Duration effect of desflurane anesthesia and its awakening time and arterial concentration in gynecologic patients

OBJECTIVES: To determine the awakening arterial blood concentration of desflurane and its relationship with the end-tidal concentration during emergence from various durations of general anesthesia. METHOD: In total, 42 American Society of Anesthesiologists physical status class I-II female patients undergoing elective gynecologic surgery were enrolled. General anesthesia was maintained with fixed 6% inspiratory desflurane in 6 l min-1 oxygen until shutoff of the vaporizer at the end of surgery. One milliliter of arterial blood was obtained for desflurane concentration determination by gas chromatography at 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after the discontinuation of desflurane and at the time of eye opening upon verbal command, defined as awakening. Concentrations of inspiratory and end-tidal desflurane were simultaneously detected by an infrared analyzer. RESULTS: The mean arterial blood concentration of desflurane was 1.20% at awakening, which correlated with the awakening end-tidal concentration of 0.96%. The mean time from the discontinuation of desflurane to eye opening was 5.2 minutes (SD = 1.6, range 3-10), which was not associated with the duration of anesthesia (60-256 minutes), total fentanyl dose, or body mass index (BMI). CONCLUSIONS: The mean awakening arterial blood concentration of desflurane was 1.20%. The time to awakening was independent of anesthetic duration within four hours. Using well-assisted ventilation, the end-tidal concentration of desflurane was proven to represent the arterial blood concentration during elimination and could be a clinically feasible predictor of emergence from general anesthesia

Design of polymeric materials for culturing human pluripotent stem cells: progress toward feeder-free and xeno-free culturing

This review describes recent developments regarding the use of natural and synthetic polymers to support the propagation of human pluripotent stem cells (hPSCs), human embryonic stem cells (hESCs), and induced pluripotent stem cells (hiPSCs) while maintaining pluripotency in feeder-free and xeno-free cultures. The development of methods for culturing these cells without using mouse embryonic fibroblasts (MEFs) as a feeder layer will enable more reproducible culture conditions and reduce the risk of xenogenic contaminants, thus increasing the potential clinical applications of differentiated hPSCs. Human or recombinant fibronectin, laminin-511, and vitronectin, which are components of the extracellular matrix (ECM), have been used instead of Matrigel for the feeder-free growth of undifferentiated hPSCs. Successful hPSC cultures have been described for the following conditions: on oligopeptide-immobilized surfaces derived from vitronectin, on microcarriers prepared from synthetic polymers, and encapsulated within three-dimensional (3D) hydrogels composed of alginate and other hydrophilic natural polymers. Recently, synthetic biomaterials that allow hPSCs to maintain pluripotency by secreting endogenous ECM components have been designed. The combination of human ECM proteins or cell adhesion molecules (e.g., oligopeptides and poly-d-lysine) and synthetic biomaterials with well-designed surfaces and/or structures (e.g., scaffolds, hydrogels, microcarriers, microcapsules, or microfibers) in the presence of a chemically defined medium containing recombinant growth factors would offer a xeno-free alternative to feeder cells for culturing hPSCs and maintaining their pluripotency

Coexistent squamous cell carcinoma and adenoid basal carcinoma in the uterine cervix and infection with human papillomavirus (HPV 31)

AbstractObjectiveAdenoid basal carcinoma (ABC) is an uncommon neoplasm of the uterine cervix. ABC can be accompanied by carcinoma in situ or invasive carcinoma. Most cases are discovered accidentally during radical hysterectomy. ABC is associated with a high risk of human papillomavirus infection (HPV), most often HPV 16 infection.Case reportWe present a rare case of an 86-year-old Taiwanese married woman who suffered from bloody vaginal discharge and occasional lower abdominal pain and received cervical biopsy. The pathological report revealed squamous cell carcinoma (SCC) of the uterine cervix. After radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymph node dissection, the final pathological report revealed SCC coexisting with ABC, and both of the components were infected by HPV 31. After receiving radiotherapy, she maintained outpatient department follow-up.ConclusionA literature review revealed that this was a rare case of combined ABC–SCC associated with HPV 31 infection. In this case, the ABC component did not affect the tumor stage because it was confined to the cervix. However, we must avoid overestimating the clinical stage because the ABC component is thought to be a benign lesion

Purification and differentiation of human adipose-derived stem cells by membrane filtration and membrane migration methods

Human adipose-derived stem cells (hADSCs) are easily isolated from fat tissue without ethical concerns, but differ in purity, pluripotency, differentiation ability, and stem cell marker expression, depending on the isolation method. We isolated hADSCs from a primary fat tissue solution using: (1) conventional culture, (2) a membrane filtration method, (3) a membrane migration method where the primary cell solution was permeated through membranes, adhered hADSCs were cultured, and hADSCs migrated out from the membranes. Expression of mesenchymal stem cell markers and pluripotency genes, and osteogenic differentiation were compared for hADSCs isolated by different methods using nylon mesh filter membranes with pore sizes ranging from 11 to 80 μm. hADSCs isolated by the membrane migration method had the highest MSC surface marker expression and efficient differentiation into osteoblasts. Osteogenic differentiation ability of hADSCs and MSC surface marker expression were correlated, but osteogenic differentiation ability and pluripotent gene expression were not

Development of biomaterial surfaces with and without microbial nanosegments

Infections by microorganisms are a major problem in public health throughout the world. Artificial materials, including biomedical goods, inherently lack defense against microbial development. Therefore, microbial cells can adhere on any type of artificial surface, particularly in a moist environment, and start to multiply to form a huge population. In this review, we will discuss a strategy for designing antimicrobial polymers and antimicrobial surfaces. Generally, there are five types of antimicrobial polymers: (a) polymeric biocides, (b) biocidal polymers, (c) biocide-releasing polymers, (d) bioactive oligopeptides, and (e) antimicrobial surfaces. Antimicrobial surfaces preventing the growth of microorganisms are a promising method to inhibit the spread of microbial infections. The antimicrobial surfaces can reject the attachment of microbes and/or kill microbes in the vicinity and can be designed to kill microbes on contact. It is recommended that the material surface not release biocidal substances, therefore preventing exhaustion of biocide release to kill microbes. Furthermore, the antimicrobial surfaces are desired to be nontoxic to human cells. The development of contact-active antimicrobial surfaces by grafting antimicrobial nanosegments onto the material surface will be an important topic in the future

Pluripotency maintenance of amniotic fluid-derived stem cells cultured on biomaterials

The stem cell fates of pluripotency and differentiation are regulated by not only soluble biological cues but also insoluble biochemical cues (i.e., extracellular matrix (ECM)) and the physical cues of cell culture biomaterials (i.e., elasticity). We investigated the maintenance of pluripotency and the differentiation lineages of human amniotic fluid-derived stem cells (hAFSCs) cultured on poly(vinyl alcohol-co-itaconic acid) (PVA) hydrogels grafted with several types of ECM and corresponding oligopeptides in expansion medium. hAFSCs cultured on soft PVA hydrogels (12.2 kPa) that were grafted with oligopeptides derived from fibronectin and vitronectin showed high pluripotency, which was evaluated by Oct4, Sox2 and Nanog expression. The hAFSCs grown on soft PVA hydrogels (12.2 kPa) grafted with each oligopeptide showed higher pluripotency, as assessed by Oct4 and Nanog expression, than hAFSCs grown on stiff PVA hydrogels (25.3 kPa) grafted with the same oligopeptides and a much higher pluripotency than those grown on rigid tissue-culture polystyrene dishes. Soft biomaterials appeared to be adequate to maintain the pluripotency of hAFSCs. Surprisingly, hAFSCs that showed higher pluripotency on PVA hydrogels grafted with oligopeptides derived from fibronectin and vitronectin also expressed higher levels of early differentiation markers for three germ layers in expansion medium. This result suggests that hAFSCs are heterogeneous and that this population contains highly pluripotent stem cells and stem cells that can be easily differentiated

Effect of Obstructive Sleep Apnea on the Risk of Injuries—A Nationwide Population-Based Cohort Study

Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall injury. The data were collected during 2000–2015 from Taiwan’s National Health Insurance Research Database. A total of 8901 individuals diagnosed with OSA were inpatients, or outpatients at least three times were enrolled. Finally, 6915 participants with OSA were included as the study cohort. We matched the study cohort with a comparison cohort, at a ratio of 1:4. Cox proportional hazards regression was used to analyse the association between OSA and overall injury. Patients with OSA had 83.1% increased risk of overall injury, compared to non-OSA individuals [adjusted hazards ratio (HR) = 1.831, confidence interval (CI) = 1.674–2.020, p < 0.001]. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 2.014; CI = 1.842–2.222, p < 0.001). Patients with OSA were at a higher risk of falls, traffic injury, poisoning, suffocation, suicide, and abuse or homicide than non-OSA individuals, with falls and traffic injury as the leading causes of injuries. The data demonstrated that patients with OSA have a higher risk of overall injury. The study results can be a reference for developing injury prevention strategies in the future. The general population and clinicians should have more awareness regarding OSA and its negative effects on injury development

Physiological and pharmacological characterization of transmembrane acid extruders in cultured human umbilical artery smooth muscle cells

Background: Intracellular pH (pH i) is a pivotal factor for cellular functions and homeostasis. Apart from passive intracellular buffering capacity, active transmembrane transporters responsible for kinetic changes of pH i impacts. Acid extrusion transporters such as Na + /H + exchanger (NHE) and Na + /HCO3− cotransporter (NBC) have been found to be activated when cells are in an acidic condition in different cell types. However, such far, the pH i regulators have not been characterized in human umbilical artery smooth muscle cells (HUASMCs). Materials and Methods: We, therefore, investigated the mechanism of pH i recovery from intracellular acidosis, induced by NH 4 Cl-prepulse, using pH-sensitive fluorescence dye: 2′,7′-bis(2-carboxethyl)-5(6)-carboxy-fluorescein in HUASMCs. Cultured HUASMCs were derived from the segments of the human umbilical artery that were obtained from women undergoing children delivery. Results: The resting pH i is 7.23 ± 0.03 when cells in HEPES (nominally HCO 3− -free) buffered solution. The resting pH i is higher as 7.27 ± 0.03 when cells in CO 2 /HCO3− -buffered solution. In HEPES-buffered solution, a pH i recovery following induced intracellular acidosis could be inhibited completely by 30 μM HOE 694 (a specific NHE inhibitor) or by removing [Na +]o . In 5% CO2/HCO3− -buffered solution, 30 μM HOE 694 slowed the pH i recovery from the induced intracellular acidosis only. On the contrary, HOE 694 adding together with 0.2 mM 4,4′-diisothiocyanatostilbene-2,2′-disulphonic acid (a specific NBC inhibitor) or removal of [Na +]o entirely blocked the acid extrusion. By using Western blot technique, we demonstrated that four different isoforms of NBC, that is, SLC4A8 (NBCBE), SLC4A7 (NBCn1), SLC4A5 (NBCe2) and SLC4A4 (NBCe1), co-exist in the HUASMCs. Conclusions: We demonstrate, for the 1 st time, that apart from the housekeeping NHE1, another Na + couple HCO3− -transporter, that is, NBC, functionally coexists to responsible for acid-extruding in HUASMCs