[Impact of enhanced recovery after surgery strategy on early postoperative quality of recovery in patients undergoing laparoscopic surgery for gynecologic malignancy].

Objective: To investigate the impact of perioperative anesthesia management with enhanced recovery after surgery (ERAS) strategy on postoperative recovery in patients undergoing laparoscopic surgery for gynecologic malignancy. Methods: Ninety patients undergoing laparoscopic surgery for gynecologic malignancies from April 2018 to April 2019,aged 18-65 years,with American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, were recruited and randomly divided into two groups (n=45) using a random number table:ERAS group (group E) and control group (group C). Patients in group E received general anesthesia combined with transverses abdominis plane block and a series of interventions to optimize anesthetic and perioperative management, while patients in group C were treated with routine anesthesia management. Quality of Recovery-40 questionnaire (QoR-40) was administered to assess the early postoperative quality of recovery on 1 day before surgery, and at 24 and 48h after surgery. C-reactive protein (CRP) before and after the operation were evaluated. The incidence of nausea, vomiting and shivering, the time of first exhaust, ambulation, resumption of normal diet, postoperative hospital stay and complications were recorded. Results: The scores of QoR-40 [M(Q1, Q3)] in Group E were 175(171, 179) and 185(183, 189) at 24 h and 48 h after operation, which were higher than those in group C [162(160, 167) and 180(179, 183)] (both P<0.01). The levels of CRP in both group E and group C increased at 24 h and 72 h after operation. Moreover, the extent of increasing level of CRP in group C was much higher than that in group E [(39.8±18.0) mg/L vs (13.4±6.3) mg/L, (16.6±8.6) mg/L vs (6.7±2.5) mg/L] at 24 h and 48 h after operation (both P<0.01). Compared with group C, the numerical rating scale (NRS) for nausea decreased significantly in group E [0(0, 2) vs 3 (0, 5), P<0.01]. Meanwhile, the incidence of vomiting and shivering in group E was lower than that in group C [8.9% (4/45) vs 26.7% (12/45); 11.1% (5/45) vs 31.1% (14/45); both P<0.05]. The time of first exhaust, ambulation and resumption of normal diet in group E was (14±6) h, 6(6, 13) h and 1(1, 2) d, respectively, which was markedly shorter than that in group C [(25±10) h, 21(19, 27) h and 3(2, 3) d] (all P<0.01). Overall, the postoperative length of hospital stay reduced significantly for patients who followed the ERAS protocol [7(5, 11) d vs 10(7, 14) d, P<0.01]. The incidence of postoperative complications was 17.8% (8/45) and 37.8% (17/45) in group E and group C, respectively, with a significant difference (P<0.05). Conclusion: Implementation of ERAS anesthesia management in gynecologic oncology patients undergoing minimally invasive surgery alleviates perioperative discomfort, decreases surgical stress response, and improves the early postoperative quality of recovery.

Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study.

BACKGROUND: While oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD). METHOD: Thirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ⩾ 24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (⩾ 50% MADRS score reduction) was the primary outcome. RESULTS: By 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01-0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02-0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days-2 weeks; effect size (ES) = 1.08-1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation. CONCLUSIONS: Single-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy.

[Reduced port surgery : Developing a safe pathway to single port access surgery]. / Reduced-Port-Chirurgie : Entwicklung eines sicheren Weges zur Single-Port-Access-Chirurgie.

"Scarfree" surgery is a desired goal in the world of laparoscopy and interventional endoscopy. One possibility to achieve this goal is abdominal access via a natural orifice (natural orifice transluminal endoscopic surgery, NOTES); however, this procedure and its applications lack an appropriate platform. Further possibilities are reduced port techniques or single port access surgery, which result in minimal scarring. Development and continued growth in this area cover a broad spectrum. Although acceptance has been demonstrated, the technique must be adopted in a safe and effective manner and must be economically and ecologically safe. This article gives an overview of the development of the technique, the learning curve, and new applications for this new technique. An English full-text version of this article is available at SpringerLink as supplemental.

Association of single-nucleotide polymorphisms in FOXP3 gene with systemic lupus erythematosus susceptibility: a case-control study.

Foxp3, encoded by the human FOXP3 gene, is a transcription factor that regulates regulatory T-cell (Treg) development and function. Associations have been reported between FOXP3 gene variants and autoimmune endocrinopathy and non-endocrine autoimmune disease. The aim of this study was to investigate the possible influence of single nucleotide polymorphisms (SNP) in the FOXP3 gene on genetic predisposition to systemic lupus erythematosus (SLE). The study cohort comprised 172 SLE patients and 181 controls, who were genotyped for the FOXP3 gene variants. Of five SNPs identified, the FOXP3 -6054 ATT carrier was shown to be associated with renal disorder (odds ratio [OR] 3.26, 95% confidence interval [95% CI] 1.33-8.03, p = 0.0077). Furthermore, lower anti-dsDNA levels were found in patients with the -3279 A carrier (p = 0.0109). To the authors' knowledge, this is the first study to investigate the association of FOXP3 SNPs with susceptibility to SLE, as well as sub-phenotype susceptibility. Although the exact role of Foxp3 and FOXP3 gene variations in SLE is still not clear, the present data support the importance of variations in the FOXP3 gene region for the etiology of certain manifestations of SLE.

Acrylic acid removal from synthetic wastewater and industrial wastewater using Ralstonia solanacearum and Acidovorax avenae isolated from a wastewater treatment system manufactured with polyacrylonitrile fiber.

Ralstonia solanacearum and Acidovorax avenae were isolated from a wastewater treatment system manufactured with polyacrylonitrile fiber. The investigation goal is to elucidate the effectiveness of Ralstonia solanacearum and Acidovorax avenae in treating acrylic acid from synthetic wastewater and industrial wastewater. The results reveal that Ralstonia solanacearum and Acidovorax avenae could utilize acrylic acid from synthetic wastewater for growth, when the initial acrylic acid concentration was below 1,009.1 mg/l and 1,383.4 mg/l, respectively. When the acrylic acid concentration was below 606.8 mg/l, the acrylic acid removal ability reached 96.7% and 100%, respectively. Both strains could tolerate acrylamide toxicity, but only Ralstonia solanacearum could tolerate acrylonitrile toxicity. Ralstonia solanacearum and Acidovorax avenae could utilize acrylic acid from industrial wastewater for growth, when the initial acrylic acid concentration was below 1,741.1 mg/l and 1,431.2 mg/l, respectively. When the acrylic acid concentration was below 690.8 mg/l, the acrylic acid removal efficiency reached 83.5% and 62.2%, respectively. Whether the acrylic acid existed in synthetic wastewater or in industrial wastewater, the removal efficiency of acrylic acid by Ralstonia solanacearum exceeded that by Acidovorax avena.

The incidence of intra-operative awareness during general anesthesia in China: a multi-center observational study.

BACKGROUND: The incidence of awareness in patients undergoing general anesthesia is 0.1-0.2% in Western countries. The medical literatures about awareness during general anesthesia are still rare in China, but some previous studies have reported a higher incidence (1.4-6%) of intra-operative awareness. To find out the reason why the incidence reported in China is much higher than that in Western countries, we performed a prospective, multicenter, non-randomized observational study to determine the true incidence of intra-operative awareness in China. METHODS: This is a prospective, non-randomized descriptive cohort study that was conducted at 25 academic medical centers in China. Eleven thousand one hundred and eighty-five patients were interviewed by research staff for evaluation of awareness at the first and fourth day after general anesthesia with muscle relaxation. An independent blinded committee evaluated the responses and determined whether awareness occurred. Necessary data were collected for a binary logistic regression analysis. RESULTS: Data from 11,101 patients were presented. Forty-six cases (0.41%) were reported as definite awareness and 47 additional cases (0.41%) as possible awareness. Three hundred and fifty-five patients (3.19%) had dreams during general anesthesia. Awareness was associated with increased American Society of Anesthesiologists (ASA) physical status, a previous anesthesia, and anesthesia methods of total intravenous anesthesia. CONCLUSION: The incidence of intra-operative awareness in China is approximately 0.41%, two to three times higher than that widely cited in Western countries. Inappropriately light anesthesia, and the population proportion of surgery and general anesthesia in China may account for the difference. (ClinicalTrials.gov Identifier, NCT00693875.).

Putting more genetics into genetic algorithms.

The majority of current genetic algorithms (GAs), while inspired by natural evolutionary systems, are seldom viewed as biologically plausible models. This is not a criticism of GAs, but rather a reflection of choices made regarding the level of abstraction at which biological mechanisms are modeled, and a reflection of the more engineering-oriented goals of the evolutionary computation community. Understanding better and reducing this gap between GAs and genetics has been a central issue in an interdisciplinary project whose goal is to build GA-based computational models of viral evolution. The result is a system called Virtual Virus (VIV). VIV incorporates a number of more biologically plausible mechanisms, including a more flexible genotype-to-phenotype mapping. In VIV the genes are independent of position, and genomes can vary in length and may contain noncoding regions, as well as duplicative or competing genes. Initial computational studies with VIV have already revealed several emergent phenomena of both biological and computational interest. In the absence of any penalty based on genome length, VIV develops individuals with long genomes and also performs more poorly (from a problem-solving viewpoint) than when a length penalty is used. With a fixed linear length penalty, genome length tends to increase dramatically in the early phases of evolution and then decrease to a level based on the mutation rate. The plateau genome length (i.e., the average length of individuals in the final population) generally increases in response to an increase in the base mutation rate. When VIV converges, there tend to be many copies of good alternative genes within the individuals. We observed many instances of switching between active and inactive genes during the entire evolutionary process. These observations support the conclusion that noncoding regions serve as scratch space in which VIV can explore alternative gene values. These results represent a positive step in understanding how GAs might exploit more of the power and flexibility of biological evolution while simultaneously providing better tools for understanding evolving biological systems.

Neuronal intestinal dysplasia presenting as an abdominal mass: report of a case.

An unusual clinical presentation of a patient with neuronal intestinal dysplasia is presented. A 46-year-old male noted a palpable mass in the right lower quadrant of his abdomen for two months. A computed axial tomographic scan showed a thickened wall of the cecum with a tumor-like appearance. The excised specimen consisted of a mass caused by the thickened, edematous wall of the dilated cecum and appendix. The wall of the cecum and appendix measured up to 2.5 and 0.8 cm, respectively, in thickness. Microscopic studies showed extensive hyperplasia and hypertrophy of the ganglia and nerve plexuses and hypertrophy of the muscularis propria, consistent with neuronal intestinal dysplasia.

The oral health status and treatment needs of adults aged 65+ living independently in Ottawa-Carleton.

We report the findings from a dental survey of a random sample of 299 senior citizens living in Ottawa-Carleton. Those examined were younger, less likely to have a regular dentist, and more likely to have oro-facial pain, difficulty chewing, and to perceive a need to visit a dentist compared with those responding to the enrollment phone interview. Among the 65% of seniors who were dentate, 37% had dental decay; men and seniors with low incomes had more decay (p less than 0.05). Periodontal disease was worse among older seniors, men and poor seniors (p less than 0.05). One third of all seniors reported recent oro-facial pain, 50% had difficulty chewing foods and 30% reported some social impact resulting from their oral health. The resources required to treat the prevalent disorders were considerable and differences between dentate and edentulous people were negligible. Senior citizens expressed attitudes which indicate that they value dental health and would like help to achieve it.

Interactive effects of organic and inorganic selenium with cadmium and mercury on spermatozoal oxygen consumption and motility in vitro.

The effects of cadmium (Cd), mercury (Hg), and three different chemical forms of selenium (Se) (selenite, selenocystine, and selenomethionine) on ram spermatozoal motility and oxygen consumption in vitro were studied over a 4-mo period. Concentrations of 10(-6) to 10(-2) M Cd and Hg were injurious to spermatozoa as indicated by depressed motility and reduced oxygen uptake. Equimolar concentrations of Se as selenite, selenocystine, or selenomethionine counteracted the toxicity of Cd and Hg at low concentrations (10(-5) and 10(-6) M) but not at higher concentrations (10(-4) to 10(-2) M). Gel filtration (Sephadex G-75) of seminal plasma and solubilized sperm prepared from semen incubated with Cd or Hg with or without the Se compounds revealed that Cd or Hg eluted with the void volume proteins in all treatments. Incubation of ram spermatozoa with any of the three chemical forms of Se ranging from 10(-6) to 2.5 X 10(-5) M significantly improved sperm motility and oxygen consumption.

Incorporation of selenium-75 into semen and reproductive tissues of bulls and rams.

After intramuscular injections of 500 muCi 75Se, semen was collected periodically over a 63-day period from a selenium-deficient and a selenium-injected ram which were then killed for collection of the reproductive organs for the gel filtration studies. Testes, accessory glands and semen were also obtained from a bull injected intravenously with 75Se. Gel filtration (Sephadex G 150) of ram testis cytosol resulted in 4 75Se peaks (Ve/Vo ratios of 1 X 1, 1 X 5, 2 X 3, 2 X 9). In the selenium-injected ram the glutathione peroxidase (GSH-Px) peak (Ve/Vo 1 X 5) predominated, but in the selenium-deficient ram, radioactivity of the GSH-Px peak was less than that of the higher molecular weight peak (Ve/Vo 1 X 1). Gel filtration chromatograms of bull testis cytosol yielded 5 75Se peaks (Ve/Vo 1 X 1, 1 X 5, 1 X 9, 2 X 4, 2 X 8). In chromatograms of ram seminal plasma on Sephacryl S-200 there were 2 major (Ve/Vo 1 X 4, 1 X 1) and 2 minor peaks (Ve/Vo 1 X 7, 2 X 4). 75Se increased with time up to 49 days after injection in all peaks. 75Se-labelled bull seminal plasma yielded 2 75Se peaks (Ve/Vo 1 X 1, 1 X 4) which corresponded to the major peaks of ram seminal plasma. Bull and ram seminal plasma GSH-Px activities per mg protein were comparable (28 and 29 nmol NADPHox/min, respectively), but when expressed per ml seminal plasma, activity of the bull was more than 7 times the highest activity of ram seminal plasma (2908 and 385 nmol NADPHox/min, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Fine structural abnormalities of spermatozoa from a subfertile bull: a case report.

Spermatozoa from a nine-year-old subfertile Holstein bull were evaluated by light and electron microscopy. Morphological abnormalities observed included cytoplasmic droplet-like structures, constriction of the midpiece, missing axial filaments and abnormal spermatozoal head shapes.