Impact of a positive end-expiratory pressure strategy on oxygenation, respiratory compliance, and hemodynamics during laparoscopic surgery in non-obese patients: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Higher positive end-expiratory pressure (PEEP) during laparoscopic surgery may increase oxygenation and respiratory compliance. This meta-analysis aimed to compare the impact of different intraoperative PEEP strategies on arterial oxygenation, compliance, and hemodynamics during laparoscopic surgery in non-obese patients. METHODS: We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from January 2012 to April 2022 comparing the different intraoperative PEEP (Low PEEP (LPEEP): 0-4 mbar; Moderate PEEP (MPEEP): 5-8 mbar; high PEEP (HPEEP): >8 mbar; individualized PEEP - iPEEP) on arterial oxygenation, respiratory compliance (Cdyn), mean arterial pressure (MAP), and heart rate (HR). We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied. RESULTS: 21 RCTs (n = 1554) met the inclusion criteria. HPEEP vs. LPEEP increased PaO2 (+ 29.38 [16.20; 42.56] mmHg, p < 0.0001) or PaO2/FiO2 (+ 36.7 [+ 2.23; +71.70] mmHg, p = 0.04). HPEEP vs. MPEEP increased PaO2 (+ 22.00 [+ 1.11; +42.88] mmHg, p = 0.04) or PaO2/FiO2 (+ 42.7 [+ 2.74; +82.67] mmHg, p = 0.04). iPEEP vs. MPEEP increased PaO2/FiO2 (+ 115.2 [+ 87.21; +143.20] mmHg, p < 0.001). MPEEP vs. LPEP, and HPEEP vs. MPEEP increased PaO2 or PaO2/FiO2 significantly with different heterogeneity. HPEEP vs. LPEEP increased Cdyn (+ 7.87 [+ 1.49; +14.25] ml/mbar, p = 0.02). MPEEP vs. LPEEP, and HPEEP vs. MPEEP did not impact Cdyn (p = 0.14 and 0.38, respectively). iPEEP vs. LPEEP decreased driving pressure (-4.13 [-2.63; -5.63] mbar, p < 0.001). No significant differences in MAP or HR were found between any subgroups. CONCLUSION: HPEEP and iPEEP during PNP in non-obese patients could promote oxygenation and increase Cdyn without clinically significant changes in MAP and HR. MPEEP could be insufficient to increase respiratory compliance and improve oxygenation. LPEEP may lead to decreased respiratory compliance and worsened oxygenation. PROSPERO REGISTRATION: CRD42022362379; registered October 09, 2022.

Surgical treatment of epilepsy in a patient with bilateral periventricular nodular heterotopia: A case report.

Background: Periventricular nodular heterotopia (PNH) is a rare pathological condition characterized by the presence of nodules of gray matter located along the lateral ventricles of the brain. The condition typically presents with seizures and other neurological symptoms, and various methods of surgical treatment and postoperative outcomes have been described in the literature. Case Description: We present a case study of a 17-year-old patient who has been experiencing seizures since the age of 13. The patient reported episodes of loss of consciousness and periodic freezing with preservation of posture. Two years later, the patient experienced his first generalized tonic-clonic seizure during nocturnal sleep and was subsequently admitted to a neurological department. A magnetic resonance imaging scan of the brain with an epilepsy protocol (3 Tesla) confirmed the presence of an extended bilateral subependymal nodular heterotopy at the level of the temporal and occipital horns of the lateral ventricles, which was larger on the left side, and a focal subcortical heterotopy of the right cerebellar hemisphere. The patient underwent a posterior quadrant disconnection surgery, which aimed to isolate the extensive epileptogenic zone in the left temporal, parietal, and occipital lobes using standard techniques. As of today, 6 months have passed since the surgery and there have been no registered epileptic seizures during this period following the surgical treatment. Conclusion: Although PNHs can be extensive and located bilaterally, surgical intervention may still be an effective way to achieve seizure control in selected cases.

Electrophysical Properties and Heat Capacity of Activated Carbon Obtained from Coke Fines.

This paper studies the dependence of the specific heat capacity (Cp) of activated carbon obtained by the activation of coke fines on temperature (T, K) and the dependence of electrical resistance (R, Om) on temperature (T, K). In the course of the work, it was found that in the temperature range of 298.15-448 K on the curve of dependence Cp - f(T) at 323 K there is a jump in heat capacity, associated with a phase transition of the second kind. Measurements of the temperature dependence of electrical resistance on temperature were also carried out, which showed that activated carbon in the temperature range of 293-343 K exhibits metallic conductivity, turning into a semiconductor in the temperature range of 343-463 K. The calculation of the band gap showed that the resulting activated carbon is a semiconductor with a moderately narrow band gap. The satisfactory agreement of the phase transition temperatures on the curves of the temperature dependences of the heat capacity on temperature (323 K) and on the curves of the dependences of electrical resistance and the relative permittivity on temperature (343 K) indicates the nature of this phase transition, i.e., at a temperature of 323 K, the change in heat capacity is associated with the transition from semiconductor conductivity to metallic.

Production of Activated Carbon from Sifted Coke and Determination of Its Physicochemical Characteristics.

The possibility of obtaining effective coal sorbents from a low-liquid product of coke chemical production-coke fines-has been studied. To obtain a coal sorbent, coke fines with a size of ≤10 mm were crushed and sieved to obtain a fraction of 2-5 mm. The resulting fraction was activated in a specially designed reactor at 850 °C with steam treatment. Activation was carried out at different durations of the process: 60, 90, and 120 min. It was found that the sample obtained with a process duration of 120 min has the best indicator for the ability to remove phenol from aqueous solutions (74.94 mg/g) and methylene blue (145 mg/g). When cleaning tap water with the resulting carbon sorbent, there is a decrease in the content of calcium, sulfates, and bicarbonate and a decrease in total mineralization. Obtained activated carbon was studied by scanning electron microscopy, low-temperature nitrogen adsorption (BET), and FTIR spectroscopy. It was found that the resulting activated carbon has a porous structure consisting of meso- and macropores, and the specific surface value was ~301 m2/g. The presence of high-intensity absorption bands corresponding to acid functional groups has also been established.

Disease modifying treatment of spinal cord injury with directly reprogrammed neural precursor cells in non-human primates.

BACKGROUND: The development of regenerative therapy for human spinal cord injury (SCI) is dramatically restricted by two main challenges: the need for a safe source of functionally active and reproducible neural stem cells and the need of adequate animal models for preclinical testing. Direct reprogramming of somatic cells into neuronal and glial precursors might be a promising solution to the first challenge. The use of non-human primates for preclinical studies exploring new treatment paradigms in SCI results in data with more translational relevance to human SCI. AIM: To investigate the safety and efficacy of intraspinal transplantation of directly reprogrammed neural precursor cells (drNPCs). METHODS: Seven non-human primates with verified complete thoracic SCI were divided into two groups: drNPC group (n = 4) was subjected to intraspinal transplantation of 5 million drNPCs rostral and caudal to the lesion site 2 wk post injury, and lesion control (n = 3) was injected identically with the equivalent volume of vehicle. RESULTS: Follow-up for 12 wk revealed that animals in the drNPC group demonstrated a significant recovery of the paralyzed hindlimb as well as recovery of somatosensory evoked potential and motor evoked potential of injured pathways. Magnetic resonance diffusion tensor imaging data confirmed the intraspinal transplantation of drNPCs did not adversely affect the morphology of the central nervous system or cerebrospinal fluid circulation. Subsequent immunohistochemical analysis showed that drNPCs maintained SOX2 expression characteristic of multipotency in the transplanted spinal cord for at least 12 wk, migrating to areas of axon growth cones. CONCLUSION: Our data demonstrated that drNPC transplantation was safe and contributed to improvement of spinal cord function after acute SCI, based on neurological status assessment and neurophysiological recovery within 12 wk after transplantation. The functional improvement described was not associated with neuronal differentiation of the allogeneic drNPCs. Instead, directed drNPCs migration to the areas of active growth cone formation may provide exosome and paracrine trophic support, thereby further supporting the regeneration processes.

Evaluation of a Telehealth Counseling Program for Expatriates.

Background: Health problems for expatriates are common due to their vulnerability to local infectious diseases, psychosocial problems, and chronic diseases, but many problems go largely unmet in this unique population. Introduction: Telehealth counseling was developed and tested for Korean expatriates. We explored the current status of using telehealth counseling systems and showed its feasibility and acceptability in three countries. Materials and Methods: This retrospective study was based on the "Development and demonstration of telehealth counseling program for overseas Koreans" project funded by the Korea Health Industry Development Institute. In this project, we established five Digital Healthcare Centers (DHCs): 3 in Vietnam and 1 each in Uzbekistan and Cambodia. We used data from October 2016 to September 2017; descriptive analysis and one-way ANOVA were used to present detailed information. Results: A total of 442 patients made an appointment for telehealth counseling services. Overall user satisfaction rates were 96.1%. Over two thirds of patients (302/442, 68.3%) completed one-time telehealth counseling. About 13% were referred to primary care, and 17 (3.8%) were referred to specialists or tertiary hospital. The most common diagnostic category was endocrine, nutritional, and metabolic diseases (14%), followed by diseases of the circulatory system (12.3%) for one-time visit patients. Discussion: Our telehealth counseling program for expatriates was feasible and acceptable in three countries. It also has the potential to minimize language barriers and the cost of healthcare usage. Conclusion: Further research for sustainable effective telehealth systems for expatriates will be needed.

Clinical results of photodynamic therapy in tracheobronchial malignancy.

Photodynamic therapy (PDT) has been adopted as an alternative therapy for lung cancer patients who could not receive surgery due to their poor condition. It also has expanded its roles in lung cancer treatment for palliative treatment for increasing symptoms. We retrospectively reviewed medical records of patients of tracheobronchial cancers who received photodynamic therapy in our institute. Outcomes of the treatment results were evaluated, and survival analysis was performed via Kaplan-Meier analysis. We performed 25 cases of photodynamic therapy for tracheobronchial cancer patients between 2003 and 2013. A total of 21 patients were involved. Average ages at the time of treatment were 68.1. In those 25 cases, 8 cases achieved complete remission, and 15 cases remained partial remission. There were 2 cases of no response. Seven patients died during the follow-up periods, but none of these were related with complications. Only two minor complications were observed during the follow-up periods. One was granulation at the site of PDT, and the other was hemoptysis. Average overall survival periods for the therapeutic group were 50.1 months and those of the palliative group were 29.3 months. Photodynamic therapy was safe and feasible for palliative therapy in tracheobronchial cancer with acceptable complication rates. Also, it could be a treatment option for double primary lung cancer in inoperable patients.

Nuclear deadenylation/polyadenylation factors regulate 3' processing in response to DNA damage.

We previously showed that mRNA 3' end cleavage reaction in cell extracts is strongly but transiently inhibited under DNA-damaging conditions. The cleavage stimulation factor-50 (CstF-50) has a role in this response, providing a link between transcription-coupled RNA processing and DNA repair. In this study, we show that CstF-50 interacts with nuclear poly(A)-specific ribonuclease (PARN) using in vitro and in extracts of UV-exposed cells. The CstF-50/PARN complex formation has a role in the inhibition of 3' cleavage and activation of deadenylation upon DNA damage. Extending these results, we found that the tumour suppressor BARD1, which is involved in the UV-induced inhibition of 3' cleavage, strongly activates deadenylation by PARN in the presence of CstF-50, and that CstF-50/BARD1 can revert the cap-binding protein-80 (CBP80)-mediated inhibition of PARN activity. We also provide evidence that PARN along with the CstF/BARD1 complex participates in the regulation of endogenous transcripts under DNA-damaging conditions. We speculate that the interplay between polyadenylation, deadenylation and tumour-suppressor factors might prevent the expression of prematurely terminated messengers, contributing to control of gene expression under different cellular conditions.

Pulpal blood flow measurement with ultrasound Doppler imaging.

INTRODUCTION: This study compared the difference in pulpal blood flow between vital and root-filled teeth by using ultrasound Doppler imaging. METHODS: To compare the difference in pulpal blood flow between vital and root-filled teeth, 11 patients (mean age, 32.06 years; 3 male, 8 female) who had undergone root canal treatment on the anterior tooth of the maxilla or mandible and had a vital contralateral tooth were examined. Pulpal blood flow measurements were performed on the vital and root canal-treated teeth by using ultrasound Doppler imaging. The parameters examined were the maximum linear velocity (Vas), average linear velocity (Vam), minimum linear velocity (Vakd), pulsation index (PI), and circulation resistance (RI), which are indicators of the pulpal blood flow. The differences between the vital and root-filled teeth were examined by using a paired t test at the 95% confidence interval. RESULTS: There were significant differences in the Vas, Vam, Vakd, and RI between the vital and root-filled teeth (P<.05). With the root-filled teeth, ultrasound Doppler imaging revealed a linear and nonpulsed waveform, whereas the vital teeth showed a pulsed waveform that is characteristic of an arteriole. CONCLUSIONS: Ultrasound Doppler imaging can detect pulpal blood flow in vital tooth through indicators such as Vas, Vam, Vakd, PI, and RI.

The Haemonetics Cell Saver 5 washing properties: effect of different washing pump and centrifuge speeds.

This study evaluated the effect of different washing and centrifuge rates of the Cell Saver 5 on the quality of processed autologous blood. Autologous blood was washed with 1000 ml of sterile normal saline at centrifuge speed of 5650 revolutions per minute (rpm) (group I) or 4350 rpm (group II) with different washing pump speeds--500, 800 and 1000 ml/min. Hemoglobin, free hemoglobin, hematocrit, erythrocytes, leukocytes, platelets, and protein were measured before and after processing. The highest values of hemoglobin, hematocrit and erythrocytes were achieved using 800 and 1000 ml/min pump speeds in group I and 500 ml/min speed in group II. Red blood cells concentration was higher in group I. There were no significant changes of free hemoglobin removal within group I. In group II the lowest free hemoglobin was achieved when 1000 ml/min rate was used. Platelets and protein did not depend on wash pump speeds in both groups. Platelet recovery in group I was higher than in group II at all washing pump speeds. Leukocytes were not adequately removed at all pump speeds. The Cell Saver 5 produces optimum results when the high wash pump speeds (800 and 1000 ml/min) and standard centrifuge speed are used.