Improving mucosal anesthesia for awake endotracheal intubation with a novel method: a prospective, assessor-blinded, randomized controlled trial.

BACKGROUND: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. METHODS: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. RESULTS: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). No adverse side effects attributable to either tetracaine or dyclonine were observed in this study. CONCLUSIONS: In awake endotracheal intubation, novel care using oral dyclonine hydrochloride mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray. TRIAL REGISTRATION: ChiCTR1900023151 . Date of registration: May 14th, 2019.

The Effect of Pectinase-Assisted Extraction on the Physicochemical and Biological Properties of Polysaccharides from Aster scaber.

The edible and medicinal perennial herb Aster scaber is known to have anticancer, antioxidant, and immunomodulatory properties. However, the biological effects of its polysaccharides are not well understood. Here, we aimed to extract novel polysaccharides with enhanced biological properties from Aster scaber using enzyme-assisted methods. Amylase, cellulase, and pectinase were used to extract enzyme-assisted polysaccharide (ASEP)-A, ASEP-C, and ASEP-P, respectively. The yields, physicochemical properties, and immunostimulatory activities of the polysaccharides were investigated and compared with those of hot water extracted polysaccharide (ASWP). The highest yield (3.8%) was achieved for ASEP-P extracted using pectinase digestion. Fourier-transform infrared spectroscopy (FT-IR) and chemical composition analysis revealed that ASWP and three ASEPs were typical acidic heteropolysaccharides, mainly comprising rhamnose, arabinose, galactose, glucose, and galacturonic acid. Immunostimulatory activity assays on RAW264.7 macrophages showed ASEP-P to have the greatest immunostimulatory potential in terms of nitric oxide (NO) and cytokine productions and phagocytic activity. ASEP-P administration improved immune-enhancing effects in normal mice by improving the spleen index and splenic lymphocyte proliferation, and in immunosuppressed mice by modulating lymphocyte proliferation, natural killer (NK) cell activity, and leukocyte counts. The ASEP-P derived from pectinase hydrolysate of Aster scaber demonstrated efficacious immunostimulatory properties and has potential applications as an immune stimulator.

Enzyme-assisted extraction, chemical characteristics, and immunostimulatory activity of polysaccharides from Korean ginseng (Panax ginseng Meyer).

In this study, enzyme-assisted extraction was used to isolate functional polysaccharides from Korean ginseng (Panax ginseng Meyer) and the physicochemical and biological properties of the extracted polysaccharides were investigated, comparing with those from traditional hot-water extraction (FGWP). In macrophages, their effects on cytokines production could be ordered as FGEP-CA ≥ FGEP-A > FGEP-C > FGWP, suggesting that FGEP-CA (combined cellulase- and α-amylase-extracted polysaccharide) is a potent immunostimulator. In addition, enzymatic digestion led to differences in the monosaccharide profile of the extract. FGWP mainly consisted of rhamnose, arabinose, galactose, galacturonic acid, and glucose in molar percentages of 1.8:10.1:9.2:17.8:60.6, whereas FGEP-CA was 3.2:11.4:16.5:22.3:45.8, respectively, suggesting that enzyme-assisted extraction of ginseng polysaccharides produces a higher proportion of pectin polysaccharides. The HPLC profile of FGEP-CA also showed lower and more heterogeneous molecular weights than FGWP did. In cyclophosphamide-induced immunosuppressed mice, FGEP-CA administration ameliorated decreased spleen and thymus indices (200 mg/kg), lymphocyte proliferation, natural killer cell activity, leukocyte counts, and the serum cytokines, interleukin-2, interleukin-6, and interferon-γ (100 and 200 mg/kg). These results suggest that enzyme-assisted extraction using cellulase and α-amylase is an effective method for the preparation of functional polysaccharides from fresh Korean ginseng, and FGEP-CA could be utilized as a potential immune-stimulatory agent.

Gallic acid increases atrial natriuretic peptide secretion and mechanical dynamics through activation of PKC.

AIMS: Gallic acid (GA) protects against myocardial ischemia-reperfusion (I/R) injury, prevents cardiac hypertrophy and fibrosis, and has anti-inflammatory activity in the heart. However, its effects in regulating atrial natriuretic peptide (ANP) secretion are unknown. The aim of this study was to determine the function of GA in regulating ANP secretion and atrial dynamics in rat atria. KEY FINDINGS: GA (0.01, 0.05, and 0.1µmol/L) significantly increased atrial ANP secretion and induced positive inotropy dose-dependently. GA (0.1µmol/L) also increased plasma level of ANP and hemodynamics in rats. These effects were accompanied by upregulation of atrial protein kinase C subtypes ß and ε (PKCß and PKCε), which was completely blocked by LY333531 and EAVSLKPT, antagonists of protein PKCß and PKCε, respectively. GA-induced ANP secretion was also attenuated by Gö6983 but not rottlerin, antagonists of PKCα and PKCδ, and the positive inotropy was reversed by Gö6983. U-73122, a phospholipase C (PLC) antagonist, mitigated the effects of GA on ANP secretion and mechanical dynamics and downregulated Phospho-PLCß at Ser537 (pPLCß S537), Phospho-PLCß at Ser1105 (pPLCß S1105), PKCß and PKCε levels, whereas KN62, an inhibitor of Ca2+/calmodulin-dependent kinase II, was not modified the GA-induced ANP secretion and suppressed GA-induced mechanical dynamics. SIGNIFICANCE: GA promotes ANP secretion and effects positive inotropy with regard to mechanical dynamics through the activation of PLC-PKC signaling in rat atria.

CYP2C93 variant is associated with antidiabetes efficacy of gliclazide in Chinese type 2 diabetes patients.

AIMS/INTRODUCTION: The objective of the present study was to investigate the effects of CYP2C9*3 polymorphisms on the therapeutic response to gliclazide in type 2 diabetes patients. MATERIALS AND METHODS: A total of 746 incident type 2 diabetes patients were included in this study. After enrolment, patients went on 4-week gliclazide monotherapy. Fasting plasma glucose was measured before and after treatment. Hypoglycemia episodes and lifestyle information were collected by weekly follow up. Genotyping of rs1057910 was carried out using the single base primer extension method. The t-test, analysis of variance and chisquare-test were used to evaluate the effects of rs1057910 alleles on the therapeutic response to gliclazide. RESULTS: After the therapy, fasting plasma glucose decreased significantly from 11.2 ± 2.7 mmol/L to 8.0 ± 2.2 mmol/L (P < 0.001). Patients with AC/CC genotypes of rs1057910 had a greater reduction of fasting plasma glucose (3.6 vs 3.0 mmol/L, P < 0.001; 31.4 vs 24.5%, P < 0.001) and a higher rate of treatment success (54.7 vs 37.5%, P < 0.001; 51.4 vs 32.3%, P < 0.001; 71.6 vs 48.3%, P < 0.001 for criterion 1, 2 and 3, respectively). CONCLUSIONS: The present study showed that the polymorphism at rs1057910 significantly affected the therapeutic response of gliclazide in type 2 diabetes mellitus patients. The risk allele is associated with a greater decrease of fasting blood glucose and a higher rate of treatment success with gliclazide monotherapy.

Cheonggukjang polysaccharides enhance immune activities and prevent cyclophosphamide-induced immunosuppression.

Cheonggukjang is a traditional Korean fermentation product prepared from soybean that is reported to have various biological functions. We previously reported that the polysaccharides from Cheonggukjang (PSCJ) have immunostimulatory activities in RAW 264.7 macrophages and primary cultured splenocytes. In this study, the immunostimulatory activities of the PSCJ were investigated further using various experimental models such as in vitro, ex vivo, and in vivo. The PSCJ was able to stimulate the complement system (ITCH50: 30.6%). In primary cultured mouse peritoneal macrophages, the PSCJ was found to significantly increase nitric oxide and immunostimulatory cytokines (IL-6 and IL-12) production in a concentration-dependent manner (1-100 µg/mL). In the normal mice model, the oral administration of the PSCJ increased the weight of spleen (p < 0.05 at 100 and 200 mg/kg) and improved the phagocytic rates of peritoneal macrophages (p < 0.05 at 200 mg/kg) and lymphocytes proliferation (p < 0.05 at 100 and 200 mg/kg). Similarly, the PSCJ markedly restored the decreased lymphocytes proliferation (p < 0.01 at 200 mg/kg), natural killer cell activity (p < 0.01 at 200mg/kg), and white blood cell count (p<0.01 at 100 and 200 mg/kg) in the cyclophosphamide-induced immunosuppressed mice model. These results suggest that the PSCJ could be utilized as an effective immunostimulatory agent.

Immunostimulatory effects of polysaccharides isolated from Makgeolli (traditional Korean rice wine).

Makgeolli is a traditional Korean rice wine, reported to have various biological functions. In this study, the immunostimulatory activity of a polysaccharide from makgeolli (PSM) was investigated. The polysaccharide fraction was isolated from makgeolli by hot water extraction, ethanol precipitation, dialysis, and lyophilization. The major constituents in PSM were neutral sugars (87.3%). PSM was composed of five different sugars, glucose, mannose, galactose, xylose, and arabinose. In normal mice, PSM treatment increased the spleen index (p<0.05) as well as splenocyte proliferation (p<0.05) in combination with concanavalin A or lipopolysaccharide. The immunostimulatory activities of PSM were also examined in cyclophosphamide (CY)-induced immunosuppressed mice. Mice treated with PSM exhibited increased splenocyte proliferation (p<0.05), natural killer cell activity, and white blood cell counts (p<0.01) compared with immunosuppressed mice. These results indicate that PSM can enhance immune function in normal mice and CY-induced immunosuppressed mice.

[Nutritional status survey in 200 of the Korean and Han nationality elderly in Yanji].

OBJECTIVE: To assess the nutritional status and dietary intake of the Korean and Han nationality elderly in Yanji. METHODS: We selected 200 of the Korean and Han nationality adults aged 60 and older and measured their blood pressure. Dietary survey was performed with 24-hour dietary recall method. RESULTS: (1) The daily average intake of energy surpassed recommended nutrient intake (RNI) value in male and amounted RNI in women. In the male, Breakfast energy intake ratio was significantly lower and supper energy intake ratio was significantly higher than female. Supper energy intake in male with hypertension was significantly higher than normal blood pressure. (2) The daily average intake of fat in the Korean was significantly lower than in Han nationality (P < 0.01), and also was lower than RNI value. The daily average intake of carbohydrate in the Korean was significantly higher than in Han nationality (P < 0.01). (3) The daily average intake of protein exceed RNI value in the Korean male and was slightly lower than RNI value in Han male and both nationality women. The daily average intake of protein in the Korean males was significantly higher than in Han males (P < 0.01). The ratio of good protein was 35%-45% and bean protein exceed 15%. (4) The daily average intakes of calcium and vitamin A were only half RNI value and vitamin B2 lower than RNI values. CONCLUSION: The consumption of some nutrients among the Korean and Han nationality is inequality. The daily intake of calcium, vitamin A and vitamin B2 in elderly is seriously inadequate. Distribution of three meal energy is irrational and the high ratio of supper energy in male relates to hypertension.

Protective effects of Hippophae rhamnoides L. juice on lead-induced neurotoxicity in mice.

We examined the effect of Hippophae rhamnoides L. (HRL) juice on lead-induced memory impairment and neuronal damage in the brains of adult mice. Kunming mice were exposed to lead acetate 10 mg/kg body weight for 20 d. Twenty percent and 40% HRL prevented the lead-induced decrease in step-through latency. In the water maze test, the swimming time was lengthened in mice treated with lead acetate, but this time was decreased in mice that received 20% and 40% HRL. The malondialdehyde (MDA) levels were increased in lead-treated mice, which were reduced by 20% and 40% HRL in dose-dependent manner. The activities of acetylcholinesterase (AchE) and monoamine oxidase-A and -B were significantly increased in the lead-treated group, which were decreased by 40% HRL but not by 20% HRL. The levels of norepinephrine, serotonin, and 5-hydroxyindole acetic acid were decreased significantly in the lead-treated mice, and the decreases were antagonized by 40% HRL, except for than in dopamine, but 20% HRL had no effect on this change. These data suggest that the different doses of the HRL juice protect against the lead acetate-induced deficits in learning and memory and changes in neurobiochemical parameters.