[A prospective before-after self-control study of the scenario simulation teaching of junior nurses in a burns department on the fluid resuscitation care of massive burn patients during shock stage]

Objective: To explore the effects of scenario simulation teaching of junior nurses in a burns department on the fluid resuscitation care of massive burn patients during shock stage. Methods: From March 2018 to July 2019, 25 junior nurses fixed in the Department of Burn of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine met the inclusion criteria and were recruited in this prospective before-after self-control study, including 21 females and 4 males, aged 23 to 26 years. They had a work experience of 1.0 (1.0, 2.0) years in the Department of Burn. Three teaching scenarios were made according to the three major problems in the fluid resuscitation nursing of extensive burn patients during shock stage. The teaching plans were written based on the theoretical framework of Jeffrie's nursing simulation teaching. The high feasibility and practicability of the teaching plans was verified through expert consultation and evaluation by junior nurses. According to the three scenarios in the teaching plan, the junior nurses were performed with scenario simulation teaching, with 2 hours for each scenario, 6 hours in total. In one month before and after the teaching (hereinafter referred to as before and after teaching), the comprehensive ability of junior nurses was evaluated by the teachers using the self-designed junior nurse comprehensive ability evaluation scale, and their behaviors were evaluated by themselves with Performance Self-rating Scale for Nursing Students on High Simulation Training. Data were statistically analyzed with paired sample t test. Results: After teaching, the scores on communication skills, patient admissions, condition assessments, fluid resuscitation, emergency treatment, drug management, nursing skills, instrument use, teamwork, and humanitarian care and total score in the comprehensive ability evaluation of junior nurses as evaluated by teachers were significantly higher than those before teaching (t=-8.060, -11.421, -17.232, -24.800, -4.670, -11.916, -12.131, -11.606, -14.632, -13.325, -25.068, P<0.01), with 4 items including fluid resuscitation, condition assessment, nursing skills, and equipment operation having higher scores. After teaching, the nurses' self-rating scores on communication, division of labor and cooperation, clinical decision-making, professional knowledge and skills, and professional development and critical thinking and total score were (4.6±0.4), (4.8±0.3), (4.6±0.3), (4.6±0.4), (4.6±0.4), and (23.2±1.5) points respectively, which were significantly higher than the corresponding scores of (4.1±0.7), (4.2±0.7), (3.9±0.5), (3.7±0.6), (3.9±0.5), and (18.8±2.6) points before teaching (t=-3.361, -5.721, -6.987, -7.923, -7.922, -7.367, P<0.01). Conclusions: With solving the practical problems in nursing works of fluid resuscitation care of massive burn patients during shock stage as entry point, scenario simulation teaching aims to train the clinical practice ability and adaptability of junior nurses, thereby improving junior nurses' comprehensive ability of clinical practice in the fluid resuscitation care of massive burn patients during shock stage, enhancing their self-confidence and critical thinking ability.

Short communication: Influence of intramuscular injection of vitamin B12 in early-lactation dairy cows on Mozzarella cheese quality and vitamin B12 stability

The current study explored the effect of intramuscular injection of vitamin B₁₂ (VB₁₂) in early-lactation dairy cows on subsequent low-moisture part-skim Mozzarella cheese quality and VB₁₂ levels during cheese processing and storage. Twenty-four peripartum dairy cows were blocked based on parity and milk yield and randomly assigned into 2 treatments: basal diet (CON) and basal diet with an intramuscular injection of 10 mg of VB₁₂ per cow per week (VB₁₂). Raw milk was collected to determine VB₁₂ content and then used to make low-moisture part-skim Mozzarella cheese 8 wk after injection. The VB₁₂ content of raw milk and cheese was determined using ultra-performance liquid chromatography coupled with tandem mass spectrometry. We found that VB₁₂ content was significantly increased in milk (15.43 vs. 3.30 ng/mL) and fresh cheese (3.72 ng/g vs. undetectable) from the VB₁₂ group compared with the CON group. However, approximately 70% of VB₁₂ was lost in the whey during cheese making, and no VB₁₂ was detectable in either cheese treatment after 8 wk of storage. Furthermore, no significant differences were observed in fat and protein contents in the cheese between the 2 groups. For cheese color, the b* value increased and the a* value decreased slightly in fresh VB₁₂ cheese. Functional properties of stretchability, flowability, and meltability of VB₁₂ cheese were initially comparable to that of CON cheese, but higher flowability and meltability was observed in VB₁₂ cheese after 8 wk of storage. In summary, intramuscular injection of VB₁₂ in early-lactation dairy cows increases the content of VB₁₂ in milk and fresh cheese with no adverse effect on cheese quality, but substantial VB₁₂ is lost during cheesemaking and declines rapidly during storage.

Short communication: Effects of dietary N-carbamoylglutamate supplementation on the milk amino acid profile and mozzarella cheese quality in mid-lactating dairy cows

N-Carbamoylglutamate (NCG) is an enhancer of Arg, which is a functional AA and could prevent cardiovascular disease and improve immunity. The present study was conducted to investigate the effects of supplementing NCG in diets of lactating cattle on the NCG concentration and AA composition of raw milk and on mozzarella cheese quality. Thirty multiparous cows with a mean body weight of 669 kg (standard deviation = 71) and days in milk of 176 (standard deviation = 55) were blocked based on parity and milk production and randomly assigned to 1 of 2 treatments: basal diet (CON) and basal diet supplemented with 40 g of NCG per day per cow (NCG). After 8 wk of treatment, raw milk samples were collected from the 2 groups for AA analysis and mozzarella cheese-making. Furthermore, the NCG concentration and distribution in milk and mozzarella cheese were detected. The AA concentration in milk was greater and the NCG concentration in raw milk was approximately 6 times greater in the NCG group than in the CON group. No NCG was detected in cheese from the CON group, and very little NCG (<1.0 μg/kg) of cheese was detected in the NCG group. Most of the dietary NCG was transferred into whey, stretch water, and brine during cheese production. No significant difference was found between the 2 groups on cheese texture and color except that hardness was lower in the NCG group. Overall, the results indicated that dietary supplementation of NCG could improve the NCG and AA concentrations in raw milk without affecting the quality of cheeses such as mozzarella.

Improving bone marrow biopsy quality through peer discussion and data comparisons: A single institution experience

INTRODUCTION

Bone marrow biopsy (BMB) is crucial for the diagnosis, staging, and monitoring of a variety of hematologic diseases. Obtaining an adequate BMB can be challenging given the need to balance patient comfort with acquisition of high quality specimens. We had observed variable BMB quality at our institution with poor quality specimens sometimes affecting diagnosis. We thus undertook this quality improvement (QI) project to improve the quality of diagnostic BMB specimens.

METHODS

We used an A3 QI process to identify factors possibly influencing BMB quality. We collected baseline data on 211 BMB, with short and long-term follow-up data on a further 382 cases. We used clinical conferences to discuss data, perform peer comparisons and identify strategies to create a sustainable improvement in BMB quality.

RESULTS

Baseline data showed that BMB length was influenced most by the individual performer, with some influence of needle gauge. Other factors such as sedation, BMB indication were noncontributory. BMB lengths improved following performer education and individual performer data comparisons (15.2 mm post vs 12.8 mm baseline, P < .0001) and with use of an 8- rather than 11-gauge needle (18.3 mm 8-gauge vs 13.3 mm 11-gauge P < .0001), and were sustained over the long term.

CONCLUSIONS

Education on BMB standards, sharing of performer data, and changing needle gauge are relatively straightforward methods to improve BMB quality, leading to easier pathology diagnosis.

FBXO10 deficiency and BTK activation upregulate BCL2 expression in mantle cell lymphoma

Targeting Bruton tyrosine kinase (BTK) by ibrutinib is an effective treatment for patients with relapsed/refractory mantle cell lymphoma (MCL). However, both primary and acquired resistance to ibrutinib have developed in a significant number of these patients. A combinatory strategy targeting multiple oncogenic pathways is critical to enhance the efficacy of ibrutinib. Here, we focus on the BCL2 anti-apoptotic pathway. In a tissue microarray of 62 MCL samples, BCL2 expression positively correlated with BTK expression. Increased levels of BCL2 were shown to be due to a defect in protein degradation because of no or little expression of the E3 ubiquitin ligase FBXO10, as well as transcriptional upregulation through BTK-mediated canonical nuclear factor-κB activation. RNA-seq analysis confirmed that a set of anti-apoptotic genes (for example, BCL2, BCL-XL and DAD1) was downregulated by BTK short hairpin RNA. The downregulated genes also included those that are critical for B-cell growth and proliferation, such as BCL6, MYC, PIK3CA and BAFF-R. Targeting BCL2 by the specific inhibitor ABT-199 synergized with ibrutinib in inhibiting growth of both ibrutinib-sensitive and -resistant cancer cells in vitro and in vivo. These results suggest co-targeting of BTK and BCL2 as a new therapeutic strategy in MCL, especially for patients with primary resistance to ibrutinib.

High-resolution chromatin immunoprecipitation (ChIP) sequencing reveals novel binding targets and prognostic role for SOX11 in mantle cell lymphoma

Sex determining region Y-box 11 (SOX11) expression is specific for mantle cell lymphoma (MCL) as compared with other non-Hodgkin's lymphomas. However, the function and direct-binding targets of SOX11 in MCL are largely unknown. We used high-resolution chromatin immunoprecipitation sequencing to identify the direct target genes of SOX11 in a genome-wide, unbiased manner and elucidate its functional significance. Pathway analysis identified WNT, PKA and TGF-beta signaling pathways as significantly enriched by SOX11-target genes. Quantitative chromatin immunoprecipitation sequencing and promoter reporter assays confirmed that SOX11 directly binds to individual genes and modulates their transcription activities in these pathways in MCL. Functional studies using RNA interference demonstrate that SOX11 directly regulates WNT in MCL. We analyzed SOX11 expression in three independent well-annotated tissue microarrays from the University of Wisconsin (UW), Karolinska Institute and British Columbia Cancer Agency. Our findings suggest that high SOX11 expression is associated with improved survival in a subset of MCL patients, particularly those treated with intensive chemotherapy. Transcriptional regulation of WNT and other biological pathways affected by SOX11-target genes may help explain the impact of SOX11 expression on patient outcomes.

Resveratrol induces apoptosis in pancreatic cancer cells

BACKGROUND

Pancreatic cancer is one of the most lethal human cancers with a very low survival rate of 5 years. Conventional cancer treatments including surgery, radiation, chemotherapy or combinations of these show little effect on this disease. Several proteins have been proved critical to the development and the progression of pancreatic cancer. The aim of this study was to investigate the effect of resveratrol on apoptosis in pancreatic cancer cells.

METHODS

Several pancreatic cancer cell lines were screened by resveratrol, and its toxicity was tested by normal pancreatic cells. Western blotting was then performed to analyze the molecular mechanism of resveratrol induced apoptosis of pancreatic cancer cell lines.

RESULTS

In the screened pancreatic cancer cell lines, capan-2 and colo357 showed high sensitivity to resveratrol induced apoptosis. Resveratrol exhibited insignificant toxicity to normal pancreatic cells. In resveratrol sensitive cells, capan-2 and colo357, the activation of caspase-3 was detected and showed significant caspase-3 activation upon resveratrol treatment; p53 and p21 were also detected up-regulated upon resveratrol treatment.

CONCLUSION

Resveratrol provides a promising anti-tumor strategy to fight against pancreatic cancer.

Protective effects of pyrrolidine dithiocarbamate on liver injury in rats with severe acute pancreatitis

AIM: To investigate the relationship between nuclear factor-kB (NF-κB) activation and liver injury in rats with acute pancreatitis, and to assess the effectiveness of pyrrolidine dithiocarbamate (PDTC), an inhibitor of NF-κB, on experimental acute necrotizing pancreatitis.

METHODS: Sprague-Dawley rats were randomly divided into five groups: normal (Z), pancreatitis (Y), pre-intervention with intraperitoneal PDTC 1 h before modeling (A); post-intervention 1 hour after modeling (B); and PDTC 6 hours after modeling (C). Each group was randomly sub-divided into 6-, 12- and 24- hour groups, respectively. An acute pancreatitis rat model was produced by injecting taurocholate into the biliopancreatic duct. Sub-groups were sacrificed at 6, 12 or 24 hours after modeling. NF-κB activity in the pancreas and liver was examined by gel electrophoretic mobility shift assay. Levels of alanine aminotransferase (ALT) and amylase (AMY) were detected and pathological changes in liver and pancreas were observed.

RESULTS: NF-κB binding activity was not detected in the Z group. At 6, 12, 24 hour, NF-κB activities of the pancreas and liver in the Y group were significantly higher than that in the Z group (P < 0.001). One hour before and 1 hour after PDTC, PDTC could effectively inhibit NF-κB activity in the pancreas and liver (18.14 ± 3.30, 23.79 ± 3.62 vs 24.82 ± 4.57; 10.68 ± 2.51, 13.83 ± 2.70 vs 16.38 ± 2.50; P < 0.05). NF-κB binding activity in the A group was more inhibited than that in groups Y or B. ALT and AMY were distinctly elevated in group Y. However there were no meaningful changes observed among groups A, B, C and Y. Phlogistic changes in the liver and pancreas could be observed in the Y group. After intervention with PDTC, pathological changes were significantly alleviated in group A.

CONCLUSION: There are clear relationships between NF-κB and liver injury in severe necrotizing pancreatitis. Early blockade of NF-κB activity may be effective for avoiding liver injury in acute necrotizing pancreatitis.

Fatigue of the cement/bone interface: the surface texture of bone and loosening

Loosening is recognized as one of the primary sources of total hip replacement (THR) failure. In this study the influence of the bone surface texture on loosening of the cement/bone interface was studied. Model cemented hip replacements were prepared and subjected to cyclic loads that induced pure shear fatigue of the cement/bone interface. The femoral canals were textured with the use of specific cutting tools to achieve a desired surface topography. Loosening of the implant with cyclic loading was characterized in terms of the initial migration (Region I), steady-state loosening (Region II), and unstable loosening (Region III). Results from the experiments showed that the initial migration and rate of steady-state loosening were dependent upon the bone surface topography. The apparent fatigue strength ranged from 0.8 to 5.1 MPa, and denotes the cyclic shear stress required for loosening of 1 mm within 10 million cycles. Regardless of the bone surface topography the ratio of apparent fatigue strength and ultimate shear strength of the interfaces was approximately 0.24. In general, the apparent fatigue strength increased proportional to the average surface roughness of the femoral canal and the corresponding volume available for cement interdigitation. In addition, there was a strong correlation between the normalized initial migration and the apparent fatigue strength (i.e., specimens with the highest initial migration exhibited the lowest fatigue strength).

Relationship between telomerase activity and its subunit expression and inhibitory effect of antisense hTR on pancreatic carcinoma

AIM: To directly investigate the relationship between telomerase activity and its subunit expression and the inhibitory effect of antisense hTR on pancreatic carcinogenesis.

METHODS: We examined the telomerase activity and its subunit expression by cell culture, polymerase chain reaction (PCR), PCR-silver staining, PCR-ELISA, DNA sequencing, MTT and flow cytometry methods.

RESULTS: PCR-silver staining and PCR-ELISA methods had the same specificity and sensitivity as the TRAP method. Telomerase activity was detected in the extract of the 10^th, 20^thand 30^th passages of P3 cells,while it was absent in fibroblasts. Furthermore, after the 30th generation, the proliferation period of fibroblast cells was significantly prolonged. Telomerase activity and hTERTmRNA were detected in two pancreatic carcinoma cell lines, but were found to be negative in human fibroblast cells. Telomerase activity and hTERTmRNA were tested in pancreatic carcinoma specimens of 24 cases. The telomerase activity was positive in 21 of the 24 cases (87.5%), and the hTERTmRNA in 20 cases (83.3%). In adjacent normal tissues positive rates were both 12.5%. There was a significant difference between the two groups. This indicated a significant correlation between the expression level of telomerase activity and histologic differentiation, metastasis and advanced clinical stage of pancreatic carcinoma. Our findings showed that the expressions of hTR and TP1mRNA were not correlated with the activity of telomerase but the expression of hTERTmRNA was. After treatment with PS-ODNs, telomerase activity in P₃ cells weakened and the inhibiting effect became stronger with an increase in PS-ODNs concentration. There was a significant difference between different PS-ODN groups (P < 0.05). Inhibition of telomerase activity occurred most significant with PS-ODN1.The results of the FCM test of pancreatic cancer P₃ cells showed an increase in the apoptotic rate with increasing PS-ODN1 and PS-ODN2 concentrations.

CONCLUSION: The expression of telomerase activity has a significant relationship to carcinogenesis. A strong correlation exists between telomerase activity and hTERTmRNA expression. The up-regulation of hTERTmRNA expression may play a critical role in human carcinogenesis. The expression of telomerase activity and its subunit level in pancreatic carcinoma significantly correlate with the clinical stage of pancreatic carcinoma and hence, may be helpful in its diagnosis and prognosis. The anti-hTR complementary to the template region of hTR is sufficient to inhibit P3 cell telomerase activity and cell proliferation in vitro, and can lead to a profound induction of programmed cell death.

Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China

AIM

To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000).

METHODS

The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively.

RESULTS

Abdominal pain,jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%). Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures.In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality.

CONCLUSION

The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly.CT and ERCP were of great help in the classification of the disease.Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli's disease) with frequently recurrent cholangitis.

[Inhibition effects of phosphorothioate-modified antisense hTR on the telomerase activity and the growth of P3 cells derived from pancreatic cancer in culture]

This paper is to investigate PS-ODN's (antisense-PS-ODN of hTR,sense-PS-ODN of hTR and random sequence) effects on telomerase activity and proliferation of P3 pancreatic cancer cells,and to find a novel method for gene therapy of pancreatic cancer. The results indicate that the anti-hTR complementary to the template region of hTR is sufficient to inhibit P3 cell telomerase activity and cell proliferation in vitro,and as a result, they can lead to a profound induction of programmed cell death. Telomerase represents an interesting and promising anticancer drug target and anti-telomerase technology may have potential significance in tumor therapy.

The apparent volume of interdigitation: a new parameter for evaluating the influence of surface topography on mechanical interlock

A new parameter has been defined to estimate the apparent volume of interdigitation (V(i)) that is available from a surface to support mechanical interlock. The parameter is estimated in terms of the core roughness parameters, which can be obtained from the material ratio curve of a representative surface profile. A verification of the definition for V(i) is performed with the use of ideal surface profiles consisting of Gaussian and skewed height distributions. In contrast to conventional surface roughness parameters, the expression for V(i) is capable of differentiating between positive and negative skewed surfaces with the same average surface roughness. It is expected that V(i) will be a useful tool for optimization of the prosthesis and bone surface topographies, which are essential to the long-term success of cemented total joint replacements.

Diagnosis and treatment of congenital choledochal cyst: 20 years′ experience in China

AIM: To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years (1980-2000).

METHODS: The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively.

RESULTS: Abdominal pain, jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%). Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 39 patients. Before 1985 the diagnosis and classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures. In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality.

CONCLUSION: The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly. CT and ERCP were of great help in the classification of the disease. Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli’s disease) with frequently recurrent cholangitis.

[Phylogenetic relationships among Viperidae, Crotalinae based on mitochondrial 12S rRNA sequence variations]

This paper analyzed the phylogenetic relationships and classification of pit vipers (Viperidae, Crotalinae) based on mitochondrial 12S rRNA gene sequence variations. We have sequenced mtDNA 12S rRNA gene about 370 bp fragment from Gloydius saxatilis Emelianov, Gloydius shedaoensis Zhao, Gloydius ussurriensis (Emelianov), Trimeresurus stejnegeri Schmidt and Deinagkistrodon acutus, Gloydius brevicaudus (Stejneger) from two different localities, respectively. Combined with the sequence of Dinodon semicarinatus from GenBank, we have constructed two molecular phylogenetic trees using both Maximum-parsimony analysis and Neighbor-joining. Our results support the following conclusions: (1) Deinagkistrodon is a valid genus; (2) we also discussed the origin of Gloydius shedaoensis and showed it is a subspecies of Gloydius saxatilis; (3) Gloydius brevicaudsu and Gloydius ussurriensis are classified two species.

Carrots and sticks: fertility effects of China's population policies

For 20 years following 1949, average total fertility per woman in China hovered just above six children. The year 1970 marked the beginning of persistent fertility declines. By 1980, the rate had dropped to 2.75, and since 1992 it has remained under 2. While some of this transition can be accounted for by broad socioeconomic developments, the extent to which it is attributable to China's unique population policies remains controversial. This paper analyzes household data from the 1992 Household Economy and Fertility Survey (HEFS) to provide the first direct microeconomic empirical evidence on the efficacy of these policies.

Impact of flumazenil on recovery after outpatient endoscopy: a placebo-controlled trial

BACKGROUND

Flumazenil is an imidazobenzodiazepine that blocks the central effects of benzodiazepines by competitive interaction at the receptor level. In this study we assessed the impact of flumazenil use on postsedation observation time in outpatients undergoing endoscopy.

METHODS

Sixty outpatients received midazolam for conscious sedation and were randomized after endoscopy to receive intravenous flumazenil (0.1 mg/mL) or placebo until awake or a total of 10 mL was given. All patients were assessed using various psychomotor and cognitive tests at baseline and at 5, 15, 30, 45 and 60 minutes after flumazenil or placebo was administered.

RESULTS

The two groups were similar in age, gender, midazolam dose (mg/kg), vital signs, and baseline parameters. The average dose of flumazenil given was 0.41 mg. Sedation scores returned to presedation levels earlier in the flumazenil group, with significant differences compared to placebo at 5 minutes (84.6% vs. 24.2%), 15 minutes (88. 5% vs. 57.6%) and 30 minutes (96.2% vs. 66.7%). Other parameters tested were not significantly different for patients receiving placebo compared to those given flumazenil. Sedation scores returned to baseline earlier than other psychomotor and cognitive tests in both groups. Flumazenil reduced the mean observation time from 23.5 minutes to 8.3 minutes (p < 0.0005), a difference of 15.2 minutes (64.7%) based on sedation score.

CONCLUSIONS

Flumazenil significantly reduces postsedation observation time. Actual cost savings will vary depending on staff and facility capacity, patient volume, flumazenil cost, and unit cost of observation time.

Percutaneous endoscopic polypectomy of gallbladder polyps

We report here our preliminary experience with percutaneous endoscopic polypectomy of gallbladder polyps. Five patients with a total of 17 cholesterol polyps (size: 4-6 mm) and one patient with two gallbladder adenomas (size: 5 mm), four of whom were symptomatic and all of whom refused cholecystectomy, underwent a single-stage procedure under epidural anesthesia. All patients had functioning gallbladders, as assessed by oral cholecystography after stimulation. Following a small incision, the gallbladder was pulled out of the abdominal wall, incised, and a cholecystoscope introduced. The polyps were coagulated at their stalk using microwave irradiation (70-80 mA, 9 sec) and removed for histopathological evaluation thereafter. A catheter was left in situ for ten days. Follow-up for a mean of 11.6 months (8-16 months) showed all patients to be symptom-free and without recurrence of polyps on ultrasonography. Gallbladder function was assessed in five cases by meal-stimulated oral cholecystography, and in one by hepato-iminodiacetate acid (HIDA) scan and was found to be well preserved. The preliminary results warrant further evaluation of this method of removing indeterminate gallbladder polyps.

Pre- and post-operative hypothalamic-pituitary-thyroidal axis function in patients with prolactinoma, growth hormone tumour and ACTH tumour

Pre- and postoperative hypothalamic-pituitary-thyroid axis function was studied in 38 patients with pituitary adenomas (PRL, GH and ACTH tumours), of whom 35 were surgically confirmed and three diagnosed by clinical signs, CT scanning and hormone assessments. About ten days after operation, the same study was repeated in 10 patients with prolactinoma and 7 with growth hormone (GH) tumour. The preoperative abnormal serum TSH response to TRH was found in 8/20 patients with prolactinoma, 9/16 with GH tumour, and 2/2 with Cushing's disease due to ACTH microadenoma. The incidence of abnormal TSH response to TRH was not significantly increased in patients with larger adenoma in either PRL or GH tumour group. In 8 cases of prolactinoma, metoclopramide (MCP, 10 mg, P.O.) test was also performed and there was a significant positive correlation between TSH responses to TRH and to MCP. Serum TT3 in the GH tumour group was within normal ranges, but significantly higher than that of the normal and prolactinoma groups. After operation, TT3 was significantly decreased as compared with that before operation and there were marked changes in TSH response to TRH. In conclusion, there were some abnormalities in TSH control in patients with non-TSH pituitary tumour, and in serum TT3 control in patients with GH tumour. The surgical treatment of pituitary adenoma can lead to transient decrease in TSH reserve and serum TT3 level probably resulting from both stress and/or destruction of thyro-trophs by the operation.

Effect of the nitro group conformation on the rat liver microsomal metabolism and bacterial mutagenicity of 2- and 9-nitroanthracene

The aerobic and hypoxic metabolism of 2-nitroanthracene (2-NA) and 9-nitroanthracene (9-NA), two components of diesel exhaust, was studied and the mutagenicities of the parent compounds and their metabolites were compared. 2-NA was metabolized by 3-methylcholanthrene-induced rat liver microsomes under aerobic conditions to 2-NA trans-5,6-dihydrodiol, 2-NA trans-7,8-dihydrodiol, 2-NA 7-keto-5,6,7,8-tetrahydro-trans-5,6-diol, 2-NA 6-keto-5,6,7,8-tetrahydro-trans-7,8-diol, 2-nitro-9,10-anthraquinone and 2-NA 5,6,7,8-tetrahydrotetrol. When incubations were conducted under hypoxic conditions, 2-aminoanthracene was produced facily. N.m.r. spectral analysis indicated that the nitro-substituent of 2-NA and all of its ring-oxidized metabolites preferentially adopted an orientation in which the nitro group was coplanar or nearly co-planar with the aromatic ring system. 2-NA and its two trans-dihydrodiol metabolites were mutagenic in Salmonella typhimurium strain TA98, both in the presence and in the absence of S9 enzymes while the two tetrahydrodiol-ketones were much less mutagenic. When assayed in strains TA98NR and TA98/1,8-DNP6, the mutagenic activities of 2-NA and the trans-7,8-dihydrodiol were decreased. 2-Aminoanthracene was mutagenic in strain TA98 only in the presence of S9 enzymes. When 2-aminoanthracene was metabolized aerobically, the corresponding trans-5,6- and 7,8-dihydrodiols were not detected. These results suggest that 2-NA can be metabolized to mutagenic products by nitroreduction and ring-oxidation followed by nitroreduction, but not nitroreduction followed by ring-oxidation. Aerobic metabolism of 9-NA produced 9-NA trans-1,2- and 3,4-dihydrodiols, while metabolism was not detected under anaerobic conditions. Previous studies indicated that 9-NA and its two metabolites were not mutagenic in TA98. The differences in the orientation of the nitro substituents in 2-NA and its ring-oxidized metabolites and in 9-NA and its metabolites can be employed to explain the strong mutagenicity of 2-NA and weak mutagenicity of 9-NA when assayed both in the absence and in the presence of S9 activation enzymes.

Production, isolation, and preliminary toxicity studies of brevianamide A from cultures of Penicillium viridicatum

Brevianamide A, one of a novel group of alkaloids first obtained from Penicillium brevi-compactum, has also been isolated as a principal metabolite from two key isolates of P. viridicatum. Procedures for bioproduction and purification are described. This compound was not toxic when fed or injected into mice and had no antibiotic properties against several common bacterial and fungal microorganisms. Brevianamides A and B are among at least four yellow metabolites that may be formed by isolates of P. viridicatum.