Effect of intraoperative dexmedetomidine on renal function after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized, placebo-controlled trial.

INTRODUCTION: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) predispose to postoperative renal dysfunction. Dexmedetomidine is an α2 adrenoreceptor agonist, which has renoprotective effects after cardiac surgery. OBJECTIVE: To assess the effect of dexmedetomidine on renal function after CRS and HIPEC. MATERIALS: Thirty-eight patients undergoing CRS and HIPEC were randomized to receive dexmedetomidine (dexmedetomidine group, n = 19, loading 1 µg/kg over 20 min followed by infusion at 0.5 µg/kg/h) or 0.9% sodium chloride (control group, n = 19) during surgery. Creatinine clearance (CrCl) was assessed daily until postoperative day 7. Urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule (KIM)-1 were measured for 24 h after surgery. RESULTS: There was no difference in the lowest CrCl value during the first 7 days postoperatively, but the % change from baseline to the lowest value was lower in the dexmedetomidine group than in the control group (p = .037). Urine NGAL and KIM-1 levels were increased over time in both groups, but the increases were significantly less in the dexmedetomidine group (p = .018 and 0.038, respectively). In the dexmedetomidine group, the length of intensive care unit stay was shorter (p = .034). CONCLUSIONS: Intraoperative dexmedetomidine infusion did not improve renal function in terms of serum Cr-related indices following CRS and HIPEC. However, as the decrease in CrCl was attenuated and early tubular-injury markers were lower in the dexmedetomidine group, dexmedetomidine may have protective effects against early tubular injury in CRS and HIPEC. Clinical Trials Registry: http://clinicaltrials.gov (NCT02641938).

Study of muscle contraction induced by electrical pulse stimulation and nitric oxide in C2C12 myotube cells.

PURPOSE: This study aimed to examine the independent effect of electrical pulse stimulation(EPS) and nitric oxide(NO) on muscle contraction and their synergistic or combined effect on contraction phenomenon using C2C12 mouse skeletal muscle cells. METHODS: Some differentiated C2C12 myotube cells were untreated (control). Other cells did not receive EPS and did receive 0.5, 1.0, or 2.0 mM of the NO donor, S-nitroso-N-acetyl-penicillamine (SNAP; -E/S0.5, -E/S1.0, and -E/S2.0, respectively). For the EPS treatments (0.3 V/mm, 1.0 Hz, and 4.0 ms), differentiated C2C12 myotube cells received only EPS or both EPS and the SNAPtreatments at the same concentrations (+E/-S, +E/S0.5, +E/S1.0, and +E/S2.0, respectively). All samples were then cultured for 4 days. RESULTS: Differentiated C2C12 cellswere stimulated by the EPS, NO, and EPS+NO treatments. The cell length of the +E/S2.0 Group after the 4-day culture (84.2±13.2㎛) was the shortest of all the groups. The expressions of AMPK, JNK, Akt, eNOS, GLUT4, and PGC1α proteins were noticeably dominant. The results indicated synergistic effect on muscle contraction of simultaneously applied EPS and SNAP. CONCLUSION: Motor skills were significantly improved when exercise was accompanied by the intake of NO precursor and/or NO, compared to that upon their independent application or treatment.

Effects of dexmedetomidine in combination with fentanyl-based intravenous patient-controlled analgesia on pain attenuation after open gastrectomy in comparison with conventional thoracic epidural and fentanyl-based intravenous patient-controlled analgesia.

Background: This study was investigated the effects of dexmedetomidine in combination with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) on pain attenuation in patients undergoing open gastrectomy in comparison with conventional thoracic epidural patient-controlled analgesia (E-PCA) and IV-PCA. Methods: One hundred seventy-one patients who planned open gastrectomy were randomly distributed into one of the 3 groups: conventional thoracic E-PCA (E-PCA group, n = 57), dexmedetomidine in combination with fentanyl-based IV-PCA (dIV-PCA group, n = 57), or fentanyl-based IV-PCA only (IV-PCA group, n = 57). The primary outcome was the postoperative pain intensity (numerical rating scale) at 3 hours after surgery, and the secondary outcomes were the number of bolus deliveries and bolus attempts, and the number of patients who required additional rescue analgesics. Mean blood pressure, heart rate, and adverse effects were evaluated as well. Results: One hundred fifty-three patients were finally completed the study. The postoperative pain intensity was significantly lower in the dIV-PCA and E-PCA groups than in the IV-PCA group, but comparable between the dIV-PCA group and the E-PCA group. Patients in the dIV-PCA and E-PCA groups needed significantly fewer additional analgesic rescues between 6 and 24 hours after surgery, and had a significantly lower number of bolus attempts and bolus deliveries during the first 24 hours after surgery than those in the IV-PCA group. Conclusions: Dexmedetomidine in combination with fentanyl-based IV-PCA significantly improved postoperative analgesia in patients undergoing open gastrectomy without hemodynamic instability, which was comparable to thoracic E-PCA. Furthermore, this approach could be clinically more meaningful owing to its noninvasive nature.

The effect of swimming exercise and powdered-Salicornia herbacea L. ingestion on glucose metabolism in STZ-induced diabetic rats.

PURPOSE: The purpose of this study is to observe the effects of Salicornia herbacea L. powder ingestion on carbohydrate metabolism in STZ-induced diabetic rats. METHODS: To achieve this objective, 35 Sprague-Dawley male rats were raised with feed mixed with Salicornia herbacia L. powder and given specific periods to swim for 5 weeks. There was no significant difference in the insulin increase rate while ingesting Salicornia herbacea L. powder and simultaneously exercising. RESULTS: Compared to the diabetes mellitus group, HOMA-IR was significantly decreased in the diabetes mellitus + exercise group, diabetes mellitus + Salicornia herbacea group, and the diabetes mellitus + Salicornia herbacea + exercise group. However, changes in blood glucose were significant in each group. Thus, for the result of GLUT-4 and GLUT-2, which are the glycose transporters of the liver and muscle, diabetes mellitus + exercise group, diabetes mellitus + Salicornia herbacea group, and diabetes mellitus + Salicornia herbacea + exercise group showed significantly higher expressions. The glycogen concentration of the liver and muscle was significantly increased in the diabetes mellitus + exercise group, diabetes mellitus + Salicornia herbacea group, and diabetes mellitus + Salicornia herbacea + exercise group. CONCLUSION: With the results above, it seems that taking Salicornia herbacea L. powder and exercise will help prevent various diabetic complications. Therefore, the findings of this study could justify Salicornia herbacea L. powder with its basal data of physiological activities and pharmacological components as a type of health functional food.

The effect of power nordic walking on spine deformation and visual analog pain scale in elderly women with low back pain.

[Purpose] The purpose of this study was to examine whether Nordic walking exercise can relieve low back pain and change the spine shape in elderly women. [Subjects] Sixteen elderly women with chronic low back pain from N University in Chungcheong-do, South Korea, were enrolled. [Methods] The participants were asked to walk in an upright posture, with the head upright and looking forward. The Nordic poles were held close to the body. When a foot was moved forward, the arm on the other side lifted the Nordic pole and moved it forward. The participants were using the Nordic pole when walked on the track with their arms lifted above their shoulders. The type of shoes worn during walking was not considered. [Results] One-way analysis of variance was used to determine the presence of significant differences between the measures of spine deformation and VAS. [Conclusion] Chronic low back pain, a complaint often received from elderly women, was reduced by pole-induced power walking reduction on the balance of the spine and back of this important exercise program is presented as a guideline.

The effect of exercise training and water extract from propolis intake on the antioxidant enzymes activity of skeletal muscle and liver in rat.

PURPOSE: In this study, the authors have intended to investigate the effects that the exercise training and the intake of the water extract from propolis have on the activity of antioxidant enzymes. METHODS: For this purpose, the exercise training (70% VO2max treadmill running exercise for 60min)of 5 times per week for six weeks and the intake (50mg/kg/day) of the water extract from propolis were performed by separating the experimental animals (SD rats, n=32) into CON(n=8) group, CON+Ex(n=8), PA(n=8), and PA+Ex(n=8). RESULTS: As a result, the following conclusions were obtained: The concentration of the blood glucose and insulin of the CON+Ex group and PA+Ex group which are the exercise parallel group were significantly decreased in comparison with the control group, whereas if comparing the glycogen concentration in skeletal muscle and liver tissue between the exercise parallel group and the CON group, the former showed significantly high value in comparison with the latter (p < .05). In the case of the activity of the antioxidant enzyme in the skeletal muscle and the liver tissue, the activities of SOD, GPX and CAT in the gastrocnemius muscle tissue of the experimental animals showed significantly high value in PA+Ex group in comparison with other experimental groups (p < .05). In addition, the SOD activity in the liver tissue showed that only PA+Ex group was significantly increased, whereas GDX activity showed significantly higher value in CON+Ex group and PA group than CON group (p < .05). However, the activity of CAT in the liver tissue showed that there is no difference between the experimental groups. As a result that measured the concentration of MDA in order to evaluate the damage level of the tissue by oxygen free radicals, the difference between the groups in the liver tissue was not shown, while it was shown that only PA+Ex group in the skeletal muscle tissue was significantly decreased in comparison with other experimental groups (p < .05). CONCLUSION: Taken together the above findings, it is considered that the parallel treatment of the exercise training and the water extract from propolis can not only increase the use of glycogen of the skeletal muscle and liver tissue, but also it can give the effect to suppress the creation of active oxygen by inducing the activity of the antioxidant enzyme in the body, and in the future, the possibility as the exercise supplements and the antioxidant of the water-soluble propolis are expected.

An evaluation of contrast medium spread on caudal epidurography with the needle positioned toward the affected side in patients with unilateral lumbosacral radiculopathy.

OBJECTIVE: We used caudal epidurography to compare the spread of contrast medium when the needle was inserted toward the affected side in patients with unilateral radiculopathy undergoing caudal steroid injection. MATERIALS AND METHODS: We enrolled 24 patients with unilateral radiculopathy. A block needle was positioned toward the affected side in the sacral epidural space. After 5 mL of iodinated contrast medium was injected, a standardized anteroposterior view was imaged. Using Adobe Photoshop software, contrast medium spread was assessed by counting pixels within the areas spread on the affected side and on the opposite side, and the pixel counts of the two sides were compared. Spinal nerve root filling was also assessed. RESULTS: The pixel count within the area of contrast medium spread on the side with the needle was significantly greater than that of the opposite side (mean [SD] 41,368.6 [13,143.1] vs 15,165.3 (10,698.1), P < 0.001]. However, 13.6% of the study patients had greater spread on the opposite side. The rates of L5 and S1 nerve root filling in the affected side were 18.2% and 36.4% respectively. CONCLUSIONS: When a needle was intentionally inserted toward the side with radiculopathy, the spread of contrast medium and number of delineated roots tended to be greater on the side with the needle, compared with those on the opposite side. However, the pattern of contrast medium spread in the sacral epidural space varied and some patients even had greater spread on the opposite side.

Analgesic mechanism of electroacupuncture in an arthritic pain model of rats: a neurotransmitter study.

PURPOSE: We investigated what kinds of neurotransmitters are related with electroacupuncture (EA) analgesia in an arthritic pain model of rats. MATERIALS AND METHODS: One hundred rats were assigned to six groups: control, EA, opioid, adrenergic, serotonin and dopamine group. A standardized model of inflammatory arthritis was produced by injecting 2% carrageenan into the knee joint cavity. EA was applied to an acupoint for 30 min in all groups except fo the control group. In the opioid, adrenergic, serotonin and dopamine groups, each receptor antagonist was injected intraperitoneally to their respective group before initiating EA. RESULTS: In the opioid receptor antagonist group, adrenergic receptor antagonist group, serotonin receptor antagonist group, dopamine receptor antagonist group and the control group weight-bearing force decreased significantly from 30 min to 180 min after EA in comparison with the EA group. CONCLUSION: The analgesic effects of EA are related to opioid, adrenergic, serotonin and dopamine receptors in an arthritic pain model of rats.

Multiple cerebral infarction and paradoxical air embolism during hepatectomy using the Cavitron Ultrasonic Surgical Aspirator -A case report-.

A venous air embolism and paradoxical air embolism (PAE) are serious complications in patients undergoing a hepatectomy. We report a case of PAE and cerebral infarctions in a patient undergoing a hepatic resection using a Cavitron Ultrasonic Surgical Aspirator (CUSA®). A 65-year-old woman underwent a left lobe hepatectomy. During the middle phase of the liver resection with CUSA®, there was a sudden decrease in arterial blood pressure, end-tidal carbon dioxide and SpO(2). With resuscitation, intraoperative ultrasonography revealed massive air emboli in both her left and right heart, which lasted for 40 min. The hepatectomy was completed after the disappearance of the air emboli from her heart. After surgery, her mental status was stuporous. The brain CT and MRI revealed multiple acute cerebral infarctions. Finally, she died from septic shock. This case highlights the need for anesthetists and surgeons to be aware of the potential for CUSA®-related massive PAE.

Trophic transfer and biotransformation of polychlorinated biphenyls in zebra mussel, round goby, and smallmouth bass in Lake Erie, USA.

Trophic transfer of polychlorinated biphenyl (PCB) congeners in zebra mussels (Dreissena polymorpha), round gobies (Neogobius melanstomus), and smallmouth bass (Micropterus dolomieu) were assessed in four sites along the south shore of the west and central basin of Lake Erie (all sites were in OH, USA). Total PCB levels in smallmouth bass (1,091-1,520 ng/g wet weight) and round gobies (118-256 ng/g wet weight) were similar among sites despite a west-to-east decrease in total PCB concentrations in zebra mussels (29-97 ng/g wet weight). At all sites, PCB body burden increased three- to fivefold at each successive trophic level, suggesting biomagnification in this nonnative food chain. Whereas fish species were dominated by the hexachlorine homologue, zebra mussels were dominated by penta- and hexachlorine homologues; the average degree of chlorination of PCBs was 56.1% for zebra mussels, 60.4% for round goby, and 59.9% for smallmouth bass bodies. Predictive structure-activity relationships based on chemical characteristics, such as the octanol-water partition coefficient (log K(ow)), had little predictive power on bioaccumulation and biotransformation of PCB congeners because of nonlinearity, threshold relationships, and species-specific differences. Calculated trophic transfer for the smallmouth bass-round goby linkage was higher than for the round goby-zebra mussel linkage. Only when PCB congeners were grouped by chemical structure first (vicinal [adjacent] H-atom position in the phenyl ring) were linear relationships achieved. It appeared that the chemical group to which each congener belonged influenced biotransformation more than species-specific (round gobies vs smallmouth bass) differences. Biotic changes at midtrophic levels, such as exotic species invasions, may have an increasingly important role in determining pollutant cycling and hence pollutant residues in top predators.

Use of a neck brace minimizes double-lumen tube displacement during patient positioning.

PURPOSE: When patients are moved from the supine to the lateral decubitus position, the double-lumen endobronchial tube (DLT) is often displaced. The aim of this study was to determine whether a DLT is displaced when there are no movements of the head and neck. METHODS: One hundred patients scheduled for elective thoracic surgery were randomly divided into control and brace groups. Only a left-sided DLT was used during the study. All patients in the brace group wore a neck collar before the positional change. Using a fibreoptic bronchoscope, the distance from the tracheal opening to the main carina and from the bronchial opening to the bronchial carina was measured in the supine and lateral decubitus positions. RESULTS: Displacement of the DLT (mean +/- SD) during a change from the supine to the lateral decubitus position was greater in the control group (6.3 +/- 5.5 mm in the trachea; 2.4 +/- 3.6 mm in the bronchus) than in the brace group (2.2 +/- 3.9 mm in the trachea; 0.6 +/- 3.1 mm in the bronchus); (P < 0.001). The incidence of clinically significant displacement, greater than 5 mm from the initial correct position, was higher in the control group than in the brace group (48% vs 12%, P < 0.001). CONCLUSION: By restricting head and neck movements with a neck brace, the DLT displacement could be minimized while positioning patients for thoracotomy. The main cause of the DLT displacement during lateral positioning appears to be related to movement of the head and neck.