Interventional Medicine and Applied Science最新文献

Background: Benign multinodular goiter (BMNG) is a common disease of the thyroid gland with palpable thyroid nodules that may be detected in 0.8%-1.5% of men and 5.3%-6.4% of women. Three major complications could be detected after total thyroidectomy: hemorrhage, recurrent laryngeal paralysis, and hypoparathyroidism.

Aims: The aim of this study was to review and assess the experience of total thyroidectomy in patients with BMNG at tertiary referral centers in Jazan Hospitals, Saudi Arabia.

Methods: A retrospective study was conducted on 320 patients diagnosed with BMNG and subjected to primary total thyroidectomy. Operative mortality and major complications [bleeding, recurrent laryngeal nerve (RLN) injury, and hypoparathyroidism] were recorded.

Results: Postoperative hemorrhage was reported in four patients (1.25%). Bilateral RLN injuries occurred in two patients (0.6%), whereas unilateral RLN injuries occurred in nine patients (2.8%). Permanent hypoparathyroidism was diagnosed in three patients (0.9%), while transient hypoparathyroidism occurred in eight patients (2.5%) and improved after 4 months.

Conclusions: Total thyroidectomy represents today the treatment of choice for BMNG. Proper preoperative preparations, meticulous surgical dissection with careful follow-up of patients will improve the surgical results and reduce postoperative complications.

Background and aims: The treatment with glucocorticoids may induce molecular changes in the level and/or degree of phosphorylation of proteins located downstream of the insulin receptor/insulin-like growth factor receptor (IR/IGF1R) in many tissues. However, few studies have investigated the intracellular insulin pathway in the masseter muscle. Therefore, this study aimed to analyze the IR/IGF1R signaling pathway in the masseter muscle of rats treated with dexamethasone.

Materials and methods: Male Wistar rats were divided into two groups: control group (intraperitoneally injected with 0.9% NaCl solution) and dexamethasone group [intraperitoneally injected with 1 mg/kg (bw) dexamethasone solution] for 10 consecutive days. Sections of the masseter muscle were removed at time zero and after the infusion of regular insulin into the portal vein.

Results: Dexamethasone administration induces body weight loss without changing masseter muscle weight and reduces the expression of total IR and PI3K proteins; total levels of IRS1, Akt, and ERK1 remain unchanged between groups. The degree of phosphorylation/activity of IRS1 after insulin stimulus increased only in the control group; degree of phosphorylation of Akt increased in both groups, but this increase was attenuated in the dexamethasone group.

Discussion and conclusion: The degree of phosphorylation/activity in the masseter muscle is different from that in other muscle territories.

Background: Obstructive sleep apnea (OSA) is a chronic, progressive disease that can cause cardiovascular complications and atherosclerosis. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with OSA.

Methods: We enrolled 84 consecutive patients with OSA. The patients underwent ultrasonography, polysomnography, and echocardiography. Blood samples were obtained from all of the subjects, which were used for biochemical comparisons. The patients were divided into groups according to cIMT values (<0.9 vs. >0.9 mm).

Results: The patient population consisted of 84 OSA patients (mean age: 54.2 + 8.0 years, 62.9% male). The OSA patients with cIMT ≥0.9 had significantly elevated high-sensitive C-reactive protein (hsCRP), Oxygen desaturation index, apnea-hypopnea index (AHI), and significantly lower total and indirect bilirubin levels. Multivariate regression analyses revealed that total bilirubin, hsCRP, and AHI were the independent predictors of subclinical atherosclerosis. There was a negative correlation between total bilirubin and cIMT.

Conclusions: This study showed that high hsCRP and low serum total bilirubin levels could be paving the way for the development of subclinical atherosclerosis. Simple measures such as total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with OSA.

Background: The early identification of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) with high risk features is particularly important. Acute inferior STEMI may be associated with ST-segment depression in the left precordial leads (V4-V6). This study assessed prognostic value of ST-segment depression in these left precordial leads during the admission of patients with acute inferior STEMI treated with primary percutaneous coronary intervention.

Methods: This retrospective study enrolled 1,374 patients with acute inferior STEMI who underwent primary percutaneous coronary angioplasty between March 2011 and June 2014. The patients were divided into two groups: one group (n = 687) with left precordial ST-segment depression and the other (n = 687) without such ST-segment changes.

Results: The patients with left precordial ST-segment depression were older and had higher incidence of hypertension, diabetes mellitus, and higher levels of troponin. In-hospital mortality was higher in patients with left precordial ST-segment depression. Advanced coronary artery disease was more observed in these patients.

Conclusion: In patients with acute inferior STEMI treated with primary coronary intervention, left precordial ST-segment depression during admission of ECG is associated with more advanced coronary artery disease, and worse in-hospital clinical outcomes.

Background and objectives: Considering that very few studies have been conducted on the effect of Entonox on oxidative stress markers, this study was conducted to compare these markers in natural vaginal delivery (NVD) with and without Entonox.

Materials and methods: The present cohort study was conducted on 120 women in maternity wards divided into two groups, including an NVD group with and an NVD group without Entonox. After obtaining the mothers' written consent, 5 cc of venous blood was taken at the end of their second stage of labor for lipid peroxidation, thiol groups, and total antioxidant capacity tests. The data obtained were analyzed using descriptive (mean) and inferential (t-test) statistics.

Results: Lipid peroxide was 6.267 ± 5.39 in NVD without Entonox and 5.12 ± 3.89 in NVD with Entonox, suggesting the lack of a statistically significant difference (p = 0.191). Thiol marker was 0.34 ± 0.26 in NVD without and 0.26 ± 0.24 in NVD with Entonox, suggesting the lack of a statistically significant difference (p = 0.09).The FRAP results were 0.936 ± 0.696 in NVD without and 1.21 ± 0.89 in NVD with Entonox, suggesting the lack of a statistically significant difference (p = 0.06).

Discussion: Entonox can be safely used in NVD without increasing the risk of oxidative stress.

Research has shown that injection of a mixture of amino acids into humans led to stimulation of protein synthesis about 30 min after injection, and the synthesis rate remained at a high level for up to 90 min. Various theories have been proposed to justify this effect, such as increasing the availability of amino acids in the body to increase their transmission to muscle, and this increase in transmission can stimulate the synthesis of protein in muscle cells. A total of 30 volunteers with a history of 2-3 years in the field of Athletics were participated in this study. The experimental group (15 subjects) used BCAAs supplement during 6-week athletics training. Control group (15 subjects) participated in athletics training for 6 weeks without any supplementation. Blood was taken before and after 6 weeks supplementary. The findings of the t-test showed that basal levels of lactate and ammonium had not changed significantly after 42 days of supplementation. The results of this study showed that BCAAs supplementation has no effect on the reduction of lactate and ammonium indices as indicators of fatigue.

Aim: This study aims to analyze the number Mutans Streptococci (MS) and its protein profile from the saliva of early childhood caries (ECC) and caries-free subjects.

Methods: MS counts were cultured from saliva samples, and the protein profile of MS was determined from ECC and caries-free subjects. The number of colonies were counted, and the protein bands with the molecular weight of 13, 29, 39, 41.3, 74, and 95 kDa were determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis method.

Results: We found that the number of colonies from saliva of ECC patients was higher than those caries-free (22.20 × 106 CFU/ml vs. 19.16 × 106 CFU/ml, p < 0.05). There are higher expression frequencies in protein 29, 39, 41.3, and 74 kDa of MS in ECC than caries-free subjects.

Conclusions: There is the higher number of MS colonies and difference of MS protein profile isolated from saliva among children with ECC and caries-free counterparts.

Objective: This paper aims to study the influence of both general and spinal anesthesia on blood sugar changes in patients undergoing cesarean.

Methods: This is a single-blind clinical trial study conducted on 60 patients with classes 1 and 2 anesthesia. The patients were divided by chance into the general anesthesia and spinal anesthesia groups (each contains 30 members). The patients in the spinal group were blocked up to the T4 level and similar methods and medicines were also utilized for those in the general anesthesia group.

Results: No significant difference was observed in the blood sugar levels of both groups before and after the operation, but the group, which had utilized the general anesthesia method, had reported with lower levels of blood sugar than the spinal anesthesia group after operation with a significant difference (P < 0.05). A difference has been observed in the levels of blood sugar at 2, 12, and 24 h after the operation in both groups, but it was not a statistically significant difference.

Conclusion: However, none of the mentioned methods had any influence on reduction of blood sugar levels during the recovery or the period after it.

A rare postoperative complication of aortic root replacement is pseudoaneurysm formation. Surgical repair may be rather challenging particularly in patients who are elder and with significant comorbidities. Endovascular approach may also be technically demanding, given the high blood velocity and the anatomical challenges of the area of the aortic root and the ascending aorta. We would like to describe a case of an 85-year-old patient with history of prosthetic graft aortic root replacement who had been developed a 7-cm pseudoaneurysm with sternotomy diastasis and extension in the subcutaneous tissue, 7 years after the initial operation. Given the comorbidities, open repair was not considered a valid option and successful endovascular repair with the use of a ventricular septal occluder plug followed. One-year follow-up confirmed satisfactory exclusion of the pseudoaneurysm with no migration of the endovascular device and no other complication. This is one of the rare cases on endovascular repair of an ascending aorta postoperative pseudoaneurysm.

The objective was to develop a stable and non-compliance coated solid-lipid nanoparticles (coated SLN) using polymer (Eudragit L100) and lipoid (glycerol monostearate: soya lecithin) for partial dose reduction of isradipine [ISR; 2.5 mg by combination of bioenhancing agent (rutin; Ru) in equivalent ratio]. The physicochemical characterizations were performed by FT-IR and DSC of elected model drug (ISR), drug mixer with Ru/polymer and coated SLN with Ru (ONbp); the resulted distinctive peaks demonstrated that no chemical interaction and incompatibility found between them. The plasma samples of formulation (ONbp) were analyzed by liquid chromatography (HPLC) using UV-spectrometer. Data were integrated and analyzed with the help of a computer-designed program "Kinetica Software" (Thermo Scientific Kinetica, PK/PD Analysis, version 5.0, Philadelphia, PA). The pharmacokinetic study showed 3.2- to 4.7-folds enhancement in oral bioavailability of coated SLN of ISR with Ru (ONbp) when compared to a coated formulation of ISR without Ru (ONps) and conventional drug suspension. In vivo studies were revealed significantly at greater extent in (drug stability and solubility) oral absorption, which has shown potential entrapment efficiency (97.85% ± 1.02%) to improve biological activity against hypertension. Hence, nano-system of ISR against hypertension is achieved with consequent dose reduction with enhanced systemic bioavailability.