Sustained Delivery of Activated Rho GTPases and BDNF Promotes Axon Growth in CSPG-Rich Regions Following Spinal Cord Injury

Background: Spinal cord injury (SCI) often results in permanent functional loss. This physical trauma leads to secondary events, such as the deposition of inhibitory chondroitin sulfate proteoglycan (CSPG) within astroglial scar tissue at the lesion. Methodology/Principal Findings: We examined whether local delivery of constitutively active (CA) Rho GTPases, Cdc42 and Rac1 to the lesion site alleviated CSPG-mediated inhibition of regenerating axons. A dorsal over-hemisection lesion was created in the rat spinal cord and the resulting cavity was conformally filled with an in situ gelling hydrogel combined with lipid microtubes that slowly released constitutively active (CA) Cdc42, Rac1, or Brain-derived neurotrophic factor (BDNF). Treatment with BDNF, CA-Cdc42, or CA-Rac1 reduced the number of GFAP-positive astrocytes, as well as CSPG deposition, at the interface of the implanted hydrogel and host tissue. Neurofilament 160kDa positively stained axons traversed the glial scar extensively, entering the hydrogel-filled cavity in the treatments with BDNF and CA-Rho GTPases. The treated animals had a higher percentage of axons from the corticospinal tract that traversed the CSPG-rich regions located proximal to the lesion site. Conclusion: Local delivery of CA-Cdc42, CA-Rac1, and BDNF may have a significant therapeutic role in overcoming CSPGmediate

Anaesthesia preference, neuraxial vs general, and outcome after caesarean section

We investigated parturients' preference for neuraxial vs general anaesthesia, while they have experienced both techniques in the past. A total of 102 parturients who underwent elective caesarean section under general or neuraxial anaesthesia at different times completed a questionnaire comparing the two techniques. According to our results, 98% vs 51% (p<0.001) of the women saw the baby and 51% vs 29% (p0.003) ambulated in the neuraxial and general anaesthesia groups, respectively, within the first 24h postoperatively. Neuraxial anaesthesia was associated with less pain assessed by the Verbal Analogue Scale VAS (54±21 vs 72±20 p<0.001), fewer days of hospital stay (4±0.5 vs 5±1.5, p0.001) and higher satisfaction scores (77±18 vs 52±24, p0.001) vs general anaesthesia. Finally, 80 of the women would choose neuraxial anaesthesia for a future caesarean section. © 2010 Informa UK, Ltd

Recovery and cognitive function after fentanyl or remifentanil administration for carotid endarterectomy

Study Objective: To compare recovery and restoration of cognitive function after fentanyl-propofol or remifentanil-propofol anesthesia administration in patients undergoing carotid endarterectomy. Design: Randomized, double-blind, prospective study. Setting: Department of Anesthesiology, University hospital. Patients: Seventy patients with ASA physical statuses II and III (53 men and 17 women) undergoing elective carotid endarterectomy. Interventions: Anesthetic technique and drugs were identical in the 2 groups, with the exception of remifentanil and fentanyl administration. Induction of anesthesia was obtained with a bolus dose of propofol (1-2 mg/kg), maintenance was achieved with a propofol infusion according to hemodynamics and nitrous oxide/oxygen (FIO2, 0.50). Muscle relaxation was achieved with rocuronium. The remifentanil group received I mu g/kg of remifentanil as a single dose during the-induction of anesthesia and 0.5 mu g/kg per minute as an infusion throughout the procedure. The fentanyl group received 2 mu g/kg of fentanyl as a single dose during the induction of anesthesia. Measurements: Intraoperative hemodynamic adverse events were recorded. All patients were also evaluated with regard to their recovery and the restoration of their cognitive function, recording the immediate recovery times and using the Aldrete score 15 and 60 minutes after surgery and the Hasegawa scale 6 hours after surgery. For evaluation of postoperative pain, the Numeric Pain Scale (0-10) was used. Main Results: Patients receiving remifentanil had significantly (P <.05) fewer episodes of intraoperative hypertension and needed nitroglycerine administration less frequently (P <.05) than those receiving fentanyl. Immediate recovery was significantly earlier (P <.05) with remifentanil (eye opening, 5.1 +/- 1.3 [remifentanil] and 7.2 +/- 3.7 [fentanyl] minutes; extubation time, 5.4 +/- 1.9 [remifentanil] and 7.8 +/- 4.1 [fentanyl] minutes). The Hasegawa Dementia Scale scores 6 hours after surgery and Aldrete scores 15 and 60 minutes after surgery did not differ significantly between the 2 groups. Pain levels were also similar for patients taking remifentanil and fentanyl. Conclusions: Although intraoperative hemodynamics were better preserved and immediate recovery was more rapid with remifentanil, overall postoperative recovery and restoration of cognitive functions as well as postoperative pain intensity seem to be similar for patients receiving remifentanil and for those receiving fentanyl combined with propofol for carotid endarterectomy operations. (c) 2005 Elsevier Inc. All rights reserved

Intra-articular morphine enhances analgesic efficacy of ropivacaine for knee arthroscopy in ambulatory patients

The aim of this double-blind, randomized control trial was to compare the effectiveness of intra-articular ropivacaine alone or with morphine or ketoprofen for controlling pain after arthroscopic knee surgery. One hundred fifty-six patients scheduled for elective knee arthroscopy were recruited. All patients received general anesthesia and were randomly assigned to 4 groups to receive intraropivacaine 40 mg (group R), ropivacaine 24 mg plus morphine 8 mg (group R+M), ropivacaine 36 mg plus ketoprofen 100 mg (group R+K), or normal saline (group N/S). Pain, sedation, orientation, nausea, vomiting, and urine retention were recorded at 0, 1, 2, 4, 8, 12, and 24 hours postoperatively. Pain was evaluated by a 10-cm visual analog scale (VAS). When the pain was >2, a suppository of 400 paracetamol plus 10 mg codeine plus 50 mg caffeine was given. Results showed that at 4 hours postoperatively, pain differed significantly among the 4 groups (P<.001), with less pain recorded in the R+M group. Similarly, the number of suppositories administered postoperatively to the R+M group was significantly less (P<.001) vs the other groups. Patients who received ropivacaine and morphine or normal saline had a higher incidence of nausea and vomiting vs the other groups (P=.001 and P=.036, respectively). The combination of intra-articular ropivacaine and morphine is associated with less pain after knee arthroscopy during early recovery but with a higher incidence of nausea and vomiting. However, the addition of ketoprofen to ropivacaine provides relatively satisfactory pain relief, but with fewer side effects compared to morphine

Effect of early changes in functional geometry of left ventricular contraction on the development of ventricular fibrillation during acute myocardial ischaemia. An experimental study

Objective: The early appearance of ventricular fibrillation (VF) following acute myocardial infarction (MI) is associated with adrenergic effects and electrical interactions although some early " mechanical" changes may also occur. The aim of the present experimental study was to examine whether early changes in the functional geometry of left ventricular (LV) contraction may be associated with ventricular arrhythmias occurring during the first 120. min of MI. Methods: In 11 swine left anterior descending (LAD) coronary artery ligation was performed. Aortic flow, LV end-diastolic pressure (LVEDP), LV long and short axis lengths were measured and their fractional shortening (FS) was calculated before and during the initial 120. min period of MI. Results: LV long axis FS and aortic flow decreased (p< 0.001) whereas LVEDP increased (p< 0.01) in all 11 animals within 30. min following LAD ligation. LV long and short axis lengths and LV short axis FS did not change significantly. VF occurred in 5 of the 11 animals within this 30. min period. LV short axis FS decreased (p< 0.05) in all 5 animals prior to VF and increased (p< 0.05) in all 6 animals without VF. In 3 of the 6 animals that had no VF during the initial 30. min VF occurred later. Similarly, LV short axis FS decreased prior to VF in all those 3 animals. LV short axis FS did not decrease in any of the remaining 3 swine without VF during the same period of time. Conclusion: Early changes in the functional geometry of LV contraction, in the form of a reduction of LV short axis FS, are associated with a greater incidence of VF in experimental acute MI. © 2010 Elsevier Ireland Ltd

Pacing within the ischemic area significantly decreases the left ventricular ejection fraction during experimental acute myocardial infarction

Background: The aim of this study was to examine the effects on left ventricular (LV) function of LV apical or/and lateral wall pacing during an experimental acute myocardial infarction. Methods: In 12 anesthetized pigs, epicardial LV pacing at the apex or lateral wall, or at both sites simultaneously, was performed before and after left anterior descending (LAD) ligation. Data concerning LV function were obtained by two-dimensional echo during spontaneous sinus rhythm (SR) and during pacing before and 15, 45, 60, and 90 minutes after LAD ligation. Results: Before ligation of the LAD, pacing at the lateral wall (48.04 ± 6.25%) or both sites (45.71 ± 6.31%) reduced the LV ejection fraction (EF) significantly (P < 0.01) in comparison to SR (55.44 ± 4.10%). However, during pacing at the apex (50.19 ± 6.50%), the reduction was not significant. After LAD ligation, the EF during lateral pacing (43.02 ± 7.71%) was significantly higher than during apical pacing (38.78 ± 8.26%, P < 0.04) but was not significantly different from that during dual-site pacing (41.65 ± 8.69%). Conclusions: Pacing within the ischemic LV apical zone after LAD ligation impairs left ventricular ejection fraction, as compared with pacing the nonischemic LV lateral wall, and should therefore be avoided in clinical settings where the LV pacing site may be chosen. (PACE 2011; 63-71) ©2010 Wiley Periodicals, Inc