A Comparison of Norepinephrine versus Phenylephrine to Prevent Hypotension after Spinal Anesthesia for Cesarean Section: Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis aimed to compare the effects of using phenylephrine or norepinephrine on the pH and base excess (BE) of the umbilical artery and vein in parturients undergoing cesarean section. METHODS: The study protocol was registered in INPLASY. Independent researchers searched Ovid-Medline, Ovid-EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases and Google Scholar for relevant randomized controlled trials (RCTs). The primary outcome of this study was the umbilical artery (UA) or umbilical vein (UV) pH as neonatal condition at birth, and the secondary outcome was the UA or UV BE as an additional prognostic value over the measurement of umbilical pH. RESULTS: There was no evidence of a difference between phenylephrine and norepinephrine for overall, UA, and UV pH (mean difference (MD) -0.001, 95% confidence interval (CI) -0.004 to 0.007; MD 0.000, 95%CI -0.004 to 0.004; and MD 0.002, 95%CI -0.013 to 0.017). There was also no evidence of a difference between phenylephrine and norepinephrine for overall, UA, and UV BE (MD 0.096, 95% CI -0.258 to 0.451; MD 0.076, 95%CI -0.141 to 0.294; and MD 0.121, 95%CI; -0.569 to 0.811). A meta-regression showed that factors such as umbilical artery or vein, infusion method, single or twin, and the number of parturients per study had no effect on the UA pH, UV pH, UA BE, or UV BE. No evidence of publication bias was detected. CONCLUSIONS: There was no evidence of a difference between phenylephrine and norepinephrine for umbilical pH and BE. A subgroup analysis and meta-regression also did not show evidence of differences.

Comparison of remimazolam and desflurane in emergence agitation after general anesthesia for nasal surgery: a prospective randomized controlled study.

BACKGROUND: Remimazolam is an ultrashort-acting benzodiazepine. Few studies have evaluated the effects of remimazolam-based total intravenous anesthesia (TIVA) on emergence agitation (EA). This study aimed to compare the incidence and severity of EA between TIVA using remimazolam and desflurane. METHODS: This prospective randomized controlled study enrolled 76 patients who underwent nasal surgery under general anesthesia. Patients were randomized into two groups of 38 each: desflurane-nitrous oxide (N2O) (DN) and remimazolam-remifentanil (RR) groups. The same protocol was used for each group from induction to emergence, except for the use of different anesthetics during maintenance of anesthesia according to the assigned group: desflurane and nitrous oxide for the DN group and remimazolam and remifentanil for the RR group. The incidence of EA as the primary outcome was evaluated using three scales: Ricker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, and Aono's four-point agitation scale. Additionally, hemodynamic changes during emergence and postoperative sense of suffocation were compared. RESULTS: The incidence of EA was significantly lower in the RR group than in the DN group in all three types of EA assessment scales (all P < 0.001). During emergence, the change in heart rate differed between the two groups (P = 0.002). The sense of suffocation was lower in the RR group than in the DN group (P = 0.027). CONCLUSIONS: RR reduced the incidence and severity of EA in patients undergoing nasal surgery under general anesthesia. In addition, RR was favorable for managing hemodynamics and postoperative sense of suffocation.

Comparison of retinal thickness measurements among four different optical coherence tomography devices.

We sought to compare the retinal thickness measurements collected using different optical coherence tomography (OCT) devices. This prospective study included 21 healthy cases, and the retinal thickness was measured using the PLEX Elite (Carl Zeiss Meditec, Dublin, California, USA), DRI OCT-1 Atlantis (Topcon Corp, Tokyo, Japan), Cirrus 5000 HD-OCT (Carl Zeiss Meditec), and Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany), respectively. The mean central retinal thickness (CRT) and mean retinal thickness of the Early Treatment of Diabetic Retinopathy Study (ETDRS) area were compared. The CRT varied significantly among the different OCT devices (P < 0.001). Post-hoc analysis revealed that the CRT measured using PLEX Elite (278.95 ± 20.04 µm) and Spectralis (271.86 ± 17.92 µm) were similar, and both were greater than the CRT measurements of DRI OCT-1 (239.57 ± 21.06 µm) and Cirrus (256.76 ± 17.82 µm). Additionally, the mean retinal thickness in each ETDRS area showed significant differences among the four devices (all P < 0.001). The mean retinal thickness measured varied according to the device used, and this needs to be considered when comparing retinal thickness measurements taken with different devices.

Genetic modification regulates pathogenicity of a fowl adenovirus 4 strain after cell line adaptation (genetic mutation in FAdV-4 lowered pathogenicity).

Fowl adenovirus 4 (FAdV-4) is a major avian virus that induces fatal diseases in chicken such as, hydropericardium and hepatitis. The viral structure consists of hexon, penton, fiber-1, and fiber-2 which are associated with immunopathogenesis. In this study, we investigated the genetic modification of a FAdV-4 strain after continuous passages in a cell line and evaluated the pathogenicity associated with mutations. We used the FadV-4 KNU14061 strain, which was isolated from layers in 2014. The virus went through 80 passages in the Leghorn male hepatoma (LMH) cell line. The full genetic sequence was identified, and we found a frameshift in the fiber-2 amino acid sequence after the initial thirty passages. To examine whether the frameshift in the fiber-2 gene affects the pathogenicity in chicken, we inoculated LMH80 (80 times passaged) and LMH10 (10 times passaged) into 3-day-old chickens and examined the pathogenesis. LMH10 infection via intramuscular route induced fatal pathology, but LMH80 did not. Furthermore, LHM80 pre-treatment protected hosts from the LMH10 challenge. Thus, the genetic modification isolated by serial passage lowered pathogenicity and the resulting virus acted as an attenuated vaccine that can be a FAdV-4 vaccine strain candidate.

Risk Assessment and Determination of Heavy Metals in Home Meal Replacement Products by Using Inductively Coupled Plasma Mass Spectrometry and Direct Mercury Analyzer.

This study quantified six heavy metals (Pb, Cd, As, Sn, Hg, and Me-Hg) in home meal replacement products. Satisfactory linearity (R2 > 0.99), recovery (80.65-118.02%), limits of detection (0.02-2.81 µg/kg), limits of quantification (0.05-8.51 µg/kg), accuracy (80.49-119.87%), precision (0.26-14.93%), standard uncertainty (0.082-0.321%) and relative standard uncertainty (0.084-0.320%) of the six heavy metals were obtained. The average concentration of the six heavy metals was 8.87 µg/kg. Heavy metal concentrations were converted to food intake data of 0.009 µg/kg to recalculate the 95th percentile food intake data (g/day) of individual heavy metals. These were then divided by age group to evaluate the average exposure to heavy metals and determine the 95th percentile of exposure from daily intake and for the whole population, of home meal replacement products. The chronic daily intake amount of six heavy metals was 1.60 × 10-2 µg/kg/day. Based on total chronic daily intake values, the risk and margin of exposure of each of the heavy metals was 9.13 × 107, demonstrating that intake associated with home meal replacement products is negligible.

Quantitative OCT angiography findings according to pattern classification of type 1 neovascularization exudative age-related macular degeneration.

OBJECTIVES: To define neovascularization (NV) patterns and their association with exudative activity in type 1 neovascular age-related macular degeneration (NVAMD). METHODS: In optical coherence tomography angiography (OCTA) images of type 1 NVAMD, we stratified NV patterns according to whether they contained core vessel (C+/C-) and fine branching vessels (F+/F-) or not into C - F +, C + F +, and C + F - groups. Qualitative analyses assessing the status of peripheral tiny branching, inner branching capillaries, arcade, loop, and perilesional halo and quantitative analyses considering the NV area, length, density, and numbers of junctions and endpoints (open-ended vessels) in NV were conducted according to NV patterns and the presence of exudation on structural OCT. RESULTS: Among 96 eyes, exudation was found in the C - F + (33.3%) and C + F + (47.6%) groups, related to peripheral tiny branching in both groups (p = 0.022 and p < 0.001) and perilesional halo in the C + F + group (p < 0.001). Peripheral arcades, inner branching capillaries, and loops were observed in more than half (68.3%, 58.7%, and 69.8%) in the C + F + group but not related with exudative activity in the C + F + group. In quantitative analysis, the number of endpoints was associated with exudation in univariate and multivariate analyses (p = 0.011 and p = 0.016) in C + F + group. CONCLUSIONS: After pattern classification, type 1 NV patterns with fine branching vessels were considered to have exudative activity compared to NV without fine branching. The quantitative analysis of type 1 NV according to patterns showed the presence of peripheral tiny branching vessels was associated with NV activity.

Grape Pomace Extracted Tannin for Green Synthesis of Silver Nanoparticles: Assessment of Their Antidiabetic, Antioxidant Potential and Antimicrobial Activity.

In nanoscience, the "green" synthesis approach has received great interest as an eco-friendly and sustainable method for the fabrication of a wide array of nanoparticles. The present study accounts for an expeditious technique for the synthesis of silver nanoparticles (AgNPs) utilizing fruit waste grape pomace extracted tannin. Grape pomace tannin (Ta) involved in the reduction and capping of AgNPs and leads to the formation of stable Ta-AgNPs. Various conditions were attempted to optimize the particle size and morphology of Ta-AgNPs which was further analyzed using various analytical tools for different characteristic motives. UV-visible spectroscopy showed a characteristic peak at 420 nm, indicating successful synthesis of AgNPs. Energy disperses spectroscopy (EDS) analysis proved the purity of the produced Ta-AgNPs and manifested a strong signal at -2.98 keV, while Fourier-transform infrared spectrophotometer (FTIR) spectra of the Ta-AgNPs displayed the existence of functional groups of tannin. Zeta potential measurements (-28.48 mV) showed that the Ta-AgNPs have reasonably good stability. High resolution transmission electron microscopy (HR-TEM) analysis confirmed the average dimension of the synthesized NPs was estimated about 15-20 nm. Ta-AgNPs potentials were confirmed by in vitro antidiabetic activity to constrain carbohydrate digesting enzymes, mainly α-amylase and α-glucosidase, with a definite concentration of sample displaying 50% inhibition (IC50), which is about 43.94 and 48.5 µg/mL, respectively. Synthesized Ta-AgNPs exhibited significant antioxidant potential with respect to its 2,2'-azino-bis(3-ethylbenzothi-azoline-6-sulfonic acid) (ABTS) (IC50 of 40.98 µg/mL) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) (IC50 of 53.98 µg/mL) free radical scavenging activities. Ta-AgNPs exhibited extraordinary antibacterial activity against selected pathogenic strains and showed comparable antimicrobial index against ampicillin as a positive control.

Relationship between retinal capillary vessel density of OCT angiography and intraocular pressure in pig.

The purpose of this study was to evaluate density change in the retinal capillary plexus during intra ocular pressure (IOP) elevation in vitrectomized pigs' eyes using optical coherence tomography angiography (OCTA). Eight eyes of eight micro pigs received vitrectomy and the IOP was controlled from 15 mmHg (baseline) to 105 mmHg in 15 mmHg increments using a vented-gas forced-infusion system, and then decreased back to normal IOP (recovery state). The spectral-domain OCTA device was set to scan an area of 8.8 × 4.4 mm (30° × 15°) above the optic nerve head for each IOP. The relative vessel density (rVAD) compared to baseline was determined for the total retinal blood flow (RBF) which included major retinal artery and venous vessels, radial peripapillary capillaries (RPCs), superficial (SVP), intermediate (IVP), and deep vascular plexus (DVP). The mean rVAD was 0.890 in RBF, 0.826 in RPCs, 0.817 in SVP, 0.819 in IVP, and 0.794 in DVP at 30 mmHg. While the rVAD of RBF and RPCs decreased to 0.504 and 0.541 at 45 mmHg, the SVP, IVP, and DVP decreased to 0.433, 0.359, and 0.345, respectively. When IOP was normalized, the rVAD was recovered in all layers and the VAD of RBF, IVP, and DVP were higher than baseline (P = 0.040, 0.019, and 0.019, respectively). Retinal capillary density deterioration in each layer was found from 30 mmHg using an OCTA system which showed excellent depth-resolved segmentation of retinal capillary layers even at higher IOPs. Reduction in VAD showed full recovery after IOP normalization.

Effects of Menthol-Containing Artificial Tears on Tear Stimulation and Ocular Surface Integrity in Normal and Dry Eye Rat Models.

PURPOSE: To evaluate the effects of menthol-containing artificial tears on tear stimulation and ocular surface integrity in normal and dry eye rat models. METHODS: A total of 54 male Lewis rats were used. The levels of tear secretion and tear MUC5AC concentrations were compared between the menthol-containing artificial tear-treated group (menthol group) and the vehicle-treated group (vehicle group). The groups were compared after a single instillation to evaluate the immediate effects, and after repeated instillation (five times a day for 5 days) to evaluate the longer-term effects. Tear lactate dehydrogenase (LDH) activity was measured to evaluate eye drop instillation-induced ocular surface damage. The effects of menthol-containing artificial tears were also evaluated in a dry eye rat model. RESULTS: After a single instillation of menthol-containing artificial tears, tear secretion increased from 4.37 (±0.75) mm at baseline to 7.37 (±1.60) mm. However, after repeated instillations, the effects of tear stimulation decreased. The tear MUC5AC concentration was significantly lower in the menthol group than in the vehicle group after a single instillation, but not after repeated instillation. However, the tear LDH concentration was significantly increased in the menthol group after repeated instillation. In the dry eye rat model, the extent of menthol-induced tear stimulation was reduced. CONCLUSIONS: Menthol-containing artificial tears increased tear secretion, but lowered the tear MUC5AC concentration. Menthol-induced tear stimulation was reduced after repeated instillation for 5 days and in the dry eye rat model. Conversely, repeated instillation of menthol-induced ocular surface damage, resulting in increased tear LDH activity.

Analysis of Surgical Outcome After Levator Advancement by Assessing Changes in Eyelid Contour.

PURPOSE: The authors analyzed changes in eyelid contour after levator advancement by measuring multiple radial midpupil lid distance (MPLD). METHODS: The study enrolled 61 eyes of 61 patients with involutional ptosis who underwent levator advancement from 2 oculoplastic surgeons from September 2008 to December 2013. An analysis of upper lid contours was performed using front gaze photographs of the preoperative and postoperative states and comparing them to the front gazes of normal patients. Conventional and 12 oblique midpupil lid distances were measured every 15 degrees across the temporal (105, 120, 135, 150, 165, and 180 degrees) and nasal (75, 60, 45, 30, 15, and 0 degrees) fields of the eyelid fissure using custom software. RESULTS: Ptosis patients had low temporal eyelid height and significantly decreased MPLD at all angles compared with normal controls. Compared with the preoperative eyelid, all MPLD angles were significantly increased after surgery, and the temporal peak height of the eyelid was recovered. CONCLUSIONS: The normal shape and temporal peak height of eyelids should be considered for levator advancement surgery with ptosis. The authors retrospectively compared postoperative changes in eyelid contour to modify the method of surgery.