The effect of mesenchymal stem cells administration on DNA repair gene expressions in critically ill COVID-19 patients: prospective controlled study.

When the studies are evaluated, immunomodulatory effect of MSCs, administration in critically ill patients, obstacle situations in use and side effects, pulmonary fibrosis prevention, which stem cells and their products, regeneration effect, administration route, and dosage are listed under the main heading like. The effect of MSC administration on DNA repair genes in COVID-19 infection is unknown. Our aim is to determine the effect of mesenchymal stem cells (MSCs) therapy applied in critically ill patients with coronavirus infection on DNA repair pathways and genes associated with those pathways. Patients (n = 30) divided into two equal groups. Group-1: Patients in a critically ill condition, Group-2: Patients in critically ill condition and transplanted MSCs. The mechanism was investigated in eleven genes of five different pathways; Base excision repair: PARP1, Nucleotide excision repair (NER): RAD23B and ERCC1, Homologous recombinational repair (HR): ATM, RAD51, RAD52 and WRN, Mismatch repair (MMR): MLH1, MSH2, and MSH6, Direct reversal repair pathway: MGMT. It was found that MSCs application had a significant effect on 6 genes located in 3 different DNA damage response pathways. These are NER pathway genes; RAD23 and ERCC1, HR pathway genes; ATM and RAD51, MMR pathway genes; MSH2 and MSH6 (p < 0.05). Two main points were shown. First, as a result of cellular damage in critical patients with COVID-19, DNA damage occurs and then DNA repair pathways and genes are activated in reaction to this situation. Second, administration of MSC to patients with COVID-19 infection plays a positive role by increasing the expression of DNA repair genes located in DNA damage pathways.

Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass Techniques in Coronary Artery Bypass Grafting Surgeries on Cerebral Perfusion.

Objective: We aimed to evaluate the effects of cardiopulmonary bypass (CPB) machines used in coronary artery bypass grafting surgeries on cerebral perfusion by performing cerebral oximetry monitoring [near-infrared spectroscopy (NIRS)], S100-ß protein measurements, and neurocognitive function assessment tests using both pulsatile and non-pulsatile modes. Methods: A total of 44 patients, 22 non-pulsatile (Group NP) and 22 pulsatile (Group P), were included in the study. Hemodynamic parameters, arterial blood gas values, NIRS values and blood S100ß protein levels were analyzed at five points: pre-induction (T1), initiation of CPB (T2), termination of CPB (T3), end of surgery (T4), and postoperative 24 h (T5). Two different neuropsychological tests were administered to patients in the preoperative and postoperative periods. Results: There were no significant differences between the groups for demographic characteristics such as age, gender, body mass index, aortic cross-clamping, CPB, and operation durations. The mean arterial blood pressure and PaO2 values for the T2 measurements were significantly higher in group NP (P < 0.05). Regional cerebral oxygen saturation (rSO2) (NIRS) values at T3 and T4 were significantly higher in group P (P < 0.05). Serum S100ß measurement values at T3 and T5 were significantly higher in group NP than in group P (P < 0.05). Serum S100ß protein levels at T3 correlate with rSO2 results. There was no statistically significant difference between the two groups in terms of pH, lactate, glucose, partial pressure of carbon dioxide, and peripheral oxygen saturation values. Conclusion: Despite no difference between the two groups for neurocognitive function tests, we believe that pulsatile perfusion may be more beneficial for cerebral perfusion when S100ß protein and NIRS values are considered. Further clinical studies are needed to evaluate the benefits of the pulsatile technique for cerebral perfusion.

Comparing Preoperative Anxiety Effects of Brachial Plexus Block and General Anesthesia for Orthopedic Upper-Extremity Surgery: A Randomized, Controlled Trial.

Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.

Perioperative goal-directed fluid management using noninvasive hemodynamic monitoring in gynecologic oncology.

BACKGROUND: Intraoperative fluid management is important for the prevention of perioperative morbidity and mortality. Our study aimed to investigate the perioperative feasibility and benefits of Goal-Directed Fluid Management (GDFM) using noninvasive hemodynamic monitoring in gynecologic oncology patients with acute blood loss and severe fluid loss. We assessed the effects of GDFM on hemodynamics, organ perfusion, complications, and mortality outcomes. METHODS: This randomized prospective study included 104 patients over the age of 18 years, including 56 patients with endometrial cancer and 48 patients with ovarian cancer who had open surgery. The anesthetic approach was standardized for all patients. We compared the perioperative results of the subjects who were randomized into GDFM (n = 51) and Liberal Fluid Management (LFM) (n = 53) groups using a computer program. RESULTS: The median perioperative crystalloid replacement (2000 vs. 2700; p < 0.001) and total volume of fluid (2260 vs. 3200; p < 0.001) were lower in the GDFM group compared to the LFM group. The hemodynamic findings and the HCO3 and lactate levels of the GDFM group did not significantly change perioperatively. The heart rate, mean arterial pressure, and HCO3 levels of the LFM group decreased and serum lactate levels increased perioperatively. The hospitalization rate in ICU (7.8% vs. 28.3%; p = 0.010), rate of patients with comorbidity conditions indicated in ICU (2% vs. 17%; p = 0.024), and rate of complications (17.6% vs. 35.8%; p = 0.047) were lower in the GDFM group compared to the LFM group. CONCLUSION: The amount of intraoperatively administered crystalloid solution and complication rates were significantly lower in gynecologic oncologic surgery patients who received GDFM. Besides, hemodynamic findings, and lactate levels of the GDFM group did not change significantly during the perioperative period.

DNA damage effects of inhalation anesthetics in human bronchoalveolar cells.

BACKGROUND: The main objective was to evaluate and compare the local genotoxicity of sevoflurane and desflurane in bronchoalveolar cells, while the secondary outcome was to detect systemic oxidative DNA damage. To our knowledge, our study is the first one to evaluate the local effects of inhalation anesthetics in human bronchoalveolar cells in patients. METHODS: American Society of Anesthesiologists group I-II patients scheduled for lumbar discectomy surgery were enrolled in this randomized prospective study. Patients were randomized to sevoflurane or desflurane for anesthesia maintenance. Bronchoalveolar lavage samples and peripheral blood samples were taken at 2-time points: the first point (baseline, T1); and the second point (postexposure, T2). Final number of 48 samples were the sevoflurane (n = 22) and desflurane (n = 26) groups. Comet assay was applied to examine genotoxic properties. Oxidative DNA damage in plasma was measured with 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: T2 values were higher than baseline values in both the desflurane group (tail-length: 66 ±â€Š24, %DNA in tail: 72 ±â€Š60, tail moment: 47.52 ±â€Š14.4; P = .001, P = .005, P = .001, respectively) and the sevoflurane group (tail-length: 58 ±â€Š33, %DNA in tail: 88 ±â€Š80, tail moment: 51.04 ±â€Š26.4; P = .001, P = .012, P = .001, respectively). T2 plasma 8-OHdG levels were also higher than baseline levels in the desflurane group (3.91 ±â€Š0.19 ng/ml vs 1.32 ±â€Š0.20 ng/ml, P = .001) and sevoflurane group (3.98 ±â€Š0.18 ng/ml vs 1.31 ±â€Š0.11 ng/ml, P = .001). There were no differences between the 2 groups in comet parameters and 8-OHdG levels. CONCLUSION: Our results indicate that both inhalation agents cause DNA damage in the bronchoalveolar cells. Also, we detected increases in plasma 8-OHdG concentrations. Local genotoxicity and systemic oxidized DNA damage were similar in both groups.

Community Palliative Care in Turkey: A Collaborative Promoter to a New Concept in the Middle East.

The Middle East has been struggling with basic issues of cancer care, and in specific, palliative care, at the primary health care level in the communities. The Middle East Cancer Consortium designated this issue as the highest priority of its activities in the region. Following basic and advanced courses and national and international workshops, local governments recognized the essentiality of developing palliative care services in their respective countries. As the result of these training activities, in 2010, the Ministry of Health in Turkey initiated a novel program whereby population-based and home-based palliative care teams were developed throughout the country, including peripheral regions in the countries where appropriate care was not available. This initiative led to a dramatic increase in the number of cancer patients receiving palliative care at their homes. The Turkish initiative can serve as a model to other countries in the Middle East and beyond it.

Monitorization of the effects of spinal anaesthesia on cerebral oxygen saturation in elder patients using near-infrared spectroscopy / Monitoramento dos efeitos da raquianestesia sobre a saturação de oxigênio cerebral em pacientes idosos com o uso de espectroscopia de luz próxima ao infravermelho / Monitorización de los efectos de la raquianestesia sobre la saturación de oxígeno cerebral en pacientes ancianos con el uso de espectroscopia de luz próxima al infrarrojo

OBJECTIVE: Central blockage provided by spinal anaesthesia enables realization of many surgical procedures, whereas hemodynamic and respiratory changes influence systemic oxygen delivery leading to the potential development of series of problems such as cerebral ischemia, myocardial infarction and acute renal failure. This study was intended to detect potentially adverse effects of hemodynamic and respiratory changes on systemic oxygen delivery using cerebral oxymetric methods in patients who underwent spinal anaesthesia. METHODS: Twenty-five ASA I-II Group patients aged 65-80 years scheduled for unilateral inguinal hernia repair under spinal anaesthesia were included in the study. Following standard monitorization baseline cerebral oxygen levels were measured using cerebral oximetric methods. Standardized Mini Mental Test (SMMT) was applied before and after the operation so as to determine the level of cognitive functioning of the cases. Using a standard technique and equal amounts of a local anaesthetic drug (15 mg bupivacaine 5%) intratechal blockade was performed. Mean blood pressure (MBP), maximum heart rate (MHR), peripheral oxygen saturation (SpO2) and cerebral oxygen levels (rSO2) were preoperatively monitored for 60 min. Pre- and postoperative haemoglobin levels were measured. The variations in data obtained and their correlations with the cerebral oxygen levels were investigated. RESULTS: Significant changes in pre- and postoperative measurements of haemoglobin levels and SMMT scores and intraoperative SpO2 levels were not observed. However, significant variations were observed in intraoperative MBP, MHR and rSO2 levels. Besides, a correlation between variations in rSO2, MBP and MHR was determined. CONCLUSION: Evaluation of the data obtained in the study demonstrated that post-spinal decline in blood pressure and also heart rate decreases systemic oxygen delivery and adversely effects cerebral oxygen levels. However, ...

JUSTIFICATIVA E OBJETIVO: o bloqueio central proporcionado pela raquianestesia possibilita a realização de muitos procedimentos cirúrgicos, enquanto as alterações hemodinâmicas e respiratórias influenciam a oferta de oxigênio sistêmico, levando ao desenvolvimento em potencial de uma série de problemas, como isquemia cerebral, infarto do miocárdio e insuficiência renal aguda. O objetivo deste estudo foi detectar potenciais efeitos adversos das alterações hemodinâmicas e respiratórias sobre a oferta de oxigênio sistêmico, usando métodos oximétricos cerebrais em pacientes submetidos à raquianestesia. MÉTODOS: vinte e cinco pacientes, 65-80 anos de idade, estado físico ASA I-II, programados para correção de hérnia inguinal unilateral sob raquianestesia foram incluídos no estudo. De acordo com o monitoramento padrão, os níveis de oxigênio cerebral foram medidos no início do estudo usando métodos oximétricos cerebrais. O Mini Teste Padronizado do Estado Mental (Standardized Mini Mental Test - SMMT) foi aplicado antes e depois da operação para determinar o nível de funcionamento cognitivo dos casos. Usando uma técnica padrão e quantidades iguais de um fármaco anestésico local (15 mg de bupivacaína a 5%), o bloqueio intratecal foi realizado. Pressão arterial média (PAM), frequência cardíaca máxima (FCM), saturação periférica de oxigênio (SpO2) e níveis cerebrais de oxigênio (rSO2) foram monitorados no pré-operatório por 60 min. Os níveis pré- e pós-operatórios de hemoglobina foram medidos. As variações nos dados obtidos e suas correlações com os níveis cerebrais de oxigênio foram investigadas. RESULTADOS: não observamos ...

JUSTIFICACIÓN Y OBJETIVO: el bloqueo central proporcionado por la raquianestesia posibilita la realización de muchos procedimientos quirúrgicos, mientras que las alteraciones hemodinámicas y respiratorias influyen en la administración de oxígeno sistémico conllevando el desarrollo potencial de una serie de problemas, como la isquemia cerebral, el infarto de miocardio y la insuficiencia renal aguda. El objetivo de este estudio fue detectar potenciales efectos adversos de las alteraciones hemodinámicas y respiratorias sobre la administración de oxígeno sistémico, usando métodos oximétricos cerebrales en pacientes sometidos a la raquianestesia. MÉTODOS: veinticinco pacientes, entre 65 y 80 años de edad, estado físico ASA I-II, programados para la corrección de hernia inguinal unilateral bajo raquianestesia fueron incluidos en el estudio. De acuerdo con la monitorización estándar, los niveles de oxígeno cerebral fueron medidos al inicio del estudio usando métodos oximétricos cerebrales. El Mini Test Estandarizado del Estado Mental se aplicó antes y después de la operación para determinar el nivel de funcionamiento cognitivo de los casos. Usando una técnica estándar y cantidades iguales de un anestésico local (15 mg de bupivacaína al 5%), se realizó el bloqueo intratecal. La presión arterial media (PAM), frecuencia cardíaca máxima (FCM), saturación periférica de oxígeno (SpO2) y niveles cerebrales de oxígeno (rSO2) fueron monitorizados en el preoperatorio durante 60 min. Se midieron los niveles pre y postoperatorios de hemoglobina. Las variaciones en los datos obtenidos y sus correlaciones con los niveles cerebrales de oxígeno fueron investigadas. RESULTADOS: no observamos alteraciones significativas en las medidas de hemoglobina, puntuaciones ...

Comparison of the effects of on-pump and off-pump coronary artery bypass surgery on cerebral oxygen saturation using near-infrared spectroscopy.

BACKGROUND: Central nervous system complications are the most clinically important of those affecting mortality in patients undergoing coronary artery surgery. Newly developed sophisticated techniques and surgical interventions obviating the need for cardiopulmonary pumps have facilitated avoidance of these complications. In this study, we compared the impact of on-pump and off-pump coronary artery bypass surgery on cerebral oxygenation using near-infrared spectroscopy. METHODS: This study included 40 patients with no comorbidities who were scheduled for on-pump (n = 20) and off-pump (n = 20) cardiac surgery. Preoperative and postoperative Standardized Mini-Mental State Examination (SMMSE) scores, perioperative mean arterial blood pressure (MAP), hematocrit (Hct), peripheral oxygen saturation (SpO2), regional cerebral oximetry values (rSO2), body temperature, and partial pressure of carbon dioxide (PCO2) were recorded, for all patients. Intergroup and intragroup comparisons were then performed. RESULTS: The mean operative time was longer in the on-pump group. SMMSE scores were similar and relevant postoperative values were lower in both groups. Perioperative MAP, PCO2, and SpO2 were similar in both groups. SpO2 and PCO2 did not differ from baseline levels in either group, while the postextubation MAP at 2 h postoperatively remained low. Hct levels decreased during the perioperative and postoperative periods, while the body temperature declined perioperatively and to a greater degree in the on-pump group. The intraoperative and postoperative rSO2 decreased in both groups. In the on-pump group, the decrease in rSO2 was more prominent during the interval between the start and closure of the sternotomy. CONCLUSIONS: Physiological alterations that occur during coronary artery surgery affect cerebral oxygenation during and after the operation irrespective of the application of a cardiopulmonary pump. Cerebral oxygenation decreases to a greater extent during on-pump surgery; however, probably because of the neuroprotective effects of hypothermia, the postoperative changes resemble those of off-pump surgery.

O efeito da "sedação multifásica" no exame de tomografia computadorizada e ressonância magnética em crianças, pais e anestesiologistas / The effect of "multiphase sedation" in the course of computed tomography and magnetic resonance imaging on children, parents and anesthesiologists / El efecto de la "sedación multifásica" en el curso de la tomografía computadorizada y resonancia magnética en niños, padres y anestesiólogos

JUSTIFICATIVA E OBJETIVOS: O nosso objetivo foi investigar o efeito da "sedação multifásica" em crianças submetidas à Tomografia Computadorizada (TC) ou Ressonância Magnética (RM), em seus pais e nos anestesiologistas responsáveis. "Sedação multifásica" foi definida como "o nível de sedação pretendido obtido com um ou mais agentes através da mesma via ou vias diferentes com mais de uma administração". MATERIAL E MÉTODOS: Cem crianças e seus respectivos pais foram randomicamente designados para um dos dois grupos de estudo. Na fase 1, os pacientes do Grupo I receberam midazolam (0,5 mg.kg-1) em 5 mL de suco de frutas e os pacientes do Grupo II (grupo controle) receberam apenas suco de frutas. Na fase 2, após a canulação intravenosa (iv), bolus de propofol foi administrado para alcançar a sedação adequada para realização do exame de imagem. Os escores de ansiedade das crianças e de seus pais foram registrados usando a escala de Oucher e o IDATE, respectivamente, e a satisfação dos pais foi avaliada pela escala analógica visual (EAV). O número de tentativas para canulação iv, tempo de preparação e quantidade de hipnóticos foram registrados. RESULTADOS: O estado de ansiedade das crianças foi semelhante entre os grupos antes da pré-medicação, porém mais tarde esse nível foi menor no Grupo I. Antes do procedimento, o escore dos pais no IDATE foi semelhante, mas depois foi menor no Grupo I. A satisfação dos pais no Grupo I foi maior que no Grupo II. O número de tentativas de canulação iv e a dose necessária de propofol foi menor no Grupo I. CONCLUSÃO: O procedimento de "sedação multifásica" diminui a dor e a ansiedade das crianças e a ansiedade dos pais, aumentando a sua satisfação. Ele fornece uma sedação confortável e segura, pois possui um processo de preparação curto e sem problemas também para o anestesiologista responsável.

BACKGROUND AND OBJECTIVES: We aimed to investigate the effect on children undergoing Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), their parents and attending anesthesiologist of "multiphase sedation" which we define as "the intended sedation level achieved with one or more agents through the same or different routes with more than one administration". MATERIAL AND METHODS: One hundred children and their parents were randomly allocated to one of two study groups. In phase 1; in Group I the patients were given midazolam (0.5 mg.kg-1) in 5 mL fruit juice, and the ones in control group (Group II) were given only fruit juice. After intravenous (iv) cannulation; in phase II, boluses of propofol were given to achieve the adequate sedation for imaging. Anxiety scores of children and their parents were recorded using Oucher scale and STAI, respectively, and parental satisfaction was evaluated by visual analogue scale (VAS). The number of attempts for iv cannulation, length of time for preparation, and amount of hypnotics were recorded. RESULTS: Anxiety state of children was similar between groups before premedication, but later it was lower in Group I. Before procedure, STAI score of parents was similar and later it was lower in Group I. Parental satisfaction in Group I was higher. The number of attempts for iv cannulation and required propofol dose was less in Group I. CONCLUSION: "Multiphase sedation" procedure provides children to feel less pain and anxiety, and decreases parental anxiety while increasing their satisfaction. It supplies a comfortable and safe sedation, as it provides a short and problem-free preparation process for the attending anesthetist as well.

JUSTIFICATIVA Y OBJETIVOS: Nuestro objetivo fue investigar el efecto de la "sedación multifásica" en niños sometidos a la tomografía computadorizada (TC) o resonancia magnética (RM), en sus padres y en los anestesiólogos responsables. La "sedación multifásica" fue definida como "el nivel de sedación pretendido que se obtiene con uno o más agentes por medio de la misma vía o vías diferentes con más de una administración". MATERIAL Y MÉTODOS: Cien niños y sus respectivos padres fueron randómicamente designados para uno de los dos grupos de estudio. En la fase 1, los pacientes del Grupo I recibieron midazolam (0,5 mg.kg-1) en 5 mL de jugo de frutas, y los pacientes del Grupo II (grupo control) recibieron solamente jugo de frutas. En la fase 2 después de la canulación intravenosa (i.v.), un bolo de propofol se administró para alcanzar la sedación adecuada para la realización del examen de imagen. Las puntuaciones de ansiedad de los niños y de sus padres se registraron usando la escala de Oucher y el IDATE respectivamente, y la satisfacción de los padres fue evaluada por la escala visual analógica (EVA). También se registraron el número de intentos para canulación i.v., tiempo de preparación y cantidad de hipnóticos. RESULTADOS: El estado de ansiedad de los niños fue parecido entre los grupos antes de la premedicación sin embargo, más tarde ese nivel disminuyó en el Grupo I. Antes del procedimiento, la puntuación de los padres en el IDATE fue similar pero después cayó en el Grupo I. La satisfacción de los padres en el Grupo I fue mayor que en el Grupo II. El número de intentos de canulación i.v. y la dosis necesaria de propofol fue menor en el Grupo I. CONCLUSIONES: El procedimiento de "sedación multifásica" reduce el dolor y la ansiedad de los niños y de los padres, aumentando su satisfacción. El procedimiento suministra una sedación cómoda y segura porque posee un proceso de preparación corto y sin problemas también para el anestesiólogo responsable.

Protective effect of the nuclear factor kappa B inhibitor pyrrolidine dithiocarbamate in lung injury in rats with streptozotocin-induced diabetes.

BACKGROUND: Diabetes mellitus (DM) causes debilitating complications and, as a result, diabetics frequently require intensive care. Although lungs are not thought to be affected primarily by DM, an increasing number of studies indicate physiological and structural abnormalities in diabetic lungs. OBJECTIVES: Pyrrolidine dithiocarbamate (PDTC) is a metal chelator and a potent inhibitor of NF-kappaB. Keeping in mind that NF-kappaB activation may be crucial in end-organ injury due to DM, we studied the role of PDTC on the inhibition of NF-kappaB activation and its effects on possible lung injury in rats with streptozotocin-induced DM. METHODS: 36 Sprague-Dawley rats were allocated into 4 groups: diabetes, diabetes + PDTC, control and control + PDTC. At the end of 10 weeks, rats were sacrificed and their lungs were taken for histopathological and immunohistochemical evaluation [for NF-kappaB (p65) and endothelial nitric oxide (eNOS) immunoreactivities]. Protein carbonyl content (PCC), superoxide dismutase (SOD) and reduced glutathione (GSH) activities were measured. RESULTS: Histopathologically, basal membranes were thickened and there was intense inflammatory reaction in diabetic lungs. However, the PDTC group, in which there were poor positive expressions of eNOS and p65 activity compared to diabetes group, revealed fewer inflammatory changes. PCC levels in diabetic lungs were higher, but SOD and GSH activities were lower. However, measurements of these parameters in the PDTC group and controls gave similar results. CONCLUSION: Lungs are exposed to changes induced by oxidative stress in diabetes through NF-kappaB activation and PDTC seems to be useful to prevent diabetic lung injury.