The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis

Purpose

Intranasal dexmedetomidine premedication is a newly introduced method for reducing stress and anxiety before general anesthesia in children. We performed a meta-analysis to identify the effects of intranasal dexmedetomidine premedication in children.

Source

We conducted a systematic review to find published randomized-controlled trials using intranasal dexmedetomidine as premedication. We searched databases in EMBASE?, MEDLINE®, and the Cochrane Controlled Trials Register using the Ovid platform. This study was conducted based on the Cochrane Review Methods.

Principal findings

This review included 1,168 participants in 13 studies. Intranasal dexmedetomidine premedication provided more satisfactory sedation at parent separation (relative risk [RR], 1.45; 95% confidence interval [CI], 1.19 to 1.76; P = 0.0002; I² = 80%) than other premedication regimes. In addition, it reduced the need for rescue analgesics (RR, 0.58; 95% CI, 0.40 to 0.83; P = 0.003; I² = 0%). Nevertheless, there were no differences in sedation at mask induction (RR, 1.25; 95% CI, 0.98 to 1.59; P = 0.08; I² =71%) or in the incidence of emergence delirium (RR, 0.52; 95% CI, 0.24 to 1.13; P = 0.10; I² = 67%). Intranasal dexmedetomidine was associated with a significantly lower incidence of nasal irritation (RR, 0.05; 95% CI, 0.01 to 0.36; P = 0.003; I² = 0%) and postoperative nausea and vomiting (RR, 0.63; 95% CI, 0.40 to 0.99; P = 0.04; I² = 0%) than other premedication treatments. It also showed significantly lower systolic blood pressure (weighted mean difference [WMD], ?6.7 mmHg; 95% CI, ?10.5 to ?2.9; P = 0.0006; I² = 96%) and heart rate (WMD, ?6.8 beats·min^?1; 95% CI, ?11.3 to ?2.6; P = 0.002; I² = 98%).

Conclusions

Intranasal dexmedetomidine provided more satisfactory sedation at parent separation and reduced the need for rescue analgesics and the incidence of nasal irritation and postoperative nausea and vomiting when compared with other premedication treatments.

     

Reduction of Squalene Epoxidase by Cholesterol Accumulation Accelerates Colorectal Cancer Progression and Metastasis

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Plasma adiponectin level and sleep structures in children with Prader–Willi syndrome

Adiponectin, an adipose tissue-derived hormone, has been negatively related to obstructive sleep apnea syndrome. Besides sleep apnea, children with Prader–Willi syndrome (PWS) may have excessive daytime sleepiness and rapid eye movement (REM) sleep abnormality. The aim of this study is to determine whether changes in sleep structures are related to plasma adiponectin levels in PWS. Correlations between adiponectin level and sleep variables were analyzed in 28 children with PWS and 18 controls. Overnight polysomnography was performed. The fasting plasma adiponectin levels were higher in the children with PWS than in the controls ( P  =   0.0006). In the PWS, Epworth sleepiness scale was significantly higher ( P  =   0.002); sleep latency ( P  =   0.003) and REM latency ( P  =   0.001) were significantly shortened; the apnea–hypopnea index (AHI) was significantly increased ( P  =   0.0001); and the duration of non-rapid eye movement (NREM) sleep stages 3 and 4 was decreased ( P  =   0.005). Multiple regression analysis revealed correlations between the adiponectin level and the total sleep time ( β  = 0.688, P  =   0.009), AHI ( β  = 1.274, P  =   0.010), REM latency ( β  = −0.637, P  =   0.021) and the percentage of NREM sleep ( β  = −7.648, P  =   0.002) in PWS. In children with PWS, higher plasma adiponectin levels were independently associated with several sleep variables, which was not observed in the control group. These results suggest a potential influence of elevated adiponectin level on the sleep structures in PWS.     

Expression of Vimentin and Cytokeratin in Eutopic and Ectopic Endometrium of Women with Adenomyosis and Ovarian Endometrioma

PROBLEM: To determine the expression of vimentin and cytokeratin in eutopic and ectopic endometrium of women with both adenomyosis and ovarian endometrioma and to evaluate their cyclic changes during the menstrual cycle. METHOD OF STUDY: Twenty patients requiring hysterectomy with salpingo-oophorectomy were studied by immunohistochemistry according to their menstrual cycles. RESULTS: Cyclic expression of vimentin was noted in eutopic endometrium and adenomyosis, but not in endometrioma. Cytokeratin expression did not change during the menstrual cycles. The mean intensities of epithelial vimentin were significantly different from each other, being the lowest in endometrioma, intermediate in adenomyosis, and the highest in eutopic endometrium. There was no significant difference in intensities of cytokeratin between adenomyosis and endometrioma, but these intensities were significantly lower than that of eutopic endometrium. CONCLUSIONS: Lower intensities of cytokeratin in adenomyosis and endometrioma than in eutopic endometrium suggest that the ectopic endometria may have a lower degree of differentiation regardless of the site. The lower intensity of epithelial vimentin in endometrioma than in adenomyosis during the proliferative phase may reflect decreased functional activity, probably because of a pressure effect on the lining epithelium within the endometrioma.     

Clinical study using novel endoscopic system for measuring size of gastrointestinal lesion

AIM:To verify the performance of a lesion size measurement system through a clinical study.METHODS:Our proposed system,which consists of a conventional endoscope,an optical device,an optical probe,and a personal computer,generates a grid scale to measure the lesion size from an endoscopic image.The width of the grid scale is constantly adjusted according to the distance between the tip of the endoscope and lesion because the lesion size on an endoscopic image changes according to the distance.The shape of the grid scale was corrected to match the distortion of the endoscopic image.The distance was calculated using the amount of laser light reflected from the lesion through an optical probe inserted into the instrument channel of the endoscope.The endoscopist can thus measure the lesion size without contact by comparing the lesion with the size of the grid scale on the endoscopic image.(1)A basic test was performed to verify the relationship between the measurement error eM and the tilt angle of the endoscope;and(2)The sizes of three colon polyps were measured using our system during endoscopy.These sizes were immediately measured by scale after their removal.RESULTS:There was no error atα=0°.In addition,the values of eM(mean±SD)were 0.24±0.11 mm(α=10°),0.90±0.58 mm(α=20°)and 2.31±1.41mm(α=30°).According to these results,our system has been confirmed to measure accurately when the tilt angle is less than 20°.The measurement error was approximately 1 mm in the clinical study.Therefore,it was concluded that our proposed measurement system was also effective in clinical examinations.CONCLUSION:By combining simple optical equipment with a conventional endoscope,a quick and accurate system for measuring lesion size was established.     

Synergistic effect between catechin and ciprofloxacin on chronic bacterial prostatitis rat model

Abstract Background: Chronic bacterial prostatitis (CBP) is the most common urological disease in adult men. Antibiotic therapy is the gold standard of treatment. However, long‐term therapy resulted in many side‐effects and bacterial resistance. Because of these reasons, we need new treatment modality that could replace traditional antibiotic therapy. Catechin, an extract of green tea, has antimicrobial effect against various bacteria and synergy effect to antibiotics. We evaluate the synergistic effects of catechin on the treatment of CBP in an animal model. Methods: An experimental CBP model was induced in 70 male Wistar rats by instillation of 0.2 mL bacterial suspension (E‐coli Z17, O2:K1:H‐) containing 1 × 108 CFU/mL into the prostatic urethra. Microbiologically and histologically proven CBP model was demonstrated in 58.6% (41 of 70) of the rats after 4 weeks of bacterial instillation. The 41 rats demonstrating CBP were randomly divided into four groups; the control, catechin, ciprofloxacin and catechin with ciprofloxacin groups. All drug treatments were conducted over a period of 2 weeks. After treatment, the results were analyzed with microbiological cultures and histological findings of the prostate and urine samples to compare each group. Results: Microbiological cultures and histological findings of the prostate and urine samples demonstrated reduced bacterial growth and improved inflammatory responses in all three experimental groups compared with the control group. The catechin group showed coherent trends of decrease in bacterial growth and improvements in prostatic inflammation compared with the control group, but not to a statistically significant degree (P > 0.05). However, the ciprofloxacin and catechin with ciprofloxacin groups showed statistically significant decreases in bacterial growth and improvements in prostatic inflammation compared with the control group (P < 0.05). The catechin with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvements in prostatic inflammation compared with the ciprofloxacin group (P < 0.05). Conclusions: These results suggest that catechin may be an effective material in CBP treatment. Particularly, combination treatment of catechin and ciprofloxacin has synergistic effect. Therefore, we suggest that the combination of catechin and ciprofloxacin may be effective in treating CBP with a higher success rate.     

Magnetic Resonance Imaging of Pulmonary Embolism: Diagnostic Accuracy of Unenhanced MR and Influence in Mortality Rates

Objectives

We evaluated the diagnostic value for pulmonary embolism (PE) of the True fast imaging with steady-state precession (TrueFISP) MRI, a method that allows the visualization of pulmonary vasculature without breath holding or intravenous contrast.

Methods

This is a prospective investigation including 93 patients with suspected PE. All patients underwent TrueFISP MRI after undergoing CT pulmonary angiography (CTPA). Two independent readers evaluated each MR study, and consensus was obtained. CTPA results were analysed by a third independent reviewer and these results served as the reference standard. A fourth radiologist was responsible for evaluating if lesions found on MRI for both analysis were the same and if these were the correspondent lesions on the CTPA. Sensitivity, specificity, predictive values and accuracy were calculated. Evidence for death from PE within the 1-year follow-up was also assessed.

Results

Two patients could not undergo the real-time MRI and were excluded from the study. PE prevalence was 22%. During the 1-year follow-up period, eight patients died, whereas PE was responsible for 12.5% of cases. Between patients who developed PE, only 5% died due to this condition. There were no differences between MR and CT embolism detection in these subjects. MR sequences had a sensitivity of 85%, specificity was 98.6% and accuracy was 95.6%. Agreement between readers was high (κ=?0.87).

Conclusions

Compared with contrast-enhanced CT, unenhanced MR sequences demonstrate good accuracy and no differences in the mortality rates in 1 year were detected.