Fatigue Alleviation by Low-Level Laser Pre-Exposure in Ischemic Neuromuscular Electrical Stimulation.

PURPOSE: Despite its susceptibility to muscle fatigue, combined neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) is an effective regimen for managing muscle atrophy when traditional resistance exercises are not feasible. This study investigated the potential of low-level laser therapy (LLLT) in reducing muscle fatigue after the application of combined NMES and BFR. METHODS: Thirty-six healthy adults were divided into control and LLLT groups. The LLLT group received 60 J of 850 nm wavelength LLLT before a training program of combined NMES and BFR of the non-dominant extensor carpi radialis longus (ECRL). The control group followed the same protocol but received sham laser therapy. Assessments included maximal voluntary contraction (MVC), ECRL mechanical properties, and isometric force-tracking for wrist extension. RESULTS: The LLLT group exhibited a smaller normalized difference in MVC decrement (-4.01 ± 4.88%) than the control group (-23.85 ± 7.12%) (P < .001). The LLLT group demonstrated a smaller decrease in muscle stiffness of the ECRL compared to the control group, characterized by the smaller normalized changes in frequency (P = .002), stiffness (P = .002), and relaxation measures (P = .011) of mechanical oscillation waves. Unlike the control group, the LLLT group exhibited a smaller post-test increase in force fluctuations during force-tracking (P = .014), linked to the predominant recruitment of low-threshold MUs (P < .001) without fatigue-related increases in the discharge variability of high-threshold MUs (P > .05). CONCLUSIONS: LLLT pre-exposure reduces fatigue after combined NMES and BFR, preserving force generation, muscle stiffness, and force scaling. The functional benefits are achieved through fatigue-resistant activation strategies of motor unit recruitment and rate coding.

Inhibition of Synaptic Glutamate Exocytosis and Prevention of Glutamate Neurotoxicity by Eupatilin from Artemisia argyi in the Rat Cortex.

The inhibition of synaptic glutamate release to maintain glutamate homeostasis contributes to the alleviation of neuronal cell injury, and accumulating evidence suggests that natural products can repress glutamate levels and associated excitotoxicity. In this study, we investigated whether eupatilin, a constituent of Artemisia argyi, affected glutamate release in rat cortical nerve terminals (synaptosomes). Additionally, we evaluated the effect of eupatilin in an animal model of kainic acid (KA) excitotoxicity, particularly on the levels of glutamate and N-methyl-D-aspartate (NMDA) receptor subunits (GluN2A and GluN2B). We found that eupatilin decreased depolarization-evoked glutamate release from rat cortical synaptosomes and that this effect was accompanied by a reduction in cytosolic Ca2+ elevation, inhibition of P/Q-type Ca2+ channels, decreased synapsin I Ca2+-dependent phosphorylation and no detectable effect on the membrane potential. In a KA-induced glutamate excitotoxicity rat model, the administration of eupatilin before KA administration prevented neuronal cell degeneration, glutamate elevation, glutamate-generating enzyme glutaminase increase, excitatory amino acid transporter (EAAT) decrease, GluN2A protein decrease and GluN2B protein increase in the rat cortex. Taken together, the results suggest that eupatilin depresses glutamate exocytosis from cerebrocortical synaptosomes by decreasing P/Q-type Ca2+ channels and synapsin I phosphorylation and alleviates glutamate excitotoxicity caused by KA by preventing glutamatergic alterations in the rat cortex. Thus, this study suggests that eupatilin can be considered a potential therapeutic agent in the treatment of brain impairment associated with glutamate excitotoxicity.

Protective effects of bupivacaine against kainic acid-induced seizure and neuronal cell death in the rat hippocampus.

The excessive release of glutamate is a critical element in the neuropathology of epilepsy, and bupivacaine, a local anesthetic agent, has been shown to inhibit the release of glutamate in rat cerebrocortical nerve terminals. This study investigated whether bupivacaine produces antiseizure and antiexcitotoxic effects using a kainic acid (KA) rat model, an animal model used for temporal lobe epilepsy, and excitotoxic neurodegeneration experiments. The results showed that administering bupivacaine (0.4 mg/kg or 2 mg/kg) intraperitoneally to rats 30 min before intraperitoneal injection of KA (15 mg/kg) increased seizure latency and reduced the seizure score. In addition, bupivacaine attenuated KA-induced hippocampal neuronal cell death, and this protective effect was accompanied by the inhibition of microglial activation and production of proinflammatory cytokines such as interleukin (IL)-1ß, IL-6, and tumor necrosis factor-α in the hippocampus. Moreover, bupivacaine shortened the latency of escaping onto the platform in the Morris water maze learning performance test. Collectively, these data suggest that bupivacaine has therapeutic potential for treating epilepsy.

Palmitoylethanolamide inhibits glutamate release in rat cerebrocortical nerve terminals.

The effect of palmitoylethanolamide (PEA), an endogenous fatty acid amide displaying neuroprotective actions, on glutamate release from rat cerebrocortical nerve terminals (synaptosomes) was investigated. PEA inhibited the Ca²âº-dependent release of glutamate, which was triggered by exposing synaptosomes to the potassium channel blocker 4-aminopyridine. This release inhibition was concentration dependent, associated with a reduction in cytosolic Ca²âº concentration, and not due to a change in synaptosomal membrane potential. The glutamate release-inhibiting effect of PEA was prevented by the Ca(v)2.1 (P/Q-type) channel blocker ω-agatoxin IVA or the protein kinase A inhibitor H89, not affected by the intracellular Ca²âº release inhibitors dantrolene and CGP37157, and partially antagonized by the cannabinoid CB1 receptor antagonist AM281. Based on these results, we suggest that PEA exerts its presynaptic inhibition, likely through a reduction in the Ca²âº influx mediated by Ca(v)2.1 (P/Q-type) channels, thereby inhibiting the release of glutamate from rat cortical nerve terminals. This release inhibition might be linked to the activation of presynaptic cannabinoid CB1 receptors and the suppression of the protein kinase A pathway.

Acacetin inhibits glutamate release and prevents kainic acid-induced neurotoxicity in rats.

An excessive release of glutamate is considered to be a molecular mechanism associated with several neurological diseases that causes neuronal damage. Therefore, searching for compounds that reduce glutamate neurotoxicity is necessary. In this study, the possibility that the natural flavone acacetin derived from the traditional Chinese medicine Clerodendrum inerme (L.) Gaertn is a neuroprotective agent was investigated. The effect of acacetin on endogenous glutamate release in rat hippocampal nerve terminals (synaptosomes) was also investigated. The results indicated that acacetin inhibited depolarization-evoked glutamate release and cytosolic free Ca(2+) concentration ([Ca(2+)]C) in the hippocampal nerve terminals. However, acacetin did not alter synaptosomal membrane potential. Furthermore, the inhibitory effect of acacetin on evoked glutamate release was prevented by the Cav2.2 (N-type) and Cav2.1 (P/Q-type) channel blocker known as ω-conotoxin MVIIC. In a kainic acid (KA) rat model, an animal model used for excitotoxic neurodegeneration experiments, acacetin (10 or 50 mg/kg) was administrated intraperitoneally to the rats 30 min before the KA (15 mg/kg) intraperitoneal injection, and subsequently induced the attenuation of KA-induced neuronal cell death and microglia activation in the CA3 region of the hippocampus. The present study demonstrates that the natural compound, acacetin, inhibits glutamate release from hippocampal synaptosomes by attenuating voltage-dependent Ca(2+) entry and effectively prevents KA-induced in vivo excitotoxicity. Collectively, these data suggest that acacetin has the therapeutic potential for treating neurological diseases associated with excitotoxicity.

Determinants of metals exposure to metalworking fluid among metalworkers in Taiwan.

Metalworking fluids (MWFs) aerosols are known to have carcinogenic potential to humans that monitoring of MWFs is necessary to reduce risks. This study summarizes biological monitoring and occupational hygiene findings from a survey of metalworkers exposed to heavy metals in a socket manufacturing plant. Manganese, nickel, iron, copper, chromium, and zinc were selected for target metals. Air samples were collected and postshift urines were obtained from the thread cutting workers and punch press machine operators. There were positive correlations between the airborne concentrations of Cr, Mn, as well as Zn and the corresponding levels of urine for the exposed groups. Therefore, the integration of biological and environmental monitoring is feasible for Cr, Mn, and Zn. The results indicated significant correlations between the levels of Cu, Cr, Fe, as well as Zn from the air and sump MWFs at thread cutting and punch press sites.

Determination of trace indium in urine after preconcentration with a chelating-resin-packed minicolumn.

A simple and rapid chelating-resin-packed column has been developed for preconcentration of trace indium in biological samples. A large-sized urine sample was pumped through a minicolumn at a flow rate of 1.0 mL/min by using a peristaltic pump, and the eluents were analyzed using graphite furnace atomic absorption spectrometry (GFAAS). Four commercially available chelating resins including Chelex-100, Amberlite IRC-50, Duolite GT-73, and Celite 545-AW were studied for evaluating the indium sorption performance. Several parameters, such as pH, resin amount, eluent volume, eluent flow rate, and the volume of sample, were investigated and optimized. A 100-200 mL of the sample was loaded into a column containing 1.2 g of wet Chelex-100 and subjected to the ion-exchange procedure. The retained analytes were eluted with 5.0 mL of 0.1 M HNO(3) and quantified by GFAAS. The correlation coefficient in the range 10-250 ng/mL was of 0.9994. The limit of detection of the proposed method was 2.75 ng/mL. The method developed was successfully applied to analysis of spiked urine samples with good recoveries of 93-103% (n = 6) and reproducibility (relative standard deviation < 4.9%). The accuracy of procedure was confirmed by indium determination in spiked certified reference materials.

Antiemetic efficacy of metoclopramide and diphenhydramine added to patient-controlled morphine analgesia: a randomised controlled trial.

BACKGROUND AND OBJECTIVE: the objective of this study was to assess whether antiemetic drugs metoclopramide and diphenhydramine, administered together as opposed to alone, can have better efficacy in preventing postoperative nausea and vomiting when added to patient-controlled morphine analgesia. PATIENTS AND METHODS: during the period July 2007 to August 2008, 200 women scheduled for abdominal total hysterectomy were randomised to one of four postoperative, patient-controlled analgesia regimens: group 1, morphine 1 mg ml; group 2, morphine 1 mg ml with metoclopramide 0.5 mg ml; group 3, morphine 1 mg ml with diphenhydramine 0.6 mg ml; and group 4, morphine 1 mg ml with metoclopramide 0.5 mg ml and diphenhydramine 0.6 mg ml. Dexamethasone 4 mg was administered to all patients in all groups after anaesthesia induction as a prophylactic antiemetic medication, and prochlorperazine 5 mg was administered by intramuscular injection as necessary as a salvage/rescue therapy. Nausea, vomiting, pruritus, level of sedation, pain and morphine consumption were compared between the four groups. RESULTS: the incidence of nausea was significantly (P < 0.05) lower in group 4 compared to the other groups. In addition, there was a significant (P = 0.006) difference in the incidence of vomiting between groups 1 and 4. Repeated measurement analysis showed that numeric rating scale scores for group 4 were significantly (P < 0.001) lower than those for the other groups. CONCLUSION: results of this study showed that a combination of metoclopramide with diphenhydramine in patients treated with dexamethasone at anaesthesia induction decreased postoperative nausea and vomiting compared to metoclopramide or diphenhydramine in these patients, when added to patient-controlled anaesthesia with morphine.

Tetrandrine ameliorated reperfusion injury of small bowel transplantation.

PURPOSE: In small bowel transplantation, the bowel graft is susceptible to reperfusion injury. This study investigated the effects of tetrandrine, a bisbenzylisoquinoline alkaloid, on the development of intestinal reperfusion injury in small bowel transplantation in pigs. MATERIALS AND METHODS: Pigs underwent small bowel transplantation and were treated with tetrandrine or a vehicle. Blood and small bowel specimens were harvested at 1, 3, and 24 hours after reperfusion. Histopathologic analysis of the small bowel was assessed for tissue damage. Serum levels of tumor necrosis factor-alpha, interleukin-1beta (IL-1beta), and IL-6 were measured by enzyme-linked immunosorbent assay. Reverse-transcriptase polymerase chain reaction analysis was performed to analyze the expression of proinflammatory cytokines, and immunohistochemical analysis was used to study the expression of intercellular adhesion molecule-1 (ICAM-1) in the small bowel. Myeloperoxidase staining detected neutrophil infiltration in the small bowel and the number of myeloperoxidase positively stained cells was counted. RESULTS: Pigs receiving small bowel transplantation had elevated serum proinflammatory cytokine levels. The transplanted small bowel showed mucosal damage, increased expression of proinflammatory cytokines and ICAM-1, and prominent neutrophil infiltration. Tetrandrine administration reduced mucosal damage, serum and tissue proinflammatory cytokine levels, ICAM-1 expression, and neutrophil accumulation in the transplanted small bowel. CONCLUSIONS: Tetrandrine reduced the reperfusion injury in porcine intestinal transplantation during the first 24 hours after the procedure.

Recovery of indium from etching wastewater using supercritical carbon dioxide extraction.

This study presents supercritical carbon dioxide (scCO(2)) extraction as an inherently safer and cleaner method for the recovery of indium (In) from the real etching wastewater obtained from indium tin oxide (ITO) etching process. Efficient chelation-supercritical fluids extraction (SFE) from etching wastewater was obtained at 80 degrees C, a pressure of 20.7MPa, and with 15 min static extractions followed by 15 min dynamic extraction. The extractions were performed using unmodified scCO(2) in the presence of the fluorinated beta-diketone chelating agent, 2,2-dimethyl-6,6,7,7,8,8,8-heptafluoro-3,5-octanedione (HFOD). Percentages of indium recovery from etching wastewater were between 90.8% and 100.3% (n=6) with relative standard deviations of <10%. The accuracy of the procedure was confirmed by determining indium levels in a single element standard solution. The developed method was applied to the analysis of real etching wastewater samples as well as to a commercially available ITO etching reagent (ITO-06SD) with satisfactory results.

Determination of gallium in human urine by supercritical carbon dioxide extraction and graphite furnace atomic absorption spectrometry.

This study presents supercritical carbon dioxide (scCO(2)) extraction as an inherently safer and cleaner sample treatment method for identifying trace gallium in urine samples. Extraction is performed in the presence of a fluorinated beta-diketones chelating agent, 2,2-dimethyl-6,6,7,7,8,8,8-heptafluoro-3,5-octanedione (HFOD), by unmodified scCO(2). Quantitative extractions are conducted at 80 degrees C and 20.7 MPa with 15 min static plus 15 min dynamic extractions, and are followed by analysis via graphite furnace atomic absorption spectroscopy (GFAAS). The proposed procedure is successfully applied to determine the concentrations of gallium in real urine samples spiked with various levels of gallium with satisfactory recoveries of 90.8-100.3% (n=6) and relative standard deviations <10%. A standard reference material (SRM), Seronorm Trace Elements Urine, is used to validate the accuracy of the proposed method.

Spleen rupture after mitral valve replacement for infective endocarditis.

We present a case of splenic rupture as the cause of a sudden drop in blood pressure soon after mitral valve surgery for infective endocarditis. This case suggests that, in addition to more common causes of unstable vital signs after valvular surgery, such as cardiac tamponade or bleeding at the operation site, splenic rupture, although rare, should be considered in the differential diagnosis. This is particularly important in the case of infective endocarditis.

Acute myocarditis-related complete atrioventricular block---an accidental finding in an acute appendicitis patient.

We report a 20-year-old male patient with preoperatively undiagnosed myocarditis, who received general anesthesia for laparoscopic appendectomy. Because of arrhythmia, a cardiologist was consulted postoperatively. The 12-lead electrocardiogram showed complete atrioventricular block and the echocardiogram showed global hypokinesia of the left ventricle with impaired contractility, a left ejection fraction of 37%, and a dilated right heart. Subsequently, a permanent pacemaker was implanted and the patient was discharged from hospital without any complications.

Local infusion of bupivacaine combined with intravenous patient-controlled analgesia provides better pain relief than intravenous patient-controlled analgesia alone in patients undergoing minimally invasive cardiac surgery.

OBJECTIVE: This prospective randomized double-blind study examined the effect of local wound infusion of anesthetics on pain control in the thoracotomy wound of patients undergoing minimally invasive cardiac surgery. METHODS: Patients who underwent coronary artery bypass grafting or cardiac valvular procedures via a minimally invasive thoracotomy were studied. Patients were enrolled and randomly allocated to two groups with different modalities of postoperative analgesia. The thoracotomy wound infusion group received 0.15% bupivacaine infused continuously at 2 mL/h through a catheter embedded in the wound, as well as intravenous patient-controlled analgesia. The control group had patient-controlled analgesia alone with a sham thoracotomy wound infusion of normal saline. Verbal analog pain scores (0-10 points) and recovery profiles were investigated. RESULTS: There were 19 patients in each group for complete data analysis. On the first day after the operation, infusion of local anesthetics significantly reduced the verbal analog pain scores both at rest and during motion (thoracotomy wound infusion vs control). The improved pain relief with thoracotomy wound infusion persisted at day 3 and even at 3 months after the operation. No difference was noted about time to extubation, length of intensive care unit stay, or hospital stay. CONCLUSION: In this controlled double-blind study, thoracotomy wound infusion and patient-controlled analgesia were superior to patient-controlled analgesia alone in reducing pain at 1, 3, and 90 days after minimally invasive cardiac surgery.

Does different time interval between staggered bilateral total knee arthroplasty affect perioperative outcome? A retrospective study.

Staggered bilateral total knee arthroplasty (BTKA) performed 4 to 7 days apart has been shown to have fewer postoperative complications than sequential or staged BTKA. However, there has been no comparison of staggered BTKA with different intervals. A retrospective study involving 79 patients who underwent BTKA from 2002 to 2004 was performed to determine whether the interval between each TKA influenced the clinical outcome. Staggered operations performed 2 days (n = 46) or 7 days (n = 33) apart had similar incidence of major (acute myocardial infarction, pulmonary embolism, etc) and minor complications (transient hypotension or low Sp(o)(2)) throughout hospitalization. Perioperative complications in the first and second TKAs were similar when TKAs were performed with a 2- or a 7-day interval.

Cardioversion corrects cardiac arrhythmia and reverts the resultant reversed shunt flow direction during transcatheter closure of atrial septal defect--a case report.

Closure of atrial septal defect (ASD) is critically dependent on the shunt flow direction. However, shunt flow direction through ASD may change under variable clinical conditions. We present here a 53-year-old woman with a confirmed left-to-right shunt ASD prior to Amplatzer Septal Occluder placement. The development of atrial flutter during the procedure had been found to change the shunt from unidirectional to bidirectional and the procedure was then forced to a temporary halt. The cardiac arrhythmia and altered shunt direction simultaneously reverted to the old state after cardioversion. A successful placement of Amplatzer septal occluder was successfully performed afterward and she recovered uneventfully.

Two different anesthetic managements of a patient with von Gierke's disease.

Von Gierke's disease, a form of glycogen storage disturbance, is a rare metabolic disorder with important implications for anesthesiologists. It is caused by the lack of the glucose-6-phosphatase, which is necessary for the liver to convert glycogen to glucose. To avoid severe hypoglycemia, it is crucial to keep oral feeding at intervals 2-3 hr for maintaining a normal blood sugar level. The metabolic derangements of von Gierke's disease may result in serious complications in patients undergoing surgery and anesthesia. We report the anesthetic managements of a patient with von Gierke's disease in two operations with different encounters.

Starting dose of gabapentin for patients with post-herpetic neuralgia--a dose-response study.

BACKGROUND: Gabapentin has been shown to provide pain relief for post-herpetic neuralgia at dosage of 1200 to 2400 mg/day. However, the initial dosing strategy has not been thoroughly investigated. The purpose of this study was to establish the initial dosing strategy in the treatment of the gabapentin-naive patients with post-herpetic neuralgia. METHODS: This clinical study was an open-label, randomized, time-sequence and controlled trial. Each gabapentin-naive subject was allocated to receive either 200 mg (100 mg, twice daily), 400 mg (100 mg, four times daily), or 600 mg (200 mg, three times daily) of gabapentin for three days. The analgesic effect and occurrence of dizziness, drowsiness, and fatigue were assessed at day 0 and day 3. RESULTS: A total of 61 subjects (32 male/29 female) were enrolled in this study. The intensity of pain was greatly improved in all three groups after three days of treatment (visual analog scale decreased from 6.5 +/- 1.6 to 4.5 +/- 2.1, P < 0.05). There was no statistically significant difference among subjects taking 200 mg, 400 mg, or 600 mg with respect to dizziness, drowsiness or fatigue. CONCLUSIONS: This study shows that elderly gabapentin-naive subjects no matter whether receiving 200, 400 or 600 mg/day of gabapentin benefited a moderate pain relief with minimal side effects at the first three days of treatment. Since starting with a minimal dose of 200 mg/day did not offer a better reduction of side effects, we suggest that 600 mg/day gabapentin could be a safe and effective starting dose for patients with post-herpetic neuralgia.