Isolation and in vitro cultivation of human urine-derived cells: an alternative stem cell source.

OBJECTIVE: For in vitro tissue engineering in urology, stem cells are commonly isolated from tissue specimens obtained during open or endoscopic surgery. Within the context of the present study our aim was to isolate cells from human urine by an alternative and safe technique rather than using the indicated method. MATERIAL AND METHODS: After human urine samples had been collected from young and healthy donors via urethral catheterization, cells were precipitated by centrifugation and cultured. Following this isolation procedure, cells were characterized by immunocytochemical method using specific antibodies. RESULTS: When these cells were characterized by immunocytochemical methods using specific antibodies some of them were positive for mesenchymal stem cell marker CD90 while the others were labelled with urothelial marker cytokeratin 7. When all these results were taken into consideration, urothelial cells together with stem cells were observed in the urine- derived cell population. CONCLUSION: According to the results obtained from this study human urine may be preferred as an alternative stem cell and urothelial cell source in that this method is and easily reproducible non-invasive method.

Comparison of Patient Satisfaction Between General and Spinal Anaesthesia in Emergency Caesarean Deliveries.

OBJECTIVE: Obstetric anaesthesia aims to deliver a healthy baby as well as render a comfortable operation for the mother. This study compared general and spinal anaesthesia in terms of the quality of recovery and patient satisfaction in women undergoing emergency caesarean deliveries. METHODS: In total, 100 patients were enrolled in this prospective, single-blind, cross-sectional clinical study. Patients were divided into spinal (n=50) and general (n=50) anaesthesia groups. The recovery score, pain and satisfaction were evaluated by Quality of Recovery Score (QoR-40), Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 24 hours postoperatively. RESULTS: The total QoR-40 scores were significantly higher and the total operation time was longer in the spinal anaesthesia group (median score: 194.5 vs. 179.0, p<0.001 and mean±SD: 69.0±13.3 vs. 62.7±13.4 minutes, p=0.02, respectively). There was no significant difference in VAS and NRS scores between the groups. CONCLUSION: Both spinal anaesthesia and general anaesthesia have advantages and disadvantages in terms of emergency caesarean deliveries. Spinal anaesthesia speeds up the recovery time and enables the mother to return to normal life earlier, while general anaesthesia has a short initiation time and does not affect patient satisfaction.

Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft Surgery.

OBJECTIVE: Existing myocardial damage in coronary artery disease patients causes prolonged QT syndrome. The primary objective of this trial is to explore the effects of different doses of the muscle relaxant agent rocuronium (0.6 mg kg(-1) and 1.2 mg kg(-1)) on QTc following anaesthetic induction. The second objective is to determine the incidence and kinds of arrhythmias. METHODS: In this prospective and randomized trial, patients undergoing elective coronary artery revascularization surgery were included in one of two groups. Both groups took the same anaesthetic induction agents: midazolam and fentanyl. Rocuronium was administered in Group 1 (n=20) with dose of 0.6 mg kg(-1) and in Group 2 (n=20) with a dose of 1.2 mg kg(-1) for muscle relaxation. Heart rate, average arterial pressure and QTc were recorded before induction (T0), after induction (T1), after muscle relaxant (T2), and 2 minutes (T3) and 5 minutes after intubation (T4). RESULTS: QTc was significantly longer 2 minutes after intubation (in Group 1 and Group 2, respectively, 447.9±28.3 and 466.1±37.8 ms) than at the beginning (respectively, 426.9±25.7, 432.0±35.5 ms) (p<0.01). In the intergroup comparison, average QTc values were similar in all trial periods (p>0.05). The prevalence of arrhythmias in between Group 1 (35%, n=7) and Group 2 (15%, n=3) was similar (p=0.06). Arrhythmias were recorded 2 minutes after intubation in both groups (n=10, 25%). CONCLUSION: In patients undergoing coronary artery revascularization surgery, rocuronium doses of 0.6 mg kg(-1) and 1.2 mg kg(-1) prolong the QTc interval after intubation. Cardiac arrhythmias related to long QTc arising after intubation should be taken into consideration.

The effect of remifentanil on the emergence characteristics of children undergoing FBO for bronchoalveolar lavage with sevoflurane anaesthesia.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the effects of sevoflurane vs. sevoflurane and remifentanil on cough and agitation during emergence and recovery after fiberoptic bronchoscopy. METHODS: Children between 2 and 6 years of age undergoing fiberoptic bronchoscopy were enrolled. All patients were premedicated with oral midazolam. Patients were randomly assigned to either group S (sevoflurane alone, n = 25) or group SR (sevoflurane with remifetanil, n = 25). Anaesthesia was induced and maintained with sevoflurane in all patients. Group SR received remifentanil at a bolus dose of 1 microg/kg over 2 min followed by a maintenance infusion of 0.15 microg/kg/min. In addition to routine anaesthesia documentation, agitation scores and cough scores were recorded every 5 min during emergence and recovery. RESULTS: Duration of the procedure, anaesthesia and emergence phases was similar in both groups (P > 0.05). Time until recovery was significantly shorter in group SR than in group S (7.0 +/- 5.5 min and 13.0 +/- 3.5 min, respectively; P = 0.001). Cough scores were not significantly different between the two groups during emergence and recovery (Kruskal-Wallis ANOVA test, P > 0.05). However, the mean agitation score at 5 min in group SR was significantly higher than that in group S (Kruskal-Wallis ANOVA test, P < 0.01). One case of hypoxaemia from thoracic rigidity occurred in a patient in group SR. CONCLUSION: The addition of remifentanil significantly shortened recovery time in children undergoing fiberoptic bronchoscopy under sevoflurane anaesthesia. In the recovery period, remifentanil did not decrease cough, and increased agitation.

Basic life support skills of doctors in a hospital resuscitation team.

The aim of the present study was to evaluate the basic life support skills of doctors in a hospital resuscitation team and to identify potential factors affecting those skills. Twelve anesthesiology residents were induced in this study. Each doctor was asked to perform mouth-to-mouth ventilation for 10 minutes and then chest compression for another 10 minutes on a Laerdal Skillmeter Resusci-Anne manikin during the day (10 am) and at night (10 pm). The rates of correct ventilation, correct chest compression, ventilation errors (i.e., excessive inflation, stomach insufflation, insufficient ventilation), and compression errors (i.e., insufficient chest compression/decompression, excessive chest compression, incorrect hand placement) were determined for each 2-min interval up to 10 min. In addition, effects of sex, seniority, CPR duration, and time of day (day vs night) on those skills were assessed. The mean rates of correct ventilation were 53.3+/-23.9% (day) and 60.4+/-16% (night); the mean rates of correct chest compression, 76.9+/-15% (day) and 76.5+/-14.7% (night). During the first 2-minutes period of testing at night, men doctors more frequently achieved correct ventilation than did women doctors (p<0.05). Overall, the practical CPR skills of the study participants were not influenced by sex, seniority, CPR duration, or time of day; however, the participants' skills were poor. This suggests that all medical staff, especially members of in-hospital resuscitation teams, should undergo regular, periodic CPR training.

Assessment of in-hospital cardiopulmonary resuscitation using Utstein template in a university hospital.

The aim of this study was to evaluate the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) strategies and identify key predictors of post-CPR survival in a university hospital setting. Using a form recommended by the European Resuscitation Council, data regarding in-hospital CPR attempts from January 2001 to December 2002 were recorded and analyzed. The main outcomes of interest were immediate survival after CPR and survival to hospital discharge. Of 307 patients who suffered cardiac arrest in the study period, 103 (33.5%) were resuscitated. Of these 103 patients, 28 (27.2%) survived immediately and 12 (11.7%) survived to hospital discharge. The key predictors of immediate survival were CPR duration and initial cardiac rhythm as monitored by ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The key predictors of survival to hospital discharge were CPR duration, immediate defibrillation, Glasgow Coma Scale score, and Early Prediction Score. Together, our results suggest that in-hospital CPR strategies require improvement. They also underscore the importance of data collection and analysis in evaluating the effectiveness of inhospital CPR strategies.