Norepinephrine versus phenylephrine affects prethrombotic response in patients undergoing cesarean section under spinal anesthesia: a randomized, double-blind, controlled study.

BACKGROUND: Venous thromboembolism (VTE) is one of the most common and serious complications of cesarean section in parturients. Norepinephrine (NE) has been shown to activate coagulation. The aim of this study was to compare the effect of a fixed-rate prophylactic norepinephrine infusion and a fixed-rate prophylactic phenylephrine（PHE） infusion under spinal anesthesia for caesarean section on the prethrombotic response. MATERIALS AND METHODS: Sixty-six women undergoing cesarean section under spinal anesthesia were randomly assigned to the NE group or PHE group, starting simultaneously with the administration of the subarachnoid solution, a "study drug" solution containing either NE or PHE was pumped intravenously at a constant rate of 15 ml/h until the end of the operation. Plasma coagulation factor VIII activity (FVIII: C), Fibrinogen, and D-dimer levels were measured in blood samples obtained on admission to the operating theatre and at the end of the procedure. RESULTS: Compared with preoperative levels, there were no significant differences in postoperative fibrinogen and D-dimer levels in the NE group, except for a decrease in FVIII: C levels (P = 0.003). However, postoperative levels of FVIII: C (P = 0.009), fibrinogen (P = 0.035) and D-dimer (P = 0.025) were increased in the NE group compared with postoperative levels in the PHE group. CONCLUSIONS: NE does not affect the maternal prethrombotic response and can be safely used in cesarean sections. Compared with PHE infusion, NE infusion increased the level of coagulation molecules, suggesting that NE maybe more beneficial for women with high intraoperative bleeding requiring hemostasis.

A Noise-Tolerating Gene Association Network Uncovering an Oncogenic Regulatory Motif in Lymphoma Transcriptomics.

In cancer genomics research, gene expressions provide clues to gene regulations implicating patients' risk of survival. Gene expressions, however, fluctuate due to noises arising internally and externally, making their use to infer gene associations, hence regulation mechanisms, problematic. Here, we develop a new regression approach to model gene association networks while considering uncertain biological noises. In a series of simulation experiments accounting for varying levels of biological noises, the new method was shown to be robust and perform better than conventional regression methods, as judged by a number of statistical measures on unbiasedness, consistency and accuracy. Application to infer gene associations in germinal-center B cells led to the discovery of a three-by-two regulatory motif gene expression and a three-gene prognostic signature for diffuse large B-cell lymphoma.

Efficacy of 595nm pulsed dye laser therapy for Mibelli angiokeratoma.

OBJECTIVE: To retrospectively study the clinical efficacy of 595nm pulsed dye laser therapy for Mibelli angiokeratoma. METHODS: 50 cases of Mibelli angiokeratoma, from 10 to 41 year-old，were treated with the 595nm pulsed dye laser. The parameters were as follows: a wavelength of 595 nm, pulse duration of 10ms, spot size of 7 mm and energy fluency of 12.0-13.5 J/cm(2). The treatments were repeated at intervals of 4-6 weeks until the lesion was cleared, or the parents discontinued the treatment. Detailed demographics and the assessment of the degree of lesion clearance were statistically analyzed through SASS18.0. RESULTS: All the 50 patients were treated 1-4 times. The total rate of significant improvement was 80%, and the rate of full recovery was 30%. We failed to find statistical significance between genders, or the size and color of lesions, which might be due to limited sample size. The most common adverse effects after treatment were purpura and edema, which usually lasted for 12 h to several days. Temporary pigment alterations were not common. Other side effects such as scar or skin texture change were not observed. CONCLUSION: Our experience confirmed the clinical efficacy and safety of the 595 nm pulse dye laser in the treatment of Mibelli angiokeratoma.

Mathematical guide to minimize donor size in full-thickness skin grafting.

BACKGROUND: Full-thickness skin grafting is a common repair option in dermatologic surgery. Generally, a 3:1 ellipse is designed for the donor area. This results in occasional large donor site defects. A new formula to guide donor site design would potentially create smaller donor defects. OBJECTIVE: To design a mathematical formula to facilitate smaller donor incisions. METHODS: A geometric analysis was undertaken to design a practical formula to create smaller defects. This strategy was then used in a case series of 23 patients with large (average 11 cm in diameter) defects [This sentence was corrected after online publication on June 29, 2009: (average 16 x 11 cm) changed to read (average 11 cm in diameter).]. A geometrical analysis was used to design the best way to divide donor grafts to minimize tissue loss. RESULTS: A formula called for the diameter of the primary defect to be multiplied by 3/2 and 2/3 to design a donor ellipse length and width, respectively. The resulting graft was divided into two equal sizes, using a tangential acute angle. The width and the area of the donor were significantly smaller, so the donor site was repaired using a shorter and faster repair. CONCLUSION: Skin graft harvest may be accomplished using a smaller donor graft than previously described using the formula reported here. This will probably reduce surgical morbidity, time, and expense. The authors have indicated no significant interest with commercial supporters.