Surgical stress response following hip arthroplasty regarding choice of anesthesia and postoperative analgesia

© 2017, Inst. Sci. inf., Univ. Defence in Belgrade. All Rights Reserved. Background/Aim. Significant surgical stress response consisting of hormonal, metabolic and inflammatory changes can be initiated by the hip replacement surgery. Appropriate choice of anesthesia and postoperative analgesia should provide diminution of surgical stress response and may reduce number of perioperative complica-tions. Surgical stress response after peripheral nerve blocks has not been studied extensively in patients who underwent hip replace-ment. The aim of the study was to investigate whether continuous lumbar plexus block can significantly reduce surgical stress re-sponse in comparison to other types of postoperative analgesia – continuous epidural analgesia and intravenous patient controlled analgesia (PCA) with morphine. Methods. Prospective study in-cluded 60 patients, scheduled for total hip arthroplasty. The pa-tients were randomized into 4 groups: group CNB (central nerve block - epidural), group PNB (Peripheral nerve block - lumbar plexus block), SAM (Spinal anesthesia- PCA (anesthesia) mor-phine) and GAM (General anesthesia + PCA with Morphine). Se-rum levels of cortisol, thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH), insulin, glucose and C-reactive pro-tein (CRP) were measured in all groups – preoperatively, as well as 4 h, 12 h and 24 h after surgery. Results. The study showed that average serum cortisol levels were significantly lower 4 h after the operation in the groups where methods of regional anesthesia were performed intraoperatively (SAM, CNB, PNB); (F = 19.867; p < 0.01). Groups with postoperative continuous catheter analgesia (CNB, PNB) had significantly lower serum cortisol levels 12 h after the operation (F = 8.050; p < 0.01). The highest serum insulin levels were detected 4 h postoperatively in the CNB and PNB group, while the lowest were in the GAM group (F = 5.811; p < 0.05). Twelve hours after the operation, the lowest values of insulin were measured in the SAM group (F = 5.052; p < 0.05), while 24 h postoperatively, the lowest values were found in the SAM and GAM group (F = 6.394; p < 0.05). T3, T4 and TSH levels showed slight reduction in comparison to preoperative values without sta-tistical significance. Blood glucose levels were significantly different among the groups 4 h after surgery with the highest values re-corded in the GAM group and the lowest ones in the SAM group (F = 10.084; p < 0.01). On the other hand, 12 h after the operation significant rise in blood glucose levels was detected in the SAM group (F = 7.186; p < 0.01) Levels of CRP increased remarkably 12 h and 24 h after the surgery, but without significant difference among the groups. Conclusion. Administration of postoperative analgesia using continuous lumbar plexus block following hip ar-throplasty reduces significantly stress response in comparison to postoperative PCA with morphine and has comparable effects on hormone release to epidural analgesia. Spinal anesthesia provides the best diminution of surgical stress response in the early postoperative period in comparison with other types of intraoperative analgesia

Spore-forming bacteria in the dairy chain

Spore-forming bacteria form the most diverse and most complex group of bacteria in terms of their elimination from the dairy chain, due to their ability to form highly resistant spores. As ubiquitous microorganisms, spore-formers can enter the product along the milk-processing continuum from different sources, and subsequently cause spoilage in various types of dairy products. The most important classes of spore-forming bacteria relevant to the dairy industry are Bacilli and Clostridia. Bacilli are responsible mainly for the spoilage and decreased shelf-life of fluid milk, while Clostridia cause late gas blowing in cheese. Spore-forming microorganisms contaminate raw milk primarily at the farm level, with potential for recontamination to occur at various points along the dairy production continuum. The most effective measure in reducing spore load at the farm level is adequate pre-milking teat preparation, while at the dairy plant level, bactofugation and microfiltration are applied. Understanding the ecology of spore-formers can improve application of systematic approaches for controlling the spoilage bacteria in dairy processing systems. Also, novel technologies, such as high-pressure processing, ultrasound treatment, irradiation etc., could provide the dairy industry with the powerful tools to eliminate these bacteria from the dairy chain

Noviji pogledi na postmortalne promene mišića ribe

Odmah nakon prekida cirkulisanja krvi, pa zbog toga i nedostatka izvora kiseonika, glikogen podlaže anaerobnom razlaganju i preko niza fosforilovanih derivata glukoze prelazi u mlečnu kiselinu, koja se nagomilava u mišićima, što rezultira smanjenjem pH vrednosti sa vrednosti blizu 7,4 na šest, ponekada i nižu. Mišićni osmotski pritisak raste u roku od sat vremena nakon smrti, sadržaj ATP (adenozin trifosfat) opada a lipidi oksidišu. Trimetilaminoksid (TMAO) prelazi u trimetilamin (TMA), usled dejstva endogenih enzima, a kasnije bakterijskih - kada počne mikrobiološka aktivnost. Količina azot-oksida i reaktivnih metabolita kiseonika se takođe povećava. Mitohondrije i sarkoplazmatski retikulum prestaju sa radom tokom pada pH vrednosti i promena osmotskog pritiska, što rezultira oslobađanjem kalcijumovih jona u citosol, gde njihova koncentracija može da dostigne i 0.2 mM slobodnog kalcijuma. Proteoliza komponenata citoskeleta rezultira degradacijom miofilamenata. Kod ribe, u zavisnosti od vrste, ona može da obuhvati degradaciju titina, nebulina, distrofina, oslobađanje α-aktinina, proteolizu miozina i delokalizaciju tropomiozina. Sarkoplazmatski 16 kDa protein (označen kao nukleozid difosfat kinaza) takođe podleže proteolizi tokom skladištenja. Tropomiozin se oslobađa iz miofibrila, a sadržaj ektrahovanog tropomiozina raste između 0 i 48 sati u prisustvu 5 mM EGTA. U ekstrakciji sa 5 mM Ca2+, tropomiozin je pronađen u manjoj količini nakon 48 sati. U mišićnim ćelijama postoje različiti proteolitički sistemi: multikatalitički kompleks, lizozomalni sistem koji uključuje aspartamske i cisteinske kisele katepsine, citosolni Ca-zavisni kalpaini i citoplazmatične aminopeptidaze, alkalne proteaze, kao i hidrolitični enzimi vezivnog tkiva, elastaze i kolagenaze. Multikatalitički kompleks ili proteazom učestvuje u razgradnji hormona, antigena, transkripcionih faktora i ubikvitin konjugovanih i oksidovanih proteina. Za aktivnost 26S proteazoma protreban je ATP i hidrolizovani ubikvitin konjugovani proteini. Proteazom 20S, koji predstavlja deo 26S proteazoma, postoji u latentnoj formi koja može da se aktivira različitim jedinjenjima. Katepsini su kisele proteaze, najčešće lokalizovane u lizozomima. Stoga su uglavnom neaktivni u tkivu živih organizama, ali bivaju oslobođeni usled povreda ili smrzavanja i odmrzavanja u mišićima postmortem. Katepsini mogu biti specifični po svom aktivnom mestu (aspartam, cistein ili serin proteaza), kao i po svojoj supstrat specifičnosti ili osetljivosti na određene inhibitore. U lizozomima se može naći najmanje 13 različitih katepsina. Pored njih katepsini B, D, L su već izolovani iz ćelija ribe. Katepsini B, D, L i H su najzastupljenije grupe katepsina u lizozomima mišićnih ćelija ribe. Kalpaini su cistein proteaze, aktivne pri neutralnoj pH vrednosti i zavisne od kalcijuma. Ubikvitarni kalpain se sastoji od kalpaina I ili mikro(µ)-kalpaina, koji zahteva mikromolarne koncentacije kalcijuma za punu aktivnost (10 do 50 µM) i kalpaina II ili mili(m)-kalpaina, koji zahteva milimolarne koncentracije kalcijuma (300 µM do 1 mM). Kalpainski heterodimeri se razdvajaju u prisustvu kalcijuma. Mala subjedinica (30 kDa) je ista kod svih kalpaina, dok je velika subjedinica (80 kDa) specifična za određeni tip kalpaina i odgovorna za katalitičku aktivnost. Aktivnost kalpaina, aktivnih pri intracelularnoj fiziološkoj pH vrednosti, je u velikoj meri regulisana in vivo. Regulacija aktivnosti kalpaina je kompleksna i nije poznata u potpunosti. Četiri osobine kalpaina su kalcijum zavisne: vezivanje za celularne komponente, kao što su membrane, vezivanje za kalpastatin, proteolitička aktivnost i autoliza. Metaloproteaze matriksa (MMP-Matrix metalloproteases) predstavljaju brojnu familiju strukturno sličnih endopeptidaza, odgovornih za katabolizam vezivnog tkiva. One su sposobne da razgrade različite tipove kolagena i proteine citoskeleta povezujući sarkolemu za ekstracelularni matriks. Oni su cink i kalcijum zavisni enzimi, klasifikovani u 4 podfamilije: kolagenaze, želatinaze, stromelizin i membranski tip MMP-a. Postmortalne promene mesa ribe vezane su za metaboličke promene (prekid nukletida, hidroliza i oksidacija masti, pad pH, rast osmotskog pritiska, povećanje koncentracije Ca2+, povećanje azot oksida i slobodnih radikala), za promene strukture miofibrila (oslobađanje i proteolizu α-aktinina, degradaciju titina, proteolizu nebulina i miozina, delokalizaciju tropomiozina, proteolizu troponina T, pristustvo 30kDa fragmenta, degradaciju aktina, dezmina i distrofina). U ovim promenama učestvuje brojni faktori,a promene neminovno dovode do gubitka svežine ribe

Alergenski proteini u ribi

Riba predstavlja znatan deo ishrane ljudi u svetu. Pre svega, riba je značajan izvor proteina (15-24%) visoke biološke vrednosti, bogata je mineralima, vitaminima, a posebno esencijalnim masnim kiselinama za koje je dokazano da pogoduju u prevenciji mnogobrojnih oboljenja. Zbog velikog značaja polinezasićenih masnih kiselina n-3 klase, u Evropi su date i preporuke o optimalnom dnevnom unosu. Međutim, pored hranljivih svojstava koje ima, riba može biti i izvor različitih bioloških i hemijskih opasnosti. Od bioloških opasnosti posebno su značajni paraziti (Trematodae, Nematodae, Cestodae), bakterije (Salmonella spp, E. coli, Vibrio parahemolyticus, Vibrio vulnificus, Listeria monocytogenes, Clostridium botulinum, Staphyloccocus aureus), virusi (Norwalk virus, Entero virusi, Hepatitis A, Rotavirus) i biotoksini. Najznačajnije hemijske opasnosti su policiklična aromatična jedinjenja, histamin i teški metali (živa, olovo, kadmijum, arsen, gvožđe). Alergije usled konzumiranja pojedinih vrsta namirnica su u porastu poslednjih godina. Veliki pokret oko pravilnog načina ishrane je doveo do toga da ljudi sve češće konzumiraju ribu, proizvode od ribe kao i različite plodove mora. Pored različitih opasnosti koje mogu poticati iz ribe, posebni značaj poslednjih godina se daje ribi kao potencijalnom alergenu. Naime, veliki broj alergija koje se javljaju u svetu pripisuju se alergenima koji potiču iz mesa ribe, pre svega proteinima mesa ribe. Učestalost alergija koje se povezuju za unosom mesa ribe varira u Evropskim zemljama (Norveška 1,5%; 2,3% Turska, 2,3% Grčka; Švedska 1.2-3.2 %). Kao najznačajniji proteinski alergen iz mesa ribe navodi se parvalbumin (ß tip), koji je izolovan kod velikog broja vrsta. Smatra se da su šaran i bakalar najčešći izvori parvalbumina koji se dovodi u vezu sa različitim vidovima alergijskih reakcija. Potencijalni alergeni su takođe kolagen i želatin koji su izolovani iz kože i pojedinih organa riba. Takođe, značajan alergen iz plodova voda je i tropomiozin, arginin kinaza, aldolaza. Pored ovih alergena, značajni alergeni mogu da potiču iz ikre, pojedih vrsta kavijara, a opisani su slučajevi gde su alergijske reakcije povezane sa kolagenom koji se nalazi u ekstracelularnom matriksu proteina. Alergeni koji dovode do različitih alergijskih reakcija, pored proteina mesa ribe, mogu poticati i od gotovih proizvoda od ribe. Tu spadaju različiti panirani proizvodi od ribe koji sadrže celer, gluten i druge dodatke koji mogu biti potencijalni alergeni. Zbog značaja koji imaju na zdravlje ljude, tehnologija je omogućila različite metode za detekciju ovih alergena. Kao neke od njih navode se ELISA (Enzyme-linked immunosorbent assay), RAST (Radioallergosorbent test) i RIE (Rocket Immuno-electrophoresis). Koja će se metoda detekcije primeniti, prvenstveno zavisi od dostupnosti alergena i praga njegove detekcije. Industija mesa je razvojem tehnologije uvela pojedine tehnološke prosece koji imaju mogućnost inaktivacije pojedinih alergena, pre svega proteina mesa ribe. Visoke temperature koje se primenjuju u obradi mesa ribe mogu uticati na ove alergene, tako što će smanjiti alergeni potencijal, dok neki tehnološki postipci nemaju tu mogućnost

Immune Response in Severe Infection: Could Life-Saving Drugs Be Potentially Harmful?

Critically ill patients suffer a high rate of nosocomial infection with secondary sepsis being a common cause of death. Usage of antibiotics and catecholamines is often necessary, but it can compromise complex immune response to infection. This review explores influence of these life-saving drugs on host immune response to severe infection

Predictive value of serum bicarbonate, arterial base deficit/excess and SAPS III score in critically ill patients

Abstract. Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically ill patients, but requires an arterial puncture and blood gas analysis. We hypothesized that serum bicarbonate (HCO 3 ), which can be routinely obtained, strongly correlates with arterial BD/E and provides equivalent predictive information. In addition, we evaluated predictive value of simplified acute physiology score III (SAPS III). Total of 152 critically ill surgical patients were included in retrospective analysis. On admission to intensive care unit sets of simultaneously obtained paired laboratory data, including an arterial blood gas and serum chemistry panel with serum HCO 3 were obtained. Very strong correlation between BD/E and simultaneously measured serum HCO 3 levels was found (r = 0.857, R 2 = 0.732, p &lt; 0.01). The serum HCO 3 level reliably identified a significant metabolic acidosis (AUC = 0.761, p &lt; 0.05). BD and SAPS III were good predictors of mortality (AUCs 0.70 and 0.74, respectively). Serum HCO 3 may be used as substitute to detect severe metabolic acidosis. BD and SAPS III score were good predictors of mortality

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Primordialistic concept of national identity in Serbia

Usually, two rivaling concepts of national identity are taken into consideration: primordialism, stemming from the principle that national identity is an unchangeable, unyielding and basic human category, given by birth and colored with irrational feelings; and instrumentalism, claiming that national identity is changeable, fluid and gain producing. This study investigated the dominant concept of national identity in Serbia and was based on two surveys conducted in August 2003 (n = 1004) and August 2006 (n = 1005) on representative samples of eligible voters. Both studies confirmed dominancy of the primordial concept of national identity in contemporary Serbia. Data from the 2006 survey point an even more homogenized primordial concept (defined by a single factor) of national identity relative to the data from the 2003 survey. Primordial concept of national identity suppresses the importance of the state, culture and politics. In times of strong social turbulences, individual is moving away from the socially dependent concept of national identity towards an individualistic, familial concept of national identity.