The Influence of the Severity of Chronic Virus-Related Liver Disease on Propofol Requirements during Propofol-Remifentanil Anesthesia

Purpose

The purpose of this study was to investigate the influence of chronic virus-related liver disease severity on propofol requirements.

Materials and Methods

In this study, 48 male patients with chronic hepatitis B infection were divided into three groups according to Child-Turcotte-Pugh classification of liver function (groups A, B, and C with mild, moderate and severe liver disease, respectively). After intubation, propofol concentration was adjusted by ±0.3 µg/mL increments to maintain bispectral index in the range of 40-60. Target propofol concentrations at anesthesia initiation, pre-intubation and pre-incision were recorded.

Results

The initial concentration used in group C was significantly lower than that used in group A or B (p<0.05), whereas no difference was observed between groups A and B. At pre-intubation, the actual required concentration of propofol increased significantly (3.2 µg/mL) in group A (p<0.05), which lead to significant differences between the groups (p<0.05). At pre-incision, the requirements for propofol decreased significantly in both groups A and B (3.0 µg/mL and 2.7 µg/mL, respectively) compared with those at pre-intubation (p<0.05), and were significantly different for all three groups (p<0.05), with group C demonstrating the lowest requirement (2.2 µg/mL). The required concentrations of propofol at pre-incision were similar to those at induction.

Conclusion

In this study, propofol requirements administered by target-controlled infusion to maintain similar depths of hypnosis were shown to depend on the severity of chronic virus-related liver dysfunction. In other words, patients with the most severe liver dysfunction required the least amount of propofol.     

Lipid-emulsion propofol less attenuates the regulation of body temperature than micro-emulsion propofol or sevoflurane in the elderly

Purpose

Anesthesia and surgery commonly cause hypothermia, and this caused by a combination of anesthetic-induced impairment of thermoregulatory control, a cold operation room environment and other factors that promote heat loss. All the general anesthetics markedly impair normal autonomic thermoregulatory control. The aim of this study is to evaluate the effect of two different types of propofol versus inhalation anesthetic on the body temperature.

Materials and Methods

In this randomized controlled study, 36 patients scheduled for elective laparoscopic gastrectomy were allocated into three groups; group S (sevoflurane, n=12), group L (lipid-emulsion propofol, n=12) and group M (micro-emulsion propofol, n=12). Anesthesia was maintained with typical doses of the study drugs and all the groups received continuous remifentanil infusion. The body temperature was continuously monitored after the induction of general anesthesia until the end of surgery.

Results

The body temperature was decreased in all the groups. The temperature gradient of each group (group S, group L and group M) at 180 minutes from induction of anesthesia was 2.5±0.6℃, 1.6±0.5℃ and 2.3±0.6℃, respectively. The body temperature of group L was significantly higher than that of group S and group M at 30 minutes and 75 minute after induction of anesthesia, respectively. There were no temperature differences between group S and group M.

Conclusion

The body temperature is maintained at a higher level in elderly patients anesthetized with lipid-emulsion propofol.     

Propofol pretreatment attenuates lipopolysaccharide-induced acute lung injury in rats by activating the phosphoinositide-3-kinase/Akt pathway

The aim of this study was to investigate the effect of propofol pretreatment on lipopolysaccharide (LPS)-induced acute lung injury (ALI) and the role of the phosphoinositide-3-kinase/protein kinase B (PI3K/Akt) pathway in this procedure. Survival was determined 48 h after LPS injection. At 1 h after LPS challenge, the lung wet- to dry-weight ratio was examined, and concentrations of protein, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF) were determined using the bicinchoninic acid method or ELISA. Lung injury was assayed via lung histological examination. PI3K and p-Akt expression levels in the lung tissue were determined by Western blotting. Propofol pretreatment prolonged survival, decreased the concentrations of protein, TNF-α, and IL-6 in BALF, attenuated ALI, and increased PI3K and p-Akt expression in the lung tissue of LPS-challenged rats, whereas treatment with wortmannin, a PI3K/Akt pathway specific inhibitor, blunted this effect. Our study indicates that propofol pretreatment attenuated LPS-induced ALI, partly by activation of the PI3K/Akt pathway.     

Classification of adhesive domains in the Plasmodium falciparum erythrocyte membrane protein 1 family

The Plasmodium falciparum Erythrocyte Membrane Protein 1 (PfEMP1) family of cytoadherent proteins has a central role in disease from malaria infection. This highly diverse gene family is involved in binding interactions between infected erythrocytes and host cells and is expressed in a clonally variant pattern at the erythrocyte surface. We describe by sequence analysis the structure and domain organization of 20 PfEMP1 from the GenBank database. Four domains comprise the majority of PfEMP1 extracellular sequence: the N-terminal segment (NTS) located at the amino terminus of all PfEMP1, the C2, the Cysteine-rich Interdomain Region (CIDR) and the Duffy Binding-like (DBL) domains. Previous work has shown that CIDR and DBL domains can possess adhesive properties. CIDR domains grouped as three distinct sequence classes (, β, and γ) and DBL domains as five sequence classes (, β, γ, δ, and ). Consensus motifs are described for the different DBL and CIDR types. Whereas the number of DBL and CIDR domains vary between PfEMP1, PfEMP1 domain architecture is not random in that certain tandem domain associations — such as DBLCIDR, DBLδCIDRβ, and DBLβC2 — are preferentially observed. This conservation may have functional significance for PfEMP1 folding, transport, or binding activity. Parasite binding phenotype appears to be a determinant of infected erythrocyte tissue tropism that contributes to parasite survival, transmission, and disease outcome. The sequence classification of DBL and CIDR types may have predictive value for identifying PfEMP1 domains with a particular binding property. This information might be used to develop interventions targeting parasite binding variants that cause disease.     

ATZ (3-amino-1,2,4-triazole) injected into the fourth cerebral ventricle influences the Bezold-Jarisch reflex in conscious rats

OBJECTIVES:

Many studies have investigated the importance of oxidative stress on the cardiovascular system. In this study we evaluated the effects of central catalase inhibition on cardiopulmonary reflex in conscious Wistar rats.

METHODS:

Male Wistar rats were implanted with a stainless steel guide cannula in the fourth cerebral ventricle. The femoral artery and vein were cannulated for mean arterial pressure and heart rate measurement and for drug infusion, respectively. After basal mean arterial pressure and heart rate recordings, the cardiopulmonary reflex was tested with a dose of phenylbiguanide (PBG, 8 µg/kg, bolus). Cardiopulmonary reflex was evaluated before and µl15 minutes after 1.0 µL 3‐amino‐1,2,4‐triazole (ATZ, 0.01g/100µL)0.01 g/100 µL) injection into the fourth cerebral ventricle. Vehicle treatment did not change cardiopulmonary reflex responses.

RESULTS:

Central ATZ significantly increased hypotensive responses without influencing the bradycardic reflex.

CONCLUSION:

ATZ injected into the fourth cerebral ventricle increases sympathetic inhibition but does not change the parasympathetic component of the cardiopulmonary reflex in conscious Wistar rats.     

The pattern of the coronary arterial orifices in hearts with congenital malformations of the outflow tracts: a marker of rotation of the outflow tract during cardiac development?

Outflow tract defects, including cardiac neural crest defects (so-called conotruncal defects) and transposition of the great arteries, are due to an abnormal rotation of the outflow tract during cardiac development. Coronary orifices are often abnormal in outflow tract defects, particularly in common arterial trunk (CAT). A recent study indicates that abnormal coronary artery pattern in a mouse model with common arterial outlet (Tbx1−/− mouse mutant) could be due to a reduced and malpositioned subpulmonary coronary-refractory myocardial domain. The aim of our study was to demonstrate the relation between coronary orifices pattern in outflow tract defects in human and the abnormal embryonic rotation of the outflow tract. We analyzed 101 heart specimens with outflow tract defects: 46 CAT, 15 tetralogy of Fallot (TOF), 29 TOF with pulmonary atresia (TOF-PA), 11 double-outlet right ventricle with subaortic ventricular septal defect (DORV) and 17 controls. The position of left and right coronary orifices (LCO, RCO) was measured in degrees on the aortic/truncal circumference. The anterior angle between LCO and RCO (α) was calculated. The LCO was more posterior in TOF (31 °), TOF-PA (47 °), DORV (44 °), CAT (63 °), compared with controls (0 °, P < 0.05), and more posterior in CAT than in other outflow tract defects (P < 0.05). The RCO was more anterior in TOF (242 °), TOF-PA (245 °) and DORV (271 °) than in controls (213 °, P < 0.05), but not in CAT (195 °). The α angle was similar in TOF, TOF-PA, DORV and controls (149 °, 162 °, 133 °, 147 °), but significantly larger in CAT (229 °, P < 0.0001). In all outflow tract defects but CAT, the displacement of LCO (anterior) and RCO (posterior), while the α angle remains constant, might be due to incomplete rotation of the myocardium at the base of the outflow tract, leading to an abnormally positioned subpulmonary coronary-refractory myocardial domain. The larger α angle in CAT could reflect its dual identity, aortic and pulmonary.     

In vitro antifungal activity of epigallocatechin 3-O-gallate against clinical isolates of dermatophytes

Previously, we reported that epigallocatechin 3-O-gallate (EGCg) has growth-inhibitory effect on clinical isolates of Candida species. In this study, we investigated the antifungal activity of EGCg and antifungal agents against thirty-five of dermatophytes clinically isolated by the international guidelines (M38-A2). All isolates exhibited good susceptibility to EGCg (MIC₅₀, 2-4 µg/mL, MIC₉₀, 4-8 µg/mL, and geometric mean (GM) MICs, 3.36-4 µg/mL) than those of fluconazole (MIC₅₀, 2-16 µg/mL, MIC₉₀, 4-32 µg/mL, and GM MICs, 3.45-25.8 µg/mL) and flucytosin (MIC₅₀, MIC₉₀, and GM MICs, >64 µg/mL), although they were less susceptible to other antifungal agents, such as amphotericin B, itraconazole, and miconazole. These activities of EGCg were approximately 4-fold higher than those of fluconazole, and were 4 to 16-fold higher than flucytosin. This result indicates that EGCg can inhibit pathogenic dermatophyte species. Therefore, we suggest that EGCg may be effectively used solely as a possible agent or combined with other antifungal agents for antifungal therapy in dermatophytosis.     

The efficacy of the crude root bark extracts of Erythrina abyssinica on rifampicin resistant Mycobacterium tuberculosis

Introduction

Tuberculosis (TB) is one of the leading causes of morbidity and mortality with a global mortality rate at two million deaths per year while one third of the world''s population is infected with the TB bacillus.

Ojective

To determine the efficacy of the crude extracts of Erythrina abyssinica root bark on rifampicin-resistant TB.

Methods

Crude extracts of root bark of Erythrina abyssinica, were screened against three strains of Mycobacterium tuberculosis including rifampicin-resistant TMC-331. Susceptibility tests used the disc diffusion method and were done on solid Middle brook 7H10, while the Minimum Inhibitory concentration (MICs) and minimum bactericidal concentration (MBCs) were determined by the Microtitre plate method using Middle brook 7H9 broth.

Results

The total crude methanol extract showed activity against all the three strains of mycobacterium used, at 50mg/ml and diameters of zones of inhibition of up to 26 mm. Erythrina abyssinica total crude methanol extract showed the highest activity on the pan sensitive strain H37Rv (0.39±0.0 mg/ml) and the rifampicin resistant strain (TMC-331) (2.35±1.11 mg/ ml) and was also active on Mycobacterium avium (0.39±0.mg/ml. The values for isoniazid were 0.25µg/ml and 9.38µg/ml for H37Rv and TMC-331 respectively, while for rifampicin the MIC value was 0.25µg/ml for H37Rv but it was not active on TMC-331. Acute toxicity test gave an LD50 of 776.2mg/kg body weight while the phytochemical analysis showed the presence of alkaloids, tannins and flavones.

Conclusion

The conclusion from the study was that Erythrina abbyssinica has antimycobacterial activity and reasonable safety that merits further research.     

Influence of asymptomatic pneumonia on the response to hemorrhage and resuscitation in swine

INTRODUCTION:

Investigation of resuscitation fluids in our swine hemorrhage model revealed moderate to severe chronic pneumonia in five swine at necropsy. Our veterinary staff suggested that we perform a retrospective analysis of prospectively collected data from these animals. We compared the data to that of ten healthy swine to determine the physiologic consequences of the added stress on our hemorrhage/resuscitation model.

METHODS:

Anesthetized, immature female swine (40 ± 5 kg) were instrumented for determining arterial and venous pressures, cardiac output and urine production. A controlled hemorrhage of 20 ml/kg over 4 min 40 sec was followed at 30 min by a second hemorrhage of 8 ml/kg and resuscitation with 1.5 ml/kg/min of LR solutions to achieve and maintain systolic blood pressure at 80 ± 5 mmHg for 3.5 hrs. Chemistries and arterial and venous blood gasses were determined from periodic blood samples along with hemodynamic variables.

RESULTS:

There were significant decreases in survival, urine output, cardiac output and oxygen delivery at 60 min and O₂ consumption at 120 min in the pneumonia group compared to the non‐pneumonia group. There were no differences in other metabolic or hemodynamic data between the groups.

CONCLUSION:

Although pneumonia had little influence on pulmonary gas exchange, it influenced cardiac output, urine output and survival compared to healthy swine, suggesting a decrease in the physiologic reserve. These data may be relevant to patients with subclinical infection who are stressed by hemorrhage and may explain in part why some similarly injured patients require more resuscitation efforts than others.     

Simvastatin-induced cardiac autonomic control improvement in fructose-fed female rats

OBJECTIVE:

Because autonomic dysfunction has been found to lead to cardiometabolic disorders and because studies have reported that simvastatin treatment has neuroprotective effects, the objective of the present study was to investigate the effects of simvastatin treatment on cardiovascular and autonomic changes in fructose-fed female rats.

METHODS:

Female Wistar rats were divided into three groups: controls (n = 8), fructose (n = 8), and fructose+simvastatin (n = 8). Fructose overload was induced by supplementing the drinking water with fructose (100 mg/L, 18 wks). Simvastatin treatment (5 mg/kg/day for 2 wks) was performed by gavage. The arterial pressure was recorded using a data acquisition system. Autonomic control was evaluated by pharmacological blockade.

RESULTS:

Fructose overload induced an increase in the fasting blood glucose and triglyceride levels and insulin resistance. The constant rate of glucose disappearance during the insulin intolerance test was reduced in the fructose group (3.4±0.32%/min) relative to that in the control group (4.4±0.29%/min). Fructose+simvastatin rats exhibited increased insulin sensitivity (5.4±0.66%/min). The fructose and fructose+simvastatin groups demonstrated an increase in the mean arterial pressure compared with controls rats (fructose: 124±2 mmHg and fructose+simvastatin: 126±3 mmHg vs. controls: 112±2 mmHg). The sympathetic effect was enhanced in the fructose group (73±7 bpm) compared with that in the control (48±7 bpm) and fructose+simvastatin groups (31±8 bpm). The vagal effect was increased in fructose+simvastatin animals (84±7 bpm) compared with that in control (49±9 bpm) and fructose animals (46±5 bpm).

CONCLUSION:

Simvastatin treatment improved insulin sensitivity and cardiac autonomic control in an experimental model of metabolic syndrome in female rats. These effects were independent of the improvements in the classical plasma lipid profile and of reductions in arterial pressure. These results support the hypothesis that statins reduce the cardiometabolic risk in females with metabolic syndrome.     

Rheumatoid factors reacting with autologous native gamma-G-globulin and joint fluid gamma-G aggregates

Inflammatory joint fluids from patients with definite or classical rheumatoid arthritis (RA), selected because they precipitated strongly with rheumatoid factors (RF), were examined by sucrose density gradient ultracentrifugation for sedimentation of γG-globulin (γG) and behaviour of RF activity. All contained some γG that sedimented to the γM globulin (γM) zone at pH 7·4; at pH 3·6, γG disappeared from the γM zone. With four joint fluids, no RF activity was detected by cells sensitized with anti-CD Ripley at pH 7·4, but RF activity appeared in the γM zone at pH 3·6. This demonstration of inhibition of RF activity by autologous γG aggregates depended upon the relative amount of RF and γG aggregates in the joint fluid. Two joint fluids which contained γG aggregates and high titre RF activity precipitated with γM RF isolated in high concentration from the corresponding sera.In sera, RF activity often sedimented faster at pH 7·4 than at pH 3·6, and inhibitors of RF activity against red cells sensitized with various anti-D sera were found in the macroglobulin zone at pH 7·4. These inhibitors were characterized as γG. When aggregate-free ¹²⁵I-labelled pooled human γG was mixed with isolated γM RF, 7% of the radioactivity sedimented with RF activity by zone ultracentrifugation at pH 8·0; when mixed with a Waldenström type γM globulin (γM), only 0·2% of the radioactivity was found in the γM zone. Radioimmunoelectrophoresis incidated that ¹²⁵I-labelled γG was still bound to γM RF following electrophoresis. These results suggest that native γG is firmly bound to a fraction of RF in some sera. The relationship between these complexes and the 22S complexes of certain rheumatoid sera is discussed.     

IL-1beta induces and TGF-beta reduces vitamin D3-induced bone resorption in mouse calvarial bone cells

Bone cells produce multiple growth factors and cytokines that have effects on bone metabolism and can be incorporated into the bone matrix. The present study was designed to extend these observations by examining the interactions between transforming growth factor-β (TGF-β) or interleukin-1β (IL-1β) and bone cells in a rat long bone culture model. IL-1β regulates several activities of the osteoblast cells derived from rat long bone explants in vitro. IL-1β stimulated cellular proliferation and the synthesis of prostaglandin E₂ and plasminogen activator activity in the cultured cells in a dose-dependent manner. TGF-β is present in the bone matrix and potentially can be released during bone resorption. TGF-β reduced basal bone resorption and inhibited vitamin D₃ [1,25(OH)₂D₃]-induced bone resorption in rat long bone cells. These studies support the role of IL-1β in the pathological modulation of bone cell metabolism, with regard to implication in the pathogenesis of osteoporosis by IL-1β, and that TGF-β is positively inhibiting the bone resorption.     

Studies of reversed anaphylaxis in the perfused guinea-pig lung

Histamine release was produced in the isolated perfused guinea-pig lung by injecting the pulmonary artery with rabbit antiserum to guinea-pig γ-globulin. The activity of the antiserum was absorbed by electrophoretically fast migrating guinea-pig γ-globulin but not by slow γ-globulin. Histamine release was enhanced by maleate or succinate and was inhibited by 20°, 45°, phenol, iodoacetate, N-ethylmaleimide, adrenaline, theophylline or deprivation of calcium. There was no apparent dependence on complement. These characteristics were the same as those of histamine release activated by antigen in guinea-pig lung sensitized with antibody. Therefore, the term reversed anaphylaxis was considered applicable to this reaction.     

近似熵在脑电监测麻醉深度中的应用

目的:探究脑电近似熵在麻醉深度监测中的应用。 方法:以2017年1月~2018年1月择期行全麻手术的80例患者为研究对象,测定所有患者麻醉前、麻醉诱导5 min、术中60 min、麻醉苏醒时脑电双频指数（BIS）、脑电近似熵,且观察不同丙泊酚血浆浓度、改良镇静/警觉评分（MOAA/S）BIS值、脑电近似熵值的变化情况,Pearson相关性分析BIS、脑电近似熵值与丙泊酚血浆浓度的相关性。 结果:麻醉诱导5 min、术中60 min BIS值、脑电近似熵值比麻醉前均显著降低（P<0.05）,且术中60 min的值显著低于麻醉诱导5 min时的值（P<0.05）;BIS值、脑电近似熵值随丙泊酚血浆浓度上升而下降,均呈显著负相关（P<0.05）;脑电近似熵在MOAA/S评分0~1分变化中有显著差异（P<0.05）,而BIS值无显著差异（P>0.05）。 结论:脑电近似熵对丙泊酚药效变化评价效果与BIS相当,但其相对在麻醉镇静深度判断上有优势。     

Effects of Different Peep Levels on Mesenteric Leukocyte-Endothelial Interactions in Rats During Mechanical Ventilation

INTRODUCTION:

Mechanical ventilation with positive end expiratory pressure (PEEP) improves oxygenation and treats acute pulmonary failure. However, increased intrathoracic pressure may cause regional blood flow alterations that may contribute to mesenteric ischemia and gastrointestinal failure. We investigated the effects of different PEEP levels on mesenteric leukocyte-endothelial interactions.

METHODS:

Forty-four male Wistar rats were initially anesthetized (Pentobarbital I.P. 50mg/kg) and randomly assigned to one of the following groups: 1) NAIVE (only anesthesia; n=9), 2) PEEP 0 (PEEP of 0 cmH₂O, n=13), 3) PEEP 5 (PEEP of 5 cmH₂O, n=12), and 4) PEEP 10 (PEEP of 10 cmH₂O, n=13). Positive end expiratory pressure groups were tracheostomized and mechanically ventilated with a tidal volume of 10 mL/kg, respiratory rate of 70 rpm, and inspired oxygen fraction of 1. Animals were maintained under isoflurane anesthesia. After two hours, laparotomy was performed, and leukocyte-endothelial interactions were evaluated by intravital microscopy.

RESULTS:

No significant changes were observed in mean arterial blood pressure among groups during the study. Tracheal peak pressure was smaller in PEEP 5 compared with PEEP 0 and PEEP 10 groups (11, 15, and 16 cmH₂O, respectively; p<0.05). After two hours of MV, there were no differences among NAIVE, PEEP 0 and PEEP 5 groups in the number of rollers (118±9,127±14 and 147±26 cells/10minutes, respectively), adherent leukocytes (3±1,3±1 and 4±2 cells/100μm venule length, respectively), and migrated leukocytes (2±1,2±1 and 2±1 cells/5,000μm², respectively) at the mesentery. However, the PEEP 10 group exhibited an increase in the number of rolling, adherent and migrated leukocytes (188±15 cells / 10 min, 8±1 cells / 100 μm and 12±1 cells / 5,000 μm², respectively; p<0.05).

CONCLUSIONS:

High intrathoracic pressure was harmful to mesenteric microcirculation in the experimental model of rats with normal lungs and stable systemic blood pressure, a finding that may have relevance for complications related to mechanical ventilation.     

Moderate-to-heavy alcohol intake is associated with differences in synchronization of brain activity during rest and mental rehearsal

In alcohol-dependent individuals, synchronization of brain activity is different from that in non-alcohol-dependent individuals as reflected by EEG differences at alpha and beta frequencies (8–30 Hz). These EEG differences may not only be related to long-term alcohol intake but also to genetic factors that are associated with alcohol dependence. Thus, it is not known what the pure effect of long-term alcohol intake on synchronization of brain activity is. Therefore, we investigated whether EEG synchronization differs between light (0.5–6 drinks per week), moderate (7–20 drinks per week), and heavy (21–53 drinks per week) drinkers. All participants (49 males and 47 females) were free of a personal and family history of alcohol dependence. Eyes-closed EEG was recorded at rest and during mental rehearsal of pictures. EEG synchronization was determined by computing Synchronization Likelihood for six frequency bands (0.5–4 Hz, 4–8 Hz, 8–12 Hz, 12–20 Hz, 20–30 Hz, 30–45 Hz). Both male and female heavy drinkers displayed a loss of lateralization in alpha (8–12 Hz) and slow-beta (12–20 Hz) synchronization. In addition, moderately and heavily drinking males had lower fast-beta (20–30 Hz) synchronization than lightly drinking males. It is concluded that both male and female drinkers who drink 21 alcoholic drinks per week or more have impaired synchronization of brain activity during rest and mental rehearsal at alpha and beta frequencies as compared to individuals who drink less. As individuals with a personal or family history of alcohol dependence were excluded, the confounding effects of genetic factors related to alcohol dependence on synchronization of brain activity were minimized.     

Propofol action in both spinal cord and brain blunts electroencephalographic responses to noxious stimulation in goats

STUDY OBJECTIVES: Anesthetics, including propofol, depress the electroencephalogram (EEG) and neuronal activity in the midbrain reticular formation (MRF). Because propofol has anesthetic effects in the spinal cord, we hypothesized that it would indirectly depress EEG and MRF neuronal responses to noxious stimulation in part by a spinal cord action. DESIGN: Six goats were anesthetized with isoflurane and the jugular veins and carotid arteries were isolated to permit cranial bypass and differential propofol delivery. A noxious mechanical stimulus was applied to the distal forelimb while recording bifrontal EEG and MRF single-unit activities. Propofol was separately administered to the cranial (0.08 +/- 0.06 mg/kg) and torso circulations (4 mg/kg) and the noxious stimulus applied at 1,5, 10, and 15 min after each injection. SETTING: N/A PATIENTS OR PARTICIPANTS: N/A INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: Noxious stimulation decreased total power (TP) from 96 +/- 33, microV2/Hz to 38 +/- 20microV2/Hz, (mean +/- SD) and increased spectral edge frequency (SEF) from 10 +/- 3 Hz to 19 +/- 5 Hz (p<0.01). Propofol administered to the torso prevented stimulus-evoked changes in TP (121+/- 80 microV2/Hz, 121 +/- 74 microV2/Hz, 114 +/- 74 microV2/Hz at 1,5, and 10 min respectively, p<0.01 compared to control evoked response) and SEF (11 +/- 6Hz, 9 +/- 2Hz, 10 +/- 6Hz, and 12 +/- 5Hz at 1, 5, 10 and 15 min, respectively, p<0.001 compared to control evoked response). Propofol administered to the cranial circulation significantly blunted the EEG and MRF response, while torso-administered propofol had slight effects on MRF responses. CONCLUSIONS: Propofol blunted the EEG response to noxious stimulation in part via a subcortical action.     

A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval

OBJECTIVE:

To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval.

METHODS:

Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effect-site concentration of 1.5 µg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded.

RESULTS:

Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea.

CONCLUSION:

Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL.     

Assessment of Crohn's disease activity by doppler ultrasound of superior mesenteric artery and mural arteries in thickened bowel wall: cross-sectional study

Aim

To define sensitive and reliable Doppler parameters for measurements in the superior mesenteric artery and mural arteries of affected bowel loops used in the assessment of Crohn’s disease activity.

Methods

We performed cross-sectional study at a tertiary care setting in Zagreb, Croatia, between January 2001 and March 2005. We measured arterial flow in the superior mesenteric artery and affected bowel wall in 138 patients with Crohn’s disease (74 with active, 64 with inactive disease) and 67 healthy volunteers. The disease activity was determined by the clinical examination, Crohn’s disease activity index, and standard laboratory tests. Superior mesenteric artery color and pulsed Doppler parameters were peak systolic velocity, end-diastolic velocity, resistance index, mean velocity flow, cross-sectional area, and flow volume. When gut mural vessels were identified, we performed spectral analysis of mural arteries by pulsed Doppler, with a measurement of resistance index.

Results

The measurements in the superior mesenteric artery showed statistically and clinically significant difference in flow volume in active group, compared with inactive and control groups (C±Q = 564 ± 263 mL/min for active, 421 ± 157 for inactive and 416 ± 248 for control group). Affected bowel loops analysis showed significant difference between inactive and active Crohn’s disease group in wall thickness (3.1 ± 1.4 vs 5.0 ± 1.8 mm, P<0.001, Mann-Whitney test) while all participants from control group had thickness below 2mm. Intensity of color Doppler signals was different for all groups (P<0.001, χ² test) with the highest level of hyperemia in the active group. Resistance index measurements of mural arteries in bowel wall revealed differences between all three groups (0.61 ± 0.05 in active group, 0.71 ± 0.05 in the inactive group and 0.80 ± 0.11 in the control group, P<0.001, Kruskal-Wallis test).

Conclusion

Intensity of color Doppler signals and resistance index measurements of mural arteries in the thickened bowel wall can be used as quantitative diagnostic tool in the assessment of Crohn’s disease activity.Most studies have found high resolution bowel ultrasound to be a useful tool in the management of Crohn’s disease (1). Another useful tool was Doppler ultrasound, which is used for detection of complications, assessing disease activity, and reduction of patients'' radiation exposure (2-4).Several tests and parameters are used to evaluate the disease activity and to guide therapeutic options (5,6). These include Crohn’s disease activity index (CDAI); laboratory findings (white cell count, C-reactive protein, erythrocyte sedimentation rate, alpha-1 antitrypsin clearance rate in feces, etc); endoscopy, scintigraphy, conventional x-ray examinations, computed tomography, and magnetic resonance imaging. Assessment of disease activity is a major clinical problem, which can lead to undertreatment or overtreatment of patients, because there is no absolute reference method to assess disease activity. The increase in mesenterial blood flow in Crohn’s disease can be demonstrated by mesenteric angiography and recently by Doppler ultrasound. Doppler ultrasound could be an ideal method, because it is a non-invasive, non-ionizing, safe, and reproducible technique. Therefore, Doppler ultrasound has received an increasing interest in the investigations of splanchnic hemodynamics in Crohn’s disease, where hypervascularity exists (7,8).In the last decade, assessment of Crohn’s disease activity by Doppler ultrasound has been mainly based on the measurements in superior mesenteric artery. Some authors emphasize the resistance index in the superior mesenteric artery (9,10) as a parameter that can assess activity in Crohn’s disease, while others emphasize maximum flow volume (8,11). A few studies have analyzed local mesenterial flow in affected bowel loops. Vascularization, characterized by increased blood flow, in these loops is increased in the active form of Crohn’s disease, which can be depicted by Doppler ultrasound. Hyperemia of the inflammable gut wall was mostly described by color Doppler and sometimes by power Doppler (12,13). Pulsed Doppler spectral analysis, as an objective method, was described in a few studies (14,15).The purpose of this study was to define Doppler ultrasound parameters of the superior mesenteric artery and dilated mural arteries of thickened bowel wall for the assessment of Crohn’s disease activity.     

Short Insulin Tolerance Test Can Determine the Effects of Thiazolidinediones Treatment in Type 2 Diabetes

Purpose

The short insulin tolerance test is a simple and reliable method of estimating insulin sensitivity. This study was designed to compare the insulin sensitizing effects of thiazolidinediones (TZDs) on the degree of insulin resistance, determined by a short insulin tolerance test (Kitt) in type 2 diabetic patients.

Patients and Methods

Eighty-three subjects (mean age = 57.87 ± 10.78) with type 2 diabetes mellitus were enrolled and received daily one dose of rosiglitazone (4 mg) or pioglitazone (15 mg). The mean follow-up duration was 25.39 ± 9.66 months. We assessed insulin sensitivity using HOMA-IR and the short insulin tolerance test before and after TZDs treatment.

Results

When we compared patients'' characteristics before and after TZDs treatment, the mean fasting glucose level was significantly decreased (183.27 ± 55.04 to 137.35 ± 36.42 mg/dL, p < 0.001) and the mean HbA1C level was significantly decreased (9.24 ± 1.96 to 8.11 ± 1.39%, p < 0.001). Also, Kitt values were significantly increased (2.03 ± 1.14 to 2.67 ± 0.97%/min, p = 0.003), whereas HOMA-IR was significantly decreased (2.98 ± 0.68 to 1.04 ± 0.24, p < 0.05). When classifying insulin resistance by Kitt values, insulin resistant subjects'' values were increased (< 2.5 %/min; 1.51 ± 0.53%/min to 2.63 ± 0.88, p < 0.001), whereas the values decreased in insulin sensitive subjects (≥ 2.5%/min; 3.50 ± 0.75%/min to 2.75 ± 1.12%/min, p = 0.002).

Conclusion

The glucose lowering effects of TZDs by improving insulin resistance could be determined by using Kitt. However, Kitt may be a beneficial tool to determine TZDs'' effects only when patients'' Kitt values are less than 2.5%/min.