Prevalence of Asthma in East Azerbaijan Adult Population and Its Determinants Factors: A Cross-Sectional Study from the Northwest of Iran.

Background: Asthma is one of the most common chronic respiratory diseases. It is estimated that more than 400 million people will suffer from it by 2025. This study aims to determine the prevalence of asthma in East Azerbaijan and investigate the association between asthma and some environmental and demographic factors. Materials and Methods: This is a cross-sectional study based on a major Lifestyle Promotion Project (LPP) conducted in the districts of East Azerbaijan, including 2641 participants aged 15 to 65 years of the general population selected through probability proportional to size (PPS) multistage stratified cluster sampling. We used the World Health Survey questionnaire about doctor-diagnosed asthma to determine the prevalence of asthma. Age, smoking status, physical activity level, socioeconomic variables such as job and education level, and body mass index (BMI) were used as covariates in regression models. A questionnaire was used to obtain socio-demographic information and smoking status. The short form of the International Physical Activity Questionnaire was used to estimate the level of physical activity (IPAQ). Results: The mean age of participants was 40.9 ± 12.05 years including 1242 (47 %) males and 1399 (53 %) females. The prevalence of asthma was 3.3 %. The frequency of smokers was significantly higher in the asthmatic group compared with the non-asthmatic group (OR=2.33 [1.76-3.31]; p=0.03). There was no significant association between asthma and other demographic and lifestyle characteristics. Obesity has also played a significant role in the development of asthma. Conclusion: According to the results of this study, obesity and smoking have played a significant role in the development of asthma but there is no statistically significant relationship between socioeconomic and demographic factors.

A Population-based Study of the Prevalence of Cataract and Its Relationship with Smoking in the Northwest of Iran: The Azar Cohort Eye Study.

PURPOSE: The purpose of the to determine the prevalence of cataract and study the relationship of smoking and other potential risk factors with visually significant cataract. METHODS: This is a cross-sectional study based on the Azar cohort databases including 11,208 participants aged 35-70 years of the general population. According to the questionnaire, participants were divided into five groups in terms of smoking. Eye examinations were performed in two steps. The first step was performed by an optometrist, and in the second step, participants with poor red reflex or visual acuity of <8/10 were examined by an ophthalmologist for diagnosing cataract. RESULTS: Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of visually significant cataract was 7.2%. The frequency of ex-smoking in the male and female population in the cataract group was significantly higher than that in the noncataract group (male: P = 0.008, female: P = 0.01), but after adjustment for age and education level, lost its significance (male odds ratio [OR] = 1.1 [0.8-1.5], P = 0.4; female OR = 1.5 [0.5-4], P = 0.3). CONCLUSION: There is no association between cigarette smoking in different doses and the history of smoking with cataracts but other factors such as aging, education level, and underlying diseases including diabetes mellitus, hypertension, and myopia have statistically significant association with visually significant cataract.

Prevalence of metabolic syndrome in East Azerbaijan-Iran and its determinants factors.

Introduction: Metabolic syndrome (MetS) is a prevalent metabolic disorder with increasing prevalence attributed to extended life expectancy. This study aims to investigate MetS prevalence and its determinants in the East-Azerbaijan population. Methods: Conducted as a cross-sectional study within the East Azerbaijan region, this research is based on a major Lifestyle Promotion Project. The study encompasses 700 participants aged 15 to 65 years, representing the general population and selected using probability proportional to size multistage stratified cluster sampling. MetS diagnoses were conducted using the adult Panel III criteria. Data on socio-demographics, smoking status, and physical activity levels were collected through questionnaires. Results: Among participants, the mean age was 42.4±12.38 years, and the mean body mass index was 27.69±4.94 kg/m2. The MetS group exhibited higher mean age and body mass index compared to the non-MetS group (P<0.001). The prevalence of MetS in the population was 34.2%, with higher rates in females (37.1%) compared to males (30.5%), though this difference wasn't statistically significant (P=0.11). Notably, a substantial distinction was observed between the two groups regarding education levels (P<0.001). Conclusion: The study reveals a significant association between increasing age and higher prevalence of MetS. Furthermore, lower educational levels were linked to an elevated prevalence of MetS. While other socio-demographic factors didn't demonstrate statistically significant relationships, these findings emphasize the importance of targeted interventions and education in mitigating MetS risks.

Transnasal Endoscopy for Children and Adolescents With Eosinophilic Esophagitis: A Single-Center Experience.

Background: Transnasal endoscopy (TNE) has been introduced in the care of pediatric patients with eosinophilic esophagitis (EoE) who require repeated esophagoscopies. TNE, as compared to conventional endoscopy, is less invasive and avoids sedation or anesthesia allowing for frequent assessments of the esophageal mucosa when making management decisions. The aim of this study is to review our early experience with TNE. Methods: We extracted data from all patients with EoE who underwent TNE at UH Rainbow Babies & Children's Hospital, Cleveland, Ohio from December 2018 to April 2021. We assessed total visit time, procedure time, success rate, and complications. Data are presented as percentages or medians with interquartile ranges (IQRs). Comparisons were made using Chi-square (and Fisher's exact) test for categorical data, Mann-Whitney test and the unpaired t-test for non-normally distributed and normally distributed data, respectively. Results: Thirty-three patients underwent 65 TNE procedures during our study period. The male-to-female ratio was 4.5:1 and median age was 13 years (IQR: 10 - 15 years; range: 4 - 20 years). Sixty-three (96.9%) of 65 procedures were completed. Distraction methods were used in all procedures (virtual reality goggles in 19.3% and television in 80.7%). Isolated elevated blood pressure (BP) measurements prior to the procedure were more frequent in those undergoing TNE as compared to sedated esophagogastroduodenoscopy (P = 0.04). We also calculated the heart rate (HR) for patients undergoing TNE and sedated upper endoscopy; no difference was noted (P = 0.71). Only minor adverse events occurred with TNE: nosebleed (n = 1), pre-syncope (n = 1), and pain (n = 4). None of the patients who underwent a sedated upper endoscopy developed an event. Two TNE procedures were not completed due to an inability to traverse the upper esophageal sphincter. Conclusions: We demonstrate TNE is an efficient and well-tolerated means of monitoring patients with EoE. Various straight forward distraction methods may contribute to the successful completion of the procedure. The safety as compared to conventional esophagoscopy requires large multicenter studies.

Pediatric endoscopy across multiple clinical settings: Efficiency and adverse events.

BACKGROUND: Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood, and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings. Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner. However, there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments. We hypothesized that there are significant differences in efficiency between settings. AIM: To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings. METHODS: A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy (EGD) or combined EGD and colonoscopy performed between January 1, 2014 and May 31, 2018 by 6 experienced pediatric gastroenterologists in three different clinical settings, including a tertiary care hospital operating room, community hospital operating room, and free-standing pediatric ambulatory endoscopy center at a community hospital. The following strict guidelines were used to schedule patients at all three locations: age greater than 6 mo; American Society of Anesthesiologists class 1 or 2; normal craniofacial anatomy; no anticipated therapeutic intervention (e.g., foreign body retrieval, stricture dilation); and, no planned or anticipated hospitalization post-procedure. Data on demographics, times, admission rates, and adverse events were collected. Endoscopist time (elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering) and patient time (elapsed time from patient registration to that patient exiting the operating room or endoscopy suite) were calculated to assess efficiency. RESULTS: In total, 58% of the cases were performed in the tertiary care operating room. The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations. Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room (63.3 ± 21.5 min vs 51.4 ± 18.9 min, P < 0.001) and 7 min longer compared to the endoscopy center (vs 56.6 ± 19.3 min, P < 0.001). Patient time at the tertiary care operating room was 11 min longer compared to the community operating room (133.2 ± 39.9 min vs 122.3 ± 39.5 min, P < 0.001) and 9 min longer compared to the endoscopy center (vs 124.9 ± 37.9 min; P < 0.001). When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations, endoscopist, and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room. Adverse events from procedures occurred in 0.1% (n = 2) of cases performed in the tertiary care operating room, with 2.2% (n = 35) of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder. CONCLUSION: Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.

Prevalence of Primary Open-Angle Glaucoma and its Relationship with Smoking in the Population of the Azar Cohort: A Cross-Sectional Study.

PURPOSE: The purpose is to determine the prevalence of primary open-angle glaucoma (POAG) and study the relationship of smoking and other potential risk factors with POAG. METHODS: This is a cross-sectional study based on the Azar cohort databases (including the eye cohort study) in Iran, including 11,208 participants aged 35-70 years. According to the questionnaire, participants were divided into five groups in terms of smoking. Ophthalmologic examinations were performed in two steps. The first step was performed by an optometrist, and all referred participants underwent a complete ophthalmological examination in the second step, then after POAG cases were diagnosed using Criteria of the International Society of Geographic and Epidemiological Ophthalmology. RESULTS: Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of POAG in our study population was 1%, which included 58 (1.2%) males and 58 (0.9%) females. There was no significant difference between the two groups in terms of the prevalence of different smoking categories in both genders. There was a statistically significant difference between the two groups in both genders in terms of diabetes mellitus (DM) after adjusting for age and there was a statistically significant difference between the two groups in the male population in terms of triglycerides ≥150 mg/dl. CONCLUSION: Findings of this study indicated that there is no association between cigarette smoking in different doses and a history of smoking with POAG. Other factors, such as aging and underlying diseases, including DM and hypertriglyceridemia, have a statistically significant association with POAG.

A simple self modelling curve resolution (SMCR) method for two-component systems.

Multivariate self-modeling curve resolution (SMCR) methods are the best choice for analyzing chemical data when there is not any prior knowledge about the chemical or physical model of the process under investigation [[1Q3: The reference '1' is only cited in the abstract and not in the text. Please introduce a citation in the text.]]. However, the rotational ambiguity is the main problem of SMCR methods, yielding a range of feasible solutions. It is, therefore, important to determine the range of all feasible solutions of SMCR methods. Different methods have been presented in the literature to find feasible solutions of two, three, and four component systems. Here, a novel simple SMCR method is presented for calculating the boundaries of feasible solutions of two-component systems. At first, the simple strategy is presented for calculating the feasible solutions of two-component systems. Next, four different experimental two-component systems are analyzed in detail for calculating the boundaries of feasible solutions in both spaces, including complex formation equilibrium, keto-enol tautomerization kinetic, lipidomics data, and a case for quantification of an analyte in gray systems. In all cases, the boundaries of range of feasible solutions are properly determined by the proposed simple strategy.

The effect of dietary organic selenium on reproductive performance of broiler breeder roosters under dexamethasone induced stress.

Stress has deleterious impact on semen quality and fertility of roosters. This study was investigated to know whether dietary supplementation of organic selenium (oSe) could improve semen quality and fertility of male broiler breeder under dexamethasone (Dexa) induced stress. Forty broiler breeder roosters (64 week of age) were randomly allotted to four groups (10 roosters/group) and fed a standard diet supplemented with different levels of oSe during 10 successive weeks of the experimental period. To induce stress, the birds received injections of 2 mg/kg BW of Dexa during weeks 5 and 6 of the experiment, in one-day-intervals manner. The roosters were not treated with Dexa and oSe (negative control; NC), or treated with Dexa and different levels of oSe including 0 (positive control; PC), 0.30 (Se30+Dexa) or 0.45 (Se45+Dexa) mg/kg diet. Body weight was measured weekly and semen quality parameters and fertility were evaluated every two weeks. Except for seminal volume and total sperm production which was not affected by the treatment, body weight, semen quality parameters, total antioxidant capacity (TAC) and malondialdehyde (MDA) in seminal plasma were influenced by interactive effect of treatment and time (P < 0.05). Dexamethasone injection adversely affected semen quality parameters (semen concentration, motility and plasma membrane integrity) in PC group compared to NC group (P < 0.05); however, dietary supplementation of oSe ameliorated these negative impacts in Dexa-treated roosters (P < 0.05). Fertility was also improved by dietary supplementation of oSe compared to control groups (P < 0.05). These results indicate that although induction of stress have negative effects on rooster semen quality parameters, dietary inclusion of oSe may exert beneficial impact on mitigating the harmful effects of stress on semen quality and fertility rate of broiler breeder roosters.

Under-expression of microRNA-146a and 21 and their association with Crohn's disease.

MicroRNAs (miRNAs) can post-transcriptionally regulate gene expression and are involved in the immune response. Excessive immune response to the gut microbiota plays a major role in the pathogenesis of Crohn's disease (CD). Regarding the role of miRNAs in immune response, this study aimed to investigate the contribution of miRNAs in the pathogenesis of CD. A total of 53 participants, including 23 CD patients and 30 healthy controls (HCs) were enrolled in this study. miRNAs, including miR-21, miR-29a, miR-29b, miR-31, miR-146a, miR-155, miR-181a, and miR-181c were evaluated via TaqMan MicroRNA Assays. Among the eight miRNAs, the amounts of miR-146a and miR-21 were significantly decreased in the CD patients relative to HC subjects. Moreover, we showed that there was a negative correlation between miR-146a and Harvey-Bradshaw index (HBI), as well as a positive correlation of miR-21 and miR-29b with HBI. Under-expression of miR-146a and miR-21, which are critical for the regulatory function of regulatory T cells (Tregs), is remarkably associated with CD.

Association of quality of life with physical activity, depression, and demographic characteristics and its predictors among medical students.

BACKGROUND: Medical students face a variety of challenges during their years of medical education that can affect their quality of life (QOL). This study aimed to investigate the association of QOL with physical activity (PA), depression, and demographic characteristics, as well as to determine its predictors among medical students in different stages of education. METHODS: A cross-sectional descriptive-correlational study was conducted on 186 medical students of Tabriz University of Medical Sciences in different educational stages including basic sciences, physiopathology, externship, and internship using stratified random sampling method. Data were collected using demographic questionnaire, International PA Questionnaire, World Health Organization QOL Questionnaire, and Beck depression inventory-2. Data analysis was performed using SPSS/Ver 23 through descriptive and analytic statistics including one-way analysis of variance, independent t-test, Pearson and Spearman correlation coefficient, and multivariate linear regression model. RESULTS: There were significant differences in total score of QOL among students in different stages (P < 0.05). There were indirect significant correlations between total score of QOL (ß [confidence interval 95%]:-0.85 [-1.11--0.59]) and its all subdomains with Beck depression score but direct significant correlations with total PA (P < 0.05) except for social relationship. Educational stage, employment status, family income, inhabitant, moderate PA, and depression were the predictors of QOL and altogether explained 63% of its variance. CONCLUSIONS: To pay attention to the predictors of QOL, life among medical students seems necessary for increasing their QOL to provide high-quality care for people with disabilities as well as for the whole community.

A comparative study of the analgesic effects of intravenous ketorolac, paracetamol, and morphine in patients undergoing video-assisted thoracoscopic surgery: A double-blind, active-controlled, randomized clinical trial.

Background: Opioids are traditionally used as the drug of choice for the management of postoperative pain. However, their use is limited in patients undergoing Video-assisted thoracic surgery (VATS), due to their side effects, such as respiratory depression, nausea, and vomiting. Aim: In this double-blind active-controlled randomized study, we have compared the analgesic effects of ketorolac and paracetamol to morphine. Methods: Patients were randomly chosen from a pool of candidates who were undergoing VATS and were divided into three groups. During the first 24 h postsurgery, patients in the control group received a cumulative dose of morphine 20 mg, while patients in two treatment groups received ketorolac 120 mg and paracetamol 4 g in total. Doses were administered as bolus immediately after surgery and infusion during the first 24 h. Patients' pain severity was evaluated by visual analogue scale rating (VAS) at rest and during coughing episodes. Results: The average pain score at recovery time was 2.29 ± 2.13 and 2.26 ± 2.16 for ketorolac and paracetamol, respectively, and it was significantly lower than the morphine group with an average pain score of 3.87 (P = 0.003). Additionally, the VAS score during cough episodes was significantly higher in the control group throughout the study period compared to study groups. Comparison of mean morphine dose utilized as liberation analgesic (in case of patients had VAS >3) between three groups was not significantly different (P = 0.17). Conclusion: Our study demonstrates the non-inferiority of ketorolac and paracetamol to morphine in controlling post-VATS pain without causing any significant side effects. We also show that ketorolac and paracetamol are superior to morphine in controlling pain during 2 h postsurgery.

Thermo-mechanical contact problems and elastic behaviour of single and double sides functionally graded brake disks with temperature-dependent material properties.

A thermo-elastic contact problem of functionally graded materials (FGMs) rotating brake disk with different pure brake pad areas under temperature dependent material properties is solved by Finite Element Method (FEM). The properties of brake disk change gradually from metal to ceramic by power-law distribution along the radial direction from the inner to the outer surface. Areas of the pure pad are changing while the vertical force is constant. The ratio of brake pad thickness to FGMs brake disk thickness is assumed 0.66. Two sources of thermal loads are considered: (1) Heat generation between the pad and brake disk due to contact friction, and (2) External thermal load due to a constant temperature at inner and outer surfaces. Mechanical responses of FGMs disk are compared with several pad contact areas. The results for temperature-dependent and temperature-independent material properties are investigated and presented. The results show that the absolute value of the shear stress in temperature-dependent material can be greater than that for temperature-independent material. The radial stress for some specific grading index (n = 1.5) is compressive near the inner surface for double contact while it is tensile for a single contact. It is concluded that the radial strain for some specific value of grading index (n = 1) is lower than other FGMs and pure double side contact brake disks.

Safety and Efficacy of Intravenous Iron Sucrose for Iron-Deficiency Anemia in Children and Adolescents With Inflammatory Bowel Disease.

Background. Anemia is common in inflammatory bowel disease (IBD). Oral iron is widely used but efficacy can be reduced by poor compliance and insufficient absorption. Intravenous iron is safe and effective in adults but is not well studied in children. Purpose. To assess safety and efficacy of intravenous iron sucrose (IVIS) in children with IBD. Methods. We reviewed medical records of IBD patients <22 years of age who received IVIS at our institution between 2009 and 2014. Anemia was defined as hemoglobin (Hgb) level below normal for age and gender and iron-deficiency anemia as serum iron studies and red cell mean corpuscular volume below normal ranges. Each IVIS infusion was evaluated for safety. Efficacy was defined as ≥2 g/dL increase in Hgb ≤12 weeks from IVIS initiation. Results. We identified 88 patients (Crohn's disease, n = 52; ulcerative colitis, n = 33; IBD-unclassified, n = 3) who underwent 329 IVIS infusions over 121 courses. No patient developed anaphylaxis. Six patients developed minor adverse reactions. Of the 121 IVIS courses, 80 were included in the efficacy evaluation. There was a significant rise in Hgb (mean 9.1 ±1.4 to 11.9 ± 1.8 g/dL; P < .0001, paired t test). Overall, 58.7% (47/80 courses) resulted in goal Hgb increase. Conclusions. IVIS is safe and effective in treating iron-deficiency anemia in pediatric IBD. There were only minor adverse events, and the observed rise in Hgb was clinically significant, with the majority achieving goal Hgb.

Enterourachal Fistula as an Initial Presentation in Crohn Disease.

Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.

Reversal of Immunogenicity in Pediatric Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Medications.

Loss of response to anti-tumor necrosis factor (anti-TNF) agents in the treatment of inflammatory bowel disease (IBD) is a major consideration to maintain sustained response. Reversal of immunogenicity can re-establish response and increase the durability of these agents. Strategies to reverse immunogenicity include dose-intensification and/or the addition of an immunomodulator. However, there is a relative paucity of data on the efficacy of such interventions in pediatric IBD patients. Available reports have not strictly utilized homogenous mobility shift assay, which reports on anti-drug antibodies even in the presence of detectable drug, whereas prior studies have been confounded by the use of drug sensitive assays. We report four pediatric inflammatory bowel disease patients with successful reversal of immunogenicity on an anti-TNF agent using dose intensification and/or addition of an immunomodulator.

High-Frequency Jet Ventilation in Nonintubated Patients.

OBJECTIVES: High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it. MATERIALS AND METHODS: Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. RESULTS: Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. CONCLUSION: High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.

Effect of Adding Magnesium Sulphate to Epidural Bupivacaine and Morphine on Post-Thoracotomy Pain Management: A Randomized, Double-Blind, Clinical Trial.

Post-thoracotomy pain is very severe and may cause pulmonary complications. Thoracic epidural analgesia can greatly decrease the pain experience and its consequences. However, finding new methods to decrease the amount of administered opioids is an important issue of research. We aimed to evaluate the effect of adding epidural magnesium sulphate to bupivacaine and morphine on pain control and the amount of opioid consumption after thoracotomy. Eighty patients undergoing thoracotomy at a tertiary cardiothoracic referral centre were enrolled in a randomized, double-blind trial. Patients were randomly allocated to two groups. Bupivacaine (12.5 mg) and morphine (2 mg) were administered epidurally to all patients at the end of operation. Patients in the magnesium (Mg) group received epidural magnesium sulphate (50 mg), and patients in the control (C) group received normal saline as an adjuvant. Visual analogue scale (VAS) score and the amount of morphine consumption were measured during 24 hr post-operation. Thirty-nine patients in the Mg group and 41 patients in the C group completed the study. Patients in the Mg group had significantly less VAS score at recovery time (p < 0.05), 2 hr (p < 0.01) and 4 hr (p < 0.05) after surgery. The patient-controlled analgesia pump was started earlier in the C group than in the Mg group (p < 0.05). The amount of morphine needed in the Mg group was significantly lower than in the C group (5.64 ± 1.69 mg/24 hr versus 8.44 ± 3.98 mg/24 hr; p < 0.001). Pruritus was seen in the C group (9.7%) and absent in the Mg group (p < 0.05). Co-administration of magnesium sulphate with bupivacaine and morphine for thoracic epidural analgesia after thoracotomy leads to a reduction in post-operative pain score and the need for opioid administration.

CD4+CD25+CD127low FoxP3+ regulatory T cells in Crohn's disease.

BACKGROUND: Regulatory T (Treg) cell plays a key role in autoimmune diseases. We evaluated the regulatory function and frequency of Treg cells and secreted IL-10, IL-35 concentration in Crohn's disease (CD). METHODS: Twenty-three patients with CD and 25 healthy controls (HC) were included in this study. We analysed the alteration of Tregs frequency using flow cytometry for CD4, CD25, CD127 and FoxP3 markers. Surface expression of CD4, CD25 and CD127 markers were used for isolation of relatively pure Treg cells. Suppressive activity of Tregs was determined by measuring their ability to inhibit the proliferation of T responder (Tres) cells. In addition, the amounts of IL-10 and IL-35 cytokines in co-culture supernatants were measured by ELISA assay after stimulation with anti-CD2/CD3/CD28. RESULTS: CD patients had significantly lower frequency of CD4+ CD25+ CD127low FoxP3+ Treg cells in comparison with controls (2.17 ± 1.04 vs. 2.83 ± 1.07, p = 0.0352). Additionally, Treg cells mediated suppression was not significantly different in CD patients compared to controls. There was a significant difference in IL-10 secretion in response to anti-CD2/CD3/CD28 stimulation compared with HC (p = 0.0074). CONCLUSION: The frequency of CD4+ CD25+ CD127low FoxP3+ Tregs decreased in active stage of CD but there was no impaired suppressive function of CD4+ CD25+ CD127low FoxP3+ Treg cells. We suggest that an alteration in the balance of Tregs and T effectors may contribute to pathogenesis of CD.

Evaluation of cerebral oxygen saturation during hypotensive anesthesia in functional endoscopic sinus surgery.

BACKGROUND AND AIMS: Controlled hypotensive anesthesia in endoscopic sinus surgery would provide a clean surgical field. Cerebral oxygen saturation (ScO2) is important in endoscopic sinus surgery patients and it may be low during controlled hypotension. The aim of the present study was to assess ScO2 in these patients. MATERIAL AND METHODS: In this observational study, 41 patients who underwent endoscopic sinus surgery with hypotensive anesthesia were enrolled for the study and all of the patients received the same anesthetic medication, nitroglycerin for controlled hypotension. Variables were measured prior to surgery, after induction of anesthesia, 5 min, and every 30 min after controlled hypotension. Near-infrared spectroscopy was used for ScO2 evaluation. Mean arterial blood pressure (MAP) was maintained at 55-60 mmHg in the surgical duration. We used t-test, Wilcoxon, and repeated measures analysis of variance (ANOVA). We examined the cross-correlation functions of the time series data between end-tidal carbon dioxide (ETCO2)/MAP and ScO2. RESULTS: The mean of intraoperative ScO2 was not significantly different from the baseline evaluation (P > 0.05). ETCO2 was cross correlated with current ScO2 [r: 0.618, confidence interval (CI) 95%: 0.46-0.78]. We found moderate cross correlation between the MAP and current ScO2 (r: 0.728, CI 95%: 0.56-0.88). About 92% of the patients recovered within 30 min. Recovery time was associated with intraoperative MAP (P: 0.004, r: 0.438), intraoperative ETCO2 (P: 0.003, r: 0.450), and ScO2 (P: 0.026, r: 0.348). CONCLUSIONS: Based on our findings, the assessment of ScO2 and maintained MAP >55 mmHg may provide safe conditions for endoscopic sinus surgery.