ (III). At the end of the experiment, all the animals were sacrificed and testes excised. The activity of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and MDA levels were measured. Also, histopathological examinations, Johnsen scores and sperm parameters were determined. There was a significant (p<0.05) increase in the activity level of CAT (0.223±0.005), SOD (0.177±0.0062), GPx (9.575±0.318) and a significant (p<0.05) reduction in the MDA level (2.674±0.336) of the experimental varicocele treated with royal jelly when compared to the activity of CAT (0.011±0.004), SOD (0.035±0.0096), GPx (8.864±0.397) and MDA level (4.630±0.579) of the experimental varicocele and administration of normal saline. Results of the Johnsen score showed a significant increase (p<0.05) in the mean score of the RJ group (7.94±1.5) when compared to the normal saline group (6.04±1.4). Therefore, RJ is a potential area for further studies and improving in spermatogenesis cycle after varicocele.

Effects of ginseng neutral polysaccharide on gut microbiota in antibiotic-associated diarrhea mice

To investigate the effect of ginseng neutral polysaccharide on gut microbiota composition and diversity as well as the therapeutic effect for antibiotic associated diarrhea( AAD) in mice. The water-soluble ginseng neutral polysaccharide( WGPN) was purified from water-soluble ginseng polysaccharides( WGP) by DEAE-sepharose fast flow column,which was obtained from the roots of Panax ginseng. AAD mice were induced by gastric gavage with lincomycin hydrochloride,followed by administration of normal saline( natural recovery group,NR) or WGPN( WGPN group) for one week. Body weight changes,psychosis and diarrhea status were observed and assessed. 12 h after the last administration,histological observation of ileum and 16 S rRNA high throughput sequencing analysis of intestinal contents were conducted to identify the effects of WGPN on AAD mice. The results showed that WGPN could alleviate the symptoms of diarrhea in mice,decrease the inflammation and edema of ileum,and increase the length of intestinal villi. As compared to NR mice,WGPN could increase the relative abundance of Lactobacillus,and significantly decrease the relative abundance of Bacteroides,Streptococcus,Ochrobactrum and Pseudomonas at the genus level. In conclusion,WGPN could improve the gut microecology by recovering the ileum structure and improving the diversity and composition of the gut microbiota in AAD mice.

A Comparative Study on the Effect of Low-Dose Oral Ketamine and Subcutaneous Ketamine on Post General Anesthesia Delirium and Pain in Children Undergoing Inguinal Hernia Surgery

Objective: Acute pain is a common complication in children undergoing surgery. Acute pain and delirium are associated with agitated behavior, in which there is a risk that the patient causes harm to himself and others. Acute pain and delirium also dissatisfy parents and caregivers during recovery, prolong the recovery and hospitalization, and make more nursing care necessary.&#x0D; &#x0D; Material and Methods: In this study, 90 ASA I children, aged 3-8, and two candidates for elective inguinal hernia surgery were divided into three groups based on a random number table using block size of four. Parental permission was obtained beforehand. In group 1, 1mg/kg of ketamine (3cc) was administered orally. In group 2, 0.5mg/kg of ketamine was administered subcutaneously after the anesthetic induction. In Group 3, or control group, the same amount of normal saline was administered as the placebo, then the surgery got underway.&#x0D; &#x0D; Results: Comparing the administration of oral ketamine, subcutaneous ketamine and normal saline, the study showed that the pain was significantly higher in the placebo group at 30, 60, 90 and 120 minutes. Subcutaneous ketamine resulted in higher delirium at 30, 60, 90 and 120 minutes than the placebo and oral ketamine. Satisfaction of nurses from the patient&amp;rsquo;s recovery was significantly higher in the oral ketamine group and subcutaneous ketamine group (p=0/007). The need for narcotics in the oral ketamine group and subcutaneous ketamine group was lower than the placebo group (p=0/001). Ketamine administration prolonged the length of stay in the PACU, but it did not increase the frequency of complications such as postoperative nausea and vomiting and laryngospasm or bronchospasm in the two groups during the recovery.&#x0D; &#x0D; Conclusion: In conclusion, the study indicated that oral administration of low-dose ketamine before surgery can reduce pain severity and spare the need for analgesics after surgery.

Polygonum minus ethanolic extracts attenuate cisplatin–induced oxidative stress in the cerebral cortex of rats via its antioxidant properties

Objective: To explore the protective effect of Polygonum minus ethanolic extract on cisplatin-induced neurotoxicity. Methods: In vitro test, total phenolic content assay and DPPH assay were performed to determine the antioxidant activity of Polygonum minus. For in vivo test, 30 male Sprague- Dawley rats were randomly divided into 5 groups: the control group, cisplatin 10 mg/kg, Polygonum minus 100 mg/kg, Polygonum minus 200 mg/kg and Polygonum minus 400 mg/kg. The control group and the cisplatin group were given distilled water whereas Polygonum minus groups received the respective dose of Polygonum minus extract orally for 14 d. On day 15, a single intraperitoneal administration of normal saline was given to the control group; while 10 mg/kg of cisplatin was given to the cisplatin group and Polygonum minus groups. Body weight, signs of illness, daily activity and mortality were observed at least once daily throughout the experimental period. On day 18, the anterior part of the brain was collected and processed for histological and ultrastructural analyses (right hemisphere). The remaining part (left hemisphere) of the brain was assayed to determine malondialdehyde and catalase levels for oxidative stress analyses. Results: Polygonum minus ethanolic extract possessed high phenolic content (977.6 mg GAE/g) and 95.9% DPPH radical scavenging activities. No mortality was observed in all groups. Rats in the cisplatin group were weak and less active compared to Polygonum minus treated rats. In the cisplatin group, disorganised cellular layers of the cerebral cortex were observed whereas rats treated with low and mid doses of Polygonum minus extract had normal cerebral cortex as in the control group. Mild ultrastructural changes were observed in rats treated with low and mid doses of Polygonum minus extract. Meanwhile, low and mid doses of Polygonum minus extract significantly reduced malondialdehyde level whereas low and mid doses of Polygonum minus extracts groups significantly increased catalase activity compared to the cisplatin group. Conclusions: Polygonum minus ethanolic extract at 100 and 200 mg/kg attenuates cisplatin-induced oxidative stress in the cerebral cortex via its antioxidant activity.

Amelioration of Lipopolysaccharide-Induced Acute Lung Injury in Rats by Na-H Exchanger-1 Inhibitor Amiloride Is Associated with Reversal of ERK Mitogen-Activated Protein Kinase.

Background Na-H exchanger-1 (NHE-1) is expressed in the lung of rats. Accumulating evidence shows that Na-H exchangers are involved in inflammation. Amiloride, an inhibitor of NHE-1, inhibits the activation of macrophages and endothelial cells and reduces their production of cytokines. Since these processes have been implicated in acute lung injury (ALI) induced by lipopolysaccharide (LPS), we examined the protective effect of amiloride on ALI induced by LPS in rats. Material and Methods ALI in specific pathogen-free male Sprague-Dawley rats was induced by an intravenous injection of 6 mg/kg LPS. Amiloride pretreated rats received an intravenous injection of 10 mg/kg amiloride 30 min before the administration of LPS. Controls received normal saline in a similar manner. All animals were sacrificed 6 h after LPS or normal saline administration. The degree of ALI was assessed by wet-to-dry weight ratio (W/D) and lung histological examination. Neutrophilic infiltration was determined by myeloperoxidase (MPO) activity in lung tissue. Concentrations of total protein (TP), tumor necrosis factor-alpha (TNF-α), and macrophage inflammatory protein-2 (MIP-2) in bronchoalveolar lavage fluid (BALF) were also measured. Expression of NHE-1 and mitogen-activated protein kinase (MAPK) p38, p-p38, ERK, and p-ERK was evaluated by western blot analysis. Results Pretreatment with amiloride significantly reduced the increase in W/D, ALI score, lung tissue MPO activity, concentrations of TP, TNF-α, and MIP-2 in BALF, resulting in attenuation of ALI induced by LPS. Meanwhile, levels of NHE-1 and p-ERK proteins were reversed, whereas that of p-p38 was not. Conclusions These findings suggest that NHE-1 inhibitor amiloride could attenuate ALI induced by LPS in rats. This effect is mediated through reversal of ERK.

Inhibiting Succinate Dehydrogenase by Dimethyl Malonate Alleviates Brain Damage in a Rat Model of Cardiac Arrest

Brain damage is a leading cause of death in patients with cardiac arrest (CA). The accumulation of succinate during ischemia by succinate dehydrogenase (SDH) is an important mechanism of ischemia–reperfusion injury. It was unclear whether inhibiting the oxidation of accumulated succinate could also mitigate brain damage after CA. In this study, rats were subjected to a 6 min of CA, and cardiopulmonary resuscitation (CPR) was performed with administration of normal saline or dimethyl malonate (DMM, a competitive inhibitor of SDH). After the return of spontaneous circulation, neurological function of the rats was assessed by a tape removal test for 3 days. The rats were then sacrificed, and their brains were used to assess neuronal apoptosis by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Hippocampal tissues were used for Western blotting analysis and biochemical detection. In addition, hippocampal mitochondria during CA and CPR were isolated. The relative mitochondrial membrane potential (MMP) and cytochrome C in the cytosol were detected. Our results show that DMM promoted ROSC and neurological performance in rats after CA. The TUNEL assay showed that DMM reduced neuronal apoptosis. Western blotting analysis showed that DMM inhibited the activation of caspase-3 and enhanced the expression of HIF-1α. Moreover, DMM inhibited excessive hyperpolarization of MMP after CPR, and prevented the release of cytochrome C. Therefore, inhibiting SDH by DMM alleviated brain damage after CA, and the main mechanisms included inhibiting the excessive hyperpolarization of MMP, reducing the generation of mtROS and stabilizing the structure of HIF-1α.

Nebulized Normal Saline Solution for Treatment of Bronchial Asthma Exacerbations and Bronchiolitis: Not Standard of Care.

Nebulized normal saline is frequently prescribed for the treatment of bronchiolitis or bronchial asthma exacerbations. We aimed to reinforce guidelines care by educating providers on the futility of saline administration. Frequency and indications for nebulized normal saline prescription were documented from November 1, 2014, to April 1, 2015, and then again, after dissemination of educational material to providers, from November 1, 2016, to April 1, 2017. A total of 263 patients had bronchiolitis and 470 had asthma. Nebulized normal saline for bronchiolitis decreased significantly in the emergency department (ED) and inpatient settings ( P < .001 and P = .027, respectively). For asthma exacerbations, the use of nebulized normal saline decreased significantly in the inpatient setting ( P = .025), while in the ED, numbers were low at baseline and remained unchanged. Nebulized normal saline administration in the hospital setting results in continued use in the community, where this leads to unnecessary ED visits, where first-line therapy should have been administered.

Therapeutic effect of irbesartan combined with atorvastatin calcium in the treatment of rats with coronary heart disease.

This study aimed to investigate the therapeutic effect of irbesartan combined with atorvastatin calcium in the treatment of rats with coronary heart disease. One hundred sixty Wistar rats were selected to establish coronary heart disease model. Rats with coronary heart disease were randomly divided into 4 groups: Model, irbesartan, atorvastatin calcium and combination groups (irbesartan combined with atorvastatin calcium group). Rats in irbesartan group were treated with 50 mg/(kg.day) irbesartan; rats in atorvastatin calcium group were given atorvastatin calcium at a dose of 10 mg/(kg.day); rats in combination group were subjected to atorvastatin calcium at a dose of 10 mg/(kg.day) and irbesartan at a dose of 50 mg/(kg.day), while rats in model groups were given intragastric administration of normal saline at a dose of 2 ml/day. Serum lipids, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and TC/HDL-C, were measured by automatic biochemical analyzer. Expression of sPLA2-V in myocardium and aortic trunk of rats was detected by reverse transcription-PCR (RT-PCR) and western blot analysis. After treatment, levels of serum TC, TG, LDL-C, HDL-C and TC/HDL-C in rats of each treatment group were better than those in model group (p<0.05). Expression level of sPLA2-V in myocardium and aortic trunk in model group was significantly higher than that in other groups (p<0.05). Expression level of sPLA2-V in combination group was significantly lower than that in irbesartan and atorvastatin calcium groups (p<0.05). Combination of irbesartan and atorvastatin calcium is superior to irbesartan or atorvastatin calcium alone in the treatment of rats with coronary heart disease. The possible explanation is that the two drugs can reduce the expression of sPLA2-V in myocardium and aortic trunk, which in turn relieved atherosclerosis and achieved better therapeutic effect.

Anesthetic approach to postdural puncture headache in the peripartum period: An Israeli national survey.

Accidental dural puncture frequency among pregnant women is about 1.5%, while approximately 60% of these women will suffer from post-dural puncture headache (PDPH) that may be debilitating. Following IRB approval, we conducted a national survey of the lead anesthesiologist in 23 labor and delivery rooms in Israel. Each survey inquired about medical center annual delivery volume, training program for residents, accidental dural puncture management, processing of information, and PDPH management strategies. Data were collected from all 23 surveyed hospitals. As for methods for PDPH prevention, in most hospitals (87%) a prophylactic epidural blood patch (EBP) is not considered. Injection of epidural normal saline after delivery as a preventive measure is never considered in most (78.3%) hospitals, while four (17.4%) hospitals reported of constitutive use of this technique and one hospital only occasionally. Duration of conservative treatment was 24-48hours in 95.7% of PDPH cases. In this survey, different aspects of treatment and PDPH management were examined. EBP is considered the gold standard in treating PDPH, although prophylactic blood patch is ineffective. We observed a tendency of very low performance of both prophylactic EBP and epidural normal saline administration after delivery in most centers. Most hospitals perform EBP after 24-48hours of conservative treatment, along with published recommendations that show increased EBP efficiency with this timeframe. In light of the survey information, we aim to reach a uniform literature-based management strategy across Israeli hospitals.

Comparison of botulinum toxin type A and Rho-inhibitor on ATDC5 chondrocyte

Knee osteoarthritis (OA) has an incidence rate of 25% per year and its responses to treatment are variable. The analgesic effect of intra-articular injection of botulinum toxin type A (BTX-A) has been observed in patients with knee OA. BTX-A might inhibit Rho GTPase by ADP-ribosylation of amino acid asparagine-41. Rho activity has a role in mediation of chondrocyte catabolic signaling pathways, and Rho/ROCK (Rho-associated coiled-coil containing kinase) activation induces articular cartilage degradation. In our unpublished data, chondroprotection of BTX-A was observed based on pathological findings in rat knee OA. ROCK I & II were found to be altered in chondrocytes treated with BTXA, with dose-dependent effect. This study aimed to compare the effect on chondrocyte of BTX-A and Rho-inhibitor. ATDC5 chondrocytes were compared based on cell phenotype and markers for chondrocyte differentiation and growth after administration of BTX-A, Rho-inhibitor (Y27632), and normal saline (control) to clarify the downstream signaling pathway. Reverse transcription-PCR (RT-PCR) showed that in ATDC5 chondrocyte cell culture, Y27632 and BTX-A elevated aggrecan on culture day 4 and day 7. On day 21, the level of collagen type X and MMP13 were lowered in Y27632 and BTX-A. ROCK I and II level were decreased on day 4 and 7 in all three groups, but were remarkably higher on day 14 and 21 in Y27632. On day 8, in ATDC5 cells not pretreated with insulin, decreased cell density, small and flat chondrocyte morphology were observed after addition of Y27632 and BTX-A, in comparison to control. BTX-A and Rho-inhibitor decreased ROCK I & II and increased aggrecan level during early stage, and decreased collagen type X and MMP13 during late stage. Potential dedifferentiation effect in BTX-A and Rho-inhibitor were observed as well. Rho-signaling pathway might play different roles during early and late stage in chondrocyte growth.

Graft protective effect and induction of CD4+Foxp3+ cell by Thrombomodulin on allograft arteriosclerosis in mice

BackgroundThrombomodulin (TM) is a promising therapeutic natural anti-coagulant, which exerts the effects to control disseminated intravascular coagulation. However, little is known whether TM on micro-vessels could play an important role in the regulation of intimal hyperplasia. We investigated the vessel-protective effect of TM in the survival of fully major histocompatibility complex (MHC)-mismatched murine cardiac allograft transplantation.MethodsCBA recipients transplanted with a C57BL/6 heart received intraperitoneal administration of normal saline or 0.2, 2.0, and 20.0 μg/day of TM for 7 days (n = 5, 7, 11, and 11, respectively). Immunohistochemical and fluorescent staining studies were performed to determine whether CD4+Foxp3+ regulatory T cell were generated at 2 and 4 weeks after grafting. Morphometric analysis for neointimal formation in the coronary arteries of the transplanted allograft was conducted at 2 and 4 weeks after grafting.ResultsUntreated CBA recipients rejected C57BL/6 cardiac grafts acutely (median survival time [MST], 7 days). CBA recipients exposed with the above doses had significantly prolonged allograft survival (MSTs, 17, 24 and 50 days, respectively). Morphometric assessment showed that intimal hyperplasia was clearly suppressed in the left and right coronary arteries or allografts from TM-exposed recipients 2 and 4 weeks. Immunohistochemical studies at 2 weeks showed more CD4+Foxp3+ cells and lower myocardial damage in the allografts from TM-exposed recipients. Notably, fluorescent staining studies demonstrated that TM-exposed recipients 4 weeks post-engraftment had strong aggregation of CD4+Foxp3+ cells in the intima of the coronary arteries of the cardiac allografts.ConclusionsTM may prolong the survival of fully MHC-mismatched cardiac allografts through suppressing intimal hyperplasia and inducing the accumulation of regulatory CD4+Foxp3+ cells within coronary arteries.

Efficacy of prophylactic epidural ketamine for reducing shivering in patients undergoing caesarean section with combined spinal-epidural anesthesia.

Intravenous ketamine is known to inhibit postoperative shivering; however, at present, there has been little research on whether this effect may be achieved with epidural application. The aim of the present study was to evaluate the efficacy and safety of epidural ketamine as a prophylactic agent to prevent shivering in patients undergoing caesarean section during combined spinal-epidural anesthesia. A prospective, randomized, double-blind study was performed. A total of 60 patients who were undergoing elective caesarean section under combined spinal-epidural anesthesia and had an American Society of Anesthesiologists physical status of I or II were recruited. Patients were randomly allocated to group S (epidural administration of normal saline; n=30) or group K (epidural ketamine 0.5 mg/kg; n=30). An investigator, blinded to the treatment groups, graded postoperative shivering using a 4-point scale and postoperative sedation on a 5-point scale. Operative time, hemodynamic changes and side effects, including hypotension, bradycardia, nausea and hallucinations, were recorded. The results demonstrated that patients' characteristics were not significantly different between groups. Heart rate, peripheral capillary oxygen saturation (SpO2) values and Apgar scores at 1 and 5 min also did not differ significantly between groups. The incidence and severity of shivering in group K was significantly reduced compared with group S (P<0.05). The mean arterial pressure (MAP) was significantly different in groups S and K compared with baseline values at 10, 30 and 60 min (P<0.05). Furthermore, MAP values at 10, 30 and 60 min were significantly higher in group K compared with in group S (P<0.05). The results of the present study suggest that epidural administration of prophylactic low-dose ketamine may be an effective strategy for preventing postoperative shivering.

A Case Study on Ascites of Hepatic Origin and Their Proper Management in a Male German Shepherd Dog

A male German shepherd dog of 11 months was presented to HART Clinic, Pokhara with the history of abdominal swelling, respiratory distress, lethargy, anorexia and weakness. Physical examination revealed dyspnea, pale mucous membrane, and undulating movement (thrills) of fluid on tapping the abdomen. Fecal sample collected for assessing the severity of endoparasites which was found negative. The hematological study showed an increase in numbers of neutrophils, while there were decreased erythrocytes and hemoglobin concentration. The biochemical analysis resulted in an elevated SGOT, SGPT level but decrease in total protein level. Ascitic fluid collected from abdominal paracentesis on examination revealed transudate fluid with serum-albumin ascetic gradient (SAAG) &gt;1.1 gm/dl suggesting ascites due to portal hypertension (96% accuracy) caused by Liver cirrhosis. The dog was diagnosed as ascites of hepatic origin resulting portal hypertension and hypoproteinemia. The abdominocentesis was performed to drain the ascetic fluid followed by albumin and normal saline administration. The dog was further treated with antibiotic, diuretic, amino acid and liver tonics along with protein rich but salt free diet. The dog showed remarkable improvement with gradual reduced in abdominal distention and normalization of the appetite after 7 days of treatment.Int. J. Appl. Sci. Biotechnol. Vol 5(4): 555-558