[Correlation between postoperative microstructural changes in cerebral white matter and early postoperative cognitive function in patients undergoing meningioma resection]

Objective: To analyze the correlation between microstructure changes in cerebral white matter before and after surgery and early postoperative cognitive function in patients undergoing meningioma resection. Methods: A total of 17 patients who underwent their first meningioma resection at Xuanwu Hospital of Capital Medical University from April 2022 to April 2023 were prospectively included as observation group, with 5 males and 12 females, aged (56.4±7.3) years. Another 15 age- and education-matched patients with cerebral benign tumor were recruited as control group during the same period, with 5 males and 10 females, aged (55.2±8.0) years. Neuropsychological tests (NST), mainly including auditory verbal learning test of Huashan version (AVLT-H), the Montreal cognitive assessment-basic (MoCA-B), clock drawing task-30 (CDT-30), shape trails test-B (STT-B) and animal fluence test (AFT), were conducted at 1 day before surgery, 1 day and within 3-4 days after surgery in the observation group. Simultaneously, magnetic resonance imaging (MRI) scans were performed to collect diffusion tensor imaging (DTI) images at 1 day before surgery and within 3-4 days after surgery. The same NST were conducted at 1 day, 3 days and 6 days after admission in the control group to adjust for learning effects from repeated tests. The microstructure changes of the whole brain white matter were evaluated at the group level by using tract-based spatial statistics (TBSS) technology, including changes of fractional anisotropy (FA), mean diffusion (MD), axial diffusion (AD), and radial diffusion (RD). Then, correlation was performed between DTI indicators with statistically significant and cognitive function. Results: After adjusting for the learning effects, the AVLT-H (R), MoCA-B, and CDT-30 scores decreased, and the evaluation time of STT-B prolonged after surgery in patients with meningioma. And their perioperative decreased values were -0.78 (95%CI:-3.28--0.28) points, -2.22 (95%CI:-4.22--0.72) points, -2.74 (95%CI:-5.29--0.19) points, and 61.49 (95%CI: 5.71-117.27) seconds, respectively, with statistically significant differences (all P<0.05). Group level analysis of TBSS based on DTI images showed decreased FA mainly in the right superior cerebellar peduncle, left posterior limb of internal capsule and genu of corpus callosum, and increased RD mainly in the left anterior corona radiata in patients undergoing meningioma resection, with statistically significant differences (all PFWE<0.05). Linear correlation showed that the perioperative decreased values of FA in genu of corpus callosum and right superior cerebellar peduncle were positively correlated with the perioperative decreased values of AVLT-H (L) after adjusting for learning effects (r=0.72, 0.52, all PFWE<0.05). Conclusions: Patients undergoing meningioma resection are at risk of postoperative cognitive decline. Perioperative decreased values of FA in genu of corpus callosum and right superior cerebellar peduncle based on DTI images are positively correlated with the perioperative decreased values of AVLT-H (L) after adjusting for learning effects.

[The ventilation efficacy and safety of new nasopharyngeal airway applied in left atrial appendage occlusion]

Objective: The present retrospective study aimed to analyses the ventilation efficacy and safety of new nasopharyngeal airway applied in left atrial appendage occlusion. Methods: A total of 37 advanced aged patients diagnosed with atrial fibrillation(>65 years)who underwent left atrial appendage occlusion (LAAO) in Xuanwu Hospital of Capital Medical University from March 2021 to March 2022 were enrolled in this study. All patients received supplemental oxygen by a new nasopharyngeal airway to ensure intraoperative ventilation. The primary outcome was the occurrence of hypoxemia. The secondary outcomes included the incidence of hypotension after anesthesia, the incidence of body movement during surgery, significant fluctuations of the vital signs such as mean arterial pressure (MAP), heart rate (HR), saturation of pulse oxygen (SpO2) and respiratory rate (RR) at different time points (T1: pre-operation; T2: at the time of placing nasopharyngeal airway; T3: at the time of placing transesophageal echocardiography(TEE); T4: at the time of TEE intraoperative exploration; T5: end of the surgery; T6: at the time of patient woke up), and the incidence of postoperative adverse events. Results: There were 24 males and 13 females with a mean age of (73.8±7.7) years. The incidence of hypoxemia was 16.2% (6/37), which could return to normal after simple treatment. The incidence of hypotension was 27.0% (10/37), occurred after anesthesia induction mainly.32.4% (12/37) of the patients experienced movements, but no adverse events led to surgical termination. MAP at different time points was significantly different (P=0.001), but other vital signs of HR, SpO2 and RR were not significantly different(all P>0.05), without serious hemodynamic fluctuations. The incidence of postoperative adverse cardiovascular events was 10.8% (4/37), and delirium was 2.7% (1/37). All patients successfully completed the surgery and were safely discharged from the hospital. Conclusion: The new nasopharyngeal airway can meet the requirements of airway management during left atrial appendage occlusion under intravenous anesthesia without serious adverse events.

[Accelerating the transformation from anesthesia clinic to comprehensive anesthesia and multi-disciplinary evaluation, consultation, pre-rehabilitation and follow-up center in outpatient under aged society]

The acceleration of aging process in China bring challenges for the anesthesia management of elderly patients. The co-morbidity, decreased function and high risk of postoperative severe complications and mortality are the main reasons of resultant lower anesthesia and surgery rate,higher medical expenses for elderly patients. The transformation from anesthesia clinic service to comprehensive anesthesia and multi-disciplinary evaluation, consultation,pre-rehabilitation and follow-up center in outpatient is a new medical mode to resolve the problem, which depends on the collaboration among hospital, disciplines and government to undertake the task.

[The applications and challenges of combined monitoring of macro/micro-circulation and mitochondrial homeostasis in early warning of perioperative organ injury]

Perioperative organ injury is a leading risk factor for mortality in surgical patients. Given the current limitations in the timeliness and accuracy of markers for perioperative organ injury, this article proposes a comprehensive early-warning assessment system that jointly monitors the macro-circulation, micro-circulation, and mitochondrial homeostasis. Macro-circulation monitoring allows for real-time evaluation of key indicators such as blood pressure and cardiac output, while micro-circulation monitoring aids in assessing the status of microvascular perfusion. Monitoring of mitochondrial homeostasis provides timely insights into cellular energy metabolism. These three facets are interconnected and collectively determine the balance between tissue oxygenation and energy supply and demand. This article will elucidate commonly used monitoring methods and clinically valuable assessment models within this system, offering theoretical and technical guidance to deepen our understanding of the pathological processes of perioperative organ injury, enhance surgical safety and success rates, and improve patient prognosis and quality of life.

[Considerations on pathological diagnosis of inherited metabolic liver disease]

A liver biopsy has an important suggestive role in the diagnosis of inherited metabolic liver disease (IMLD). This article introduces the IMLD pathological diagnosis considerations, five types of classification of liver biopsy based on the morphological characteristics (basic normal liver tissue morphology, steatosis, cholestatic disease, storage/deposition, and hepatitis), and a summary of the pathological characteristics of different injury patterns and common diseases in order to provide clues for the correct diagnosis.

[Histological regression and clinical benefits in patients with liver cirrhosis after long-term anti-HBV treatment]

Objective: Our study aims to determine histological regression and clinical improvement after long-term antiviral therapy in hepatitis B virus-related cirrhosis patients. Methods: Treatment-naïve chronic hepatitis B patients with histologically or clinically diagnosed liver cirrhosis were enrolled. Liver biopsies were performed after 5 years entecavir-based antiviral treatment. Patients were followed up every 6 months. Cirrhosis regression was evaluated based on Metavir system and P-I-R score. Clinical improvement was evaluated before and after the long-term treatment. Kruskal Wallis test and Wilcoxon signed-rank test were used for continuous variables, Fisher's exact test was used for categorical variables and multivariate analysis was performed using logistic regression analysis. Results: Totals of 73 patients with HBV-related liver cirrhosis were enrolled. Among them, 30 (41.1%) patients were biopsy proved liver cirrhosis and the remaining 43 (58.9%) cirrhotic patients were diagnosed by clinical features. Based on Metavir system and P-I-R score, 72.6% (53/73) patients attained histological regression. Furthermore, 30.1% (22/73) were defined as significant regression (Metavir decrease ≥2 stage), 42.5% (31/73) were mild regression (Metavir decrease 1 stage or predominantly regressive by P-I-R system if still cirrhosis after treatment) and 27.4% (20/73) were the non-regression. Compared to levels of clinical characteristics at baseline, HBV DNA, ALT, AST, liver stiffness(decreased from 12.7 to 6.4 kPa in significant regression, from 18.1 to 7.3 kPa in mild regression and from 21.4 to 11.2 kPa in non-regression)and Ishak-HAI score significantly decreased after 5 years of anti-HBV treatment, while serum levels of platelets and albumin improved remarkably (P<0.05). In multivariate analysis, only the pre-treatment liver stiffness level was associated with significant regression (OR=0.887, 95%CI: 0.802-0.981, P=0.020). Conclusions: After long-term antiviral therapy, patients with HBV-related cirrhosis are easily to attain improvements in clinical parameters, while a certain percentage of these patients still cannot achieve histological reversal.

[Campaigning the innovation and practice of anesthesia and perioperative management for elderly patients in China]

The aged population in China is rapidly increasing, but there is a relative lower anesthesia rate with surgical indication for elderly patients because of worry for higher morbidity and mortality. In past five years, Chinese anesthesiologists have made the tremendous efforts to change this situation in as follow aspects. Firstly, establishing the anesthesia and multidisciplinary evaluation system for elderly patients to improve preoperative functional status, and accelerating the postoperative rehabilitation process. Secondly, releasing the publications of perioperative experts consensus for elderly patients based on the high level clinical researches to highlight clinical practice in China. Thirdly, implementing online virtual MDT discussion of anesthesia and perioperative management for critical elderly patients to improve perioperative diagnosis and treatment level. Fourthly, making the innovation of clinical practice and management pathway to adopt to the ERAS' clinical requests for elderly patients, especially advanced aged patients.

Value of sTNF-R1 and linc0597 as indicators for disease activity and diagnosis of lupus nephritis

OBJECTIVE

To explore whether Soluble tumor necrosis factor-receptor 1 (sTNF-R1) and linc0597 can be used as indicators for disease activity and diagnosis of lupus nephritis (LN).

PATIENTS AND METHODS

Eighty LN patients treated in our hospital were enrolled as the LN group, while 60 Systemic Lupus Erythematosus (SLE) patients without nephritis were included in the SLE group, and 50 healthy subjects who conducted physical examination during the same period as the control group. After admission, 5 mL of venous blood was taken from all the study subjects to measure sTNF-R1 level and linc0597 expression by enzyme-linked immunosorbent assay (ELISA) and RT-qPCR respectively. In addition, the receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic value of serum sTNF-R1 and linc0597 for LN, and Spearman correlation coefficient was adopted for the correlation between sTNF-R1, linc0597, and LN clinical disease Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Moreover, the logistic multiple regression analysis was applied to analyze the independent risk factors affecting the complication of LN in SLE patients.

RESULTS

The LN group presented significantly higher serum sTNF-R1 and linc0597 levels than the control group and the SLE group. Besides, ROC curve analysis revealed that sTNF-R1 and linc0597 had good clinical diagnostic value in LN and SLE. Furthermore, Spearman correlation coefficient indicated that serum sTNF-R1 and linc0597 were positively correlated with disease activity index SLEDAI (r=0.551, p<0.001; R =0.604, p<0.001). Moreover, multivariate Logistic regression analysis demonstrated that age (p=0.001), fever (p=0.004), arthralgia (p=0.034), serum uric acid (p=0.019), decreased complement C3 (p=0.023), ANA peripheral type (p=0.007), anti-ds-DNA antibody (p=0.003), ANCA (p=0.002), sTNF-R1 (p=0.001), and linc0597 (p<0.001) were all independent risk factors affecting the complication of LN in SLE patients.

CONCLUSIONS

STNF-R1 and linc0597 can be used as the indicators for disease activity and diagnosis of LN.

[The low-dose opioids therapy of perioperative multi-mode analgesia is pivotal to the enhanced recovery after surgery for elderly patients]

The implementation of enhanced recovery after surgery in elderly patients should be under the premise of adequate perioperative analgesia/anti-stress. The aims of perioperative multimodal low-dose opioids analgesia therapy are reducing opioid-related adverse reactions and the impact on process of postoperative recovery.

Meishan neonatal piglets tend to have higher intestinal barrier function than crossbred neonatal piglets

Meishan pigs tend to have higher disease resistance than commercial breeds, although more studies are needed to confirm this difference. This study compared intestinal barrier function between Meishan and crossbred neonatal piglets to provide guidance for both the breeding and nutritional regulation of pigs. Six Meishan piglets and 6 Duroc × (Landrace × Yorkshire) crossbred neonatal piglets (all with normal birth weights) were obtained and allocated into the MEIS and CROSS groups, respectively. Intestinal morphology, goblet cell numbers, antioxidant enzyme activity, and cytokine gene and tight junction protein expression were assessed. The results showed that BW was lower in the MEIS group than in the CROSS group (P < 0.01). The relative lengths of the duodenum (P < 0.05), jejunum (P < 0.01) and ileum (P < 0.01) in the MEIS group were higher than those in the CROSS group. Compared with the CROSS group, the MEIS group exhibited shorter villus lengths in the duodenum and jejunum (P < 0.01), a shallower crypt depth in the ileum (P < 0.001) and denser and longer microvilli in the intestine. The numbers of GCs in the duodenum (P < 0.01) and jejunum (P < 0.001) and the activity levels of glutathione peroxidase (P < 0.05) in the jejunum and of catalase (P < 0.01) and superoxide dismutase (P < 0.01) in the ileum were higher in the MEIS group than in the CROSS group. Compared with the CROSS group, the MEIS group exhibited higher gene expression levels of interleukin (IL) 4 and interferon γ (IFNγ) in the jejunum (P < 0.05); IL2 (P < 0.05), IL4 (P < 0.01) and IFNγ (P < 0.001) in the ileum; and mucin 2 (P < 0.01) and occludin (P < 0.05) in the duodenum. In conclusion, Meishan neonatal piglets showed lower birth weights but higher intestinal barrier function than crossbred piglets.

[Qualitative pathological assessment of liver fibrosis regression after antiviral therapy in patients with chronic hepatitis B]

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion: This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.

[Continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control in elderly hip fracture patients]

Objective: The purpose of this study was to assess the efficacy of ultrasound-guided continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control in elderly patients with hip fracture. Methods: One hundred and sixteen patients with hip fractures in Xuan Wu Hospital of Capital Medical University during Dec. 2015 to Dec. 2016 were included. These patients were randomized into 2 groups: control group (group C) (receiving the traditional analgesia: tramadol 50 mg and paracetamol 500 mg tid, po from admission to surgery), study group (group S) (receiving ultrasound-guided continuous fascia iliaca compartment block combined with oral analgesics for pre-operative pain control from admission to surgery). Pain relief or pain intensity was assessed preoperatively at before administration of analgesia (T₀), 1 h after administration of analgesia (T₁), the second day after admission(T₂), in the morning of surgery day (before surgery) (T₃) using a visual analog scale. The satisfaction score with the analgesic regimen preoperatively was recorded. The amount of rescue analgesia, occurrence of adverse events (nausea, vomiting, respiratory depression, over sedation) and continuous fascia iliaca compartment block complications were also collected. Results: Pain scores (VAS) at passive movement of group S were significantly lower at T₁ (32±8), T₂ (32±8) and T₃ (34±7) than that at T₀ (73±12) (all P<0.05). VAS at rest of group S were significantly lower than those of group C at T₃ (t=3.488, P<0.05). VAS at passive movement of group S were significantly lower than those of group C at T_1,T_2,T₃ (P<0.05). The satisfaction score with the analgesic regimen was greater in group S (74±10) than that in group C (46±11) (t=-14.209, P<0.05). The incidence of rescue analgesia was lower in group S (0) than in group C (17.2%) (χ²=5.472, P<0.05). The occurrence of nausea and vomiting was 6.9% and 1.7% in group S, which were lower than that in group C (22.4%, 12.1%) (χ²=6.779, 2.416, all P<0.05). There were no obvious complications of continuous fascia iliaca compartment block in group S. Conclusion: Ultrasound guided continuous fascia iliaca compartment block combined with oral analgesics preoperatively is an effective way of providing analgesia for elderly with hip fracture, which can improve the patient's comfort and satisfaction.

"All citizens of the world can save a life" - The World Restart a Heart (WRAH) initiative starts in 2018

"All citizens of the world can save a life". With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative - World Restart a Heart (WRAH) - to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by "first responders". Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR ("KIDS SAVE LIVES"), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.

On the manifestation of higher-order nonlinearities in a noble gas medium undergoing strong ionization

While there is a consensus that higher-order effects beyond χ⁽³⁾ are present also in high-intensity light-matter interactions, when and how they become apparent needs further study. The central question addressed in this Letter is whether it is possible to design a situation in which they show up before being completely masked by the electrons freed by a high-intensity field. The second question we attempt to answer is how much such observations, if and when feasible, can reveal about the nature of the nonlinear polarization. We answer the first question in the affirmative, but our comparative simulations indicate that distinguishing the higher-order nonlinearity from the third-order polarization can be extremely challenging. We also briefly discuss the implications for the interpretation of the measured values of the nonlinear index.

[Expression and mechanism of nitric oxide synthase in cerebral hyperperfusion rats]

OBJECTIVE

To explore the expression and mechanism of different nitric oxide synthase in cerebral hyperperfusion rats.

METHODS

Male Wistar rats were anesthetized and a ventral midline incision was made. The bilateral common carotid arteries were gently separated. Each artery was ligated with a 5-0 silk suture. Sham groups underwent the same operation without occlusion two weeks later, the ligature was loosened under a microscope to induce reperfusion. Phenylephrine was administered at concentration of 50 μg/ml via tail vein.After hyperperfusion, the expression of iNOS and eNOS in hippocampus , cortex and common carotid arteries of rats brain was observed by using Western blot of each group.

RESULTS

The expression of iNOS in differernt sites were increased significantly after reperfusion of 24 hours. The ratio of iNOS and β-actin in hippocampus in sham, BCAO, HP, HP 24 and HP 48 groups were 21.10±2.53, 24.37±2.30, 28.34±2.86, 43.76±2.58, 38.90±3.17, respectively. There was significant difference between HP 24 and other groups (F=13.03, all P<0.05). The ratio of iNOS and β-actin in cortex in each group were 12.98±2.31, 15.00±1.66, 14.71±1.48, 34.76±5.01, 32.60±5.73, respectively (F=8.42, all P<0.05). The ratio of iNOS and β-actin in common carotid arteries in each group were 7.30±2.55, 8.83±1.45, 4.76±0.71, 28.00±2.21, 26.29±3.33 (F=24.82, all P<0.05). While the levels of eNOS in that three sites presented no significant change(all P>0.05).

CONCLUSIONS

Hyperperfusion can induce iNOS ecpression in quantities in hippocamps, cortex and common carotid arteries. These levesl would last until 48 hours after reperfusion. This process suggests that iNOS is the possible mechanism of hyperperfusion.

Transcutaneous electrical nerve stimulation on acupoints reduces fentanyl requirement for postoperative pain relief after total hip arthroplasty in elderly patients

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) is regarded as an effective treatment for various types of pain. However, no randomized controlled trial has investigated TENS on acupoints for postoperative analgesia in elderly patients. This study aim to investigate whether TENS on acupoints has any favorable effect on complementary analgesia after total hip arthroplasty (THA) for elderly patients compared with a sham control treatment.

METHODS

Sixty-eight elderly patients requiring THA surgery were enrolled and randomly allocated to one of two groups. Group Acu received true TENS on acupoints (bilateral P6, L14; ST36, GB31 ipsilateral to the surgery site) and Group Sham received sham treatment. All patients received patient-controlled analgesia for two days postoperatively. Analgesia was assessed by postoperative fentanyl requirement and pain intensity using a visual analogue scale (VAS-10 cm). The incidence of analgesia-related side effects, optional medication use and effects of patients' blinding were recorded.

RESULTS

Fentanyl consumption in Group Acu was lower than that in Group Sham at 24 h (mean ± SD; 360±117 vs. 572±132 μg; P<0.001) and 48 h (712±184 vs. 1022±197 μg; P<0.001) after surgery. Postoperative pain intensity measured by VAS was similar in both groups. The incidence of opioid-related side effects and rescue medication for postoperative analgesia was significantly higher in Group Sham than in Group Acu. Differences between the groups regarding the effects of patients' blinding were not significant.

CONCLUSION

TENS on specific acupoints is an effective and complementary approach to reduce postoperative analgesic requirement in elderly patients after THA.

Recent progress of small molecular VEGFR inhibitors as anticancer agents

Vascular endothelial growth factor receptor (VEGFR) is an important receptor tyrosine kinase (RTK) in the induction of angiogenesis. Abnormal activation of VEGFR leads to several disorders including cancer. Nowadays, inhibition of VEGFR kinase has been one of the most powerful clinical strategies in cancer treatment and great efforts to design and synthesize small molecular VEGFR inhibitors for cancer research have been made in recent years. This review highlights the major progress and development of them, including their structure and pharmacophore features, biological activities and structure-activity relationships (SAR). Special attentions are paid to the compounds available in market or in advanced clinical stages.

Inhibition effect of poly(γ-glutamic acid) on lead-induced toxicity in mice

The objectives of this study were to evaluate the efficiency in treatment of lead-induced intoxication in mice with γ-PGA as chelating agent and compare with the drug (meso-2,3-dimercaptosuccinic acid). The results showed the incorporation of γ-PGA at 200 and 400 mg/kg could reduce the accumulation of lead in the liver, heart, and testis; however, the latter was more effective in decreasing the lead content in the kidney and spleen. Nevertheless, both doses failed to inhibit the lead accumulation in the lung and brain. Additionally, both doses of γ-PGA could reduce TBARs in the kidney and brain, as well as elevate δ-aminolevulinic acid dehydrase (δ-ALAD) activity in blood and decrease glutamic pyruvic transaminase (GPT) and lactic dehydrogenase (LDH) activities in the serum. For hematological parameters, both white blood cells (WBCs) and hematocrite (HCT) were raised by 400 mg/kg of γ-PGA, while for both doses of γ-PGA, a slight decline in hemoglobin (HGB), mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC) was observed, with the red blood cells (RBCs) being unaffected.

Proposed thermodynamic method to predict the glass formation of the ternary transition metal systems

By considering the energetic competition between the crystalline solid solution and glass phase, a thermodynamic method is proposed to predict/determine the glass forming range of a ternary metal system and in terms of the dynamics, the parameter gamma(ABC)* is further defined to search for a proper alloy with superior glass forming ability in the system. 10 more ternary/binary metal systems, e.g. the Cu-Zr-Ti and Cu-Hf-Ti systems, were studied and the predicted alloys of superior glass forming ability match well with those reported from experimental observations.

Gabapentin toxicity: an important cause of altered consciousness in patients with uraemia

Gabapentin toxicity should be considered one of the differential diagnoses of altered consciousness in patients with compromised renal function, even after a single dose. We report a 57-year-old woman with diabetes mellitus and uraemia on regular haemodialysis who developed severe dizziness and lethargy after a single recommended dose of gabapentin for bilateral leg dysthesia. Because of progressive drowsiness and decreasing level of consciousness, one session of haemodialysis was performed and clinical recovery was dramatic. The adverse effects of gabapentin seem to vary from person to person and should be viewed with a high degree of suspicion, especially in patients taking this drug at the beginning.

Laser channeling in millimeter-scale underdense plasmas of fast-ignition targets

Two dimensional particle-in-cell simulations show that laser channeling in millimeter-scale underdense plasmas is a highly nonlinear and dynamic process involving longitudinal plasma buildup, laser hosing, channel bifurcation and self-correction, and electron heating to relativistic temperatures. The channeling speed is much less than the linear group velocity of the laser. The simulations find that low-intensity channeling pulses are preferred to minimize the required laser energy but with an estimated lower bound on the intensity of I approximately 5x10(18) W/cm(2) if the channel is to be established within 100 ps. The channel is also shown to significantly increase the transmission of an ignition pulse.

Gabapentin toxicity: an important cause of altered consciousness in patients with uraemia

Gabapentin toxicity should be considered one of the differential diagnoses of altered consciousness in patients with compromised renal function even after a single dose. We report a 57-year-old woman with diabetes mellitus and uraemia on regular haemodialysis who developed severe dizziness and lethargy after a single recommended dose of gabapentin for bilateral leg dysthesia. Because of progressive drowsiness and decreasing level of consciousness, one session of haemodialysis was performed and clinical recovery was dramatic. The adverse effects of gabapentin seem to vary from person to person and should be viewed with a high degree of suspicion, especially in patients taking this drug at the beginning.

Ovarian torsion caused by teratoma masquerading as renal colic

Ovarian torsion is a well known but poorly recognised disease and prompt treatment is necessary to avoid adverse outcomes. We report a patient with severe right flank pain initially diagnosed as renal colic. She was brought to our emergency department because of persistent pain. After further investigation, ovarian torsion caused by teratoma was diagnosed. Because of the timely management, the patient made a good recovery. This is an uncommon but important case that emergency physicians should be aware of.

Assessment of TP53 mutation using purified tissue samples of ovarian serous carcinomas reveals a higher mutation rate than previously reported and does not correlate with drug resistance

The TP53 mutation frequency in ovarian serous carcinomas has been reported to range between 50% and 80%, but a stringent analysis of TP53 using purified epithelial samples has not yet been performed to accurately assess the mutation frequency and to correlate it with the histologic grade. The purpose of this study was to assess the TP53 mutational profile in a relatively large series of high-grade (53 primary and 18 recurrent) and 13 low-grade ovarian serous tumors using DNA isolated from affinity-purified tumor cells and to correlate it with in vitro drug resistance. All samples were affinity purified, and the tumor DNA was analyzed for TP53 mutations in exons 4-9. In vitro drug resistance assays to carboplatin, cisplatin, paclitaxel, and taxotere were performed on the same tumor samples and correlated with the TP53 mutation status. TP53 mutations were detected in 57 (80.3%) of 71 high-grade carcinomas and in one (7.8%) of 13 low-grade serous tumors (an invasive low-grade serous carcinoma). The mutations were predominantly missense mutations (59.6%). TP53 mutations were associated with high-grade serous carcinomas and recurrent disease (P < 0.0001). There was no statistically significant correlation between TP53 mutation status and drug resistance assays or clinical stage (P > 0.25). The frequency of TP53 mutations using purified tumor DNA from ovarian serous carcinomas was 80.3%, which is much higher than previously reported. Furthermore, we found that TP53 is not directly involved in the development of drug resistance in high-grade ovarian serous carcinomas.

Role of proximal gastric acid reflux in causation of respiratory symptoms in children with gastroesophageal reflux

OBJECTIVES

The association of gastroesophageal reflux (GER) and respiratory disorders is well known but the mechanism is still unclear. This study aims to evaluate the presence and severity of proximal gastric acid reflux in children having GER with or without respiratory symptoms.

METHODS

24 hour esophageal pH monitoring with a dual pH probe placed in the proximal and distal esophagus was performed in 23 and 31 children having GER with or without respiratory symptoms, respectively.

RESULTS

No significant difference in the parameters of pH monitoring in either proximal or distal esophagus was observed between GER patients with or without respiratory symptoms. The proportion of patients having proximal GER among those with respiratory symptoms was not significantly different from those without respiratory symptoms (P > 0.05).

CONCLUSION

Proximal esophageal acid reflux does not seem to play a role in the development of persistent respiratory symptoms in children with GER. Distal esophageal acid reflux is the predominant form of reflux in children with GER regardless of the occurrence of respiratory symptoms.

Observations of distinct atomic packings in Cu-Nb metallic glasses synthesized by ion beam mixing

The structural transformation and disordered atomic packing of metallic glasses in a selected immiscible system at equilibrium, i.e. the Cu-Nb system characterized by a positive heat of formation, are studied using ion beam mixing far from equilibrium. The experimental results indicate that the Cu-Nb metallic glasses could be formed in a composition range from 30 to 85 at.% of Nb and that the Cu-Nb metallic glasses are formed through two different structural phase transition routes, i.e. from the Nb-based body centred cubic and face centred cubic solid solutions, in which the two distinct predominant atomic packings have icosahedral and icositetrahedral orderings, respectively, revealed by the respective diffraction patterns. These observations not only help in formulating a general atomic structural spectrum for the binary metallic glasses, but also suggest an important concept of structural heredity: that the crystalline structure of the constituent metals plays a decisive role in determining the atomic structure of the resultant metallic glasses.

Risk stratification of severe sepsis patients in the emergency department

OBJECTIVE

To determine the efficacy of the Mortality in Emergency Department Sepsis (MEDS) score in the stratification of patients who presented to the emergency department (ED) with severe sepsis.

METHODS

Adults who presented to the ED with severe sepsis were retrospectively recruited and divided into group A (MEDS score <12) and group B (MEDS score > or =12). Their outcomes were evaluated with 28 day hospital mortality rate, length of hospital stay, Kaplan-Meier survival analysis, and receiver operating characteristic (ROC) analysis. Discriminatory power of the MEDS score in mortality prediction was further compared with the Acute Physiology and Chronic Health Evaluation (APACHE) II model.

RESULTS

In total, 276 patients (44.6% men and 55.4% women) were analysed, with 143 patients placed in group A and 133 patients in group B. Patients with MEDS score > or =12 had a significantly higher mortality rate (48.9% v 17.5%, p<0.01) and higher median APACHE II score (25 v 20 points, p<0.01). Significant difference in mortality risk was also demonstrated with Kaplan-Meier survival analysis (log rank test, p<0.01). No difference in the length of hospital stay was found between the groups. ROC analysis indicated a better performance in mortality prediction by the MEDS score compared with the APACHE II score (ROC 0.75 v 0.62, p<0.01).

CONCLUSION

Our results showed that mortality risk stratification of severe sepsis patients in the ED with MEDS score is effective. The MEDS score also discriminated better than the APACHE II model in mortality prediction.

Mesenteric injury caused by minor blunt abdominal trauma

The authors present an unusual case of mesenteric injury caused by minor blunt abdominal trauma and also provide a review of the literature.

An unusual presentation of baclofen overdose

Baclofen has become increasingly popular in the treatment of spasticity disorders. Its availability for misuse has also increased. We report a case of baclofen overdose in a 20-year-old man, who manifested atypical symptoms of baclofen overdose--that is, delirium and rhabdomyolysis. He was treated successfully with full supportive management, and was discharged from the hospital on the 12th day following admission. If a past medication history is not immediately available, baclofen overdose should be included in the differential diagnosis of an acutely confused patient complicated with rhabdomyolysis, as routine toxicology screening does not include baclofen.

Isolated oculomotor nerve palsy from minor head trauma

Isolated third cranial nerve palsies in head trauma patients can be the result of direct or indirect damage to the oculomotor nerve. They are usually associated with severe head trauma. We reported a case of isolated oculomotor nerve palsy associated with minor head injury. No initial loss of consciousness was recalled. Computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) of the brain were normal. Previous reports in the literature were reviewed and the possible mechanism of injury was discussed. Head injuries are commonly seen in sports settings. Our case illustrated that even minor head trauma can cause isolated oculomotor nerve palsy in the absence of abnormal brain imaging findings.

Comparison of lidocaine and bronchodilator inhalation treatments for cough suppression in patients with chronic obstructive pulmonary disease

BACKGROUND

This study aimed to assess and compare the effectiveness of lidocaine and bronchodilator inhalation treatments for rapid cough suppression in patients with chronic obstructive pulmonary disease (COPD).

METHODS

Prospective comparison study carried out in a tertiary emergency department. Consecutive COPD patients presenting with intractable cough were randomly assigned to receive lidocaine or terbutaline inhalation treatments for cough suppression. Patients with dyspnoea, unstable vital signs, and pneumonia or neoplasm on chest x ray were excluded. A subjective, 10 point questionnaire based cough severity score was used for assessing the outcome.

RESULTS

The final study sample included 127 patients (mean (SD) age, 69.2 (12.1) years; 33.1% women) of whom 62 received nebulised lidocaine and 65 nebulised bronchodilator. The cough severity score was significantly reduced one hour after inhalation treatment with both lidocaine and bronchodilator, with no significant difference in efficacy. Common but mild side effects in the lidocaine group included oropharyngeal numbness and bitter taste, and, in the bronchodilator group, tremor and palpitation. Dyspnoea, dizziness, and nausea and vomiting were equally uncommon in both groups. None of these problems caused any of the patients to discontinue their treatments and no allergic reactions were reported.

CONCLUSIONS

Both lidocaine and bronchodilator inhalation treatments are equally effective for short term cough suppression in patients with COPD.

Preconsultation use of analgesics on adults presenting to the emergency department with acute appendicitis

OBJECTIVE

279 cases of appendicitis were reviewed and compared for the difference between those patients who received pain medication before consulting a surgeon and those who were not treated with analgesics.

METHODS

All patients aged 15 years and older who underwent appendicectomy for appendicitis between 1 July 2001 and 30 June 2002 were divided into group 1 (those who received preconsultaion use of analgesics) and group 2 (those who were not treated with analgesics). The following measures were compared: age, sex, symptom duration, initial vital signs, white blood cell counts, frequency of imaging studies, time to operative intervention, and operative findings. Continuous and categorical variables were analysed using t and chi(2) tests, respectively.

RESULTS

A total of 279 patients were included for analysis. Patient details (age, sex, symptom duration) of the two study groups were similar. There was no statistically significant difference between group 1 and group 2 with respect to vital signs (systolic blood pressure, pulse rate, respiratory rate, body temperature), white blood cell counts, and frequency of imaging studies (ultrasound, computed tomography). There was no significant difference in the rate of perforated appendicitis between the two study groups although a shorter median time to operative intervention has been found in the group who received analegesia.

CONCLUSION

The preconsultation use of analgesics in ED patients with a final diagnosis of appendicitis is not associated with a longer delay to operative intervention and is not associated with an increased rate of perforated appendicitis.

Rhabdomyolysis in 119 students after repetitive exercise

Exercise induced rhabdomyolysis is well known, but has rarely been reported in high school students. This is the report of 119 cases in high school students who exercised vigorously (120 push ups in five minutes) in cold weather. Most of them developed muscle pain and dark urine within two to four days of the exercise.

Mutant alleles at the rugosus loci in pea affect seed moisture sorption isotherms and the relations between seed longevity and moisture content

Pea (Pisum sativum L.) mutant near-isogenic lines (RRrbrb, rrRbRb, rrrbrb) with lower starch but higher lipid contents, brought about by lesions in the starch biosynthetic pathway, had seed moisture sorption isotherms displaced below that of the wild type (RRRbRb). The negative logarithmic relationship between seed longevity and seed storage moisture content (%, f.wt basis), determined in hermetic storage at 65 degrees C, also differed: longevity in the mutant near-isogenic lines was poorer and less sensitive to moisture content than in the wild type (i.e. C(W) was lower). The low-moisture-content limit (m(c)) to this relation also differed, being lower in the mutant near-isogenic lines (5.4-5.9%) than in the wild type (6.1%). In contrast, all four near-isogenic lines showed no difference (P >0.25) in the negative semi-logarithmic relationship between equilibrium relative humidity (ERH) and seed longevity. It is concluded that the effect of these alleles at the r and rb loci on seed longevity was largely indirect; a consequence of their effect on seed composition and hence on moisture sorption isotherms. However, this explanation could not be invoked at moisture contents below m(c) where differences in longevity remained substantial (RRRbRb double that of rrrbrb). Hence, these mutant alleles affected seed longevity directly at very low moisture contents.

Mutant alleles at the rugosus loci in pea affect seed moisture sorption isotherms and the relations between seed longevity and moisture content

Pea (Pisum sativum L.) mutant near-isogenic lines (RRrbrb, rrRbRb, rrrbrb) with lower starch but higher lipid contents, brought about by lesions in the starch biosynthetic pathway, had seed moisture sorption isotherms displaced below that of the wild type (RRRbRb). The negative logarithmic relationship between seed longevity and seed storage moisture content (%, f.wt basis), determined in hermetic storage at 65 degrees C, also differed: longevity in the mutant near-isogenic lines was poorer and less sensitive to moisture content than in the wild type (i.e. C(W) was lower). The low-moisture-content limit (m(c)) to this relation also differed, being lower in the mutant near-isogenic lines (5.4-5.9%) than in the wild type (6.1%). In contrast, all four near-isogenic lines showed no difference (P >0.25) in the negative semi-logarithmic relationship between equilibrium relative humidity (ERH) and seed longevity. It is concluded that the effect of these alleles at the r and rb loci on seed longevity was largely indirect; a consequence of their effect on seed composition and hence on moisture sorption isotherms. However, this explanation could not be invoked at moisture contents below m(c) where differences in longevity remained substantial (RRRbRb double that of rrrbrb). Hence, these mutant alleles affected seed longevity directly at very low moisture contents.

Structural studies of starches with different water contents

The proportion of double helices in starches from a series of pea [rb, rug4-b, rug3-a, and lam-c mutants, and the wild type (WT) parental line], potato and maize (normal and low amylose), and wheat (normal) lines, ranged from about 30-50% on a dry weight basis. In relatively dry starch powders, only about half of the double helices were in crystalline order, this proportion being higher for A-type than for B-type starches. Using starch from WT pea as an example, it was found that increasing water content results in an increase in total crystallinity. When the water content was raised to a level similar to that in excess water, the proportion of crystallinity was close to the proportion of double helices (DH). Measuring crystallinity in starches with a high water content is difficult using traditional methods such as x-ray diffraction. A method was developed, therefore, for determining starch structural characteristics in excess water by measuring the enthalpy of gelatinization transition in quasi-equilibrium differential scanning calorimetry (DSC) experiments. It is suggested that DH% = DeltaH(sp)/DeltaH(DH) x 100%, where DeltaH(sp) and DeltaH(DH) represent the specific enthalpies of gelatinisation transition, DeltaH(sp) being measured as J/g dry starch weight and DeltaH(DH) as J/g DH, in starch. Studies on potato and maize starches in excess water and in 0.6M KCl showed, respectively, that DeltaH(DH) was 36.3 and 35.6 J/g for B-type polymorphs and 33.0 and 35.0 J/g for A-type polymorphs. For C-type starches, such as those from pea, intermediate values of DeltaH(DH), related to the proportions A-/B-polymorphs, should be used. The type of crystallinity in starch can be determined by the shift in peak temperature for thermograms in excess water and in excess 0.6M KCl. For B-polymorphs this shift was found to be approximately 2-3 degrees C and for A-polymorphs approximately 7-12 degrees C. The ratio between ordered areas with both A- and B-polymorphs can be determined from the enthalpies of disruption of each area. These enthalpies can be obtained by deconvolution of bimodal thermograms produced by C-type starches in excess 0.6M KCl. This methodical approach can be applied to all starches that give a sharp gelatinisation thermogram in excess water. Using a range of methods, including DSC, it was found that starch granules from the mutant peas are constructed in a similar way to those from the WT, with B-polymorphs in the centre and A-polymorphs at the periphery of all granules. The proportion of A/B-polymorphs, however, differed between the mutants. It was found that in addition to increasing the total crystallinity, increasing the water content within the granules also resulted in an increase in the proportion of B-polymorphs.

Kinetics of iron release from pig spleen ferritin with bare platinum electrode reduction

Several anaerobic electrochemical cells were employed to study the kinetics of iron release from pig spleen ferritin (PSF) at a bare platinum electrode. Controlled potential microcoulometry (CPM) is the principal technology used to investigate the kinetics in the absence of a mediator. A kinetic study of iron release by microcoulometry has revealed that ferritin undergoes direct electron transfer at the electrode in the absence of a mediator, indicating that ferritin is an electroactive protein. Several experiments failed to show that alpha'alpha-bipyridyl has the capacity to reduce hydrolyzed Fe(3+) within the ferritin core after it has been reduced by the electrode at -600 mV vs. NHE in the absence of mediator. PSF is known to bind heme to generate a hemeoprotein, named pig spleen hemeoferritin (PSF(ho)). The rate of iron release is accelerated by the heme binding to PSF(ho) without the need for small mediators. Under similar conditions, two kinetic processes for iron release from PSF and bacterial ferritin of Azoaobacter vinelandii (AvBF) were studied and both fit a zero-order law. In addition, the rate of iron release in PSF can be accelerated two-fold by a specific reduction system consisting of ascorbic acid (AA) and the bare platinum electrode at -600 mV. However, this kinetic process does not follow zero-, half-, first, or second-order rate laws. A model is proposed to explain a mechanism of direct electron transfer between ferritin and the electrode is derived to describe the kinetics of iron release.

Multiple, distinct isoforms of sucrose synthase in pea

Genes encoding three isoforms of sucrose synthase (Sus1, Sus2, and Sus3) have been cloned from pea (Pisum sativum). The genes have distinct patterns of expression in different organs of the plant, and during organ development. Studies of the isoforms expressed as recombinant proteins in Escherichia coli show that they differ in kinetic properties. Although not of great magnitude, the differences in properties are consistent with some differentiation of physiological function between the isoforms. Evidence for differentiation of function in vivo comes from the phenotypes of rug4 mutants of pea, which carry mutations in the gene encoding Sus1. One mutant line (rug4-c) lacks detectable Sus1 protein in both the soluble and membrane-associated fractions of the embryo, and Sus activity in the embryo is reduced by 95%. The starch content of the embryo is reduced by 30%, but the cellulose content is unaffected. The results imply that different isoforms of Sus may channel carbon from sucrose towards different metabolic fates within the cell.

Multiple, distinct isoforms of sucrose synthase in pea

Genes encoding three isoforms of sucrose synthase (Sus1, Sus2, and Sus3) have been cloned from pea (Pisum sativum). The genes have distinct patterns of expression in different organs of the plant, and during organ development. Studies of the isoforms expressed as recombinant proteins in Escherichia coli show that they differ in kinetic properties. Although not of great magnitude, the differences in properties are consistent with some differentiation of physiological function between the isoforms. Evidence for differentiation of function in vivo comes from the phenotypes of rug4 mutants of pea, which carry mutations in the gene encoding Sus1. One mutant line (rug4-c) lacks detectable Sus1 protein in both the soluble and membrane-associated fractions of the embryo, and Sus activity in the embryo is reduced by 95%. The starch content of the embryo is reduced by 30%, but the cellulose content is unaffected. The results imply that different isoforms of Sus may channel carbon from sucrose towards different metabolic fates within the cell.