The effect of sugammadex on postoperative cognitive function and recovery / O efeito de sugamadex sobre a função cognitiva e recuperação no pós-operatório

Abstract Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001). Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001). Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

Resumo Justificativa e objetivo: Sugamadex é o primeiro agente de ligação relaxante seletivo. Após a administração de sugamadex, os tempos de despertar e de recuperação dos pacientes são menores, em comparação com neostigmina. Neste estudo, a hipótese foi que um despertar mais rápido e claro dos pacientes submetidos à anestesia geral tem efeitos positivos sobre as funções cognitivas no pós-operatório imediato. Métodos: Após a aprovação do Comitê de Ética local, 128 pacientes foram incluídos neste estudo prospectivo, randômico, controlado e duplo-cego. Os pacientes foram designados para o grupo sugamadex (Grupo S) ou grupo neostigmina (Grupo N). O desfecho primário do estudo foi a recuperação cognitiva no pós-operatório imediato, de acordo com a mensuração da Avaliação de Montreal da Função Cognitiva (MoCA) e com o Mini Exame do Estado Mental (MMSE), após a avaliação inicial 12-24 h antes da operação. Após a operação, quando o escore de recuperação de Aldrete modificado era ≥ 9, o teste MMSE e, uma hora depois, o teste MoCA foram repetidos. Resultados: Embora tenha havido uma redução nos escores de MoCA e MMSE tanto no Grupo S quanto no Grupo N, entre os escores pré- e pós-operatório não houve diferença estatisticamente significativa nas reduções (p > 0,05). O tempo para atingir TOF 0,9 foi de 2,19 min no Grupo S e de 6,47 min no Grupo N (p < 0,0001). O tempo de recuperação foi de 8,26 min no Grupo S e de 16,93 min no Grupo N (p < 0,0001) Conclusão: Mostramos que o procedimento cirúrgico e/ou procedimento anestésico de acompanhamento pode causar uma regressão temporária ou permanente da função cognitiva no pós-operatório imediato. No entanto, um desempenho cognitivo melhor não pode ser provado no grupo sugamadex em comparação com o grupo neostigmina.

Traumatic internal carotid artery dissection associated with playing soccer: a case report.

Soccer, one of the most popular sports worldwide among young men, can result in a wide range of orthopedic injuries. Although vascular injuries such as dissection occur rarely, they can cause significant mortality if left undiagnosed. We report herein a 31-year-old male who suffered a large middle cerebral artery infarction due to traumatic internal carotid artery dissection after a ball struck his head and neck. He recovered with mild neurologic deficit after decompressive surgery.

Antimicrobial and antioxidant activities of Turkish extra virgin olive oils.

Turkish extra virgin olive oils (EVOO) from different varieties/geographical origins and their phenolic compounds were investigated in terms of their antimicrobial and antioxidant properties in comparison to refined olive, hazelnut, and canola oils. Antimicrobial activity was tested against three foodborne pathogenic bacteria, Escherichia coli O157:H7, Listeria monocytogenes , and Salmonella Enteritidis. Although all EVOOs showed a bactericidal effect, the individual phenolic compounds demonstrated only slight antimicrobial activity. Moreover, refined oil samples did not show any antimicrobial activity. Among the phenolic compounds, cinnamic acid (2 mg/kg of oil) had the highest percent inhibition value with 0.25 log reduction against L. monocytogenes. The synergistic interactions of tyrosol, vanillin, vanillic, and cinnamic acids were also observed against Salmonella Enteritidis. The antioxidant activities of oils were tested by beta-carotene-linoleate model system and ABTS method. In both methods, EVOOs showed higher antioxidant activities, whereas refined oils had lower activity. The ABTS method provided a higher correlation (0.89) with total phenol content.

Hyperhomocysteinemia as an independent risk factor for cardioembolic stroke in the Turkish population.

Homocysteine, a sulfur-containing amino acid, is an intermediate during the conversion of methionine to cysteine. Homocysteine can cause vascular injury and atherosclerotic plaque instability. In addition, homocysteine may be directly correlated with hyperlipidemia and lipoprotein(a) and inversely with high-density lipoprotein cholesterol. However, the results regarding the association of homocysteine level with subtypes of stroke and traditional risk factors for stroke have been inconsistent, perhaps due to ethnic differences. The aim of this study was to evaluate the role of serum homocysteine levels in Turkish patients diagnosed with atherosclerotic stroke and those with cardioembolic stroke. We measured homocysteine levels, traditional risk factors for stroke (hypertension, diabetes mellitus, and smoking) and lipoprotein(a) levels in 103 patients with large-vessel atherosclerotic stroke, 37 patients with cardioembolic stroke, and 37 controls with normal cranial magnetic resonance imaging. Only hypertension was found to be a risk factor in all patient groups (p = 0.001). Hyperhomocysteinemia (homocysteine level > or = 15.90 micromol/L) was more common in patients with large-vessel atherosclerotic stroke and cardioembolic stroke (p = 0.0435 and p = 0.007, respectively); nevertheless, it was found to be a risk factor only in patients with cardioembolic stroke (p = 0.023; odds ratio (OR): 5.745). Furthermore, in the patients with large-vessel atherosclerotic stroke, hyperhomocysteinemia was positively correlated with the lipoprotein(a) level (r = 0.227, p = 0.035). In conclusion, hyperhomocysteinemia is common in patients with large-vessel atherosclerotic stroke and cardioembolic stroke. More importantly, hyperhomocysteinemia is an independent risk factor only for cardioembolic stroke in the Turkish population.

Effects of bovine oviduct epithelial cells, fetal calf serum and bovine serum albumin on gene expression in single bovine embryos produced in the synthetic oviduct fluid culture system.

In this study the synthetic oviduct fluid (SOF) system with bovine oviduct epithelial cell (BOEC) co-culture is compared with an SOF system with common protein supplements. One thousand six hundred bovine embryos were cultured in SOF media supplemented with BOEC, fetal calf serum (FCS) and bovine serum albumin (BSA). Eight different culture groups were assigned according to the different supplementation factors. Developmental competence and the expression levels of five genes, namely glucose transporter-1 (Glut-1), heat shock protein 70 (HSP), connexin43 (Cx43), (2)-actin (ACTB) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), analysed as mRNA by using reverse transcription-polymerase chain reaction, were measured on bovine embryos cultured for 9 days. Gene expression of these in vitro-produced embryos was compared with the gene expression of in vivo-produced embryos. There was no significant difference found in embryo developmental competence between the Day 9 embryos in BOEC co-culture, FCS and BSA supplements in SOF media. However, differences in gene expression were observed. With respect to gene expression in in vivo and in vitro embryos, BOEC co-culture affected the same genes as did supplementation with FCS and BSA. HSP was the only gene that differed significantly between in vitro and in vivo embryos. When the different in vitro groups were compared, a significant difference between the BOEC co-culture and the FCS supplementation groups due to Glut-1 expression was observed.

Dietary supplement oil classification and detection of adulteration using Fourier transform infrared spectroscopy.

Fourier transform infrared spectroscopy (FT-IR) methods and common chemometric techniques [including discriminant analysis (DA), Mahalanobis distances, and Cooman plots] were used to classify various types of dietary supplement oils (DSO) and less expensive, common food oils. Rapid FT-IR methods were then developed to detect adulteration of DSO with select common food oils. Spectra of 14 types of DSO and 5 types of common food oils were collected with an FT-IR equipped with a ZnSe attenuated total reflectance cell and a mercury cadmium telluride A detector. Classification of DSO and some common food oils was achieved successfully using FT-IR and chemometrics. Select DSO were adulterated (2-20% v/v) with the common food oils that had the closest Mahalanobis distance to them in a Cooman plot based on the DA analysis, and data were also analyzed using a partial least-squares (PLS) method. The detection limit for the adulteration of DSO was 2% v/v. Standard curves to determine the adulterant concentration in DSO were also obtained using PLS with correlation coefficients of >0.9. The approach of using FT-IR in combination with chemometric analyses was successful in classifying oils and detecting adulteration of DSO.

Detection of hazelnut oil adulteration using FT-IR spectroscopy.

Fourier transform infrared spectroscopy (FT-IR) was used to detect the adulteration of hazelnut oil with different types of oils and to detect the adulteration of extra-virgin olive oil with hazelnut oil. Spectra of hazelnut oil, seven other types of oils, extra-virgin olive oil, and the adulterated oils were collected with a FT-IR equipped with a ZnSe-ATR accessory and a MCTA detector. Discriminant analysis and partial least-squares analysis were used to analyze the data. Classification of hazelnut oil, olive oil, and the other types of oils was achieved successfully with FT-IR. The detection level for sunflower oil adulteration of hazelnut oil was 2%, and the correlation coefficient for the PLS model was 0.99. Adulteration of virgin olive oil with hazelnut oil could be detected only at levels of 25% and higher.