The effect of the enhanced recovery after surgery protocol and the reduced use of opioids on postoperative outcomes in elderly patients with colorectal cancer.

OBJECTIVE: The study aimed to assess the impact of the enhanced recovery after surgery (ERAS) pathways and the reduced use of opioids on postoperative outcomes in elderly colorectal cancer (CRC) patients who underwent laparoscopic surgery under general anesthesia (GA). PATIENTS AND METHODS: Clinical data from 99 elderly patients who underwent laparoscopic CRC surgery in the First Affiliated Hospital of Hebei North University from April 2021 to April 2023 were retrospectively analyzed and grouped based on the method of pain control measures received. Of 99 patients, 51 received conventional doses of opioid drugs (conventional group), and 48 patients were treated with reduced doses of opioids based on the principles of ERAS (low-dose group). Perioperative characteristics, postoperative pain level, cognitive function, serum biochemical index levels, and adverse reactions were compared between the two groups. RESULTS: The first exhaust time, defecation time, and bedtime activity time of the low-dose group were compared to the conventional group (p<0.05). On the first day after the surgery, the mini-mental state examination (MMSE) score of the low-dose group was higher than the conventional group (p<0.05). After the surgery, the levels of serum brain-derived neurotrophic factor (BDNF) decreased in both groups, while the levels of neuron-specific enolase (NSE) and 5-hydroxytryptamine (5-HT) increased. However, compared to the conventional group, the low-dose group had higher levels of BDNF and lower levels of NSE and 5-HT (p<0.05). The incidence of adverse reactions in the low-dose group was lower than that in the conventional group (p<0.05). CONCLUSIONS: ERAS protocol and the reduced use of opioid drugs in CRC patients who underwent surgery under GA is associated with an analgesic effect that is comparable to that of conventional opioid use. Reduced dosage of opioid drugs lessened cognitive impairment and lowered the incidence of adverse reactions in surgical patients with CRC.

Phenanthrene biodegradation by halophilic Martelella sp. AD-3.

AIMS: To investigate the phenanthrene-degrading abilities of the halophilic Martelella species AD-3 under different conditions and to propose a possible metabolic pathway. METHODS AND RESULTS: Using HPLC and GC-MS analyses, the phenanthrene-degrading properties of the halophilic strain AD-3 and its metabolites were analysed. This isolate efficiently degraded phenanthrene under multiple conditions characterized by different concentrations of phenanthrene (100-400 mg l(-1) ), a broad range of salinities (0·1-15%) and varying pHs (6·0-10·0). Phenanthrene (200 mg l(-1) ) was completely depleted under 3% salinity and a pH of 9·0 within 6 days. The potential toxicity of phenanthrene and its generated metabolites towards the bacterium Vibrio fischeri was significantly reduced 10 days after the bioassay. On the basis of the identified metabolites, enzyme activities and the utilization of probable intermediates, phenanthrene degradation by strain AD-3 was proposed in two distinct routes. In route I, metabolism of phenanthrene was initiated by the dioxygenation at C-3,4 via 1-hydroxy-2-naphthoic acid, 1-naphthol, salicylic acid and gentisic acid. In route II, phenanthrene was metabolized to 9-phenanthrol and 9,10-phenanthrenequinone. Further study indicated that strain AD-3 exhibited a wide spectrum of substrate utilization including other polycyclic aromatic hydrocarbons (PAHs). CONCLUSIONS: The results suggest that strain AD-3 possesses a high phenanthrene biodegradability and that the degradation occurs via two routes that remarkably reduce toxicity. SIGNIFICANCE AND IMPACT OF THE STUDY: To the best of our knowledge, this work presents the first report of phenanthrene degradation by a halophilic PAH-degrading strain via two routes. In the future, the use of halophilic strain AD-3 provides a potential application for efficient PAH-contaminated hypersaline field remediation.

Efficacy of zafirlukast in the treatment of patients with bronchial asthma.

Zafirlukast is a drug newly used for the treatment of asthma. In this study, we examined the efficacy of zafirlukast on asthmatic patients and compared this efficacy between patients in different age groups and with different severities of pulmonary function. Patients concurrently inhaled long-acting beta2-agonist, corticosteroid or taken an oral aminophylline regimen, were treated with 20 mg oral zafirlukast twice daily for 6 weeks. In total, 32 asthmatic patients were included in the study. The primary efficacy measures included morning and evening peak expiratory flows (PEFs); secondary efficacy measures were the scoring of asthma symptoms including sleeping, coughing, and wheezing scores. Pulmonary functions including forced expiratory flow in 1 sec (FEV1), forced vital capacity (FVC), and PEF rate (PEFR) were examined during each clinical visit. Results showed that oral zafirlukast administration resulted in improvements in morning and evening PEFs and asthma symptom scores with the following statistical p values: morning PEF (285.8 vs 308.4 L/min), p = 0.003; evening PEF (293.3 vs 312.1 L/min), p = 0.007; coughing score (1.03 vs 0.72), p = 0.011; and wheezing score (0.71 vs 0.51), p = 0.009. As to the pulmonary function during the clinical visit, only the improvement of PEFR reached a statistically significant level (74.3 vs 82, p = 0.017). We compared the efficacy between asthmatic patients of different ages and those with different severities of pulmonary function. In patients aged below 50 years, those with FEV1 above 80% of the predicted value and FVC above 85% of the predicted value were more responsive to zafirlukast. In conclusion, we demonstrate the efficacy of zafirlukast in asthma therapy particularly for those patients who are younger and have better pulmonary function. When asthmatic patients do not respond to inhaled corticosteroid, long-acting beta2-agonist, or oral aminophylline, zafirlukast may provide an adjunct effect for asthma therapy.

Effect of valsartan and captopril in rabbit carotid injury. Possible involvement of bradykinin in the antiproliferative action of the renin-angiotensin blockade.

The effects of the specific angiotensin II (Ang II) AT1-receptor blocker valsartan on events related to restenosis were investigated in rabbits after common carotid balloon injury. Six animals were given valsartan from two days prior to injury until 14 days post-injury. Three control groups (n=6 in each group) were either sham-operated, untreated or treated with the angiotensin-converting enzyme (ACE) inhibitor,captopril. Both ACE inhibition and AT,-receptor blockade had marked effects on plasma levels of endothelin ET1, thromboxane TXB2 and 6-keto-PGF1-alpha. The most dramatic effects on ET, levels were seen in rabbits treated with valsartan, where levels were reduced to values close to those for sham-operated animals (96.85 vs. 86.45 pg/ml). Captopril treatment led to a statistically significant (p<0.01) reduction in ET1 levels compared with untreated animals, but the reduction was only about half that seen with AT1-receptor blockade. TXB2 levels doubled (202.58 vs.413.28 pg/ml) upon arterial injury in control animals but rose by only 20-35% in rabbits treated with captopril (246.45 pg/ml) or valsartan (268.13). In untreated animals, 6-keto-PGF1-alpha levels decreased slightly after injury, but for both the captopril and valsartan groups, there were significant increases in levels of this prostaglandin derivative, effects attributed to the action of bradykinins. Levels were highest in the captopril-treated animals. Valsartan and captopril treatment led to a significant reduction in neointimal thickness and the extent of lumen stenosis compared with untreated animals. Both treatments were effective in reducing neointimal area and significantly (p<0.05)reduced cell proliferation. The differences between treatments can be attributed to the different actions of the agents, as valsartan leaves the AT2-receptor unblocked, while captopril, through inhibition of Ang II synthesis, prevents stimulation of both receptors.A combination of both treatments may be a possible way forward in the clinical prevention of restenosis.

Enhanced prostaglandin E2 secretion in sputum from asthmatic patients after zafirlukast therapy.

BACKGROUND AND PURPOSE: Leukotrienes are important inflammatory mediators of bronchial asthma that cause bronchoconstriction, mucous secretion, and increased vascular permeability. Current guidelines recommend anti-leukotriene agents as alternative treatments for asthma; however, data on their anti-inflammatory effect is lacking. METHODS: The purpose of this study was to determine the anti-inflammatory effect of zafirlukast, a leukotriene antagonist, in patients with bronchial asthma. A total of 30 adult patients with mild persistent asthma received 6 weeks of zafirlukast treatment. Peak expiratory flow rate (PEFR) was determined before and after therapy to assess clinical efficacy. Both serum and sputum samples were collected before and after therapy and concentrations of eosinophil cationic protein (ECP), prostaglandin E2 (PGE2), and leukotriene E4 (LTE4) were measured. RESULTS: A significant improvement in PEFR was found after zafirlukast therapy (p = 0.017). There was also a significant reduction in serum ECP concentration (13.6 +/- 2.4 micrograms/L vs 10.3 +/- 2.1 micrograms/L, p < 0.025) and a significant increase in sputum PGE2 concentration (112.7 +/- 14.0 pg/mL vs 176.8 +/- 32.1 pg/mL, p < 0.01). The percentage eosinophil count and the concentrations of ECP and LTE4 in the sputum were not significantly different after therapy. CONCLUSION: This study found a significant reduction in serum ECP and a significant increase in sputum PGE2 concentrations in asthmatic patients after zafirlukast treatment, both of which were significantly associated with improvement in PEFR. The modulation of PGE2 and ECP production might occur through the anti-inflammatory effect of zafirlukast.

[Analysis of 27 patients with lung cancer misdiagnosed as tuberculosis].

Because lung cancer is similar to tuberculosis not only in clinical symptoms but also in X-ray manifestation, it is occasionally misdiagnosed. Currently, as the incidence of tuberculosis in the elders tends to increase and lung cancer is not rare in the youth patient's age is no more a good reference in differential diagnosis. Accurate diagnosis should be based, besides X-ray examination, on sputum cytology, bronchoscopy and biopsy.

Glutaraldehyde-fixed biological tissue calcification: effectiveness of mitigation by dimethylsulphoxide.

The conditions defining the extent of dimethylsulphoxide (DMSO) effectiveness in mitigating calcification of glutaraldehyde (GA)-fixed tissue have been evaluated. Exposure of GA-fixed tissue porcine aortic valve cusps to low concentrations of DMSO does not impart calcification inhibitory activity. Mitigation in calcification becomes evident only as the DMSO component nears 100% and is best when neat DMSO is used. In all instances, regardless of the DMSO concentration, exposure to DMSO resulted in an increase in the tissue shrinkage temperature, attributed to further cross-linking in the tissue. Histological examination of samples before implantation indicate some deleterious effects to the tissue, the degree dependent on concentration, time and temperature of DMSO exposure. The results of this study suggest that treatment of GA-fixed tissue with high concentrations of DMSO for a short duration at a lowered temperature could give a bioprosthesis that has good mitigating calcification properties with retention of tissue integrity.

Boundary conditions for the diffusion equation in radiative transfer.

Using the method of images, we examine the three boundary conditions commonly applied to the surface of a semi-infinite turbid medium. We find that the image-charge configurations of the partial-current and extrapolated-boundary conditions have the same dipole and quadrupole moments and that the two corresponding solutions to the diffusion equation are approximately equal. In the application of diffusion theory to frequency-domain photon-migration (FDPM) data, these two approaches yield values for the scattering and absorption coefficients that are equal to within 3%. Moreover, the two boundary conditions can be combined to yield a remarkably simple, accurate, and computationally fast method for extracting values for optical parameters from FDPM data. FDPM data were taken both at the surface and deep inside tissue phantoms, and the difference in data between the two geometries is striking. If one analyzes the surface data without accounting for the boundary, values deduced for the optical coefficients are in error by 50% or more. As expected, when aluminum foil was placed on the surface of a tissue phantom, phase and modulation data were closer to the results for an infinite-medium geometry. Raising the reflectivity of a tissue surface can, in principle, eliminate the effect of the boundary. However, we find that phase and modulation data are highly sensitive to the reflectivity in the range of 80-100%, and a minimum value of 98% is needed to mimic an infinite-medium geometry reliably. We conclude that noninvasive measurements of optically thick tissue require a rigorous treatment of the tissue boundary, and we suggest a unified partial-current--extrapolated boundary approach.