Effect of Low-dose Lidocaine on Motor Evoked Potentials in Patients Undergoing Intracranial Tumor Resection With Propofol Anesthesia

ObjectTo investigate the effect of low-dose lidocaine on motor evoked potentials (MEP) in patients undergoing intracranial tumor resection with propofol anesthesia.MethodsForty patients undergoing intracranial tumor resection and required MEP monitoring were selected.They were randomly divided into the lidocaine group (Group L, n=20) and control group (Group C, n=20) by computer generated randomization. All patients were given propofol anesthesia under the guidance of bispectral index (BIS).In Group L, lidocaine 1 mg/kg was injected intravenously during anesthesia induction. Then, lidocaine was continuously pumped at the speed of 1 mg/kg·h until the operation start. Group C was given the equal volume of normal saline. Heart rate (HR), mean artery pressure (MAP), and BIS were recorded before anesthesia induction (T0), 2 min after tracheal intubation (T1), 35 min (T2) and 50 min (T3) after anesthesia induction. The amplitude and latency of MEP at T2 and T3, the total dosage of propofol, and adverse events before T3 were recorded.ResultsCompared with Group C, HR and MAP were significantly decreased at T1 in Group L. No significant difference was observed in HR and MAP at T0, T2 and T3 between Group L and Group C. The total dosage of propofol and the incidence of adverse events were significantly lower in Group L than in Group C before T3. There was no significant difference in the amplitude and latency of MEP between the two groups at each time point.ConclusionLow-dose lidocaine has no effect on MEP in patients undergoing intracranial tumor resection. In addition, it increased hemodynamic stability, reduced propofol use, and decreased the incidence of adverse events.

Effects of Ropivacaine Combined with Ketorolac Transverse Abdominis Plane Block on Postoperative Analgesia in Patients Undergoing Gynecological Laparoscopic Surgery

Objective — To observe the effects of ropivacaine combined with ketorolac transverse abdominis plane (TAP) block on postoperative analgesia in patients undergoing gynecological laparoscopic surgery. Methods — 90 ASAⅠorⅡpatients, aged 18-65 years and weighting 40-80 kg, scheduled for gynecological laparoscopic surgery were recruited and divided into three groups using random number table:ropivacaine combined with ketorolac 15 mg/side for TAP block (KR group), ropivacaine for TAP block and 30 mg preoperatively intravenous ketorolac (KIVR group) and ropivacaine for TAP block alone (R group) with 30 patients in each group. Intraoperative opioid consumption, Bruggrmann comfort scale (BCS) scores at 2h (T1), 4h (T2), 8h (T3), 12h (T4), 16h (T5), 24h (T6) after surgery were recorded. Adverse reactions such as nausea and vomiting, respiratory depression, local anesthetic poisoning, gastrointestinal bleeding, and complications related to TAP block operation were recorded. Results — The total consumpsion of sufentanil was higher in the R group than that in the KIVR group and KR group (P < 0.05). The total dosage of remifentanil in R group was higher than that in KR group (P < 0.05). The BCS scores of the three groups at T3, T4, T5 and T6 were lower in R group than that in KR group (P < 0.05) while R Group was lower than KIVR group at T3 and T4 (P < 0.05), and KIVR group was lower than KR group at T5 and T6. There was no statistically differences in BCS score between the three groups at T1 and T2 (P > 0.05). No statistical differences in the incidence of adverse reactions among all groups were observed. Conclusion — Ropivacaine combined with ketolorac transverse abdominisplane block reduced the intraoperative opioid consumption, improved postoperative comfort score and do not increased the incidence of adverse reactions in gynecological laparoscopic surgery.

Mortality after Use of Paclitaxel-Coated Balloons Correlates with Total Cumulative Dosage of Paclitaxel in Real-World Analysis

This study used independent, real-world, patient-level data to examine whether the dosage or frequency of paclitaxel exposure correlated with mortality during follow up. We conducted a retrospective analysis of patients treated with a drug-coated balloon (DCB) for an atherosclerotic femoropopliteal lesion from February 2013 to December 2018, excluding patients with non-atherosclerotic lesions or restenosis after DCB treatment in another hospital. We investigated the causes of death, comorbidities (including cancer status), and the initial and total cumulative dosages and frequency of paclitaxel use. To determine whether the dosage or frequency of paclitaxel exposure affected mortality during follow up, we analyzed the risk factors for all-cause death by conducting a time-dependent Cox regression analysis that considered demographics, comorbidities, lesion and procedural characteristics, and paclitaxel exposure data (dosage and frequency). Our analysis examined 225 patients (mean age 71 ± 9 years, range 38–93 years, male 81%). During a mean follow-up duration of 35 months (range 1–89 months), 56 patients (24.9%) died from cardiac disorders (16%, including acute myocardial infarction, heart failure, or sudden cardiac arrest), malignancy (14.3%), respiratory failure with pneumonia (12.5%), septic shock (12.5%), or another cause. Univariable and multivariable Cox regression analyses identified age (hazard ratio, HR, 1.057; 95% confidence interval, CI, 1019–1096; p = 0.0032), critical limb ischemia (CLI) (HR, 4135; 95% CI, 2171–7876; p < 0.0001), and the total dosage of paclitaxel (mg) (HR, 1.040; 95% CI, 1006–1074; p = 0.0210) as predictors of mortality during follow up. The subgroup analysis found that the total dosage of paclitaxel (mg) was also a predictor of mortality during follow up in the CLI group (HR, 1.046; 95% CI, 1007–1087, p = 0.0198). The estimated cut-off value of total cumulative paclitaxel dosage for predicting mortality was 12 mg as evaluated by minimum p value approach. This patient-level analysis identified the total cumulative dosage of paclitaxel as a predictor of mortality after the use of paclitaxel-coated balloons. Our results provide limited information about the potential dose–response relationship underlying paclitaxel-associated mortality concerns.

Antiparkinsonian drugs as potent contributors to nocturnal sleep in patients with Parkinson’s disease

Objective To clarify whether antiparkinsonian drugs contribute to nocturnal sleep disturbances in patients with Parkinson’s disease (PD). Background Although the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients. Methods The study participants consisted of 112 PD patients (median age 72.5 years [inter-quartile range: IQR 65–79]; mean disease duration 8.44 years [standard deviation: 7.33]; median Hoehn and Yahr stage 3 [IQR 2–3.75]) taking one of three types of non-ergot extended-release DAs (rotigotine 32; pramipexole 44; ropinirole 36) with or without L-dopa (median daily total dosage of antiparkinsonian drugs 525.5 mg [IQR 376.25–658] levodopa equivalent dose [LED]). Participants were assessed using the PD Sleep Scale-2 (PDSS-2). Results For the whole PD patient cohort, the PDSS-2 sleep disturbance domain score and the scores for item 1 assessing sleep quality and item 8 assessing nocturia were positively correlated with daily total dosage of antiparkinsonian drugs and dosage of L-dopa, but not with the dosage of DAs. Sub-analysis according to DA treatment revealed that DA dosage was not correlated with item 1 or 8 score in any of the subgroups. The LED ratio of rotigotine to the total dosage of antiparkinsonian drugs was inversely correlated with the item 1 score. Conclusions These data suggest that antiparkinsonian drugs, in particular L-dopa, adversely affect nocturnal sleep in PD patients, especially in terms of sleep quality and nocturia. Thus, adjusting both the total dosage of antiparkinsonian drugs and the dose-ratio of L-dopa might be key actions for alleviating poor sleep quality in patients with PD. Among DAs, we found a clear positive correlation between the dose-ratio of rotigotine and sleep quality. Thus, partial L-dopa replacement with rotigotine could improve sleep quality in patients with PD.

Effect of Polymerizable Emulsifiers on the Properties of Polyacrylate Latexes and the Relative Waterborne Inks

Polyacrylate latexes made from non-polymerizable emulsifiers and their inks typically suffer from poor ethanol resistance stability and low adhesion on biaxially oriented polypropylene (BOPP) and polyethylene (PE) films. In this contribution, a composite emulsifier system containing a polymerizable anionic and a polymerizable non-ionic emulsifier was used to synthesize core-shell polyacrylate latexes. Additionally, a control latex was also prepared using a traditional emulsifier TX-30 to replace the polymerizable non-ionice mulsifier in the above composite emulsifiers. The effect of the polymerizable emulsifier on ethanol resistance, Ca 2+ resistance stability, and adhesion on PE and BOPP films of the latexes and the inks, and water resistance of the latex films and ink films were studied. The results show that, when compared with the control latex, the one made from double polymerizable compound emulsifier system and its ink demonstrates better ethanol resistance, higher stability of calcium ions and higher adhesion on BOPP and PE. When the ratio of anionic emulsifier to non-ionic emulsifier is 1.5/1 and the total dosage is 2.5 wt%, the latex showed the best comprehensive performance. The calcium ion resistance stability of the latex increased from 5% of the control latex to 25%. Accordingly, the adhesion of yellow ink on BOPP film increased from 92% of the ink based on the control latex to 99% and increased from 99% to 100% on PE film. The adhesion of blue ink on BOPP film increased from 92% to 99%, and from 99% to 100% on PE film. These results indicate that the fully polymerizable emulsifiers can effectively improve the properties of latex.

Specificity, redundancy and dosage thresholds among gata4/5/6 genes during zebrafish cardiogenesis

ABSTRACTThe Gata4/5/6 sub-family of zinc finger transcription factors regulate many aspects of cardiogenesis. However, critical roles in extra-embryonic endoderm also challenge comprehensive analysis during early mouse cardiogenesis, while zebrafish models have previously relied on knockdown assays. We generated targeted deletions to disrupt each gata4/5/6 gene in zebrafish and analyzed cardiac phenotypes in single, double and triple mutants. The analysis confirmed that loss of gata5 causes cardia bifida and validated functional redundancies for gata5/6 in cardiac precursor specification. Surprisingly, we discovered that gata4 is dispensable for early zebrafish development, while loss of one gata4 allele can suppress the bifid phenotype of the gata5 mutant. The gata4 mutants eventually develop an age-dependent cardiomyopathy. By combining combinations of mutant alleles, we show that cardiac specification depends primarily on an overall dosage of gata4/5/6 alleles rather than a specific gene. We also identify a specific role for gata6 in controlling ventricle morphogenesis through regulation of both the first and second heart field, while loss of both gata4/6 eliminates the ventricle. Thus, different developmental programs are dependent on total dosage, certain pairs, or specific gata4/5/6 genes during embryonic cardiogenesis.This article has an associated First Person interview with the first author of the paper.

Investigating the application value of propofol combined with sufentanil and dexmedetomidine in cosmetic anesthesia

Objective: To investigate the effects of propofol combined with sufentanil and dexmedetomidine in cosmetic anesthesia. Methods: The clinical data of 40 plastic surgery patients admitted to the hospital from June to November 2019 were retrospectively analyzed. According to the different anesthesia methods during surgery, they were divided into control group (propofol combined with sufentanil and normal saline, 20 cases) and was compared with the observation group (propofol combined with sufentanil and dexmedetomidine, 20 cases). The anesthetic effect, total dosage of propofol, spontaneous breathing recovery time, and adverse reactions were compared between the two groups. Results: The total dosage of propofol in the observation group was less than that in the control group, and the spontaneous breathing recovery time was shorter than that in the control group. The difference was statistically significant (P?0.05). There was no significant difference in the anesthetic effect and adverse reaction rate between the two groups (P>0.05). Conclusion: The application of propofol in combination with sufentanil and dexmedetomidine in cosmetic anesthesia can reduce the dosage of propofol, speed up the anesthesia recovery, and have better anesthetic effect and safety.

Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures

ABSTRACTBackgroundOpioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem. Our objective was to analyze ED opioid prescription practices for patients with acute fractures.MethodsWe conducted a review of ED patients seen at two campuses of a tertiary care hospital. We evaluated a consecutive sample of patients with acute fractures (January 2016–April 2016) seen by ED physicians. Patients admitted or discharged by consultant services were excluded. The primary outcome was the proportion of patients discharged with an opioid prescription. Data were collected using screening lists, electronic records, and interobserver agreement. We calculated simple descriptive statistics and a multivariable analysis.ResultsWe enrolled 816 patients, including 441 females (54.0%). Most common fracture was wrist/hand (35.2%). 260 patients (31.8%) were discharged with an opioid; hydromorphone (N = 115, range 1–120 mg) was most common. 35 patients (4.3%) had pain related ED visits <1 month after discharge. Fractures of the lumbar spine (OR 10.78 [95% CI: 3.15–36.90]) and rib(s)/sternum/thoracic spine (OR 5.46 [95% CI: 2.88–10.35)] had a significantly higher likelihood of opioid prescriptions.ConclusionsThe majority of patients presenting to the ED with acute fractures were not discharged with an opioid. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Overall, there were few return to ED visits. We recommend standardization of ED opioid prescribing, with attention to limiting total dosage.

Antioxidant, anti-inflammatory and antimicrobial activities of methanolic and aqueous extract of the leaves of Pistacia lentiscus L.

1 ABSTRACT In this study, The Montaigne of Boutaleb contains a plant heritage characterized by the presence of several species that possess medicinal properties. The methanolic and aqueous extract of the leaves of Pistacia lentiscus were prepared, the yield of the methanolic extract was 2 .99 g the percentages 37.2% and the yield of the aqueous extract is 0.98 g with percentages 19.6%. The total dosage of polyphenols and flavonoids in the methanol extract was 38.27 ± 6.30 mg EAG/g extract and 9.80 ± 0,160, mg EAG/g extract, respectively. The total dosage of polyphenols and flavonoids in the aqueous extract was 26.76± 2.47 mg EAG/g extract and 4, 15±0.09 mg EAG/g extract, respectively. The effect of aqueous and methanolic extracts of mastic leaves were evaluated using the DPPH test. Both extracts have shown a weak trapping effect towards the free radicals with an IC50 68.27 ± 9.96 μg/ml and with an IC50 72.92 ± 9.43 μg/ml respectively, then weak activity antioxidant .The antibacterial activity of the methanolic and aqueous extract of the leaves of Pistacia lentiscus is significant. The aqueous and methanolic extract of mastic leaves possess a very strong anti-inflammatory activity to protect the membrane of human blood red blood cells.

Effect of electroacupuncture on sedation requirements during colonoscopy: a prospective placebo-controlled randomised trial

Introduction: Propofol provides excellent sedation during colonoscopy. However, its application, namely when used together with an opioid, is associated with cardiopulmonary depression. Acupuncture is used nowadays for the treatment of pain and anxiety, and also to induce sedation. We hypothesised that electroacupuncture (EA) during colonoscopy would have sedative effects, thereby reducing propofol requirements to achieve an adequate level of sedation. Method: The study was designed and conducted as a single centre, patient and observer blinded, sham- and placebo-controlled randomised trial. Patients scheduled for elective colonoscopy under deep propofol/alfentanil sedation were randomly assigned to receive unilateral EA, sham-acupuncture (SA) or placebo-acupuncture (PA) at ST36, PC6 and LI4. The primary outcome parameter was the total dosage of propofol. Secondary outcomes included the patients’ and endoscopists’ satisfaction levels evaluated by questionnaires. Results: The dosage of propofol required (median [IQR]) was not significantly different between the three groups (EA group 147 μg/kg/min [109–193] vs SA group 141 μg/kg/min [123– 180] vs PA group 141 μg/kg/min [112–182]; P=0.776). There was also no significant difference in alfentanil consumption (P=0.634). Global satisfaction (median [IQR]) among patients (EA group 6.6 [6.0–7.0] vs SA group 6.8 [6.0–7.0] vs PA group 6.5 [6.0–7.0]; P=0.481) and endoscopists (6.0 [5.0–6.0] for all groups; P=0.773) did not significantly differ between the three groups. There was no significant difference in the number of cardiorespiratory events. Conclusion: For colonoscopy, the applied mode of EA did not show any propofol-sparing sedative effect compared with sham or placebo acupuncture. Trial registration: The trial is registered in the Netherland’s Trial Registry (NTR4325).