Remifentanil versus Fentanyl for Analgesia in Mechanically Ventilated Patients: A Multicenter, Prospective, Randomized, Double-Blind, Parallel-Group Clinical Trial.

Purpose: Fentanyl is approved for use in many countries as an analgesic for patients requiring mechanical ventilation. However, it redistributes and accumulates easily in the plasma because of its long half-life. Remifentanil is a short context-sensitive half-life analgesic with a lower risk of redistribution and accumulation. Materials and methods: We conducted a multicenter, randomized, double-blind, non-inferiority trial. Critically ill patients requiring mechanical ventilation were randomly allocated to receive an infusion of either remifentanil or fentanyl for up to 72 h. The primary outcome was the analgesic success rate. A 95% confidence interval lower boundary greater than -8% for the difference between the groups was considered to indicate non-inferiority between the drugs. Results: A total of 137 patients received remifentanil (69) or fentanyl (68). Remifentanil's non-inferiority to fentanyl concerning its analgesic success rate was established (difference, 5.97%; 95% confidence interval: -3.99% to 16.35%). Mechanical ventilation duration, extubation duration, successful extubation, intensive care unit discharge, intensive care unit length of stay, and adverse events did not differ significantly between the two groups. Conclusions: Remifentanil was non-inferior to fentanyl regarding the analgesic success rate in critically ill patients requiring mechanical ventilation.

As Clinical Markers, Hand-Foot-Skin Reaction and Diarrhea Can Predict Better Outcomes for Hepatocellular Carcinoma Patients Receiving Transarterial Chemoembolization plus Sorafenib.

Background: Combination therapy of transarterial chemoembolization plus sorafenib (TACE-S) has been proven to be safe and effective for hepatocellular carcinoma (HCC); however, this combination therapy is associated with a high incidence of adverse events (AEs). Our study focused on the relationships between AEs and treatment outcomes and aimed to discover AE-based clinical markers that can predict the survival benefits of combination treatment. Methods: From January 2010 to June 2014, a total of 235 HCC patients treated with TACE-S were retrospectively enrolled. Major sorafenib-related AEs were prospectively recorded, and their correlations with overall survival (OS) were analysed using time-dependent covariate Cox regression analyses. Results: The majority of the patients (200, 85.1%) were male, and the median age was 51 years old. After two years of follow-up, the median OS of the study population reached 12.4 months. In all, 218 patients (92.8%) presented at least one AE, and 174 (74.0%) suffered AEs ≥2 grade. Based on time-dependent multivariate analyses, the development of hand-foot skin reaction (HFSR) ≥2 grade (HR = 0.43, 95% CI: 0.32-0.58, P < 0.001) and diarrhoea ≥1 grade (HR = 0.72, 95% CI: 0.53-0.97, P=0.029) were identified as independent predictors of prolonged OS. Moreover, patients who developed both HFSR ≥2 grade and diarrhoea ≥1 grade achieved better outcomes than those patients who developed either or neither of these AEs (HR = 1.51, 95% CI: 1.11-2.06, P=0.009). Conclusions: The development of HFSR ≥2 grade or diarrhoea ≥1 grade during TACE-S treatment indicated prolonged OS, and these AEs should be considered important clinical markers for predicting patient prognoses.

Effects of hydrochloric acid washing on the microstructure and pyrolysis bio-oil components of sweet sorghum bagasse.

Acid washing is an alternative and promising approach for biomass to produce high-quality bio-oil. The hydrochloric acid washing pretreatment of sweet sorghum bagasse was performed in this study. The effects of acid washing on the ultrastructure of sweet sorghum bagasse were investigated using scanning electron microscope and Fourier transform infrared, and the effects on pyrolysis using thermogravimetric analyzer and a fast pyrolysis device. The results indicated acid treatment obviously changed the surface morphology of the cell walls of sweet sorghum bagasse, effectively removed most metals from sweet sorghum bagasse, and increased the volatiles and bio-oil yields. The results showed that bio-oil produced from pretreated sweet sorghum bagasse contained less components categories, lower contents of phenols, aldehydes, furans and alcohols, while much higher contents of d-allose and ketones than that from the original sample. Hydrochloric acid-washing pretreatment of sweet sorghum bagasse can increase the contents of some high-value chemicals in bio-oil.

Inhibition of Glycolate Oxidase With Dicer-substrate siRNA Reduces Calcium Oxalate Deposition in a Mouse Model of Primary Hyperoxaluria Type 1.

Primary hyperoxaluria type 1 (PH1) is an autosomal recessive, metabolic disorder caused by mutations of alanine-glyoxylate aminotransferase (AGT), a key hepatic enzyme in the detoxification of glyoxylate arising from multiple normal metabolic pathways to glycine. Accumulation of glyoxylate, a precursor of oxalate, leads to the overproduction of oxalate in the liver, which accumulates to high levels in kidneys and urine. Crystalization of calcium oxalate (CaOx) in the kidney ultimately results in renal failure. Currently, the only treatment effective in reduction of oxalate production in patients who do not respond to high-dose vitamin B6 therapy is a combined liver/kidney transplant. We explored an alternative approach to prevent glyoxylate production using Dicer-substrate small interfering RNAs (DsiRNAs) targeting hydroxyacid oxidase 1 (HAO1) mRNA which encodes glycolate oxidase (GO), to reduce the hepatic conversion of glycolate to glyoxylate. This approach efficiently reduces GO mRNA and protein in the livers of mice and nonhuman primates. Reduction of hepatic GO leads to normalization of urine oxalate levels and reduces CaOx deposition in a preclinical mouse model of PH1. Our results support the use of DsiRNA to reduce liver GO levels as a potential therapeutic approach to treat PH1.

[Study on the correlation between "Gucuofeng and Jinchucao" and cervical spondylosis].

OBJECTIVE: To explore the relation between "Gucuofeng and Jinchucao" and cervical spondylosis. METHODS: From March 2006 to October 2011,333 patients with cervical spondylosis were collected in the study as cervical spondylosis group; 30 subjects of control group come from student of Shuguang Hospital and other health volunteer. There were 119 males and 214 females with a mean age of (48.11 +/- 12.21) years in cervical spondylosis group and there were 6 males and 24 females with a mean age of (45.27 +/- 10.12) years in control group. In aspect of the symptom and sign, dynamic palpation, X-ray examination wer performed to find the incidence rate of "Gucuofeng and Jinchucao" in two groups. RESULTS: There was significant difference in symptom and sign, dynamic palpation, X-ray examination between two groups (P<0.01). In cervical spondylosis group, "Gucuofeng and Jinchucao" occurred in 293 cases (87.99%),there was significant difference compared with control group (P<0.01). CONCLUSION: Cervical "Gucuofeng and Jinchucao" is one of pathological point of cervical spondylosis,and it can provide a guidance for the diagnosis and treatment of cervical spondylosis.