Comparison of postoperative analgesic effects in response to either dexamethasone or dexmedetomidine as local anesthetic adjuvants: a systematic review and meta-analysis of randomized controlled trials.

This review compares the effects of peripheral dexamethasone and dexmedetomidine on postoperative analgesia. We included six randomized controlled trials (354 patients) through a systematic literature search. We found that analgesia duration was comparable between dexamethasone and dexmedetomidine (58.59 min, 95% CI (confidence interval), - 66.13, 183.31 min) with extreme heterogeneity. Secondary outcome was also compared and no significant difference was observed in sensory block onset and duration and motor block duration and also for postoperative nausea and vomiting. It is noteworthy that dexamethasone reduced analgesic consumption (fentanyl) by 29.12 mcg compared with dexmedetomidine. We performed subgroup analyses and found no significant difference between the following: (1) lidocaine vs ropivacaine (P = 0.28), (2) nerve block vs nerve block + general anesthesia (P = 0.47), and (3) upper limb surgery vs thoracoscopic pneumonectomy (P = 0.27). We applied trial sequential analysis to assess the risks of type I and II errors and concluded that the meta-analysis was insufficiently powered to answer the clinical question, and further analysis is needed to establish which adjuvant is better. In conclusion, we believe that existing research indicates that dexamethasone and dexmedetomidine have equivalent analgesic effects in peripheral nerve blocks.

Plasma protein profiling in patients undergoing coronary artery bypass grafting surgery and clinical significance.

This study was designed to identify the protein profiling in patients with triple vessel coronary artery disease (CAD) undergoing CABG, in order to detect CAD-related differential proteins in these patients. CABG patients with triple vessel disease with/without left main stenosis (n =160) were compared to normal coronary angiographic subjects (n =160). Plasma samples of 20 males and 20 females in each group were analyzed with iTRAQ technique. ELISA test was used to test the chosen proteins from iTRAQ results in plasma samples from a new cohort of the CABG group (n=120, male/femal=61/59) and control (n =120, male/female=60/60). iTRAQ detected 544 proteins with 35 up-regulated and 41 down-regulated (change fold > 1.2 or < 0.83, p < 0.05). Three proteins including platelet factor 4 (PF4), coagulation factor XIII B chain (F13B), and secreted frizzled-related protein 1 (sFRP1) were selected for validation by using ELISA that demonstrated significant up-regulation of PF4 and sFRP1 (p < 0.05). There was a positive correlation between these proteins and CAD (p < 0.05) and myocardial infarction history (p < 0.05). Thus, we for the first time have found 76 proteins differentially expressed in plasma of CABG patients. The thrombotic disease/inflammation progress-related protein PF4 and sFRP1, a member of the Wnt/fz signal-transduction pathway and related to myocardial repair, are significantly up-regulated in triple-vessel disease with/without left main stenosis. PF4 may be developed as a biomarker for the diagnosis of the severity of CAD requiring CABG procedure.

The outcome of cryoablation in treating advanced pancreatic cancer: a comparison with palliative bypass surgery alone.

OBJECTIVE: This study aimed to investigate the efficacy and safety of palliative bypass surgery combined with cryoablation in treating patients with advanced pancreatic cancer and compare this combination therapy with palliative bypass surgery alone. METHODS: Medical records of 118 patients with advanced pancreatic cancer who received palliative bypass surgery combined with cryoablation (the combination treatment group) or bypass surgery alone (the bypass surgery alone group) at the Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital (Tianjin, China) were retrospectively reviewed. Their baseline and peri-operative parameters were collected and compared. RESULTS: In both groups abdominal distension and pain was significantly ameliorated after treatment. Preoperative jaundice was more common in the bypass surgery group while backache was more frequent in the combination treatment group, which were both relieved by treatment. The pre-operative serum bilirubin level was higher in the bypass surgery group and was decreased significantly after treatment. However, a significant reduction in tumor size and serum carbohydrate antigen 19-9 level was found only in the combination treatment group. There was no significant difference in the incidence of postoperative complications and prognosis between the two groups. CONCLUSIONS: Cryoablation can reduce tumor size and relieve the patients' symptoms and signs such as abdominal discomfort and backache, although it could not improve the patients' prognosis significantly. It is a safe and efficient modality when combined with bypass surgery for patients with advanced pancreatic cancer.

Ascites metabolism measurement enhanced the diagnostic value and accuracy of prognostic evaluation in 18F-FDG PET/CT studies in malignant ascites patients.

OBJECTIVE: This study aimed to evaluate the role of ascites metabolism measurement in (18)F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) for auxiliary diagnosis and prognostic evaluation of malignant ascites. MATERIALS AND METHODS: This was a retrospective study on 55 patients, including 36 with malignant ascites and 19 with benign ascites of undetermined origin, before they underwent their first (18)F-FDG PET/CT scan. The χ(2) -test was used to compare the diagnostic efficiencies among (18)F-FDG PET/CT ascites metabolism measurement, tumor localization, and ascites cytology examination. The standard uptake values of ascites and of the normal liver were measured, respectively, and their ratio, denoted as T/NT, was calculated for each patient. The receiver-operating characteristic curve was used to analyze the diagnostic efficiency of the ascites T/NT, ascites carcinoembryonic antigen, ascites CA1(25), and ascites CA(199), and the linear regression was used to analyze the relationship between the ascites T/NT and the survival time of patients. RESULTS: The metabolic level of malignant ascites was high. The sensitivity and accuracy of ascites metabolism measurement were higher than those of ascites cytology examination (χ(2) =6.98, 4.58; all P's<0.05). The specificity of ascites metabolism measurement was higher than that of (18)F-FDG PET/CT tumor localization (χ(2) =5.70, P<0.05). The T/NT value of malignant ascites (0.68 ± 0.17) was higher than that of benign ascites (0.38 ± 0.10) (t=7.21, P<0.05). The area under the receiver-operating characteristic curve of ascites T/NT was larger than those of ascites carcinoembryonic antigen, CA(125), and CA(199). There was a negative correlation between the ascites T/NT and the survival of patients with malignant ascites (r=-0.647, P<0.01). CONCLUSION: Ascites metabolism measurement has an important auxiliary diagnostic value in (18)F-FDG PET/CT for ascites patients. The ascites T/NT may be a good index for prognostic evaluation of malignant ascites.

[A study of mechanical ventilation pattern in different recovery stages of muscle relaxant after general anesthesia].

OBJECTIVE: To observe the effects of intermittent positive pressure ventilation (IPPV), synchronized intermittent mandatory ventilation (SIMV), and biphasic intermittent positive airway pressure (BiPAP) on the recovery time of automatic breathing in patients in different stages of recovery of general anesthesia with muscle relaxant. METHODS: Thirty patients were randomly divided into three groups. The initial ventilation pattern was IPPV for all patients. After the last dose of muscle relaxant, the pattern of ventilation of group II and group III was adjusted to SIMV and BiPAP, respectively. The airway peak pressure(Ppeak), minute ventilation(MV), expiration carbon dioxide(P(Et)CO(2)), blood gases, and the interval between the last dose of muscle relaxant and automatic breathing(LR-S) was observed. RESULTS: (1) When T(1) appeared, Ppeak of the BiPAP group was lower than that of the IPPV group and SIMV (all P<0.01). When T(R)=0.75, Ppeak of IPPV group was lower compared with the SIMV and BiPAP groups (all P<0.01). (2) When T(1) re-appeared, the MV of BiPAP was higher than that of the IPPV group (P<0.05), but was not different from that of the SIMV group (P>0.05). When T(4) appeared, T(R)=0.25, T(R)=0.75, MV of SIMV group and BiPAP group was higher than that of IPPV group (all P<0.01). (3) When T(R)=0.25, T(R)=0.75, the P(Et)CO(2) of the SIMV group and BiPAP group was lower than that of IPPV group (all P<0.05). (4) Partial pressure of carbon dioxide in artery (PaCO(2)) of the SIMV and BiPAP group was lower than that of the IPPV group (all P<0.05). (5) The LR-S before extubation was shorter in SIMV and BiPAP group than that in IPPV group (P<0.05). CONCLUSION: SIMV and BiPAP have the advantages as follows: no confrontation between mechanical ventilation and autonomous breathing, quick recovery of autonomous breathing, little change in airway pressure, high MV and low P(Et)CO(2). So SIMV and BiPAP are more suitable for recovery from anesthesia. In addition, BiPAP can lower the airway's peak pressure and decrease the probability of barotrauma therefore it is more suitable for those patients with high airway pressure.