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1.
Nat Commun ; 15(1): 2480, 2024 Mar 20.
Article in English | MEDLINE | ID: mdl-38509097

ABSTRACT

The expression of genes encompasses their transcription into mRNA followed by translation into protein. In recent years, next-generation sequencing and mass spectrometry methods have profiled DNA, RNA and protein abundance in cells. However, there are currently no reference standards that are compatible across these genomic, transcriptomic and proteomic methods, and provide an integrated measure of gene expression. Here, we use synthetic biology principles to engineer a multi-omics control, termed pREF, that can act as a universal molecular standard for next-generation sequencing and mass spectrometry methods. The pREF sequence encodes 21 synthetic genes that can be in vitro transcribed into spike-in mRNA controls, and in vitro translated to generate matched protein controls. The synthetic genes provide qualitative controls that can measure sensitivity and quantitative accuracy of DNA, RNA and peptide detection. We demonstrate the use of pREF in metagenome DNA sequencing and RNA sequencing experiments and evaluate the quantification of proteins using mass spectrometry. Unlike previous spike-in controls, pREF can be independently propagated and the synthetic mRNA and protein controls can be sustainably prepared by recipient laboratories using common molecular biology techniques. Together, this provides a universal synthetic standard able to integrate genomic, transcriptomic and proteomic methods.


Subject(s)
DNA , Proteomics , RNA, Messenger/genetics , RNA, Messenger/metabolism , DNA/genetics , Genomics , RNA
2.
Nat Commun ; 14(1): 5663, 2023 09 21.
Article in English | MEDLINE | ID: mdl-37735471

ABSTRACT

The success of mRNA vaccines has been realised, in part, by advances in manufacturing that enabled billions of doses to be produced at sufficient quality and safety. However, mRNA vaccines must be rigorously analysed to measure their integrity and detect contaminants that reduce their effectiveness and induce side-effects. Currently, mRNA vaccines and therapies are analysed using a range of time-consuming and costly methods. Here we describe a streamlined method to analyse mRNA vaccines and therapies using long-read nanopore sequencing. Compared to other industry-standard techniques, VAX-seq can comprehensively measure key mRNA vaccine quality attributes, including sequence, length, integrity, and purity. We also show how direct RNA sequencing can analyse mRNA chemistry, including the detection of nucleoside modifications. To support this approach, we provide supporting software to automatically report on mRNA and plasmid template quality and integrity. Given these advantages, we anticipate that RNA sequencing methods, such as VAX-seq, will become central to the development and manufacture of mRNA drugs.


Subject(s)
Commerce , mRNA Vaccines , RNA, Messenger/genetics , Sequence Analysis, RNA
3.
Nat Commun ; 13(1): 6437, 2022 10 28.
Article in English | MEDLINE | ID: mdl-36307482

ABSTRACT

Library adaptors are short oligonucleotides that are attached to RNA and DNA samples in preparation for next-generation sequencing (NGS). Adaptors can also include additional functional elements, such as sample indexes and unique molecular identifiers, to improve library analysis. Here, we describe Control Library Adaptors, termed CAPTORs, that measure the accuracy and reliability of NGS. CAPTORs can be integrated within the library preparation of RNA and DNA samples, and their encoded information is retrieved during sequencing. We show how CAPTORs can measure the accuracy of nanopore sequencing, evaluate the quantitative performance of metagenomic and RNA sequencing, and improve normalisation between samples. CAPTORs can also be customised for clinical diagnoses, correcting systematic sequencing errors and improving the diagnosis of pathogenic BRCA1/2 variants in breast cancer. CAPTORs are a simple and effective method to increase the accuracy and reliability of NGS, enabling comparisons between samples, reagents and laboratories, and supporting the use of nanopore sequencing for clinical diagnosis.


Subject(s)
Nanopore Sequencing , Reproducibility of Results , Gene Library , High-Throughput Nucleotide Sequencing/methods , RNA
4.
Stem Cell Reports ; 17(6): 1476-1492, 2022 06 14.
Article in English | MEDLINE | ID: mdl-35523177

ABSTRACT

Advances in the study of neurological conditions have been possible because of pluripotent stem cell technologies and organoids. Studies have described the generation of neural ectoderm-derived retinal and brain structures from pluripotent stem cells. However, the field is still troubled by technical challenges, including high culture costs and variability. Here, we describe a simple and economical protocol that reproducibly gives rise to the neural retina and cortical brain regions from confluent cultures of stem cells. The spontaneously generated cortical organoids are transcriptionally comparable with organoids generated by other methods. Furthermore, these organoids showed spontaneous functional network activity and proteomic analysis confirmed organoids maturity. The generation of retinal and brain organoids in close proximity enabled their mutual isolation. Suspension culture of this complex organoid system demonstrated the formation of nerve-like structures connecting retinal and brain organoids, which might facilitate the investigation of neurological diseases of the eye and brain.


Subject(s)
Induced Pluripotent Stem Cells , Pluripotent Stem Cells , Brain , Cell Differentiation , Organoids , Proteomics , Retina
5.
Genome Biol ; 23(1): 19, 2022 01 12.
Article in English | MEDLINE | ID: mdl-35022065

ABSTRACT

BACKGROUND: Next-generation sequencing (NGS) can identify mutations in the human genome that cause disease and has been widely adopted in clinical diagnosis. However, the human genome contains many polymorphic, low-complexity, and repetitive regions that are difficult to sequence and analyze. Despite their difficulty, these regions include many clinically important sequences that can inform the treatment of human diseases and improve the diagnostic yield of NGS. RESULTS: To evaluate the accuracy by which these difficult regions are analyzed with NGS, we built an in silico decoy chromosome, along with corresponding synthetic DNA reference controls, that encode difficult and clinically important human genome regions, including repeats, microsatellites, HLA genes, and immune receptors. These controls provide a known ground-truth reference against which to measure the performance of diverse sequencing technologies, reagents, and bioinformatic tools. Using this approach, we provide a comprehensive evaluation of short- and long-read sequencing instruments, library preparation methods, and software tools and identify the errors and systematic bias that confound our resolution of these remaining difficult regions. CONCLUSIONS: This study provides an analytical validation of diagnosis using NGS in difficult regions of the human genome and highlights the challenges that remain to resolve these difficult regions.


Subject(s)
Genome, Human , High-Throughput Nucleotide Sequencing , Chromosomes , High-Throughput Nucleotide Sequencing/methods , Humans , Microsatellite Repeats , Sequence Analysis, DNA/methods , Software
6.
Genes (Basel) ; 12(11)2021 10 30.
Article in English | MEDLINE | ID: mdl-34828360

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a prototypical neurodegenerative disease characterized by progressive degeneration of motor neurons to severely effect the functionality to control voluntary muscle movement. Most of the non-additive genetic aberrations responsible for ALS make its molecular classification very challenging along with limited sample size, curse of dimensionality, class imbalance and noise in the data. Deep learning methods have been successful in many other related areas but have low minority class accuracy and suffer from the lack of explainability when used directly with RNA expression features for ALS molecular classification. In this paper, we propose a deep-learning-based molecular ALS classification and interpretation framework. Our framework is based on training a convolution neural network (CNN) on images obtained from converting RNA expression values into pixels based on DeepInsight similarity technique. Then, we employed Shapley additive explanations (SHAP) to extract pixels with higher relevance to ALS classifications. These pixels were mapped back to the genes which made them up. This enabled us to classify ALS samples with high accuracy for a minority class along with identifying genes that might be playing an important role in ALS molecular classifications. Taken together with RNA expression images classified with CNN, our preliminary analysis of the genes identified by SHAP interpretation demonstrate the value of utilizing Machine Learning to perform molecular classification of ALS and uncover disease-associated genes.


Subject(s)
Amyotrophic Lateral Sclerosis/classification , Image Interpretation, Computer-Assisted/methods , RNA, Messenger/genetics , Algorithms , Amyotrophic Lateral Sclerosis/genetics , Databases, Genetic , Deep Learning , Gene Expression Profiling , Gene Expression Regulation , Humans , Neural Networks, Computer , Sequence Analysis, RNA
7.
Nat Commun ; 11(1): 3609, 2020 07 17.
Article in English | MEDLINE | ID: mdl-32681090

ABSTRACT

Standard units of measurement are required for the quantitative description of nature; however, few standard units have been established for genomics to date. Here, we have developed a synthetic DNA ladder that defines a quantitative standard unit that can measure DNA sequence abundance within a next-generation sequencing library. The ladder can be spiked into a DNA sample, and act as an internal scale that measures quantitative genetics features. Unlike previous spike-ins, the ladder is encoded within a single molecule, and can be equivalently and independently synthesized by different laboratories. We show how the ladder can measure diverse quantitative features, including human genetic variation and microbial abundance, and also estimate uncertainty due to technical variation and improve normalization between libraries. This ladder provides an independent quantitative unit that can be used with any organism, application or technology, thereby providing a common metric by which genomes can be measured.


Subject(s)
DNA/analysis , DNA/chemical synthesis , Base Sequence , DNA/genetics , Gene Dosage , Gene Library , Genomics , Humans
8.
Nat Protoc ; 14(7): 2119-2151, 2019 07.
Article in English | MEDLINE | ID: mdl-31217595

ABSTRACT

Next-generation sequencing (NGS) has been widely adopted to identify genetic variants and investigate their association with disease. However, the analysis of sequencing data remains challenging because of the complexity of human genetic variation and confounding errors introduced during library preparation, sequencing and analysis. We have developed a set of synthetic DNA spike-ins-termed 'sequins' (sequencing spike-ins)-that are directly added to DNA samples before library preparation. Sequins can be used to measure technical biases and to act as internal quantitative and qualitative controls throughout the sequencing workflow. This step-by-step protocol explains the use of sequins for both whole-genome and targeted sequencing of the human genome. This includes instructions regarding the dilution and addition of sequins to human DNA samples, followed by the bioinformatic steps required to separate sequin- and sample-derived sequencing reads and to evaluate the diagnostic performance of the assay. These practical guidelines are accompanied by a broader discussion of the conceptual and statistical principles that underpin the design of sequin standards. This protocol is suitable for users with standard laboratory and bioinformatic experience. The laboratory steps require ~1-4 d and the bioinformatic steps (which can be performed with the provided example data files) take an additional day.


Subject(s)
DNA/chemical synthesis , Genome, Human , High-Throughput Nucleotide Sequencing/methods , Calibration , Computational Biology/methods , DNA/genetics , High-Throughput Nucleotide Sequencing/standards , Humans , K562 Cells , MCF-7 Cells , Neoplasms/genetics , Proto-Oncogene Proteins B-raf/genetics
9.
Nat Commun ; 10(1): 1342, 2019 03 22.
Article in English | MEDLINE | ID: mdl-30902988

ABSTRACT

Chirality is a property describing any object that is inequivalent to its mirror image. Due to its 5'-3' directionality, a DNA sequence is distinct from a mirrored sequence arranged in reverse nucleotide-order, and is therefore chiral. A given sequence and its opposing chiral partner sequence share many properties, such as nucleotide composition and sequence entropy. Here we demonstrate that chiral DNA sequence pairs also perform equivalently during molecular and bioinformatic techniques that underpin genetic analysis, including PCR amplification, hybridization, whole-genome, target-enriched and nanopore sequencing, sequence alignment and variant detection. Given these shared properties, synthetic DNA sequences mirroring clinically relevant or analytically challenging regions of the human genome are ideal controls for clinical genomics. The addition of synthetic chiral sequences (sequins) to patient tumor samples can prevent false-positive and false-negative mutation detection to improve diagnosis. Accordingly, we propose that sequins can fulfill the need for commutable internal controls in precision medicine.


Subject(s)
DNA/genetics , Genomics , Base Sequence , High-Throughput Nucleotide Sequencing , Humans , Microsatellite Repeats/genetics , Mutation/genetics , Nanopores , Neoplasms/genetics , Polymerase Chain Reaction , Sequence Alignment
10.
J Cell Sci ; 132(5)2019 03 14.
Article in English | MEDLINE | ID: mdl-30745338

ABSTRACT

Cancers that utilize the alternative lengthening of telomeres (ALT) mechanism for telomere maintenance are often difficult to treat and have a poor prognosis. They are also commonly deficient for expression of ATRX protein, a repressor of ALT activity, and a component of promyelocytic leukemia nuclear bodies (PML NBs) that are required for intrinsic immunity to various viruses. Here, we asked whether ATRX deficiency creates a vulnerability in ALT cancer cells that could be exploited for therapeutic purposes. We showed in a range of cell types that a mutant herpes simplex virus type 1 (HSV-1) lacking ICP0, a protein that degrades PML NB components including ATRX, was ten- to one thousand-fold more effective in infecting ATRX-deficient cells than wild-type ATRX-expressing cells. Infection of co-cultured primary and ATRX-deficient cancer cells revealed that mutant HSV-1 selectively killed ATRX-deficient cells. Sensitivity to mutant HSV-1 infection also correlated inversely with PML protein levels, and we showed that ATRX upregulates PML expression at both the transcriptional and post-transcriptional levels. These data provide a basis for predicting, based on ATRX or PML levels, which tumors will respond to a selective oncolytic herpesvirus.


Subject(s)
Herpes Simplex/metabolism , Herpesvirus 1, Human/physiology , Immediate-Early Proteins/metabolism , Kidney/metabolism , Promyelocytic Leukemia Protein/metabolism , Ubiquitin-Protein Ligases/metabolism , X-linked Nuclear Protein/deficiency , Animals , Cell Death , Cell Line, Tumor , Cricetinae , Herpes Simplex/pathology , Humans , Immediate-Early Proteins/genetics , Immunity, Innate/genetics , Kidney/pathology , Mutation/genetics , Oncolytic Virotherapy , Promyelocytic Leukemia Protein/genetics , Telomere Homeostasis , Ubiquitin-Protein Ligases/genetics
11.
Nat Commun ; 9(1): 3096, 2018 08 06.
Article in English | MEDLINE | ID: mdl-30082706

ABSTRACT

The complexity of microbial communities, combined with technical biases in next-generation sequencing, pose a challenge to metagenomic analysis. Here, we develop a set of internal DNA standards, termed "sequins" (sequencing spike-ins), that together constitute a synthetic community of artificial microbial genomes. Sequins are added to environmental DNA samples prior to library preparation, and undergo concurrent sequencing with the accompanying sample. We validate the performance of sequins by comparison to mock microbial communities, and demonstrate their use in the analysis of real metagenome samples. We show how sequins can be used to measure fold change differences in the size and structure of accompanying microbial communities, and perform quantitative normalization between samples. We further illustrate how sequins can be used to benchmark and optimize new methods, including nanopore long-read sequencing technology. We provide metagenome sequins, along with associated data sets, protocols, and an accompanying software toolkit, as reference standards to aid in metagenomic studies.


Subject(s)
Metagenome , Metagenomics , Sequence Analysis, DNA , DNA, Bacterial/analysis , Gene Library , Genome, Bacterial , High-Throughput Nucleotide Sequencing , Models, Biological , Nanopores , Phylogeny , Reference Standards , Reproducibility of Results , Software
12.
Bioinformatics ; 33(11): 1723-1724, 2017 Jun 01.
Article in English | MEDLINE | ID: mdl-28130232

ABSTRACT

SUMMARY: Spike-in controls are synthetic nucleic-acid sequences that are added to a user's sample and constitute internal standards for subsequent steps in the next generation sequencing workflow. AVAILABILITY AND IMPLEMENTATION: : The software is implemented in C ++/R and is freely available under BSD license. The source code is available from github.com/student-t/Anaquin , binaries and user manual from www.sequin.xyz/software and R package from bioconductor.org/packages/Anaquin. CONTACT: anaquin@garvan.org.au or t.mercer@garvan.org.au. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.


Subject(s)
High-Throughput Nucleotide Sequencing/methods , Sequence Analysis, DNA/methods , Sequence Analysis, RNA/methods , Software , Humans
13.
Nat Methods ; 13(9): 784-91, 2016 09.
Article in English | MEDLINE | ID: mdl-27502217

ABSTRACT

The identification of genetic variation with next-generation sequencing is confounded by the complexity of the human genome sequence and by biases that arise during library preparation, sequencing and analysis. We have developed a set of synthetic DNA standards, termed 'sequins', that emulate human genetic features and constitute qualitative and quantitative spike-in controls for genome sequencing. Sequencing reads derived from sequins align exclusively to an artificial in silico reference chromosome, rather than the human reference genome, which allows them them to be partitioned for parallel analysis. Here we use this approach to represent common and clinically relevant genetic variation, ranging from single nucleotide variants to large structural rearrangements and copy-number variation. We validate the design and performance of sequin standards by comparison to examples in the NA12878 reference genome, and we demonstrate their utility during the detection and quantification of variants. We provide sequins as a standardized, quantitative resource against which human genetic variation can be measured and diagnostic performance assessed.


Subject(s)
DNA Copy Number Variations , DNA/genetics , Genome, Human , Genomics/methods , Polymorphism, Single Nucleotide , Sequence Analysis, DNA/methods , Chromosomes, Artificial/chemistry , Chromosomes, Artificial/genetics , DNA/chemical synthesis , DNA/chemistry , Humans , Reference Standards , Sequence Analysis, DNA/standards
14.
Nat Methods ; 13(9): 792-8, 2016 09.
Article in English | MEDLINE | ID: mdl-27502218

ABSTRACT

RNA sequencing (RNA-seq) can be used to assemble spliced isoforms, quantify expressed genes and provide a global profile of the transcriptome. However, the size and diversity of the transcriptome, the wide dynamic range in gene expression and inherent technical biases confound RNA-seq analysis. We have developed a set of spike-in RNA standards, termed 'sequins' (sequencing spike-ins), that represent full-length spliced mRNA isoforms. Sequins have an entirely artificial sequence with no homology to natural reference genomes, but they align to gene loci encoded on an artificial in silico chromosome. The combination of multiple sequins across a range of concentrations emulates alternative splicing and differential gene expression, and it provides scaling factors for normalization between samples. We demonstrate the use of sequins in RNA-seq experiments to measure sample-specific biases and determine the limits of reliable transcript assembly and quantification in accompanying human RNA samples. In addition, we have designed a complementary set of sequins that represent fusion genes arising from rearrangements of the in silico chromosome to aid in cancer diagnosis. RNA sequins provide a qualitative and quantitative reference with which to navigate the complexity of the human transcriptome.


Subject(s)
Gene Expression Profiling/standards , Genes, Synthetic , RNA Splicing , RNA, Messenger/genetics , Sequence Analysis, RNA/standards , Chromosomes, Artificial , Humans , Quality Control , RNA Splicing/genetics , RNA, Messenger/chemical synthesis , RNA, Messenger/chemistry , Reference Standards , Sequence Analysis, RNA/methods
15.
Surgery ; 138(6): 979-84; discussion 984-5, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16360381

ABSTRACT

BACKGROUND: Among the most promising new therapies for thyroid cancer are the histone deacetylase inhibitors. Valproic acid (VA) is an anticonvulsant that inhibits histone deacetylase activity at nontoxic concentrations. We hypothesized that VA would have antineoplastic effects on human thyroid cancer cells. METHODS: We treated 1 papillary and 3 follicular thyroid cancer cell lines with VA (0.5-2 mmol/L) for 24 to 72 hours. Cell proliferation was measured with a cell proliferation assay kit. Annexin V-fluorescein isothiocyanate was used to quantitate cells that were undergoing apoptosis. Quantitative polymerase chain reaction was used to measure expression of apoptosis-regulatory and differentiation genes. RESULTS: VA inhibited growth in all cell lines by 26% to 59% at 48 hours and up to 77% at 72 hours. Nineteen percent to 30% of VA-treated cells underwent apoptosis, compared with 4% to 8% of the control cells. Expression of pro survival genes bcl-2 and bcl-xl was down-regulated by 10% to 60%; expression of the proapoptosis gene bax was up-regulated by 23% to 85%. Sodium-iodide symporter and thyroglobulin messenger RNA expression were up-regulated by 93% to 370% in follicular cell lines but remained unchanged in the papillary cell line. CONCLUSION: VA inhibits growth, induces apoptosis, and modulates apoptosis-regulatory and differentiation gene expression in thyroid cancer cells. These findings suggest that VA may be useful clinically for patients with thyroid cancers of follicular cell origin.


Subject(s)
Adenocarcinoma, Follicular/pathology , Adenocarcinoma, Papillary/pathology , Apoptosis/drug effects , Histone Deacetylase Inhibitors , Thyroid Neoplasms/pathology , Valproic Acid/pharmacology , Adenocarcinoma, Follicular/metabolism , Adenocarcinoma, Papillary/metabolism , Apoptosis Regulatory Proteins/genetics , Apoptosis Regulatory Proteins/metabolism , Cell Culture Techniques , Cell Line, Tumor , Humans , RNA, Messenger/metabolism , Symporters/genetics , Symporters/metabolism , Thyroglobulin/genetics , Thyroglobulin/metabolism , Thyroid Neoplasms/metabolism
16.
Dev Dyn ; 229(3): 591-9, 2004 Mar.
Article in English | MEDLINE | ID: mdl-14991714

ABSTRACT

The timing of myogenic differentiation of hypaxial muscle precursor cells in the somite lags behind that of epaxial precursors. Two hypotheses have been proposed to explain this delay. One attributes the delay to the presence of negative-acting signals from the lateral plate mesoderm adjacent to the hypaxial muscle precursor cells located in the ventrolateral lip of the somitic dermomyotome (Pourquié et al. [1995] Proc. Natl. Acad. Sci. USA 92:3219-3223). The second attributes the delay to an absence of positive-acting inductive signals, similar to those from the axial structures that induce epaxial myotome development (Pownall et al. [1996] Development 122:1475-1488). Because both studies relied principally upon changes in the expression pattern of mRNAs specific to early muscle precursor cell markers, we revisited these experiments using two methods to assess muscle terminal differentiation. First, injection of fluorescent dyes before surgery was used to determine whether ventrolateral lip cells transform from epithelial cells to elongated myocytes. Second, an antibody to a terminal differentiation marker and a new monoclonal antibody that recognises avian and mammalian Pax3 were used for immunohistochemistry to assess the transition from precursor cell to myocyte. The results support both hypotheses and show further that placing axial structures adjacent to the somite ventrolateral lip induces an axial pattern of myocyte terminal differentiation and elongation.


Subject(s)
Extremities/embryology , Muscles/embryology , Animals , Cell Differentiation , Cell Movement , Chick Embryo , Coturnix , DNA-Binding Proteins/metabolism , Fluorescent Dyes/pharmacology , Immunohistochemistry , In Situ Hybridization , Microscopy, Fluorescence , Models, Biological , Muscles/cytology , MyoD Protein/metabolism , PAX3 Transcription Factor , Paired Box Transcription Factors , RNA, Messenger/metabolism , Signal Transduction , Time Factors , Transcription Factors/metabolism
17.
Can J Anaesth ; 50(9): 946-52, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14617595

ABSTRACT

PURPOSE: To compare the recovery profiles, efficacy and safety of remifentanil and morphine for transitional analgesia with fentanyl in patients undergoing elective craniotomy for supratentorial mass lesions. METHODS: Ninety-one patients were enrolled in this prospective, randomized, multicentre study. Anesthesia was induced with thiopental and remifentanil (1.0 micro g x kg(-1) bolus and a 1 micro g x kg(-1) x min(-1) infusion) or fentanyl (1 micro g x kg(-1) bolus and a 1.0 micro g x kg(-1) x min(-1) infusion). The opioid infusion continued until the level of anesthesia was deemed appropriate for intubation. Anesthesia was maintained with N(2)O/O(2), isoflurane 0.5 MAC and remifentanil 0.2 micro g x kg(-1) x min(-1) or fentanyl 0.04 micro g x kg(-1) x min(-1). At bone flap replacement, either morphine 0.08 mg x kg(-1) (remifentanil group) or saline (fentanyl group) was given. RESULTS: Systolic blood pressure was greater in those receiving fentanyl during induction (145.6 +/-17.5 mmHg vs 128.8 +/-18.3 mmHg; P = 0.006) and intubation (126.9 +/-17.1 vs 110.9 +/-16.5 mmHg; P < 0.001). Median time to tracheal extubation was similar but less variable in the remifentanil group (remifentanil = 8 min: range = 2-44 min; fentanyl = 8 min: range = 1-732 min). The fentanyl patients required a longer time to achieve the first normal neurological score (fentanyl = 38.0 min; remifentanil = 26.0 min; P = 0.035). Both the anesthesiologists and the recovery room nurses rated remifentanil better with respect to level of consciousness. Analgesics were required earlier in patients receiving remifentanil; median time 0.5 vs 1.08 hr, P < 0.001. CONCLUSIONS: Remifentanil is a suitable alternative to fentanyl in supratentorial craniotomy. Time to preoperative neurological recovery is faster and morphine provides some transitional analgesia without compromising the quality of recovery.


Subject(s)
Brain/drug effects , Craniotomy , Fentanyl/therapeutic use , Morphine/therapeutic use , Piperidines/therapeutic use , Supratentorial Neoplasms/surgery , Adult , Analgesia/methods , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Anesthesia Recovery Period , Canada , Double-Blind Method , Drug Therapy, Combination , Female , Hemodynamics/drug effects , Humans , Male , Middle Aged , Morphine/administration & dosage , Morphine/adverse effects , Piperidines/administration & dosage , Piperidines/adverse effects , Prospective Studies , Remifentanil , Treatment Outcome
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