Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis

BACKGROUND: Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems. METHODS: We performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles. RESULTS: Twelve studies included 14,105 patients, of whom 5,026 (36%) had vascular surgery, 4,971 (35%) cardiac surgery, and 4,108 (29%) thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850). There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600). CONCLUSION: These estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding

A phosphotyrosine-imprinted polymer receptor for the recognition of tyrosine-phosphorylated peptides.

Synthesis of a molecularly imprinted polymer (MIP) for selective SPE extraction of peptides hyperphosphorylated at tyrosine. Proof of concept is presented by using HPLC and microLC on models such as phosphorylated angiotensin II in the presence of an excess of its non-phosphorylated counterpart. This approach appears suited for targeting disease biomarkers. One of the first MIPs capable to recognize peptides or protein epitopes thus advocating the usage for the recognition of biotechnological drugs. Sintesi di un materiale per estrazione in fase solida (SPE) altamente specifico per l’analisi qualitativa (riconoscimento) di peptidi iperfosforilati alla tirosina. Verifica mediante HPLC e microLC su modelli quali l’angiotensina II fosforilata e non fosforilata. Applicazione per l’analisi qualitativa di sostanze aventi attività biologica o tossicologica e per la diagnostica di patologie tumorali. Uno dei primi esempi di MIPs in grado di riconoscere peptidi o epitopi di proteine, preconizza l’impiego per il riconoscimento di farmaci biotecnologici

Bis(cyclopentadienyl)titanium complexes of naphthalene-1,8-dithiolates, biphenyl 2,2 '-dithiolates, and related ligands

Titanocene 1,8-dithiolato-naphthalene and titanocene 2,2'-dithiolato biphenyl are produced by the reaction of naphtho[1,8-cd]-1,2-dithiole [or the biphenyl] with titanocene dicarbonyl (Ti(II)) in toluene at room temperature. The proligands 2,7-di(tert-butyl)naphtho[1,8-cd]-1,2-dithiole, 5,6-dihydroacenaphtho[5,6-cd]-1,2-dithiole, 4,5-dithioacephenanthrylene, and 13,14-dithiapicene have been used in similar reactions with titanocene dicarbonyl to investigate the effect of steric bulk and of varying the naphthalene backbone on the final complex. The resulting Cp2TiS2Ar complexes (Ar = naphthalene) have been shown by temperature-dependent H-1 NMR spectroscopy to exist in solution in an envelope conformation with the six-membered TiS2C3 rings undergoing inversion on the NMR time scale while the similar Cp2TiS2Ar complexes (Ar = biphenyl, binaphthalene) interconvert more rapidly. Titanocene 2,2'-disulfinato biphenyl has been synthesized by the salt elimination reaction of titanocene dichloride (Ti(IV)) and the disodium salt of biphenyl 2,2'-disulfinic acid. Finally, the effect of using pro-ligands where the sulfur atoms have been mono- or di-oxidized has been studied, and an interesting oxygen elimination reaction is observed for the S=O fragments but not for the SO2 groups. All complexes have been characterized spectroscopically and seven X-ray structures are reported