Cerebral protective effect of nicorandil premedication on patients undergoing liver transplantation

BACKGROUND:Neurological injury is a common complication in the early period after liver transplantation,posing an enormous obstacle to treatment efficiency and patient survival.Nicorandil is a mitochondrial ATP-sensitive potassium channel(mitoK ATP) opener.It has been reported to be effective in reducing brain injury in recent studies.However,it is still unclear whether nicorandil has cerebral protective effect in patients undergoing liver transplantation.METHODS:Fifty patients scheduled for liver transplantation were randomly divided into a nicorandil group(group N)(n=25),in which patients received 10 mg nicorandil through a nasogastric tube 30 minutes before induction of anesthesia,and a control group(group C)(n=25) who received 10 mL normal saline.The Mini-Mental State Examination(MMSE) was performed before anesthesia(day 0),and on days 3 and 7 after surgery.Blood samples were obtained before induction of anesthesia(T1),and at 12(T2) and 36 hours(T3) after surgery for determination of serum neuron-specific enolase(NSE) and S100β protein(S100β) concentrations.RESULTS:During surgery,5 patients in each group were eliminated due to severe reperfusion or renal insufficiency.Therefore,20 patients remained in each group.The MMSE scores after operation were significantly lower than those before operation in group C.However,there was no difference at days 3 and 7 compared with day 0 in group N.Serum NSE concentrations after surgery were significantly higher than baseline(at T1) in both groups,except at T3 in group N.Serum S100β concentration after surgery was significantly higher than baseline(at T1) in both groups.The MMSE scores at days 3 and 7 in group N were significantly higher than those in group C.The concentrations of serum NSE and S100β at T2 and T3 in group N were significantly lower than those in group C.CONCLUSIONS:Oral nicorandil,as a premedication before liver transplantation,improves postoperative MMSE scores.It also attenuates the increase of NSE and S100β in blood,indicating its cerebral protective effect.

Protective Effect of Oral Steroid Premedication: Adverse Reactions to Nonionic Iodine Contrast Media for Computed Tomography

This study aimed to investigate the protective effect of oral steroid premedication in terms of adverse reactions to non-ionic contrast media. We investigated the incidence of adverse reactions among patients who underwent contrast-enhanced computed tomography. Patients in the premedication group took 30 mg of prednisolone orally the night before and on the morning of the scheduled computed tomography. Sixty-five patients received the same contrast media. Among them, 56 took prednisolone orally prior to the procedure (premedication without change of contrast media group) and nine without premedication (no premedication and no change of contrast media group). In total, 379 patients received different contrast media. Among them, 340 took prednisolone orally (premedication with change of contrast media group), while 39 did not take the premedication (no premedication with change of contrast media group). The adverse reaction rates in the premedication with change of contrast media and no premedication with change of contrast media groups were 1.8% (6/340 cases) and 2.6% (1/39 cases) (P = 0.54), respectively. The incidence of adverse reaction after the administration of non-ionic iodinated contrast media did not differ significantly based on whether an oral steroid was administered prior to compute tomography. Our evaluation is limited due to the small sample size of the contrast media-changed group. However, even if premedication with steroids is effective, it may only result in an adverse reaction reduction rate of ≤3%.

Effect of oral premedication of midazolam, ketamine, and dexmedetomidine on pediatric sedation and ease of parental separation in anesthesia induction for elective surgery: A randomized clinical trial

Objective:To compare effect of midazolam,dexmedetomidine,and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction.Methods:This multicenter,prospective,randomized,double-blind,clinical trial focused on a pediatric population aged 2-7 years(n=153)with the American Society of AnesthesiologistsⅠ-Ⅱwho required elective surgery.The patients were stratified into three intervention groups:midazolam,ketamine,and dexmedetomidine.Hemodynamic parameters(blood pressure,heart rate,and oxygen saturation)every 5 min until induction of anesthesia along with non-hemodynamic factors,comprised of sedation score before the administration and at the time of being separated from the parents,as well as parental separation anxiety scale,acceptance of anesthesia induction,and side effects were recorded and compared.Results:No statistically significant difference in oxygen saturation,heart rate,blood pressure,duration of surgery,time to achieve an Aldrete score of 9-10,or sedation score was noted in the study groups.More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group(P=0.001).Moreover,fewer patients accept anesthesia induction(P=0.001)and more had side effects in the ketamine group(P=0.047).Conclusions:Our findings indicate that compared to the ketamine group,dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects.Dexmedetomidine and midazolam may be considered better choices.However,the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference.Clinical registarion:This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.

Efforts to increase image quality during endoscopy:The role of pronase

Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and suction,which tend to prolong total procedure time. However,mucus,foam,and bubbles often hinder clear visibility during endoscopy. Premedication with pronase,a compound of mixed proteolytic enzymes,has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach,premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy,narrow-band imaging,magnifying endoscopy,and endoscopic ultrasonography. In addition,endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes,premedication with pronase may be helpful for increasing the detection rate of early cancers.

Efficacy of small-volume simethicone given at least 30 min before gastroscopy

AIMTo evaluate the efficacy of 5 mL simethicone solution in decreasing gastric foam if given at least 30 min before gastroscopy. METHODSThis was a randomized, placebo controlled, endoscopist blinded study performed at Changi General Hospital. Patients were at least 21 years old, had no prior surgical resection of the upper gastrointestinal tract, and scheduled for elective diagnostic gastroscopies. The primary outcome was the total mucosal visibility score (TMVS) which was evaluated using McNally score. The sample size was calculated to be 24 per group (SD 2.4, 80% power, P t test). RESULTSFifty-four patients were randomised to receive either simethicone [1 mL liquid simethicone (100 mg) in 5 mL of water] or placebo (5 mL of water) at least 30 min before their gastroscopy. Six accredited consultants conducted the gastroscopy, and the interobserver agreement of scoring TMVS was good with a Kappa statistic of 0.73. The simethicone group had significantly better mean TMVS compared to placebo (5.78 ± SD 1.65 vs 8.89 ± SD 1.97, P CONCLUSIONWith a premedication time of at least 30 min, 5 mL simethicone can significantly decrease gastric foam, decrease the volume of additional flushes, and shorten gastroscopy time.

Preoperative Sedation, Hemodynamic Stability during General Anesthesia and Improving Postoperative Pain: Pregabalin Is the Answer

Background: Tracheal intubation is a noxious stimulus that tends to provoke a marked sympathetic response which is potentially deleterious in some patients. Various methods have been used to minimize and attenuate these potentially harmful responses. Aim of the study: The present study compared the efficacy and safety of two different doses (150 mg and 300 mg) of oral pregabalin premedication on attenuation of the hemodynamic pressor response to airway instrumentation, perioperative hemodynamic stability, preoperative sedation, and postoperative pain reduction. Patients and methods: This prospective, observational study consisted of 60 adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized into three groups of 20 patients each. Group I (P0) received an oral placebo, group II (P150) received 150 mg of oral pregabalin and group III (P300) received 300 mg of oral pregabalin 1 h prior to induction. All patients were assessed for pre-operative sedation, perioperative hemodynamic changes, Post-operative pain and analgesic consumption. Results: Regarding the efficacy of the preoperative administration of oral pregabalin, a dose dependent attenuation in the increased in heart rate, systolic, and diastolic blood pressure, and mean arterial blood pressure resulting from laryngoscopy and intubation was observed (300 mg > 150 mg), along with a subsequent decrease in intraoperative fentanyl supplementation. On anxiolysis, patients were more comfortable and asleep in the pregabalin groups as compared with the control group, in which more patients were awake and agitated. Post-operative pain and analgesic consumption were effectively reduced by (150 mg and 300 mg) pregabalin in a dose-dependent manner. Postoperative nausea and vomiting were significantly lower with the administration of pregabalin compared with the placebo group (P < 0.008). Additionally, pregabalin increased the incidence of dizziness and visual disturbances in a dose-dependent manner. Conclusion: Oral pregabalin premedication adequately sedated patients and attenuated the hemodynamic pressor response to airway instrumentation in a dose-dependent manner. Premedicated patients were haemodynamically stable perioperatively without recovery time prolongation or side effects, except dizziness with 300 mg of oral pregabalin. Additionally, oral pregabalin reduced postoperative pain and analgesic consumption in a dose-dependent manner.

The Emergence of Modern Physics Research in China:The Yenching Department of Physics and the Rockefeller Foundation

Based on archival materials discovered in America,Britain,and China,this paper carefully examines the history of the short-lived and completely overlooked Department of Physics in the Premedical School of Peking Union Medical College(PUMC),and uncovers this department’s extensive interconnections with its counterpart at Yenching University.This project also looks into the Master of Science(MS)program in the Department of Physics at Yenching University,which,founded in 1927,was the first graduate program in physics in China.It was this MS program that transformed the Yenching Department from a largely premedical training center serving the PUMC into a prominent cradle of Chinese physics research.This Yenching Department,despite its small faculty and brief existence,nurtured many eminent Chinese physicists,such as Chao-Ying Meng孟昭英,Wen-Yu Chang张文裕,Ming-Chen Wang王明贞,Chia-Liu Luke Yuan袁家骝,Cheng-Shu Wang(Chang)王承书,Ho-Fu Lu卢鹤绂,Ting-Sui Ke葛庭燧,Kun Huang黄昆,and Chia-Lin Hsieh谢家麟.It would have been impossible to achieve these outstanding accomplishments without the effective leadership and pioneering work of C.H.Corbett,P.A.Anderson,Y.M.Hsieh,and W.Band—the first four Department Chairs—in combination with relatively abundant private funding,mostly from America,and extensive educational connections with Western institutions.This paper not only introduces in detail these four department heads and their contributions,but also discloses the unique role played by the Rockefeller Foundation via the China Medical Board and the PUMC in the development of the Yenching Department of Physics.