Significant Difference In HR Research Articles

Safety and efficacy of side-by-side versus stent-in-stent stenting for malignant hilar biliary obstruction: a systematic review and meta-analysis.

Stenting of the malignant hilar biliary obstruction (MHBO) area for bile drainage is challenging. Bilateral stenting techniques of stent-in-stent (SIS) and stent-by-stent (SBS) have shown promising results. This study evaluates the efficacy of different stenting methods for MHBO. A meta-analysis was performed to determine the efficacy of SIS and SBS stenting strategies for MHBO. Medical databases such as PubMed, Web of Science, Embase, and Scopus, were searched up to August 2023. We selected eligible studies reporting the data on technical and clinical success, adverse events, and incidence of re-obstruction (RO) of SBS and SIS groups in MHBO patients. We compared the outcomes of SBS and SIS groups. A total of 9 studies comparing the data of 545 patients (268 in the SBS group and 277 in the SIS stenting group) were analyzed. There was no significant difference (p > 0.05) in the odds ratio (OR) of Re-obstruction (RO) 0.87 (95% confidence interval (95% CI) 0.6-1.25), technical success 0.58 (95% CI 0.16-2.11), clinical success 1.13 (95% CI 0.62-2.07), and adverse events 1.53 (95% CI 0.88-2.64). The mean difference in procedure time was -12.25 min (95% CI -18.39, -6.12), and the hazard ratio of stent patency was 1.22 (95% CI 1.01-1.47), favoring SBS, with high heterogeneity (I 2 = 94%). There was no significant difference in HR for survival 1.05 (95% CI 0.95-1.16) with high heterogeneity (I 2 = 84%). Compared with SIS, SBS showed better stent patency with comparable technical and clinical success and adverse events. The registration number for this study on PROSPERO is CRD42024523230.

Intensity of arm swing exercise with music-movement synchrony in untrained young adults

IntroductionThe research aimed to study the intensity of arm swing exercise (ASE) with different tempi of music-movement synchrony in untrained young adults and to investigate the effect of different music tempi on heart rate and oxygen consumption.MethodsParticipants were 30 healthy volunteers (15 males and 15 females), 20.67 ± 1.37 years and low-to-moderate physical activity. They performed ASE synchronised with music at a tempo of 60 and 140 bpm with a random sequence. They were measured for heart rate and oxygen consumption using a Quark SPIRO (COSMED) before and after the ASE for 6 minutes of each tempo. They rested for at least 15 minutes between music tempi during the ASE. The intensity of ASE with music-movement synchrony of each tempo was calculated as a percentage of maximum heart rate (%HRmax) and percentage maximum oxygen consumption (%VO<sub>2max</sub>).ResultsThe %HRmax of all participants post-ASE at 60 and 140 bpm were 58.64 ± 8.82 and 60.12 ± 8.95%, respectively. The %VO<sub>2max</sub> of all participants post-ASE at 60 and 140 bpm were 38.65 ± 11.36 and 40.17 ± 10.71%, respectively. There was no significant difference in HR and VO2 of ASE between music tempi.ConclusionsThe ASE with music-movement synchrony at 60 and 140 bpm is a low-intensity aerobic exercise, so is a suitable choice for people with low physical activity. Furthermore, the faster tempo did not significantly alter the intensity, therefore, we recommend selecting the slower music tempo at 60 bpm to avoid repetitive shoulder joint injury.

Comparison of Effect of Dexmedetomidine Versus Lignocaine on Haemodynamic Response and Quality of ExtubationIn Patients Undergoing Interventional Neuroradiological Procedures: A Randomized Double-Blind Interventional Study

Background and Aims: Haemodynamic and airway responses during and after extubation may be precarious in neurosurgical patients. We aimed to compare the effects of dexmedetomidine versus lignocaine on haemodynamic response and quality of extubation in patients undergoing interventional neuroradiological procedures. Material and methods: This prospective study was conducted in a randomized double-blind manner on a total of 80 patients of either sex aged 20-50 yrs of ASA grades I, II & III who were randomly allocated into two groups (40 in each group). In Group A inj. Dexmedetomidine 0.5mcg/kg i.v and in Group B - inj. Lignocaine 1.5mg/kg i.v was given as a single bolus in 10 ml normal saline, at the end of the procedure. Haemodynamic variables (HR, SBP, DBP, MAP) were recorded at extubation, 1, 3, 5, 10, and 15min after extubation. Quality of extubation, sedation score and side effects (bradycardia, hypotension, nausea & vomiting) were also noted. Statistical analysis was performed by using the student-t-test and Chi-square test (significant p-value ≤ 0.05). Results: The SBP, DBP and MAP were significantly higher in group B than in group A at extubation, 1min, 3min, 5min, 10min and 15min post-extubation whereas the significant difference in HR was observed only at extubation and 1min post-extubation (Group B > A). Dexmedetomidine produced a higher sedation score grade 2 (73.68%) than lignocaine (20.51%) with better quality of extubation and nonsignificant side effects. Conclusion: Dexmedetomidine administered 10 min before extubation effectively attenuates the haemodynamic and airway responses during extubation as compared to Lignocaine. Keywords: Dexmedetomidine, Lignocaine, Interventional, Extubation, Haemodynamic

Abstract P3-18-12: Achieving negative margin after repeated attempts for lumpectomy does not nullify the risk of ipsilateral breast tumor recurrences

Abstract Introduction: Currently, the widely accepted principle in managing lumpectomy margins in early breast cancer patients is to avoid the presence of tumor cell at the margin. The presence of tumor cells on lumpectomy margin can represent two different aspects of local control in breast cancer. One aspect is related to the potential technical failure that may lead to an incomplete resection of the tumor. The other aspect of positive margin is associated with a biologic nature of the tumor. For example, some tumors show features of extensive intraductal component which often result in positive lumpectomy margins and may lead to increased risk of local recurrence after breast conservation surgery. Therefore, the two-fold increase of IBTR risk with positive margin would be the reflection of the combined effect of both technical failure and the biologic features.In this study, we aimed to address this issue by investigating the IBTR rates of patients in whom negative margins were achieved by initial lumpectomy or by re-excision. Our assumption was if the IBTR rates of the two groups are identical, then the two-fold increase of IBTR risk is mostly caused by the technical incomplete resection and therefore the measures to achieve negative margins would be justified. Methods: We retrospectively reviewed the data of 5,633 patients who underwent breast conservation surgery and whole breast irradiation for invasive breast cancer between January 2004 and December 2018 from Seoul National University Hospital. During the period, a total of 828 patients had positive lumpectomy margin after their initial surgery. Among them, thirty-five patients who did not undergo re-operation were excluded due to the small sample size. Results: The median age of the studied patients was 49 years old (19-92), and nearly two third of the patients had T1 tumors (64.3%). 4,293 patients (76.7%) were node negative and 4,332 patients (77.4%) had hormone receptor positive tumors. During the median follow-up period of 76.6 ( ± 44.6) months, a total of 121 patients (2.2%) experienced IBTR. Patients who underwent re-excision to achieve negative margins experienced significantly higher rate of IBTR compared to patients in whom the margins were clear at the first lumpectomy (p=0.031, HR: 1.61; 95% C.I., 1.04-2.48). The survival curves began to separate around 4-5 years after surgery (98.5% vs 98.0% at 5 year and 97.4% vs 94.7% at 10 years of follow-up). The survival difference was more clearly observed for younger patients (p=0.033, HR 1.72; 95% C.I., 1.04-2.85 for age less than 50). When the patients were divided according to their hormone receptor and HER2 amplification status, we observed significant difference in HR+/HER2- and HR-/HER2- subtypes while the HER2-amplified tumors showed no significant differences.By using Cox regression analysis, we adjusted for other significant predictors of IBTR such as age, histologic grade, lymphovascular invasion, hormone receptor status, HER2 amplification status, and Ki-67 levels. The results of the Cox regression analysis showed that re-excision to achieve negative margin is significantly associated with the risk of IBTR after adjusting for these variables (p=0.023, HR: 1.72; 95% C.I., 1.08-2.74). Conclusion: Patients who underwent re-excision after lumpectomy for initial positive margin carry increased risk of developing IBTR even they achieve final negative margin when compared to patients with initially negative lumpectomy margin. Our observation indicate that a substantial proportion of the increasing risk of IBTR associated with positive lumpectomy margin can be attributed to the biologic characteristics of the tumor rather than technical incomplete resection. Citation Format: Jong Ho Cheun, Hong-Kyu Kim, Han-Byoel Lee, Wonshik Han, Hyeong-Gon Moon. Achieving negative margin after repeated attempts for lumpectomy does not nullify the risk of ipsilateral breast tumor recurrences [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-12.

Adjuvant Treatment of Early Ovarian Clear Cell Carcinoma: A Population-Based Study of Whole Abdominal Versus Pelvic Nodal Radiotherapy.

Adjuvant treatment in early ovarian clear cell carcinoma (OCCC) is not yet standardized. The objective of this population-based study was to compare the outcome of patients with early OCCC treated with adjuvant chemotherapy versus chemoradiotherapy (chemoRT) and evaluate the association of adjuvant radiotherapy regimens (whole abdominal radiotherapy [WART] versus pelvic nodal radiotherapy [PRT]) with outcome. Chart review was conducted to identify patients with stage I and II OCCC with complete information on staging. Patients with stage IA, IB, or IC OCCC purely resulting from capsular rupture were excluded because the provincial protocol does not recommend adjuvant treatment. Overall, 403 patients were identified and 343 received adjuvant treatment, of whom 255 had stage IC or II OCCC and 153 were eligible for final analysis. On Cox multivariable regression, receipt of chemoRT (n=90) was associated with an improvement in failure-free survival (FFS) (hazard ratio [HR], 0.57; 95% CI, 0.34-0.94) compared with chemotherapy alone (n=63). Use of chemoRT also resulted in 54% reduction in the cumulative incidence of cancer-specific mortality (subdistribution HR, 0.46; 95% CI, 0.24-0.89). However, there was no significant difference in the HR for overall survival (OS) between the chemoRT (HR, 0.70; 95% CI, 0.43-1.13) and chemotherapy group. Relative to chemotherapy + WART (chemo-WART), chemotherapy + PRT (chemo-PRT) was not associated with any significant difference in HR for FFS (HR, 1.34; 95% CI, 0.40-4.44) or OS (HR, 1.13; 95% CI, 0.37-3.46). Adjuvant chemoRT was associated with a lower risk of failure compared with chemotherapy alone. However, there was no difference in OS between the adjuvant chemotherapy and chemoRT regimens. Additionally, no significant difference in terms of FFS or OS was found between the chemo-WART and chemo-PRT groups.

Inverse ratio ventilation combined with PEEP in infants undergoing thoracoscopic surgery with one lung ventilation for lung cystadenomas: a randomized control trial of 63 cases

To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P < 0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P < 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P > 0.05). The level of RAGE significantly increased after the surgery in both groups (P < 0.05), and was significantly lower in R group than in N group (P < 0.05). In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.

Small-Dose Ropivacaine Hydrochloride with Fentanyl versus Large-Dose of Ropivacaine Hydrochloride for Cesarean Section.

To compare the effect of small-dose ropivacaine hydrochloride combined with fentanyl versus large-dose of ropivacaine hydrochloride for cesarean section. Experimental study. Department of Anesthesiology, Gansu People's Hospital, China, from February 2017 to April 2018. A total of 134 maternal women, who underwent cesarean section, were randomly divided into control group and observation group, with 67 cases in each group. Control group was anesthetized with a large dose (1.5 mL) of ropivacaine hydrochloride, and observation group was anesthetized with a small dose (1 mL) of ropivacaine hydrochloride in combination with 10 µg of fentanyl. Then anesthetic effects of the two groups were compared. The onset time of anesthesia and postoperative pain scores of the anesthesia in observation group were better than those in control group (both p<0.001). There was no significant difference in HR, SpO₂ and MAP between the two groups after 15 minutes of anesthesia, and after the operation (p=0.393, 0.275, 0.108, 0.740, 0.068 and 0.230, respectively). After the delivery of the fetuses, the HR, SpO₂ and MAP of the parturients in observation group were better than those in control group (all p<0.001). Frequency of adverse reactions of parturients in observation group was lower than that in control group (p=0.033). In comparison to large-dose of ropivacaine hydrochloride, small-dose of ropivacaine hydrochloride combined with fentanyl, in combined spinal-epidural analgesia on parturients accepting cesarean section, can more effectively maintain their hemodynamic stability, relieve postoperative pain, and have a low incidence of adverse reactions.

Effect of short term exercise on cardiorespiratory parameters in exercise trained and untrained young adults

Effect of short term exercise on cardiorespiratory parameters in exercise trained and untrained young adults - IJCAP- Print ISSN No: - 2394-2118 Online ISSN No:- 2394-2126 Article DOI No:- 10.18231/2394-2126.2019.0025, Indian Journal of Clinical Anatomy and Physiology-Indian J Clin Anat Physiol

Application of oxygen supply tracheal intubation in improving respiration in patients under general anesthesia

Objective To explore the effect of oxygen supply tracheal intubation on ventilation quality in patients under general anesthesia. Methods Sixty patients for great saphenous vein closures with laser under general anesthesia were randomly divided into two groups (each including 30 cases) and respectively received tracheal intubation with either size 7 common tracheal tubes (group C) or oxygen supply tracheal tubes with the same size (group O). During operation, HR, MAP, SpO2, Ppeak, Ppla and PETCO2 were monitored and recorded. All patients were admitted to anesthesia recovery room after surgery. When patients regained autonomous respiration, the PETCO2, the number of patents relying on continue oxygen supply and the number of patents with reduced SpO2 during aspiration of sputum were recorded. Results There was no significant difference in HR and MAP between two groups in operation room before and during operation (P>0.05). Group C and group O did not differ in Ppeak, Ppla and PETCO2 during operation (P>0.05). However, there was significant difference in postoperative HR, MAP and PETCO2 between the two groups (P<0.05). Additionally, the number of patients in group C depending on continued oxygen supply was significantly higher than that in group O (P<0.05). Conclusions Oxygen supply tracheal tubes were able to ensure ventilation and oxygen supply during and after the surgery, and reduce the dependence of patients on auxiliary breathing equipment during anesthesia recovery. Key words: Oxygen supply tracheal tube; Airway parameters; Recovery from anesthesia; Safety during perioperative period

Cardiovascular Evaluation in Bitches in Oestrus, Pregnancy and Puerperium

Background: Pregnancy may change maternal hemodynamic, which is considered a physiological mechanism for adaptation. Cardiac output tends to be influenced by reductions in vascular resistance and increases in uterine vasculature, as well as reduced autonomic tone combined with gestational physiological anaemia and increased blood volume due to increased plasma volume and hormonal mechanisms. In bitches, few studies have been conducted investigating the changes of the system and the clinical implications for the mother and foetuses due to poor cardiac adaptation during pregnancy.Materials, Methods &amp; Results: Systolic blood pressure (SBP), electrocardiographic and Doppler echocardiographic measurements and serum sodium (Na), potassium (K), calcium (Ca) and phosphorus (P) levels were evaluated in six bitches of reproductive age. An evaluation was performed in oestrus (M0), followed by evaluations at 25 (M1), 45 (M2), and 60 days (M3) after the last natural or artificial insemination and 15 days after delivery (M4). For the statistical analysis, the means, medians and the standard deviation were calculated. The data were analysed using ANOVA and the Tukey test, with significance level of 5%. A descriptive analysis was performed for color Doppler in echocardiogram evaluation, cardiac axis and rhythm in electrocardiogram evaluation. In the electrolytic evaluation, significant differences were found only in the serum levels of Na, noticed as a reduction in M0-M1 and M3-M2 and an increase in M1-M2 and M3-M4. No significant differences were observed in the SBP, although there was a tendency to SBP reduction. ECG parameters were not significantly different, with no rhythm or conduction disturbances. There was not a significant difference in HR. Four animals (66.6%) had axis deviation to the right when comparing the oestrous phase with the final quarter of pregnancy. The echocardiographic parameters did not show significant changes.Discussion: The reduction observed in Na can occur by salt depletion, by dilutional or metabolic mechanisms. In contrast, the elevation in Na concentration could occur as a result of fluid and electrolyte retention by kidneys during gestation. The absence of electrocardiographic changes may be justified by the stability of mean serum potassium concentrations. An increase in HR five days before the expected calving time, demonstrating the maximum cardiac activity in this gestational phase, is related by other authors, therefore, in the present study, the absence of significant change in HR can be explained by the period in which the data collection was performed, 45 days of gestation, being therefore prior to the period of greatest HR. The cardiac axis deviation can be explained by the distension of the gravid uterus that cause compression of the adjacent organs, leading to diaphragmatic compression and consequent repositioning of the thoracic structures. A tendency to SBP reduction observed is directly influenced by peripheral vascular resistance and cardiac output that occur during pregnancy. Although the echocardiographic findings did not show changes, it is suggested that there are changes related to increased blood volume in pregnancy to provide an appropriate blood flow to the conceptus. It was concluded that pregnancy and the postpartum period in bitches did not cause changes in electrolytes levels, SBP values, echocardiographic and electrocardiographic parameters as compared to values obtained during oestrus.

Moderate-vigorous Intensity Run Vs. Walk On Hemodynamics, Metabolism And Perception Of Effort

The ability to use an alternative (i.e., walking) to running would provide great benefit to those who are uncomfortable running or can’t run, in order to meet minimum activity recommendations. PURPOSE: We compared two exercise modalities (Run, Walk) matched for VO2, on HR, RPE, and a visual analog scale (VAS). METHODS: Active, college-aged males (n=7; weight = 72.5 + 3.9 kg; Bf% = 17.9 + 1.2; VO2max = 51.5 + 1.36 mL/kg/min) participated in a crossover-designed study, and studied on each of 2 occasions: Walk (W) and Run (R). Subjects completed a body composition and VO2max test. (R) = 60-min on a treadmill at 0%grade and speed equal to 65% VO2max (694.4 + 26.1 kcal). (W) = 60-min at 3.3mph and a steep incline equal to 65% VO2max (677.9 + 20.9 kcal). Pulmonary gas exchange (VO2, RER, respiratory rate (RR)) was assessed within the first 10 min of exercise, with HR and RPE recorded every 15 min. A VAS was used to assess overall perceived effort (0-100mm). RM ANOVAs were used for statistical analysis. Values were calculated as mean + SE. RESULTS: There was no significant difference in VO2 (Run, 33.2 ± 1.1; Walk, 32.7 ± 1.1 mL/kg/min; Con, p=0.59), RPE (Run, 11.1 + 0.8; Walk, 11.7 + 0.8, p=0.28), VAS (Run, 51.2 ± 5; Walk, 48 ± 5mm, p=0.54), or %VO2max (Run, 64.6 + 1.2; Walk, 63.5 + 1.2%, p=0.56) between the groups. There was a significant difference in HR (Run, 167.0 + 4.9; Walk, 157.3 + 4.9 BPM), RR (Run, 35.1 + 2.3; Walk, 30.5 + 2.3 BPM), and RER (Run, 0.86 + 0.02; Walk, 0.9 + 0.02) between the groups. There was no significant difference in the amount of sleep (R, 6.6; W, 6.8hr) between the two groups (p=0.68). 5 out of 7 subjects complained about their legs “burning” or “hurting” during the W trial. CONCLUSION: Walking and Running, even when matched for intensity, via VO2, led to the R having a significantly higher HR and breathing rate for 60-min in active males, but a significantly lower RER. Despite the subjects complaining of their legs being sore (W), RPE did not reflect a difference in perception, nor did the VAS post-exercise. These results indicate that a walk can be recommended for a moderate-vigorous intensity, and elicit a similar metabolic and hemodynamic response, without causing a significant increase in perceived effort. This promotes the use of “steep” walking as energetically beneficial for those not able or desiring to run at higher intensities.

Influence of Physical Activity Patterns and Age on Acute Mountain Sickness Incidence during Mt. Kilimanjaro Trek

PURPOSE: Physical activity is often noted as a risk factor for the development of AMS. We sought to explore the interaction between age and physical activity patterns on the development of AMS in a group of 27 individuals during a gradual ascent of Mt. Kilimanjaro (19,341 ft). METHODS: 27 adults (44±15 yrs; 24.45±3.90 BMI; n=11/27 Female) climbed over an 11-day period. Use of acetazolamide and NSAIDs were minimized but remained optionally taken as necessary during the ascent. Physical activity was monitored using BodyMedia activity monitors; heart rate and oxygen saturation were monitored with Biovotion devices; AMS incidence was classified from the Lake Louise Questionnaire; and total symptoms were scored from the questionnaire’s original five symptoms plus an additional five symptoms. Groups were divided based on age (group 1: 28±2 yrs, 2: 44±8 yrs, and 3: 58±10 yrs). Comparisons were made using ANOVA and independent T-tests, and post hoc analyses were made using Tukey’s method. RESULTS: Throughout the trek, 59% (n=16/27) of subjects displayed AMS at least for one day during the climb. Average total symptom scores were 4.2±2.9, 2.2±1.9, 3.3±1.5 for group 1 vs. 2 vs. 3 respectively. Focusing on the summit push (day 10), AMS incidence was highest in group 1 (87.5%; n=7/8) compared to group 2 (33%; n=3/9) and group 3 (25%; n=2/8) with an ANOVA statistical significance of p<0.05. Moreover, percentage of climb spent in moderate to vigorous activity (MVPA), hiking speed (KPH), and steps taken per minute were highest for group 1 (MVPA: 65%±14% vs. 54%±19% vs. 52%±14%; KPH: 1±0.1 vs. 0.91±0.09 vs. 0.85±0.06; Steps/min: 23±5 vs. 22±5 vs. 14±2; ANOVA p<0.05 for KPH, steps/min). Average heart rate and SpO2 was higher for group 1 during the climb to summit (HR: 109±13 bpm vs. 88±14 bpm vs. 87±8 bpm; SPO2: 85.5±5.5% vs. 83.2±9.4% vs. 81.9±8.0%; p<0.05 for HR). Post hoc analyses depicted a significant difference between group 1 and group 3 in AMS incidence, KPH and steps/min, and a significant difference in HR between group 1 and the rest. CONCLUSIONS: In this study, the youngest group averaged a higher total symptom score throughout the trek, and exerted greater physical intensity, hiking speed, and activity on summit day. It was found that AMS was more common in young adults, which may be due to being more active and adventurous than older individuals.

12주간 모바일 홈 헬스케어를 통한 자발적 운동프로그램이 성인 남, 여의 신체조성 및 체력요소의 변화에 미치는 영향

The purpose of this study is to provide necessary raw data for mobile device training by developing health care service which is able to check and assess health, prescribe exercise and monitor. 36 candidates are selected between age 20~30, 15 male and 21 female without any heart disease. After mobile home health care exercise, body composition of male candidates shows significant difference in weight, body fat, % body fat and WHR, but not in muscle mass. For female candidates body composition, significant differences are shown in weight, body fat, %body fat and WHR except muscle mass. The result of health of male candidates shows significant difference in HR, sit-up, push-up, squat, trunk forward flextion. However no significant differences are shown in O2max, back strength, grip strength, sergeant and balance. In female health, significant differences are shown from HR, sit-up, push-up, squat, back strength, sergeant, balance and trunk forward flextion except O2max and grip strength. Comparing between male and female body compositions, muscle mass shows significant difference, but no significant difference are shown in body fat, %body fat and WHR. Between male and female health, no significant difference are shown in HR, sergeant, balance and trunk forward flextion. However, significant differences are shown in O2max, sit-up, push-up, squat, back strength and grip strength.

The expression changes of norepinephrine, acetylcholine, muscarinic receptors-2, adenosine receptors-1 on sinus bradycardia model caused by dexmedetomidine in rabbits

Objective To investigate the effects of dexmedetomidine(Dex) on norepinephrine(NE), acetylcholine(Ach), muscarinic receptors 2(M2), adenosine receptors 1(A1) of rabbits, and to clarify the mechanism of dex-induced bradyarrhythmias. Methods Twenty four healthy male rabbits were randomly divided into 3 groups(n=8), including control(group C), low dose of Dex (group D1), and high dose of Dex(group D2). Rabbits were administered normal saline in group C. Rats in group D1 were administered Dex at loading dose of 10 μg/kg for 10 min, and then at 5 μg·kg-1·h-1 for 50 min. Rats in group D2 were administered with Dex at loading dose of 60 μg/kg for 10 min and then at 30 μg·kg-1·h-1 for 50 min. After rabbits were anesthesia by sodium pentobarbital, basic operations were quickly were completed in order to measure MAP and ECG. HR, MAP were obtained before(T0), 15 min after (T1), 30 min after(T2), 60 min after(T3) intravenous pumping of Dex. After observation of Dex pump injection, hearts were quickly removed and divided accurately the sinus node. The experiment indicators were detected by the Real-time quantitative PCR, Immunohistochemical, ELISA. Results There was no significant difference in HR and MAP at T0 among the three groups(P>0.05). Compared with group C,HR, MAP were decreased at T1, T2, T3 in group D1, D2(P 0.05). Relative gene expression of A1 in group D2 significantly increased than group C[(13±5) vs (5±3)], D1[(13±5) vs (6±4)](P 0.05). Ach in group D2 were significantly increased than group C, D1(P<0.05). Conclusions Dex decreases NE of sympathetic transmitter and Ach vagus nerve neurotransmitter of only increases significantly in the high-dose group. High dose of Dex directly increasing vagus nerve activities. M2, A1 in the high-dose group showed a trend of rise significantly. Key words: Dexmedetomidine; Sinus bradycardia; Sinuatrial node; Norepinephrine; Acetylcholine; Muscarinic receptors-2; Adenosine receptors-1; Rabbits

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Background: Severe pain caused by multiple rib fractures (MRF) can compromise oxygenation, ventilation and pulmonary functions so can affect patient outcome. Adequate pain control helps to avoid these complications. Thoracic paravertebral analgesia is comparable to thoracic epidural with fewer side effects. Methods: Seventy-five patients were randomly allocated into three groups, (n=25 each). Group (GM) received intravenous morphine with a loading dose of 0.1-0.2 mg/kg followed by PCA bolus of 1mg with a six min lockout. Group (GMD) received also intravenous morphine with a loading dose of 0.1-0.2 mg/kg then PCA bolus of 1 mg morphine plus 5 μg dexmedetomidine with a six min lockout. Group (GPV) received paravertebral morphine loading dose of 0.2 mg/kg then PCA bolus of 0.1 ml/kg of a solution with a concentration of 0.5 mg/ml morphine mixed with 1 μg/ml dexmedetomidine and 60 min lockout. Any patient with VAS score more than 4, a top-up dose was given until VAS ≤ 4 Results: No significant difference between the three groups as regards age, BMI, sex, and ASA. Road traffic accident was the main cause of blunt chest trauma (64%, 76% and 68% in GM, GMD, and GPV respectively). Total morphine requirements were significantly lower in GMD and GPV than GM and in GPV than GMD (GM=190.9 ± 45.26, GMD=117.1 ± 31.9 and GPV=86.2 ± 21.7). There was a significant decrease in nausea and vomiting in GMD and GPV than GM. No significant difference in RR between the three groups although 8 patients in GM developed respiratory depression which was significantly higher than in GMD (2 patients) and GPV (0 patient). No significant difference in HR, MAP, and SpO2 between the groups. VAS scores at rest and with cough were significantly lower in both GMD and GPV than GM. FVC, FEV1 and PaO2/FiO2 ratio were significantly increased and PaCO2 significantly decrease in GMD and GPV than GM. Conclusion: Adding dexmedetomidine to morphine either TPV or IV PCA significantly decreases VAS scores, improves pulmonary functions and also decrease morphine consumption with fewer side effects in patients with MRF.

Effects of hypothermia combined with dexmedetomidine on myocardial monophasic action potentials in isolated rabbit hearts

Objective To investigate the effects of hypothermia combined with dexmedetomidine on myocardial monophasic action potentials(MAPs)in isolated rabbit hearts. Methods Adult rabbits, weighing 2.0-2.5 kg, were heparinized and anesthetized with pentobarbital sodium 30 mg/kg.Their hearts were rapidly removed and retrogradely perfused in a Langendorff apparatus at 37 ℃.Eighteen hearts were randomly divided into 3 groups(n=6 each)using a random number table: control group(group C), hypothermia group(group H), and hypothermia+ dexmedetomidine group(group HD). The hearts were continuously perfused for 60 min with 37 ℃ K-H solution in group C, with 32 ℃ K-H solution in group H, or with 32 ℃ K-H solution containing dexmedetomidine 25 ng/ml in group HD.At the end of equilibration(T0)and at 15, 30 and 60 min of perfusion with K-H solution, HR and MAPs of left ventricular epicardium, mid-myocardium and endocardium were recorded.MAP duration at 50% repolarization(MAPD50)and at 90% repolarization(MAPD90), monophasic action potential amplitude(MAPA)and maximal velocity(Vmax)were calculated. Results Compared with group C, HR was significantly decreased, and MAPD50 and MAPD90 were prolonged at each time of perfusion with K-H solution in H and HD groups.There was no significant difference in HR, MAPD50 and MAPD90 between H group and HD group.There was no significant difference in MAPA and Vmax between the three groups. Conclusion Hypothermia combined with dexmedetomidine can lead to prolongation of myocardial repolarization, and dexmedetomidine exerts no effect on hypothermia-induced change in MAPs in isolated rabbit hearts. Key words: Hypothermia, induced; Dexmedetomidine; Action potentials; Intraoperative complications

DEEP THERMAL INFRARED IMAGING OF HR 8799 bcde: NEW ATMOSPHERIC CONSTRAINTS AND LIMITS ON A FIFTH PLANET

We present new $L^\prime$ (3.8 $\mu m$) and Br-$\alpha$ (4.05 $\mu m$) data and reprocessed archival $L^\prime$ data for the young, planet-hosting star HR 8799 obtained with Keck/NIRC2, VLT/NaCo and Subaru/IRCS. We detect all four HR 8799 planets in each dataset at a moderate to high signal-to-noise (SNR $\gtrsim$ 6-15). We fail to identify a fifth planet, "HR 8799 f", at $r$ $<$ 15 $AU$ at a 5-$\sigma$ confidence level: one suggestive, marginally significant residual at 0.2" is most likely a PSF artifact. Assuming companion ages of 30 $Myr$ and the Baraffe (Spiegel \& Burrows) planet cooling models, we rule out an HR 8799 f with mass of 5 $M_{J}$ (7 $M_{J}$), 7 $M_{J}$ (10 $M_{J}$), and 12 $M_{J}$ (13 $M_{J}$) at $r_{proj}$ $\sim$ 12 $AU$, 9 $AU$, and 5 $AU$, respectively. All four HR 8799 planets have red early T dwarf-like $L^\prime$ - [4.05] colors, suggesting that their SEDs peak in between the $L^\prime$ and $M^\prime$ broadband filters. We find no statistically significant difference in HR 8799 cde's colors. Atmosphere models assuming thick, patchy clouds appear to better match HR 8799 bcde's photometry than models assuming a uniform cloud layer. While non-equilibrium carbon chemistry is required to explain HR 8799 bc's photometry/spectra, evidence for it from HR 8799 de's photometry is weaker. Future, deep IR spectroscopy/spectrophotometry with the Gemini Planet Imager, SCExAO/CHARIS, and other facilities may clarify whether the planets are chemically similar or heterogeneous.

Comparison of dexmedetomidine, propofol and midazolam for short-term sedation in postoperatively mechanically ventilated neurosurgical patients.

Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. Ninety patients aged 20-65 years, ASA physical status I to III, undergoing neurosurgery and requiring postoperative ventilation were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.7 mcg/kg/h. Group P received propofol 1 mg/kg over 15 minutes as a loading dose, followed by 1-3 mg/kg/h. Group M received midazolam 0.04 mg/kg over 15 minutes as a loading dose, followed by 0.08 mg/kg/h. Heart rate, mean arterial pressure, sedation level, fentanyl requirement, ventilation and extubation time were recorded. Adequate sedation level was achieved with all three agents. Dexmedetomidine group required less fentanyl for postoperative analgesia. In group D there was a decrease in HR after dexmedetomidine infusion (p<0.05), but there was no significant difference in HR between group P and group M. After administration of study drug there was a significant decrease in MAP comparison to baseline value in all groups at all time intervals (p<0.05), except postextubation period (p>0.05). Extubation time was lowest in group P (p<0.05). Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol. Dexmedetomidine also reduced postoperative fentanyl requirements.

Abstract P6-06-20: Predictive factors for pathologic complete response and disease-free survival after neoadjuvant chemotherapy with trastuzumab: A multicenter retrospective observational study in patients with HER2-positive primary breast cancer (JBCRG-C03 study)

Abstract BACKGROUND: Addition of trastuzumab to neoadjuvant chemotherapy (NAC) improved pathologic complete response (pCR) rate in HER2-positive breast cancer. Although recent trials have shown favorable prognosis with NAC plus trastuzumab, clinicopathological factors to predict the outcome have not been fully understood. The aim of this study was to investigate the survival after NAC with trastuzumab and to explore the predictive factors. PATIENTS AND METHODS: This is a multicenter retrospective observational study. Patients with HER2-positive primary breast cancer treated with NAC plus trastuzumab from 2001 to 2010 were identified from the institutional database. Primary end point was disease-free survival (DFS). pCR was defined as ypT0/is+ypN0. Kaplan-Meier method was used to estimate DFS. Logistic regression and proportional hazard analysis were used to identify clinicopathological factors to predict pCR and DFS, respectively. RESULTS: 733 patients were included in the analysis (whole dataset). 425 were ER/PgR-negative (HR- dataset) and 306 were ER/PgR-positive (HR+ dataset). Radiation therapy was performed in 90% of lumpectomy and 31% of mastectomy. Hormonal therapy was performed in 84% of HR+ dataset. pCR rate was 45% in whole dataset, 60% in HR- dataset, and 34% in HR+ dataset. Table 1 showed the result of multivariate analysis for pCR in whole dataset. When HR+ and HR- dataset were analyzed separately, no definitive predictors for pCR were identified in multivariate analysis. Although the patients with pCR showed a significantly favorable prognosis than those without pCR at 3 years DFS, in whole dataset (93% vs 83%, p&amp;lt;0.0001) and HR- dataset (94% vs 80%, p&amp;lt;0.0001), there was no significant difference in HR+ dataset (89% vs 86%, p = 0.10). Different predictors were selected for DFS when multivariate analysis was conducted separately between HR- and HR+ dataset (Table 2). CONCLUSIONS: In this observational study, we clarified predictors for pCR and DFS in HER2-positive patients treated with neoadjuvant trastuzumab containing therapy based on tumor subtype. Our results may help us to predict the prognosis more precisely and to simulate the disease course. Table 1) Multivariate logistic regression analysis for pCR in whole datasetFactorsOR95%CIp-valuePost- vs Pre-menopause1.50(1.05-2.15)0.026*cT1-2 vs cT3-41.72(1.16-2.59)0.008*ER/PgR-negative vs ER/PgR-positive3.32(2.30-4.82)&amp;lt;0.0001*Grade 3 vs 1-21.28(0.89-1.84)0.183 Table 2) Multivariate proportional hazard analysis for DFSFactors†HR95%CIp-valueWhole dataset Pre- vs Post-menopause1.61(1.04-2.52)0.033*cN2-3 vs cN03.06(1.58-6.24)0.001*cN1 vs cN02.26(1.23-4.41)0.007*Grade 3 vs 1-21.87(1.20-2.97)0.006*non-pCR vs pCR1.90(1.18-3.13)0.008*HR- dataset Pre- vs Post-menopause1.70(1.01-2.85)0.046*cT3-4 vs cT1-21.86(1.09-3.17)0.024*non-pCR vs pCR3.28(1.90-5.87)&amp;lt;0.0001*HR+ dataset cN2-3 vs cN05.01(1.79-16.19)0.002*cN1 vs cN03.50(1.40-10.61)0.006*Grade 3 vs 1-22.95(1.52-5.87)0.001*†Only factors with statistical significance Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-20.

Effect of sufentanil preconditioning on expression of Toll-like receptor 4 in myocardium during myocardial ischemia-reperfusion in rats

Objective To investigate the effect of sufentanil preconditioning on the expression of Toll-like receptor 4 (TLR4) in myocardium during myocardial ischemia-reperfusion (I/R) in rats.Methods Thirty-six male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =12 each):sham operation group (group S),I/R group and sufentanil preconditioning group (group SPC).Myocardial ischemia was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 2 h of reperfusion.In group SPC,the rats were subjected to 3 consecutive cycles of 5 min sufentanil infusion at 0.2 μg· kg-1 ·min-1 via the femoral vein at 5 min interval before ischemia.In groups S and I/R,the rats were subjected to the equal volume of normal saline instead.HR and mean arterial pressure (MAP) were recorded at 30 min before ischemia (T0),immediately before ischemia (T1),at 30 min of ischemia (T2),and at 30 and 120 min of reperfusion (T3-4).At the end of reperfusion,blood samples were obtained to determine the serum concentration of TNF-α.The rats were then sacrificed and hearts were removed for measurement of myocardial infarct size and expression of TLR4 and NF-κB p65 in myocardium (using Western blot).Results There was no significant difference in HR among the three groups (P ＞ 0.05).Compared with group S,MAP was significantly decreased at T2-4,the serum concentration of TNF-α was increased,and the expression of TLR4 and NF-kB p65 protein in myocardium was upregulated in groups I/R and SPC (P ＜ 0.01).Compared with group I/R,no significant difference was found in MAP at all time points (P ＞ 0.05),and myocardial infarct size was significantly decreased,serum concentrations of TNF-α were decreased,and the expression of TLR4 and NF-κB p65 protein in myocardium was down-regulated in group SPC (P ＜ 0.01).Conclusion The mechanism by which sufentanil preconditioning alleviates myocardial I/R injury may be related to down-regulation of TLR4 expression in rat myocardium. Key words: Sufentanil; Ischemic preconditioning; Toll-like receptor 4; Myocardial reperfusion injury