Comparison of Analgesic Effects of Levobupivacaine (0.25%) versus Bupivacaine (0.25%) using Ultrasound Guided Transversus Abdominis Plane Block in Total Abdominal Hysterectomy under General Anesthesia — An Interventional Study

Background : Transversus Abdominis Plane (TAP) block is recently being used for effective pain relief following Total Abdominal Hysterectomy (TAH). Ultrasound guided block helps in correct localization of the plane and proper deposition of drugs. This study was done to compare the efficacy of Levobupivacaine and Bupivacaine in TAP block in TAH. Materials and Method : Seventy patients (ASA 1 and 2) prepared for TAH under General Anesthesia were randomly allocated into two groups. Ultrasound guided TAP block was performed bilaterally with 20ml of Levobupivacaine (0.25%) in Group A (n=35) and Bupivacaine (0.25%) in Group B (n=35) on each side of abdomen after skin closure at the end of operation. Intensity of pain was evaluated by 10cm Visual Analogue Scale (VAS) score at 0, 2, 6, 12,24 hours. If VAS >3, 1gram paracetamol infusion was given as rescue analgesic. Duration of analgesia, total rescue analgesic requirement and hemodynamic changes by measuring MAP and PR were noted. Results : VAS at 12 hours was significantly lower in Group A (mean 3.2±1) than Group B (mean 4.1±0.7, p<0.0001). Time of first rescue analgesic requirement was longer in Group A (mean 12.0±1.1h) compared to Group B (mean 11.2±1.1h, p=0.0059). Total analgesic requirement( paracetamol) in 24 hours was lower in Group A (mean 1.7±0.7g) compared to Group B (mean 2.2±0.7g, p=0.007). Hemodynamic changes were comparable in both groups. Conclusion : Levobupivacaine provided better postoperative analgesia than Bupivacaine with stable hemodynamic condition in TAP block.

Seroprevalence of IgG Antibodies for Dengue among Blood Donors

Dengue fever is endemic India and the prevalence of dengue is on the rise owing to various social and economic factors. Prevalence of asymptomatic dengue infection varies widely from less than 1 % to 80 % in India. Transfusion transmissible dengue has been reported in different parts of the word. Prevalence of subclinical dengue among blood donor poses a threat to the blood supply leading to transfusion transmissible dengue. We wanted to estimate the prevalence of IgG antibodies for Dengue in the blood donor population. METHODSSix hundred and eight whole blood donors were included in the study during the period January 2017 to October 2018. Donor registration and education was done as per the national guidelines. Donors who gave a history of previous dengue or symptoms consistent with dengue were excluded from the study. Serum samples from whole blood donors were tested for IgG antibodies using ELISA technology. RESULTSOf the total of 608 donors, 602 were male donors and 55 % of the donors were in the age group 21 - 30 years. Majority (69 %) of the donors were from urban locations. Anti IgG antibodies for dengue were present in 4.14 % of donors of which 38 % of donors were in the age group 31 - 40 years. Three hundred and eighty-four donors revealed history of fever, myalgia and headache in the past one year. No statistical significance was found between fever, myalgia and the presence of IgG anti-dengue antibodies. CONCLUSIONSThe subclinical or asymptomatic prevalence of dengue infection is low when compared to other studies in other parts of the country. Enquiring into donor history for history of dengue or symptoms of dengue and deferring such donors for a recommended period will prevent transfusion transmissible dengue.

Association between lithium in tap water and suicide mortality rates in Miyazaki Prefecture

BACKGROUND@#Most studies have reported that suicide mortality rates are negatively associated with lithium levels in tap water; however, a few studies showed either no association or a positive association. Thus, the association between suicide mortality and lithium levels in tap water remains controversial. To clarify the association, our study evaluated the association between lithium levels in tap water and suicide mortality rates in Miyazaki Prefecture of Japan, after adjusting for confounding factors.@*METHODS@#We measured lithium levels in tap water across the 26 municipalities of Miyazaki Prefecture in Japan. We examined the standardized mortality ratio (SMR) for suicide in each municipality and used the data as the average suicide SMRs over 5 years (2009-2013). Weighted least-squares regression analysis, adjusted for the size of each municipality's population, was used to investigate the association between lithium levels in tap water and suicide SMRs. In addition to a crude model, in an adjusted model, potential confounding factors (proportion of elderly people, proportion of one-person households, annual marriage rate, annual mean income, unemployment rate, the density of medical doctors per 100,000 people, annual total rainfall, and proportion of people with a college education or higher) were added as covariates.@*RESULTS@#We showed that male and female suicide SMRs were not associated with lithium levels in tap water in Miyazaki Prefecture. After adjusting for confounders, male suicide SMRs were significantly and positively associated with the proportion of elderly people in the population and annual total rainfall, and female suicide SMRs were associated with the proportion of elderly people in the population.@*CONCLUSIONS@#No association between lithium levels in tap water and suicide mortality rates was found in Miyazaki Prefecture.

Normal-pressure hydrocephalus: A critical review / Hidrocefalia de pressão normal: uma revisão crítica

ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords "normal-pressure hydrocephalus" / "idiopathic normal-pressure hydrocephalus" / "secondary normal-pressure hydrocephalus" / "NPH" / "ventriculoperitoneal shunt". The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

RESUMO. A hidrocefalia de pressão normal (HPN) é uma síndrome potencialmente reversível marcada por ventrículos cerebrais alargados (ventriculomegalia), declínio cognitivo, apraxia da marcha e incontinência urinária. Revisar criticamente o conceito, a fisiopatologia, o diagnóstico e o tratamento da HPN idiopática e secundária. Os autores acessaram as bases de dados Medline e Pubmed entre janeiro de 2012 e dezembro de 2018, utilizando as palavras-chave "normal-pressure hydrocephalus" / "idiopathic normal-pressure hydrocephalus" / "secondary normal-pressure hydrocephalus" / "NPH" / "ventriculoperitoneal shunt". A busca inicial resultou em 341 artigos. Após cuidadosa seleção, 54 estudos foram escolhidos e pesquisas adicionais foram incluídas durante o processo de elaboração do manuscrito. A HPN é uma importante causa de demência potencialmente reversível, quedas frequentes e infecção urinária recorrente em idosos. As características clínicas e de imagem da HPN podem ser incompletas ou inespecíficas, de modo que este se torna um diagnóstico difícil para médicos. Não raro uma avaliação por especialista é necessária, visando minimizar tratamentos cirúrgicos ineficazes. Avanços recentes advindos do uso não invasivo de ressonância magnética para quantificação do fluxo sanguíneo cerebral, em particular arterial spin-labeling (ASL), assim como a usual associação entre HPN e apneia obstrutiva do sono representam novos meios de entender e de tratar a HPN.

A prospective study of efficacy of ultrasound guided transversus abdominis plane block for postcesarean analgesia

Background: The ultrasound guided transversus abdominis plane (TAP) block which provides effective analgesia after lower abdominal surgeries including caesarean section. It is a simple and reliable technique. In this prospective, randomized double-blind study, we determined the efficacy of TAP block using 0.25% Bupivacaine and 0.9N Saline with respect to VAS for pain, postoperative Tramadol consumption and post-operative ondansetron usage.Methods: This study was conducted on 100 adult patients of ASA physical status I and II in the   age group of 18 to 40 years undergoing elective lower segment cesarean section under spinal anaesthesia. Study group received TAP block with 0.25% Bupivacaine and control group received 10 ml of 0.9N saline on each side. Patients were analyzed for postoperative pain by pain score (at rest, on movement, on cough) using VAS was recorded at 0, ½, 1, 2, 4, 6, 12 and 24 hours postoperatively. Need for rescue analgesia was assessed by time to first dose of Tramadol requirement and total dose of Tramadol over 24 hours of postoperative period. Ondansetron (4 mg i.v.) was administered whenever nausea score was more than 2 or the patient vomited. All the data was noted using uniform performs.Results: Patients received TAP block with 0.25% Bupivacaine had better pain scores at first hour of postoperative period during rest, cough and movement which was statistically significant (p<0.0010) in comparison to group B. There was a statistically significant difference (p <0.001) in the requirement of total dose of Tramadol as a rescue analgesia in patients who received transversus abdominis block with 0.25% Bupivacaine (138.77 mg) in comparison with other group(240 mg).The mean time to first request for Tramadol was significantly longer in group A (5.8 hrs)  in comparison to group B (1.93 hrs) with p value <0.001. Patients received TAP block with 0.9N saline needed more dose of Ondansetron, however, the difference was not statistically significant (p >0.001).Conclusions: TAP block using ultrasound provides substantial reduction in Tramadol consumption, time to first dose of rescue tramadol when compared with control group. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.

Clinical Study on Expression of Tumor Abnormal Glycoproteins in Patients with Gastrointestinal Malignancies after Fluorouracil-based Chemotherapy / 中国药学杂志

OBJECTIVE: To acquire the expressing information about tumor abnormal glycoprotein (TAP) in the peripheral blood of the gastric cancer patients who are treated with fluorouracil and the colorectal cancer patients treated with fluorouracil, and to discuss the factors that affect its expression and its clinical significance. METHODS: This research was conducted on the basis of 99 gastric cancer patients and colorectal cancer patients whose diseases were pathologically diagnosed from May to December, 2018, including 53 gastric cancer patients treated with fluorouracil and paclitaxel and 46 colorectal cancer patients treated with fluorouracil and oxaliplatin. It tested their TAP values, collected the basic information, the type of the cancer, the stage of the cancer, serum tumor markers, etc. of the patients as well as analyzed the differences of the expression of TAP in gastrointestinal tumors with different characteristics. RESULTS: The expression value of TAP in the peripheral blood of the gastrointestinal cancer patients is (158.11±33.63), and the expression of TAP value has no statistical differences in the expression of different sexes, ages, types of the cancer, clinical stages and serum tumor markers. CONCLUSION: The fact that the expression of TAP has no differences in the gastrointestinal cancer patients with different characteristics can't be taken as the basis of identifying or diagnosing gastrointestinal tumors which are different in character.

Different Outcomes in Two Cases of Idiopathic Normal Pressure Hydrocephalus in the Elderly Living Alone Diagnosed by Internists during Hospitalization / 日本プライマリ・ケア連合学会誌

Idiopathic normal pressure hydrocephalus (iNPH) is a disorder observed in elderly patients causing gait disturbance, urinary incontinence and cognitive impairment. Due to the rapidly aging society, the number of patients with iNPH continues to increase yearly. However, iNPH is often overlooked because of its insidious and variable presentation. In the primary care setting, iNPH can be coincidentally discovered by neuroimaging findings, including disproportionately enlarged subarachnoid space hydrocephalus (DESH). We report two cases of iNPH in the elderly living alone that had different outcomes depending upon the availability of neurosurgery specialists. It is essential for primary care physicians to consult neurosurgeons without delay because prompt diagnosis and treatment can improve the patient's quality of life and prolong their duration of living at home.

Evaluation of the Efficacy of Subcostal Transversus Abdominis Plane Block for Patients Undergoing Open Liver Carcinoma Resection / 中山大学学报(医学科学版)

@#【Objective】To evaluate the efficacy of three different methods of subcostal transversus abdominis plane（TAP）block for patients undergoing open liver carcinoma resection.【Methods】A total of 60 adult patients，undergoing elective open liver carcinoma resection through a“reverse L”incision below the rib bow，were enrolled. The subjects were randomly divided into three groups（20 cases in each），including Group A，B and C，according to the position of local anesthetic injection. All patients underwent ultrasound- guided bilateral subcostal TAP block under local anesthesia. The TAP injection was injected at the middle line of the clavicle in Group A；Two separate injections were at the parasternal line and at the anterior axillary line in Group B；Multiple injections were proformed between the anterior median line and the middle axillary line in Group C. After completion of TAP block，the onset time，duration，blocking extent，hemodynamics and abdominal muscle thickness were evaluated. The operating time of TAP block and incidence of complications were recorded.【Results】The blocking extent of Group B or Group C was greater than that of Group A（P < 0.05），with no significant difference between Group B and Group C. The duration of TAP block in Group B or Group C was longer than that of Group A，while the onset time was not significantly different between the three groups. The mean arterial pressure and heart rate during laparotomy were higher than the base value in Group A，while there were no evident changes in Group B and Group C. The rectus abdominis became thinner after TAP block in all patients，but there was no significant difference in muscle thickness change among the three groups. The operating time of TAP block in the three groups was （8.4±1.9），（13.8±3.1），（23.3±4.2）min，respectively，with significant difference between any two groups（P < 0.05）. None of the patients enrolled showed such complications as local anesthetic poisoning，abdominal wall hematoma，nerve injury， abdominal viscera injury，and puncture point infection.【Conclusion】The outcome of subcostal TAP block for patients undergoing open liver surgery is related to injecting position of anesthetics. Two- point-injection method is superior to one- point-injection method or multiple-point-injection method，for adequate analgesic extent as well as less operating time.

Systemization of laparoscopic inguinal hernia repair (tapp) based on a new anatomical concept: inverted y and five triangles / Sistematização do reparo da hérnia inguinal laparoscópica (tapp) baseada em um novo conceito anatômico: y invertido e cinco triângulos

ABSTRACT Background: Laparoscopic inguinal hernia repair has been shown to be superior than open repairs with faster return to daily activities and decrease in the occurrence of chronic pain. However, higher direct costs and mandatory use of general anesthesia are arguments against their use. In addition, increased complexity of surgery resulting from an anatomy that is unusual to general surgeons prevents the widespread adoption of laparoscopic approach. Aim: To propose a technical systematization for transabdominal laparoscopic repair (TAPP) of inguinal hernias based on anatomical concepts. Method: To offer a systematization of TAPP repair based on well defined anatomic landmarks, describing the concept of "inverted Y", identification of five triangles and three zones of dissection, to achieve the "critical view of safety" for laparoscopic inguinal hernia repair. Results: Since this standardization was developed five years ago, many surgeons were trained following these precepts. Reproducibility is high, as far as, it´s rate of adoption among surgeons. Conclusion: The concept of the "inverted Y", "Five triangles" and the dissection based in "Three Zones" establish an effective and reproducible standardization of the TAPP technique.

RESUMO Racional: O reparo laparoscópico da hérnia inguinal tem se mostrado superior aos reparos abertos, com retorno mais rápido às atividades diárias e diminuição na ocorrência de dor crônica. No entanto, custos diretos mais altos e o uso obrigatório de anestesia geral são argumentos contra seu uso. Além disso, o aumento da complexidade da operação resultante de uma anatomia incomum aos cirurgiões gerais impede a ampla adoção da abordagem laparoscópica. Objetivo: Propor uma sistematização técnica para reparo laparoscópico transabdominal (TAPP) de hérnias inguinais com base em conceitos anatômicos. Método: Oferecer sistematização do reparo do TAPP baseado em pontos anatômicos bem definidos, descrevendo o conceito de "Y invertido", identificação de cinco triângulos e três zonas de dissecação, para alcançar a "visão crítica de segurança" para o reparo de hérnia inguinal laparoscópica. Resultados: Desde que essa padronização foi desenvolvida há cinco anos, muitos cirurgiões foram treinados seguindo esses preceitos. A reprodutibilidade é muito alta, assim como a taxa de adoção entre cirurgiões. Conclusão: O conceito de "Y invertido", dos "Cinco triângulos" e a dissecção baseada em "Três Zonas" estabelecem uma padronização efetiva e reprodutível da técnica TAPP.

Combination of Transversus abdominis plane block and Serratus plane block anesthesia in dogs submitted to masctetomy / Combinação dos bloqueios anestésicos do plano transverso abdominal e do plano serrátil em cadelas submetidas à mastectomia

This paper pretends to demonstrate the effect of the combination of transversus abdominis plane block (TAP block) and Serratus plane block (SP block) techniques in analgesia of 4 dogs undergoing total unilateral mastectomy. Dogs were premedicated with methadone (0.5mg.kg-1) intramuscularly. Anesthesia was induced with propofol (6mg.kg-1) and midazolam (0.3mg.kg-1) and maintained with isoflurane. SP and TAP block were performed unilaterally using ultrasound by the injection of bupivacaine 0.25% (0.3mL kg-1) diluted with NaCl solution 1:1. Heart rate (HR), respiratory rate (f), non-invasive arterial pressure, esophageal temperature (T), oxygen saturation (SpO2) and electrocardiogram were monitored continuously. Animals were monitored for two and four hours after extubation for pain by using the Canine Acute Pain Scale from Colorado State University. Two hours after extubation, tramadol (4mg.kg-1) and dipyrone (25mg.kg-1) was administered to all dogs. It was not observed any alteration on cardiac rhythm. HR, f, T and mean arterial pressure remained below the preincisional values for all dogs. No dog required intraoperative rescue analgesia. Recovery from anesthesia was without any complication. All animals scored 0 (0/5) at pain scale, two and four hours after extubation and none of them expressed concern over the surgical wound. Dogs were able to walk before two hours after extubation. The combination of both techniques is effective in anesthetic blocking the thoracic and abdominal walls and it is suggested both may be included in the multimodal analgesia protocols for this type of surgery.(AU)

Este trabalho pretende demonstrar o efeito analgésico da combinação das técnicas de bloqueio do plano transverso abdominal (TAP block) e bloqueio do plano serrátil (SP block) em 4 cadelas submetidas à mastectomia unilateral total. Os animais foram pré-medicados com metadona (0,5mg.kg-1) por via intramuscular. A anestesia foi induzida com propofol (6mg.kg-1) e midazolam (0,3mg.kg-1) e mantida com isoflurano. Os bloqueios SP e TAP foram realizados unilateralmente, utilizando ultrassonografia, pela injeção de bupivacaína a 0,25% (0,3mL.kg-1), diluída com solução de NaCl a 1:1. A frequência cardíaca (FC), frequência respiratória (f), pressão arterial não invasiva, temperatura esofágica (T), saturação de oxigênio (SpO2) e eletrocardiograma foram monitorados continuamente. Os animais foram monitorizados durante duras e quatro horas após a extubação para a dor usando a Escala de Dor Aguda Canina da Universidade Estadual do Colorado. Duas horas após a extubação, tramadol (4mg.kg-1) e dipirona (25mg.kg-1) foram administrados a todos os cães. Não foi observada qualquer alteração no ritmo cardíaco. HR, f, T e pressão arterial média permaneceram abaixo dos valores basais para todos os cães. Nenhum cão requereu resgate analgésico intra-operatório. Não houve complicações na recuperação anestésica. Todos os animais apresentaram escore 0 (0/5) na escala de dor, duras e 4 quatro horas após a extubação e nenhum expressou desconforto com a ferida cirúrgica. Todos os cães foram capazes de caminhar antes de duas horas após extubação. A combinação de ambas as técnicas é eficaz no bloqueio anestésico das paredes torácica e abdominal e sugere-se que ambos podem ser incluídos nos protocolos de analgesia multimodal para este tipo de cirurgia.(AU)

Preparation of Protein Hybrid Fluorescence Nanoclusters for Rapid Detection of Mercury Ion / 分析化学

One-step green synthetic approach,with bovine serum albumin(BSA) as stabilizer and reductant, was developed for preparation of BSA hybrid fluorescence gold nanoclusters (AuNCs@BSA). The prepared AuNCs@BSA exhibited strong red fluorescence under UV light illumination. Upon excited at 360 nm, the fluorescence spectrum of AuNCs@ BSA exhibited maximum emission peak at 635 nm. AuNCs@ BSA was presented as uniform spherical morphology with diameter at (2.0 ±0.05) nm. The fluorescence of AuNCs@BSA could be quenched by Hg2+because of its metallophilic reaction. Based on the fluorescent spectrometry, a rapid detection system was developed for Hg2+detection in tap water. The AuNCs@BSA amount, pH and buffer system were optimized in this study. According to optimization results, ultrapure water (pH 5.0) was selected to dilute the AuNCs@BSA by 100 times, and 50 μL/well of AuNCs@BSA dilution was applied to detect mercury ion in tap water. Under the optimized conditions, the detection could be completed within 3 min,the fluorescence intensity of the system was linearly proportional to the concentration of mercury ion in the range of 0.5–900 μg/L with linear equations y=-26.76lgx+803.1(0.5-75 μg/L,R2=0.9951) and y=-0.27x+762.02 (75-900 μg/L,R2=0.9959). The limit of detection was 0.14 μg/L(3σ). The average recoveries in spiked tape water samples ranged from 86.8%-113.4% with relative standard deviation of less than 15%. The result implied that the developed method was able to apply to detect mercury ion rapidly, sensitively and conveniently.

Influence of Water Properties on the Contents of Aconitine-Type Diester Alkaloids in the Decoctions of Unprocessed Aconite Root / 日本東洋医学雑誌

The decoctions of unprocessed aconite root (uzu) were prepared with the tap water samples collected in Tianjin and Shanghai in China, and the contents of alkaloids in the decoctions were compared to those prepared with purified water or with tap water collected in Niigata, Japan. The contents of aconitine-type diester alkaloids (ADA) in the decoctions prepared with tap water collected in China were significantly lower than those with purified water or tap water in Niigata. It was speculated that this difference appeared by buffering effect of bicarbonic anion in tap water in China to decline pH of the decoction. When uzu was decocted with glycyrrhiza, ginger, or jujube, the contents of ADA in the decoctions exhibited the tendency to have higher levels than those prepared using unprocessed aconite root singly, and also this tendency was observed more remarkably when the decoctions were prepared with tap water collected in China. It was suggested that even the decocting period was fixed, unexpected change of the contents of ADAs might be induced by the differences in the properties of water used for decoction or the crude drugs decocted with aconite root. The physicians in the era when “Songban Shanghanlun” had established may have adjusted the contents of ADA in the decoction by carefully choosing the crude drugs combined to aconite root.

The transformation of microcystin-LR during tap water treatment process and analysis of its degradation products / 中华预防医学杂志

Objective@#To establish a liquid chromatography-tandem mass spectrometry (LC/MS/MS) method for the determination of microcystin-LR (MC-LR) in drinking water, investigate its removal efficiency during tap water advanced treatment process and analyze its degradation products in the tap water.@*Methods@#Two parallel water samples were collected from each point of tap water advanced treatment process in September 2015, November 2015 and January 2016, respectively, and treated by mixing, filtration, concentration, elution, nitrogen blow and re-dissolvement. The samples were analyzed by LC/MS/MS to determine the MC-LR concentration and its removal efficiency during treatment process. The combination of actual water enrichment (including source water enrichment of 50 times and 1 500 times concentrated, finished water enrichment of 50 times and 2 500 times concentrated) and laboratory simulated water (including the mixture of MC-LR and liquid chlorine in the mass ratio of 1∶10, 1∶20, 1∶100 and 1∶1 000, respectively) were used to qualitative analyze the MC-LR degradation products by Orbitrap mass spectrometry.@*Results@#The linearity of MC-LR ranged from 2 to 200 μg/L with the detection limit of 0.007 9 μg/L and the limit of quantification of 0.026 3 μg/L. The recovery rate of MC-LR from different contration in drinking water were from 94.88%-101.47%. The intra-day precision was 2.51%-7.93% and the intra-day precision was 3.24%-8.41%. The average concentration of MC-LR in source water was (0.631±0.262) μg/L, 94.0% of which can be removed by ozone exposure while the concentrate was (0.038±0.016) μg/L, biological pre-treatment and chlorination. The remaining can hardly be removed by sand filtration, ozone exposure, activated carbon, ultrafiltration and other processes. The MC-LR average concentration in the finished water maintained at about (0.036±0.016) μg/L. Degradation products including hydroxy-microcystin, methyl-hydroxy-microcystin, methyl-microcystin were identified in the laboratory simulated water of the mixture of MC-LR and liquid chlorine in the mass ratio of 1∶10.@*Conclusion@#The established MC-LR detection method can be well applied to the monitoring of MC-LR in drinking water due to its simple pre-treatment process and good methodological validation parameters. The degradation products of treatment processes was different.

Evaluating the adjuvant effect of dexamethesone to ropivacaine in transversus abdominis plane block for inguinal herniorrhaphy / 实用医学杂志

Objective To evaluate the adjuvant analgesia effect of the addition of dexamethasone to ropiva-caine in a transversus abdominis plane(TAP)block after inguinal herniorrhaphy. Methods 100 adult male pa-tients who underwent open tension-free inguinal herniorrhaphy from August 2015 to June 2017,randomized into two groups equally. TAP block with ropivacaine with additional dexamethasone was experiment group(group D) and with ropivacaine was control group(group C). Before the operation,all the patients were performed TAP block by the same group of surgeons. Celecoxib(200mg,Q12h,po)was prescribed to all patients in 48 hours after oper-ation. VAS and clinical symptoms were recorded. The sum and time of celecoxib consumption were also recorded af-ter 72 hours postoperatively. The surveys about the Carolinas comfort scale(CCS)of all the patients one week after operation were collected. Results The averaged pain score in 48 hours after operation has no statistical signifi-cance. The occurrence of postoperative nausea and vomiting of group D is lower than group C,neither of them were statistically significant. The averaged CCS of group D was lower than group C;the difference was significant. Con-clusions Compared to single usage of ropivacaine in the single-shot TAP as a preemptive analgesia method for in-guinal herniorrhaphy,adding dexamethasone to ropivacaine didn′t show significance in analgesic intensity after in-guinal herniorrhaphy,though the adjuvant usage of dexamethasone reduced the sum and duration of other analgesic medications and enhanced the comfort of the patients after mesh-used herniorrhaphy.

Identification and Genotypic Characterization of Potentially Pathogenic Acanthamoeba Isolated from Tap Water in Wuxi, China

Members of genus Acanthamoeba are widely distributed in the environment. Some are pathogenic and cause keratitis and fatal granulomatous amoebic encephalitis. In this study, we isolated an Acanthamoeba CJW/W1 strain from tap water in Wuxi, Jiangsu Province, China. Its 18S rDNA was sequenced and a phylogenetic tree was constructed. The isolated cysts belonged to morphologic group II. Comparison of 18S rDNA sequences of CJW/W1 strain and other isolates showed high similarity (99.7%) to a clinical isolate Asp, KA/E28. A phylogeny analysis confirmed this isolate belonged to the pathogenic genotype T4, the most common strain associated with Acanthamoeba-related diseases. This is the first report of an Acanthamoeba strain isolated from tap water in Wuxi, China. Acanthamoeba could be a public health threat to the contact lens wearers and, therefore, its prevalence should be monitored.

Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study / Dor no período pós-operatório de nefrectomia laparoscópica com bloqueio do plano transverso abdominal guiado por ultrassom versus infiltração do sítio do trocarte: um estudo prospectivo

Abstract Background Transversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery. Methods A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0-100 mm) at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge) and 24 h after surgery (T3). Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS > 30 mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24 h after surgery. Statistical analysis: Student's t-test and Chi-square test, and linear regression models. A p-value < 0.05 was considered significant. Data are presented as mean (SD). Results Forty patients were enrolled in the study. The primary outcome variable, VAS pain scores did not show a statistical significant difference between groups (p > 0.05). VAS at rest (TAP vs. TSI groups) was: T1 = 33 ± 29 vs. 39 ± 32, T2 = 10 ± 9 vs. 17 ± 18 and T3 = 7 ± 12 vs. 10 ± 18. VAS with cough (TAP vs. TSI groups) was: T1 = 51 ± 34 vs. 45 ± 32, T2 = 24 ± 24 vs. 33 ± 23 and T3 = 20 ± 23 vs. 23 ± 23. VAS with incentive spirometer (TAP vs. TSI groups) was: T3 = 21 ± 27 vs. 21 ± 25. Intraoperative remifentanil consumption was similar between TAP (0.16 ± 0.07 mcg.kg-1.min-1) and TSI (0.18 ± 0.9 mcg.kg-1.min-1) groups. There were no differences in opioid consumption between TAP (4.4 ± 3.49 mg) and TSI (6.87 ± 4.83 mg) groups during recovery. Functional recovery parameters were not statistically different between groups. Conclusions Multimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic nephrectomies.

Resumo Justificativa O bloqueio do plano transverso abdominal (TAP) é útil para reduzir a dor no pós-operatório de nefrectomia laparoscópica comparado com o placebo. O objetivo deste estudo foi comparar a dor no pós-operatório e a recuperação após bloqueio TAP ou infiltração do sítio do trocarte (TSI) nesse tipo de cirurgia. Métodos Estudo prospectivo e cego com pacientes agendados para nefrectomia laparoscópica. Os pacientes foram divididos em dois grupos: Grupo TSI: infiltração do sítio do trocarte ao final da cirurgia; Grupo TAP: bloqueio TAP unilateral guiado por ultrassom após a indução. Sevoflurano e remifentanil administrado em perfusão alvo-controlada foram usados para a manutenção da anestesia geral. Paracetamol, tramadol e morfina foram administrados antes do fim da cirurgia. Escala analógica visual (VAS 0-100 mm), para avaliar a dor em repouso e durante a tosse, foi aplicada em três momentos: na sala de recuperação [na admissão (T1) e antes da alta (T2)] e 24 horas após a cirurgia (T3). Os escores de dor com espirômetro de incentivo também foram avaliados em T3. Durante a recuperação, morfina foi administrada como medicamento de resgate, sempre que VAS > 30 mm. Os tempos até a ingestão oral, sentar em cadeira, deambulação e de permanência hospitalar foram avaliados 24 horas após a cirurgia. Análise estatística: teste t de Student, teste do qui-quadrado e modelos de regressão linear. Um valor de p < 0,05 foi considerado significativo. Os dados foram expressos em média (DP). Resultados Quarenta pacientes foram incluídos no estudo. Os escores do desfecho primário e da VAS não apresentaram diferença estatística significativa entre os grupos (p > 0,05). Os escores VAS em repouso (TAP vs. TSI) foram: T1 = 33 ± 29 vs. 39 ± 32; T2 = 10 ± 9 vs. 17 ± 18 e T3 = 7 ± 12 vs. 10 ± 18. Os escores VAS durante a tosse (TAP vs. TSI) foram: T1 = 51 ± 34 vs. 45 ± 32; T2 = 24 ± 24 vs. 33 ± 23 e T3 = 20 ± 23 vs. 23 ± 23. Os escores VAS com espirômetro de incentivo (TAP vs. TSI) foram: T3 = 21 ± 27 vs. 21 ± 25. O consumo de remifentanil no intraoperatório foi semelhante entre os grupos TAP (0,16 ± 0,07 mcg.kg-1.min-1) e TSI (0,18 ± 0,9 mcg.kg-1.min-1). Não houve diferença no consumo de opioides entre os grupos TAP (4,4 ± 3,49 mg) e TSI (6,87 ± 4,83 mg) durante a recuperação. Os parâmetros funcionais de recuperação não foram estatisticamente diferentes entre os grupos. Conclusões A analgesia multimodal com bloqueio TAP não mostrou benefício clínico significativo comparado com a infiltração do sítio do trocarte em nefrectomia laparoscópica.

Validación del Cuestionario de Intención Emprendedora en una muestra de estudiantes universitarios de Colombia / Validation of the Entrepreneurial Intention Questionnaire in a Sample of University Students from Colombia

RESUMEN Este artículo presenta la validación del Cuestionario de Intención Emprendedora (CIE) en Colombia. Este cuestionario, desarrollado y validado en España (Rueda, Moriano, & Liñán, 2015), se enmarca dentro de la Teoría de la Acción Planificada (TAI, Ajzen, 1991). La TAP resulta en la actualidad el modelo más ampliamente utilizado para predecir las intenciones emprendedoras. Con una muestra de 316 estudiantes universitarios colombianos, el modelado de ecuaciones estructurales confirma que el CIE tiene una alta fiabilidad y validez predictiva sobre la intención emprendedora. Disponer de escalas de medida fiables y validadas en distintos contextos culturales permite las comparaciones entre distintas entidades y/o para una misma entidad en diferentes momentos (por ejemplo, antes y después de impartir un curso orientado al emprendimiento). Un mejor conocimiento de los antecedentes psicosociales (actitudes hacia el emprendimiento, norma subjetiva y autoeficacia emprendedora) que conducen a jóvenes universitarios a emprender puede contribuir a un diseño más adecuado de los programas de formación emprendedora que se están impulsando en muchas universidades y desde otro tipo de instituciones.

ABSTRACT This paper presents the validation of the Entrepreneurial Intention Questionnaire (EIQ) in Colombia. This questionnaire, developed and validated in Spain (Rueda, Moriano, & Linân, 2015), draws on the Theory of Planned Behaviour (TPB, Ajzen, 1991). The TPB is the most widely used model for predicting entrepreneurial intention nowadays. With a sample of 316 Colombian university students, the results of the structural equation modeling confirm that the EIQ has a high reliability and predictive validity of entrepreneurial intentions. The availability of reliable measurement scales validated in different cultural contexts allows comparisons among institutions and/or within an institution along the time (e.g. before and after a course on entrepreneurship). A deep understanding of the psychosocial antecedents (i.e. attitudes toward entrepreneurship, subjective norms, and entrepreneurial self-efficacy) that lead young university students to become entrepreneurs might contribute to a better design of the entrepreneurship education programmes that are being developed from universities and other institutions.

Expression and clinical significance of TAP in lung cancer patients / 实用医学杂志

Objective To investigate the expression and clinical significance of tumor abnormal protein (TAP)in patients with lung cancer.Methods Plasma TAP concentration was measured by enzyme-linked immu-nosorbent assay(ELISA)in 93 patients with lung cancer and 100 healthy subjects.Results The plasma TAP con-centration[(187.71 ± 82.295)μm2]in lung cancer group was significantly higher than that in the healthy control group[(67.836 ± 28.642)μm2,t=13.991,P<0.05).The sensitivity of TAP in lung cancer group was 83.87%. Conclusions TAP can improve the early diagnosis rate of lung cancer patients,which is important for early diag-nosis and early treatment. TAP detection is suitable for lung cancer screening in healthy people and people with high risks.

Non-fastidous antibiotic-resistance bacteria pollution in tap water / 军事医学

Objective To study the non-fastidous antibiotic-resistance bacteria pollution in tap water from a neighborhood in Tianjin.Methods Tap water samples were collected and bacteria were isolated by R2A agar,and 16S rRNA gene sequence for the identification of bacteria isolates was used.Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method.Results Among the 39 non-fastidous bacteria isolates,the resistance rate of antibioticresistance bacteria was 79.49％,including Enterococcus,Staphylococcus,Acinetobacter and Pseudomonas.Some bacteria (28.21％) showed resistance against only one antibiotic.The others (51.28％) were multiple resistant bacteria.Trimethoprim/sulfamethoxazole resistance was most prevalent (53.85％),and sulfamethoxazole resistance was also widely distributed (28.21％).Conclusion Tap water from this neighborhood is heavily polluted by non-fastidous antibioticresistantance bacteria,which deserves more attention.

Advances in p73-targeting anti-tumor drugs / 中国药理学通报

The transcription factor p73 belongs to the p53 family of tumor suppressors,and can be transcribed into different isoforms with either pro-or anti-apoptotic(TAp73 and △Np73)functions.However,the tumor suppressor activity of TAp73 is inhibited through complex formation with inhibitory proteins(e.g.△Np73,mutant p53,MDM2 and iASPP).Therefore,it is a kind of tumor therapy strategy to reactivate TAp73 through targeting these inhibitors directly or release TAp73 from the complex by targeting their interaction.This review discusses the possible strategies of targeting p73 for its reactivation and the acting mechanism of related compounds.