Preinduction Period Research Articles

Optimization of fermentation conditions for the production of recombinant feruloyl esterase BpFaeT132C-D143C.

Feruloyl esterases (FAEs) are a crucial component of the hemicellulose-degrading enzyme family that facilitates the degradation of lignocellulose while releasing hydroxycinnamic acids such as ferulic acid with high added value. Currently, the low enzyme yield of FAEs is one of the primary factors limiting its application. Therefore, in this paper, we optimized the fermentation conditions for the expression of FAEBpFaeT132C-D143C with excellent thermal stability in Escherichia coli by experimental design. Firstly, we explored the effects of 11 factors such as medium type, isopropyl-β-D-thiogalactopyranoside (IPTG) concentration, and inoculum size on BpFaeT132C-D143C activity separately by the single factor design. Then, the significance of the effects of seven factors, such as post-induction temperature, shaker rotational speed, and inoculum size on BpFaeT132C-D143C activity, was analyzed by Plackett-Burman design. We identified the main factors affecting the fermentation conditions of E. coli expressing BpFaeT132C-D143C as post-induction temperature, pre-induction period, and post-induction period. Finally, we used the steepest ascent path design and response surface method to optimize the levels of these three factors further. Under the optimal conditions, the activity of BpFaeT132C-D143C was 3.58 U/ml, which was a significant 6.6-fold increase compared to the pre-optimization (0.47 U/ml), demonstrating the effectiveness of this optimization process. Moreover, BpFaeT132C-D143C activity was 1.52 U/ml in a 3-l fermenter under the abovementioned optimal conditions. It was determined that the expression of BpFaeT132C-D143C in E. coli was predominantly intracellular in the cytoplasm. This study lays the foundation for further research on BpFaeT132C-D143C in degrading agricultural waste transformation applications.

Efficacy comparison of ketofol and etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery

Introduction: Anesthesia induction is a critical phase characterized by hemodynamic changes that disrupt the delicate balance between myocardial oxygen demand and supply, resulting in myocardial ischemia in patients with underlying coronary artery disease and impaired left ventricular systolic function. Consequently, maintaining stable hemodynamics during the induction process holds paramount importance. This study aims to compare the hemodynamic changes and evaluate the quality of endotracheal intubation between ketofol and etomidate during anesthesia induction for patients undergoing coronary artery bypass graft (CABG) surgery with diminished left ventricular function.
 Methods: A total of 159 adult patients undergoing CABG with extracorporeal circulation were enrolled from the Department of Anesthesiology and Intensive Care, Hanoi Heart Hospital. The patients were divided into two groups: The ketofol group (83 patients) receiving intravenous infusion of Ketofol (ketamin 0,75mg/kg + 1,5mg/kg propofol) and etomidate group (76 patients) receiving intravenous infusion of 0,2mg/kg etomidate. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and heart rate (HR) were recorded at various time points, including pre-induction, post-endotracheal intubation, and assessment of endotracheal intubation quality.
 Results: The most substantial decrease in blood pressure was observed from the pre-induction period to just prior to endotracheal intubation. Subsequently, stable levels were maintained at 1, 2, and 3 minutes post-intubation in both study groups (p>0.05). In the ketofol group, heart rate did not increase during the induction process, but rather exhibited a decreasing trend (5±8%), with no statistically significant difference compared to the etomidate group (p=0.283). The quality of endotracheal tube placement was comparable between the ketofol group (excellent: 51.8%, good: 48.2%) and the etomidate group (excellent: 52.6%, good: 47.4%).
 Conclusion: Utilizing ketofol and etomidate for anesthesia induction demonstrated equivalent maintenance of hemodynamic stability and quality of endotracheal intubation in patients with impaired left ventricular function undergoing CABG surgery.

Experimental study of pure Class G cement hydration up to 150 °C and 50 MPa

A comprehensive experimental investigation of Portland cement hydration kinetics in a wide temperature range from 35 °C to 150 °C with pressure up to 50 MPa was performed by heat of hydration, chemical shrinkage and ultrasonic measurements. Increasing curing temperature was found to have a stronger acceleration effect during the main hydration period while increasing curing pressure had a stronger acceleration effect during the pre-induction period of cement hydration. By comparing chemical shrinkage test results with other methods of estimating cement degree of hydration, such as quantitative X-ray diffraction, non-evaporable water content measured by thermogravimetric analysis, as well as heat of hydration, it was observed that total chemical shrinkage of cement at complete hydration decreased with curing temperature from 35 °C to 75 °C and then stayed stable between 75 °C and 150 °C. Similarly, the P-wave velocity of cement (which is an indicator of physical and mechanical properties) as a function of hydration degree decreased with increasing curing temperature in the range between 35 °C to 75 °C, then remained relatively stable between 75 °C and 130 °C. The reduction of gel water content in C–S–H from 35 °C to 75 °C is believed to be the primary cause of these observed phenomena.

Effect of elevated Al concentration on early-age hydration of Portland cement

To understand the effect of elevated Al concentration on early hydration in Portland cement, hydration heat, the evolution of solid and aqueous composition in paste blended with reactive alumina were investigated in this study. The increase of Al concentration depletes gypsum rapidly with massive precipitation of ettringite during the pre-induction period, resulting in decreased Ca and S concentration in pore solution. The elevated Al concentration passivated the active sites on C3S surface, and the decreased Ca concentration inhibited the nucleation of C–S–H and precipitation of portlandite, hence prolonging the induction period. Meanwhile, the reaction of C3A has not been accelerated even after the complete depletion of gypsum, which is associated with the lowered undersaturation degree caused by the increased Al concentration. Additionally, the precipitation of large amounts of ettringite and foil-shaped C–S–H reduced available nucleation sites, thus hindering the reaction of both C3S and C3A during the acceleration period.

Effects of phosphorus and iron on the composition and property of Portland cement clinker utilized incinerated sewage sludge ash

Recently, a large amount of incinerated sewage sludge ash (ISSA) has been produced with the popularization of sludge incineration technology. And it needs to be disposed of properly to reduce the environmental impact. In this work, the ISSA is used as a partial substitution of raw materials in the production of Portland cement clinker. Moreover, the influence of phosphorus and iron on the mineral composition and hydration property of Portland cement clinker utilized ISSA is studied. In the experiment, 0 ∼ 3 wt% of Fe2O3 and P2O5 are respectively added into the raw material incorporated 3.6 wt% of ISSA. The results show that the C3A in the clinker increases and the hydration heat rate grows in the pre-induction period with the incorporation of P2O5. In addition, the formation of C3S is blocked and the general hydration process of produced clinker is delayed. With the addition of 0.5 wt% P2O5 the compressive strength of clinker could achieve 96.7% of the reference clinker, however, when P2O5 achieves 3 wt%, there is no C3S forming in the clinker and the compressive strength is reduced by 83.3% at 28d. Furthermore, little influence on the mineral composition and hydration property of produced clinkers has been observed with the addition of Fe2O3. The results provide supports for the utilization of ISSA in the production of industrial cement clinker.

Understanding the effect of vitamin B3, B6 and C as a corrosion inhibitor on the ordinary Portland cement hydration: Experiments and DFT study

The existence of vitamins nicotinic acid (B3), pyridoxine (B6) and ascorbic acid (C) affects cement hydration when utilized as a new corrosion inhibitor. The mechanism of the effect of vitamin molecules on ordinary Portland cement hydration is still unclear at the atomic level. In this work, the microstructures of hydration products are found to be changed by vitamin inhibitors, which is the main reason for their impact on cement workability and mechanical performances. The pre-induction period was delayed in various degrees by vitamin inhibitors. The paste with vitamin C shows no induction and acceleration period in the tests. DFT calculations show that vitamin molecules dissociated in the adsorption process. The dissociated H atom occupied the ionic O site of the C3S (tricalcium silicate) surface, preventing the dissociation of water. This phenomenon may be one reason for the hydration postponement of cement with vitamin type inhibitors at the atomic level. The charge density difference and the independent gradient model analysis also confirmed the chemical and physical interactions between vitamin molecules and the C3S surface. The findings in this research may broaden the applicability of these new environment-friendly corrosion inhibitors.

Effect of alkoxysilane on early age hydration in portland cement pastes

Silanes added during mortar or concrete preparation, may modify the fresh state properties, hydration kinetics and mechanical strength of the final product. The effects of silanes on cement hydration have been widely studied in the literature, however, there is some controversy about its effect at short ages. The present study was undertaken to determine the effect of a TEOS-based alkoxysilane (UCA-T), produced by ultrasound-assisted pre-hydrolysis of an oligomeric precursor, on early age cement paste hydration. The nature of the processes modifying the various stages of cement hydration kinetics in the presence of the alkoxysilane was ascertained by analysing paste composition at several ages (defined on the grounds of calorimetric curve results) using XRD, TG-DTG, FTIR and Raman spectroscopy. The calorimetric curve of pastes containing UCA-T exhibited a new early age, pre-induction period exothermal peak, indicative of UCA-T hydrolysis, C3A and C3S dissolution and ettringite and C–S–H gel precipitation. Portlandite, however, did not precipitate but reacts with the Si(OH)4 sourced from UCA-T hydrolysis to generate further C–S–H gel. The induction period following on that new exothermal peak was considerably longer than the period observed in the reference cement, an effect that intensified at higher UCA-T content.

A Study to Evaluate the Efficacy of Dexamethasone as an Adjuvant in Ultrasound-Guided Bilateral Superficial Cervical Plexus Block using 0.25% Bupivacaine in Patients Undergoing Thyroid Surgeries under Entropy-Guided General Anesthesia.

Context:Ultrasound-guided bilateral superficial cervical plexus block (BSCPB) is a technique described for thyroid surgeries for postoperative analgesia as the surgery can cause severe pain and discomfort. Perineural dexamethasone is known to prolong analgesic duration and reduce postoperative nausea/vomiting.Aims:To assess the efficacy of dexamethasone as an adjuvant to BSCPB with 0.25% bupivacaine on isoflurane consumption, intraoperative hemodynamic parameters, and postoperative analgesia in patients undergoing thyroid surgeries under general anesthesia.Settings and Design:This was a randomized control trial.Subjects and Methods:Eighty patients were randomized to two equal groups using random number table into Group A with BSCPB receiving 20 mL of 0.25% bupivacaine and Group B with BSCPB receiving 19 mL of 0.25% bupivacaine + injection dexamethasone 4 mg in the preinduction period. Hemodynamic parameters, isoflurane consumption, postoperative visual analog scale (VAS) score, and antiemetic effect over 24 h were compared between two groups.Statistical Analysis Used:Microsoft excel data sheet, Chi-square test, and independent t-test were used for statistical analysis.Results:The intraoperative hemodynamic parameters were comparable between the two groups. There was a significant difference in mean VAS score between two groups from 6 h to 20 h postoperatively. The time of rescue analgesic in Group A was 7.09 ± 1.04 min and Group was 13.19 ± 1.46 min with P < 0.0001. In Group A, 40% had nausea and 35% had vomiting, and in Group B, 7.5% had nausea and 5% had vomiting.Conclusions:Preinduction ultrasound-guided BSCPB with bupivacaine and dexamethasone provides longer duration of postoperative analgesia and lesser nausea and vomiting compared to bupivacaine alone.

MP12-20 THE EVOLUTION OF LEADERS IN UROLOGY

You have accessJournal of UrologyEducation Research II (MP12)1 Sep 2021MP12-20 THE EVOLUTION OF LEADERS IN UROLOGY Jordan Levine, Zafardjian Dalimov, Julia Yu, Jinwei Hu, and Teresa Danforth Jordan LevineJordan Levine More articles by this author , Zafardjian DalimovZafardjian Dalimov More articles by this author , Julia YuJulia Yu More articles by this author , Jinwei HuJinwei Hu More articles by this author , and Teresa DanforthTeresa Danforth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001985.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare reform has changed the landscape of urology over the last several decades. However, little is known about the changing characteristics amongst leaders in urology. In this study, we evaluated the trend in demographic, fellowships, additional degrees pursued and scientific publication characteristics of the past presidents of the American Urological Association (AUA). METHODS: The BoardCertifiedDocs.com database was queried for demographic information of the past presidents of the AUA. The Web of Science database was queried for the quality and quantity of their publications from 1970 to 2020. Measures of academic output, including author’s personal impact factor (h-index) and number of publications, were compared pre and post induction using paired t-tests. RESULTS: There have been 50 past presidents of the AUA since 1970. No females have been elected president. No past presidents held PhDs or advanced non-PhD equivalents. The proportion of surgical fellowships has increased throughout the last 50 years, with 60% of past presidents in the last decade having undergone surgical fellowship training. In terms of the productivity and citation impact of the publications, there was a statistical difference between author h-index between pre- and post-induction (18.42±1.92 vs 5.58±1.29, p <0.01). There was a significant decrease in number of publications post-induction as compared with pre-induction (72.76±11.90 vs 16.96±4.15, p <0.01). The h-index has increased throughout the last 5 decades, however there has been a disproportionately smaller increase in h-index compared to the increase in number of publications. The proportion of h-index to publication count is lower in the pre-induction period as compared to the post-induction period. CONCLUSIONS: Trending the shift in background may be important in identifying the characteristics valuable to recruitment into leadership roles and to address any gaps in characteristics for more comprehensive representation of an evolving workforce. The lack of gender balancing in leadership roles has poorly reflected the changes observed in the modern urologic workforce. While subspecialty fellowships were once seldom pursued, they are becoming more ubiquitous amongst leaders in urology. The observed increase in academic productivity has been reserved to the pre-induction period, however the citation impact per publication is consistently greater in the post-induction period. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e196-e196 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Levine More articles by this author Zafardjian Dalimov More articles by this author Julia Yu More articles by this author Jinwei Hu More articles by this author Teresa Danforth More articles by this author Expand All Advertisement Loading ...

Clinical Audit on Current Practice of Anesthesia Machine Check and Equipment Preparedness Before Use in Debre Berhan Comprehensive Specialized Hospital, North Shewa, Ethiopia, 2020

Background: Assessing the quality assurance of providing work-ready anesthesia equipment in operating rooms is so vital. Most of the anesthesia-related adverse events are preventable by the identification and correction of anesthesia machine errors and equipment preparation in the pre-induction period. This paper aimed to keep a high-quality environment for workers and patients in the surgical operating theater. Materials and Methods: Data were collected after ethical clearance obtained from the institutional ethical review board, and daily observations of pre-induction anesthesia preparation were done in all surgical rooms at the start of each day and continuously before the next cases with a prepared anesthesia machine checklist. Descriptive statistical analysis and cross-tabulation of each checklist with the type of anesthesia and urgency of surgery were done to determine the degree of staff compliance with daily preparations using SPSS version 22, and finally, results were presented by texts and graphs. Results: In this study, a total of 61 checking events with 19 items were involved during the study period. There were 893 (77.1%) fully met checking events, 205 (17.7%) not-met checking events(sodalime) 61 (5.3%) not available in anesthesia machine check and equipment preparation before use. Among 19 checklists, only three (power source plugged in, power source switched on, and functionality of monitoring) were perfectly completed;however, the rest sixteen checklists are in bad practice among them seven checklists (presence of functional self-inflating bag, automatic machine check, power source backup battery, anti-hypoxic device, ventilator, difficult airway equipment and scavenging systems) were checked below 90%. Conclusions and Recommendations: This study concludes there is poor compliance among anesthetists in pre-induction preparation and underperformed since all anesthesia machine checklists have zero tolerance for errors. . This paper recommends that every responsible anesthetist perform anesthesia machine check and equipment preparation regardless of the type of anesthesia and type of surgery and avoid professional negligence.

A Prospective Observational Study of Plethysmograph Variability Index and Perfusion Index in Predicting Hypotension with Propofol Induction in Noncardiac Surgeries.

Context:Propofol induction is associated with hypotension due to changes in intravascular volume, tone of vessels and cardiac output. Plethysmograph variability index (PVI) and perfusion index (PI) are derived indices from pulse oximeter, used for assessing fluid responsiveness and vessel tone, respectively. We studied the utility of these indices in predicting hypotension due to propofol.Aims:The aim of the study is to test the baseline cutoff values of PVI > 15% and PI <1.05 in predicting hypotension with propofol induction.Settings and Design:This is a prospective double-blind observational study in tertiary care hospital.Methods:Institutional ethical committee approval was obtained. 106 surgical in-patients as per inclusion and exclusion criteria were randomly allotted by computer-generated random numbers. All patients were nil by mouth for 6 h. Injection midazolam and fentanyl were used as premedicants. Propofol at dose of 2 mg.kg−1 was used for induction. Masimo Radical 7® monitor was used for recording of PVI and PI from the upper limb. Baseline values of PVI and PI were recorded every minute from preinduction period till intubation. Standard monitors of noninvasive blood pressure, pulse oximeter, and electrocardiography were used. As per the occurrence of hypotension, patients were grouped as Group H (hypotension) and Group NH (no hypotension).Statistical Analysis:Data were analyzed with SPSS version 20. Quantitative data were analyzed using mean, standard deviation, interquartile range as per distribution. Shapiro–Wilk test with P < 0001 was used descriptive parameters. Scatter plot and Spearman correlation were used to find correlation between the two variables. Mann–Whitney U test was used to compare the two groups in terms of PVI and PI at different time points. Receiver operator characteristic curve was plotted for PI and PVI against hypotension, and cutoff value was calculated. Sensitivity, specificity, positive predictive value, negative value, and diagnostic accuracy of PI and PVI were calculated. P <0.05 was considered statistically significant.Results:Eighty-one patients (76.4%) who had hypotension were grouped into Group H and 25 patients (23.6%) without hypotension as Group NH. There was no difference between groups with respect to doses of midazolam (P = 0.28), fentanyl (P = 0.54), and propofol (P = 0.28). Baseline cutoff of PVI >15 had sensitivity of 58% and specificity of 56%, respectively. PI cutoff value of < 1.05 had sensitivity of 30.9% and specificity of 48%. The risk ratio of PVI cutoff and PI cutoff were 1.41 and 0.43, respectively. There was poor agreement between mean arterial blood pressure (MAP) estimation and prediction of hypotension by PVI (Cohen's kappa = 0.106, P = 0.218) and PI values (Cohen's kappa = −0.133, P = 0.054). Area under the receiver operator curve was 0.596 and 0.511 for PVI >15% and PI < 1.05, respectively. New cutoff values PVI >17.5% and PI > 0.76 were found. PVI and PI had poor diagnostic performance. There was no significant correlation of PVI and PI with hemodynamic variables such as heart rate, MAP, SBP, DBP, and PP.Conclusion:Baseline values of PVI >15% and PI < 1.05 are not good tools for predicting hypotension with propofol induction. New values of baseline cutoff of PVI >17.5% have high specificity, and PI > 0.76 has high sensitivity and positive predictive value.

Effect of General Anesthesia on Levels of Blood Sugar Values in Different Times of Operation

The present study was carried out on a period between December 2019 to February 2020 on 50 healthypatients, their ages ranged from eighteen to fifty years. They were 26 males and 24 females. These healthypatients were attending Baghdad Educational Hospital, Al-Harriri Hospital, and Al-Diwaniyah GeneralHospital in order to perform various surgeries. And after all tests are done. Then they were admitted to theoperating theater. In this study used the general anesthesia method. And they were given drugs of anesthesia,during each step; the values of blood sugar levels (Mg\dl) were measured. Such as pre induction, postinduction, after incision, after fluid, and recovery. To know the effect of general anesthesia method on bloodsugar levels in different times of operation on gender and age groups.This study showed that total numbers of patients were 50 including males about 26 (52.0%) and femalesabout 24(48.0%), their age of all individuals ranged from less than 20 years old (&lt;20-29) which numberand percentage 22,44.0% to 50 years old 7 (14.0%). Also there are no significant difference was observedin the blood sugar levels changes (Mg\dl) in both males and females (gender) before and after the operationor surgery, also no found any differences between blood sugar levels changes (Mg\dl) at the age groups andthe general anesthesia method, after and before the operation in different times of surgery. So in this studysummarized the mean and stander deviation values according to the levels of blood sugar (Mg\dl) amongdifferent times of surgery, and then show the mean of pre induction period about 83.84, While mean ofvalues of blood sugar at post induction time at general anesthesia method about 104.94.Aims and Objectives: This study was investigated the influence of general anesthetic drugs that effect onthe blood sugar level changes of patients with surgery. This was done with the following objectives:• To administer general anesthesia by using a different combination of drugs.• To assess and compare the blood sugar level changes of the patients at different time intervals.• Complications, if any were observed and noted on patients at different time intervals.

Evaluation of Nursing Actions in Anesthesia Guided by the Patient Safety Checklist: Nursing in Anesthetic Procedure (PSC/NAP): A Cross-Sectional Study

PurposeThis study aimed to evaluate the implementation of nursing actions in anesthesia guided by the Patient Safety Checklist: Nursing Anesthetic Procedure and the difficulties in performing patient care. DesignA cross-sectional study. MethodsNursing actions were evaluated in 282 anesthetic procedures of adult patients undergoing general anesthesia in three periods of anesthesia in a private hospital operating room in Brazil, from January to July 2018. The evaluated outcomes were the number of items performed by nurses during anesthesia periods and limitations for applying the Patient Safety Checklist: Nursing Anesthetic Procedure instrument. FindingsExecution of the nursing actions presented a mean percentage of 85.6, highlighting the anesthetic induction stage and differences between the periods before induction and reversal. The main items not performed in evaluating the nursing care in anesthesia were as follows: the anesthesia equipment test (84; 29.78%) in the preinduction period; the evaluation of adequate ventilation (132; 46.81%) in the induction period; and the tracheal aspiration assistance (62; 21.98%) during reversal. Receiving a call from another room with care interruption was highlighted among the nurses' justifications for not performing the activities and difficulty in continuing care because of shift change. ConclusionsThe execution of nursing care actions in anesthesia mainly occurred during the period related to induction, with limitations because of dimensioning of operating rooms and simultaneous procedures.

A randomized controlled trial of Dilapan-S vs Foley balloon for preinduction cervical ripening (DILAFOL trial)

The objective of the study was to test the hypothesis that Dilapan-S is not inferior to the Foley balloon for preinduction cervical ripening at term. Pregnant women ≥37 weeks scheduled for induction with unfavorable cervix (≤3 cm dilated and ≤60% effaced) were randomly assigned to 12 hours of either Foley balloon inflated with 60 mL saline or Dilapan-S for cervical ripening. If the cervix remained unfavorable, then 1 more round of the assigned dilator was used. Management following ripening was left up to the clinical providers. The primary outcome was vaginal delivery. A satisfaction survey was also obtained after the preinduction period. Sample size was based on a noninferiority margin of 10%, 90% power, and an estimated frequency of vaginal delivery of 71% in Foley balloon and 76% in Dilapan-S. From November 2016 through February 2018, 419 women were randomized (209 to Foley balloon; 210 to Dilapan-S). In the intent-to-treat analysis, vaginal delivery was more common in Dilapan-S vs Foley balloon (81.3% vs 76.1%), with an absolute difference with respect to the Foley balloon of 5.2% (95% confidence interval, -2.7% to 13.0%) indicating noninferiority for the prespecified margin. The difference was not large enough to show superiority. Noninferiority was confirmed in the per-protocol population (n= 204 in the Foley balloon, n= 188 in Dilapan-S), supporting the robustness of the results. Secondary outcomes were not different between groups, except for a longer time the device remained in place in Dilapan-S compared with the Foley balloon. Maternal and neonatal adverse events were not significantly different between groups. A priori interaction analyses showed no difference in the effect on vaginal delivery by cervical dilation at randomization, parity, or body mass index >30 kg/m2. Patients with Dilapan-S were more satisfied than patients with the Foley balloon as far as sleep (P= .01), relaxing time (P= .001), and performance of desired daily activities (P= .001). Dilapan-S is not inferior to the Foley balloon for preinduction cervical ripening at term. Advantages of Dilapan-S over Foley include Food and Drug Administration approval, safe profile, no protrusion from the introitus, no need to keep under tension, and better patient satisfaction.

Process intensification for the production of rituximab by an inducible CHO cell line.

Mammalian-inducible expression systems are increasingly available and offer an attractive platform for the production of recombinant proteins. In this work, we have conducted process development for a cumate-inducible GS-CHO cell-line-expressing rituximab. To cope with the limitations encountered in batch when inducing at high cell densities, we have explored the use of fed-batch, sequential medium replacements, and continuous perfusion strategies applied during the pre-induction (growth) phase to enhance process performance in terms of product yield and quality. In shake flask, a fed-batch mode and a complete medium exchange at the time of induction were shown to significantly increase the integral of viable cell concentration and antibody titer compared to batch culture. Further enhancement of product yield was achieved by combining bolus concentrated feed additions with sequential medium replacement, but product galactosylation was reduced compared to fed-batch mode, as a result of the extended culture duration. In bioreactor, combining continuous perfusion of the basal medium with bolus daily feeding during the pre-induction period and harvesting earlier during the production phase is shown to provide a good trade-off between antibody titer and product galactosylation. Overall, our results demonstrate the importance of selecting a suitable operating mode and harvest time when carrying out high-cell-density induction to balance between culture productivity and product quality.

Identification of inflammatory response patterns in experimental gingivitis studies.

We used novel analytical approaches to identify inflammatory response patterns to plaque accumulation in experimental gingivitis studies in humans. Data from two experimental gingivitis studies [Dataset I (n=40) and Dataset II (n=42)], which differed in design and recording methods, were used. Both studies comprised a three-phase program as follows: pre-induction period (oral hygiene as usual for Dataset I; professional tooth cleaning for Dataset II); induction period (plaque accumulation); and resolution period (oral hygiene as usual). Clinical recordings of plaque and gingival inflammation were made on days 0, 4, 9, and 14 for Dataset I and on days -14, 0, 7, 21, and 35 for Dataset II. Group-based-trajectory and growth curve modeling were used for data analysis. In Dataset I, gingival response to plaque accumulation was found to be lagged in time. Different group-based response patterns for gingival inflammation were not identified. However, in Dataset II, 'fast' and 'slow' gingival inflammation responders were identified. 'Slow' responders had lagged inflammation responses, whereas 'fast' responders seemed to respond immediately to plaque. The findings show that analytical approaches which consider the data structure allow investigation of the dynamics of the relationship between plaque accumulation and gingival inflammation and facilitate the identification of differential patterns of gingival inflammation development.

DEXMEDETOMIDINE VERSUS MAGNESIUM SULPHATE OR LIDOCAINE FOR BLUNTING STRESS RESPONSE TO DIRECT LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION IN ABDOMINAL SURGERIES.

Back ground: Direct laryngoscopy and endotracheal intubation frequently induces a cardiovascular stress response characterized by hypertension and tachycardia and also hormonal stress response characterized by increased secretion of pituitary hormones. The present study was undertaken to compare the efficacy of intravenous dexmedetomidine, lidocaine and magnesium sulphate in attenuating the stress response to direct laryngoscopy and endotracheal intubation. Subjects and Methods: The current prospective randomized clinical study was performed in Zagazig University hospitals. A total of 87 patients posted for elective abdominal surgeries under general anesthesia were enrolled in the study. Patients were randomly divided into three groups, group-D (dexmedetomidine group), group-L (lidocaine group) and group-M (magnesium sulphate group) with 29 patients in each group. Group-D was given 1mcg/kg dexmedetomidine , Group-M was given 30mg/kg of magnesium sulphate and Group-L was given 1.5mg/kg lidocaine all the study drugs were given by IV infusions over a period of 10 minutes before induction of anesthesia which was standardized for all patients. The three groups were observed for changes in hemodynamic parameters at preinfusion of the study drug and preinduction of the anesthesia and 1, 3,5,10 minutes post intubation, blood glucose and cortisol level were measured at preinfusion and 10 min after intubation, Ramsay sedation score and postoperative pain were assessed at preinduction period and 1 hour postoperatively. Results: It was observed that both dexmedetomidine and magnesium sulphate attenuated the rise in the mean arterial blood pressure significantly, but lidocaine failed to attenuate it.Also dexmedetomidine only decreased the changes in the mean heart rate , serum cortisol, serum glucose level, Ramsay sedation score and postoperative pain significantly. Conclusion: This study seems to prove that dexmedetomidine and magnesium sulphate play an important role in blunting the stress response resulting from direct laryngoscopy and intubation.

Effect of M/P and Borax on the Hydration Properties of Magnesium Potassium Phosphate Cement Blended with Large Volume of Fly Ash

The effect of the borax content and magnesia to phosphate ratio (M/P) on the hydration properties of the magnesium potassium phosphate cement (MKPC) with large volume of fly ash was investigated, and a five-hydration-stage for MKPCs was proposed. The results show that MKPC sets rapidly with less than 8% of borax, which is unfavorable to the application of MKPC on construction. Adding more than 8% (including 8%) of borax results in a secondary hydration peak for MKPC, in which the process of hydration can be divided into five stages, namely, pre-induction period, induction period, acceleration period, deceleration period and stable period. M/P ratios could not change the multi-step reactive stages but higher M/P ratios could accelerate the hydration. Borax tends to impact the formation of Mg-containing hydrated products.

Comparison of Cardiovascular Status Between Pre- Induction Period and The Different Positions of Anaesthetized Patients in Laparoscopic Cholecystectomy

The laparoscopic cholecystectomy nowadays is the method of choice for treatment of patients with cholelithiasis. This surgery involves different types of positioning of the anaesthetized patient. Our study was planned to compare the haemodynamic changes between the pre-induction period with the different positions of the anaesthetized patients during laparoscopic cholecystectomy. Thirty two (32) female patients of ASA physical status - 1 &amp; 11, aged between 18 to 55 years, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were enrolled in the study. All the patients were medicated with tablet clonazepam (0.5mg) on the night before surgery. On arrival to the operation theatre, baseline heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and arterial oxygen saturation (SpO2) were recorded. The patients were then induced with Inj. propofol (1.5 to 2mg/kg). Endotracheal intubation was facilitated with Inj. vecuronium (0.1mg/kg). Anaesthesia was maintained with halothane 0.5% and nitrous oxide 60%, in oxygen. The propofol was infused to strengthen the maintenance of anaesthesia. During operation patient was monitored for HR, NIBP, ECG, ETCO2, and SpO2. The haemodynamic tools of the patients were continuously recorded. The pre-induction mean HR, SBP, DBP, MAP were compared with the values found after induction in trendelenburg and reverse trendelenburg position. The mean HR during pre-induction period &amp; after induction in trendelenburg position, &amp; reverse trendelenburg position were respectively 79.2±8.2, 76.6±9.6, and 70.1±5.9beats/min. The mean HR was statistically significant (p&lt;0.05) between pre-induction, trendelenburg and reverse trendelenburg position. The mean SBP during pre-induction period &amp; after induction in trendelenburg &amp; reverse trendelenburg position were respectively 138.0±11.6, 130.3±9.9, and 119.3 ±12.7 mm Hg. The mean SBP was statistically significant (p&lt;0.05) between pre-induction, trendelenburg and reverse trendelenburg position. The mean DBP during pre-induction period, after induction in trendelenburg &amp; reverse trendelenburg position were respectively 75.5±10.9, 72.6±6.1, and 70.6±6.1mm Hg. The mean DBP was statistically significant (p&lt;0.05) between pre-induction, trendelenburg and reverse trendelenburg position. The mean MAP during pre-induction period, after induction in trendelenburg &amp; reverse trendelenburg position were respectively 96.3±10.7, 95.0±9.8, and 72.6 ±6.1mm Hg. The mean MAP was statistically significant (p&lt;0.05) between pre-induction, trendelenburg and reverse trendelenburg position. So, it can be concluded that the cardiovascular status was significantly decreased in both trendelenburg and reverse trendelenburg position than the pre-induction values found during laparoscopic cholecystectomy. JBSA 2017; 30(1): 27-33

Bishop scoring: Perceived benefits of using in labour induction by Turkish midwives.

It is not always possible to achieve a successful induction. Bishop scoring system is an efficient method used in determining whether the induction will be effective or not. The aim of this study was to train midwives on the benefits and use of the Bishop scoring system and to minimize the unnecessary use of induction. This study was conducted as pretest-posttest quasi-experimental design. This study was conducted in a maternity hospital in Erzurum between 01 February and 31 July 2012. In the study, the midwives received training on the use of the Bishop scoring system, and changes in their knowledge levels and application during practice of induction were then evaluated. While only 20% of midwives were using the Bishop score before the training, 56.7% started to use this tool after the training. Comparing the examinations performed on pregnant women by the midwives in the pre-induction period before and after the training, the mean of the Bishop score changed from 7.26 to 9.68 after the training. It was determined that the training could increase the knowledge levels of midwives regarding the Bishop scoring system and their attention paid to the Bishop scoring system in the practice of induction.