Time Points T1 Research Articles

Effects of electroacupuncture on insulin resistance in patients with knee arthroplasty

To explore the effect of electroacupuncture on the improvement of insulin resistance after knee joint replacement based on the combined spinal and epidural anesthesia and postoperative epidural analgesia. Eighty patients with insulin resistance but normal blood glucose were randomly divided into a control group and an observation group, 40 cases in each group.Both groups of patients underwent combined spinal and epidural anesthesia and postoperative epidural analgesia for knee arthroplasty. On the basis of the treatment,electroacupuncture (EA) was applied during the operation and within 1 month after the operation in the observation group, and EA was used at Hegu (LI 4), Qihai (CV 6), Zhongwan (CV 12), Pishu (BL 20), Shenshu (BL 23), etc. once every other day. The control group was not treated with electroacupuncture. Fasting blood glucose and fasting insulin were recorded 30 min before surgery (T0), immediately (T1), 1 d (T2), 3 d (T3), 7 d (T4) and 1 month (T5) after surgery, and the insulin resistance (IR) index was calculated. Compared with those at T0 time point, the IR index of the control group at T1, T3, T4 and T5 time points and the observation group at T1, T4, T5 time points were lower (all P<0.05). Compared with the control group at the same time point, the IR index of the T1 and T5 time points in the observation group was significantly lower (both P<0.05), and it was lower than the insulin resistance standard. Combined spinal and epidural anesthesia and postoperative epidural analgesia can improve short-term insulin resistance. Combined with EA, the improvement of insulin resistance is more obviously and longer.

The TAM-TB Assay-A Promising TB Immune-Diagnostic Test With a Potential for Treatment Monitoring.

Tuberculosis (TB) epidemiology is changing in Western and Central Europe due to the rise in immigration and refugees fleeing high-TB-burden areas of war and devastation. The change in local demography and the lack of sensitive and specific TB diagnostic and monitoring tools, especially for cases of childhood TB, leads to either missed cases or over-treatment of this group. Here we present a promising new diagnostic approach, the T cell activation marker (TAM)-TB assay, and its performance in a case of extra-pulmonary TB occurring in a 16 year old refugee from Afghanistan. This assay is based on the characterization of 3 activation markers (CD38, HLA-DR, and Ki67) and one maturation marker (CD27) on M. tuberculosis-specific CD4 T cells. It was performed at time-points T0 (10 days), T1 (1 month), T2 (6 months), and T3 (12 months) post-treatment initiation. All markers were able to detect active tuberculosis (aTB) within this patient at T0 and reverted to a healthy/LTBI phenotype at the end of treatment. Tantalizingly, there was a clear trend toward the healthy/LTBI phenotype for the markers at T1 and T2, indicating a potential role in monitoring anti-TB treatment in the future. This assay may therefore contribute to improved TB diagnostic algorithms and TB treatment monitoring, potentially allowing for individualization of TB treatment duration in the future.

Transferring knowledge into practice? Exploring the feasibility of action learning for improving knowledge, skills and confidence in clinical communication skills

BackgroundEffective communication between patients and practitioners is fundamental to the delivery of high-quality care. This is particularly important in the complex and challenging nature of working in palliative and end of life care. Following specialist communication skills training, a group of healthcare professionals explored the impact of action learning (AL) on the perceptions of their knowledge, skills and confidence in communication skills. The research also aimed to establish an evidence base by exploring the nature and impact of the AL approach employed to facilitate improvements in professional practice.MethodsThe research employed a mixed methods approach. Learners (n = 57) scored their perceptions in key areas of communication skills through questionnaires as a baseline measure at time point T0. From this group, 12 participants were selected to undertake further follow-up, divided into Control (n = 6) and Intervention arms (n = 6). All repeated the same questionnaire at 3 subsequent time points (T1, T2, T3) scheduled monthly. Half also received additional telephone-coaching conversation intervention based on Weber’s TLA® critical and reflexive approach (2014). To explore and assess perceptions, similarities and differences of their experience of undertaking the specific AL approach and processes, all completed participants (n = 4) and coaches (n = 2) were interviewed at time point T4 (33% response rate). Quantitative data from questionnaires was analysed for comparison of variables to provide a visual illustration of perceived learning journeys. Qualitative data from coaching conversations, interviews and questionnaire responses was analysed inductively to create final themes.ResultsPerceived improvements in knowledge, skills and confidence measured at 35% at time point T0, and improvement of 46% reported at time point T3. In the Control arm this was calculated at 25%, and at 67% from the Intervention arm. Findings indicate encouraging evidence for perceived improvements of knowledge, skills and confidence.ConclusionsThe research demonstrates a positive appetite for, and experience of, the process and method. The value of such a solution-focused, critically reflexive AL practice suggests this may act as a facilitator for successful transfer of learning into practice for individuals and their organisations.

Ropivacaine for Intercostal Nerve Block Improves Early Postoperative Cognitive Dysfunction in Patients Following Thoracotomy for Esophageal Cancer.

BackgroundRopivacaine is commonly used as an intercostal nerve block, but its effects on postoperative cognitive dysfunction (POCD) have not previously been investigated. This study aimed to examine the effects of the use of ropivacaine as an intercostal nerve block on early POCD, postoperative analgesia, and inflammation in patients following thoracotomy for esophageal cancer.Material/MethodsOne hundred patients with esophageal cancer undergoing thoracotomy were randomly divided into a group with intercostal nerve block (group A) (n=50) and a control group (group B) (n=50). The cognitive function score and visual analog scale (VAS) scores for pain were measured at one hour before surgery (T1), two hours after surgery (T2), 12 hours after surgery (T3), and 24 hours after surgery (T4). Blood samples were collected at each time point, and plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-10, and S100-β were measured using an enzyme-linked immunosorbent assay (ELISA). Cognitive function was determined using the Mini-Mental State Examination (MMSE) scale.ResultsThe VAS scores in group A were significantly lower compared with group B (p<0.05). In the T2, T3, and T4 time points, group A had significantly increased MMSE scores compared with group B (p<0.05). Compared with group B, the levels of IL-6 and TNF-α were significantly decreased in group A at T3 and T4 (p<0.05), while the levels of IL-10 were significantly increased (p<0.05) when compared with group A.ConclusionsThe use of the intercostal nerve block, ropivacaine, improved early PCOD in patients following thoracotomy for esophageal cancer.

Sublingual microcirculation in pancreatico-biliary surgery: An observational study.

An observational cohort study was conducted to identify potential sublingual microcirculation parameters as a target for goal-directed fluid therapy. Patients that were scheduled for an open elective pancreatico-biliary surgery in Erasmus Medical Center were included. All patients underwent sublingual microcirculatory measurement at three time points: one day before surgery (T0), within the first 24 hours after surgery (T1) and on the fourth day after surgery (T2). The following parameters were obtained: microvascular flow index (MFI (AU)), Total vessels density (TVD (mm/mm2/)), Perfused vessels density (PVD (mm/mm2)), and proportion of perfused vessels (PPV (%)). Sixteen patients were included in the final analysis. The differences between the time points T1 and T0 in patients without clinical significant complication and in patients with these complications gave a significant difference for PVD small vessels (PVDs) (delta PVDs mean -0.1 vs -8.2, p=0.01) and PPV small vessels (PPVs) (delta PPVs median 7.0 % vs -15.5 %, p=0.01). The most significant microcirculatory parameter for a perioperative complicated course is the change of PVD and PPV. In the first 24 hours after surgery, if these parameters decrease there is a high chance of a complicated perioperative course.

Propofol activates autophagic activity of vascular endothelial cells by inhibiting SENP1 expression and attenuates vascular endothelial injury induced by ischemia-reperfusion in orthopedic surgery

The aim of this study was to examine the effect and mechanism of SENP1 in the protection of vascular endothelial cells by propofol during ischemia-reperfusion (IR) injury. Thirty-eight patients undergoing minor lower limb orthopedic surgery under general anesthesia were included, and divided evenly into sevoflurane group and propofol group. Peripheral blood was collected before fixing tourniquets (T0 time point) and one hour after releasing tourniquets (T1 time point). Contents of endothelin, vWF and malondialdehyde were determined by enzyme-linked immunosorbent assay to evaluate vascular injury. Quantitative real-time polymerase chain reaction was used to determine mRNA expression; western blotting, to determine protein expression; CCK-8 assay, Transwell assay and flow cytometry, to examine the proliferation, migration and apoptosis of human umbilical vein endothelial cells (HUVECs); western blotting and laser scanning confocal microscopy, to analyze autophagy of HUVECs; protein immunoprecipitation, to examine the relationship between SENP1 and the SUMOylation of autophagy-associated VPS34 protein. The results showed that the contents of peripheral blood vessel injury markers and the expression of SENP1 were elevated when vascular injury was induced by IR in patients undergoing orthopedic surgery, whereas propofol reduced these levels. Inhibition of SENP1 expression reduced injury of HUVECs induced by IR. Silencing expression of SENP1 promoted autophagy of HUVECs. SENP1 promoted deSUMOylation of VPS34, leading to reduced autophagy of HUVECs. The study demonstrates that propofol activates autophagic activity of HUVECs by inhibiting SENP1 expression and attenuates vascular endothelial injury induced by IR in orthopedic surgery. This effect may be related to SENP1 regulating the deSUMOylation of VPS34.

Blood absorption capacity of different xenograft bone substitutes. An in-vitro study.

BackgroundCommercially available xenograft blocks, claim to have adequate characteristics to interact with biological media and thus permitting biological fluid absorption. The objective of this in vitro study was to compare the blood absorption capacity of four different xenograft block materials of different composition of collagen and porosity.Material and MethodsFour brands of xenograft block materials were used (NuOss®, Bio-Oss®, Osteobiol® and Smartbone®). Five samples of each brand were analyzed, making a total of 20 tests. Human blood was used as the absorption liquid for the present experiment. The time period, in which the block remains in contact with the blood, was registered at 30 seconds (T1), 60 seconds (T2) and 5 minutes (T3). The xenograft blocks were evaluated according to their absorption capacity.ResultsThe absorption capacity of the different biomaterials were statistical significant different (p<0,001) at T1, T2 and T3 time points. At 30 seconds, Smartbone® absorbed significantly less blood than NuOss® and Bio-Oss®, however, without differences comparing with Osteobiol®. The NuOss®, Bio-Oss® and Osteobiol® did not register any significant difference between them. At 60 seconds, the Smartbone® absorbed significantly less blood than the other biomaterials.ConclusionsThe NuOss® was significantly superior than Osteobiol®, but without differences relatively with Bio-Oss®. Also the Bio-Oss® and Osteobiol® did not register any difference between them. At 5 minutes, the Smatbone® continued to significantly absorbed less blood than any other biomaterial, nevertheless, NuOss®, Bio-Oss® and Osteobiol® not register again any significant difference between them. Despite of small sample size, it can be concluded that NuOss® was superior, in terms of blood absorption capacity, comparing with the other block biomaterials at 30 seconds, 60 seconds and 5 minutes. However, more investigation in a clinical setting are needed to know the clinical implications of the absorption capacity of such biomaterials. Key words:Blood absorption, osteoconduction, xenograft, bone regeneration.

Application of remifentanil combined with propofol in the diagnosis of colon cancer with awakening painless digestive endoscopy.

Anesthetic effect of remifentanil combined with propofol in awakening painless endoscopy was analyzed. Retrospective analysis of 120 cases of colon cancer were treated in Dongying People's Hospital from June 2015 to December 2017. All of them were treated by awakening painless digestive endoscopy, divided into 60 cases in observation group (combined with remifentanil and propofol anesthesia), and 60 cases in control group (combined intravenous anesthesia of finanib and propofol). The data were respectively recorded at time-points of oxygen inhalation, intubation for 10 min, awakening time, waking time, and the time-points for each represented as the time-points of T1, T2, T3, T4, T5 and recorded the diastolic blood pressure (DBP), respiratory rate (RR) and heart rate (HR), and compared the awakening effect and the occurrence of adverse reaction. There was no significant difference in the DBP index between the two groups at time-point T1 (P>0.05). The time-points of T2, T3, T4 and T5 were significantly different from the observation group (P<0.05). There was no significant difference in RR index between the two groups and between the same groups (P>0.05). Compared with the control group, the awakening time and consciousness recovering of the observation group is lower (P<0.05). The incidence of adverse reactions after awakening operation between the two groups was statistically significant (P<0.05). The local pain rate in the observation group after the awakening operation was lower than the control group. The combined use of trace remifentanil and small dose propofol in the awakening painless digestive endoscopy can make the patients with colon cancer more stable when they are in the awakening state, so as to improve the safety of awakening painless digestive endoscopy. It is worth promoting in clinical practice.

Supine vs. Prone Position With Turn of the Head Does Not Affect Cerebral Perfusion and Oxygenation in Stable Preterm Infants ≤32 Weeks Gestational Age.

Intraventricular hemorrhage (IVH) is a frequent major damage to the brain of premature babies ≤32 weeks gestational age, and its incidence (20–25%) has not significantly changed lately. Because of the intrinsic fragility of germinal matrix blood vessels, IVH occurs following disruption of subependymal mono-layer arteries and is generally attributed to ischemia-reperfusion alterations or venous congestion, which may be caused by turn of the head. Therefore, supine position with the head in a midline position is considered a standard position for preterm infants during their first days of life. We asked whether a change in body position (supine vs. prone) linked with a turn of the head by 90° in the prone position would change blood flow velocities and resistance indices in major cerebral arteries and veins of stable premature babies at two different time points (t0, day of life 2, vs. t1, day 9). Moreover, we assessed cerebral tissue oxygenation (cStO2) by near-infrared spectroscopy and determined correlations for changes in velocities and oxygenation. Twenty one premature infants [gestational age 30 (26–32) weeks] with sufficiently stable gas exchange and circulation were screened by ultrasonography and near-infrared spectroscopy. Peak systolic and end-diastolic blood flow velocities in the anterior cerebral arteries (29 ± 6 m/s vs. 28 ± 7 peak flow at t0, 36 ± 8 vs. 35 ± 7 at t1), the basilar artery, the right and the left internal carotid artery, and the great cerebral vein Galen (4.0 ± 0.8 m/s vs. 4.1 ± 1.0 maximum flow at t0, 4.4 ± 0.8 vs. 4.4 ± 1.0 at t1) did not show significant differences following change of body and head position. Also, there were no differences in cStO2 (83 ± 7% vs. 84 ± 7 at t0, 76 ± 10 vs. 77 ± 11 at t1) and in vital signs such as heart rate and blood pressure. We conclude that change in body position with turn of the head in the prone position does not elicit significant alterations in cerebral blood flow velocities or in oxygenation of cerebral tissues. Maturational changes in arterial flow velocities and cStO2 are not correlated. For this subgroup of premature infants at low risk of IVH our data do not support the concept of exclusive preterm infant care in supine position.

Impact of CYP3A4*1G Polymorphism on Fentanyl Analgesia Assessed by Analgesia Nociception Index in Chinese Patients Undergoing Hysteroscopy.

Background:The clinical efficacy of fentanyl for pain control differs greatly across individuals. The purpose of this study was to investigate the impact of CYP3A4*1G polymorphism including wild-type homozygote (CYP3A4*1/*1, GG), mutant heterozygote (CYP3A4*1/*1G, GA), and mutant homozygote (CYP3A4*1G/*1G, AA) on fentanyl analgesia in Chinese patients undergoing hysteroscopy by the assessment of analgesia nociception index (ANI).Methods:A total of 200 gynecologic patients scheduled for elective hysteroscopy under general anesthesia at Peking University People's Hospital from May to December in 2017 were enrolled in this study. Venous blood was withdrawn for genotyping of CYP3A4*1G before operation. Fentanyl 1 μg/kg was administered preoperatively followed by target-controlled infusion of propofol for induction and maintenance. Intraoperative analgesic efficacy of fentanyl was assessed by ANI monitoring at T0 (entering room), T1 (cervical dilation), T2 (start of cervical aspiration), and T3 (end of cervical aspiration) time points. The duration of propofol infusion and total dosage of propofol were recorded as well.Results:The patients were divided into three groups according to CYP3A4*1G polymorphism, including 143 in GG group, 47 in GA group, and 10 in AA group. There was no significant difference in clinical demographics among three groups. The frequency of CYP3A4*1G variant alleles accounted for 16.8% and the distribution of variant alleles was consistent with Hardy–Weinberg equilibrium. Using a multilevel model, ANI values at T1 (63.81 ± 19.61), T2 (63.63 ± 17.82), and T3 (65.68 ± 17.79) were significantly lower than that at T0 (77.16 ± 12.93) in the study population (F = 23.50, P < 0.001), suggesting that higher levels of pain at T1, T2, and T3 than T0. Patients with GG genotype showed significantly lower ANI than those with GA or AA genotypes during hysteroscopy under the same dose of fentanyl.Conclusion:CYP3A4*1G polymorphism associated with the analgesic efficacy of intraoperative fentanyl in the patients undergoing hysteroscopy under general anesthesia.

Motor system recruitment during action observation: No correlation between mu-rhythm desynchronization and corticospinal excitability.

Observing others’ actions desynchronizes electroencephalographic (EEG) rhythms and modulates corticospinal excitability as assessed by transcranial magnetic stimulation (TMS). However, it remains unclear if these measures reflect similar neurofunctional mechanisms at the individual level. In the present study, a within-subject experiment was designed to assess these two neurophysiological indexes and to quantify their mutual correlation. Participants observed reach-to-grasp actions directed towards a small (precision grip) or a large object (power grip). We focused on two specific time points for both EEG and TMS. The first time point (t1) coincided with the maximum hand aperture, i.e. the moment at which a significant modulation of corticospinal excitability is expected. The second (t2), coincided with the EEG resynchronization occurring at the end of the action, i.e. the moment at which a hypothetic minimum for action observation effect is expected. Results showed a Mu rhythm bilateral desynchronization at t1 with differential resynchronization at t2 in the two hemispheres. Beta rhythm was more desynchronized in the left hemisphere at both time points. These EEG differences, however, were not influenced by grip type. Conversely, motor potentials evoked by TMS in an intrinsic hand muscle revealed an interaction effect of grip and time. No significant correlations between Mu/Beta rhythms and motor evoked potentials were found. These findings are discussed considering the spatial and temporal resolution of the two investigated techniques and argue over two alternative explanations: i. each technique provides different measures of the same process or ii. they describe complementary features of the action observation network in humans.

A Comparative Study on Efficacy and Safety of Propofol versus Dexmedetomidine in Sleep Apnea Patients undergoing Drug-Induced Sleep Endoscopy: A CONSORT-Prospective, Randomized, Controlled Clinical Trial.

The aim of this study is to compare the efficacy and safety of propofol with dexmedetomidine in patients with obstructive sleep apnea hypopnea syndrome (SAHS) undergoing drug-induced sleep endoscopy (DISE). The 88 patients diagnosed with SAHS in the Affiliated Hospital of Xuzhou Medical University were randomly allocated into 2 groups (n = 44). Patients in the group dexmedetomidine (group D) received continuous intravenous infusion of dexmedetomidine 1 μg/kg over 15 minutes before the endoscopy, and propofol 2 mg/kg was intravenously administrated in the group propofol (group P). Cardiopulmonary parameters of patients were recorded. The time to fall asleep, duration of endoscopic examination, the wakeup time of patients, the number of mask ventilations for patients, the satisfaction of patients and endoscopic performers, and false positive cases of SAHS of patients were compared between the two groups. Compared with group D, mean arterial pressure (MAP) and blood oxygen saturation (SPO2) of patients in the P group were lower at the time point of T1 (P < 0.05), the duration of endoscopic examination and wakeup time of patients were obviously prolonged, the incidence of mask ventilation for patients and false positive cases of SAHS of patients was observably higher, and the satisfaction of endoscopic performers was markedly lower, but the time to fall asleep was significantly shortened (P < 0.05). Dexmedetomidine served as a novel sleep induced drug and can provide satisfactory conditions and be safely and effectively applied for endoscopy in patients with SAHS, without adverse hemodynamic effects.

The Impact of Probiotic Supplements on Cognitive Parameters in Euthymic Individuals with Bipolar Disorder: A Pilot Study

Introduction: Cognitive dysfunction is prevalent in depressive as well as manic episodes in individuals with Bipolar Disorder (BD). Even more, after symptom remission, many individuals with BD experience persisting cognitive impairment also in euthymic periods, leading to high illness burden and low quality of life. According to a recent research in animals and healthy humans, microbiota may influence cognitive processes via the brain-gut axis. A strategy to examine the role of the microbiota in different diseases is the intake of supplements that modulate the gut microbiome. The aim of this pilot study was to analyze the impact of probiotic supplements on cognitive parameters in a cohort of euthymic individuals with BD, receiving daily probiotic treatment over a time period of 3 months. Methods: A total of 20 euthymic individuals with BD received probiotic supplement over a time period of 3 months and completed a cognitive test battery at 3 time points (t1 at time of inclusion, t2 after one month and t3 after 3 months of probiotic intake). Results: We found a significant improvement of performance concerning attention and psychomotor processing speed measured with the Digit Symbol Test after one (t2) as well as after 3 months (t3) of treatment (F = 8.60; η² = 0.49, p < 0.01). Furthermore, executive function measured with the TMT-B, increased significantly over 3 months (F = 3.68; η² = 0.29, p < 0.05). Conclusion: The results confirm the hypotheses that probiotic supplement might help stable individuals with BD to improve the cognitive function, which in turn might lead to better psychosocial, occupational, work and financial functioning. Nevertheless, the idea of this potential new treatment is challenging because of the variety of the human’s gut microbiota.

Effect of anesthetic methods on postoperative CD3+, CD4+ and CD4+CD25+ in patients with lung cancer undergoing radical operation.

Effects of anesthesia methods on immune function in patients with lung cancer undergoing radical operation were investigated. A total of 122 patients undergoing radical resection of lung cancer who were treated in Zhejiang Cancer Hospital from September 2013 to April 2016 were randomly divided into the combined anesthesia group and the intravenous anesthesia group, with 61 cases in each group. The patients in the combined anesthesia group were given intravenous combined epidural anesthesia. Patients in the intravenous anesthesia group were given intravenous anesthesia. The change of CD3+, CD4+ and CD4+CD25+ at time-point T0 (before anesthesia), T1 (the time of anesthesia), T2 (after operation), T3 (24 h after operation), T4 (72 h after operation) were compared between the two groups. The levels of CD3+, CD4+ and CD4+CD25+ at T1, T2, T3 and T4 in the combined anesthesia group were higher than that in the intravenous anesthesia group (P<0.05). Αfter starting anesthesia, the levels of CD3+, CD4+ and CD4+CD25+ began to decrease in both groups. The levels of CD3+, CD4+ and CD4+CD25+ at T2 and T1 were lower than those at T0 (P<0.05). The levels of CD3+, CD4+ and CD4+CD25+ at T2 were lower than T1 (P<0.05). After T3, the levels of CD3+, CD4+ and CD4+CD25+ began to increase in both groups. Τhe levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were higher in both groups than those at T2 and T1 (P<0.05), and the levels of CD3+, CD4+ and CD4+CD25+ at T4 were higher in both groups than those at T3, but the levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were lower than those at T0 (P<0.05). Intravenous combined epidural anesthesia can maintain a relatively stable immune function compared with simple intravenous anesthesia patients.

Protective effect of ulinastatin combined with dexmedetomidine on lung injury after cold ischemia-reperfusion in rats.

We investigated the protective effect of ulinastatin combined with dexmedetomidine on lung injury after hepatic ischemia-reperfusion in rats. A total of 60 healthy and clean male Sprague Dawley (SD) rats were divided into the blank control group (group O), the model control group (group K), the ulinastatin and dexmedetomidine group (group F) according to random number table with 20 rats in each group. The plasma concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) and malondialdehyde (MDA) at T1, T2 and T3 time points in rats of the three groups were significantly higher than those of the T0 time point (p<0.05). The superoxide dismutase (SOD) activity in the plasma of rats of the three groups was significantly lower at T1, T2 and T3 time point when compared with that of T0 (p<0.05). The concentrations of TNF-α, IL-6, IL-8 and MDA in group K at T1, T2 and T3 moments were significantly higher than those of group O (p<0.05). However, the concentrations of IL-6, IL-8, TNF-α and MDA in group F at T1, T2, T3 were significantly lower than those of group K (p<0.05). The activities of SOD in group K at T1, T2, T3 were all significantly higher than those of group O (p<0.05). Meanwhile, the activities of SOD in group F at T1, T2, T3 were significantly higher than those of group K (p<0.05). Ulinastatin combined with dexmedetomidine can reduce the inflammatory response and inhibit lipid peroxidation, eventually alleviating acute lung injury after hepatic ischemia-reperfusion in rats.

Supportive Care in Radiotherapy Based on a Mobile App: Prospective Multicenter Survey.

BackgroundConsumer electronics and Web-enabled mobile devices are playing an increasing role in patient care, and their use in the oncologic sector opens up promising possibilities in the fields of supportive cancer care and systematic patient follow-up.ObjectiveThe objective of our study was to assess the acceptance and possible benefits of a mobile app–based concept for supportive care of cancer patients undergoing radiotherapy.MethodsIn total, 975 patients presenting for radiotherapy due to breast or prostate cancer were screened; of them, 200 owned a smartphone and consented to participate in the survey. Patients were requested to complete a questionnaire at 2 time points: prior to the initiation (T0) and after the completion (T1) of radiotherapy. The questionnaire included questions about the habits of smartphone usage, technical knowledge and abilities of the participants, readiness to use a mobile app within the context of radiotherapy, possible features of the mobile app, and general attitude toward the different aspects of oncologic treatments. For quantitative analysis, sum scores were calculated for all areas of interest, and results were correlated with patient characteristics. Additionally, answers were quantitatively compared between time points T0 and T1.ResultsMedian patient age was 57 (range 27-78) years. Of the 200 participants, 131 (66.2%) reported having the ability to use their smartphones with minimal to no help and 75.8% (150/200) had not used their smartphones in a medical context before. However, 73.3% (146/200) and 83.4% (166/200) of patients showed a strong interest in using a mobile app for supportive care during radiotherapy and as part of the clinical follow-up, respectively. Patients most commonly requested functionalities regarding appointment scheduling in the clinic (176/200, 88.0%) and the collection of patient-reported outcome data regarding their illness, therapy, and general well-being (130/200, 65.0%). Age was identified as the most influential factor regarding patient attitude, with patients aged <55 years being significantly more inclined toward and versed in smartphone use (P<.001). The acceptance of mobile apps was significantly higher in patients exhibiting a Karnofsky performance index <80% (P=.01). Support in the context of therapy-related side effects was judged most important by patients with poor clinical performance (P=.006). The overall acceptance of mobile apps in the context of radiotherapy surveillance was high at a median item sum score of 71.4/100 and was not significantly influenced by tumor stage, age, gender, treatment setting, or previous radiotherapies.ConclusionsThe acceptance of mobile apps for the surveillance and follow-up of cancer patients undergoing radiotherapy is high; this high acceptance level will serve as a basis for future clinical trials investigating the clinical benefits of mobile app–based treatment support. Introduction of mobile apps into the clinical routine should be considered as an opportunity to improve and intensify supportive treatment for cancer patients.

The Difference in Perceptual Anticipation Between Professional Tennis Athletes and Second-Grade Athletes Before Batting.

To investigate the differences in cognitive processing of perceptual anticipation of tennis players at different levels before batting by the event-related potential (ERP) technique, we used the skilled-expert paradigm. We compared the cognitive and neural mechanisms of professional tennis athletes and second-grade athletes relating to their perceptual anticipation of the batting line at different time points [the time point of the ball landing (T0), and the 80 ms before batting time point (T1)]. The results showed that, regardless of the T0 or T1 time point, professional tennis athletes had shorter anticipation times and higher correct batting line rates than second-grade athletes. The ERP results demonstrated that compared with second-grade athletes, professional tennis athletes induced smaller N1 amplitudes and larger P2 amplitudes in early perceptual anticipation, and induced smaller N2 and larger P3 amplitudes in late perceptual anticipation. These studies suggest that, regardless of whether they are in an early or late stage, tennis professional athletes are faster and more accurate in respect of their perceptual anticipation of tennis lines than second-grade athletes are. This is possible since the relevant neural network of the former is more easily activated and faster. The prefrontal cortex may be a critical area of the brain for perceptual anticipation in tennis.

Evaluation of three-dimensional superimposition technique on parietal bone of the puberty beagle dogs.

This study aimed to (a) evaluate the stability of the parietal bone of 6-9months old beagles and (b) examine whether parietal regional superimposition can provide an atraumatic and effective solution for further maxillary expansion study. Six prepubertal 6-month-old male beagles were included. Six miniscrew markers were inserted into the left and right sides of the parietal bone, and two of them were placed bilaterally near the palatal suture. The subjects were scanned with cone beam computed tomography (CBCT) at three time points of T0 (6months old), T1 (7.5months old) and T2 (9months old), respectively. All skull models were analyzed by both the miniscrew superimposition and the parietal regional superimposition. The two superimposition methods had no significant difference (p>0.05) in displacements of miniscrew markers between left and right first premolars (PM1). The maxillary superimposition between T0 and T2 indicated that the length and width of the maxillary as well as the width of the zygoma root increased significantly (p<0.05), while the height of maxillary had no significant difference (p>0.05) over the 3months. The parietal bone is relatively stable for beagles from 6months old to 9months old and thus can be used as a reference region for 3D skull model superimposition of the beagle dog.

A Prospective, Randomized, Phase III Study to Evaluate the Efficacy and Safety of Fibrin Sealant Grifols as an Adjunct to Hemostasis as Compared to Cellulose Sheets in Hepatic Surgery Resections

BackgroundLocal hemostatic agents have a role in limiting bleeding complications associated with liver resection. MethodsIn this randomized, phase III study, we compared the efficacy and safety of Fibrin Sealant Grifols (FS Grifols) with oxidized cellulose sheets (Surgicel®) as adjuncts to hemostasis during hepatic resections. The primary efficacy endpoint was the proportion of patients achieving hemostasis at target bleeding sites (TBS) within 4 min (T4) of treatment application. Secondary efficacy variables were time to hemostasis (TTH) at a later time point if re-bleeding occurs and cumulative proportion of patients achieving hemostasis by time points T2, T3, T5, T7, and T10. ResultsThe rate of hemostasis by T4 was 92.8% in the FS Grifols group (n = 163) and 80.5% in the Surgicel® group (n = 162) (p = 0.01). The mean TTH was significantly shorter (p < 0.001) in the FS Grifols group (2.8±0.14 vs. 3.8±0.24 min). The rate of hemostasis by T2, T5, and T7 was higher and statistically superior in the FS Grifols group compared to Surgicel®. No substantial differences in adverse events (AE) were noted between treatment groups. The most common AEs were procedural pain (36.2 vs. 37.7%), nausea (20.9 vs. 23.5%), and hypotension (14.1 vs 6.2%). ConclusionsFS Grifols was safe and well tolerated as a local hemostatic agent during liver resection surgeries. Overall, data demonstrate that the hemostatic efficacy of FS Grifols is superior to Surgicel® and support the use of FS Grifols as an effective local hemostatic agent in these surgical procedures.

Efficacy of radial extracorporeal shock wave therapy compared to botulinum toxin type a in the treatment of lower extremity spasticity in patients with cerebral palsy

Radial extracorporeal shock wave therapy (rESWT) and infiltration with botulinum toxin type A (BoNT-A) are established therapies for spasticity in cerebral palsy. Using a randomized, controlled, cross-over clinical trial design (level of evidence, 1) this study tested the null hypothesis that infiltration with BoNT-A is more efficient in reducing plantar flexor muscle spasticity in patients with cerebral palsy than rESWT. Seventy patients were randomly allocated to rESWT (Group A; n = 35) (three rESWT sessions; one session per week; 2000 radial extracorporeal shock waves [rESWs] per session; positive energy flux density of the rESWs between 0.10 and 0.12 mJ/mm 2 ) or a single infiltration with BoNT-A (Group B; n = 35) at time point T0. Six months after T0 (i.e., at time point T1) patients in Group A received a single infiltration with BoNT-A, and patients in Group B three rESWT sessions as described for patients in Group A. Treatment success was evaluated using V1 and V3 of the Tardieu scale at three weeks (W3), two months (M2) and three months (M3) after both T0 and T1. In six out of 32 direct comparisons (two muscles [soleus and gastrocnemius], two tests [V1 and V3 of the Tardieu scale], two rounds of treatment [starting at T0 and T1] and four times of evaluation per round of treatment [at T0 and T1 baseline as well as at W3, M2 and M3 after both T0 and T1]) rESWT resulted in statistically significantly better outcome than infiltration with BoNT-A. The null hypothesis was rejected. There were no significant complications. This study demonstrates that rESWT may be superior to infiltration with BoNT-A in the treatment of plantar flexor muscle spasticity in patients with cerebral palsy. Further studies need to evaluate long-term effectiveness and safety of rESWT in the treatment of plantar flexor muscle spasticity in patients with cerebral palsy.