Comparative evaluation of single and combined efficacy of dipyridamole, ketotifen and quercetin on cyclosporine induced hepatorenal toxicity.

Cyclosporine is an immunosuppressive drug that is used to prevent tissue rejection in organ transplants and to treat autoimmune diseases such as psoriasis and rheumatoid arthritis. It has important toxic effects in many organs such as the liver and kidney. The aim of this study was to determine and compare the effectiveness of the single and combined treatment of dipyridamole, which is a vasodilator and has an antioxidant effect, ketotifen which is toll-like receptor-4 inhibitory and has an antioxidant effect, quercetin which is an antioxidant and has an anti-inflammatory effect in cyclosporine-induced hepatorenal toxicity. Forty-eight Wistar Albino rats were divided into 7 groups. The research period was 21 days. The cyclosporine increased serum ALT and AST levels, in contrast to their increased levels prevented by all the treatments. The serum creatinine level decreased significantly with ketotifen and combined treatment, while cyclosporine partially increased serum creatinine and urea levels. The urine microalbumin and protein levels were increased significantly by cyclosporine, whereas they decreased with dipyridamole treatment. The protein levels decreased by quercetin and combined treatments. The kidney injury molecule- 1 and retinol-binding protein levels were increased by the cyclosporine, while ketotifen treatment partially decreased them. In conclusion, ketotifen and dipyridamole can prevent cyclosporine- induced hepatorenal toxicity and quercetin can increase the effectiveness of this treatment.

Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study.

BACKGROUND: Distal radius fractures (DRF) account for one in five bony injuries in both primary and secondary trauma care. Enhanced recovery after surgery (ERAS) has been adopted successfully to improve clinical outcomes in multiple surgical disciplines; however, no study has investigated the effect of different degrees of compliance with ERAS protocol on short-term outcomes following distal radius surgery. We aimed to analyze whether different degrees of compliance with the ERAS pathway are associated with clinical improvement following surgery for DRF. METHODS: We retrospectively analyzed all consecutive patients with ERAS who underwent surgery for DRF at our department between May 2019 and October 2022. Their pre-, peri-, and post-operative compliance with the 22 elements of the ERAS program were assessed. We compared parameters between low- (< 68.1%) and high-compliance (> 68.1%) groups, including patient complications, total length of hospitalization, discharge time after surgery, hospital costs, time taken to return to preinjury level performance level, number of visual analogue scale (VAS) pain scores > 3 points during hospitalization, disabilities of the arm, shoulder and hand (DASH) scores. We performed multiple linear regression analyses to assess the impact of ERAS compliance on the postoperative function level (DASH scores). RESULTS: No significant differences were detected between the high- and low-compliance groups with respect to demographics, including sex, age, body mass index (BMI), and comorbidities (P > 0.05). We observed significant differences between the high- and low-compliance groups in terms of the DASH score (32.25 ± 9.97 vs. 40.50 ± 15.65, p < 0.05) at 6 months postoperatively, the discharge time after surgery (2.45 ± 1.46 vs. 3.14 ± 1.50, p < 0.05), and number of times when the VAS pain score was > 3 points during hospitalization (0.88, [0.44, 1.31], p < 0.05). Our study demonstrated a significant negative association between ERAS compliance and the function level of patients postoperatively (DASH scores) when adjusted for age, comorbidity, sex, and BMI. CONCLUSIONS: This study provided a realistic evaluation and comparison of the ERAS protocol among patients with DRF and can guide clinical decision making. The ERAS protocol may improve outcomes after surgery, with high postoperative function levels and reduced pain and discharge time after surgery, without increased complication rates or hospital costs.

A quantitative sonoelastography evaluation of ocular and periocular elasticity after intravitreal ranibizumab injection.

PURPOSE: We evaluated changes in ocular and periocular elasticity by ultrasound (US) elastography in intravitreal ranibizumab-treated eyes and the healthy fellow eyes of patients with neovascular AMD. METHODS: The study was performed on 52 eyes of 26 volunteers who ranged in age from 59 to 89 (mean 72±7.78) years old. The study group consisted of the patients with neovascular AMD treated with intravitreal ranibizumab. The fellow eyes (without choroidal neovascularization) of the study group were selected as the control group. All patients were examined with sonoelastography before intravitreal injection and at 1day, 1week, and 1month after intravitreal injection. All images were acquired with a Toshiba Aplio 500 ultrasound system (Tokyo, Japan) including software with a combined autocorrelation method and a multifrequency linear probe. The elastography values of the anterior vitreous (AV), posterior vitreous (PV), retina-choroid-sclera complex (RCS), retrobulbar fat tissue (RF), optic nerve head (ONH) and retrobulbar optic nerve (RON) were measured in each eye. RESULTS: There were 13 male (50%) and 13 female (50%) participants in our study. Anterior vitreous, posterior vitreous, RCS, retrobulbar fat tissue, ONH, and RON US elastography values were similar in both groups (P˃0.05 for all). On the other hand, there was a positive correlation between the difference between baseline and 1-month PV sonoelastography values and age (r=0.47, P=0.035). CONCLUSION: A single dose intravitreal Ranibizumab (Lucentis®, Genentech, USA) injection does not alter the elasticity of ocular and periocular structures.

Upregulation of serum exosomal SUMO1P3 predicts unfavorable prognosis in triple negative breast cancer.

OBJECTIVE: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with poor prognosis. Identification of reliable biomarkers for predicting prognosis of TNBC contributes significantly to improve the clinical outcome and disease management. Long non-coding RNAs (LncRNAs) have been demonstrated to play a critical role in tumorigenesis of TNBC. In this study, we aimed to investigate the prognostic significance of serum exosomal lncRNA small ubiquitin-like modifier 1 pseudogene 3 (SUMO1P3) in TNBC. PATIENTS AND METHODS: The expression level and clinical significance of tissue lncRNA SUMO1P3 in BC were analyzed using the public The Cancer Genome Atlas (TCGA) dataset. Then,A. Na-er, Y.-Y. Xu, Y.-H. Liu, Y.-J. Gan the serum exosomal lncRNA SUMO1P3 levels were examined in patients with TNBC, patients with non-TNBC, patients with benign breast disease and healthy controls using the quantitative real-time PCR. The potential clinical significance of serum exosomal lncRNA SUMO1P3 was further evaluated. RESULTS: Based on the TCGA data, tissue lncRNA SUMO1P3 was upregulated in BC tissues, and its upregulation was significantly correlated with poor survival. Our findings showed that the expression level of serum exosomal lncRNA SUMO1P3 was significantly higher in patients with TNBC compared to patients with non-TNBC, patients with benign breast disease and healthy controls. In addition, serum exosomal lncRNA SUMO1P3 was closely correlated with lymphovascular invasion, lymph node metastasis and histological grade. The serum exosomal lncRNA SUMO1P3 levels were markedly decreased in chemosensitive cases, while not in the chemoresistance cases. Moreover, patients in the high serum exosomal lncRNA SUMO1P3 group had worse overall survival than the patients in the low serum exosomal lncRNA SUMO1P3 group. The multivariate analysis showed that serum exosomal lncRNA SUMO1P3 was an independent prognostic factor for TNBC. CONCLUSIONS: Collectively, serum exosomal lncRNA SUMO1P3 might be a reliable and robust prognostic biomarker for TNBC.

The 12-hour shift: radiographers' perspectives and its applicability during a pandemic.

INTRODUCTION: Traditionally, shift work for radiographers at our institution comprised of three shift patterns - morning (8am-2pm), afternoon (2pm-9pm) and night (9pm-8am). However, when COVID-19 was first detected in Singapore in January 2020, the 12-h shift was introduced for better team segregation and deployment to meet the service needs of the Emergency Department. The 12-h shift consisted of the day (9am-9pm) and night (9pm-9am) shifts. While the 12-h shift is common to nursing practices, it is new to the radiography profession within the study centre. This study explores the radiographers' perspectives of the new shift and the impact of shift patterns on radiographers' wellness and work performance compared to the original three shift patterns. METHODS: A mixed-methods design study was adopted for this single-centre evaluation. An anonymous online questionnaire was administered to radiographers who had experienced both shift types. Additionally, the number of radiographers who had taken sick leave, and images rejected and accepted from the X-ray consoles were retrospectively collected to measure the impact of the new shift. RESULTS: Radiographers experienced fatigue and appreciated the longer rest days associated with the 12-h shift. Additionally, the sick leave rates and image reject counts were more favourable with the 12-h shift pattern. CONCLUSION: The findings indicate that the extended shift hours are effective during a pandemic but may result in radiographer burnout during a prolonged outbreak. IMPLICATIONS FOR PRACTICE: Studying these variables will provide an effective starting point in understanding the efficacy and applicability of a 12-h shift system during pandemic periods.

Anatomical location of the vertebrobasilar junction: computed tomography morphometrics for planning endoscopic transsphenoidal transclival approaches.

BACKGROUND: The aim of this study was to determine the anatomical localisation and morphometry of vertebrobasilar junction (VBJ) by computed tomography (CT) images which may be helpful in planning the correct procedure before surgery such as endoscopic transsphenoidal transclival approach to the retroclival space. MATERIALS AND METHODS: Vertebrobasilar junction level was determined on axial, coronal reformat and sagittal reformat images. Clivus length, the distances of the VBJ to the upper and lower end of the clivus and to the bottom of the sphenoid sinus were measured. In addition, the position and distance of the VBJ relative to the midline were measured. The vertebral artery dominance was determined and the position of VBJ relative to the midline was evaluated. RESULTS: When compared by gender, 1, a, b and c values were significantly longer in males than in females (p < 0.05). The location of the bottom of the sphenoid sinus was higher than the VBJ level in 263 (98.1%) cases, equal to the VBJ level in 1 (0.4%) case, and lower than the VBJ level in 4 (1.5%) cases. There was no statistically significant difference between the distances to the midline when the VBJs with right and left localisation were compared (p > 0.05). A statistically significant relationship was found between vertebral artery predominance and localisation of VBJ relative to the midline (p < 0.001). CONCLUSIONS: Careful perusal of CT images and the described VBJ morphometrics can help in accurate procedure planning to avoid basilar artery injury.

Development of a risk-stratification scoring system for predicting lymphovascular invasion in breast cancer.

BACKGROUND: Lymphovascular invasion (LVI) is a vital risk factor for prognosis across cancers. We aimed to develop a scoring system for stratifying LVI risk in patients with breast cancer. METHODS: A total of 301 consecutive patients (mean age, 49.8 ± 11.0 years; range, 29-86 years) with breast cancer confirmed by pathological reports were retrospectively evaluated at the authors' institution between June 2015 and October 2018. All patients underwent contrast-enhanced Magnetic Resonance Imaging (MRI) examinations before surgery. MRI findings and histopathologic characteristics of tumors were collected for analysis. Breast LVI was confirmed by postoperative pathology. We used a stepwise logistic regression to select variables and two cut-points were determined to create a three-tier risk-stratification scoring system. The patients were classified as having low, moderate and high probability of LVI. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discrimination ability of the scoring system. RESULTS: Tumor margins, lobulation sign, diffusion-weighted imaging appearance, MRI-reported axillary lymph node metastasis, time to signal intensity curve pattern, and HER-2 were selected as predictors for LVI in the point-based scoring system. Patients were considered at low risk if the score was < 3.5, moderate risk if the score was 3.5 to 6.0, and high risk if the score was ≥6.0. LVI risk was segmented from 0 to 100.0% and was positively associated with an increase in risk scores. The AUC of the scoring system was 0.824 (95% confidence interval [CI]: 0.776--0.872). CONCLUSION: This study shows that a simple and reliable score-based risk-stratification system can be practically used in stratifying the risk of LVI in breast cancer.

Pharmacokinetics of cefquinome in red-eared slider turtles (Trachemys scripta elegans) after single intravenous and intramuscular injections.

The purpose of this study was to evaluate the pharmacokinetics of cefquinome (CFQ) following single intravenous (IV) or intramuscular (IM) injections of 2 mg/kg body weight in red-eared slider turtles. Plasma concentrations of CFQ were determined by high-performance liquid chromatography and analyzed using noncompartmental methods. The pharmacokinetic parameters following IV injection were as follows: elimination half-life (t1/2λz ) 21.73 ± 4.95 hr, volume of distribution at steady-state (Vdss ) 0.37 ± 0.11 L/kg, area under the plasma concentration-time curve (AUC0-∞ ) 163 ± 32 µg hr-1  ml-1 , and total body clearance (ClT ) 12.66 ± 2.51 ml hr-1  kg-1 . The pharmacokinetic parameters after IM injection were as follows: peak plasma concentration (Cmax ) 3.94 ± 0.84 µg/ml, time to peak concentration (Tmax ) 3 hr, t1/2λz 26.90 ± 4.33 hr, and AUC0-∞ 145 ± 48 µg hr-1  ml-1 . The bioavailability after IM injection was 88%. Data suggest that CFQ has a favorable pharmacokinetic profile with a long half-life and a high bioavailability in red-eared slider turtles. Further studies are needed to establish a multiple dosage regimen and evaluate clinical efficacy.

Bacterial pathogens and health problems of Acipenser gueldenstaedtii and Acipenser baerii sturgeons reared in the eastern Black Sea region of Turkey.

Farming sturgeons is an economically important practice in a number of Asian and European countries. However, since it is not widely implementedin Turkey, fertilized eggs necessary for research and industrial activities are imported from Germany. Due to the interest of several fish farms in culturing sturgeon in Turkey and the lack of relevant data, this study investigated bacteria related health problems of two different sturgeon species, the diamond sturgeon (Acipenser gueldenstaedtii) and the Siberian sturgeon (Acipenser baerii). The fungal, parasitic and bacterial pathogens found in these fish were investigated until the fish reached about 3 kg of weight (3+ years). A number of bacterial disease pathogens (Acinetobacter radioresistens, some Aeromonas and Pseudomonas species and Bacillus mycoides) and parasite Trichodina sp. and fungus Saprolegnia sp. were identified in the fish. Both phenotypic and molecular characterizations of the isolated bacteria were performed. Furthermore, swim bladder and spinal problems, cannibalism, tumor growth and mechanical injuries on the external surface of the fish were observed during the study period.

ASSESSING THE COST BURDEN OF DENGUE INFECTION TO HOUSEHOLDS IN SEREMBAN, MALAYSIA.

Dengue is endemic in all parts of Malaysia. However, there is limited data regarding the cost burden of this disease at household level. We aimed to examine the cost of dengue infection at the household level in Seremban District, Malaysia. This cost assessment can provide an insight to policy-makers about economic impact of dengue infection in order to guide and prioritize control strategies. The data were collected via interview. We evaluated120 previous dengue infection patients registered at the Tuanku Ja'afar Hospital, Seremban District, Malaysia. The average duration of dengue illness was 9.69 days. The average household days lost was 18.7; students lost an average of 6.3 days of school and patients and caregivers lost an average of 12.5 days of work. The mean total cost per case of dengue infection was estimated to be USD365.16 with the indirect cost being USD327.90 (89.8% of the total cost) and the direct cost being USD37.26 (10.2% of the total cost). Our findings suggest each episode of dengue infection imposes a significant financial burden at the household level in Seremban District, Malaysia; most of the burden being indirect cost. This cost needs to be factored into the overall cost to society of dengue infection. This data can inform policy makers when allocating resources to manage public health problems in Malaysia.

[Preparation and property study of doxorubicin loaded microspheres].

OBJECTIVE: To prepare doxorubicin-loaded polyvinylalcohol-acrylic acid (PVA-AA) microspheres and evaluate properties of this chemoembolic agent. METHODS: PVA-AA microspheres were synthesized by inverse suspension polymerization method and then verified by infrared spectroscopy. drug loading (DL) and entrapment efficiency (EE%) were measured after doxorubicinwas loaded on PVA-AA microspheres. Their morphology and elasticity were investigated by optical microscope, environmental scanning electron microscope and texture analyzer, respectively. T-cell apparatus was used to evaluate the in vitro release behavior of doxorubicin-loaded microspheres.The external carotid of the rabbit was chosen as an embolization site to evaluate the in vivo embolic property of the microspheres. RESULTS: PVA-AA microspheres, which were transparent spheres,turned into red spheres after doxorubicin loading. DL of the microspheres was (20.56 ± 0.69)g/L and (23.25 ± 0.27) g/L,and EE% was 82.22% ± 2.76% and 93.00% ± 1.06% within 20 min and 6 h, respectively. The in vitro release results showed a significantly delayed release of the drug for 10.32% ± 0.47% after 24 h. The Young's modulus was (178.30 ± 12.33) kPa and (213.29 ± 15.61) kPa for blank microspheres and doxorubicin-loaded microspheres, respectively. Both blank microspheres and doxorubicin-loaded microspheres exhibited good elasticity. In vivo embolization showed that 0.3 mL of microspheres could produce distal embolic efficiency. CONCLUSION: The doxorubicin-loaded microspheres are expected to be a promising new chemoembolic agent.

Trends of dengue infections in Malaysia, 2000-2010.

OBJECTIVE: To analyze trends of dengue incidences and deaths in Malaysia from 2000 to 2010 as well as the predominant dengue virus serotypes during the last decade. METHODS: We used the national data on annual reported cases, deaths, incidence rate, mortality rate, and case fatality rate of dengue fever (DF) and dengue hemorrhagic fever (DHF) as well as dengue virus serotypes prevalent in Malaysia during the last decade. Trend/ regression lines were fitted to investigate the trend of dengue incidences and deaths due to the disease for a 11-year period (2000-2010). For the distribution of national incidence rate, mortality rate, and case fatality rate of DF and DHF, descriptive statistics using mean and 95% confidence intervals (CI 39) for means, and range were applied. RESULTS: The number of dengue cases and number of deaths have increased, on average, by 14% and 8% per year respectively. The average annual incidence rate of DF per 100 000 populations was higher as compared to that of DHF. Conversely, the yearly mean mortality rate of DHF per 100 000 populations was greater than that of DF. The simultaneous circulation of all four dengue serotypes has been found in Malaysia. But a particular dengue virus serotype predominates for at least two years before it becomes replaced by another serotype. CONCLUSIONS: The dengue situation in Malaysia has worsened with an increasing number of reported cases and deaths during the last decade. The increasing trend of dengue highlights the need for a more systematic surveillance and reporting of the disease.

Poly(acrylic acid) microspheres loaded with lidocaine: preparation and characterization for arterial embolization.

A new embolic agent, poly(acrylic acid) microspheres (PMs), was synthesized and the cytocompatibility was proved by mouse L929 fibroblast cells. An analgesic drug, lidocaine, was loaded on the PMs to relief pain caused by embolization. PMs and lidocaine loaded microspheres (LMs) were characterized by investigating infrared spectrum, morphology, particle size, and equilibrium water contents (EWC). A series of tests were employed to evaluate the elasticity of PMs, LMs and Embosphere™, including once compression, twice compression, and stress relaxation test. The pressures of PMs and LMs passing through a catheter were measured on line by our new designed device. Drug release was studied with T-cell apparatus. The properties of PMs and LMs were proved to be suitable for embolization. Both PMs and LMs in this study might be potential embolic agents in the future.

Long-term outcomes of kidney transplants with multiple renal arteries: a retrospective study.

OBJECTIVE: The aim of this study was to investigate whether kidney transplantations performed using grafts with multiple arteries negatively affected renal function or increased the risk of vascular or urologic complications. METHODS: Among 249 kidney transplant patient followed for at least 1 year between 2000 and 2005, we retrospectively evaluated their donor renal artery anatomy to compare postoperative vascular and urologic complications: creatinine clearance at 1, 2, and 5 years, as well as graft survival at 3 and 5 years. RESULTS: While 214 (85.9%) displayed a single artery (group 1), 35 (14.1%) showed multiple renal arteries (group 2). Thirty-one of the group 2 allografts had two, three donors had three, and one had four arteries. The postoperative vascular and urologic complications and the creatinine clearance values at 1, 2, and 5 years of both groups were similar. The 3- and 5-year graft survivals among group 1 were 95% and 90%, whereas those of group 2 were 94% and 91% respectively (P < .05). CONCLUSION: Our study indicated that multiple renal arteries did not adversely affect postoperative urologic or vascular complications or kidney allograft or patient survival compared with single renal artery cases.

Evaluation of perinatal and intrafamilial hepatitis B prevention programmes in a well child clinic: 9-year follow-up study in Turkey.

Evaluating the performance of well child clinics on adherence to recommended perinatal hepatitis B prevention programmes as well as assessing the outcome of infants living with hepatitis B surface antigen (HBsAg)-positive parents is important. A retrospective study was performed of 336 babies who had at least one HBsAg-positive parent and were followed-up in the well child clinic of Gazi University Hospital (Ankara, Turkey) between 2001 and 2009. Rates of passive immunisation in 109 babies with HBsAg-positive mothers and initiation of hepatitis B vaccination of all 336 babies with HBsAg-positive parents were 98.8% and 100% respectively. Ninety-two babies (27.4%) were lost to follow-up before completing primary immunisation. The recommended perinatal hepatitis B prevention programme was performed successfully in 194 of the 306 infants who were old enough for post-vaccination serotesting (63.4%). One baby became HBsAg-positive, and 88.1% of babies were seroprotected. Hepatitis B surface antibody (anti-HBs) levels were found to be increased if the HBsAg-positive parent was the father. There was a negative correlation between serotesting time and anti-HBs titres. The study infants had a total of 187 siblings and 123 (65.8%) were serotested after completing primary immunisation with 108 found to be seropositive. Although the vaccination rate in the perinatal hepatitis B prevention programme is satisfactory, post-vaccination serotesting and evaluation of infants and their siblings are still deficient.

Spinal anesthesia for transurethral resection operations: bupivacaine versus levobupivacaine.

BACKGROUND: This study tested the hypothesis that 0.5% levobupivacaine might be a good alternative to 0.5% plain bupivacaine for local spinal anesthesia during transurethral resection (TUR) operations. METHODS: A prospective, randomized, double-blinded study was conducted on 50 male ASA I-III patients aged >60 years who were scheduled for elective transurethral resection operations. After routine monitoring, spinal anesthesia was performed with patients in the left lateral position using a 25G Quincke needle in the L3-4 interspace with a midline approach. Group B (N.=25) received 2.5 mL of 0.5% plain bupivacaine and Group L (N.=25) received 2.5 mL of 0.5% levobupivacaine via intratechal injection. The characteristics of sensory and motor block, hemodynamic data, side effects, and patient and surgeon satisfaction were recorded. Patients were observed until the level of sensory block was S1 and the Bromage score was 0. RESULTS: There were no significant differences between the two groups for patient demographic data, American Society of Anesthesiologists (ASA) classification, type and duration of operation, side effects, and patient and surgeon satisfaction. Hemodynamic parameters were similar in both groups before and during the operation. The highest level of sensory block was T(7)(T(3)-T(10)) in Group B and T9(T4-T12) in Group L (P=0.001). CONCLUSION: Administration of 0.5% levobupivacaine may be a good alternative to 0.5% plain bupivacaine for local spinal anesthesia during TUR operations.

A high phase-space-density gas of polar molecules.

A quantum gas of ultracold polar molecules, with long-range and anisotropic interactions, not only would enable explorations of a large class of many-body physics phenomena but also could be used for quantum information processing. We report on the creation of an ultracold dense gas of potassium-rubidium (40K87Rb) polar molecules. Using a single step of STIRAP (stimulated Raman adiabatic passage) with two-frequency laser irradiation, we coherently transfer extremely weakly bound KRb molecules to the rovibrational ground state of either the triplet or the singlet electronic ground molecular potential. The polar molecular gas has a peak density of 10(12) per cubic centimeter and an expansion-determined translational temperature of 350 nanokelvin. The polar molecules have a permanent electric dipole moment, which we measure with Stark spectroscopy to be 0.052(2) Debye (1 Debye = 3.336 x 10(-30) coulomb-meters) for the triplet rovibrational ground state and 0.566(17) Debye for the singlet rovibrational ground state.