Immediate Postoperative Analgesia of Nalbuphine-Ketamine Combination Compared with Ketamine Alone in Xylazine-Sedated Goats Undergoing Left Flank Laparotomy.

Goats have been used as animal models in research, and the need for achieving safer anesthesia for research or surgical intervention is gaining much attention. The objective of this study was to evaluate intraoperative effects and the immediate postoperative analgesia of nalbuphine-ketamine regimen in goats. Twenty clinically healthy adult female crossbred goats weighing 14 ± 2 kg were allocated randomly into each of two equally sized groups. All animals were sedated with intramuscular (IM) xylazine (0.07 mg/kg), then anesthesia was intravenously (IV) induced with ketamine alone (10 mg/kg) (XK group), or a combination of nalbuphine (0.5 mg/kg) and ketamine (5 mg/kg) (XNK group). Following induction, left flank laparotomy was performed and then sutured. The quality of anesthesia and immediate postoperative analgesia was evaluated. Immediate postoperative analgesia was assessed up to 5 h after standing, using a modified Unesp-Botucatu acute composite pain scale (USAPS). Serum cortisol, glucose, insulin, and C-reactive protein (CRP) were measured at ½, 1, 2, 4, 6, 12, and 24 h, postoperatively (PO). The USAPS pain scores were significantly lower in the XNK compared to the XK group (p < 0.05). The XNK group exhibited a statistically significant difference in the level of serum cortisol at ½ and 1 h PO (p = 0.018 and 0.045, respectively) compared to the XK group. At 2, 4, 6 h PO, CRP significantly decreased (p = 0.023, 0.040 and 0.005, respectively) in the XNK compared to the XK group. Nalbuphine-ketamine produced an acceptable induction of anesthesia and recovery compared to ketamine. Recovery with nalbuphine-ketamine was faster and better quality. The USAPS pain scores were lower in nalbuphine-ketamine, indicating that this novel combination produces better postoperative pain control than ketamine alone.

Adipose mesenchymal stem cells combined with platelet-rich plasma accelerate diabetic wound healing by modulating the Notch pathway.

BACKGROUND: Diabetic foot ulceration is a serious chronic complication of diabetes mellitus characterized by high disability, mortality, and morbidity. Platelet-rich plasma (PRP) has been widely used for diabetic wound healing due to its high content of growth factors. However, its application is limited due to the rapid degradation of growth factors. The present study aimed to evaluate the efficacy of combined adipose-derived mesenchymal stem cells (ADSCs) and PRP therapy in promoting diabetic wound healing in relation to the Notch signaling pathway. METHODS: Albino rats were allocated into 6 groups [control (unwounded), sham (wounded but non-diabetic), diabetic, PRP-treated, ADSC-treated, and PRP+ADSCs-treated groups]. The effect of individual and combined therapy was evaluated by assessing wound closure rate, epidermal thickness, dermal collagen, and angiogenesis. Moreover, gene and protein expression of key elements of the Notch signaling pathway (Notch1, Delta-like canonical Notch ligand 4 (DLL4), Hairy Enhancer of Split-1 (Hes1), Hey1, Jagged-1), gene expression of angiogenic marker (vascular endothelial growth factor and stromal cell-derived factor 1) and epidermal stem cells (EPSCs) related gene (ß1 Integrin) were assessed. RESULTS: Our data showed better wound healing of PRP+ADSCs compared to their individual use after 7 and 14 days as the combined therapy caused reepithelialization and granulation tissue formation with a marked increase in area percentage of collagen, epidermal thickness, and angiogenesis. Moreover, Notch signaling was significantly downregulated, and EPSC proliferation and recruitment were enhanced compared to other treated groups and diabetic groups. CONCLUSIONS: These data demonstrated that PRP and ADSCs combined therapy significantly accelerated healing of diabetic wounds induced experimentally in rats via modulating the Notch pathway, promoting angiogenesis and EPSC proliferation.

Shear bond strength of composite repair system to bilayered zirconia using different surface treatments (in vitro study) / Resistência ao cisalhamento de reparos de resina composta e zircônia bicamada usando diferentes tratamentos de superfície (estudo in vitro)

Objective: the study is aimed to evaluate the effect of different surface treatment methods on shear bond strength between composite repair system and both of zirconia core and veneering porcelain and analyze the mode of failure between composite repair and ceramic surface. Material and methods: 40 Ceramic discs were fabricated with diameter of 7mm and 3mm thickness and divided according to material into two groups, Zirconia core discs (n = 20) and veneering porcelain discs (n = 20). Specimens were thermocycled and then each group was subdivided according to surface treatment method into 4 equal sub groups (n = 5) ,control subgroup I air abrasion, subgroup II Cojet, subgroup III laser, subgroup IV combination of air abrasion and laser surface treatment. Composite blocks were built up and polymerized on the surface of the specimens and shear bond strength of composite to each specimen was tested using a universal testing machine and mode of failure was evaluated using stereomicroscope. Results: Regardless of ceramic type; there was a statistically significant difference between surface treatments. Cojet recorded the highest mean shear bond strength. Laser showed the highest prevalence of adhesive failure. Porcelain + Cojet showed the highest prevalence of cohesive failure. Conclusion: Cojet surface treatment provided superior shear bond strength regardless of the ceramic type whether zirconia or porcelain. Porcelain provided superior shear bond strength values in comparison to zirconia regardless of the surface treatment method tested. Porcelain showed higher percentage of cohesive failure that while the mode of failure in zirconia was most commonly adhesive. (AU)

Objetivo: O objetivo deste estudo foi avaliar o efeito de diferentes métodos de tratamento de superfície na resistência ao cisalhamento de reparos de resina composta e núcleos de zircônia ou cobertura de porcelana, e analisar o modo de falha entre o reparo e a superfície cerâmica. Material e métodos: 40 discos de cerâmica foram fabricados com diâmetro de 7 mm e 3 mm de espessura e divididos de acordo com o material em dois grupos, discos de zircônia (n = 20) e discos de porcelana (n = 20). As amostras foram termocicladas e, em seguida, cada grupo foi subdividido de acordo com o método de tratamento de superfície em 4 subgrupos iguais (n = 5), subgrupo I :controle (abrasão a ar); subgrupo II: Cojet; subgrupo III: laser; subgrupo IV: combinação de abrasão a ar e tratamento de superfície a laser. Blocos de resina composta foram construídos e polimerizados na superfície das amostras e a resistência ao cisalhamento do compósito para cada amostra foi testada usando uma máquina de teste universal e o modo de falha foi avaliado usando o estereomicroscópio. Resultados: Independentemente do tipo de cerâmica houve diferença estatisticamente significante entre os tratamentos de superfície. Cojet registrou a maior força média de união ao cisalhamento. O laser mostrou a maior prevalência de falha adesiva. Porcelana + Cojet apresentou a maior prevalência de falha coesiva. Conclusão: O tratamento superficial com Cojet proporcionou resistência superior ao cisalhamento, independentemente do tipo de cerâmica, seja zircônia ou porcelana. A porcelana forneceu valores superiores de resistência ao cisalhamento em comparação com a zircônia, independentemente do método de tratamento de superfície testado. A porcelana apresentou maior porcentagem de falha coesiva que enquanto o modo de falha na zircônia era mais comumente adesivo. (AU)

Sedative, analgesic, behavioral and clinical effects of intravenous nalbuphine-xylazine combination in camels (Camelus dromedarius).

This study examined the sedative, analgesic, behavioral, and clinical effects of a combination of xylazine (XY) and nalbuphine-xylazine (NA-XY) in camels. A total of five adult camels were used in a prospective randomized cross-over design with a wash out period of two weeks. Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5, 15, 30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation (p < 0.001) and analgesia (p < 0.01). The behavioral parameters showed higher scores with a NA-XY combination than xylazine alone. Although a XY injection resulted in a significant decline in the heart and respiratory rate, the NA-XY combination group revealed a non-significant change in both clinical parameters compared to the baseline. In conclusion, the use of a NA-XY combination in camels improved the sedative and analgesic onset and duration with an improved outcome in the behavioral scores, as well as in both the heart and respiratory rates compared to XY alone.

Effect of Portal Venous Pressure on Liver Function of Donors in Living Donor Liver Transplantation.

BACKGROUND We assessed the alterations in portal hemodynamics associated with donor right hepatectomy and its effects on functional regeneration of the remnant liver. MATERIAL AND METHODS This prospective study included 30 adult living donors who underwent right hepatectomy in the Liver Transplantation Unit, Faculty of Medicine, Cairo University from June 2015 to October 2016. During donor surgery, portal venous pressure (PVP) was measured using an antithrombotic catheter inserted into the main portal vein, and was measured before and after clamping of the right portal vein. Postoperatively, liver function tests were done daily until normalization. The outcome measures were the time to normalization of liver function tests and effect of residual volume and steatosis on PVP. RESULTS All donors had normal PVP before clamping and changed significantly after clamping (p<0.001). After clamping, 25 donors (83%) had a PVP above 12 mmHg; i.e. had high portal pressure. The median percentage of change was 55%. There were obvious increases in liver enzymes and bilirubin after surgery, but albumin and international normalized ratio showed progressive decreases postoperatively. The percent change in PVP was positively correlated with the levels of liver enzymes, time to normalization of liver enzymes, albumin, and bilirubin, and with the degree of steatosis, bit it was negatively correlated with residual liver volume. CONCLUSIONS During living donor liver transplantation, PVP increases by over 50% after clamping of the right portal vein of the donor's liver. This increase is associated with temporary delay of normalization of liver function of the donors.

Conventional Versus Distal Laparoscopic One-Anastomosis Gastric Bypass: a Randomized Controlled Trial with 1-Year Follow-up.

BACKGROUND: There is no consensus on the ideal small bowel length that should be bypassed in laparoscopic one-anastomosis gastric bypass (OAGB). This study aimed to compare the safety and efficacy of conventional versus distal techniques of laparoscopic OAGB. METHODS: This randomized controlled trial involved 60 adults with morbid obesity scheduled for laparoscopic OAGB randomly assigned to one of the two techniques; conventional technique (fixed anastomosis 200 cm from the ligament of Treitz) and distal technique (anastomosis 400 cm from the ileocecal valve). Total small bowel length (TSBL) was measured in all cases. Quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI). Outcome measures were excess body weight loss percentage (EBWL%), resolution of associated comorbidities, frequency of nutritional deficiencies, and quality of life. RESULTS: No patients were lost to follow-up. The two groups were comparable in TSBL, EBWL%, and complete resolution of comorbidities up to 12 months. The percentage of afferent loop length to TSBL was significantly higher in the distal group (p < 0.001) but was not correlated with EBWL%. The levels of hemoglobin, cholesterol, triglycerides, iron, and albumin were significantly lower and parathormone hormone was higher in the distal group. The GIQLI score was significantly higher in the conventional group during follow-up. CONCLUSION: OAGB achieves optimum results when the afferent loop length is 200 cm; bypassing more than 200 cm does not improve weight loss or comorbidity resolution. Measuring TSBL is recommended to avoid excessive small bowel shortening that increases the risk of nutritional consequences.

Effect of oral ursodeoxycholic acid on cholelithiasis following laparoscopic sleeve gastrectomy for morbid obesity.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a definitive solution for morbid obesity and its related co-morbidities. Cholelithiasis is a postoperative complication of LSG. The use of ursodeoxycholic acid (UDCA) after LSG is a proposed solution to reduce the incidence of cholelithiasis. OBJECTIVE: To evaluate the effect of UDCA prophylaxis on cholelithiasis following LSG in morbidly obese patients. SETTING: Two university hospitals in Egypt, Cairo, and Beni Suef Universities' hospitals. METHODS: This prospective study was conducted between July 2015 and March 2018 and included 200 patients scheduled for LSG. They were randomly divided into 2 groups. The UDCA group received a postoperative prophylaxis regimen for prevention of cholelithiasis in the form of 250 mg twice daily of UDCA for 6 months. The control group did not receive prophylactic treatment. Abdominal ultrasound was done at 3, 6, 9, and 12 months for all patients to detect cholelithiasis. The primary outcome measure was cholelithiasis. RESULTS: Only 6% of the UDCA group developed cholelithiasis compared with 40% in the control group (P < .001). Age, sex, initial body mass index, and excess weight loss at 6 months did not significantly affect cholelithiasis. CONCLUSION: UDCA treatment for 6 months after LSG is effective in the prevention of cholelithiasis.