Validation of simplified postoperative nausea and vomiting intensity scale in Taiwan.

This study determined whether the Simplified Postoperative Nausea and Vomiting Impact Scale (SPONVIS), could be used to predict clinically important PONV in Taiwanese. In this prospective, observational study, SPONVIS, simplified Apfel PONV Risk Scores, post-operative anti-emetic drug use, total PONV score, and 3-month recall score for PONV were recorded from Taiwanese patients who had undergone general anesthesia and surgery. With antiemetic use and 3-month recall score as validations of clinical significance, we determined whether the elements and cut-off points used in the original SPONVIS study could be used in Taiwanese patients. A total of 378 patients were included in the analysis. One hundred forty (37.1%) patients had PONV. Forty-eight patients (12.7%) had clinically important PONV (SPONVIS score ≥ 5). The odds ratios were 14.26 (CI 6.91-29.43; P < 0.001) and 4.95 (CI 2.42 to 10.11; P < 0.001), respectively, for prediction of anti-emetic drug use and 3-month recall. The SPONVIS and its construct elements were significantly related to anti-emetic drug use, 3-month recall score for PONV, total PONV score, and Apfel risk score (all P ≤ 0.005), results similar to those reported in the original Australian PONV impact score study. The SPONVIS cut-off points 3 and 5 were statistically significant predictors of anti-emetic drug use. However, a cut-off point of 3 had a higher OR (24.08) than a cut-off of 5 (14.26) for prediction of anti-emetic drug use. SPONVIS and both construct elements (the nausea and vomiting impact scores) are useful predictors of clinically important PONV in Taiwanese.

[Response surface analysis for the optimization of extraction condition for polysaccharides from Epimedium polysaccharides and studies on its tumor immune activities].

To enhance the efficiency of the extraction for Epimedium koreanum Nakai polysaccharides, we conducted the Box-Benhnken experiment and examined the response surface. C57 BL6 mice were used as Lewis-bearing mice model in the study of the polysaccharides in the regulation of tumor immunity. In the first place, different factors including extraction time, temperature, and ratio were evaluated in the yield of polysaccharides. The second order polynomial equation was formed to fit the experimental data. The optimal condition was temperature 87 ℃, extraction time 3.84 h, and ratio of solution and material 1:16.33 to get polysaccharides from Epimedium koreanum Nakai. Under this condition, model-predicted and experimentally measured values of polysaccharide yield were 1.045% and 1.023%, respectively, with a relative error between them at 2.15%. The extraction method is reliable, simple and applicable to the extraction of Epimedium polysaccharides. In addition, this data suggests that Epimedium polysaccharides have obvious immune-regulatory activities in the tumor-bearing mice through increasing the immune-enhancing cytokines to override the immune- suppressing factors.

Em08red, a dual functional antiproliferative emodin analogue, is a downregulator of ErbB2 expression and inducer of intracellular oxidative stress.

Expression of ErbB2 protein is inversely correlated with the prognosis in cancer patients. Consequently, strategies targeting ErbB2 remain an attractive option in treating several types of malignancies, including oral cancer. In addition, many studies have shown that emodin and emodin derivatives are able to inhibit growth of ErbB2-overexpressing tumor cells. In this study, a series of computer modeling-generated emodin analogues were synthesized and tested for their antiproliferative activity against oral cancer cell lines overexpressing ErbB2. Among these analogues, em08red (1,8-dihydroxy-9(10H)-anthracenone) demonstrated potent antiproliferative activity against all three tested ErbB2-overexpressing cell lines, ie, FaDu, HSC3, and OECM1. Treatment with em08red significantly downregulated activation of ErbB2 as well as the ErbB2 protein expression level in the tested cell lines and induced G2 arrest. Antiapoptosis protein (Bcl-xl and Bcl-2) expression levels were also downregulated, and active caspase-3 and caspase-9 was detected in cells after treatment with em08red. Moreover, treatment with em08red stimulated production of cytotoxic reactive oxygen species in treated cells, and this could be partially reversed by pretreatment with N-acetylcysteine. Overall, we demonstrated inhibition of ErbB2 function and induction of reactive oxygen species in tumor cells by em08red, which prevented proliferation of tumor cells and induced apoptotic cell death.

MicroRNA-224 suppresses colorectal cancer cell migration by targeting Cdc42.

The metastatic spread of tumor cells is the major risk factor affecting the clinical prognosis of colorectal cancer (CRC) patients. The metastatic phenotype can be modulated by dysregulating the synthesis of different structural and functional proteins of tumor cells. Micro(mi)RNAs are noncoding RNAs that recognize their cognate messenger (m)RNA targets by sequence-specific interactions with the 3' untranslated region and are involved in the multistep process of CRC development. The objective of this study was to investigate the expression and biological roles of miR-224 in CRC. The miR-224 expression level was assessed by a quantitative real-time PCR in 79 CRC and 18 nontumor tissues. Expression levels of miR-224 in CRC tissues were significantly lower than those in nontumor tissues. Its expression level was associated with the mutation status of the APC gene. Ectopic expression of miR-224 suppressed the migratory ability of CRC cell line, but cell proliferation was less affected. Increased miR-224 diminished Cdc42 and SMAD4 expressions at both the protein and mRNA levels and inhibited the formation of actin filaments. Overall, this study indicated a role of miR-224 in negatively regulating CRC cell migration. The expression level of miR-224 may be a useful predictive biomarker for CRC progression.

Role of a Janus kinase 2-dependent signaling pathway in platelet activation.

INTRODUCTION: Janus kinases (JAKs) are intracellular non-receptor tyrosine kinases that transduce cytokine-mediated signals through a pathway mediated by JAK and the signal transducer and activator of transcription (STAT) proteins. The JAK-STAT pathway is involved in immune response, inflammation, and tumorigenesis. Platelets are anuclear blood cells that play a central role in hemostasis. METHODS: The aggregometry, immunoblotting, and platelet functional analysis used in this study. RESULTS: We found that the JAK2 inhibitor AG490 (25 and 50µM) attenuated collagen-induced platelet aggregation and calcium mobilization in a concentration-dependent manner. In the presence of AG490, the phosphorylation of PLCγ2, protein kinase C (PKC), Akt or JNK in collagen-activated aggregation of human platelets was also inhibited. In addition, we found that various inhibitors, such as the PLCγ2 inhibitor U73122, the PKC inhibitor Ro318220, the phospoinositide 3-kinase inhibitor LY294002, the p38 mitogen-activated protein kinase inhibitor SB203580, the ERK inhibitor PD98059, and the JNK inhibitor SP600125, had no effects on collagen-induced JAK2 activity. However, U73122, Ro318220 and SP600125 significantly diminished collagen-induced STAT3 phosphorylation. These findings suggest that PLCγ2-PKC and JNK are involved in JAK2-STAT3 signaling in collagen-activated platelets. CONCLUSION: Our results demonstrate that the JAK2-STAT3 pathway is involved in collagen-induced platelet activation through the activation of JAK2-JNK/PKC-STAT3 signaling. The inhibition of JAK2 may represent a potential therapeutic strategy for the preventing or treating thromboembolic disorders.

[Clinical observation of icotinib hydrochloride for patients with advanced non-small cell lung cancer].

OBJECTIVE: To explore the efficacy and side effects of icotinib hydrochloride in the treatment of patients with advanced non-small cell lung cancer (NSCLC). METHODS: The efficacy and side effects of icotinib hydrochloride in treatment of 59 cases with stage IV NSCIC and followed-up from March 2009 to January 2012 were retrospectively analyzed. RESULTS: Twenty seven patients (45.8%) showed partial response (PR), 17 patients (28.8%) achieved SD, and 15 (25.4%) had progressive disease. The objective response rate (ORR) was 45.8% (27/59), and disease control rate (DCR) was 74.6% (44/59). Among the 23 patients with EGFR mutation, ORR was 73.9% (17/23), and DCR was 95.7% (22/23). Thirty six patients (61.0%) achieved remission of symptoms to varying degrees. The main symptoms relieved were cough, asthmatic suffocating, pain and hoarseness. The major adverse events were mild skin rash (35.6%) and diarrhea (15.3%). Others were dry skin, nausea and stomach problems. The efficacy of icotinib hydrochloride were related to the ECOG performance status, smoking history, EGFR mutation and rash significantly (P < 0.05). CONCLUSIONS: Monotherapy with icotinib hydrochloride is effective and tolerable for patients with advanced NSCLC, especially with EGFR mutation.

Combination of topical EMLA with local injection of lidocaine: superior pain relief after Ferguson hemorrhoidectomy.

OBJECTIVE: To determine whether a combination of topical anesthetic (EMLA) and local injection with lidocaine is better than lidocaine alone for pain relief after Ferguson hemorrhoidectomy. METHODS: Sixty patients scheduled for hemorrhoidectomy were randomized into 2 groups: (1) control group (CG, n=30) received neomycin ointment (5 g), and (2) EMLA group (EG, n=30) received EMLA (5 g), both agents applied topically after surgery. Before the surgical incision was made, lidocaine (10 mL of a 1% solution) was locally injected into all 60 patients. After surgery, analgesics were provided when necessary. The visual analog scale score was recorded at 4 time points: (1) upon arrival in the postanesthesia room, (2) 2 hours after arriving in the postanesthesia room, (3) between 9 and 10 PM on the first postoperative evening, and (4) on the first postoperative morning. The frequency of meperidine requests, 1-time catheterizations for urinary retention, and patient satisfaction with postoperative pain management, were also recorded. RESULTS: The median visual analog scale scores and cumulative dosages of meperidine were significantly lower in the EG than the CG (P<0.05). Patient satisfaction with postoperative pain control was also significantly higher in the EG than the CG (P<0.01). No systemic complications occurred. DISCUSSION: EMLA is considered a breakthrough in cutaneous analgesia, capable of reducing pain in many cutaneous procedures. Because Ferguson hemorrhoidectomy has been performed for years with ongoing concerns over postoperative pain, we felt that using EMLA could lower postoperative pain intensity and the number of requests for additional medication.

Earlier cessation of desflurane supply in closed-circuit anesthesia reduces emergence time in patients undergoing breast surgery.

BACKGROUND: Minimizing the time of anesthesia emergence can facilitate faster patient turnover in the operating rooms of a busy surgery center. According to Lin's new concept of inhalation uptake, after turning off the vaporizer under close-circuit anesthesia (CCA) with a very low fresh gas flow rate, the concentration of desflurane decreases at a slow rate. The aim of this study was to determine if earlier cessation of desflurane supply would shorten the emergence time and at the same time register the changes of desflurane concentration in the circuit after turning off the vaporizer. METHODS: 30 patients were randomly assigned to two groups, i.e., the control group and the study group. In the control group, the desflurane supply was continued up till the end of the operation, while in the study group the desflurane supply was cut off prior to the suturing the skin. In the study group, data regarding the hemodynamic changes, time from turning off desflurane with high flow washout to wakefulness, and the inspired as well as the expired desflurane concentrations at the low-flow anesthetic phase were collected. The time required from high flow washout to emergence was recorded in all patients. Inter-group and intra-group data were analyzed with nonparametric 2-independent-samples Mann-Whitney test and 2 related-samples Wilcoxon signed ranks test, respectively. RESULTS: Under CCA with similar surgical duration, the patients in the study group emerged from anesthesia significantly faster than those in the control group (5.6 +/- 1.9 min versus 8.8 +/- 2.3 min; P < 0.05), without molestation of stable hemodynamic signs. At the low-flow wash-in stage, the inspired desflurane concentrations were significantly higher than the expired ones from 0 to 2nd min; no significant difference was noted from the 3rd to 6th min, but after which the expired concentrations were significantly higher. Desflurane concentrations decreased most noticeably during the first 5 min (0.35 +/- 0.14%), and then the decrease was moderating from 6th to 10th min (0.21 +/- 0.58%) and staggered from 11th to 15th (0.14 +/- 0.06%). The mean duration of low flow wash was 25.6 +/- 11.6 min. No patient reported awareness during surgery. CONCLUSIONS: Ceasing desflurane supply earlier in CCA (250 mL/min) significantly shortens emergence time without significant hemodynamic changes.