The relationship between serum bilirubin level with interleukin.6, interleukin.10 and mortality scores in patients with sepsis

Context: Bilirubin has been shown to influence the mechanisms of both apoptosis and inflammation.Aims: The aim of the following study is to investigate the relationship between the serum bilirubin level with sepsis progression.Settings and Design: A total of 20 patients from intensive care unit were included for this study.Materials and Methods: Patients were divided into two groups: Patients diagnosed with sepsis according to the American College of Chest  Physicians/Society of Clinical Care Medicine consensus conference criteria (n = 10) and patients treated for various other diagnoses (n = 10). Blood samples were collected for both groups at the time of origin (defined as the time of diagnosis) and 24 and 48 h after diagnosis. Serum interleukin (IL).6, IL.10 and bilirubin levels were analyzed and compared. Acute physiology and chronic health evaluation (APACHE) II and sepsis related organ failure (SOFA) scores of the patients were also evaluated. Statistical Analysis Used: We used Statistical Package for Social Sciences (SPSS for Windows, version 17.0, SPSS Inc. 233 South Wacker Drive, Chicago) for statistical analysis.Results: At all.time intervals, serum IL.6, IL.10 and total, direct and  indirect serum bilirubin levels were significantly higher in the sepsis group (P < 0.05); APACHE II and SOFA scores were also significantly higher. Both SOFA scores and serum IL.10 levels were positively correlated with bilirubin levels 24 h after diagnosis (P < 0.05, r = .0.76).Conclusions: Although levels of bilirubin and other associated parameters were higher for the sepsis group, only SOFA score and bilirubin levels were correlated. Because bilirubin is already a SOFA parameter, this correlation was not considered as clinically significant.Key words: Acute physiology and chronic health evaluation, bilirubin, interleukin.6, interleukin.10, sepsi

Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy

Background: Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro‑immuno‑endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, can affect these reactions.Objective: The aim of this study was to evaluate the effect of the combination of general anesthesia and thoracic epidural analgesia (TEA) on cytokine reaction in laparoscopic cholecystectomy.Study Design: Prospective, randomized clinical comparative study.Materials and Methods: Sixty adult patients scheduled for elective laparoscopic cholecystectomy were divided into four groups. Group saline (Group S), group fentanyl (Group F), group bupivacaine (Group B), and group levobupivacaine (Group L) were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively, via epidural catheter before surgical incision.Results: There were no differences among groups in the demographic features, heart rate, mean arterial pressure, and peripheral oxygen saturation values. Group L had lower visual analogue scale value compared to the other postoperative groups (P < 0.01). In all groups, interleukin‑6 (IL‑6), IL‑8, and IL‑10 levels started to increase at 2 h and returned to the basal level at 24 h. IL levels increased in most of the epidural saline‑administered group compared to other groups (P < 0.05).Conclusion: Combined general anesthesia and TEA provided pain control and hemodynamic stability more efficiently during the first 24 h of the intraoperative and postoperative period by suppressing cytokine levels. However, we determined that this effect was more obvious with the local anesthetic and opioid combination.Keywords: Bupivacaine, combined‑general‑epidural anesthesia, inflammatory cytokines, laparoscopic cholecystectomy, levobupivacain

Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure

Context: Endotracheal tube cuff pressure (ETCP) is recommended to be maintained between 20.30 cmH2O limits. While insufficient inflation of ETC may cause aspirations, over.inflation of it may lead to damage in tracheal epithelium.Aims: We planned to investigate the effects of user experience and cuff pressure inflation method differences following endotracheal tube cuff pressure and complaints about it.Patients and Methods: Two hundred and fifty patients planned for general anaesthesia were included in this study. ETC was inflated by users with different experience according to leakage or pilot balloon palpation techniques. ETCPs were measured by manometer at three periods (5 and 60 minutes after endotracheal intubation, and before extubation). Complaints about it were recorded in post anaesthetic care unit and 24 hours postoperatively.Results: Though we found experience of user had significant effect on the ETCP regulations, we observed inflation methods did not have any effect. However we found ETCP was higher than normal range with experienced users. A correlation was observed between cuff pressure and anaesthesia duration with postoperative complaints.Conclusions: Our study concluded that the methods used do not have any significant advantage over one another. While ETC inflated at normal pressure increases as userfs experience increases, experience alone is not enough in adjusting ETCP. A manometer should be used in routine inflation of ETC instead of conventional methods. CP and anaesthesia duration have correlations with some postoperative complaints.Key words: Endotracheal tube cuff pressure, experience of user, inflation method

Comparison of anaesthetic cost in open and laparoscopic appendectomy

Context: Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia.Aims: This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopicappendectomy under general anesthesia.Settings and Design: The design is retrospective and records of 379 patients who underwent open or laparoscopicappendectomy under general anesthesia, falling under the category of I‑III risk group according to the American Societyof Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77.Subjects and Methods: Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesiawere evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluatedthe anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar $) of anesthetic agents used (induction,maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspirationprobe), and intravenously administered fluids were evaluated.Statistical Analysis Used: We used Statistical Package for the Social Sciences software (SPSS version 17.0) forstatistical analysis.Results: Of the patients, 237 were males (62.53$) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34$) inGroup II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158).Conclusions: Although a statistical difference was not established in this study in terms of time and costs inappendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditionsof drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update andrevise cost analyses from time to time.Keywords: Cost, cost comparison laparoscopic appendectomy, open appendectom

A randomised pilot Phase II study of doxorubicin and cyclophosphamide (AC) or epirubicin and cyclophosphamide (EC) given 2 weekly with pegfilgrastim (accelerated) vs 3 weekly (standard) for women with early breast cancer

Accelerated (dose-dense) chemotherapy, in which the frequency of administration is increased without changing total dose or duration, may increase the efficacy of cancer chemotherapy. We performed a randomised Phase II study to assess the safety and relative toxicity of AC (doxorubicin; cyclophosphamide) vs E(epirubicin)C given by conventional or accelerated schedules as neoadjuvant or adjuvant chemotherapy for early breast cancer. Furthermore, the relative toxicity of doxorubicin and epirubicin remains uncertain. Patients were randomised to one of four arms; four courses of standard 3 weekly cyclophosphamide 600 mg m−2 in combination with doxorubicin 60 mg m−2 (AC) vs epirubicin 90 mg m−2 (EC) 3 weekly vs the same regimens administered every 2 weeks with pegfilgrastim (G-CSF). A total of 126 patients were treated, 42 with standard AC, 42 with accelerated AC, 19 with standard EC and 23 with accelerated EC. Significantly more grade 3/4 day one neutropenia was seen with standard (6/61, 10%) compared to accelerated (0/65,) regimens (P=0.01). A trend towards more neutropenic sepsis was seen in the combined standard and accelerated AC arms (12/84, 14%) compared to the combined EC arms (1/42, 2%), P=0.06. Falls in left ventricular ejection fraction were not increased with accelerated treatment. Accelerated AC and EC with pegfilgrastim are safe and feasible regimens in the treatment of early breast cancer with less neutropenia than conventional 3 weekly schedules

Considering Trauma Exposure in the Context of Genetics Studies of Posttraumatic Stress Disorder: A Systematic Review

Background: Posttraumatic stress disorder (PTSD) is a debilitating anxiety disorder. Surveys of the general population suggest that while 50-85% of Americans will experience a traumatic event in their lifetime, only 2-50% will develop PTSD. Why some individuals develop PTSD following trauma exposure while others remain resilient is a central question in the field of trauma research. For more than half a century, the role of genetic influences on PTSD has been considered as a potential vulnerability factor. However, despite the exponential growth of molecular genetic studies over the past decade, limited progress has been made in identifying true genetic variants for PTSD. Methods: In an attempt to aid future genome wide association studies (GWAS), this paper presents a systematic review of 28 genetic association studies of PTSD. Inclusion criteria required that 1) all participants were exposed to Criterion A traumatic events, 2) polymorphisms of relevant genes were genotyped and assessed in relation to participants’ PTSD status, 3) quantitative methods were used, and 4) articles were published in English and in peer-reviewed journals. In the examination of these 28 studies, particular attention was given to variables related to trauma exposure (e.g. number of traumas, type of trauma). Results: Results indicated that most articles did not report on the GxE interaction in the context of PTSD or present data on the main effects of E despite having data available. Furthermore, some studies that did consider the GxE interaction had significant findings, underscoring the importance of examining how genotypes can modify the effect of trauma on PTSD. Additionally, results indicated that only a small number of genes continue to be studied and that there were marked differences in methodologies across studies, which subsequently limited robust conclusions. Conclusions: As trauma exposure is a necessary condition for the PTSD diagnosis, this paper identifies gaps in the current literature as well as provides recommendations for how future GWAS studies can most effectively incorporate trauma exposure data in both the design and analysis phases of studies

The taxanes: toxicity and quality of life considerations in advanced ovarian cancer

The taxanes paclitaxel and docetaxel show good activity in the management of advanced ovarian cancer when used in conjunction with platinum agents. Accumulating evidence from clinical studies, particularly the latest results from the phase III comparative SCOTROC study, indicates that the two drugs confer similar rates of tumour response and survival in women with this condition. However, it is clear that paclitaxel and docetaxel differ in their tolerability profiles and in other respects, and cannot be regarded as directly equivalent drugs. In particular, paclitaxel is associated with significant neurotoxicity; peripheral neuropathy has also been reported with docetaxel, but to a lesser extent. Neutropenia appears more prevalent with docetaxel than with paclitaxel, although clinical trial data show that this adverse effect is manageable and need not compromise dose delivery. Docetaxel is also associated with potential benefits accruing from shorter infusion times and lack of need for premedication with intravenous histamine H1 and H2 antagonists. Emerging quality of life data are expected to shed further light on the overall benefit of chemotherapy in women with advanced ovarian cancer in general, and on taxane−platinum combinations in particular

Histone Demethylase JMJD2B Functions as a Co-Factor of Estrogen Receptor in Breast Cancer Proliferation and Mammary Gland Development

Estrogen is a key regulator of normal function of female reproductive system and plays a pivotal role in the development and progression of breast cancer. Here, we demonstrate that JMJD2B (also known as KDM4B) constitutes a key component of the estrogen signaling pathway. JMJD2B is expressed in a high proportion of human breast tumors, and that expression levels significantly correlate with estrogen receptor (ER) positivity. In addition, 17-beta-estradiol (E2) induces JMJD2B expression in an ERα dependent manner. JMJD2B interacts with ERα and components of the SWI/SNF-B chromatin remodeling complex. JMJD2B is recruited to ERα target sites, demethylates H3K9me3 and facilitates transcription of ER responsive genes including MYB, MYC and CCND1. As a consequence, knockdown of JMJD2B severely impairs estrogen-induced cell proliferation and the tumor formation capacity of breast cancer cells. Furthermore, Jmjd2b-deletion in mammary epithelial cells exhibits delayed mammary gland development in female mice. Taken together, these findings suggest an essential role for JMJD2B in the estrogen signaling, and identify JMJD2B as a potential therapeutic target in breast cancer

As cold as a fish? Relationships between the Dark Triad personality traits and affective experience during the day: A day reconstruction study

The Dark Triad of personality is a cluster of three socially aversive personality traits: Machiavellianism, narcissism and psychopathy. These traits are associated with a selfish, aggressive and exploitative interpersonal strategy. The objective of the current study was to establish relationships between the Dark Triad traits (and their dimensions) and momentary affect. Machiavellianism, grandiose narcissism, vulnerable narcissism and the dimensions of the Triarchic model of psychopathy (namely, boldness, meanness and disinhibition) were examined. We used the Day Reconstruction Method, which is based on reconstructing affective states experienced during the previous day. The final sample consisted of 270 university students providing affective ratings of 3047 diary episodes. Analyses using multilevel modelling showed that only boldness had a positive association with positive affective states and affect balance, and a negative association with negative affective states. Grandiose narcissism and its sub-dimensions had no relationship with momentary affect. The other dark traits were related to negative momentary affect and/or inversely related to positive momentary affect and affect balance. As a whole, our results empirically demonstrated distinctiveness of the Dark Triad traits in their relationship to everyday affective states. These findings are not congruent with the notion that people with the Dark Triad traits, who have a dispositional tendency to manipulate and exploit others, are generally cold and invulnerable to negative feelings. The associations between the Dark Triad and momentary affect were discussed in the contexts of evolutionary and positive psychology, in relation to the role and adaptive value of positive and negative emotions experienced by individuals higher in Machiavellianism, narcissism and psychopathy