The efficacy of NMDA receptor antagonists for preventing remifentanil-induced increase in postoperative pain and analgesic requirement: a meta-analysis

BACKGROUND

Meta-analysis was performed to evaluate the preventive effects of N-methyl-D-aspartate (NMDA) receptor antagonists on remifentanil-induced increase in postoperative pain and analgesic requirement in patients.

METHODS

Pubmed, EMBase, Springer and the Cochrane Controlled Trials Register were searched to identify all randomized controlled trials (RCTs) published to November 2010 which investigated the preventive effects of NMDA receptor antagonists on remifentanil-induced postoperative hyperalgesia and/or tolerance. The studies listed at the end of these articles as reference were also searched. Two authors independently assessed the quality of each study met the inclusion criteria and extracted data. Then Meta-analysis was perfomed using RevMan 5.0 software. The outcomes analyzed were the postoperative analgesic consumption, pain intensity scores, time to first analgesic request, and the incidence of adverse effects.

RESULTS

A total of 623 patients (223 in the ketamine group, 87 in the magnesium group and 313 in the control group) from 14 prospective RCTs were included in the Meta-analysis. Administration of NMDA receptor antagonists reduced the pain scores at 4 hr after operation (P<0.05), and the standardized mean differences (SMD) was -0.21 (95% confidence interval was -0.41 to -0.01). There were no significant differences in postoperative analgesic consumption, pain scores at other time points, time to first analgesic request and the incidence of adverse effects (P>0.05). Further subgroup analyses based on the type of intervention showed that the results were almost the same.

CONCLUSION

These data do not support the use of NMDA receptor antagonists, ketamine and magnesium sulfate to prevent the development of remifentanil-induced postoperative hyperalgesia and tolerance.

WE-E-213CD-04: CT to Cone-Beam CT Deformable Registration With Simultaneous Intensity Correction

PURPOSE

To develop and validate a robust CT to cone-beam (CBCT) deformable image registration algorithm that can handle CBCT artifacts and intensity inconsistency, and thus can yield accurate registration results.

METHODS

We propose a new algorithm called Deformation with Intensity Simultaneously Corrected (DISC). DISC distinguishes itself from the original demons by performing an intensity correction procedure on the CBCT image at every iteration step of demons registration. Specifically, the intensity correction of a voxel in CBCT is achieved by matching the first and the second moments of the image intensities inside a patch around this voxel with those on the CT image. It is expected that such a strategy can remove artifacts in the CBCT image, as well as ensuring the intensity consistency between the two modalities and hence facilitating the registration process. DISC is implemented on computer graphics processing units (GPUs) using the compute unified device architecture (CUDA) programming environment. The performance of DISC has been qualitatively and quantitatively evaluated on a simulated patient case and six head-and- neck cancer patient data.

RESULTS

Visual inspection shows that original demons distorts the tissues after registration, especially in regions which are heavily degraded by artifacts. DISC, on the other hand, can effectively register CT and CBCT image even in regions contaminated by severe artifacts. The intensity corrected CBCT that extracted from the last iteration of DISC is artifact-free and has similar histogram distribution with the deformed CT.

CONCLUSIONS

We have developed a robust CT to CBCT deformable image registration method that properly deals with the CBCT artifacts and intensity inconsistency, and thus yields accurate registration results. This work is supported in part by the University of California Lab Fees Research Program, the Master Research Agreement from Varian Medical Systems, Inc., and the grants from the National Natural Science Foundation of China (No.30970866).

SU-E-T-386: Gamma Analysis of Normalized and Un-Normalized Dose Distributions

PURPOSE

The gamma index method, as currently implemented in all commercial QA software, calls for selection of a normalization point to evaluate agreement between two dose distributions. The implication of this is that there is an infinite number of possible solutions! Which one to pick? A unique and more relevant solution is obtained only if no normalization point is used.

METHODS AND MATERIALS

The set of test cases suggested by the AAPM TG1 19 were planned using Pinnacle 8.0m and delivered on a Varian 21EX linac for 6 and 18 MV photons. The recommended point and planar dose measurements were obtained using a Pinpoint ion chamber, EDR2 film and MatriXX. The gamma index method using typical 3%, 3 mm criteria with and without a normalization point was used to assess the agreement between calculated and delivered planar dose distributions. The analysis was extended to a set of data for clinically treated patients.

RESULTS

The comparison with the TG119 benchmark data showed that all point dose and planar measurements for 6 MV were within the published range. Similar results, although without published data to compare with, were obtained for 18 MV as well. For all complex tests, the percentage of points passing the gamma criteria of 3%, 3 mm was (95.8±1.6)% and (95.6±1.0)% for 6 MV and 18 MV, respectively. Without a normalization point, however, the same gamma analysis fell to (20.7±6.7)% and (13.9±4.0)% for 6 MV and 18 MV, respectively. The clinical data set showed the same trend, with the gamma passing rate declining from (98.9±0.7)% to (33.4±13.1)%.

CONCLUSION

The gamma index method provides a unique answer for gamma passing rate only without normalizing dose distributions to any particular point. The common gamma criteria of 3%, 3 mm, however, is a very poor metric in that case.

Elevated serum IL-16 and RANTES levels in patients with autoimmune thyroid diseases and modulation by methimazole therapy

Interleukine-16 (IL-16) and RANTES (regulated upon activation, normal T cell expressed and secreted) are 2 cytokines with the function of T helper cell recruitment, which might play a key role in pathogenesis of autoimmune thyroid diseases (AITD). This study was aimed to evaluate the IL-16 and RANTES in patients with AITD. Serum IL-16 and RANTES levels were measured in patients with Graves' disease (GD; n=45), Hashimoto's thyroiditis (HT; n=68), nontoxic multinodular goiter (NTMNG; n=20), and healthy individuals (n=61). The results showed that serum IL-16 and RANTES levels were elevated both in HT and higher in untreated GD patients when compared to NTMNG patients and the healthy individuals, which were decreased after MMI therapy in untreated GD patients. However, in HT patients, serum IL-16 and RANTES levels were comparable among the conditions of hyperthyroid and euthyroid received by l-thyroxine therapy and untreated hypothyroid. Furthermore, serum IL-16 levels were correlated with FT3, FT4, TRAb in GD, but not in HT patients. The data did not show any correlation between RANTES levels and clinical factors. In conclusion, IL-16 and RANTES might be involved in the pathogenesis of GD and HT, and serum IL-16 levels in GD maybe a potential marker of disease activity and severity.

Comparison of three diagnostic techniques for detection of rotavirus and coronavirus in calf faeces in Australia

Objective  Compare real‐time reverse transcription polymerase chain reaction (qRT‐PCR), a commercially available enzyme‐linked immunosorbent assay (ELISA) and lateral flow immunochromatography assay (LAT) for the detection of rotavirus and coronavirus in faecal samples collected from diarrhoeic calves.

Design  Prospective survey.

Method  Samples were tested at two separate facilities using a commercial ELISA and an in‐house qRT‐PCR. Simple logistic regression was performed to examine the relationship between the two tests. A subset of samples was screened using qRT‐PCR, ELISA and a commercial LAT dipstick (132 faecal samples were tested for coronavirus and 122 samples for rotavirus).

Results  Of the 586 samples tested, 131 (22.39%) and 468 (79.86%) were positive for coronavirus and group A rotavirus, respectively, using qRT‐PCR. The number of samples positive on ELISA for coronavirus and rotavirus was 73 (12.46%) and 225 (38.40%), respectively. Using LAT, 30 (22.73%) and 43 (35.35%) samples were positive for coronavirus and rotavirus, respectively. Simple linear regression revealed a statistically significant (P < 0.05) but weak (r²=−0.07 and −0.40) correlation between the rotavirus/coronavirus qRT‐PCR and ELISA, respectively. There was also poor agreement between the LAT and qRT‐PCR assays.

Conclusion  The sensitivity and specificity of the commercial ELISA and LAT assays evaluated in this study were low compared with qRT‐PCR. The low positive and negative predictive values of the assays suggests that they were of limited diagnostic benefit in the population sampled.

Behavioral plasticity in honey bees is associated with differences in brain microRNA transcriptome

Small, non-coding microRNAs (miRNAs) have been implicated in many biological processes, including the development of the nervous system. However, the roles of miRNAs in natural behavioral and neuronal plasticity are not well understood. To help address this we characterized the microRNA transcriptome in the adult worker honey bee head and investigated whether changes in microRNA expression levels in the brain are associated with division of labor among honey bees, a well-established model for socially regulated behavior. We determined that several miRNAs were downregulated in bees that specialize on brood care (nurses) relative to foragers. Additional experiments showed that this downregulation is dependent upon social context; it only occurred when nurse bees were in colonies that also contained foragers. Analyses of conservation patterns of brain-expressed miRNAs across Hymenoptera suggest a role for certain miRNAs in the evolution of the Aculeata, which includes all the eusocial hymenopteran species. Our results support the intriguing hypothesis that miRNAs are important regulators of social behavior at both developmental and evolutionary time scales.

Subcycle controlled charge-directed reactivity with few-cycle midinfrared pulses

The steering of electron motion in molecules is accessible with waveform-controlled few-cycle laser light and may control the outcome of light-induced chemical reactions. An optical cycle of light, however, is much shorter than the duration of the fastest dissociation reactions, severely limiting the degree of control that can be achieved. To overcome this limitation, we extended the control metrology to the midinfrared studying the prototypical dissociative ionization of D(2) at 2.1 μm. Pronounced subcycle control of the directional D(+) ion emission from the fragmentation of D(2)(+) is observed, demonstrating unprecedented charge-directed reactivity. Two reaction pathways, showing directional ion emission, could be observed and controlled simultaneously for the first time. Quantum-dynamical calculations elucidate the dissociation channels, their observed phase relation, and the control mechanisms.

A genome-wide survey of copy number variation regions in various chicken breeds by array comparative genomic hybridization method

The discovery of copy number variation (CNV) in the genome has provided new insight into genomic polymorphism. Studies with chickens have identified a number of large CNV segments using a 385k comparative genomic hybridization (CGH) chip (mean length >140 kb). We present a detailed CNV map for local Chinese chicken breeds and commercial chicken lines using an Agilent 400k array CGH platform with custom-designed probes. We identified a total of 130 copy number variation regions (CNVRs; mean length = 25.70 kb). Of these, 104 (80.0%) were novel segments reported for the first time in chickens. Among the 104 novel CNVRs, 56 (53.8%) of the segments were non-coding sequences, 65 (62.5%) showed the gain of DNA and 40 (38.5%) showed the loss of DNA (one locus showed both loss and gain). Overlapping with the formal selective sweep data and the quantitative trait loci data, we identified four loci that might be considered to be high-confidence selective segments that arose during the domestication of chickens. Compared with the CNVRs reported previously, genes for the positive regulation of phospholipase A2 activity were discovered to be significantly over-represented in the novel CNVRs reported here by gene ontology analysis. Availability of our results should facilitate further research in the study of the genetic variability in chicken breeds.