Ischemic postconditioning ameliorates acute kidney injury induced by limb ischemia/reperfusion via transforming TLR4 and NF-κB signaling in rats

Background The present study investigated the influence of ischemic postconditioning (I-postC) on the adjustment of renal injury after limb ischemia-reperfusion (I/R) injury, to elucidate the mechanisms of the Toll-like receptor 4 (TLR 4)/NF-κB signaling pathway using histopathological and immunohistochemical methods. Methods Male Sprague-Dawley rats were randomly assigned to five groups (numbered from 1 to 5): the sham group (Group 1, only the anesthesia procedure was conducted without limb I/R), the I/R group (Group 2, 4 h of reperfusion was conducted following 4 h limb ischemia under anesthesia), the I/R + I-postC group (Group 3, 4 h of ischemia and 4 h of reperfusion was conducted; before perfusion, 5 min of limb ischemia and 5 min of reperfusion were performed in the rats and repeated 3 times), the I/R + TAK group (Group 4, rats were injected with TLR4 antagonist TAK through the caudal vein before limb ischemia and reperfusion under anesthesia), the TAK group (Group 5, rats were injected with TAK, and the anesthesia procedure was conducted without limb I/R). Histological changes in the kidney in different groups were observed, and the extent of tubular injury was assessed. Changes in biochemical indexes and the expression of inflammatory factors, TLR4, and NF-κB were also evaluated. Results Compared with rats in the I/R group, the secretion of inflammatory factors and the expression levels of TLR4 and NF-κB were decreased in rats in the I/R + I-postC group. Histological analysis revealed renal injury, including inflammatory cell infiltration, dilatation of the tubuli lumen, congestion in glomerular capillaries, degeneration of tubuli epithelial cells, and necrosis was ameliorated by I-postC. Immunohistochemical studies showed that I/R-induced elevation in TLR4 and NF-κB expression was reduced by I-postC treatment. Moreover, the expression levels of TLR4, NF-κB, and inflammatory factors in rats in the I/R + TAK group were also decreased, and the renal pathological lesion was alleviated, which was similar to that in rats in the I/R + I-postC group. Conclusions The present findings suggest that I-postC can reduce tissue injury and kidney inflammation induced by limb I/R injury, possibly via inhibition of the TLR4 and NF-κB pathways.

Thyroid Surgeries under bilateral superficial cervical plexus block – A Case Series

Superficial cervical plexus block is a simple regional anesthesia procedure which can be performed by landmark guided as well as ultrasound-guided techniques. It has been used to provide anesthesia or analgesia for various procedures involving superficial surgeries in the neck and shoulder. The pain after thyroid surgery is of mild to moderate intensity and of short duration. I describe 12 cases in which bilateral superficial cervical plexus block was performed to conduct awake thyroid surgeries. Keywords: Thyroid surgery, Superficial cervical plexus block, regional anesthesia, neck surgeries, analgesia.

Minimally Invasive Triple Therapy of the Presurgical Neck

Minimally invasive in-office procedures are a fast growing field in plastic surgery. Patients often notice and complain about their neck at an earlier age. Modern treatments for the aging neck have continued to evolve over the past decade, with more options continuing to become available. In this article, we describe our noninvasive approach to the aging neck through the combination of submental liposuction, radiofrequency (RF) microneedling, and percutaneous RF as a safe and effective option. Through appropriate patient selection, preoperative counseling, and good surgical technique, appropriate results can be achieved with minimal downtime. Patient selection, counseling, appropriate anesthesia, procedure details, and results are discussed in this article.

Volatile Anesthetics Regulate Anti-Cancer Relevant Signaling

Volatile anesthetics are widely used inhalation anesthetics in clinical anesthesia. In recent years, the regulation of anti-cancer relevant signaling of volatile anesthetics has drawn the attention of investigators. However, their underlying mechanism remains unclear. This review summarizes the research progress on the regulation of anti-cancer relevant signaling of volatile anesthetics, including sevoflurane, desflurane, xenon, isoflurane, and halothane in vitro, in vivo, and clinical studies. The present review article aims to provide a general overview of regulation of anti-cancer relevant signaling and explore potential underlying molecular mechanisms of volatile anesthetics. It may promote promising insights of guiding clinical anesthesia procedure and instructing enhance recovery after surgery (ERAS) with latent benefits.

Comparison of Dexamethasone Composition with Bupivacaine and Dexmedetomidine with Bupivacaine and Bupivacaine alone in a Supraclavicular Block with Low Volume

Background: Regional blocks is a good alternative to general anesthesia in upper extremity surgeries. Supraclavicular is a kind of regional block which can be used to treat nerve block in the upper extremity. The ancillary drugs are nowadays used to enhance the quality and quantity of sensory and motor block. The present study has attempted to investigate the effect of three prescription drugs (composition Dexamethasone with Bupivacaine and Dexmedetomidine with Bupivacaine and Bupivacaine alone) on supraclavicular block. Methods: This parallel Design study was conducted in 2017 as a clinical trial at Ayatollah Taleghani Hospital in Tehran. For this purpose, 60 patients over the age of 18 and in class I, II of the American Anesthesiology Association (ASA) who were candidates for upper limb elective surgery, were enrolled. Patients included in the study (60 patients) were randomly divided into three equal groups (n= 20). Anesthesia procedure was performed for all patients in three equal groups. However, to evaluate the efficacy of selected drugs, different drugs were injected into each group. After completing the design and recording the results of the variables under study, the ttest was used to compare quantitative variables between the two groups. All statistical tests were performed in two domains (5% significance level) and SPSS 21 software was used for data analysis. Results: In the levels of intraoperative factors in the comparative conditions of the BB1 with BDexa2 and BB with BDex3 groups. However, Duration of Sensory Block (P=0.004) and Duration of Movement Block (P=0.001) were significantly different in BD and BDex groups. Conclusion: What can be clearly seen in the results are the significant changes of Duration of Sensory Block and Duration of Movement Block compared to the BDexa and BDex groups. Based on these results, in both cases we find a significant decrease in the measured duration in the BDexa group compared to the opposite group. Use of Bupivacaine + Dexamethasone has a more positive effect on Supraclavicular block compared to Bupivacaine + Dexmedetomidine and Bupivacaine alone.