Nitric oxide and tumor necrosis factor-⍺ levels are negatively correlated in endotoxin tolerance recovery in vitro.

Endotoxin tolerance (ET) is the hyporesponsiveness to lipopolysaccharide (LPS) after prior exposure. It is characterized by the downregulation of pro-inflammatory cytokine levels. Although ET protects against inflammation, its abolishment or recovery is critical for immunity. Nitric oxide (NO) plays various roles in the development of ET; however, its specific role in ET recovery remains unknown. To induce ET, RAW264.7 cells (a murine macrophage cell line) were pre-exposed to LPS (LPS1, 100 ng/mL for 24 h) and subsequently re-stimulated with LPS (LPS2, 100 ng/mL for 24 h). Expression of cytokines, NO, nitrite and inducible NO synthase (iNOS) were measured after 0, 12, 24, and 36 h of resting after LPS1 treatment with or without the iNOS-specific inhibitor, 1400W. LPS2-induced tumor necrosis factor-⍺ (TNF-⍺) and interleukin-6 (IL-6) were downregulated after LPS1 treatment, confirming the development of ET. Notably, TNF-⍺ and IL-6 levels spontaneously rebounded after 12-24 h of resting following LPS1 treatment. In contrast, levles of NO, nitrite and iNOS increased during ET development and decreased during ET recovery. Moreover, 1400W inhibited ET development and blocked the early production of NO (<12 h) during ET recovery. Our findings suggest a negative correlation between iNOS-induced NO and cytokine levels in the abolishment of ET.

Angelica dahurica and Rheum officinale Facilitated Diabetic Wound Healing by Elevating Vascular Endothelial Growth Factor.

Traditional Chinese medicine (TCM) provides alternative treatment choices for diabetic wounds. The aim of this study was to evaluate the effects of Angelica dahurica and Rheum officinale (ARE) on diabetic wounds and its underlying action mechanism. A total of 36 healthy male Sprague-Dawley rats were randomly divided into three groups: diabetes mellitus (DM) rats treated with ARE (DM-ARE), DM rats treated with 0.9% saline (DM-NS), and non-DM rats treated with 0.9% saline (NDM-NS). DM was induced by intraperitoneal administration of 40 mg/kg of streptozotocin after a 2-week high-fat diet feeding. After excisional skin wounds and treatments, the remaining wound area (RWA) in each group was measured. The RWA in the DM-NS group (69.60% ± 2.35%) was greater than that in the DM-ARE (55.70% ± 1.85%) and NDM-NS groups (52.50% ± 2.77%) on day 6. Besides, the DM-ARE group showed higher vascular endothelial growth factor (VEGF), higher inducible nitric oxide synthase (iNOs), higher [Formula: see text]-smooth muscle actin ([Formula: see text]-SMA), and lower nuclear factor kappa-light-chain-enhancer of activated B cell (NF-[Formula: see text]B) expression in the wound skin tissue. These results showed that treatment with ARE shifted the recovery pattern of diabetic rats to the pattern of nondiabetic rats, indicating that ARE may improve wound healing in diabetic conditions.

The effectiveness of valerian acupressure on the sleep of ICU patients: a randomized clinical trial.

BACKGROUND: Severely ill patients often experience problems with sleep. Either acupressure or valerian aromatherapy are reported as helpful in promoting sleep. OBJECTIVES: The purpose of this study was to explore the effectiveness of valerian acupressure on the sleep of patients in the intensive care unit (ICU). DESIGN: A randomized clinical trial. SETTING: A 42-bed adult intensive care unit. PARTICIPANTS: Forty-one subjects in the experimental group and 44 subjects in the control group. METHODS: The measurement included observation, and actigraphy measures during 10 pm-6 am, and the Stanford Sleepiness Scale (SSS) measures on the next morning. Experimental groups received valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints between 7 pm and 10 pm of the second day while control groups received regular treatment. Heart rate was measured for 5 min before and after valerian acupressure present for HR variability analysis to measure relaxation response. RESULTS: The results indicated that after receiving valerian acupressure, patients' sleeping hours increased, wake frequency reduced and SSS grades declined. The HR variability data indicated relaxation response immediately after valerian acupressure. CONCLUSION: This study supports the hypothesis that valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of ICU patients.

Effectiveness of different music-playing devices for reducing preoperative anxiety: a clinical control study.

BACKGROUND: While waiting for surgery, patients often exhibit fear and anxiety. Music is thought to be an alternative to medication to relieve anxiety. However, due to concerns about infection control, devices other than headphones may be considered for this purpose. OBJECTIVES: The purpose of this study was to determine the anxiety-relieving effect of broadcast versus headphone music playing for patients awaiting surgery. DESIGN: A randomized controlled clinical study. SETTING: The waiting area of an operating theater of a metropolitan teach hospital in Taiwan. PARTICIPANTS: Alert adult with age between 20 and 65 years old waiting for surgery without premedications. METHODS: A total of 167 patients were randomly assigned to the headphone, broadcast and control groups. Both the headphone and the broadcast groups were provided with the same instrumental music, while the control group did not listen to any music. The tools for measuring anxiety were visual analogue scale (VAS) ranging from "not anxious at all" to "extremely anxious" and heart rate variability (HRV). RESULTS: The VAS score exhibited a significant decrease for both the headphone and broadcast groups. The low frequency and low-to-high frequency LF/HF ratio of the broadcast and headphone groups were significantly lower than those of the control group. None of the heart rate variables showed significant differences between the broadcast group and the headphone group. CONCLUSION: Both headphone and broadcast music are effective for reducing the preoperative patient's anxiety in the waiting room. RELEVANCE TO CLINICAL PRACTICE: In order to take infection control into account, broadcast speakers can substitute for headphones for playing music to lower the anxiety level of patients waiting for surgery.

Persistent systemic air embolism and delayed pulmonary hemorrhage after weaning from cardiopulmonary bypass--a case report.

Systemic air embolism (SAE) occurring during cardiac surgery is usually associated with high morbidity and mortality. We present a fatal case of persistent SAE identified by transesophageal echocardiography (TEE) after weaning from cardiopulmonary bypass (CPB). Perplexities in identification of a bronchovascular fistula and hesitation in aggressive management to arrest the resultant continuous air entry into systemic circulation caused death as an aftermath. Related instances in literature have been reviewed and appropriate managements are herein discussed.

Urinary catheterization may not be necessary in minor surgery under spinal anesthesia with long-acting local anesthetics.

BACKGROUND: This prospective study was designed to compare the incidence of urinary retention after spinal anesthesia between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in patients who underwent minor orthopedic and general surgeries. METHODS: Eighty patients aged 18-40 were randomly assigned to receive either hyperbaric bupivacaine or tetracaine for spinal anesthesia. Intravenous fluids were administered for maintenance of basal requirement, replacement of blood loss and prevention of hypotension. The highest level of analgesia, regression time of sensory block to L5 level, length of time from spinal injection to spontaneous urinary voidance, and volume of perioperative fluid administered were recorded. RESULTS: Of the 80 patients who received either hernioplasty, fistulectomy, hemorroidectomy or orthopedic surgery, two were catheterized (2.5%) because of urinary retention. They were administered less than 800 mL of fluid intraoperatively. Intraoperative blood loss was less than 100 mL in all cases. There were no statistical differences in demographic data, types of surgery, sensory blockade and perioperative fluid administration between the two groups. Although the regression time of sensory blockade with tetracaine (means +/- SD, 259.3 +/- 39.6 min) was significantly longer than that of bupivacaine (225.0 +/- 38.6 min, P < 0.01), the time elapsing from the spinal injection to the first spontaneously voiding after surgery did not show statistical difference between two groups (433.9 +/- 89.1 vs. 411.0 +/- 98.3 min, P = 0.286). CONCLUSIONS: Our results show that, in younger surgical patients who did not receive large amount of fluid intraoperatively, the incidence of urinary retention was low, although prolonged sensory blockade by both long-acting local anesthetics was evident. Thus, urinary catheterization should not be a routine must for every patient undergoing minor surgery with long-acting spinal local anesthetics. From the viewpoint of financial expense, avoidance of complication and annoyance of urinary catheterization, careful observation of urinary bladder fullness in the form of lower abdominal distension, discomfort, bradycardia, or vomiting after surgery is superior to routine retention urinary catheterization just for ease with work in younger patients under-going minor surgery under long-acting spinal local anesthetics.