Smart Use of Skin Biopsy Punch in Treating Keloids: A Single-Center Retrospective Study.

BACKGROUND: Treatment of scarring has long been a problem due to high incidence and recurrence. Despite many existing treatment therapies, the efficacy remains unstable. OBJECTIVES: To determine the efficacy and safety of skin biopsy punch in combination with corticosteroid injection (BPCI) in treating keloids. APPROACH: This was a retrospective study. In total, 16 patients with keloids received BPCI. Changes in scar appearance, accompanied symptoms, and Vancouver Scar Scale (VSS) were analyzed. Patient satisfaction, VAS scores, and adverse effects were also evaluated. RESULTS: Scar appearance, accompanied symptoms, and VSS scores improved significantly after the treatment. The total effective rate was 93.75% at an 18-month follow-up on average. The mean reduction rate of VSS score was 58.44% (p < 0.0001), especially in height and pliability (84.44% and 78.19%, p < 0.0001). The recurrence rate in this study was 12.5% (n = 2) at an 18-month follow-up on average. Mild adverse effects of pain, pruritus, hypopigmentation, and telangiectasia were recorded. CONCLUSIONS: This study demonstrated BPCI might be an effective and safe therapy in keloids with a low long-time recurrence rate and well tolerance for patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An Open-Label, Uncontrolled, Single-Arm Clinical Trial of Tofacitinib, an Oral JAK1 and JAK3 Kinase Inhibitor, in Chinese Patients with Keloid.

BACKGROUND: The keloid treatment is still a thorny and complicated clinical problem, especially in multiple keloids induced by wound, severe burn, ethnic background or cultural behaviors, or unexplained skin healing. Mainstream treatments have limited efficacy in treating multiple keloids. As no oral treatment with painlessness and convenience is available, oral treatment strategies should be formulated. OBJECTIVES: This study aimed to investigate the efficacy and therapeutic mechanism of oral tofacitinib in keloid patients. METHODS: We recruited the 7 patients with keloid scars and prescribed 5 mg of tofacitinib twice a day orally with a maximum follow-up of 12 weeks. The Patient and Observer Scar Assessment Scale (POSAS), the Vancouver scar scale (VSS), ANTERA 3D camera, and the DUB Skin Scanner 75 were used to assess the characteristics of the lesion. Immunohistochemistry was performed to evaluate collagen synthesis, proliferation, and relative molecular pathways. Moreover, the effects of tofacitinib were assessed on keloid fibroblast in vitro. RESULTS: After 12 weeks of oral tofacitinib, significant improvement in POSAS, VSS, and Dermatology Life Quality Index (DLQI) scores was observed (p < 0.05). The volume, lesion height, and dermis thickness of the keloid decreased (p < 0.05). Moreover, significant decreases in the expression of collagen I, Ki67, p-STAT 3, and p-SMAD2 were observed after 12 weeks of administration. In vitro experiments suggested that tofacitinib treatment inhibits fibroblast proliferation and collagen I synthesis via suppression of STAT3 and SMAD2 pathway. CONCLUSION: Tofacitinib, a new candidate oral drug for keloid, could reduce keloid lesion volume by inhibiting collagen synthesis and inhibiting fibroblast proliferation, and alleviate itch and pain to obtain a better life quality.

Dermabrasion combined with photodynamic therapy: a new option for the treatment of non-melanoma skin cancer.

Non-melanoma skin cancer (NMSC) is the most common malignancy. Photodynamic therapy (PDT) is effective for the treatment of certain NMSCs. However, the clinical response rates of some NMSCs to single PDT are still far from ideal. The reason may be that PDT has shown limited efficacy in managing thicker NMSCs. To explore the efficacy and safety of dermabrasion combined with PDT (D-PDT) for the treatment of NMSCs. This was a retrospective, single-arm, multi-centre study. In total, 172 tumours from 40 patients were treated with D-PDT during the study period. The mean follow-up period was 40 months (range 15-110 months). D-PDT was performed with 633-nm red light at 80 m W/cm2 after lesion dermabrasion and 4 h of photosensitizer exposure. Six nodular basal cell carcinomas (nBCCs) from 6 patients, 9 squamous cell carcinomas (SCCs) from 9 patients, 17 Bowen diseases (BDs) from 10 patients and 140 actinic keratoses (AKs) from 15 patients treated with D-PDT were examined in this study. Only two patients with three AKs experienced recurrence over 12 months. The mean final follow-up periods of patients with AKs, BDs, nBCCs and SCCs were 30, 33, 45 and 60 months, respectively. Thirty-four of the 40 patients treated with D-PDT reported excellent or good cosmetic results. The mean Dermatology Life Quality Index (DLQI) scores of the patients improved significantly after treatment (estimated MD 9.72 [95% CI 8.69 to 10.75]; p < 0.001). D-PDT is a safe, cosmetic and effective treatment that could be a new candidate therapeutic for NMSC.

Transfemoral versus Transapical Aortic Implantation for Aortic Stenosis Based on No Significant Difference in Logistic EuroSCORE: A Meta-Analysis.

Background Transcatheter aortic valve implantation (TAVI) has gained increasing acceptance for patients with severe aortic stenosis (AS). The present meta-analysis was performed to assess if the transapical (TA) approach has any benefit in reduction of mortality and complications relative to the transfemoral (TF) approach for patients with AS. Methods All relevant studies comparing TF-TAVI and TA-TAVI from January 2002 to November 2013 were retrieved from Medline and Embase databases. The relative risk (RR) and 95% confidence interval (CI) were used to evaluate the difference between two groups. Heterogeneity assumption was assessed by an I (2) test. The random-effect model or fixed-effect model was used to estimate summary effect based on I (2) test. Results Nine studies conformed to the predefined criteria, including 666 patients in the TF-TAVI group and 457 patients in the TA-TAVI group. No difference was found in all-cause mortality at 30 days and beyond 1 year between the two groups (30 days: 9.2% versus 11.4%; RR, 0.72; 95% CI, 0.47 to 1.11; p = 0.14 and beyond 1 year: RR, 0.96; 95% CI, 0.59 to 1.56; p = 0.86). There was a trend toward increased incidence of stroke in patients in the TF-TAVI group (4.7% versus 2.6%; RR, 1.64; 95% CI, 0.75 to 3.58; p = 0.21), and the incidence of vascular complication and postoperative heart block were significantly increased in patients having TF-TAVI (vascular complications: 14.7% versus 7.1%; RR, 2.04; 95% CI, 1.15 to 3.61; p = 0.01 and heart block: 13.4% versus 4.6%; RR, 2.53; 95% CI, 1.10 to 5.83; p = 0.03). Additionally, more patients in the TF-TAVI group required permanent pacemaker relative to the TA-TAVI group (10.8% versus 3.4%; RR, 2.74; 95% CI, 1.41 to 5.32; p = 0.003). Conclusions Among patients with AS with no significant difference in logistic EuroSCORE, TA-TAVI has a lower risk of vascular complication and postoperative heart block but a similar incidence of stroke and mortality compared with TF-TAVI. Accordingly, TA approach is a promising and feasible option for the patients with severe AS.

Comprehensive Treatment of a Rare Case of Complete Primary Pachydermoperiostosis with Large Facial Keloid Scars: A Case Report and Literature Review.

Introduction: Pachydermoperiostosis (PDP), or primary hypertrophic osteoarthropathy, is a rare autosomal dominant disease with primary clinical features of pachydermia (thickening of skin) and periostosis (new bone formation). Keloid scar formation is also rather obscure, and some scientists have claimed that keloid scars contain an excessive amount of fibroblasts compared with normal skin as well as a dense mass of irregularly deposited connective tissues. Case Presentation: A 25-year-old man exhibited extensive skin folding on his face, a gyrus-like scalp, depressed nasolabial folds, and keloids. Symptoms began at 18 years of age, progressing insidiously. Additionally, he experienced clubbing of fingers and toes, joint pain, muscle soreness, and hyperhidrosis. Radiographic examinations revealed thickened bone and cystic regions. Diagnosed with complete primary PDP and facial keloid scars, he underwent skin dermabrasion, biopsies, and a comprehensive treatment involving, botulinum toxin injections, 5-fluorouracil, and a carbon dioxide lattice laser. Conclusion: PDP presents challenges due to its unclear etiology but stabilizes over time in most cases. Comprehensive treatment strategies, including dermabrasion and a combination of intralesional therapies, are effective in managing keloids in PDP patients. This case contributes to the understanding of managing rare diseases and underscores the importance of personalized approaches to improve therapeutic outcomes in patients with complete primary PDP and concurrent keloids.

Impact of anesthesia on postoperative breast cancer prognosis: A narrative review.

The incidence of breast cancer has exhibited an annually increasing trend, and the disease has become the most common malignant tumour worldwide. Currently, the primary treatment for breast cancer is surgical resection. However, metastatic recurrence is the main cause of cancer-related death in this patient population. Various factors are associated with breast cancer prognosis, and anaesthesia-induced changes in the tumour microenvironment have attracted increasing attention. To date, however, it remains unclear whether anaesthetic drugs have a positive or negative impact on cancer outcomes after surgery. The present article reviews the effects of different anaesthetics on the postoperative prognosis of breast cancer surgery to guide the choice of anaesthetic technique(s) and agents for such patients.

Corrigendum: The utility of high-frequency 18 MHz ultrasonography for preoperative evaluation of acral melanoma thickness in Chinese patients.

[This corrects the article DOI: 10.3389/fonc.2023.1185389.].

Biphasic co-detection of melanoma aneuploid tumor cells and tumor endothelial cells in guidance of specifying the field cancerized surgical excision margin and administering immunotherapy.

An optimum safety excision margin (EM) delineated by precise demarcation of field cancerization along with reliable biomarkers that enable predicting and timely evaluating patients' response to immunotherapy significantly impact effective management of melanoma. In this study, optimized biphasic "immunofluorescence staining integrated with fluorescence insitu hybridization" (iFISH) was conducted along the diagnosis-metastasis-treatment-cellular MRD axis to longitudinally co-detect a full spectrum of intact CD31- aneuploid tumor cells (TCs), CD31+ aneuploid tumor endothelial cells (TECs), viable and necrotic circulating TCs (CTCs) and circulating TECs (CTECs) expressing PD-L1, Ki67, p16 and Vimentin in unsliced specimens of the resected primary tumor, EM, dissected sentinel lymph nodes (SLNs) and peripheral blood in an early-stage melanoma patient. Numerous PD-L1+ aneuploid TCs and TECs were detected at the conventional safety EM (2 cm), quantitatively indicating the existence of a field cancerized EM for the first time. Contrary to highly heterogeneous PD-L1 expression and degrees of Chr8 aneuploidy in TCs and TECs in the primary lesions as well as CTCs and CTECs in peripheral blood, almost all TCs and TECs in SLNs and EM were homogeneously PD-L1+ haploid cells. Dynamic monitoring and cellular MRD assessment revealed that, in contrast to PD-L1+ CTCs being responsive to the immune checkpoint inhibitor (ICI-anti-PD-1), multiploid (≥pentasomy 8) PD-L1+ and Ki67+ CTECs were respectively resistant to ICI-sensitized T cells. In therapeutically stressed lymphatic and hematogenous metastatic cascades, stratified phenotypic and karyotypic profiling of iFISH tissue and liquid biopsied TCs, TECs, CTCs and CTECs in future large-cohort studies will enable appropriate re-specification of the optimal safety EM and distribution mapping of in-depth characterized, subcategorized target cells to help illustrate their metastatic relevance, ultimately improving risk stratification and clinical intervention of tumor progression, metastases, therapy resistance and cancer relapse.

Association of Controlling Nutritional Status Score With Adverse Outcomes in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis sought to examine the association between the controlling nutritional status (CONUT) score and adverse outcomes in patients with coronary artery disease (CAD). PubMed and Embase databases were searched for eligible studies from their inceptions to December 12, 2021 to identify studies investigating the association of the CONUT score with major adverse cardiovascular events (MACEs) and all-cause mortality in CAD patients. Twelve studies (36,198 CAD) patients satisfied the criteria. Comparison of the high with low CONUT score, the pooled multivariate adjusted risk ratios (RR) was 1.78 (95% confidence intervals [CI] 1.36-2.32) for MACEs and 1.45 (95% CI 1.27-1.66) for all-cause mortality, respectively. When compared with patients with normal nutrition, malnourished (defined by the CONUT score ≥2) patients conferred a 52% increased risk of MACEs. Additionally, per point CONUT score increment was associated with 15% and 11% higher risk of MACEs and all-cause mortality, respectively. Higher CONUT score independently predicts the MACEs all-cause mortality in CAD patients. Estimation of nutritional status using the CONUT score could be helpful for improving risk classification of CAD.

N6-Methyladenosine methylase METTL3 contributes to neuropathic pain by epigenetic silencing of mu opioid receptor.

We aimed at exploring the role and mechanism of METTL3-mediated m6A modification in neuropathic pain. Male Sprague-Dawley rats were randomly divided into four groups: Sham operation group (Sham group), chronic constriction injury (CCI) of the sciatic nerve model group (NPP group), intrathecal injection of virus down-regulated METTL3 + CCI model group (M3 + NPP group) and intrathecal injection of negative control virus + CCI model group (Scr + NPP group). The M3 + NPP group and the Scr + NPP group were intrathecally injected with virus nineteen days before operation. The paw withdrawal mechanical thresholds and paw withdrawal latency were respectively recorded one day before operation, three days, five days and seven days after operation. The rats were sacrificed on the seventh day after operation, and their spinal cord tissues were taken. The frozen sections of rats were performed to observe the expression of green fluorescent protein of the virus. The methylation level of RNA, the protein expression of m6A-related enzyme (METTL3) and mu opioid receptor (MOR) in spinal cord tissues of the four groups were measured. Downregulation of METTL3 had no effect on the overall methylation level of the spinal cord, but it could regulate the methylation level of the OPRM1 gene RNA encoding MOR, partially restore the expression of MOR, and relieve pain in rats. In the process of NPP, METTL3 may inhibit the expression of MOR by regulating the methylation level of OPRM1 gene RNA encoding MOR, and ultimately promote the occurrence and development of NPP.

The utility of high-frequency 18 MHz ultrasonography for preoperative evaluation of acral melanoma thickness in Chinese patients.

Background: Despite the increasing use of preoperative ultrasound evaluation for melanoma, there is limited research on the use of this technique for Acral Melanoma (AM). Methods: This retrospective study analyzed the electronic medical records of patients who underwent preoperative evaluation for cutaneous melanoma maximum thickness using an 18 MHz probe and histopathological examination between December 2017 and March 2021 at the Department of Dermatology in Xiangya Hospital, Central South University. Results: A total of 105 patients were included in the study. The mean tumor thickness was 3.9 mm (s.d., 2.3), with 63% of the specimens showing ulceration and 44 patients showing lymph node metastasis. The results showed a good correlation between the high-frequency ultrasonography (HFUS) and histopathological thickness measurements, with a Spearman's correlation coefficient of 0.83 [(95% CI 0.73-0.90) (P < 0.001)]. The positive predictive value (PPV) of sonography in identifying tumor thickness was also found to be high. Conclusion: Our study suggests that high-frequency 18 MHz ultrasonography is an effective tool for the preoperative evaluation of AM thickness. The HFUS measurements correlated well with the histopathological thickness measurements, making it a valuable and reliable method for clinicians to assess the thickness of melanoma lesions preoperatively.

Coronary artery bypass on survival in patients with moderate ischemic mitral regurgitation: meta-analysis.

OBJECTIVE: The objective of the study was to systematically evaluate the effect of coronary artery bypass grafting (CABG) or CABG combined with mitral valve surgery (cMVS) on post-operative survival in patients with moderate ischemic mitral valve regurgitation. MATERIALS AND METHODS: Databases including PubMed, Web of Science, COCHRANE LIBRARY, WanFang Data, and CNKI Data were searched from inception to January 2020. According to the inclusion criterion, relevant articles were screened. After that we extracted data, assessed quality, and performed meta-analysis using RevMan 5.2. RESULTS: A total of 4 randomized controlled trial and 14 retrospective study involving 4476 patients were included in the study. The CABG group was 2278 and the cMVS group was 1698. The results of meta-analysis showed that compared with CABG group, there were no statistically significant differences in the recent mortality (odds ratio [OR] = 0.88, p = 0.62), 1-year survival (OR = 1.03, p = 0.82), 1-year survival (OR = 1.07, p = 0.62), and long-term survival (OR = 0.95, p = 0.61) of the cMVS group. CONCLUSION: Current evidence indicates that patients in the cMVS group did not benefit from CABG group in survival after surgery.

OBJETIVO: . Evaluar sistemáticamente el efecto del injerto de derivación de la arteria coronaria (CABG) o el injerto de derivación de la arteria coronaria combinados con la cirugía de la válvula mitral (cMVS) sobre la supervivencia posoperatoria en pacientes con insuficiencia valvular mitral isquémica moderada. MATERIAL Y MÉTODOS: . Se realizaron búsquedas en bases de datos que incluyen Pubmed, Web of Science, COCHRANE LIBRARY, WanFang Data y CNKI Data desde el inicio hasta enero de 2020. De acuerdo con el criterio de inclusión, se seleccionaron los artículos relevantes. Después de eso, extrajimos los datos, evaluamos la calidad y realizamos el metanálisis con RevMan 5.2. RESULTADOS: . Se incluyó un total de 4 ensayos controlados aleatorios (ECA) y 14 estudios retrospectivos con 4476 pacientes. El grupo CABG fue 2278, el grupo cMVS fue 1698. Los resultados del metanálisis mostraron que, en comparación con el grupo CABG, no hubo diferencias estadísticamente significativas en la mortalidad reciente (OR = 0.88, p = 0.62), supervivencia a 1 año (OR = 1.03, p = 0.82), supervivencia a 1 año (OR = 1.07, p = 0.62) y supervivencia a largo plazo (OR = 0.95, p = 0.61) del grupo cMVS. CONCLUSIÓN: . La evidencia actual indica que los pacientes del grupo cMVS no se beneficiaron del grupo CABG en la supervivencia después de la cirugía.

Case report: B7-H3 CAR-T therapy partially controls tumor growth in a basal cell carcinoma patient.

B7-H3 is over-expressed in multiple types of solid tumors, making it an ideal target for chimeric antigen receptor (CAR)-T therapy. Here, we first report a case of multiple basal cell carcinoma (BCC) patient treated with humanized monoclonal anti-B7-H3 CAR-T cells through direct intratumoral injection. After three dose-escalated injections, the lesion in the abdomen decreased by 40% in volume, shrank from bulging to flat, but was not eradicated completely. The large lesion in the forehead became dry from original ulcer and bleeding. The adverse events observed were itching, myalgia, and redness. Immunohistochemistry analysis demonstrated that B7-H3-positive tumor cells and B7-H3 expression intensity were reduced after injections of CAR-T cells. The number of infiltrating CD3 T cells increased significantly but mainly located outside the tumor region. Subsequently, high levels of TGF-ß in the tumor area were observed, suggesting that solid tumor microenvironment may hinder the infiltration and effect of CAR-T cells. In summary, in this particular case report, intratumoral injection of B7-H3 CAR-T cells partially controls tumor growth in the BCC patient with minor adverse events. The efficacy and safety of B7-H3 CAR-T therapy need to be further investigated with a larger cohort of patients. Although only one clinical case is reported here, the anti-B7-H3 CAR-T cell therapy should be considered as a treatment option for solid tumors in the future. This clinical trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) with registration number ChiCTR2100044386.

Keratoacanthoma centrifugum marginatum: An unusual case.

Keratoacanthoma centrifugum marginatum (KCM) of the skin is a rare variant of cutaneous keratoacantoma. KCM was first reported in 1962 andpresents with progressive peripheral expansion , no spontaneous clearing and a bank-shaped outer wall with concurrent central healing. Treatment options include topical and systemic therapies.Surgical intervention is the preferred therapy for solitary KCM. We report on surgery and photodynamic therapy delivered sequentially to treat a giant facial Keratoacanthoma centrifugum marginatum patient. It was safe and effective .

A Case of Surgical Removal of a Giant and Multiple Acquired Plate-Like Osteoma Cutis After Implantation of a Dilator.

Osteoma cutis (OC) is a group of rare skin ossification diseases, most of which are secondary to inflammation, scarring, trauma, or tumors, but a small portion are primary. Plate-like osteoma cutis is rare, especially after puberty. This report documents a case of a 30-year-old female, who presented with multiple stone-hard plates on the forehead and bilateral temples, with no relevant family history, or abnormalities in metabolism. These lesions showed slow progression over the last 11 years. The pathological diagnosis confirmed osteoma cutis. The forehead lesions were treated surgically due to aesthetic problems. In addition, long-term follow-up and observations are still needed to determine progression to deeper levels of tissue.

Racial/ethnic disparities in penile squamous cell carcinoma incidences, clinical characteristics, and outcomes: A population-based study, 2004-2016.

PURPOSE: This study assessed the impact of race/ethnicity on penile squamous cell carcinoma (PSCC) incidence rates, clinical characteristics, and outcomes. MATERIALS AND METHODS: Surveillance, Epidemiology and End Results data from 2004 to 2016 was used for this study. We evaluated racial/ethnic differences in clinical characteristics using χ2 tests. Overall survival (OS) and PSCC-specific survival (PSCC-SS) were estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox regression models were performed to assess independent predictors for PSCC patient survival. RESULTS: A total of 2,720 PSCC patients were included for incidence analysis, and 2,438 patients were identified for the χ2 testing and survival analyses.The overall incidence of PSCC during 2004 to 2016 was 0.30 per 100,000. Only non-Hispanic white (NHW) patients had a statistically significant increase in age-adjusted incidence rates (annual percent change = 2.26, 95% confidence interval [CI]: 0.78-3.76; P = 0.01). In univariate analysis, race/ethnicity was an independent prognostic factor for OS and PSCC-SS. After adjusting for age, marital status, income, grade, TNM (tumor, node, metastasis) stage, and treatment strategies, non-Hispanic black patients still had a statistically significant hazard ratio of 1.35 (95% CI: 1.08-1.68; P = 0.007) for OS, and a hazard ratio of 1.36 (95% CI: 1.01-1.82; P = 0.045) for PSCC-SS compared to NHW. CONCLUSION: NHW patients had a statistically significant increase in age-adjusted incidence rate during the period 2004 to 2016. Race/ethnicity is an independent prognostic factor for OS and PSCC-SS, and non-Hispanic black were proven to have unfavorable OS and PSCC-SS compared with NHW.

Early enteral feeding on esophageal cancer patients after esophageal resection and reconstruction.

BACKGROUND: In patients under esophagectomy, early postoperative oral feeding has traditionally been contraindicated to minimize the risk of anastomotic leaks. Because early oral feeding preserves the integrity and function of gut mucosa, the aim of this study was to investigate the impact of postoperative early oral feeding on esophagectomy. METHODS: Between Oct 2013 and Jan 2016, 41 consecutive patients with esophageal carcinoma (stages I- III), who had undergone minimally invasive Ivor-Lewis surgery, were enrolled in this study. The patients were randomly arranged into the early oral feeding (EOF) group (21 cases) and the simple tube feeding (STF) group (20 cases). The nutritional goal for both groups was 25 kcal/(kg·day). The patients in the EOF group were tube-fed with enteral nutrition and orally fed with 5% glucose in normal saline during the first 4 postoperative days, after that the patients were placed on a liquid diet. The patients in the STF group were postoperatively tube-fed with enteral nutrition for 7 days before being switched to liquid diet. The length of the postoperative hospital stay, rate of perioperative complications, and overall mortality were recorded. Preoperative and postoperative levels of serum albumin (ALB), prealbumin (PA), transferrin (TP), and C reactive protein (CRP) were also monitored. RESULTS: There were no significant differences of the incidence of postoperative complications and overall mortality between the EOF group and the STF group, but the duration of hospital stay, interval until the first liquid food, and time of ambulation in the EOF group were lower than those of the STF group (P<0.05). EOF patients also showed significantly lower CRP levels compared with the STF group (P<0.05). CONCLUSIONS: EOF might reduce the duration of hospital stays and CRP levels in esophageal cancer patients who underwent esophagectomy while the mortality and complications were not affected.

Application via mechanical dropper alleviates sufentanil-induced cough: a prospective, randomized, single-blinded trial.

BACKGROUND: It was reported that prolonging the injection time or diluting administration can reduce the incidence of opioid-induced cough. However, the incidence of sufentanil-induced cough (SIC) via a standardized infusion rate is unclear. A mechanical dropper is an infusion filtering device commonly used for intravenous degassing; it can also be used to administer special drugs due to its temporary storage and dilution effect. This study assesses the effectiveness of administration via mechanical dropper on SIC. METHODS: Two hundred patients undergoing general anesthesia were enrolled. Patients received sufentanil at a strength of 0.3 µg·kg- 1 either via T-connector (group C) or by mechanical dropper (group M) at 1 ml·s- 1. Cough severity was graded as none (0), mild (1-2), moderate (3-5), or severe (> 5), and the incidence of SIC was evaluated for 5 min after the start of sufentanil injection. Other adverse reactions such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration during the induction period of general anesthesia were also observed. The primary outcome was the incidence of SIC. The secondary outcomes were the severity of SIC and other adverse reactions. RESULTS: The incidence of SIC in group M was significantly lower than that in group C (2% versus 21%, P = 0.000), and the prevalence of moderately severe coughing was also statistically different (none in group M versus 11% in group C, P = 0.001). However, there were no statistical differences in the incidence of other adverse reactions between two groups (P > 0.05). CONCLUSION: Sufentanil application via mechanical dropper can significantly alleviate the occurrence of SIC during the induction phase of total intravenous general anesthesia. This method is simple, safe, and reliable, and has wide prospective application for clinical use. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR-IOR-17011561 . Registered on 3 June 2017.

Effects of small-dose remifentanil combined with index of consciousness monitoring on gastroscopic polypectomy: a prospective, randomized, single-blinded trial.

BACKGROUND: With the development of painless diagnosis and treatment, remifentanil, a synthetic opioid agonist, is increasingly used in gastroscopy for its rapid, short-term, and potent analgesic effect. However, the dosage of remifentanil used in endoscopy is unclear. Index of consciousness (IOC) is a new anesthesia depth-monitoring indicator that can be divided into index of consciousness 1 (IOC1) and index of consciousness 2 (IOC2); IOC1 is used for estimating a patient's sedation state, whereas IOC2 reflects analgesic depth. We hypothesized that combining with IOC1 and IOC2 monitoring may be helpful to identify an optimal remifentanil dosage in gastroscopic polypectomy. METHODS: One hundred twenty patients scheduled for gastroscopic polypectomy were enrolled and were randomly assigned to remifentanil 2 ng/mL (group R2), 4 ng/mL (group R4), or 6 ng/mL (group R6), and 40 cases were in each group. During the anesthesia period, remifentanil was kept at the initial given concentration but propofol was adjusted according to IOC1. The primary outcomes were the dosage of propofol and remifentanil. The secondary outcomes were the variety of IOC1 and IOC2, patients' awakening time, and peri-operative adverse reactions such as hypotension, hypertension, bradycardia, tachycardia, body movements, hypoxemia, therapy interruption, nausea, vomiting, aspiration, and intra-operative awareness. RESULTS: With the increasing dosage of remifentanil, the propofol dosage and patients' awakening time decreased significantly, the morbidity of hypertension and body movements also declined, but the incidence of hypotension, bradycardia, and hypoxemia rose. In group R2, the value of IOC2 remained above 50 during the treatment. However, IOC2 dropped to below 30 at the beginning of the gastroscopy in group R6, and there was statistical difference in hypoxemia between groups R2 and R6 (P <0.05). CONCLUSIONS: With the help of IOC monitoring, we found that a target concentration of remifentanil 4 ng/mL is comparatively ideal in patients under gastroscopic polypectomy. TRIAL REGISTRATION: Chinese Clinical Trial Register: ChiCTR-OOD-16009489 , on October 19, 2016.