Retrobulbar dexmedetomidine in pediatric vitreoretinal surgery eliminates the need for intraoperative fentanyl and postoperative analgesia: A randomized controlled study

Purpose: This study evaluated the efficacy of retrobulbar ropivacaine plus dexmedetomidine compared with systemic fentanyl in pediatric vitreoretinal (VR) surgery. Methods: This prospective double-blind, randomized controlled study was performed in 60 children undergoing VR surgery, age from 2 to 7 years. After general anesthesia, the following procedure was administrated: (1) retrobulbar block with 0.5% ropivacaine plus dexmedetomidine 1 ?g/kg (group RD, n = 20), (2) retrobulbar block with 0.5% ropivacaine (group RB, n = 20), and (3) control group with general anesthesia only (group F, n = 20). Hemodynamics, postoperative pain scores, anesthetics consumption (remifentanil, propofol, fentanyl), and emergence agitation were recorded. Results: Respiratory depression was observed in 7 of the 20 patients in group F after the laryngeal mask airway was removed in the operating room, compared with none in groups RD and RB. All patients in group F required intraoperative rescue fentanyl (average intraoperative fentanyl consumption, 26.6 ± 12.6 ?g per patient). Some rescue fentanyl was required in group RB (three patients required one dose of rescue fentanyl). Patients in group RD required none. Groups RD and RB reported lower pain scores than group F at 4 h postoperatively (RD group: P < 0.001; RB group: P =0.002); pain scores in group RD were lower than that in group F at 6 h postoperatively (P < 0.001). Conclusion: Retrobulbar dexmedetomidine as an adjuvant to ropivacaine is a safe and effective alternative to systemic fentanyl. This regimen provides better pain management, hemodynamic stability, and stress response suppression in pediatric VR surgery.

A pregnant woman with condyloma acuminatum on the vaginal orifice, areola, groin, and umbilicus

Condyloma acuminatum (CA) is a benign tumor primarily caused by infection with human papillomavirus (HPV) type-6 or type-11, lesions of which are most frequently found on the genital, perianal squamous mucosa, and skin. CA outside the anogenital region is not common. Here, we report a case showing simultaneous presence of CA on the vaginal orifice, areola, groin, and umbilicus in a 32-year-old pregnant woman. Histopathological examination and HPV detection are essential in making a definitive diagnosis of CA on multiple sites. The patient was treated with microwave and liquid nitrogen cryotherapy, but repeated relapse of the lesions were observed. Patients with CA during pregnancy represent a special risk group. These cases are usually characterized by fast-growing warts, multi-site or special site warts, a reduced tolerance, and poor response to treatment. Hence, we should pay more attention to CA in pregnant women in the process of diagnosis and treatment, especially cases outside the anogenital region.

Objective optical assessment of tear-film quality dynamics in patients with meibomian gland dysfunction and aqueous-deficient dry eye optical quality changes in different dry eye subtypes

Purpose: To evaluate the optical quality and tear-film dynamics in patients with aqueous-deficient or evaporative subtype of dry eye disease (DED). Methods: Twenty-five aqueous-deficient dry eye (ADDE) patients, 25 DED patients with meibomian gland dysfunction (MGD), and 25 healthy subjects were included in this study. Vision-related health-targeted quality of life was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Dynamic recording with a double-pass system (Optical Quality Analysis System [OQAS]) was performed in right eyes. Scattered light was measured as the objective scatter index (OSI) at 0.5-second intervals over 20 seconds without blinking. Then, we recorded OSI every 0.5 seconds within a 20-second period with the subjects asked to blink freely. Several parameters were established to evaluate the dynamic alterations of optical quality and the effects of blinks: OSI, OSI standard deviation (SD), ?OSI, ?OSI/time, blinking change (BC), and blinking frequency (BF). Additional clinical examination included tear film break-up time (BUT), Schirmer I test (SIT), fluorescein staining grade (FL), meibomian gland quality, meibomian gland expressibility, and meibomian gland drop-out. Results: The OSI, SD, ?OSI, ?OSI/time, BC, and BF were significantly higher in DED patients than controls (P < 0.01, respectively). The OSI, SD, ?OSI, ?OSI/time, BC, and BF were significantly higher in patients with MGD than patients with ADDE (P < 0.01). In the MGD group, BUT, FL staining score, lid abnormality, meibomian gland expressibility, and meibomian gland drop-out were correlated with ? OSI and ? OSI/time. Conclusion: Dry eye patients with MGD had significant alterations of optical quality compared with ADDE patients. The double-pass system has potential to be a useful quantitative method to evaluate the optical quality and tear-film dynamics in patients with dry eye.

Syringocystadenoma papilliferum and trichoblastoma arising in the nevus sebaceous

Nevus sebaceous (NS) is a clinically common benign tumor and has a high potential to develop into a great diversity of neoplasms of epidermal and adnexal origins. However, it is a rare phenomenon of the coexistence in a single NS with two or more skin tumors. We report a case of a 58-year-old woman with two kinds of neoplastic proliferation including syringocystadenoma papilliferum and trichoblastoma arising in NS on the scalp.

Class 1 integrons contributes to antibiotic resistance among clinical isolates of Escherichia coli producing extended-spectrum beta-lactamases.

Objectives: The objective of this study is to determine the prevalence of antibiotic resistance factors, including the production of extended-spectrum beta-lactamases (ESBLs) and the presence of class 1 integrons among Escherichia coli isolated from clinical specimens. Materials and Methods: Bacterial species identifi cation was performed using a VITEK-2 system (VITEK2 GN-card; bioMérieux, France). Antimicrobial susceptibility testing was determined using the disk diffusion method according to the 2010 Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was used to detect integrons and amplify variable regions of the blaTEM, blaSHV and blaCTX-M genes. Gene cassettes were detected by deoxyribonucleic acid sequencing. Results: In this study, 58% (100/172) of clinical E. coli isolates were identifi ed as ESBL producers. We found that 90% of the ESBL-producing E. coli isolates harbored the blaCTX-M gene, whereas only 59% and 32% possessed the blaTEM and blaSHV genes respectively. The presence of class 1 integrons was based on the detection of the integrase gene by PCR. A total of 69% of the ESBL-producing isolates were integron-positive. Resistance to 10 antibiotics, including quinolones, sulfonamides and -lactam/enzyme inhibitors, was signifi cantly higher in the class 1 integron-positive isolates (P < 0.05). The occurrence of class 1 integrons in blaTEM, blaSHV and blaCTX-M gene carriers was 72.9%, 84.4% and 68.9%, respectively. Class 1 integrons were detected in 61.5% of the isolates with only one ESBL genotype, but in 69.0% and 92.3% of the isolates with two or three different ESBL genotypes, respectively. Conclusions: Our fi ndings indicate that clinical strains of bacteria with multiple ESBL genotypes may have greater opportunities to carry class 1 integrons.

Quercetin postconditioning attenuates myocardial ischemia/reperfusion injury in rats through the PI3K/Akt pathway

Quercetin (Que), a plant-derived flavonoid, has multiple benefical actions on the cardiovascular system. The current study investigated whether Que postconditioning has any protective effects on myocardial ischemia/reperfusion (I/R) injury in vivo and its potential cardioprotective mechanisms. Male Sprague-Dawley rats were randomly allocated to 5 groups (20 animals/group): sham, I/R, Que postconditioning, Que+LY294002 [a phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway inhibitor], and LY294002+I/R. I/R was produced by 30-min coronary occlusion followed by 2-h reperfusion. At the end of reperfusion, myocardial infarct size and biochemical changes were compared. Apoptosis was evaluated by both TUNEL staining and measurement of activated caspase-3 immunoreactivity. The phosphorylation of Akt and protein expression of Bcl-2 and Bax were determined by Western blotting. Que postconditioning significantly reduced infarct size and serum levels of creatine kinase and lactate dehydrogenase compared with the I/R group (all P<0.05). Apoptotic cardiomyocytes and caspase-3 immunoreactivity were also suppressed in the Que postconditioning group compared with the I/R group (both P<0.05). Akt phosphorylation and Bcl-2 expression increased after Que postconditioning, but Bax expression decreased. These effects were inhibited by LY294002. The data indicate that Que postconditioning can induce cardioprotection by activating the PI3K/Akt signaling pathway and modulating the expression of Bcl-2 and Bax proteins.

A DNA enzyme targeting Egr-1 inhibits rat vascular smooth muscle cell proliferation by down-regulation of cyclin D1 and TGF-â1

We have demonstrated that a synthetic DNA enzyme targeting early growth response factor-1 (Egr-1) can inhibit neointimal hyperplasia following vascular injury. However, the detailed mechanism of this inhibition is not known. Thus, the objective of the present study was to further investigate potential inhibitory mechanisms. Catalytic DNA (ED5) and scrambled control DNA enzyme (ED5SCR) were synthesized and transfected into primary cultures of rat vascular smooth muscle cells (VSMCs). VSMC proliferation and DNA synthesis were analyzed by the MTT method and BrdU staining, respectively. Egr-1, TGF-â1, p53, p21, Bax, and cyclin D1 expression was detected by RT-PCR and Western blot. Apoptosis and cell cycle assays were performed by FACS. Green fluorescence could be seen localized in the cytoplasm of 70.6 ± 1.52 and 72 ± 2.73 percent VSMCs 24 h after transfection of FITC-labeled ED5 and ED5SCR, respectively. We found that transfection with ED5 significantly inhibited cultured VSMC proliferation in vitro after 24, 48, and 72 h of serum stimulation, and also effectively decreased the uptake of BrdU by VSMC. ED5 specifically reduced serum-induced Egr-1 expression in VSMCs, further down-regulated the expression of cyclin D1 and TGF-â1, and arrested the cells at G0/G1, inhibiting entry into the S phase. FACS analysis indicated that there was no significant difference in the rate of apoptosis between ED5- and ED5SCR-transfected cells. Thus, ED5 can specifically inhibit Egr-1 expression, and probably inhibits VSMC proliferation by down-regulating the expressions of cyclin D1 and TGF-â1. However, ED5 has no effect on VSMC apoptosis.

Effect of hydrodynamic environment on tablet dissolution using flow-through dissolution apparatus

The main objective of this research is to investigate the principles underlying the dissolution process, study the phenomena of drug release in laminar flow, and better understand the effect of hydrodynamic condition on drug dissolution, in order to predict drug dissolution from a solid dosage form. Two drug models were selected, theophylline (Class I) and naproxen (Class II), and were formulated into conventional tablets containing 105 mg theophylline or 300 mg naproxen using wet granulation method. Additionally theophylline (105 mg) and naproxen (300 mg) matrices containing 30hydroxypropylmethylcellulose (HPMC) polymer were prepared by direct compression and tested for dissolution using both USP II and IV dissolution apparatus. Tablets were tested for dissolution (USP IV) using different cell diameter, flow rate, and different position of the tablet inside the cell. In general, the drug dissolution at a given time is a direct function of the flow rate, increasing the flow rate increases drug release. The use of a small cell resulted in faster drug dissolution and higher Reynold's Number than using a large cell. Tablet position in the cell, also has an effect on drug dissolution, inserting the tablet in a horizontal position inside the cell gave faster dissolution than a vertical position. The hydrodynamic conditions did not affect the drug dissolution from HPMC controlled release tablets indicating that the drug dissolution is controlled by the matrix. An equation to predict drug dissolution from conventional tablets was established: Sh=-21.36+10.58Re(1/2) where R2=0.98. This study demonstrated that hydrodynamic conditions, and type of dissolution testing apparatus used have an effect on dissolution rate, mass transfer rate, and film thickness underlying dissolution process.

Survivin protein expression positively correlated with proliferative activity of cancer cells in bladder cancer.

CONTEXT: Survivin is an inhibitor of apoptosis that is selectively over-expressed in common human cancers, but not in normal tissues, and that correlates with aggressive disease and unfavorable outcomes. AIMS: To identify the role of survivin in bladder carcinogenesis and the correlation between survivin protein expression and the occurrence of spontaneous apoptosis, proliferative activity of cancer cells. SETTINGS AND DESIGN: Retrospective analysis. METHODS AND MATERIAL: Bladder transitional cell cancer (BTCC) tissue samples for 128 patients were investigated, with normal bladder tissues serving as controls. From these tumor samples, 42 (32.8%) were grade I, 59 (46.1%) were grade II, and 27 (21.1%) were grade III; 72 (56.2%) were superficial, 56 (43.8%) were invasive. The survivin protein level was quantified by Western blot analysis. The apoptotic index (AI) using in situ labeling apoptotic DNA fragment kit and the Ki-67 labeling index (Ki-67LI) with an anti-Ki-67 monoclonal antibody were analyzed in these tumors, respectively. STATISTICAL ANALYSIS USED: Differences in the S/beta ratio between tumor grade and stage were evaluated by using unpaired t-test and F-test. The relationships between the S/beta ratios and AIs, Ki-67LIs of tumors were evaluated by Pearson correlation coefficient. RESULTS: High survivin levels were detected by Western blot analysis in tumor tissue extracts. None of the expression of survivin protein was found in normal bladder tissues. Survivin levels were significantly different from different clinical stages and pathological grades of the tumors (P > 0.05, respectively). Spearman rank correlation test revealed a positively correlation between survivin protein level and the proliferative activity (P < 0.001) and failed to find significant correlation between AI and survivin protein level (P > 0.05). CONCLUSIONS: Survivin protein expression played an important role in the malignant progression of BTCC.

Factors influencing malaria endemicity in Yunnan Province, PR China (analysis of spatial pattern by GIS). Geographical Information System.

This study is an initial attempt to apply disease mapping through Geographical Information System (GIS) with multiple regression analysis to determine the nature and extent of factors influencing malaria transmission in Yunnan Province, PR China, particularly in border areas. Secondary county-based data covering the period 1990 to 1996 were collected and analyzed. The malaria situation in Yunnan Province as a whole is influenced mainly by the combined effects of the physical environment, the presence of efficient vector species, and mobile population along international borders with Myanmar, Lao PDR and Vietnam.

Isotypic antibody responses of a population in an endemic area of schistosomiasis japonica and their epidemiologic significance.

The present study was designed to explore if there exists a correlation between predominant isotype-defined antibody levels and reinfection in low age groups of the population in an endemic area of schistosomiasis japonica in China. One hundred and thirty-eight individuals aged 3-25 years old were selected for serological investigations including the levels of IgG, IgG4, IgM and IgE, detected by ELISA with soluble egg antigen and soluble adult worm antigen. Results show that age is a determinant for SEA-specific IgG, IgG4, and IgE, and SWA-specific IgG and IgG4 antibody levels, which increased with age, and that SEA- and SWA- specific IgG4 antibody levels are risk factors of reinfection, ie, the risk of reinfection occurrence of the population with high level of SEA or SWA-specific IgG4 is 2.83 or 2.40 times, respectively, that with low level of SEA or SWA-specific IgG4, suggesting that in the endemic area of schistosomiasis japonica, there exists a possibility that in the population aged 3-25 years, SEA and SWA-specific IgG4 antibodies mediate a blocking immunity response.

Laboratory evaluation on the toxic effects of bednets impregnated with permethrin against malaria mosquitos.

In the laboratory, bednets impregnated with 250mg ai/m2 and 500mg ai/m2 permethrin caused respectively the mean mortalities of 86.6% within 13 months and 87.2% within 17 months on laboratory-bred An. sinensis, while they caused average mortalities of 58.3% within 4 months and 73.8% within 10 months on An. dirus respectively. The bioassay results of KT50 and LT50 on the two species showed that KT50 is shorter than LT50 after exposure to the treated bednets. The ratio is 1:2.16 - 1:3.05. It was observed Anopheles had obviously secondary knocked down after exposure to the treated bednets and there is obvious resurgent after Anopheles have been knocked down. When the temperature goes up the resurgence gets shorter, the resurgence rate gets higher and the mortality gets lower. It showed that permethrin has stronger knocking down effect than killing effect.