Circulatory responses to propofol-ketamine combination compared to propofol alone for sedation during spinal anesthesia

The present study was undertaken to establish the efficacy of low dosepropofol-ketamine infusion in maintaining hemodynamic stability when used for sedation as compared to propofol alone during spinal anesthesia. Sixty adult patients of either sex, belonging to ASA physical status I and II undergoing urological procedures were studied in a randomized manner. After administering spinal anesthesia with 0.5% bupivacaine,patients were assigned to two groups of 30 patients each. Group I (propofol-ketamine combination) received intial loading dose of propofol and ketamine followed by a continuous infusion of low dose propofol and ketamine whereas group II (propofol alone) received a bolus dose of propofol followed by a continuous infusion of propofol only. Hemodynamic parameters like heart rate, systolic blood pressure, diastolic blood pressure and sedation scores rated on a five point scale were recorded at baseline and at the predetermined intervals of 5, 10, 15, 20, 25, 30, 45, 60, 75 and 90 minutes after spinal anesthesia. It was found that heart rate, systolic and diastolic blood pressure was significantly higher in group I patients at various intervals as compared to group II patients, however sedation scores revealed no significant difference at different timeintervals between the two groups. In conclusion propofol-ketamine combination was found to confer hemodynamic stability during spinal anesthesia as compared to propofol alone

Bayesian Analysis of Generalized Exponential Distribution

Bayesian estimators of unknown parameters of a two parameter generalized exponential distribution are obtained based on non-informative priors using different loss functions

NASICON materials - a long neglected class of solid electrolytes

The so-called NASICON materials AT2P3O12 (A = alkaline metal, T = tetravalent transition metal) are known since the 1970s [1] and are derived from the first “Na+ super-ionic conductor”, Na3Zr2Si2PO12, of this group of materials. The aims of current investigations are on the one hand the better understanding of the ionic conduction and on the other hand the search for new materials with very high ionic conductivity. For this purpose, new and simple synthesis methods have been developed, which deliver very homogeneous powders with reduced temperatures for the preparation of ceramics. In this way a lithium ion conductor with the composition Li1.5Al0.5Ti1.5P3O12 was manufactured. After sintering to highly dense ceramics a total conductivity of 0.7 mS/cm was achieved at room temperature [2] and therefore this material belongs to the best known solid oxidic Li+ ion conductors. NMR and impedance spectroscopy investigations [3-5] have shown that the bulk conductivity amounts to 3-5 mS/cm and that the grain boundaries determine the quality of the material. In the case of Na+ ion conductors, the prototype Na3Zr2Si2PO12 was newly synthesized and gave a previously not achieved conductivity of 1 mS/cm [6]. The modification of the composition by substitution with scandium delivered conductivities of 0.8 mS/cm (Na3.4Sc2Si0.4P2.6O12) [7] and 4 mS/cm (Na3.4Zr1.6Sc0.4Si2PO12) [8]. The latter composition possesses one of the highest known Na+ ion conductivities of oxide ceramics and reaches the conductivity of liquid electrolytes. The mentioned compositions confirm the empirical criteria which are necessary for achieving high ionic conductivities in NASICON materials [9]. References: [1] H. Y. P. Hong, Mater. Res. Bull. 11 (1976) 173-182; H. Y. P. Hong, J. B. Goodenough, J. A. Kafalas, Mater. Res. Bull. 11 (1976) 203-220 [2] Q. Ma, Q. Xu, C.-L. Tsai, F. Tietz, O. Guillon, J. Am. Ceram. Soc., (2016), in press [3] V. Epp, Q. Ma, F. Tietz, M. Wilkening, Phys. Chem. Chem. Phys., 17 (2015) 32115-32121 [4] S. Breuer, D. Prutsch, V. Epp, Q. Ma, F. Preishuber-Pflügl, F. Tietz, M. Wilkening, J. Mater. Chem. A, 3 (2015) 21343-21350 [5] D. Rettenwander, A. Welzl, S. Pristat, F. Tietz, S. Taibl, G. J. Redhammer, J. Fleig, J. Chem. Mater. A, 4 (2016) 1506-1513 [6] S. Naqash, Q. Ma, Tietz, O. Guillon, in preparation [7] M. Guin, F. Tietz, O. Guillon, in preparation [8] Q. Ma, M. Guin, S. Naqash, C.-L. Tsai, F. Tietz, O. Guillon, in preparation [9] M. Guin, F. Tietz, J. Power Sources, 273 (2015) 1056-106

Influence of ionic conductivity of the nano-particulate coating phase on oxygen surface exchange of La0.58Sr0.4Co0.2Fe0.8O3-δ

The oxygen surface exchange kinetics of mixed-conducting perovskite La0.58Sr0.4Co0.2Fe0.8O3 d (LSCF) ceramics coated with a porous nano-particulate layer of either gadolinea (Gd2O3), ceria (CeO2) or 20 mol% Gd-doped ceria (GCO) was determined by electrical conductivity relaxation (ECR). The measurements were performed in the temperature range 700–900 C, following pO2-step changes between 0.2 and 0.4 atm. The apparent value of the surface exchange coefficient, kchem, is found to vary with the loading amount and ionic conductivity of the coated phase whilst, as expected, the chemical diffusion coefficient Dchem remains invariant with the applied coating. Partial coverage of the LSCF surface with non-ionic conductive Gd2O3 or CeO2 lowers the value of kchem relative to that observed for bare LSCF, which is attributed to surface blocking effects. In contrast, partial coverage of LSCF with GCO electrolyte particles enhances the apparent value of kchem up to a factor of 6 compared to bare LSCF. The data of pulse isotope exchange (PIE) measurements show that the surface exchange reaction on bare LSCF is predominantly limited by dissociative adsorption of O2. Different mechanisms for the improved oxygen surface exchange kinetics after partially covering the LSCF surface with GCO are discussed

Emerging Role of Immune Checkpoint Blockade in Pancreatic Cancer

Immune checkpoint blockade (ICB) with programmed cell death protein-1(PD-1)/programmed death ligand -1(PD-L1) antibodies has revolutionized the management of several cancers, especially non-small cell lung cancer, melanoma, urothelial, and renal cancer. Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers associated with high morbidity and mortality. Based on available data, it’s obvious that ICB has limited success in PDACs, which can be explained by the low immunogenicity and immunosuppressive tumor microenvironment of these tumors. In this review article, we focus on PD-L1 expression and microsatellite instability (MSI) in PDAC, and their roles as prognostic and predictive markers. We also discuss data supporting combination therapies to augment cancer immunity cycle. Combining anti-PD-1/PD-L1 agents with other modalities such as vaccines, chemotherapy, and radiation could potentially overcome resistance patterns and increase immune responsiveness in PDA

Papillary carcinoma thyroid with metastasis to ectopic cervical thymus

Papillary carcinoma of thyroid is the most common type of thyroid neoplasm which is usually confined to the thyroid and tends to metastasize to regional lymph nodes. Distant metastasis occur in up to 15% of cases. Thymic metastasis from any malignant carcinoma is extremely rare with only four cases reported in medical literature. We report a case of papillary carcinoma of thyroid metastasizing to ectopic cervical thymus which has not been previously reported

Biosynthesis and Degradation of Carotenoids in Ornamental Crops with specific reference to Chrysanthemum

Carotenoids are lipophilic secondary metabolites derived from the isoprenoid pathway, accumulated in most plant organs and widely used as an antioxidant. Carotenoids synthesized in chloroplasts are essential for protecting tissues against photo-oxidative damage in the green tissues of higher plants. The importance of carotenoids for plant growth and development is evident since at least two major phytohormones, strigolactones and abscisic acid, are derived from carotenoid precursors. In flowers, carotenoids synthesized in the chromoplasts provide colour to the petals, ranging from yellow to red, in order to attract pollinators and determines the commercial value of ornamental plants. On analysis in chrysanthemum, β, ɛ-carotenoids, lutein and its derivatives, reflecting the high expression levels of lycopene ɛ-cyclase (LCYE) were found in yellow petals compared to the ratio of β, β-carotenoids to total carotenoids found in leaves reflecting the high expression levels of lycopene β-cyclase (LCYB). Petals of the yellow-flowered cultivar Yellow Paragon showed increased accumulation and drastic componential changes of carotenoids as they mature, compared to petals of the white-flowered cultivar Paragon that showed drastically decreased carotenoid content during petal development.The white petals of chrysanthemum (Chrysanthemum morifolium Ramat.) contain a factor that inhibits the accumulation of carotenoids. All the white-flowered chrysanthemum cultivars tested showed high levels of CmCCD4a transcript in their petals, whereas most of the yellow flowered cultivars showed extremely low levels indicating that in white petals of chrysanthemums, carotenoids are synthesized but subsequently degraded into colourless compounds, which results in the white colour. Studying the regulatory mechanisms underlying carotenoid accumulation in ornamental plants at the molecular level will help in producing novel coloured cultivars by plant transformation

The molecular characterisation of Escherichia coli K1 isolated from neonatal nasogastric feeding tubes

Background: The most common cause of Gram-negative bacterial neonatal meningitis is E. coli K1. It has a mortality rate of 10–15%, and neurological sequelae in 30– 50% of cases. Infections can be attributable to nosocomial sources, however the pre-colonisation of enteral feeding tubes has not been considered as a specific risk factor. Methods: Thirty E. coli strains, which had been isolated in an earlier study, from the residual lumen liquid and biofilms of neonatal nasogastric feeding tubes were genotyped using pulsed-field gel electrophoresis, and 7-loci multilocus sequence typing. Potential pathogenicity and biofilm associated traits were determined using specific PCR probes, genome analysis, and in vitro tissue culture assays. Results: The E. coli strains clustered into five pulsotypes, which were genotyped as sequence types (ST) 95, 73, 127, 394 and 2076 (Achman scheme). The extra-intestinal pathogenic E. coli (ExPEC) phylogenetic group B2 ST95 serotype O1:K1:NM strains had been isolated over a 2 week period from 11 neonates who were on different feeding regimes. The E. coli K1 ST95 strains encoded for various virulence traits associated with neonatal meningitis and extracellular matrix formation. These strains attached and invaded intestinal, and both human and rat brain cell lines, and persisted for 48 h in U937 macrophages. E. coli STs 73, 394 and 2076 also persisted in macrophages and invaded Caco-2 and human brain cells, but only ST394 invaded rat brain cells. E. coli ST127 was notable as it did not invade any cell lines. Conclusions: Routes by which E. coli K1 can be disseminated within a neonatal intensive care unit are uncertain, however the colonisation of neonatal enteral feeding tubes may be one reservoir source which could constitute a serious health risk to neonates following ingestion

Resumption of immune checkpoint inhibitor therapy after immune-mediated colitis

PURPOSE: Immune checkpoint inhibitor (ICI) therapy often is suspended because of immune-mediated diarrhea and colitis (IMDC). We examined the rate of and risk factors for IMDC recurrence after ICI resumption. METHODS: This retrospective multicenter study examined patients who resumed ICI therapy after improvement of IMDC between January 2010 and November 2018. Univariable and multivariable logistic regression analyses assessed the association of clinical covariates and IMDC recurrence. RESULTS: Of the 167 patients in our analysis, 32 resumed an anti-cytotoxic T-cell lymphocyte-4 (CTLA-4) agent, and 135 an anti-programmed cell death 1 or ligand 1 (PD-1/L1) agent. The median age was 60 years (interquartile range [IQR], 50-69 years). The median duration from IMDC to restart of ICI treatment was 49 days (IQR, 23-136 days). IMDC recurred in 57 patients (34%) overall (44% of those receiving an anti-CTLA-4 and 32% of those receiving an anti-PD-1/L1); 47 of these patients (82%) required immunosuppressive therapy for recurrent IMDC, and all required permanent discontinuation of ICI therapy. The median duration from ICI resumption to IMDC recurrence was 53 days (IQR, 22-138 days). On multivariable logistic regression, patients who received anti-PD-1/L1 therapy at initial IMDC had a higher risk of IMDC recurrence (odds ratio [OR], 3.45; 95% CI, 1.59 to 7.69; P = .002). Risk of IMDC recurrence was higher for patients who required immunosuppression for initial IMDC (OR, 3.22; 95% CI, 1.08 to 9.62; P = .019) or had a longer duration of IMDC symptoms in the initial episode (OR, 1.01; 95% CI, 1.00 to 1.03; P = .031). Risk of IMDC recurrence was lower after resumption of anti-PD-1/L1 therapy than after resumption of anti-CTLA-4 therapy (OR, 0.30; 95% CI, 0.11 to 0.81; P = .019). CONCLUSION: One third of patients who resumed ICI treatment after IMDC experienced recurrent IMDC. Recurrence of IMDC was less frequent after resumption of anti-PD-1/L1 than after resumption of anti-CTLA-4

Solid-state synthesis of NASICON (Na3Zr2Si2PO12) using nanoparticle precursors for optimisation of ionic conductivity

In this work, the effect of varying the size of the precursor raw materials SiO2 and ZrO2 in the solid-state synthesis of NASICON in the form Na3Zr2Si2PO12 was studied. Nanoscale and macro-scale precursor materials were selected for comparison purposes, and a range of sintering times were examined (10, 24 and 40 h) at a temperature of 1230 °C. Na3Zr2Si2PO12 pellets produced from nanopowder precursors were found to produce substantially higher ionic conductivities, with improved morphology and higher density than those produced from larger micron-scaled precursors. The nanoparticle precursors were shown to give a maximum ionic conductivity of 1.16 × 10−3 S cm−1 when sintered at 1230 °C for 40 h, in the higher range of published solid-state Na3Zr2Si2PO12 conductivities. The macro-precursors gave lower ionic conductivity of 0.62 × 10−3 S cm−1 under the same processing conditions. Most current authors do not quote or consider the precursor particle size for solid-state synthesis of Na3Zr2Si2PO12. This study shows the importance of precursor powder particle size in the microstructure and performance of Na3Zr2Si2PO12 during solid-state synthesis and offers a route to improved predictability and consistency of the manufacturing process