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Baicalin isolated from Scutellaria baicalensis is a traditional Chinese herbal medicine used for cardiovascular dysfunction. The ionic mechanism of the vasorelaxant effects of baicalin remains unclear. We investigated whether baicalin relaxes mesenteric arteries (MAs) via large-conductance Ca2+-activated K+ (BK(Ca)) channel activation and voltage-dependent Ca2+ channel (VDCC) inhibition. The contractility of MA was determined by dual wire myograph. BK(Ca) channels and VDCCs were measured using whole-cell recordings in single myocytes, enzymatically dispersed from rat MAs. Baicalin (10-100 microM) attenuated 80 mM KCl-contracted MA in a concentration-related manner. L-NAME (30 microM) and indomethacin (10 microM) little affected baicalin (100 microM)-induced vasorelaxations. Contractions induced by iberiotoxin (IbTX, 0.1 microM), Bay K8644 (0.1 microM) or PMA (10 microM) were abolished by baicalin 100 microM. In MA myocytes, baicalin (0.3-30 microM) enhanced BK(Ca) channel activity in a concentration-dependent manner. Increased BK(Ca) currents were abolished by IbTX (0.1 microM). Baicalin-mediated (30 microM) BK(Ca) current activation was significantly attenuated by an adenylate cyclase inhibitor (SQ 22536, 10 microM), a soluble guanylate cyclase inhibitor (ODQ, 10 microM), competitive antagonists of cAMP and cGMP (Rp-cAMP, 100 microM and Rp-cGMP, 100 microM), and cAMP- and cGMP-dependent protein kinase inhibitors (KT5720, 0.3 microM and KT5823, 0.3 microM). Perfusate with PMA (0.1 microM) abolished baicalin-enhanced BK(Ca) currents. Additionally, baicalin (0.3-30 microM) reduced the amplitude of VDCC currents in a concentration-dependent manner and abolished VDCC activator Bay K8644-enhanced (0.1 microM) currents. Baicalin produced MA relaxation by activating BK(Ca) and inhibiting VDCC channels by endothelium-independent mechanisms and by stimulating the cGMP/PKG and cAMP/PKA pathways. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke. METHODS: Twenty-five subjects (mean age 63 yr) participated in a repeated measures design that evaluated the subjects with two baseline assessments 1 month apart, one postintervention assessment, and one retention assessment 1 month postintervention. Physical outcome measures assessed were the Berg Balance Test, 12-Minute Walk Test distance, gait speed, and stair climbing speed. Psychosocial measures assessed were the Reintegration to Normal Living Index (RNL) and Canadian Occupational Performance Measure (COPM). The 8-wk training consisted of a 60-min, 3 x wk-1 group program that focused on balance, mobility, functional strength, and functional capacity. The program was designed to be accessible by reducing the need for costly one-on-one supervision, specialized settings, and expensive equipment. RESULTS: Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention. Subjects with lower function improved the most relative to their initial physical status. Significant effects were found for the COPM, but not the RNL Index; however, subjects with lower RNL improved the most relative to their initial RNL Score. CONCLUSION: A short-term community-based exercise program can improve and retain mobility, functional capacity, and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects. Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke (e.g., falls resulting in fractures and cardiac events). [ABSTRACT FROM AUTHOR]

The increased number of people taking part in deep water running (DWR) is attributable to the weight-independent characteristic of this form of exercise. Deep water runners should, however, be aware of the respiratory and cardiovascular repercussions that result from exercising in water. It has been well documented that water immersion (WI) alone results in decrements in respiratory and cardiovascular parameters in young individuals immersed in water to the neck. These decrements become more pronounced with exercise, such that maximal oxygen consumption and heart rate (HR) are lower during DWR compared with running on land. Age also seems to influence these parameters; Derion et al. found little to no change in cardiac output, stroke volume and HR during WI in older individuals compared with the decrease experienced in younger individuals. In contrast, gender appears to have no effect on WI or DWR response. Although differences in acute metabolic responses have been observed in numerous studies, training studies examining the effectiveness of using a DWR training programme found that DWR produced equivocal training responses when compared with fit and highly trained individuals running on land. Less convincing evidence has been provided for untrained individuals seeking benefits from a DWR training programme, as some studies showed significant improvements while others did not. There is a current lack of knowledge regarding the use of this form of exercise by frail elderly individuals and/or those with osteoporosis. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to evaluate the frequency of incidental suspicious lesions detected by flourine-18 fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) scans done for staging or restaging in adult cancer patients. We further determined the detection rate of synchronous and metachronous malignancies in these suspicious lesions after further investigations., Materials and Methods: This retrospective analysis evaluated the consecutive patients with 18 F-FDG PET/CT scans done in Queen Elizabeth Hospital (QEH), Hong Kong between July 2021 and June 2022. The adult cancer patients who underwent staging or restaging 8 F-FDG PET/CT were included while the remaining were excluded. Patients' demographics, primary cancer type, tumor markers, and pathological analyses for the incidental suspicious lesions were reviewed to establish the detection rate of synchronous and metachronous malignancies., Results: A total of 2054 patients fulfilled inclusion criteria with age ranging from 18 to 93 years old. Out of the 2054 patients, 304 (14.8%) were found to have incidental suspicious lesions. Of these, 206 patients (67.8%) underwent further investigations including pathological analyses. Subsequently, 84 of these 206 patients (40.8%) had pathologically proven synchronous or metachronous malignancies., Conclusion: The detection rate of incidental suspicious lesions in adult cancer patients who underwent 18 F-FDG PET/CT scans for staging or restaging was 14.8% and the rate of synchronous and metachronous malignancies in these suspicious lesions was 40.8%. The treatment plan of these patients may potentially be altered, which should be included in the cost-benefit analysis of using this imaging modality., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Brain metastases may manifest as hypermetabolism or hypometabolism compared with normal brain activity on 18 fluorine-fluorodeoxyglucose PET ( 18 F-FDG PET). We aim to undertake a systematic review and meta-analysis to determine the diagnostic accuracy of FDG PET for detecting brain metastases from different extracranial primary cancers., Methods: PubMed and EMBASE were searched systematically. Study selection and quality assessment were performed independently by two authors. Meta-analysis was performed using a bivariate random-effects model. Subgroup analysis and meta-regression would be performed if heterogeneity was found., Results: A total of 2227 patients from 11 studies were included in the review and analysis. Using the bivariate random-effects model, summary patient-based sensitivity and specificity for all 11 studies were estimated to be 0.440 [95% confidence interval (CI)] 0.295-0.597) and 0.997 (95% CI, 0.977-1.000). In view of significant between-study heterogeneity ( I2  = 74.0% for sensitivity and I2  = 67.3% for specificity), subgroup analyses were performed. Meta-regression showed significantly higher patient-based summary sensitivity for the three better-quality studies (a total of 1037 patients) with satisfactory index test (counting both hypermetabolism and hypometabolism as positive index test) and satisfactory reference standards (other imaging and clinical follow-up) compared with other included studies [0.735 (95% CI, 0.601-0.836) vs 0.304 (95% CI, 0.223-0.400), P value = 0.000]., Conclusion: Our systematic review and meta-analysis showed that FDG PET has overall limited sensitivity and excellent specificity in the detection of brain metastases from extracranial primary cancers. Importantly, subgroup analyses showed that the sensitivity can be significantly improved by raising awareness of asymmetrical hypometabolism. Further studies are warranted to assess the benefits of including the brain in FDG PET studies for all or certain groups of oncological patients., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Although heptagons are widely found in graphenic materials, the precise synthesis of nanocarbons containing heptagons remains a challenge, especially for the nanocarbons containing multiple-heptagons. Herein, we show that photo-induced radical cyclization (PIRC) can be used to synthesize multi-heptagon-embedded nanocarbons. Notably, a nanographene containing six heptagons (1) was obtained via a six-fold cascade PIRC reaction. The structure of 1 was clearly validated and showed a Monkey-saddle-shaped conformation. Experimental bond analysis and theoretical calculations indicated that the heptagons in 1 were non-aromatic, whereas the peripheral rings were highly aromatic. Compared to planar nanographene with the same number of π electrons, 1 had a similar optical gap due to a compromise between the decreased conjugation in the wrapped structure and enhanced electronic delocalization at the rim. Electrochemical studies showed that 1 had low-lying oxidation potentials, which was attributed to the nitrogen-doping., (© 2022 Wiley-VCH GmbH.)

Well-studied cycloparaphenylenes (CPPs) correspond to the simplest segments of armchair CNTs, whereas the corresponding macrocyclic oligophenylene strip of zigzag CNTs is still missing. Herein, we present two series of conjugated macrocycles (CM2PP and CN2PP) containing two meta -phenylene or 2,7-naphthylene units facing each other in the strip. CM2PP and CN2PP can be regarded as the shortest cyclic primitive segments of zigzag CNTs. They were synthesized by gold-mediated dimerization and unambiguously characterized. They adopted the tubular structures and can further pack into one-dimensional supramolecular nanotubes. In particular, the supramolecular nanotube of CM2P4P mimics the CNT(9, 0) structure. Structural analysis and theoretical calculation accounted for the reduced ring strain in CM2PPs and CN2PPs. CM2PPs and CN2PPs exhibited a large optical extinction coefficient and high photoluminescence quantum yield. CN2P8P can accommodate fullerene C 60 , forming a Saturn-like C 60 @CN2P8P complex, a mimic structure of zigzag CNT peapods., Competing Interests: The authors declare no conflict of interest., (This journal is © The Royal Society of Chemistry.)

Purpose: To determine the feasibility of a randomized controlled trial of delayed umbilical cord clamping in preterm infants., Methods: Following informed consent, women between 24 to 32 weeks gestation experiencing imminent preterm birth were randomly assigned to either an immediate cord clamping (ICC) or delayed cord clamping (DCC) group. Umbilical cord clamping directions were 0-15 s for the ICC group and 30-45 s for the DCC group. Information regarding recruitment rate and trial compliance was collected. Neonatal outcomes of intraventricular hemorrhage (IVH), sepsis, anemia, and hyperbilirubinemia were also compared between the two groups. This trial was registered at https://clinicaltrials.gov/. (ClinicalTrials.gov Identifier: NCT00562536)., Results: Thirty-eight women were recruited in total, 19 each to the ICC and DCC groups respectively. The study recruitment rate was 33% and study compliance rate was 97%. The average time for cord clamping was 5.4 s in the ICC group and 39.7 s in the DCC group ( p  < .05). The incidence of IVH and sepsis was the same in both groups (16 and 11% respectively). Thirty-seven percent of the ICC group and 21% of the DCC group required a blood transfusion. Hyperbilirubinemia requiring phototherapy occurred in 37% of the ICC group and 26% of the DCC group., Conclusion: This study demonstrates that a trial of a short delay in umbilical cord clamping (30-45 s) is feasible for women and physicians. Larger scale studies of long term outcomes are warranted.

The radial conjugated π-system of cycloparaphenylenes (CPPs) makes them intriguing fluorophores and unique supramolecular hosts. However, the bright photoluminescence (PL) of CPPs was limited to the blue light and the supramolecular assembly behavior of large CPPs was rarely investigated. Here we present the synthesis of tetra-benzothiadiazole-based [12]cycloparaphenylene (TB[12]CPP), which exhibits a lime to orange PL with an excellent quantum yield up to 82 % in solution. The PL quantum yield of TB[12]CPP can be further improved to 98 % in polymer matrix. Benefiting from its enlarged size, TB[12]CPP can accommodate a fullerene derivative or concave-convex complexes of fullerene and buckybowl through the combined π-π and C-H⋅⋅⋅π interactions. The latter demonstrates the first case of a ternary supramolecule of CPPs., (© 2020 Wiley-VCH GmbH.)

Novel treatment strategies, including nanomedicine, are needed for improving management of triple-negative breast cancer. Patients with triple-negative breast cancer, when considered as a group, have a worse outcome after chemotherapy than patients with breast cancers of other subtypes, a finding that reflects the intrinsically adverse prognosis associated with the disease. The aim of this study was to improve the efficacy of docetaxel by incorporation into a novel nanoparticle platform for the treatment of taxane-resistant triple-negative breast cancer. Rod-shaped nanoparticles encapsulating docetaxel were fabricated using an imprint lithography based technique referred to as Particle Replication in Nonwetting Templates (PRINT). These rod-shaped PLGA-docetaxel nanoparticles were tested in the C3(1)-T-antigen (C3Tag) genetically engineered mouse model (GEMM) of breast cancer that represents the basal-like subtype of triple-negative breast cancer and is resistant to therapeutics from the taxane family. This GEMM recapitulates the genetics of the human disease and is reflective of patient outcome and, therefore, better represents the clinical impact of new therapeutics. Pharmacokinetic analysis showed that delivery of these PLGA-docetaxel nanoparticles increased docetaxel circulation time and provided similar docetaxel exposure to tumor compared to the clinical formulation of docetaxel, Taxotere. These PLGA-docetaxel nanoparticles improved tumor growth inhibition and significantly increased median survival time. This study demonstrates the potential of nanotechnology to improve the therapeutic index of chemotherapies and rescue therapeutic efficacy to treat nonresponsive cancers.

The purpose of this study was to investigate the antitumor effects of a combination of metronomic doses of a novel delivery vehicle, PLGA-PRINT nanoparticles containing docetaxel, and antiangiogenic mEZH2 siRNA incorporated into chitosan nanoparticles. In vivo dose-finding studies and therapeutic experiments were conducted in well-established orthotopic mouse models of epithelial ovarian cancer. Antitumor effects were determined on the basis of reduction in mean tumor weight and number of metastatic tumor nodules in the animals. The tumor tissues from these in vivo studies were stained to evaluate the proliferation index (Ki67), apoptosis index (cleaved caspase 3), and microvessel density (CD31). The lowest dose of metronomic regimen (0.5 mg/kg) resulted in significant reduction in tumor growth. The combination of PLGA-PRINT-docetaxel and CH-mEZH2 siRNA showed significant antitumor effects in the HeyA8 and SKOV3ip1 tumor models (P < 0.05). Individual as well as combination therapies showed significant antiangiogenic, antiproliferative, and proapoptotic effects, and combination therapy had additive effects. Metronomic delivery of PLGA-PRINT-docetaxel combined with CH-mEZH2 siRNA has significant antitumor activity in preclinical models of ovarian cancer., (©2014 American Association for Cancer Research.)

Delivery systems designed to have triggered release after passively targeting the tumor may improve small molecule chemotherapeutic delivery. Particle replication in nonwetting templates was used to prepare nanoparticles to passively target solid tumors in an A549 subcutaneous xenograft model. An acid labile prodrug was delivered to minimize systemic free docetaxel concentrations and improve tolerability without compromising efficacy.

Nanoparticle (NP) drug loading is one of the key defining characteristics of an NP formulation. However, the effect of NP drug loading on therapeutic efficacy and pharmacokinetics has not been thoroughly evaluated. Herein, we characterized the efficacy, toxicity and pharmacokinetic properties of NP docetaxel formulations that have differential drug loading but are otherwise identical. Particle Replication in Non-wetting Templates (PRINT(®)), a soft-lithography fabrication technique, was used to formulate NPs with identical size, shape and surface chemistry, but with variable docetaxel loading. The lower weight loading (9%-NP) of docetaxel was found to have a superior pharmacokinetic profile and enhanced efficacy in a murine cancer model when compared to that of a higher docetaxel loading (20%-NP). The 9%-NP docetaxel increased plasma and tumor docetaxel exposure and reduced liver, spleen and lung exposure when compared to that of 20%-NP docetaxel., (© 2013 Elsevier Ltd. All rights reserved.)

Scalable methods, PRINT particle fabrication, and spray-assisted Layer-by-Layer deposition are combined to generate uniform and functional nanotechnologies with precise control over composition, size, shape, and surface functionality. A modular and tunable approach towards design of built-to-order nanoparticle systems, spray coating on PRINT particles is demonstrated to achieve technologies capable of targeted interactions with cancer cells for applications in drug delivery., (Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The particle fabrication technique PRINT® was used to fabricate monodisperse size and shape specific poly(lactide-co-glycolide) particles loaded with the chemotherapeutic Docetaxel. The pharmacokinetics of two cylindrical shaped particles with diameter=80nm; height=320nm (PRINT-Doc-80×320) and d=200nm; h=200nm (PRINT-Doc-200×200) were compared to Docetaxel in mice bearing human ovarian carcinoma SKOV-3 flank xenografts. The Docetaxel plasma exposure was ~20-fold higher for both particles compared to docetaxel. Additionally, the volume of distribution (Vd) of Docetaxel in PRINT formulations was ~18-fold (PRINT-Doc-80×320) and ~33-fold (PRINT-Doc-200×200) lower than Docetaxel. The prolonged duration of Docetaxel in plasma when dosed with PRINT formulations subsequently led to increased tumor exposure of Docetaxel from 0 to 168h (~53% higher for PRINT-Doc-80×320 and ~76% higher for PRINT-Doc-200×200 particles). PRINT-Doc-80×320 had lower exposures in the liver, spleen and lung compared with PRINT-Doc-200×200. Thus, the use of particles with smaller feature size may be preferred to decrease clearance by organs of the mononuclear phagocyte system., From the Clinical Editor: In this study, the plasma, tumor, and tissue pharmacokinetics of different Docetaxel nanoparticles of precise shape and size were characterized in mice with human ovarian carcinoma xenograft. It is concluded that the use of particles with smaller feature size may be preferred to decrease clearance by organs of the mononuclear phagocyte system., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Target-controlled infusion (TCI) of propofol is an effective way of delivering propofol during endoscopy. However, the ideal effect-site concentration (Ce) of propofol has not yet been defined in an Asian population. This study aimed to determine the ideal Ce of propofol in painless gastrointestinal endoscopy in a Taiwanese population., Methods: A total of 121 consecutive patients undergoing diagnostic endoscopy were recruited for this study. The endoscopic procedure was carried out within 1 h. TCI of propofol was utilized during the procedure. All patients received the same regimen to induce conscious sedation, including a bolus of midazolam (0.04 mg/kg) and fentanyl (0.5 μg/kg). The Ce of propofol was calculated using the Schneider model. Patients were randomly assigned to either the low Ce group (1.5-2.5 μg/mL) or high Ce group (3.0-4.0 μg/mL). Their cardiovascular and respiratory events were monitored during the procedure and the patients' post-procedure satisfaction was evaluated., Results: The mean requirement for propofol was 232.02 mg in the low Ce group and 329.56 mg in the high Ce group, respectively (P < 0.0001). No unexpected event was observed in either group. However, more episodes of hypotension were observed in the high Ce group (P = 0.026). The post-procedure satisfaction rate between the two groups was comparable., Conclusion: A low Ce of propofol TCI (1.5-2.5 μg/mL) achieved adequate anesthesia, reduced the risk of hypotension, and attained a high satisfaction rate in a Taiwanese population undergoing diagnostic painless endoscopy., (© 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

Background: Despite gradual understanding of the multidimensional health consequences of betel-quid chewing, information on the effects of dependent use is scant., Aims: To investigate the 12-month prevalence patterns of betel-quid dependence in six Asian populations and the impact of this dependence on oral potentially malignant disorders (OPMD)., Method: A multistage random sample of 8922 participants was recruited from Taiwan, mainland China, Indonesia, Malaysia, Sri Lanka and Nepal. Participants were evaluated for betel-quid dependency using DSM-IV and ICD-10 criteria and assessed clinically for oral mucosal lesions., Results: The 12-month prevalence of dependence was 2.8-39.2% across the six Asian samples, and 20.9-99.6% of those who chewed betel-quid were betel-quid dependent. Men dominated the prevalence among the east Asian samples and women dominated the prevalence in south-east Asian samples. 'Time spent chewing' and 'craving' were the central dependence domains endorsed by the Chinese and southern/south-east Asian samples respectively, whereas the Nepalese samples endorsed 'tolerance' and 'withdrawal'. Dependency was linked to age, gender, schooling years, drinking, smoking, tobacco-added betel-quid use and environmental accessibility of betel-quid. Compared with non-users, those with betel-quid dependency had higher pre-neoplastic risks (adjusted odds ratios 8.0-51.3) than people with non-dependent betel-quid use (adjusted odds ratio 4.5-5.9) in the six Asian populations., Conclusions: By elucidating differences in domain-level symptoms of betel-quid dependency and individual and environmental factors, this study draws attention to the population-level psychiatric problems of betel-quid chewing that undermine health consequences for OPMD in six Asian communities.

Benzalkonium chloride (BAC) is commonly used as a bactericidal preservative and it may cause allergic reactions in some patients. An unusual case of anaphylactic shock in a 55-year-old woman following insertion of a central venous catheter (CVC) that was coated with BAC is presented. Assuming anaphylactic shock from the CVC, the catheter was removed immediately. Standard resuscitation was started with 100% oxygen, epinephrine, and saline infusion. The patient recovered without any sequelae. One month later, an intradermal skin test was positive for BAC., (Copyright © 2010 Elsevier Inc. All rights reserved.)

KMUP-1 inhibits monocrotaline (MCT)-induced pulmonary artery (PA) proliferation by targeting serotonin (5-HT) receptors, inactivating RhoA and reducing phosphorylation of AKT/ERK. In MCT-treated rats, KMUP-1 f (5 mg/kg p.o.; 1mg/kg i.p.x 21 days) decreased proliferation (PCNA-positive) cells and 5-HTT-expression in lung and 5-HT levels in plasma. In isolated PA, KMUP-1 and simvastatin (0.1-100 μM) inhibited 5-HT (10 μM)-induced PA constriction. l-NAME-pretreatment reduced KMUP-1-induced relaxation. In pulmonary arterial smooth muscle cells (PASMCs), KMUP-1 (1-100 μM) and simvastatin (10 μM) inhibited 5-HT-induced cell migration and proliferation and KMUP-1 (1-100 μM) inhibited 5-HT-induced Ca²+ influx. Similar to Y27632, KMUP-1 (1-100 μM) inhibited 5-HT-induced RhoA/ROCK expression, while KMUP-1, Y27632 and simvastatin at 10 μM inhibited 5-HT-induced 5-HTT expression and KMUP-1 inhibited 5-HT-induced phosphorylation of AKT and ERK1/2 in PASMCs. In human pulmonary arterial endothelial cell (HPAEC), KMUP-1 (1-100 μM) increased the expression of eNOS and 5-HT(2B) and also at 10 μM augmented eNOS expression and production of nitric oxide (NO) in 5-HT-treated HPAEC. In radioligand binding, the IC₅₀/K(i) values of KMUP-1 for 5-HT(2A), 5-HT(2B) and 5-HT(2C) receptors were 0.34/0.0971, 0.04/0.0254, and 0.408/0.214 μM respectively. In conclusion, KMUP-1 inhibits MCT-induced PA proliferation by binding to 5-HT(2A), 5-HT(2B) and 5-HT(2C) receptors, increasing endothelial eNOS/5-HT(2B) receptor expression and NO release and inhibiting 5-HTT/RhoA/ROCK expression and AKT/ERK phosphorylation. KMUP-1 is suggested to be useful in the treatment of 5-HT-induced pulmonary artery proliferation., (Copyright © 2010 Elsevier Inc. All rights reserved.)

We report a facile and reliable method to fabricate polymer-based monolithic nanofluidic channels. The nanochannels are obtained via three main steps: (1) fabrication of nanowire-transistor like structures, which are silver or zinc oxide nanowires horizontally bridging two electrodes made of zinc oxide on SiO(2)/Si substrates; (2) casting and curing polyimide solution on the nanowire structures; and (3) selective etching of the nanowire and electrode templates against the polyimide substrates. This process leads to the production of nanochannels with a diameter down to ∼ 50 nm. Our method is based on nanowires that are chemically synthesized whereas nanopattern fabrication conventionally relies on expensive equipment. Moreover, the polymer nanochannels are fabricated monolithically while a process of bonding two different materials is required in traditional methods where leakage problems are often identified at the interface. Construction of nanofluidic circuitry could be expected in the future based on the current work.

Objective: The objective of this study was to find a nondepolarizing muscle relaxant to replace succinylcholine during thyroid surgery with intraoperative neuromonitoring (IONM) because succinylcholine can cause severe adverse effects., Design: Prospective study of 232 patients undergoing thyroidectomies., Setting: A tertiary medical centre., Methods: One hundred thirty-one patients received 0.5 mg/kg rocuronium (group R) and 101 patients received 0.5 mg/kg atracurium (group A) to facilitate electromyographic (EMG) endotracheal tube insertion. EMG signals were obtained from the vagus nerve before and after dissection of the recurrent laryngeal nerve and were defined as the V1 and the V2 signal, respectively. Accelerometry (twitch [% TW]) was used to monitor the quantitative degree of neuromuscular transmission at the adductor pollicis muscle., Main Outcome Measures: The amplitude (muV) of the V1 and V2 signals and the correlated degree of neuromuscular transmission (% TW)., Results: V1 and V2 signals were obtained from all patients successfully. The % TW at the V1 signal was significantly lower than that at the V2 signal in group R and group A. The mean recovery time from complete neuromuscular blockade to the initial twitch was 43.9 +/- 11 minutes. Only in the subgroup in which the correlated TW was 0% while eliciting the V1 signal were the amplitudes of the V1 signals significantly lower than those of the V2 signal in both groups., Conclusions: A single dose (0.5 mg/kg) of rocuronium and atracurium was feasible for IONM during thyroid surgery. This study showed that 44 minutes after administration of these two muscle relaxants is adequate for eliciting an EMG signal from the vagus nerve.

Background and Purpose: KMUP-1 is known to increase cGMP, enhance endothelial nitric oxide synthase (eNOS) and suppress Rho kinase (ROCK) expression in smooth muscle. Here, we investigated the mechanism of action of KMUP-1 on acute and chronic pulmonary artery hypertension (PAH) in rats., Experimental Approach: We measured pulmonary vascular contractility, wall thickening, eNOS immunostaining, expressions of ROCK II, RhoA activation, myosin phosphatase target subunit 1 (MYPT1) phosphorylation, eNOS, soluble guanylyl cyclase (sGC), protein kinase G (PKG) and phosphodiesterase 5A (PDE-5A), blood oxygenation and cGMP/cAMP, and right ventricular hypertrophy (RVH) in rats., Key Results: In rings of intact pulmonary artery (PA), KMUP-1 relaxed the vasoconstriction induced by phenylephrine (10 microM) or the thromboxane A(2)-mimetic U46619 (0.5 microM). In endothelium-denuded PA rings, this relaxation was reduced. In acute PAH induced by U46619 (2.5 microg x kg(-1) x min(-1), 30 min), KMUP-1 relaxed vasoconstriction by enhancing levels of eNOS, sGC and PKG, suppressing those of PDE-5A, RhoA/ROCK II activation and MYPT1 phosphorylation, and restoring oxygenation in blood and cGMP/cAMP in plasma. Incubating smooth muscle cells from PA (PASMCs) with KMUP-1 inhibited thapsigargin-induced Ca(2+) efflux and angiotensin II-induced Ca(2+) influx. In chronic PAH model induced by monocrotaline, KMUP-1 increased eNOS and reduced RhoA/ROCK II activation/expression, PA wall thickening, eNOS immunostaining and RVH. KMUP-1 and sildenafil did not inhibit monocrotaline-induced PDE-5A expression., Conclusion and Implications: KMUP-1 decreased PAH by enhancing NO synthesis by eNOS, with consequent cGMP-dependent inhibition of RhoA/ROCK II and Ca(2+) desensitization in PASMCs. KMUP-1 has the potential to reduce vascular resistance, remodelling and RVH in PAH.

Fibreoptic intubation is a valuable modality for airway management. This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 microg.kg(-1) over 10 min) (n = 20) or the propofol target controlled infusion group (n = 20). Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (19/20 in each group). The median (IOR [range]) comfort score was 2 (1-2 [1-4]) in the dexmedetomidine group and 3 (2-4 [2-5]) in the propofol group (p = 0.027), favouring the former. The dexmedetomidine group experienced fewer airway events and less heart rate response to intubation than the propofol group (p < 0.003 and p = 0.007, respectively). Both dexmedetomidine and propofol target-controlled infusion are effective for fibreoptic intubation. Dexmedetomidine allows better tolerance, more stable haemodynamic status and preserves a patent airway.

Background: Local anesthetics exert their anesthetic and analgesic effects by blocking the sodium channels in the nervous system. Phenothiazine-type antipsychotics also block sodium channels, but the local anesthetic characteristics of these drugs have not been evaluated. The aim of this study was to evaluate the cutaneous analgesic effect of phenothiazine-type antipsychotics., Methods: Using a subcutaneous injection model in rats, we tested the cutaneous analgesic effects of six phenothiazine-type antipsychotics (mesoridazine, promazine, chlorpromazine, fluphenazine, perphenazine and triflupromazine) at a dose of 0.6 mumol, and compared them with those of bupivacaine and lidocaine. A saline injection was used as the control., Results: All six phenothiazine-type antipsychotics elicited cutaneous analgesia. At the dose of 0.6 mumol, the potencies of mesoridazine and promazine were similar to that of bupivacaine; the other four drugs were less potent (p<0.001 for each comparison). Mesoridazine had a longer duration of action than bupivacaine (p<0.001). In terms of ED(50) values, mesoridazine was more potent and longer-acting than bupivacaine and lidocaine (p<0.01 for each comparison)., Conclusion: Of the antipsychotic drugs tested, mesoridazine is potentially the best candidate for development into a potent, long-acting local anesthetic. However, toxicity studies are needed before these agents can be used clinically as analgesics., (2010 Taiwan Society of Anesthesiologists. Published by Elsevier B.V. All rights reserved.)

One-lung ventilation (OLV) is essential in some surgical situations. The use of double- lumen tubes (DLTs) can achieve OLV more quickly and more easily than bronchial blockers. The management of a difficult airway is a challenge for anesthesiologists when, at the same time, OLV is needed for a surgical procedure. This report describes the successful application of DLTs in two patients with difficult airways, and who were scheduled for pulmonary decortication. Case 1 already had a permanent tracheostomy, while Case 2 had oral cancer with an extremely limited mouth opening and needed elective tracheostomy for anesthesia. Nasal intubation of Case 2 was done with fiberoptic-guided intubation with the patient awake. OLV was achieved uneventfully after inserting the DLT directly through the tracheostomy in both cases. We also describe the appropriate use of airway devices for OLV, focusing on patients with an anticipated difficult airway., (2010 Taiwan Society of Anesthesiologists. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: To predict the clinicopathologic factors for early relapse of UICC stage I-III colorectal cancer (CRC) patients undergoing curative resection and thus to identify a subgroup of patients who are at high risk for postoperative early relapse., Methods: Between January 2001 and June 2007, a total of 778 UICC stage I-III CRC patients who underwent a radical resection and regular follow-up were retrospectively analyzed. Of these 778 CRC patients, 521 colon cancer and 257 rectal cancer cases were analyzed, respectively, to determine the predictors of early relapse postoperatively. These 778 patients were followed-up intensively, and their outcomes were investigated retrospectively., Results: Out of 521 colon cancer patients, postoperative relapse after primary resection was found in 142 (27.3%) patients, and 77 (54.2%) of 142 recurrent colon cancer patients were classified as postoperative early relapse. Meanwhile, among 257 rectal cancer patients, postoperative relapse was found in 68 (26.5%) patients and 44 (64.7%) of 68 recurrent rectal cancer patients were identified as postoperative early relapse. Forty-nine (63.6%) of 77 early relapsed colon cancer patients were stage III, and likewise, 26 (59.1%) of 44 early relapsed rectal cancer patients were stage III. Univariately, postoperative early relapse of colon cancer patients was significantly correlated with the presence of vascular invasion (P < 0.001), perineural invasion (P < 0.001), high postoperative carcinoembryonic antigen (CEA) level (P = 0.001), and type of surgery (P = 0.016). Using a Cox proportional hazards analysis, the presence of vascular invasion (P = 0.033), perineural invasion (P = 0.005), and high postoperative CEA levels (P = 0.001) were demonstrated to be independent predictors of postoperative early relapse of colon cancer patients, while in rectal cancer patients, both vascular invasion (P = 0.039) and perineural invasion (P = 0.008) were statistically significant predictors of early relapse by univariate analysis. Using a Cox proportional hazards analysis, only perineural invasion (P = 0.043) was an independent factor. Early relapse cases had significant lower overall survival rates than non-early relapse cases either in colon cancer (P < 0.001) or in rectal cancer (P = 0.0091) patients., Conclusions: This study suggests that vascular invasion, perineural invasion, and postoperative CEA level may be significant factors for postoperative early relapse of colon cancer; while only perineural invasion is considered to be a significant predictor in rectal cancer patients. Identification of these high-risk UICC stage I-III CRC patients of early relapse is important, and thus could help to define patients with this tumor entity for an enhanced follow-up and therapeutic program., (Copyright 2009 Wiley-Liss, Inc.)

Objective: Catheterization of the internal jugular vein (IJV) after placement of a laryngeal mask airway (LMA) has been reported to be difficult. The purpose of this study was to evaluate the accuracy of the central landmark for catheterization of the right IJV after placement of a ProSeal LMA., Methods: We enrolled 80 patients (30 men and 50 women) who were scheduled to undergo surgery under general anesthesia conveyed by a size 3 ProSeal LMA. A needle pathway based on the central landmark for right IJV catheterization was simulated. Ultrasound images were obtained, which we contrasted with the simulated pathway to evaluate whether the landmark accuracy remained unchanged after placement of the ProSeal LMA. Both frequency of simulated right carotid artery (CA) puncture and overlap between the right IJV and right CA were also investigated., Results: The simulated needle pathway ran along the course of the right IJV in 60% (48/80) of subjects, and transected the CA in 31.3% (25/80) of subjects. Both events together occurred in 20% (16/80) of subjects. The central landmark had a medial bias of 6.8 mm (95% confidence interval, 5.3-8.4). In 83.8% (67/80) of subjects, the center of the right IJV was lateral to the central landmark. The possibility of overlap of the right IJV and CA was high after ProSeal LMA placement., Conclusion: After placement of the ProSeal LMA, the central landmark could not offer a good success rate at the first puncture attempt. When using the central landmark to catheterize the IJV after a ProSeal LMA placement, medial deviation of the central landmark should be considered. Ultrasound guidance may be helpful in difficult cases.

Background: The aim of this study was to determine influence of prognostic factors in addition to UICC staging systems, on cancer-specific and overall survival rates for patients with colorectal cancer (CRC) undergoing surgical treatment., Methods: Between January 1996 and December 2006, a total of 1367 CRC patients who underwent surgical treatment in Kaohsiung Medical University Hospital were analyzed. We retrospectively investigated clinicopathologic features of these patients. All patients were followed up intensively, and their outcomes were investigated completely., Results: Of 1367 CRC patients, there were seven hundred and fifty-seven males (55.4%) and 610 (44.6%) females. The median follow-up period was 60 months (range, 3-132 months). A multivariate analysis identified that low serum albumin level (P = 0.011), advanced UICC stage (P < 0.001), and high carcinoembryonic antigen (CEA) level (P < 0.001) were independent prognostic factors of cancer-specific survival. Meanwhile, a multivariate analysis showed age over 65 years (P < 0.001), advanced UICC stage (P < 0.001), and high CEA level (P < 0.001) were independent prognostic factors of overall survival. Furthermore, combination of UICC stage, serum CEA and albumin levels as predictors of cancer-specific survival showed that the poorer the prognostic factors involved, the poorer the cancer-specific survival rate. Likewise, combination of UICC stage, age and serum CEA level as predictors of overall survival showed that the poorer the prognostic factors involved, the poorer the overall survival rate. Of these prognostic factors, preoperative serum CEA level was the only significant prognostic factor for patients with stage II and III CRCs in both cancer-specific and overall survival categories., Conclusion: Preoperative serum albumin level, CEA level and age could prominently affect postoperative outcome of CRC patients undergoing surgical treatment. In addition to conventional UICC staging system, it might be imperative to take these additional characteristics of factors into account in CRC patients prior to surgical treatment.

In craniofacial trauma patients, oral route endotracheal intubation may thwart the accuracy of dental occlusion and nasotracheal intubation carries the risk of intracranial invasion in skull base fracture cases. Between November 2005 and June 2006, patients receiving facial bone fracture operations at Kaohsiung Medical University Hospital were enrolled in this study. Intraoperatively, the endotracheal tube was pushed to either the retromolar space or the missing tooth space and secured by two 4.0 silk stitches. Then, surgeons could perform the usual procedure to explore the fracture sites, check the occlusion and correct the deviated nose without limitation. Also, for better understanding the time needed for various intubation techniques, a time-measuring study was performed. Ninety-one patients were treated by this method. Most of them were satisfied with the result of occlusion and nasal contour. Only 2 patients received second surgery to correct nasal deformity. One hundred seventeen anesthesia procedures were checked. In average, an experienced anesthesiologist could successfully intubate a patient in less than 105 seconds. The advantages and reported complications of different intubation methods were discussed. This retromolar position and tooth fixation technique allowed surgeons to correct the dental occlusion and nasal deformity simultaneously. It has served well for zygoma fracture, maxilla fracture, and Le Fort II fracture patients. It is worthy of consideration in management of middle face trauma patients involving occlusion change and nasal deviation.

Objectives: To evaluate the efficacy of a fixed dose of radioactive iodine (131-I) in the treatment of thyrotoxicosis, and to identify risk factors associated with treatment failure., Design: Retrospective study., Setting: Thyroid Clinic of a regional hospital in Hong Kong., Patients: Patients receiving their first dose of radioactive iodine for the treatment of thyrotoxicosis during the inclusive period September 1999 to August 2004., Main Outcome Measures: Relapse rate and time to relapse., Results: A total of 113 patients received a fixed dose of 5 mCi (185 MBq), 6 mCi (222 MBq), 8 mCi (296 MBq), and 10 mCi (370 MBq) 131-I in a proportion of 1:6:71:35. At 1 year, 42 (37%) of the patients had relapsed, of which 69% received a second 131-I dose. The median time to relapse after first receiving 131-I was 4 months. At 1 year, the remaining 71 (63%) of the patients were successfully treated; 46 (41%) were euthyroid, and 25 (22%) had became permanently hypothyroid. Basal free thyroxine level and goitre size were significantly associated with a relapse rate after a single dose of 131-I; larger goitres showed a trend towards high rates of relapse. Patients pretreated with propylthiouracil had a higher rate of relapse during the first year after radioactive iodine than those pretreated with carbimazole, but the difference was not significant when combined with other pretreatment variables., Conclusions: A single fixed dose of radioactive iodine is a simple, safe, and effective treatment for hyperthyroidism. High basal free thyroxine concentration and large goitre size are associated with higher chance of relapse. Higher radioiodine doses may be considered to improve the cure rate.

Two important issues after a complete right forearm amputation are replantation and ongoing pain management. There are no reports of successful forearm replantation as a consequence of a crocodile bite. Here, we discuss our pain management in a case of complete forearm amputation after a bite from a saltwater crocodile (Crocodylus porosus), which necessitated six further operations to achieve successful replantation. Continuous infraclavicular brachial plexus block was effective for acute pain control in this case. We strongly recommend performing the block with an indwelling catheter under ultrasound guidance for higher accuracy and safety.

Background: A short-acting depolarizing neuromuscular blocking agent (NMBA), succinylcholine, has been utilized for thyroid operations with intraoperative neuromonitoring (IONM). Because of its potential to cause serious side effects, this prospective study tried to determine the feasibility of IONM after administration of a nondepolarizing NMBA during thyroid operations., Methods: Complete IONM data for 179 patients who had normal cord mobility were investigated: 90 patients received an induction dose of rocuronium (group R) and 89 received atracurium (group A). Electromyography signals were obtained from the vagus nerve before and after resection of the thyroid lobe and were defined as V(1) and V(2) signals, respectively. Accelerometry (percent twitch) was used to monitor the quantitative degree of neuromuscular blockade., Results: V(1) and V(2) signals were obtained successfully in all patients. The percent twitch at the V(1) signal was significantly lower than that at the V(2) signal in both groups (39% +/- 20% vs. 69% +/- 26% in group R; 35% +/- 28% vs. 56% +/- 35 % in group A; both p < 0.01). However, the magnitude of the V(1) and V(2) signals did not differ significantly in either in group (473.8 +/- 290.8 microV vs. 528 +/- 316.2 microV in group R; 584.8 +/- 394.3 microV vs. 637.8 +/- 458.2 microV in group A; both p > 0.05)., Conclusions: A single dose of either rocuronium or atracurium was feasible for IONM during thyroid surgery and provided adequate muscle relaxation for tracheal intubation.

Purpose: Previously we developed membrane-arrays as a promising tool to detect circulating tumor cells (CTC) with KRAS oncogene in patients with malignancies. This study was conducted to determinate the predictive values of CTCs with KARS mutation by membrane-arrays for metastatic colorectal cancer patients treated with cetuximab plus chemotherapy., Experimental Design: Seventy-six metastatic colorectal cancer patients receiving cetuximab plus FOLFIRI or FOLFOX-4 chemotherapy were enrolled. KRAS mutation status in the peripheral blood of these patients was analyzed using membrane-arrays, and KRAS mutation status in tumors was analyzed by DNA sequencing., Results: Among 76 metastatic colorectal cancer patients, KRAS mutations in tumors and in peripheral blood were identified in 33 (43.4%) and 30 (39.5%) patients, respectively. The detection sensitivity, specificity, and accuracy of membrane-arrays for CTCs with KRAS oncogene were 84.4%, 95.3%, and 90.8%, respectively, and indeed a highly significant correlation to KRAS mutations in tumors (P < 0.0001) was observed. Forty-five (59.2%) patients responded to cetuximab plus chemotherapy, and 41 and 40 were wild-type KRAS in tumors and peripheral blood, respectively (both P < 0.0001). Patients with tumors that harbor wild-type KRAS are more likely to have a better progression-free survival and overall survival when treated with cetuximab plus chemotherapy (P < 0.0001). Likewise, patients with CTCs of wild-type KRAS in peripheral blood express a better progression-free survival and overall survival when treated with cetuximab plus chemotherapy (P < 0.0001)., Conclusions: These findings provide evidence that detection of KRAS mutational status in CTCs, by gene expression array, has potential for clinical application in selecting metastatic colorectal cancer patients most likely to benefit from cetuximab therapy.

We report the perioperative airway management in a 12-year-old boy suffering from Treacher Collins syndrome (TCS) and severe mental retardation who was scheduled for elective dental treatment under general anesthesia. TSC is also known as mandibulofacial dysostosis or Franceschetti syndrome, usually with a potentially difficult airway presentation. It is a major challenge for the anesthesiologist to manage an uncooperative child with such a congenital airway anomaly. A difficult airway was encountered during induction of general anesthesia, and both oral intubation by direct laryngoscopy and classic laryngeal mask airway (LMA) insertion were unsuccessful. In an expedient critical trial, with the cooperation of two anesthesiologists, one performing nasal fiberoptic intubation and the other maintaining oral mask ventilation, a nasal endotracheal tube was successfully placed at the first attempt, although at the expense of prolonged respiratory depression in the patient. Therefore, fiberoptic nasal intubation simultaneously with mask ventilation for placement of the endotracheal tube is a practical substitute for a difficult airway usually managed by LMA with inadequate ventilation. After extubation, tracheostomy may be indicated if the TCS patient suffers from persistent difficult upper airway in consequence of a traumatic intubation.

Background: A combination of antiemetic drugs could be an effective method to prevent severe postoperative nausea and vomiting (PONV). Therefore, we examined the prophylactic effect of haloperidol plus ondansetron on PONV., Methods: We enrolled 210 patients (n = 70 in each of 3 groups) undergoing elective laparoscopic cholecystectomy for this randomized double-blind study. Patients were randomized to intravenous saline 2 mL and intramuscular haloperidol 2 mg (Group H), intravenous ondansetron 4 mg and intramuscular saline 2 mL (Group O), or intravenous ondansetron 4 mg and intramuscular haloperidol 2 mg (Group H+O), administered after induction of general anesthesia and 30 minutes before the conclusion of surgery. We compared the complete response rates, incidence of PONV, nausea scores, the need for rescue medication, patient satisfaction scores, and adverse events during the 24-hour study., Results: The H+O group had the highest complete response rate to treatment (79%) compared with group H (61%) and group O (62%) (p < 0.05 for both). Patient satisfaction scores were significantly higher in the H+O group (8.3 +/- 1.8) than in the H (7.0 +/- 2.4) and O (7.2 +/- 2.5) groups (p < 0.05 for both). In addition, nausea scores were significantly lower in the H+O group (1.2 +/- 2.6) than in the H (2.5 +/- 3.3) and O (2.2 +/- 3.1) groups (p < 0.05 for both)., Conclusion: We conclude that the combination of prophylactic haloperidol (2 mg) plus ondansetron (4 mg) provides a higher complete response rate and greater patient satisfaction after laparoscopic cholecystectomy than either drug used alone.

First-line treatment of metastatic colorectal cancer with combinations of cetuximab and irinotecan-based or oxaliplatin-based chemotherapy has shown promising efficacy. The clinical response to such treatment is generally assessed by tumor measurement through imaging. This study was performed to evaluate the correlation between serial changes in imaging results and carcinoembryonic antigen (CEA) levels. In 64 patients with metastatic colorectal cancer receiving cetuximab plus FOLFIRI or FOLFOX-4 chemotherapy we retrospectively analyzed the relationship between changes in serum CEA and changes in imaging results throughout the treatment course. Response in terms of serum CEA change was defined as a >/=50% drop in CEA level for more than 4 weeks. The sensitivity and specificity of serum CEA changes after targeted chemotherapy in relation to imaging results were 80.5% (33/41) and 73.9% (17/23), respectively, with a diagnostic accuracy of 78.1% (50/64). The progression-free survival time of responders assessed by serum CEA change was significantly longer than that of nonresponders (p=0.0091). Our results highlight the importance of serum CEA monitoring in assessing the response to targeted chemotherapy and in predicting the prognosis of patients with metastatic colorectal cancer.

Background: Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent laryngeal nerve injury. The purpose of this study was to investigate the optimal depth of the nerve integrity monitor (NIM) EMG endotracheal tube., Methods: We enrolled 105 adult patients undergoing elective thyroidectomy. Each Medtronic Xomed NIM EMG endotracheal tube was placed with the middle of the exposed electrodes well in contact with the true vocal cords under direct laryngoscopy. Function of IONM was documented and the insertion depth was measured and analyzed., Results: Ninety-nine (94.3%) patients had successful IONM with the initial endotracheal tube position. Six (5.7%) patients needed further tube depth adjustment under fiberoptic bronchoscopy. All patients were finally had successful IONM. The optimal mean depth was 20.6 +/- 0.97 cm in men and 19.6 +/- 1.0 cm in women (p < 0.01). There was the trend that taller subjects had a deeper tube depth (p < 0.05)., Conclusion: We concluded that the mean depth of the NIM EMG tube would be a useful reference value for detecting the malposition of electrodes and adjusting the depth of tube during the operation.

Objective: To evaluate the effect of soy isoflavones on menopausal symptoms in women who do and who do not produce equol, a daidzein metabolite., Method: A randomized, double-blind, placebo-controlled clinical trial was conducted over 6 months with 96 healthy menopausal women. After taking take 135 mg of isoflavones daily for 1 week, the women in the study group were assigned to the equol-producing (EP) or the non-EP group according to the presence or absence of equol in their urine. Menopausal symptoms were evaluated using a modified Kupperman Index., Result: Compared with the placebo group, the scores for hot flashes and excessive sweating were significantly reduced after 3 months, and the scores for weakness, palpitations, limb paresthesia, and total symptoms after 6 months, in the EP group only., Conclusions: Isoflavone supplementation improves menopausal symptoms only in women with the ability to produce equol.

Postoperative enteric fistula is a serious complication and cause of death following gastrointestinal (GI)-tract surgery. Many reports have demonstrated the effectiveness of parenteral nutrition in the spontaneous closure of enteric fistula. Our study was aimed at analyzing the prognostic factors of parenteral nutritional support in the treatment of enteric fistula for patients with GI-tract cancer following surgery. GI-tract cancer patients receiving surgical interventions, which then unfortunately developed enteric fistula, were included in our study. All of them had to have received parenteral nutrition soon after leakages were recognized, and they were subsequently divided into successful and unsuccessful (classified as "failure") groups according to spontaneous closure of fistula or not, respectively. The studied patients' laboratory data were collected to identify the clinically relevant prognostic factors. Fifty-three primary GI-tract cancer patients with postoperative enteric fistulas were enrolled into our study. Of these, 33 patients were considered as successful parenteral nutritional therapy (successful group) and the other 20 patients (failure group) were not. After a period of parenteral nutritional therapy, serum total bilirubin, creatinine, C-reactive protein (CRP), hemoglobin, and albumin were significantly different between these two groups (all p < .05). Using a multivariate logistic regression analysis, it was determined that increased serum albumin level was an independent predictive factor of successful management for enteric fistula (p = .029), in addition to the well-known lower drainage amount (< 500 mL/day) from the enteric fistula (p = .013). Our observations show that both serum albumin levels and drainage amounts from the enteric fistula can be potentially used as important prognostic predictors of healing enteric fistula under total parenteral nutrition in patients following surgery for GI-tract malignancies.

Femoral nerve block (FNB) is by far the most useful lower extremity regional anesthetic technique for the anesthesiologist, and high-resolution ultrasonography is a useful tool with which to guide the performance of FNB. However, the relationships between the femoral nerve and the femoral artery in different lower extremity positions have rarely been discussed. The purpose of this study was to evaluate the relative positions of the femoral nerve and artery at different lateral rotational angles of the lower extremities using ultrasonographic imaging. We enrolled 41 healthy volunteers in this study. Two-dimensional ultrasonographic images of the femoral nerve were obtained using an ultrasound unit, in the inguinal crease, for four positions of the bilateral lower extremities: 0 degrees , 15 degrees , 30 degrees and 45 degrees lateral rotation of each extremity. The following assessments were made in each position: minimal skin-to-nerve distance (SN) and deviation of nerve-to-landmark (femoral artery pulsation) horizontal distance (NF). A trend towards lateral rotation of both lower extremities was identified. The Pearson correlation values between rotational degree to SN and rotational degree to NF were -0.216 and 0.430, with p values of 0.001 and less than 0.001, respectively. Body mass index had a good correlation ( r = 0.76-0.78) with SN. The results of our ultrasound study revealed that the more lateral the rotation of both lower extremities, the closer the femoral nerve was to the skin and the farther away it was from the femoral artery. In order to increase the success rate and decrease the rate of complications, a suggested lateral 45 rotation of both lower extremities is strongly recommended when performing FNB using the peripheral nerve stimulator technique or the field block technique. In any situation, individual ultrasound guidance is recommended for FNB whenever possible.

A 34-year-old man was referred to our hospital for management of multiple trauma in consequence of a car accident. Initial examination showed mild intracranial hemorrhage proven by computed tomographic scan (CT) of the brain and multiple fractures of face and thigh. Surgical repair of the multiple fractures was undertaken with stable vital signs and neurological condition. Anesthesia was induced with fentanyl and thiamylal and rocuronium was used to facilitate oroendotracheal intubation. Sevoflurane in a mixture of oxygen and air and rocuronium were used for maintenance of anesthesia and surgical relaxation, respectively. The surgeon decided to perform fixation of facial bone first, so he infiltrated the nasal mucosa with epinephrine solution to minimize blood loss. After the operation was completed, the surgeon routinely checked both pupils and found that the left pupil was fully dilated without light reflex. In fear of exacerbation of the existing intracranial hemorrhage with progressive bleeding, the operation was hastily brought to an end. An urgent CT of the brain was immediately carried out but it revealed no obvious progression compared with the preoperative examination. The patient awaked in the postanesthesia care unit (PACU) uneventfully with the left pupil returning to normal condition.

Purpose: This study was designed to evaluate the efficacy and outcome of the Starion and Ligasure vessel sealing systems for sutureless hemorrhoidectomy., Methods: Sixty-four patients with Grades III and IV hemorrhoids were randomized into two groups: 1) Starion hemorrhoidectomy (32 patients), and 2) Ligasure hemorrhoidectomy (32 patients). The patient demographics, operative details, numbers of parenteral analgesic injections, postoperative pain scores (assessed by an independent assessor), operating time, intraoperative blood loss, hospital stay, early and delayed complications, and time off from work or normal activity were recorded. The patients were regularly followed-up at 1, 2, 4, 6, 8, and 12 weeks after surgery., Results: The mean blood loss, mean operating time, duration of hospital stay, and time off from work or normal activity were not significantly different between the two methods (all P > 0.05), except for a lower pain score (P = 0.032) and reduced numbers of parenteral analgesic injections (P < 0.001) in Starion hemorrhoidectomy. In addition, there were no differences in the early and delayed postoperative complications between the two methods (all P > 0.05). Unfortunately, two patients with symptomatic anal stenosis requiring treatment were encountered by Ligasure hemorrhoidectomy, but none by Starion hemorrhoidectomy., Conclusions: Starion hemorrhoidectomy with submucosal dissection is a safe and effective procedure, comparable to Ligasure hemorrhoidectomy. Patients derive a short-term benefit of less pain and reduced parenteral analgesic use by Starion hemorrhoidectomy. The superiority of no cases complicated with symptomatic anal stenosis requiring treatment by Starion hemorrhoidectomy seems to offer a better therapeutic alternative for prolapsed hemorrhoids.