Normal Saline Research Articles

The protective effect of Ghrelin peptide on doxorubicin hydrochloride induced heart failure in rats

BackgroundTo investigate the protective effect and mechanism of Ghrelin on Doxorubicin (Dox) hydrochloride induced heart failure (HF) and myocardial injury in rats.Methods45 rats were randomly divided into control group, HF group and Ghrelin group. Dox hydrochloride was injected intraperitoneally to establish the model of HF in rats of HF group and Ghrelin group. Rats in the Ghrelin group were given intraperitoneal injection of Ghrelin twice a day, and rats in the HF group and control group were given equal volume of normal saline for a total of 6 weeks. The changes of echocardiography, cardiac hemodynamics, myocardial histology and plasma inflammatory factors were observed.ResultsAfter the Ghrelin intervention, compared with the HF group, the left ventricular end-diastolic diameter (LVDD) and left ventricular end-systolic diameter (LVSD) in the Ghrelin group was markedly reduced (P < 0.05), and left ventricular ejection fraction (LVEF) was significantly increased (P < 0.05). Compared with HF group, the left ventricular systolic pressure (LVSP), maximum rate of increase in left ventricular pressure (+ dP/dtmax) and maximum rate of decrease in left ventricular pressure (− dP/dtmax) of Ghrelin group was remarkedly increased (P < 0.05), left ventricular diastolic pressure (LVDP) decreased (P < 0.05). In the Ghrelin group, the degree and extent of cardiomyocyte degeneration and necrosis were remarkedly reduced compared with the HF group. The levels of TNF-α and iNOS in Ghrelin group were notably lower than those in HF group (P < 0.05), the IL-10 level increased markedly (P < 0.05).ConclusionGhrelin may reduce Dox-induced myocardial injury and improve cardiac function in rats by regulating inflammation and oxidative stress.

A Comparative Evaluation of the Effect of Different Endodontic Irrigating Solutions on Microhardness of Root Canal Dentin: An in vitro Study.

During endodontic therapy, irrigation solutions applied in the root canal may affect the physicochemical properties of the dentinal wall, thereby changing its microhardness. This may adversely affect the sealing ability and adhesion of dental materials. Therefore, many studies have focused on the search for an ideal root canal irrigant that has a minimal effect on dentinal microhardness. This in vitro study was conducted to determine the changes in dentin microhardness after root canal irrigation with different endodontic irrigants. Ninety-five freshly extracted maxillary central incisor teeth with straight single canals were selected. These teeth were sectioned transversely at the level of the cementoenamel junction. The working length of each tooth was determined, and canal space was prepared by the HyFlex CM rotary file system. During instrumentation, normal saline was used for irrigation. Then, teeth were split longitudinally into two segments. According to the irrigating solution employed, samples were divided into five groups (n=19): normal saline (Group A), 3% sodium hypochlorite (Group B), 2% chlorhexidine (Group C), 5% calcium hypochlorite (Group D), and 0.2% nanochitosan (Group E).3 mL of the corresponding irrigating solution was administered for total15 minutes in each prepared sample. The Vickers micro-hardness tester was then used to assess micro-hardness. The data was analyzed using one-way analysis of variance (ANOVA). All tested irrigating solutions decreased the dentinal microhardness. Samples irrigated with 5% calcium hypochlorite demonstrated dentinal microhardness of 42.43±1.62, which is the lowest among all the tested groups, followed by nano chitosan, sodium hypochlorite, and chlorhexidine. Samples treated with control group (saline) demonstrated the maximum microhardness of dentin in the present study. Within the limitations of this research, it can be concluded that the tested novel irrigating solutions, 5% calcium hypochlorite and 0.2% nanochitosan, were more detrimental to radicular dentin microhardness when compared with conventional endodontic irrigants.

Dexmedetomidine use during orthotopic liver transplantation surgery on early allograft dysfunction: a randomized controlled trial.

Previous studies have shown a protective effect of dexmedetomidine use in kidney transplantation. In contrast, it is not known whether intraoperative administration of dexmedetomidine can reduce early allograft dysfunction (EAD) incidence following liver transplantation. To investigate the effect of dexmedetomidine use during surgery on EAD following orthotopic liver transplantation (OLT). This is a single-center, double-blinded, placebo-controlled randomized clinical trial. Three hundred thirty adult patients undergoing OLT were enrolled from 14th January 2019 to 22nd May 2022. Patients received dexmedetomidine or normal saline during surgery. One year follow-ups were recorded. Patients were randomized to two groups receiving either dexmedetomidine or normal saline intraoperatively. For patients in the dexmedetomidine group, a loading dose (1μg/kg over 10min) of dexmedetomidine was given after induction of anesthesia followed by a continuous infusion (0.5μg/kg /h) until the end of surgery. For patients in the normal saline group, an equal volume loading dose of 0.9% saline was given after the induction of anesthesia followed by an equal volume continuous infusion until the end of surgery. The primary outcome was EAD. Secondary outcomes included primary graft nonfunction, acute kidney injury, and acute lung injury/acute respiratory distress syndrome. Of 330 patients included in the intention-to-treat analysis, 165 were in the dexmedetomidine group [mean (SD) age, 49 (10) years; 117 (70.9%) men], and 165 were in the normal saline group [mean SD age, 49 (9) years; 118 (74%) men]. 39 (24.4%) patients in the dexmedetomidine group and 31 (19.4%) in normal saline group developed EAD and the difference was statistically insignificant ( P =0.28). Secondary outcomes including primary graft nonfunction and acute kidney injury was similar between the two groups. Intraoperative administration of dexmedetomidine did not reduce EAD rate after OLT.

Stability of Epinephrine in a Normal Saline Solution

Objective Dilution of concentrated epinephrine prior to intravenous use during clinical emergencies can delay urgent interventions. The objective of this study was to determine whether diluted epinephrine remains stable and sterile over time in common hospital settings. Methods Epinephrine samples were prepared by clinically relevant double dilution techniques. Samples were stored in 10-mL syringes and incubated under 1 of 4 simulated hospital environments with a mixture of lighting and temperature settings: 4°C/20°C, with or without fluorescent lighting. Samples were incubated for 0, 15, 30, 60, or 90 days. Capillary zonal electrophoresis was used to quantify the concentration of epinephrine and/or presence of any degradation products. All samples were tested for the presence of bacterial growth using blood agar cultures. Results Diluted epinephrine samples remained stable for up to 90 days in all 4 simulated clinical storage conditions. No bacterial colony-forming units were detected in any of the environmental samples regardless of incubation duration, light, or temperature conditions. Conclusion Diluted epinephrine for anticipated clinical emergencies may remain clinically useful for up to 90 days, thus improving patient safety, access to medications, and overhead costs by reducing waste.

Anticancer and Immunomodulatory Activities of Prodigiosin Extracted and Purified from Serratia marcescens.

Prodigiosin is a naturally occurring compound produced by various bacteria, including Serratia marcescens. It is known for its diverse biological properties. The present study was conducted to extract and purify prodigiosin from Serratia marcescens and investigate its anticancer and immunomodulatory activities. S. presence was isolated from soil samples and characterized. Different solvents were used to extract prodigiosin from Serratia marcescens. The cytotoxic activity of prodigiosin was tested against human rhabdomyosarcoma (RD), rat embryo fibroblasts (REF), and human breast cancer MDA-MB-231 (MDA) epithelial cell lines. Albino mice were divided into six groups: Negative control (normal saline); positive control (injected with 100 µ l of Serratia marcesence); groups A-D were injected with 100 µ l of prodigiosin (1, 3, 6, and 9 µ g/mouse, respectively). After 14 days of treatment, whole blood samples were collected for immunomodulatory analysis. The study found that the highest yield of prodigiosin (65-230 mg/l) was obtained with methanol as the extraction solvent. Prodigiosin had a cytotoxic effect on cancer cells, particularly against MDA epithelial cells. However, it did not have a cytotoxic effect on normal cells. Immunological analysis revealed significant differences (p ≤ 0.01) in absolute neutrophil counts between the positive control and prodigiosin-treated groups, with the highest value in group C and the lowest in group A. Immunological analysis showed significant differences in neutrophil counts, IL-4, and IL-10 levels between prodigiosin-treated groups and the control group. Serratia marcescens prodigiosin showed cytotoxic effects on cancer cells and boosted IL-10 and IL-4 serum levels, acting as an immunomodulator.

The Surfactant Properties of Clindamycin as a Useful Adjunct for Removing Ruptured Silicone Implants.

Silicone gel removal after breast implant rupture is a difficult task. Silicone is hydrophobic and thus cannot be irrigated effectively with saline. Attempts at mechanical removal with sponges are often partially successful. Incomplete removal results in persistent silicone contamination with possible local inflammation, infection, and silicone granulomata. In this partially quantitative investigation, we assess the de-adhesion ability of different clindamycin formulations against known surfactant controls when combined with silicone gel. To demonstrate surfactant properties in vitro, clindamycin phosphate, clindamycin hydrochloride, and a known surfactant, sodium dodecyl sulfate (SDS), were compared. An amount of 170 g of silicone gel placed in a dry glass container exhibited strong adherence to the container walls. In separate trials, clindamycin phosphate (300 mg in 100 mL), clindamycin HCl (300 mg in 100 mL), and SDS (1 g in 100 mL) solutions with normal saline were added to the silicone aggregate, and de-adhesion properties were compared. All solutions aided in the de-adhesion of the sticky silicone from glass substrate. The SDS had the strongest effect, followed by clindamycin phosphate and then clindamycin HCl. The observed interactions suggested that all of the solutions behaved as ionic surfactant coating the silicone with negative charges via adsorption. However, the phosphate anionic formulation was associated with a greater surfactant effect than HCl. Clindamycin acts as a surfactant to aid in the clinical removal of ruptured silicone gel. Clindamycin phosphate seems to have a stronger effect than clindamycin HCl, likely related to the negative charges on the phosphate groups.

Vaginal Packing After Pelvic Floor Reconstructive Surgery: Does the Soaking Agent Used for Packing (Bupivacaine, Estrogen or Saline) Impact Postoperative Pain Scores?

Study ObjectiveVaginal packing is traditionally placed after pelvic floor reconstructive surgery (PFRS) to prevent hematoma formation. We seek to determine if there is a difference in post-operative pain scores after PFRS if vaginal packing is soaked with estrogen cream, bupivacaine, or saline. The primary outcome was pain as measured by a visual analog scale (VAS) at 2 hours, 6 hours, and 1 day post-operatively. Secondary outcomes include change in hemoglobin, urinary retention and length of stay (LOS) in hospital. DesignProspective cohort study SettingTertiary care academic teaching hospital. All PFRS performed by fellowship-trained urogynecologists. ParticipantsConsenting patients undergoing PFRS. InterventionsAt the completion of surgery, gauze packing soaked with either estrogen cream 0.25% bupivacaine with 1% epinephrine, or normal saline was placed inside the vagina and removed on post-operative day 1. ResultsWe included 210 patients (74 estrogen, 66 bupivacaine, 70 saline). There was no significant difference in mean post-operative pain scores between the groups (estrogen, bupivacaine, saline-soaked vaginal packs respectively) at 2 hours (2.66±2.25, 2.30±2.17, 2.24±2.07; p=.4656), 6 hours (2.99±2.38, 2.52±2.30, 2.36±2.01; p=.2181) or on post operative day 1 (1.89±2.01 vs. 2.08±2.15 vs. 2.44±2.19; p=.2832) as measured by VAS scores (0-10). There was no difference in the secondary outcomes of change in pre-/post-operative hemoglobin (21.8±10.73g/L, 20.09±11.55g/L, 21.7±9.62g/L, p=.68), urinary retention (37%, 45% and 48%, p=.45), LOS (1.05±0.46 days, 1.02±0.12, 1.03±0.24, p=.97) or in-hospital opioid usage during admission (represented in morphine milligram equivalents (median (IQR1, IQR3), Kruskal-Wallis test): 11.25mg (0,33), 7.5mg (0, 22.5) and 15mg (0, 33.88) p =0.41. ConclusionThere was no difference found between soaking vaginal packing with estrogen cream, bupivacaine, or saline after PFRS with respect to post-operative pain scores, LOS, in-hospital opioid usage, or urinary retention. Saline-soaked packing is an equivalent alternative to estrogen or bupivacaine vaginal packing. Clinical Trial RegistrationNCT03266926. Registered February 1, 2017. https://clinicaltrials.gov/study/NCT03266926

Comparative Evaluation of Dentinal Microcrack Formation During Root Canal Preparation Using Different Rotary Files: An In Vitro Study

Background:The success of endodontic treatment depends on completely removing all vital and necrotic pulp tissue, microorganisms, and microbial toxins from the root canal. During the cleaning and shaping process, the canal is shaped through the interaction between instruments and the dentin walls. These interactions can create several temporary stress points within the dentin, which may lead to the development of dentinal defects, craze lines, or microcracks. As a result, the techniques employed for shaping root canals carry the risk of starting crack formation, which, under functional pressure, could progress into complete fractures. This study was aimed to compare and evaluate the incidence of dentinal microcrack formation during root canal preparation using ProTaper Universal, ProTaper Gold, NeoEndo Flex and Hyflex EDM files. Materials and Methods: A total of 95 freshly extracted single rooted premolars with single straight canal were selected and stored in normal saline. Each specimen was examined using dental operating microscope to exclude cracked samples. Specimens then decoronated using a diamond disc and water as a coolant to a standardized length of 14 mm. Canal patency was determined by passing 10 K file passively and the working length was established 1 mm short of the file length at which the file become visible at the apical foramen. Canal was then enlarged upto15 k size file. Teeth samples were then divided into 5 groups having 19 teeth each. Group 1: Control Group (Uninstrumented teeth), Group 2 : Protaper Universal, Group 3 : Protaper Gold, Group 4 : NeoEndo Flex ,Group 5 : Hyflex EDM. After completion of cleaning and shaping procedure (to a standard apical diameter of 25), canal was rinsed with distilled water. Root was then horizontally sectioned at 3 mm, 6 mm and 9 mm from the apex with diamond disc at low speed under water cooling. All the sections were evaluated under stereomicroscope for presence of cracks and images were recorded. Cracks were observed as lines extending from the root canal lumen to the dentin or from the outer surface into the dentin. Results: All the file systems used in this study showed dentinal microcracks. ProTaper Universal exhibited the highest percentage of dentinal defects, while Hyflex EDM displayed the lowest among the file systems used (ProTaper Universal, ProTaper Gold, NeoEndo Flex and Hyflex EDM). The defects were present more in the apical third (3 mm) as compared to 6 mm (middle third) and 9 mm (coronal third) sections

The probability of implantation metastasis after peripheral lung cancer biopsy.

At present, it is known that there is a possibility of pleural cavity and needle tract implantation metastasis after lung cancer puncture biopsy, but clinicians have not paid attention to this phenomenon, and the probability of occurrence is unknown. In this study, we aimed to study the probability of implantation metastasis after peripheral lung cancer biopsy. The intraoperative isolated completely collapsed fresh intact human lung lobes of 30 patients with peripheral lung cancer were taken, and the tumor body was punctured. The pleural pinholes and puncture needle tips were repeatedly rinsed with normal saline respectively. The flushing solution was prepared as inoculum, and then the inoculum was smeared for microscopic examination to find cancer cells. The inoculum was inoculated subcutaneously into nude mice, and then the probability of pleural cavity and needle tract implantation metastasis after lung biopsy was indirectly obtained by obtaining the nude mice tumorigenesis rate. The tumorigenesis rate of nude mice in the pleural pinholes group was 3.3%, and the tumorigenesis rate of nude mice in the puncture needle tip group was 3.3%. Patients with lung nodules suspected of being early stage cancer and who are fit for surgical resection may benefit from forgoing lung biopsies to avoid pleural cavity or needle tract seeding with tumor cells.

Effects of dietary supplementation with Vitamin A, D3, E, and Garlic on heat detection, pregnancy rate, and serum profile in anestrus dairy cows

Anestrus poses substantial challenges for dairy industries worldwide. This research aims to evaluate the effect of oral supplementation with garlic alone, vitamins A, D3, E alone, and their combination on heat detection, pregnancy rate and serum profile in anestrus dairy cows. Using a completely randomized design, this study, conducted over 327 days, evaluated 72 anestrus-affected cows, which were divided into four groups. T0 (Control) received only normal saline; T1 with vitamin A,D3,E; T2 with Garlic and T3 integrated with A, D3, E + Garlic in drinking water. Results demonstrated that the treatment groups exhibited significantly higher estrus signs (p<0.05) compared to the control. The pregnancy rate was also increased (P=0.059), especially in the T3 group which had the highest heat detection (55.55%), conception (70%), and pregnancy (38.88%). In comparison, the heat detection rate for T1 was 44.44%, while the conception rate for T2 was 66.66%. Additionally, T0 exhibited the least proportion across all parameters. Additionally, the elevated BUN (Blood Urea Nitrogen) and blood glucose levels observed in non-responsive (those not showing signs of heat) cows at 32.51 and 43.65 mg/dl respectively, compared to responsive cows (those showing signs of heat) with levels of 22.40 and 51.34 mg/dl. These findings suggest a potential association between these blood parameters and the cyclicity of dairy cows. These findings highlight that oral supplementation with vitamin AD3E+Garlic significantly improves the heat detection rate and pregnancy rate than only administering vitamin AD3E or Garlic with anestrus in dairy cattle.

Evaluating the effectiveness of various agents as interim preservative media for biopsy specimens: An experimental in vitro study

In the field of medicine, diagnosing diseases involves various steps, procedures, and protocols. Histopathological examination remains the gold standard for a definitive and accurate diagnosis. This process relies on an initial step of tissue fixation.Formaldehyde is a traditional fixative material and is typically used as 10% or 4% buffered solutions. However, significant health risks are associated with formaldehyde exposure.Our paper aimed to evaluate and compare variable media as a preservative agent. The study included eight groups as follows: (1) normal saline 0.9%; (2) local anesthesia with epinephrine (2% Lidocaine HCl/ 1:100,000 epi); (3) local anesthesia without epinephrine (3% Mepivacaine HCl/ plain); (4) distilled water; (5) Saliva collected from healthy male participants; (6) Milk (Almarai- full-fat fresh milk); (7) Propolis; and (8) l0% formalin. Three tissue samples from each group were fixed in 10% formalin for 24 h after being preserved for 6 h at ambient temperature in their respective media. All specimens were stained with Hematoxylin and Eosin.The following histological structures were assessed: (1) superficial 1/3 of the epithelium, (2) middle 1/3 of the epithelium, (3) lower 1/3 of the epithelium, (4) basement membrane/rete ridges, (5) fibrous connective tissue, (6) blood vessels/endothelial cells, (7) skeletal muscle, (8) adipose tissue, and (9) nerve bundles. A numerical rating system was employed to assess these components, with scores ranging from 1 to 4.Our findings suggest propolis has promising potential as a tissue fixative. This study highlighted the effectiveness of propolis as a preservative and fixative solution, which warrants further investigation.

Comparative evaluation of effectiveness of different concentration of sodium hypochlorite with conventional irrigation method versus ultrasonic irrigation in the elimination of Enterococcus faecalis from root canals: an in-vitro study

Aim: The aim of this study is to compare the decrease in bacterial population in the root canals with 3 different concentrations of NaOCl and with two different irrigation systems Methods and Material: The study was conducted on 70 single rooted extracted teeth. Teeth were decoronated and the apices were sealed with auto polymerizing resin. The teeth were inoculated with a suspension comprising Enterococcus faecalis (E. faecalis). The canals were prepared were divided into three groups based on irrigation technique: Group 1; irrigation with 1% sodium hypochlorite, Group 2; irrigation with 3% sodium hypochlorite &amp; Group 3; irrigation with 5% sodium hypochlorite. All three groups were divided into 2 subgroups. In subgroup A irrigation was done by conventional side vented needle and in subgroup B with passive ultrasonic agitation. A fourth control group was also added in which conventional needle irrigation was done with normal saline. The samples were inoculated on the growth media and the mean colonies units were calculated. Statistical analysis used: The statistical analysis used was Student’s unpaired t-test for intergroup comparison and one-way ANOVA and Tukey’s post hoc test for intragroup comparison. Results: In our study, groups with passive ultrasonic irrigation showed better antimicrobial effect compared to groups which use conventional needle irrigation. Conclusions: Ultrasonic irrigation showed better antimicrobial activity compared to conventional needle irrigation

An Experimental Animal Study: Electroacupuncture Facilitates Antiviral Immunity Against Hepatitis B Virus Through the IFN-γ/JAK/STAT Axis.

Chronic hepatitis B (CHB) remains a global health challenge, necessitating innovative therapeutic strategies. Enhancing the body's immune response against the hepatitis B virus (HBV) emerges as a fundamental strategy for achieving a functional cure. While acupuncture has shown potential in immune modulation, its specific anti-HBV effects are not well understood. This study evaluates the potential of electroacupuncture (EA) in HBV infection and explores its underlying immunological mechanisms using a mouse model. HBV-infected mice were established using the high-pressure hydrodynamic method and divided into four groups: normal saline (NS), EA, sham EA (SE), and tenofovir disoproxil fumarate (TF), with n = 6 per group. During treatment, blood was collected every Sunday via the orbital sinus to monitor HBV DNA, HBsAg, and HBeAg levels. Transcriptomics and metabolomics analyses were employed to unearth clues regarding EA's anti-HBV mechanism. Validation of these mechanisms included splenic T-cell flow analysis, Western blotting, RT-qPCR, immunofluorescence, and ELISA. Serum HBV DNA levels decreased by 1.10, 0.19, and 1.98 log10 IU/mL in the EA, SE, and TF-treated mice, respectively, compared to the NS. Concurrently, the hepatic HBV DNA levels decreased by 1.09, 0.24, and 2.03 log10 IU/mL. EA also demonstrated superior inhibition of HBV antigens, with serum HBeAg levels decreasing by 43.86%, 8.74%, and 8.03%, and serum HBsAg levels decreasing by 28.01%, 0.26%, and 9.39% in the EA, SE, and TF groups, respectively. Further analysis through transcriptomics and metabolomics revealed that EA's anti-HBV effects primarily hinge on immune modulation, particularly the IFN-γ/JAK/STAT pathway and taurine metabolism. EA also increased the ratio of splenic CD8+ CD69+ and CD8+ IFN-γ+ T-cells while upregulating key proteins in the JAK/STAT pathway and cytokines associated with antiviral immunity. EA manifests inhibitory effects on HBV, particularly in antigen suppression, with its mode of action intricately linked to the regulation of IFN-γ/JAK/STAT.

Direct in-scope suction: an in vitro evaluation of a single use flexible ureteroscope with integrated suction capability.

To evaluate the stone clearance rate and limitations of a novel integrated suction capability within a single-use flexible ureteroscope according to stone particle size. Varying sized stone particles were created using a stone phantom (Begostone Plus, Bego ©, Lincoln, RI, USA). Particle size ranged as follows: 63-125µm, 125-250µm, 250-500µm, 500µm- 1mm and 1-2mm. These were mixed with Normal saline (0.9%) to mimic in vivo conditions. The suction enabled single-use flexible ureteroscope (Pusen, Zhuhai, China) was used to aspirate stone fragments in three trials. Firstly, aspiration of 5g of each dust range was attempted. Secondly, a direct comparison of the integrated suction to a manual syringe technique was applied to 1g of each size range. Finally, aspiration was applied to 5g of a heterogenous 1:1:1:1:1 mixture. Endoscopic clearance rate (g/min) and number of blockages were recorded. Each challenge was repeated three times. The integrated suction cleared 100% of dust < 250µm. Endoscopic clearance rates were significantly faster than manual aspiration (3.01g/min versus 0.41g/min) for dust between 125 and 250µm (p = 0.008). Complete endoscopic clearance by 180s (without encountering test limiting blockages) was unsuccessful for particles > 250µm. Clearance rates were greatly limited by stone particle size heterogeneity above 250µm, to 0.09g/min. This technology works better in vitro than previously DISS evaluated methods when challenged by stone dust < 250µm. However, this adaptation is significantly challenged in the presence of stone dust particles > 250µm.

Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis.

The current meta-analysis found no significant difference in the mortality rate between the types of resuscitation fluid, and their speed or volume of administration. However, a significantly decreased risk of AKI was found in the BC group. More evidence is needed regarding the speed and volume of administration of fluid boluses in critically ill children.Prospero registration: CRD42020209066. • Balanced crystalloids (BC) may be better than normal saline (NS) for fluid resuscitation in critically ill children. • BC are better than NS for fluid resuscitation in critically ill children as they decrease AKI and hyperchloremia.

The effect of perioperative intravenous lidocaine infusion on postoperative sleep of elderly patients with colorectal cancer: A randomized controlled study

BackgroundPostoperative sleep disturbance (POSD) caused by postoperative pain can impede the enhanced rapid recovery of elderly patients with colorectal cancer. We propose that perioperative intravenous lidocaine infusion may enhance postoperative sleep quality by alleviating postoperative pain in elderly patients undergoing laparoscopic radical resection for colorectal cancer. MethodsSixty-three elderly patients were divided into two groups: the lidocaine group (group L) and the placebo group (group C). Patients in group L received intravenous injection of lidocaine 1.5 mg/kg during the induction of anesthesia, followed by lidocaine 1.0 mg kg−1 h−1 during surgery and for 24 h after surgery. Patients in group C received the same volume of normal saline. The primary outcome was postoperative sleep function, which was evaluated using the Athens Insomnia Scale (AIS). The secondary outcomes included the pain-at-rest and pain-on-movement of patients at 2, 4, 6, 12, 24, 48, and 72 h after surgery, opioid and propofol consumption, bowel function recovery time, postoperative complications, and lidocaine side effects. ResultsCompared to group C, AIS scores in group L were significantly lower on day 1 (12.9 ± 4.0 vs 10.6 ± 3.9, P < 0.05), day 3 (8.6 ± 4.2 vs 6.2 ± 3.9, P < 0.05), and 1 week (4.3 ± 3.1 vs 2.2 ± 2.5, P < 0.05) after surgery. There were no significant differences in VAS scores between the two groups. The intraoperative consumption of propofol and remifentanil was significantly reduced in group L. Lidocaine infusion significantly shortened the recovery time of bowel function. There were no statistical differences between the two groups regarding the incidences of PONV and postoperative pulmonary complications. No cases of local anesthetic toxicity occurred in either group. ConclusionsPerioperative intravenous administration of lidocaine can facilitate the restoration of postoperative sleep function in elderly patients undergoing laparoscopic radical resection of colorectal cancer.

Efficacy of Ultrasound-Guided Interscalene Brachial Plexus Block for Acute Post-Hepatectomy Shoulder Pain: A Randomized Controlled Trial.

To investigate the efficacy of ultrasound-guided interscalene brachial plexus block in the treatment of shoulder pain following hepatectomy. A randomized controlled trial. We conducted a single-center, randomized controlled trial. Forty-four patients with shoulder pain scores of at least 5 were randomly assigned to two groups: the treatment group, which received 0.5% ropivacaine (5mL) combined with dexamethasone (5 mg) (n=22), and the control group, which received normal saline (5mL) (n=22). The intervention was performed in the postanesthesia care unit after shoulder pain was identified by using the visual analogue scale. The shoulder pain was re-evaluated 15minutes after intervention. The incidence of effective pain relief, defined as at least 75% reduction in pain intensity, was the primary outcome. Secondary outcomes included shoulder pain intensity within 2 days after surgery, the timing of the first rescue analgesia, total additional analgesic use, arterial oxygen saturation, intervention-related adverse reactions, and patient satisfaction regarding shoulder pain. The incidence of effective pain relief was significantly higher in the treatment group compared to the control group (15 (68.2%) vs 2 (9.1%), P<0.001). The interscalene brachial plexus block not only prolonged the time to first analgesic request (P <0.001), but also reduced the number of analgesic requests (P <0.001). In the comparison between groups, arterial oxygen saturation was lower in the control group than that in the treatment group, attributed to the use of sufentanil for remedial analgesia (92.4% vs 94.5%, P=0.014). Interscalene brachial plexus block can effectively relieve post-hepatectomy shoulder pain without clinically significant hypoxemia.

The implications of atorvastatin administration and the potential protective role of omega-3 on the submandibular salivary gland of albino rats (Histological, Histochemical, Ultrastructure, and Biochemical Study)

BackgroundHyperlipidemia is a risky condition that can lead to atherosclerosis and other cardiovascular problems. Statins are used to treat hyperlipidemia. The most recommended medicine to treat hyperlipidemia is atorvastatin. On the contrary, clinical trials validated statins' negative effects. Omega-3 fatty acids have antioxidant properties and have been shown to improve a variety of disease processes in the general population, including inflammatory and immunological pathways, various cardiovascular diseases, and lipid regulation. The present research aimed to determine how atorvastatin affected the submandibular salivary gland (SMG) and whether omega-3 may have a protective impact. MethodsThirty adult male albino rats were divided into three equal groups and received drugs orally as a single daily dose for one week. Control group (I): received normal saline. Atorvastatin group (II): received a dose of 80 mg Kg-1 of Atorvastatin. Group III: received Omega-3 before Atorvastatin. All rats were sacrificed 2 h following the last dose, and blood samples were gathered for the biochemical study of fasting blood glucose level (FBGL). Specimens were obtained and processed for histological and histochemical studies. ResultsAtorvastatin-treated rats showed degeneration of SMG acini. The acinar cells showed cytoplasmic vacuoles with dilated RER. Histochemical results revealed a marked decrease in total proteins. The biochemical study revealed an elevation in FBGL. The administration of Omega-3 with Atorvastatin minimizes these changes. ConclusionAtorvastatin has been proven to induce histological changes in SMG, and these changes can be attenuated by Omega-3. However, Omega-3 has no effect on FBGL.

Effect of intranasal insulin on perioperative cognitive function in older adults: a randomized, placebo-controlled, double-blind clinical trial.

Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society. A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400μL of normal saline or 40IU/400μL of insulin, respectively, once daily from 5minutes before anaesthesia induction until 3days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1day before and 3days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery. Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively). Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results.

The Chinese Herbal Formula Weichang'an Reduces the Proliferation of Human Gastric Cancer Cells via Mitochondrial Apoptosis

Abstract Objective The aim of the study was to investigate the effects of Chinese herbal formula Weichang'an (WCA) on the proliferation and mitochondria-mediated apoptosis of human gastric cancer cells. Methods Cell Counting Kit-8 (CCK8) was used to evaluate the antiproliferative activity of WCA on MKN45 cells; Giemsa staining was used to investigate cell colony formation; flow cytometry was used to analyze cell cycle, apoptosis rate, and caspases activation; and Hoechst staining was used to analyze the morphology of cell nuclei. The mitochondrial membrane potential was analyzed by both flow cytometric measurements and fluorescence microscopy. Western blot was used to analyze the protein levels of pro-caspase-3, Bcl-2, Bax, and Bcl-X. MKN45 cells were subcutaneously injected into the right forelimb of 16 nude mice to establish the tumor xenograft model, and a total of 12 nude mouse tumor xenograft models were successfully created. The nude mice were divided into the control group and the WCA-treated group. The two groups received normal saline and WCA treatment at 35.49 g/kg by a single daily oral gavage for 21 days. The body weight and tumor size of the nude mice were measured twice a week. The ultrastructural changes of subcutaneous tumors were observed by a transmission electron microscope. Results WCA can suppress cell proliferation and colony formation. It can also induce changes in the mitochondrial membrane potential and increase the activities of caspases-3, caspases-8, and caspases-9 in MKN45 cells. WCA induced S-phase arrest and apoptosis in MKN45 cells, and decreased the expression levels of antiapoptotic proteins Bcl-2 and Bcl-X in MKN45 cells, while increasing the expression levels of the proapoptotic proteins Bax and pro-caspase-3 compared with the control group. WCA inhibited the growth of a xenografted MKN45 tumor in nude mice, and the protein levels of Bax and pro-caspase-3 were significantly increased, while Bcl-X and Bcl-2 were reduced compared with the control group. The differences are statistically significant (p &lt; 0.05). Conclusion WCA could suppress the proliferation of gastric cancer cells via mitochondrial apoptosis.