The effect of remifentanil on cough suppression after endoscopic sinus surgery: a randomized study

BACKGROUND

Excessive coughing may increase the risk of complications after sinus surgery. We hypothesized that remifentanil would decrease the incidence and severity of coughing after endoscopic sinus surgery with propofol and remifentanil anaesthesia.

METHODS

Ninety patients scheduled for endoscopic sinus surgery were randomly assigned into three groups. Propofol was stopped at the completion of the surgical procedure. The remifentanil infusion was adjusted to an effect-site concentration of 1.5, 2.0 or 2.5 ng/ml, 10 min before the anticipated end of surgery, in each of the three groups (RF₁(.)₅, RF₂(.)₀ and RF₂(.)₅) and continued until after extubation. The incidence and severity of coughing was evaluated on a scale from 0 to 3.

RESULTS

The proportion of patients who did not cough was significantly higher in the RF₂(.)₀ (67.5%, 95% CI: 59.1– 75.9%) and RF₂(.)₅ (74.2%, 95% CI: 66.4–82.0%) groups than in the RF₁(.)₅ group (35.%, 95% CI: 26.5–43.5%) (P < 0.01). The incidence of grade 2 or 3 coughing was significantly higher in the RF₁(.)₅ group (grade 2: 15.1%, grade 3: 6.7%) than in the RF₂(.)₀ group (grade 2: 5.0%, grade 3: 0%) and the RF₂(.)₅ group (grade 2: 4.2%, grade 3: 0%) (P < 0.05). There was no statistically significant difference in the time to extubation among the three groups.

CONCLUSION

Maintaining anaesthesia with remifentanil to the end of the surgery, until after extubation, can suppress coughing without prolonging the recovery from anaesthesia. This effect is dose dependent and is more pronounced at higher concentrations of remifentanil (2.0 or 2.5 ng/ml).

Annexin-1 downregulation is associated with clinical outcome in Chinese patients with hilar cholangiocarcinoma

AIMS

Annexin A1 (ANXA1) is a calcium- and phospholipid-binding protein and has been implicated in regulating inflammatory responses, cell proliferation and apoptosis. The evidence of its importance in carcinogenesis increased rapidly. However, the status of ANXA1 in hilar cholangiocarcinoma remains unclear. Here, we detected ANXA1 expression and determined its clinical significance in Chinese patients with hilar cholangiocarcinoma.

METHODS

Tissue microarray blocks containing tumor specimens obtained from 61 patients were constructed. Expression of ANXA1 in these specimens was analyzed using immunohistochemical studies.

RESULTS

ANXA1 expression was observed in 27 cases (44.3%). Loss of ANXA1 expression was significantly associated with lymph node metastases and histopathologic grade. ANXA1 expression has a significant inverse correlation with recurrence and poor survival in univariate analyses.Multivariate analyses revealed that loss of ANXA1 expression was an independent predictor for future recurrence and overall survival in patients with cholangiocarcinoma.

CONCLUSIONS

Decreased expression of ANXA1 is a common event in human hilar cholangiocarcinoma and is significantly correlated with the poor outcome of patients with cholangiocarcinoma, suggesting a potential role of ANXA1 in cancer development and progression.

Downregulation of oxytocin receptors in right ventricle of rats with monocrotaline-induced pulmonary hypertension

AIM

pulmonary hypertension (PH) in the rat leads to right ventricular (RV) hypertrophy, inflammation and increased natriuretic peptide (NP) levels in plasma and RV. Because the release of nitric oxide (NO) and atrial natriuretic peptide (ANP) is a function of the oxytocin receptor (OTR), we examined the effect of PH on gene and protein expression of OTR, NP (A, atrial; B, brain) and receptors (NPRs), nitric oxide synthases (NOS), interleukin (IL)-1β, IL-6 and tumour necrosis factor-α in the hypertrophied RV in a model of PH.

METHODS

RV hypertrophy was induced in male Sprague-Dawley rats with monocrotaline (MCT; 60 mg kg(-1) ) and was confirmed by the presence of an increased RV weight and RV-to-[left ventricle (LV) and septum] ratio.

RESULTS

in the RV of MCT-treated rats, a approximately 40% reduction in OTR mRNA and protein was observed compared with the RV of control rats. This reduction was associated with increased transcripts of ANP and BNP in both ventricles and a corresponding increase in NP receptor mRNA expression for receptors A, B and C. Protein expression of inducible NOS was increased in the RV, whereas endothelial NOS transcripts were increased only in the LV of MCT-treated rats. In the RV of MCT-treated rats, downregulation of OTR was also associated with increased mRNA expression of IL-1β and IL-6.

CONCLUSION

our results show that downregulation of the OTR in the RV of MCT-treated rats is associated with increased expression of NP and their receptors as well as IL-1β and IL-6. This reduction in OTR in RV myocardium may have an impact on cardiac function in the MCT-induced model of PH.

Lateral movement of soil fumigants 1,3-dichloropropene and chloropicrin from treated agricultural fields

The soil fumigants 1,3-dichloropropene (1,3-D) and chloropicrin (CP) are often used for controlling soil-borne plant pathogens and parasitic nematodes before reestablishing new vineyards and orchards. To evaluate crop safety and environmental risks with the replant fumigation, four field experiments were performed over 2 yr to examine 1,3-D and CP lateral movement away from the treated fields. Shank injection with or without a virtually impermeable film (V1F) was used in two vineyard fumigation experiments, and spot drip application without tarp cover was used in two orchard experiments. Results showed that 1,3-D and CP gases moved laterally to 6 m from the treated fields when the fumigants were applied by shank injection. The maximum 1,3-D or CP soil gas concentration at 6 m was approximately 10 ng cm(-3) when the fumigated plot was not cover with a tarp. With VIF, the measured maximum concentration increased to approximately 100 ng cm(-3). In the spot drip application, maximum 1,3-D and CP gas concentrations reached approximately 100 ng cm(-3) but at 1.5 m radial distance from the point of fumigant injection.

Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment

The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05  GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.

Water extract of Zizyphus Jujube attenuates ischemia/reperfusion-induced liver injury in rats (PP106)

AIMS

Ischemia and reperfusion (I/R) injuries in the liver remain important clinical problems. Free oxygen radicals and nitrosative stress have been shown to be involved in the pathogenesis I/R-related liver injury. The purpose of this study was to characterize the effects of an extract of Zizyphus Jujube (ZJ), which has strong antioxidant effects, on I/R-induced liver injury.

MATERIALS AND METHODS

Ischemia (I) was induced in rat livers by clamping the common hepatic artery and portal vein for 40 minutes, after which flow was restored, and the liver was reperfused for 90 minutes. Blood samples were collected prior to I and after reperfusion to assay blood levels of alanine transaminase (ALT), lactic dehydrogenase (LDH), oxygen radical (OH), and nitric oxide (NO). In the pharmacologic intervention group a water extract of the fruit of ZJ was administered orally to rats (100 mg/mL for 7 days) that were subsequently exposed to the I/R liver injury.

RESULTS

The data showed that reperfusion (R) of the liver produced increases in blood concentrations of ALT (41.9+/-8.2 vs 338.0+/-89.6; P<.01; N=7) and LDH (317+/-129 vs 4073+/-950; P<.001; N=7). Oxygen radicals (55.1+/-14.3 vs 262.4+/-60.3; P<.001; N=7) and NO (69.3+/-14.9 vs 121.6+/-27.1; P<.01; N=7) also increased significantly in this R group. In the ZJ intervention group the liver injury, oxidative stress, and nitrosative stress were all significantly attenuated.

CONCLUSION

These results suggested that I/R-induced liver injury with white blood cell activation, oxidative stress, and nitrosative stress. Pretreatment with an extract of ZJ, which shows high antioxidant effects, significantly attenuated the I/R-induced liver injury.

Ischemia and reperfusion of the lung tissues induced increase of lung permeability and lung edema is attenuated by dimethylthiourea (PP69)

This study sought to determine whether oxygen radical scavengers of dimethylthiourea (DMTU), superoxide dismutase (SOD), or catalase (CAT) pretreatment attenuated ischemia-reperfusion (I/R)-induced lung injury. After isolation from a Sprague-Dawley rat, the lungs were perfused through the pulmonary artery cannula with rat whole blood diluted 1:1 with a physiological salt solution. An acute lung injury was induced by 10 minutes of hypoxia with 5% CO2-95% N2 followed by 65 minutes of ischemia and then 65 minutes of reperfusion. I/R significantly increased microvascular permeability as measured by the capillary filtration coefficient (Kfc), lung weight-to-body weight ratio (LW/BW), and protein concentration in bronchoalveolar lavage fluid (PCBAL). DMTU pretreatment significantly attenuated the acute lung injury. The capillary filtration coefficient (P<.01), LW/BW (P<.01) and PCBAL (P<.05) were significantly lower among the DMTU-treated rats than hosts pretreated with SOD or CAT. The possible mechanisms of the protective effect of DMTU in I/R-induced lung injury may relate to the permeability of the agent allowing it to scavenge intracellular hydroxyl radicals. However, whether superoxide dismutase or catalase antioxidants showed protective effects possibly due to their impermeability of the cell membrane not allowing scavenging of intracellular oxygen radicals.

Postischemia myocardial injury in coronary artery bypass patients (PP6)

PURPOSE

To investigate the reperfusion injury of the myocardium in patients undergoing elective coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB), we monitored the blood levels of troponin I (TNI), white blood cells, oxygen radicals, malondialdehyde, and myeloperoxidase seeking to define the relationship between the CABG-induced systemic inflammation and myocardial injury.

MATERIALS AND METHODS

We selected 10 patients undergoing primary CABG with CPB at moderate hypothermia and cardioplegic arrest concomitant with intermittent warm blood cardioplegia. We compared all data with their own baseline values to study the reperfusion injury. After release of the aortic clamp, blood was drawn from the coronary sinus, via a catheter placed through the right atrium. We measured plasma levels of inflammatory mediators, such as malondialdehyde, myeloperoxidase, oxygen radicals, and the myocardium injury parameter of TNI.

RESULTS

Patients showed no difference concerning aortic clamp time. TNI increased significantly at 1, 15, and 30 minutes after the onset of reperfusion. Blood levels of white blood cells, oxygen radicals, malondialdehyde, and myeloperoxidase also increased significantly with reperfusion time.

CONCLUSIONS

Reperfusion of ischemic myocardium induced increased TNI, which may be related to the systemic inflammatory responses induced by ischemia and reperfusion of the myocardium among patients undergoing elective coronary bypass surgery.

Chito-oligosaccharide reduces diarrhea incidence and attenuates the immune response of weaned pigs challenged with Escherichia coli K88

Seventy-two barrows (Landrace × Large White, initial BW of 4.9 ± 0.3 kg and 17 ± 3 d old) were used to determine if dietary chito-oligosaccharides can replace antibiotics as a means to reduce signs associated with infection in weaned pigs challenged with Escherichia coli. Pigs were assigned to 1 of 4 treatments in a randomized complete block design using 6 pens per treatment with 3 pigs per pen. The treatments consisted of pigs fed the unsupplemented corn-soybean meal diet challenged or unchallenged with E. coli K88 and pigs fed the same diet supplemented with 160 mg of chito-oligosaccharides or 100 mg of cyadox/kg and challenged with E. coli K88. On d 7, 1 group of pigs fed the unsupplemented diet, as well as all pigs fed diets containing chito-oligosaccharides or cyadox, were orally dosed with 30 mL of an alkaline broth containing E. coli K88. Another group of pigs fed the unsupplemented diet was orally dosed with 30 mL of sterilized alkaline broth. Fecal consistency was visually assessed each morning from d 7 to 14. Blood samples were collected at 0, 24, 48, and 168 h postinfection. On d 14 postchallenge, all pigs were killed to evaluate intestinal morphology and determine E. coli concentrations in the intestine. During the postchallenge period (wk 2), unsupplemented pigs challenged with E. coli had decreased (P < 0.05) BW gain, feed intake, fecal consistency, villus height, villus height:crypt depth ratio, and plasma IGF-1, and increased (P < 0.05) diarrhea incidence, E. coli counts in the intestine, plasma interleukin-1β, plasma IL-10, and IGA-positive cells in the jejunal and ileal lamina propria, compared with unchallenged pigs. Supplementation with cyadox largely mitigated these effects. Although chito-oligosaccharide reduced the incidence of diarrhea, the growth performance of E. coli-challenged pigs supplemented with chito-oligosaccharide was not better than that of unsupplemented pigs challenged with E. coli. Therefore, chito-oligosaccharide, at the amount used in this experiment, does not seem to be an effective substitute for antibiotics as a growth promoter for newly weaned pigs challenged with E. coli.

Application of skin traction for surgical treatment of grade IV pressure sore: a clinical report of 160 cases

STUDY DESIGN

Retrospective clinical study.

OBJECTIVE

To assess the method of primary surgical closure of pressure sores developed by the Ruixin Hospital for burns.

SETTING

Nanjing, China.

METHODS

The study included 235 grade IV pressure sores of 160 patients, M:F = 119:41. Their age ranged from 19 to 93 years (mean = 47.4, s.d. ± 15.7). The primary disease was spinal cord injury in 141 patients (88.1%). The location of sore spread over ischial, sacrococcygeal and trochanteric regions. The largest pressure sore measured 15 × 25 cm(2). The time from onset of sore to admission ranged from 3 months to 22 years (mean = 35.5 months, s.d. ± 55.8). Local preoperative preparation included external skin traction using adhesive tapes, wound cleaning and change of dressing. General condition was checked and improved by supportive measures. Operation procedures included thorough debridement, excision of hidden minor scars, mobilizing opposing skin flaps and meticulous haemostasis before closure. Skin traction continued after the operation until the wound was healed.

RESULTS

All but 10 sores healed primarily. These 10 sores healed after a revision. The length of stay in hospital ranged from 20 to 140 days (mean = 45.1 days, s.d. ± 21.1). Follow-up period was 2-51 months (mean = 22 months, s.d. ± 12.5). Two ischial sores recurred owing to long sitting. They were cured with the same method. Three illustrative cases are presented.

CONCLUSION

The method is simple and enjoys a high success rate with a short stay in hospital and hence is cost effective. The recurrence is rare.

First measurement of Bose-Einstein correlations in proton-proton collisions at √s=0.9 and 2.36 TeV at the LHC

Bose-Einstein correlations have been measured using samples of proton-proton collisions at 0.9 and 2.36 TeV center-of-mass energies, recorded by the CMS experiment at the CERN Large Hadron Collider. The signal is observed in the form of an enhancement of pairs of same-sign charged particles with small relative four-momentum. The size of the correlated particle emission region is seen to increase significantly with the particle multiplicity of the event.

Transverse-momentum and pseudorapidity distributions of charged hadrons in pp collisions at square root of s = 7 TeV

Charged-hadron transverse-momentum and pseudorapidity distributions in proton-proton collisions at square root of s = 7  TeV are measured with the inner tracking system of the CMS detector at the LHC. The charged-hadron yield is obtained by counting the number of reconstructed hits, hit pairs, and fully reconstructed charged-particle tracks. The combination of the three methods gives a charged-particle multiplicity per unit of pseudorapidity dN(ch)/dη|(|η|<0.5) = 5.78 ± 0.01(stat) ± 0.23(syst) for non-single-diffractive events, higher than predicted by commonly used models. The relative increase in charged-particle multiplicity from square root of s = 0.9 to 7 TeV is [66.1 ± 1.0(stat) ± 4.2(syst)]%. The mean transverse momentum is measured to be 0.545 ± 0.005(stat) ± 0.015(syst)  GeV/c. The results are compared with similar measurements at lower energies.