Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery

Purpose: The aim of the present study was to compare the anesthetic efficacy, and fetal and maternal effects of 7.5 mg (1 ml) intrathecal 0.75% hyperbaric ropivacaine + 25 ìg (0.5 ml) fentanyl versus 5 mg (l ml) intrathecal 0.5% hyperbaric bupivacaine + 25 ìg (0.5 ml) fentanyl in elective cesarean delivery.Materials and Methods: The study included 40 ASA I–II cases scheduled for cesarean delivery that were randomized into two groups of 20 cases each. Cases in the RF group were administered 0.75% hyperbaric ropivacaine + 25 ìg (0.5 ml) fentanyl and those in the BF group were administered 5 mg (l ml) hyperbaric bupivacaine + 25 ìg (0.5 ml)fentanyl into the spinal space. The time until spinal anesthesia in the T4 dermatome, overall duration of analgesia, hemodynamic parameters, Apgar score of newborns at 1–5 min, fetal blood gas values (pH, PO2, PCO2, HCO3., and BE), maternal side effects, the degree of motor block, maternal need for ephedrine, objective pain scale score, and patient satisfaction were recorded in each group.Results: There were no significant differences between the groups in terms of the parameters evaluated (P > 0.05).Conclusion: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects.Key words: Bupivacaine, cesarean, opioid, ropivacain

Telomerase Inhibition Targets Clonogenic Multiple Myeloma Cells through Telomere Length-Dependent and Independent Mechanisms

Plasma cells constitute the majority of tumor cells in multiple myeloma (MM) but lack the potential for sustained clonogenic growth. In contrast, clonotypic B cells can engraft and recapitulate disease in immunodeficient mice suggesting they serve as the MM cancer stem cell (CSC). These tumor initiating B cells also share functional features with normal stem cells such as drug resistance and self-renewal potential. Therefore, the cellular processes that regulate normal stem cells may serve as therapeutic targets in MM. Telomerase activity is required for the maintenance of normal adult stem cells, and we examined the activity of the telomerase inhibitor imetelstat against MM CSC. Moreover, we carried out both long and short-term inhibition studies to examine telomere length-dependent and independent activities.Human MM CSC were isolated from cell lines and primary clinical specimens and treated with imetelstat, a specific inhibitor of the reverse transcriptase activity of telomerase. Two weeks of exposure to imetelstat resulted in a significant reduction in telomere length and the inhibition of clonogenic MM growth both in vitro and in vivo. In addition to these relatively long-term effects, 72 hours of imetelstat treatment inhibited clonogenic growth that was associated with MM CSC differentiation based on expression of the plasma cell antigen CD138 and the stem cell marker aldehyde dehydrogenase. Short-term treatment of MM CSC also decreased the expression of genes typically expressed by stem cells (OCT3/4, SOX2, NANOG, and BMI1) as revealed by quantitative real-time PCR.Telomerase activity regulates the clonogenic growth of MM CSC. Moreover, reductions in MM growth following both long and short-term telomerase inhibition suggest that it impacts CSC through telomere length-dependent and independent mechanisms

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Hybrid Heuristic and Pattern Search Optimization Algorithm for Design Optimization of Energy Efficient Distribution Transformer

2022 IEEE Global Energy Conference, GEC 2022 -- 26 October 2022 through 29 October 2022 -- 185674Batman University and Batman Energy Coordination Center (EKOM)Transformers are widely used in the electric power grid. The design of power and distribution transformers is a tedious and time-consuming task that requires solving numerous equations considering technical constraints. Most conventional methods get stuck in a local optimum point. In this paper, a hybrid algorithm is proposed to solve the transformer design problem with higher closeness to the global optimum solution. The algorithm is a combination of the novel Pelican Optimization Algorithm (POA) and Pattern Search Method (PSM). The proposed POA-PSM algorithm is applied for the design optimization of 630 kVA and 1000 kVA oil-immersed eco-design distribution transformers and the results are compared to already-designed transformers with the same power ratings. © 2022 IEEE.ACKNOWLEDGMENT This work is funded by the Scientific and Technological Research Council of Turkey (TÜBİTAK) and R;D department of Eltaş Transformatör A.Ş. under grant number 119C127.Türkiye Bilimsel ve Teknolojik Araştırma Kurumu, TÜBİTAK: 119C12

Human hepatocyte growth factor levels in patients undergoing thoracic operations

KISA, Ucler/0000-0002-8131-6810WOS: 000234635100013PubMed: 16387938Human hepatocyte growth factor (hHGF) is the most potent mitogen identified for alveolar type II cells, and may have other important functions in the repair of the alveolar epithelium and compensatory lung growth. A study was conducted to evaluate the changes of serum hHGF levels in patients who underwent thoracic surgical procedures. The patients comprised 17 males and 14 females with a mean age of 47.1 +/- 13.5 yrs, who underwent either lung resection (LR group) or nonlung resection (norLR group) thoracic procedures. The changes of hHGF levels were analysed in the pre- and post-operative periods in both groups. The pre-operative hHGF levels did not differ between the LR and the nonLR groups, which were 333.2 +/- 72.9 pg center dot mL(-1) and 343.6 +/- 125.3 pg center dot mL(-1), respectively. The hHGF levels in the LR group significantly increased up to 433.6 +/- 128.1 pg center dot mL(-1) and 430.8 +/- 128.2 pg center dot mL(-1) in post-operative days 1 and 3, respectively. However, the same levels in the nonLR group appeared as 333.2 +/- 77.0 pg center dot mL(-1) and 311.9 +/- 73.0 pg center dot mL(-1), respectively. In conclusion, the increases of serum human hepatocyte growth factor levels following pulmonary resection may imply the important role of human hepatocyte growth factor in lung regeneration or compensatory lung growth in humans

Effects of oxygen supplementation during the last stage of incubation on broiler performance, ascites susceptibility and some physiological traits

The present study was conducted to determine the possible use of supplemental oxygen treatment during the last 3 days of incubation on broiler performance, ascites susceptibility and some physiological traits. On the 18th day of incubation, fertile eggs were divided into two groups. From 18 to 21 d, the eggs were placed in two hatcher cabinets: one being a control at normal atmospheric conditions, 20.9 ± 0.5% at 754 ± 2 mm Hg and the other supplemented with oxygen at 23.0±0.5%. Oxygen supplementation had a significant effect on initial chick weight. At 6 weeks of age, body weight, growth rate, and feed consumption increased as partial pressure of O2 rose from 20.9 to 23.0%. Feed conversion ratio decreased with the increasing partial pressure of oxygen. In the present study, general mortality and mortality due to ascites did not differ between the groups. At 5 weeks of age, oxygen supplementation did not cause significant changes in RBC (red blood cell count), Hb (hemoglobin) and Glucose. However, PCV (hematocrit) increased significantly as the partial pressure O2 rose from 20.9 to 23.0%. There were no differences in the right ventricle, left ventricle + septum, total ventricle and RV:TV (right ventricle:total ventricle) ratio between the oxygen supplemented and control group. © INRA, EDP Sciences, 2006