Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram.

Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal trocar insertion (3 mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.

Carnosic acid induces the NAD(P)H: quinone oxidoreductase 1 expression in rat clone 9 cells through the p38/nuclear factor erythroid-2 related factor 2 pathway.

The anticarcinogenic effect of rosemary has been partly attributed to the modulation of the activity and expression of phase II detoxification enzymes. Here we compared the effects of phenolic diterpenes from rosemary on the expression of NAD(P)H: quinone oxidoreductase 1 (NQO1) in rat Clone 9 liver cells. Cells were treated with 1-20 µmol/L of carnosic acid (CA) or carnosol (CS) for 24 h. Both CA and CS dose dependently increased NQO1 enzyme activity and protein expression, and the induction potency of CA was stronger than that of CS. The increase in NQO1 enzyme activity in cells treated with 10 µmol/L CA and CS was 4.1- and 1.9-fold, respectively (P < 0.05). RT-PCR showed that CA and CS induced NQO1 mRNA in a dose-dependent manner. Furthermore, CA dose dependently induced transcription of nuclear factor erythroid-2 related factor 2 (Nrf2) and antioxidant response element (ARE)-luciferase reporter activity. Silencing of Nrf2 expression alleviated NQO1 protein expression and ARE-luciferase activity by CA. Moreover, the phosphorylation of p38 was mainly stimulated in the presence of CA. Pretreatment with SB203580 or silencing of p38 expression inhibited Nrf2 activation and NQO1 induction. These results suggest that the increased NQO1 expression by CA is likely related to the p38-Nrf2 pathway and help to clarify the possible molecular mechanism of action of rosemary phenolic compounds in drug metabolism and cancer prevention.

A New Trend in the Management of Esophageal Foreign Body: Transnasal Esophagoscopy.

OBJECTIVES: (1) To analyze the outcomes of patients with esophageal foreign body managed by transnasal esophagoscopy. (2) To review the value of lateral neck X-ray. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. SUBJECTS AND METHODS: Lateral neck X-ray was used for initial screening in patients suspected of having an esophageal foreign body between 2007 and 2013. Rigid esophagoscopy was used as standard for further investigations before July 2010 and transnasal esophagoscopy after July 2010. RESULTS: From January 2007 to June 2010, 43 patients who were suspected of having an esophageal foreign body under lateral neck X-ray received rigid esophagoscopy, 31 of whom were found to have an esophageal foreign body. From July 2010 to December 2013, 302 patients underwent transnasal esophagoscopy, and an esophageal foreign body was noted in only 52 of these patients. In the 302 patients who underwent transnasal esophagoscopy, the sensitivity and specificity of having an esophageal foreign body by lateral neck X-ray were 59% and 83%, respectively. CONCLUSION: The introduction of transnasal esophagoscopy has changed the diagnosis and management for an esophageal foreign body. Transnasal esophagoscopy is a quick and safe procedure that can be performed under local anesthesia. Transnasal esophagoscopy could replace lateral neck X-ray to become the initial screening procedure and a useful treatment for patients with an esophageal foreign body.

Induction of the pi class of glutathione S-transferase by carnosic acid in rat Clone 9 cells via the p38/Nrf2 pathway.

Induction of phase II enzymes is important in cancer chemoprevention. We compared the effect of rosemary diterpenes on the expression of the pi class of glutathione S-transferase (GSTP) in rat liver Clone 9 cells and the signaling pathways involved. Culturing cells with 1, 5, 10, or 20 µM carnosic acid (CA) or carnosol (CS) for 24 h in a dose-dependent manner increased the GSTP expression. CA was more potent than CS. The RNA level and the enzyme activity of GSTP were also enhanced by CA treatment. Treatment with 10 µM CA highly induced the reporter activity of the enhancer element GPEI. Furthermore, CA markedly increased the translocation of nuclear factor erythroid-2 related factor 2 (Nrf2) from the cytosol to the nucleus after 30 to 60 min. CA the stimulated the protein induction of p38, nuclear Nrf2, and GSTP was diminished in the presence of SB203580 (a p38 inhibitor). In addition, SB203580 pretreatment or silencing of Nrf2 by siRNA suppressed the CA-induced GPEI-DNA binding activity and GSTP protein expression. Knockdown of p38 or Nrf2 by siRNA abolished the activation of p38 and Nrf2 as well as the protein induction and enzyme activity of GSTP by CA. These results suggest that CA up-regulates the expression and enzyme activity of GSTP via the p38/Nrf2/GPEI pathway.

Interrelationships between romance, life quality, and medical training of female residents.

BACKGROUND: For the past 30 years, there has been a steady increase in the number of female physicians, but the relationship between their romantic lives and their pattern of training has been inadequately reported. This study was designed to investigate the interrelationships between medical training, quality of life, and the attitudes that female residents have toward romance. METHODS: Of the 106 female medical residents at our medical center in 2009, a total of 78 residents (73.6%) were enrolled for the study. Structured questionnaires (Cronbach α = 0.878), which included questions about female resident quality of life, attitude toward spousal choice, and the impact of programmed professional medical training, were self-administered through an anonymous process. RESULTS: Female residents, especially ward-care specialists, were determined to have excessively long working hours (84.6% > 88 work hours/week), insufficient and irregular sleep (44.9%), and inadequate personal time (73.1% < 24 hours/week) on average. Of the 48 residents with ongoing romances, 87.5% (n = 40) of romantic partners were physicians and 58.3% (n = 28) initiated their relationships when they were medical students, but exhibited no preferential dating of senior medical students or physicians. Factors affecting the choice of spouses included time limitations, a limited circle of friends, differences in values, and work-related stress. Those presumptive factors influencing romance between the assumed partner being a doctor or a "nondoctor" were significantly different with regard to lack of time (p = 0.002), values (p < 0.001), work-related stress (p < 0.001), and family background (p = 0.004). CONCLUSION: Romance and quality of life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance.

Ectopic thyroid papillary carcinoma presenting as bilateral neck masses.

Ectopic thyroid papillary carcinoma presenting as bilateral neck lymph nodes metastasis is very rare. We report a 42-year-old male with midline submental ectopic thyroid papillary carcinoma presenting as bilateral progressively growing neck masses for 3 months. A right neck mass excisional biopsy was carried out and the pathology revealed metastatic papillary carcinoma. Total thyroidectomy, submental "ectopic thyroid tissue" excision and bilateral neck dissection were then performed. No primary lesions were found in the thyroid gland. Therefore, the differential diagnosis of bilateral neck masses should include cervical metastasis of ectopic papillary carcinoma.