Guaifenesin-Ketamine-Xylazine Infusion to Maintain Anesthesia in Mules Undergoing Field Castration

Many minor and surgical procedures can be performed in the field under sedation or general anaesthesia. Numerous drug combinations have been used for sedation, induction and maintenance. The purpose of this study was to determine if the combination of guaifenesin, ketamine and xylazine, commonly referred to as “triple drip”, produce safe and satisfactory total intravenous anaesthesia in mules undergoing field castration, premedicated with xylazine and induced with thiopental. Eight healthy adult intact male mules, aged 4 to 6 years and weighing 380 to 490, were anesthetized to performe field castration. Before anaesthesia a 14-gauge, 13–cm catheter was placed percutaneously in the external jugular vein. Mules were premedicated with 1.3 mg/kg xylazine IV and anaesthesia was then inducted with 6 mg/kg IV thiopental within 10 min after premedication, when the animals were at least moderately sedated. Additional xylazine was administered when the mules were inadequately sedated. Sedation was considered good when lowering of the head, drooping of the lower lip and drooping of the ears were present using a 4-point sedation score. Once the mules were recumbent, the infusion of guaifenesin (50 mg/ml) - ketamine (20 mg/ml) - xylazine (0.5 mg/ml) (GKX) was started to maintain general anaesthesia, approximately 1ml/kg/hr (based on monitoring eye signs, muscle relaxation of the neck, respiratory rate and pattern, and the responses to surgical stimulation. The spermatic cord of each testis was infiltrated with 5 ml of lidocaine to achieve local anaesthesia before the scrotum skin incision. The open technique of castration was applied to all mules for postoperative drainage. During anaesthesia heart rate (HR), respiratory rate RR), rectal temperature (RT) and hemoglobin saturation with oxygen (SpO2) were measured every 5 minutes. Times to sternal recumbency, lateral recumbency and standing were recorded. The data recorded were statistically analysed using simple one-way analysis of variance (ANOVA) and a pvalue>0.05 was considered significant. The qualities of anaesthesia were evaluated using induction, maintenance and recovery scores. The resultes suggest that the premedication using 1.3 mg/kg IV xylazine for mules undergoing thiopental anaesthesia was satisfactory and only one animal needed a supplemental dose of xylazine (0.3 mg/kg IV) to induce better sedation. The total IV amount of thiopental for induction was sufficient to achieve lateral recumbency in all animals. Furthermore, GKX provided adequate surgical plane of general anaesthesia to performe castration in all mules, without responses to the manuality or significant modification of HH, RR, RT, and SpO2 in comparison with the basal values and to maintain a satisfactory muscle relaxation. Recovery from anaesthesia was uneventful, smooth and clinically acceptable in all mules

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Gemtuzumab ozogamicin with cytarabine and mitoxantrone as a third-line treatment in a poor prognosis group of adult acute myeloid leukemia patients: a single-center experience

We analyzed the safety and efficacy of gemtuzumab ozogamicin (GO) combined with cytarabine and mitoxantrone in the treatment of 21 patients with acute myeloid leukemia (11 refractory and 10 in second relapse). Patients' median age was 52 years (range 36-68); all patients had previously been treated with anthracycline-containing regimens (daunorubicin and idarubicin). GO at a dosage of 3 mg/m2 was administered as a 2-h intravenous infusion on days 1 and 14, cytarabine at 100 mg/m2 on days 1-7, and mitoxantrone at 12 mg/m2 on days 1-3. Infusion-related events were observed in 15 of 21 (71.4%) patients. The incidence of grade 1 or 2 elevations of bilirubin and hepatic transaminases was 4 of 21 (19%) and 3 of 21 (14.2%). In response to chemotherapy, 2 of 21 (9.5%) achieved complete remission and 2 of 21 (9.5%) achieved complete remission with incomplete platelet recovery, with an overall remission rate of 4 of 21(19%); median survival of these 4 patients was 7 months. Four of 21 patients (19%) died during aplasia after chemotherapy; no veno-occlusive disease occurred. No treatment-related cardiotoxicity or cerebellar toxicity was observed. In our experience, the addition of GO to mitoxantrone and cytarabine is feasible in refractory or second relapse acute myeloid leukemia patients but yields a low response rate when used as a third-line treatment

FLAG-IDA in the treatment of refractory/relapsed acute myeloid leukemia: single-center experience

We evaluated the efficacy and toxicity profiles of the combination of fludarabine, high-dose cytosine arabinoside (AraC), idarubicin, and granulocyte colony-stimulating factor (G-CSF) in refractory/relapsed acute myeloblastic leukemia (AML) patients. Between October 1998 and February 2002, 46 AML patients were treated with FLAG-IDA (fludarabine 30 mg/m(2), AraC 2 g/m(2) for 5 days, idarubicin 10 mg/m(2) for 3 days, and G-CSF 5 micro g/kg from day +6 until neutrophil recovery). Thirty patients were in relapse after conventional chemotherapy including cytarabine, etoposide, and daunorubicin or mitoxantrone according to the GIMEMA protocols. Four were in relapse after autologous peripheral stem cell transplantation and two after allogeneic bone marrow transplantation. Ten patients had refractory disease (after 10 days of standard doses of cytarabine, 3 days of mitoxantrone or daunorubicin, and 5 days of etoposide). Recovery of neutrophils and platelets required a median of 19 and 22 days from the start of therapy. Complete remission (CR) was obtained in 24 of 46 patients (52.1%) and 3 of 46 (6.6%) died during reinduction therapy: 2 due to cerebral hemorrhage and 1 due to fungemia ( Candida tropicalis). Fever >38.5 degrees C was observed in 40 of 46 patients (86.9%), 27 had fever of unknown origin (FUO) and 13 documented infections; 31 of 46 (67.3%) developed mucositis and 14 of 46 (30.4%) had grade 2 WHO transient liver toxicity. After achieving CR, 11 patients received allogeneic stem cell transplantation, 4 patients received autologous stem cell transplantation, 4 were judged unable to receive any further therapy, and 5 refused other therapy. Ten patients are at present in continuous CR after a median follow-up of 13 months (range: 4-24). In our experience, FLAG-IDA is a well-tolerated and effective regimen in relapsed/refractory AML. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures

Biophysical and Structural Characterization of the Interaction between Human Galectin-3 and the Lipopolysaccharide from <i>Pseudomonas aeruginosa</i>

Given the significant involvement of galectins in the development of numerous diseases, the aim of the following work is to further study the interaction between galectin-3 (Gal3) and the LPS from Pseudomonas aeruginosa. This manuscript focused on the study of the interaction of the carbohydrate recognition domain of Gal3 with the LPS from Pseudomonas aeruginosa by means of different complementary methodologies, such as circular dichroism; spectrofluorimetry; dynamic and static light scattering and evaluation of the impact of Gal3 on the redox potential membranes of Escherichia coli and P. aeruginosa cells, as well as ITC and NMR studies. This thorough investigation reinforces the hypothesis of an interaction between Gal3 and LPS, unraveling the structural details and providing valuable insights into the formation of these intricate molecular complexes. Taken together, these achievements could potentially prompt the design of therapeutic drugs useful for the development of agonists and/or antagonists for LPS receptors such as galectins as adjunctive therapy for P. aeruginosa

VISIR: Technological infrastructure of an operational service for safe and efficient navigation in the Mediterranean Sea

VISIR (discoVerIng Safe and effIcient Routes) is an operational decision support system (DSS) for optimal ship routing designed and implemented in the frame of the TESSA (TEchnology for Situational Sea Awareness) project. The system is aimed to increase safety and efficiency of navigation through the use of forecast environmental fields and route optimization. VISIR can be accessed through a web interface (www.visir-nav.com) and mobile applications for both iOS and Android devices. This paper focuses on the technological infrastructure developed for operating VISIR as a DSS. Its main components are described, the performance of the operational system is assessed through experimental measurements, and a few case studies are presented