Enhancing surgical outcomes of posterior iliac bone harvesting through a pivotal modification.

Traditionally, patients are positioned in the prone position to access the donor site during the posterior iliac bone graft harvesting procedure. However, this well-established method is associated with complications such as pressure injuries, displacement of the endotracheal tube and intravenous catheter, and blindness. Moreover, the process of turning patients 180° between the supine and prone positions is both laborious and time consuming. However, no updates have been made in the approaches published in the literature to counteract these problems. Therefore, to overcome these challenges and improve patient outcomes, we proposed a pivotal modification: change prone position to the lateral decubitus position. This approach allowed us to effectively avoid the aforementioned complications. In addition, this modification offered significant advantages, including ease of implementation and timesaving benefits. The article presented results of the modification and a comprehensive evaluation of clinical and anesthetic considerations comparing the two methods.

Exposure to general anesthesia in early life and the risk of attention deficit/hyperactivity disorder development: a nationwide, retrospective matched-cohort study.

BACKGROUND: Postnatal exposure to anesthetics can cause neural apoptosis and degeneration in animals, but results from studies conducted on humans were discordant. Previous studies contained no information on the relationship between neurobehavioural disorders and anesthesia exposure in Asian children. We conducted a retrospective matched-cohort study in Taiwan to investigate the association of early life anesthesia exposure with risk of attention deficit/hyperactivity disorder (ADHD). METHODS: Data were obtained from the National Health Insurance Research Database of Taiwan. Children born between January 1, 2001 and December 31, 2005 were included. Each child with anesthesia exposure before 3 years of age was matched to four unexposed children. Observation was concluded on December 31, 2010. Proportional hazards regression was used to assess the association of anesthesia exposure with ADHD. Analyses were also made based on exposure number and age at the time of first exposure. RESULTS: This matched-cohort comprised of 16 465 children, among which 3293 were exposed to general anesthesia before age 3 years. The adjusted hazard ratio of developing ADHD was 1.06 (95% CI: 0.86,1.31) for general anesthesia exposure. The adjusted hazard ratio of developing ADHD for single and multiple exposures were 1.11 (95% CI: 0.88, 1.41) and 0.96 (95% CI: 0.71,1.31), respectively. No trend of increasing risk was noted based on age at the time of first exposure. CONCLUSIONS: Exposure to general anesthesia before 3 years of age was not associated with ADHD.

VSL#3 probiotics regulate the intestinal epithelial barrier in vivo and in vitro via the p38 and ERK signaling pathways.

Probiotics can play a role in enhancing intestinal barrier function. However, the underlying mechanisms are not fully understood. The aim of this study was to examine the effects of VSL#3 probiotics on colonic epithelium permeability, tight junction protein expression and MAPKs signaling pathways in vivo and in vitro. In vivo, acute colitis was induced by administration of 3.5% dextran sodium sulfate for 7 days. Rats in two groups were treated with either 15 mg VSL#3 or placebo via a gastric tube once daily after induction of colitis. Tight junction protein expression and the MAPKs signaling pathways were studied by immunohistochemistry and immunoblotting. In vitro, HT-29 cells were exposed to TNF-α for up to 48 h with or without pre-treatment with a p38 MAPK inhibitor, an ERK inhibitor or a JNK inhibitor. Then tight junction proteins and the phosphorylation of MAPKs were examined in the presence or absence of VSL#3. In vivo, VSL#3 probiotics significantly ameliorated the disease activity index from Day 4 onward. In acute colitis rats, decreased expression of the tight junction proteins were observed, whereas VSL#3 therapy prevented these changes and increased the expression of phosphorylated p38 (P-p38), and of phosphorylated ERK (P-ERK). In vitro, tight junction proteins, P-p38 and P-ERK in the VSL#3 group were significantly higher than in the control and TNF-α groups. The p38 MAPK inhibitor and the ERK inhibitor could effectively prevent this effect. VSL#3 probiotics protected the epithelial barrier and increased the tight junction protein expression in vivo and in vitro by activating the p38 and ERK signaling pathways.

Antinociceptive effect of VSL#3 on visceral hypersensitivity in a rat model of irritable bowel syndrome: a possible action through nitric oxide pathway and enhance barrier function.

Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by visceral hypersensitivity and altered bowel function. There are increasing evidences suggested that VSL#3 probiotics therapy has been recognized as an effective method to relieve IBS-induced symptoms. The aim of this study was to examine the effects of VSL#3 probiotics on visceral hypersensitivity (VH), nitric oxide (NO), fecal character, colonic epithelium permeability, and tight junction protein expression. IBS model was induced by intracolonic instillation of 4% acetic acid and restraint stress in rats. After subsidence of inflammation on the seventh experimental day, the rats were subjected to rectal distension, and then the abdominal withdrawal reflex and the number of fecal output were measured, respectively. Also, colonic permeability to Evans blue was measured in vivo, and tight junction protein expression was studied by immunohistochemistry and immunoblotting method. Rats had been pretreated with VSL#3 or aminoguanidine (NOS inhibitor) or VSL#3+ aminoguanidine before measurements. The rats at placebo group showed hypersensitive response to rectal distension (P < 0.05) and defecated more stools than control rats (P < 0.05), whereas VSL#3 treatment significantly attenuated VH and effectively reduced defecation. Aminoguanidine reduced the protective effects of VSL#3 on VH. A pronounced increase in epithelial permeability and decreased expression of tight junction proteins (occludin, ZO-1) in placebo group were prevented by VSL#3, but not aminoguanidine. VSL#3 treatment reduce the hypersensitivity, defecation, colonic permeability and increase the expression of tight junction proteins (occludin, ZO-1). As the part of this effect was lowered by NOS inhibitor, NO might play a role in the protective effect of VSL#3 to some extent.