[Effect of intravenous infusion with lidocaine on rapid recovery of laparoscopic cholecystectomy]

Objective: To investigate the effect of intravenous infusion with lidocaine on rapid recovery of laparoscopic cholecystectomy. Methods: This study was a prospective randomized controlled trial. From February to August 2016 in Affiliated Yiwu Hospital of Wenzhou Medical University, 60 patients scheduled for laparoscopic cholecystectomy under general anesthesia were involved and randomly divided into control group (n=30) and lidocaine group (n=30). Patients in lidocaine group received lidocaine 1.5 mg/kg intravenously before induction and followed by 2.0 mg·kg(-1)·h(-1) to the end of surgery. Patients in control group received equal volumes of saline intravenously. Anesthesia induction in both groups were given intravenous midazolam 0.03 mg/kg, sufentanil 0.2 μg/kg, propofol 2.0 mg/kg and cisatracuium 0.2 mg/kg. Anesthesia was maintained with propofol 0.05-0.20 mg·kg(-1)·min(-1) and remifentanil 0.1-0.5 μg·kg(-1)·min(-1) for laryngeal mask airway which bispectral index (BIS) value maintained at 40-60. BIS, heart rate(HR) and mean arterial pressure(MAP) were recorded before anesthesia induction, before and immediately after laryngeal mask implantation, intraoperative 30 min and anesthesia awake. Pain scores were assessed using visual analogue scales (VAS) at postoperation immediately, 30 min during postanesthesia care unit (PACU), 2, 6, 12, and 24 h after surgery. The time of PACU retention, postoperative ambulation, first intestine venting and discharge were recorded. The dosage of propofol and remifentanil, the frequency of sufentanil used, the incidence of postoperative nausea and vomiting were also recorded. Patient satisfaction was evaluated by using Simple Restoration Quality Score (QoR-9). Results: BIS values before and after laryngeal mask implantation in lidocaine group were 50.50±3.47 and 54.63±1.25 respectively, which was lower than those in control group(54.30±4.78, 55.80±2.33; t=3.542, 2.423, all P<0.05). The VAS score at postoperation immediately, PACU 30 min, postoperative 2, 6, 12 h in lidocaine group were 2.76±0.97, 2.37±0.93, 2.10±1.12, 1.76±0.97, 1.20±0.76 respectively, which was lower than those in control group (3.83±1.34, 3.27±1.26, 3.06±1.20, 2.63±0.88, 1.90±0.84; t=3.528, 3.154, 3.217, 3.603, 3.372, all P<0.05 ). The frequency of additional sufentanil at postoperation immediately and PACU 30 min in lidocaine group was 5(17%), 3(10%), which were less than those in control group(12(40%), 9(30%); χ(2)=4.022, 3.950, all P<0.05). The dosage of propofol and remifentanil in lidocaine group were (4.33±0.75) mg·kg(-1)·h(-1) and (9.00±1.66) μg·kg(-1)·h(-1) respectively, which were less than those in control group ((5.20±1.39) mg·kg(-1)·h(-1) and (10.43±2.20) μg·kg(-1)·h(-1;) t= 2.982, 2.842, all P<0.05). The time of PACU retention, postoperative ambulation and first intestine venting were (39.90 ± 8.06) min, (11.93±1.68) h and (10.16±1.05) h respectively in lidocaine group, which were shorter than those in control group ((48.23±10.04) min, (13.16±1.58) h and (11.13±1.30) h; t=3.514, 2.931, 3.156, all P<0.05). The QoR-9 score in lidocaine group was 15.60±1.07, which was higher than that in control group(14.73±0.74, t=-3.649, P<0.05). There was no significant difference in the incidence of postoperative nausea/vomiting and the discharge time between two groups (all P>0.05). Conclusion: Intravenous infusion of lidocaine can effectively reduce the dosages of propofol and remifentanil, postoperative early VAS score, postoperative ambulation time and first intestine venting time which could improve the satisfaction of patients.

[Analysis of the therapeutic effects of different treatment modalities on the outcomes of 87 patients with lung oligometastasis from nasopharyngeal carcinoma after radiotherapy]

OBJECTIVE

The aim of the present study was to evaluate the efficacy of three different modalities in treatment of lung oligometastases from nasopharyngeal carcinoma (NPC) after radiotherapy and to identify a more appropriate treatment modality.

METHODS

The clinical data of 87 cases of lung oligometastases from NPC were analyzed retrospectively. Among them, 33 patients underwent local small-field irradiation+ /- chemotherapy, 28 underwent whole-lung irradiation+ chemotherapy, and 26 underwent simple chemotherapy. The survival rates were calculated using Kaplan-Meier analysis. The differences among the modalities were evaluated using the log-rank test. Cox univariate and multivariate analyses were performed to determine the influencing factors.

RESULTS

The 3-year lung metastasis survival (LMS) rates of patients with lung metastasis undergoing the three treatment modalities (local small-field irradiation+ /-chemotherapy, whole-lung irradiation+ chemotherapy and chemotherapy alone) were 89.3%, 72.7%, and 72.4%, respectively, showing a significant difference between the groups (P=0.003). Further subgroup analysis showed that the 5-year LMS rate was significantly higher in the local small-field irradiation+ /-chemotherapy group than that in the whole-lung irradiation+ chemotherapy group and chemotherapy alone group (P=0.001). The 2-year progression-free survival (PFS) rates of the three groups were 57.1%, 25.8% and 3.8%, respectively, showing significant intergroup differences (P=0.002 and P<0.001). Multivariate analysis indicated that compared with the whole lung irradiation group and the chemotherapy alone group, the local irradiation+ /- chemotherapy is an independent favorable prognostic factor for LMS and PFS (P<0.05).

CONCLUSION

Local radiotherapy combined with systemic chemotherapy is the best therapeutic modality for lung oligometastases derived from NPC after radiotherapy, improving the LMS and prolonging the PFS.

Cytotoxic triterpenoid saponins from Clematis tangutica

Eight previously undescribed oleanane-type triterpenoid saponins, clematangoticosides A-H, together with eight known saponins, were isolated from the whole plants of Clematis tangutica (Maxim.) Korsh. Their structures were elucidated by extensive spectroscopic analysis, in combination with chemical methods (acid hydrolysis and mild alkaline hydrolysis). Clematangoticosides D-G were found to be unusual 23, 28-bidesmosidic glycosides. The cytotoxic activities of all of the isolated saponins were evaluated against the four human cancer cell lines SGC-7901, HepG2, HL-60 and U251MG. Clematoside S, sapindoside B, kalopanax saponin A, and koelreuteria saponin A exhibited cytotoxicity against all of the test cancer cell lines with IC50 values in the range of 1.88-27.20 μM, while clematangoticoside D and F showed selective cytotoxicity against SGC-7901 with IC50 values of 24.22 and 21.35 μM, respectively.

[One-stage tympanic cavity ventilation tube placement in canal wall down tympanomastoidectomy]

Objective:To research the clinical application of tympanic cavity ventilation tube placement in canal wall down tympanomastoidectomy. Method:There were 52 patients with otitis media received canal wall down tympanomastoidectomy. We placed ventilation tube in posterior hypotympanum during the surgery. After surgery, all patients were followed up in 12 days, 1 month, 2 months, 6 months, and 1 year. The ventilation tubes were withdrew 6 months later, and then the hearing level and tympanic cavity status was evaluated after another half year. Result:All cases were followed up at least 1 year after surgery. Forty-four patients' tubes were removed 6 months later, but other 8 tubes had been extruded within 1 to 3 months. After 1 year, all 52 cases of ears were dry; 39 patients' tympanic membranes were stable, the postoperative complications included tympanic membrane retraction in 7 cases, middle ear effusion in 4 cases, and tympanic membrane perforation at anterior-inferior quadrant in 2 cases; CT examination indicated that 39 patients' aeration between tympanic cavity and Eustachian tube bony portion was normal, 9 patients' tympanic cavity aeration was smaller, and 4 patients' cavity was obstructed; 52 patients' average air conduction thresholds were 12.5 dB lower than that of preoperation. Conclusion:One-stage tympanic cavity ventilation tube placement is a simple, safe and effective method in canal wall down tympanomastoidectomy for middle ear diseases with Eustachian tube severe stenosis or obstruction in bony portion.

Deciphering the spectrum of somatic mutations in the entire mitochondrial DNA genome

The mitochondrion is a crucial intracellular organelle responsible for regulating cellular energy metabolism, producing free radicals, initiating and executing the apoptotic pathways. Previous studies have shown that somatic mutations in mitochondrial DNA are associated with various tumors, which may be involved during carcinogenesis and tumor progression. To examine the mutation pattern in cancer, 625 reported somatic mutations in the mitochondrial DNA genome were analyzed. We found that, except for deletions and insertions, most somatic mutations were point mutations, accounting for 89.44% of somatic mutations. Transition was the predominant form of somatic mutation in the entire mitochondrial DNA genome, accounting for 87.12% of point mutations, most of which were homoplastic. Frequency statistics analysis of point mutations indicated that, except for 3 tRNA genes, the mutations were distributed on all resting genes and in the D-loop region, with the latter showing the highest frequency of somatic mutation (19.34%), followed by the tRNA leucine 2 gene and non-coding regions between base pairs 5892 and 5903, while 13 coding-region genes and 2 rRNA genes showed a relatively lower frequency of somatic point mutations. Nonsynonymous mutations and terminal amino acid changes were the primary point somatic mutations detected from 13 coding-region genes, which may cause mitochondrial dysfunction in cancer cells. We found that the somatic mutations may affect the mitochondrial DNA genome; the non-coding region should be examined to identify somatic mutations as potential diagnostic biomarkers for early detection of cancer.

Genetic variations in MOV10 and CACNB2 are associated with hypertension in a Chinese Han population

Human hypertension is a complex, multifactorial disease. Multiple variants associated with hypertension have been identified in the large numbers of genome-wide association studies, meta-analysis, and case-control studies. The present study investigated the association between the single nucleotide polymorphisms (SNPs) of five candidate genes and the susceptibility and prognosis of hypertension in a Chinese Han population. A hospital-based case-control study in a Chinese Han population was carried out, including 500 hypertension patients and 506 healthy controls. The five SNP markers were detected using the Sequenom MassArray(®) iPLEX System. The association of genotypes with susceptibility to hypertension was analyzed using odds ratio, with 95% confidence interval and logistic regression. All five variants conformed to Hardy-Weinberg proportions in the controls. No significant differences were noted in the genotype distributions for AGTR1, PRRC2A, and CALCA polymorphisms in patients with hypertension (N = 500) and healthy controls (N = 506). SNP rs2932538, a variant in MOV10, was found to be significantly associated with an increased risk of hypertension. However, SNP rs4373814, a variant in CACNB2, showed a relevant association with a decreased risk of hypertension. In conclusion, the results of our case-control study confirmed the significant association of the SNP rs2932538 in MOV10 and SNP rs4373814 in CACNB2 with an increased risk of hypertension in a Chinese Han population, suggesting that the SNP rs2932538 may be a poor prognostic indicator for hypertension, while SNP rs4373814 may be a good prognostic indicator for hypertension in the same region. However, our findings need to be replicated in larger epidemiological and functional studies.

Evaluation of relative isotopic abundance measurements in a quadrupole time-of-flight mass spectrometer for elemental composition determination of natural products in traditional Chinese medicine

The relative isotopic abundance (RIA) measurement errors of a quadrupole time-of-flight (Q-ToF) instrument incorporating analog-to-digital converter detectors were systemically evaluated by stochastically collecting about 200 data in positive ion mass spectrometry (MS) mode. Errors varied with peak intensities at definite spectral acquisition rates but were very close, even if peak intensities changed sharply at different spectral acquisition rates with the same concentration. Intensity thresholds were systematically defined at 1 Hz of spectral acquisition rates. RIA measurement errors were also evaluated using peak area. It seemed that peak area was better adapted for the high-intensity ions while peak intensity was suited for very low-intensity ions. Several known compounds were selected for RIA measurements for product ions in tandem mass spectropmetry (MS/MS) mode. An extract of a representative traditional Chinese medicinal, Paederia scandens was analyzed with high-performance liquid chromatography-electrospray ionization-QToF-MS/MS. The unique elemental compositions of some compounds could not be identified even with exact masses and MS/MS spectra of measured and reference compounds. RIA errors, especially of (M+2)M(-1), provided vital information for determining the elemental composition.

Effects of maturity stages on the nutritive composition and silage quality of whole crop wheat

The changes in yields and nutritive composition of whole crop wheat (Triticum aestivum L.) during maturation and effects of maturity stage and lactic acid bacteria (LAB) inoculants on the fermentation quality and aerobic stability were investigated under laboratory conditions. Whole crop wheat harvested at three maturation stages: flowering stage, milk stage and dough stage. Two strains of LAB (Lactobacillus plantarum: LAB1, Lactobacillus parafarraqinis: LAB2) were inoculated for wheat ensiling at 1.0×10⁵ colony forming units per gram of fresh forage. The results indicated that wheat had higher dry matter yields at the milk and dough stages. The highest water-soluble carbohydrates content, crude protein yields and relative feed value of wheat were obtained at the milk stage, while contents of crude fiber, neutral detergent fiber and acid detergent fiber were the lowest, compared to the flowering and dough stages. Lactic acid contents of wheat silage significantly decreased with maturity. Inoculating homofermentative LAB1 markedly reduced pH values and ammonia-nitrogen (NH₃-N) content (p<0.05) of silages at three maturity stages compared with their corresponding controls. Inoculating heterofermentative LAB2 did not significantly influence pH values, whereas it notably lowered lactic acid and NH₃-N content (p<0.05) and effectively improved the aerobic stability of silages. In conclusion, considering both yields and nutritive value, whole crop wheat as forage should be harvested at the milk stage. Inoculating LAB1 improved the fermentation quality, while inoculating LAB2 enhanced the aerobic stability of wheat silages at different maturity stages.

Differentiation between brain glioblastoma multiforme and solitary metastasis: qualitative and quantitative analysis based on routine MR imaging

BACKGROUND AND PURPOSE

The differentiation between cerebral GBM and solitary MET is clinically important and may be radiologically challenging. Our hypothesis is that routine MR imaging with qualitative and quantitative analysis is helpful for this differentiation.

MATERIALS AND METHODS

Forty-five GBM and 21 solitary metastases were retrospectively identified, with their preoperative routine MR imaging analyzed. According to the comparison of the area of peritumoral T2 prolongation with that of the lesion, the tumors were classified into grade I (prolongation area ≤ tumor area) and grade II (prolongation area > tumor area). The signal intensities of peritumoral T2 prolongation were measured on T2WI and normalized to the values of the contralateral normal regions by calculating the ratios. The ratio (nSI) of both types of tumors was compared in grade I, grade II, and in tumors without grading. The best cutoff values to optimize the sensitivity and specificity were determined for optimal differentiation.

RESULTS

The nSI of GBM was significantly higher than that of MET without T2 prolongation grading (P < .001), resulting in AUC = 0.725. The difference was significant (P = .014) in grade I tumors (GBM, 38; MET, 9), with AUC = 0.741, and in grade II tumors (GBM, 7; MET, 12), with AUC = 0.869 (P = .017). Both types of tumors showed a different propensity in T2 prolongation grading (χ(2) = 12.079, P = .001).

CONCLUSIONS

Combined with qualitative and quantitative analysis of peritumoral T2 prolongation, routine MR imaging can help in the differentiation between brain GBM and solitary MET.

Analysis of cipadesin limonoids from Cipadessa cinerascens using electrospray ionization quadrupole time-of-flight tandem mass spectrometry and quantum chemical calculations

RATIONALE

Limonoids, a class of tetranortriterpenoids, exhibit various biological effects, such as insect antifeedant and growth regulating activities, antimicrobial activity, potent cell adhesion inhibitory effects, antimalarial activity, anticancer activities, and antioxidant activity. The potential application brings the need for reliable, fast and low-cost analysis of this class of compounds.

METHODS

Six cipadesin limonoids (1-6), including a pairs of isomers, from leaves and barks of Cipadessa cinerascens were investigated by electrospray ionization quadrupole time-of-flight tandem mass spectrometry (ESI-QTOF-MS/MS) in positive-ion mode. Characteristic processes were further studied by theoretical calculations.

RESULTS

1,3-Hydrogen rearrangement might play a significant role in the cleavage of -O- bridge bond in ring B and further produces some characteristic ions. For [M + Na](+) precursor ions, the product ion at m/z 133 might indicate the structure of ring A and the losses of CO(2) and AcOH occur readily. Interestingly, the radical product ion at m/z 460 from [M + Na](+) ions seems to be the characteristic ion for compound 1. A deuterium-labeling experiment supported the processes forming the radical ion. For [M + NH(4)](+) ions, high-abundance product ions resulting from sequential loss of AcOH can be observed. In addition, a pairs of isomers was unambiguously differentiated based on MS or MS/MS spectra.

CONCLUSIONS

In summary, sufficient information obtained from fragmentation experiments of [M + Na](+), [M + NH(4)](+) or [M + H](+) precursor ions is especially valuable for rapid identification of these limonoids or their metabolites in complex mixtures. The high-abundance radical product ion is of scientific interest.

Analysis of sesterterpenoids from Aspergillus terreus using ESI-QTOF and ESI-IT

INTRODUCTION

Biosynthesis of terretonin was studied due to the interesting skeleton of this series of sesterterpenoids. Very recently, López-Gresa reported two new sesterterpenoids (terretonins E and F) which are inhibitors of the mammalian mitochondrial respiratory chain. Mass spectrometry (MS), especially tandem mass spectrometry, has been one of the most important physicochemical methods for the identification of trace natural products due to it rapidity, sensitivity and low levels of sample consumption. The potential application prospect and unique skeleton prompted us to study structural characterisation using MS.

OBJECTIVE

To obtain sufficient information for rapid structural elucidation of this class of compounds using MS.

METHODOLOGY

The elemental composition of the product ions was confirmed by low-energy ESI-CID-QTOF-MS/MS analyses. The fragmentation pathways were postulated on the basis of ESI-QTOF-MS/MS/MS and ESI-IT-MS(n) spectra. Common features and major differences between ESI-QTOF-MS/MS and IT-MS(n) spectra were compared. For ESI-QTOF-MS/MS/MS experiments, capillary exit voltage was raised to induce in-source dissociation. Ammonium acetate or acetic acid were added into solutions to improve the intensity of [M + H]+. The collision energy was optimised to achieve sufficient fragmentation. Some fragmentation pathways were unambiguously proposed by the variety of abundance of fragment ions at different collision energies even without MS(n) spectra.

RESULTS

Fragmentation pathways of five representative sesterterpenoids were elucidated using ESI-QTOF-MS/MS/MS and ESI-IT-MS(n) in both positive- and negative-ion mode. The key group of characterising fragmentation profiles was ring B, and these fragmentation patterns are helpful to identify different types of sestertepenoids.

CONCLUSION

Complementary information obtained from fragmentation experiments of [M + H]+ (or [M + NH4]+ and [M-H](-) precursor ions is especially valuable for rapid identification of this kind of sesterterpenoid.

(3S,NR)-3-Hydroxy-methyl-2-methyl-2-(3-methyl-but-2-en-1-yl)-1,2,3,4-tetra-hydro-isoquinolinium bromide-1,1'-bi-2-naphthol (1/1)

In the title compound, C₁₆H₂₄NO⁺·Br⁻·C₂₀H₁₄O₂, the N-hetero­cyclic six-membered ring assumes a half-chair conformation. The two naphthalene ring systems are nearly perpendicular to one another, making a dihedral angle of 89.5 (2)°. Inter­molecular O—H⋯Br hydrogen bonding helps to stabilize the crystal structure.

Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial

BACKGROUND

It is well known that intrathecal opioids have a synergic effect with spinal local anaesthetics. The aim of this study was to evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia with less maternal hypotension and vomiting than ropivacaine alone.

METHODS

80 ASA I and II parturients undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomly allocated to two groups. Group R15 received intrathecal hyperbaric ropivacaine 15 mg and group SR10 hyperbaric ropivacaine 10 mg with sufentanil 5 micrograms. Characteristics, efficacy and side effects of spinal anaesthesia in each group were measured.

RESULTS

There was no significant difference in the quality of intraoperative analgesia and muscle relaxation between groups. The incidence of hypotension was significantly higher (55% vs. 20%, P < 0.005) and the need for ephedrine less in group R15 than in group SR10. In group SR10, the onset of motor block was delayed (2.9 +/- 1.1 vs. 4.6 +/- 2.5 min, P < 0.005), the duration was shorter (65.9 +/- 15.1 vs. 125.4 +/- 26.4 min, P < 0.005). The duration of effective analgesia was longer (260 +/- 32.5 vs. 143 +/- 22.1 min, P < 0.005), the incidence of shivering (20% vs. 60%, P < 0.005) and vomiting (5% vs. 30%, P < 0.005) were lower in group SR10.

CONCLUSIONS

The combination of hyperbaric ropivacaine 10 mg with sufentanil 5 lg produced effective spinal anaesthesia for caesarean delivery with significantly less hypotension, vomiting and shivering, shorter duration of motor blockade and longer lasting analgesia than hyperbaric ropivacaine 15 mg.