Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial.

BACKGROUND: Bleeding during endoscopic sinus surgery (ESS) can hinder surgical progress and may be associated with increased complications. Tranexamic acid is an antifibrinolytic that is known to reduce operative bleeding. The current study was designed to assess the effect of adjunctive intravenous tranexamic acid on intraoperative bleeding and the quality of the surgical field during ESS. METHODS: Double-blind, randomized, controlled trial. Patients undergoing ESS for the primary diagnosis of chronic rhinosinusitis with or without polyposis were included. Sample size calculation based on a clinically relevant difference in the Wormald surgical field score yielded a sample of 28. In addition to standard measures to minimize blood loss, study patients received intravenous tranexamic acid with control patients receiving intravenous normal saline. Outcome measures included the Wormald grading scale to assess the intraoperative surgical field and estimated blood loss based on suction container contents with irrigation fluid subtracted. RESULTS: Twenty-eight patients (median age, 45 years; range, 23-80 years) were included in the study. Diagnoses included chronic rhinosinusitis without polyposis (n = 5), chronic rhinosinusitis with polyposis (n = 23). The use of the tranexamic acid was not associated with a statistically significant decrease in estimated blood loss (201 vs 231 mL; p = 0.60) or Wormald grading scale (5.84 vs 5.80; p = 0.93). There were no adverse events or complications during the study. CONCLUSION: Adjunctive intravenous tranexamic acid does not appear to result in a clinically meaningful reduction in blood loss or improve visualization of the surgical field during ESS.

Effect of conjugated linoleic acid isomers on lipoproteins and atherosclerosis in the Syrian Golden hamster.

Conjugated linoleic acid (CLA) is a group of positional and geometric isomers of linoleic acid (LA, C18:2 cis-9, cis-12) that are reported to have important biological activities, including protection against atherosclerosis. In this study, the potential role of the individual cis-9, trans-11 and trans-10, cis-12 isomers of CLA in atherogenesis were compared with LA in the Syrian Golden hamster. Supplementation of a high-fat, high-cholesterol diet (HFHC) with 1% (w/w) cis-9, trans-11 CLA or trans-10, cis-12 CLA did not significantly affect plasma cholesterol levels compared to supplementation with 1% (w/w) LA. Very low density lipoprotein cholesterol (VLDL-C) was lower and plasma triglycerides (TG) were higher in diets where C18:2 fatty acid was added to the HFHC diet, but neither the cis-9, trans-11 CLA group nor trans-10, cis-12 CLA group was significantly different from the LA control group. CLA supplementation did not significantly affect low density lipoprotein cholesterol (LDL-C). Trans-10, cis-12 CLA increased high density lipoprotein cholesterol (HDL-C) levels compared to LA or cis-9, trans-11 CLA (P<0.02), and although the ratio of non-HDL-C:HDL-C in the cis-9, trans-11 CLA group (1.11+/-0.54) and the trans-10, cis-12 CLA group (1.11+/-0.21) was lower than the LA group (1.29+/-0.45), the reduction did not reach statistical significance. Atherosclerosis was assessed in the ascending aorta by measuring the number of aortic cross-sections containing Oil Red O-stained intimal lesions. Compared to the LA group (60+/-11%), both the cis-9, trans-11 CLA group (38+/-8%) and the trans-10, cis-12 CLA group (28+/-7%) had fewer sections displaying a fatty streak lesion, although the differences did not reach statistical significance. These results suggest that individual CLA isomers may reduce atherosclerotic lesion development in the hamster, but when compared to LA, the apparent atheroprotective effects do not correlate with beneficial changes in lipoprotein profile.

Partitioning of polycyclic aromatic hydrocarbons between water and particles compared to bioaccumulation in mussels: a harbour case.

Water and particles from three sites located in Halifax Harbour, near and further away from combined municipal sewage effluents (CMSE) were analysed for parental and alkylated polycyclic aromatic hydrocarbons (par and alkPAH). Bioavailability of PAH was compared for inter-tidal mussels collected at the same sites in April and November. The PAH fingerprint determined over 9 sampling times covering a period of 19 months differed more between phases (water and particles) and seasons, than between sites. In the spring, more alkPAH associated with diesel and gasoline were detected in the soluble phase, along with more bioaccumulation of alkPAH in inter-tidal mussels. A broader number of parPAH were detected in mussels collected in the fall. The mean sum of dissolved alkPAH concentrations was higher in water at the site closer to raw CMSE than at the other two sites and particles of that site. However, lowest bioconcentration factors (BCF) were determined in mussels of this more contaminated site. Similar biota-particle accumulation factors (BPAF) were determined for parPAH in mussels from the three sites, all lower than the BCF of alkPAH. The study indicates that sewage treatment plants will reduce the amount of parPAH especially larger than fluoranthene and pyrene from being deposited in the harbour; that alk naphthalenes and fluorenes present in water will continue to be discharged; that the disturbance of sediments can make particle-bound PAH available to mussels.

Conjugated linoleic acids, atherosclerosis, and hepatic very-low-density lipoprotein metabolism.

Conjugated linoleic acids (CLAs) are isomeric forms of the 18:2 fatty acid that contain conjugated sites of unsaturation. Although CLAs are minor components of the diet, they have many reported biological activities. For nearly a decade, the potential for CLA to modify the atherosclerotic process has been examined in animal models, and studies of supplementation of the human diet with CLA were started with the anticipation that such an intervention could also reduce the risk of cardiovascular disease. Central to the hypothesis is the expectation that dietary modification could alter plasma lipid and lipoprotein metabolism toward a more cardioprotective profile. This review examines the evidence in support of the hypothesis and the mechanistic studies that lend support for a role of CLA in hepatic lipid and lipoprotein metabolism. Although there are still limited studies in strong support of a role for CLA in the reduction of early atherosclerotic lesions, there has been considerable progress in defining the mechanisms of CLA action. CLA could primarily modulate the metabolism of fatty acids in the liver. The tools are now available to examine isomer-specific effects of CLA on hepatic lipid and lipoprotein metabolism and the potential of CLA to modify hepatic gene expression patterns. Additional animal and cell culture studies will increase our understanding of these unusual fatty acids and their potential for health benefits in humans.