In recent decades, the use of nanomaterials has received much attention in industrial and medical fields. However, some reports have mentioned adverse effects of these materials on the biological ...systems and cellular components. There are several major mechanisms for cytotoxicity of nanoparticles (NPs) such as physicochemical properties, contamination with toxic element, fibrous structure, high surface charge and radical species generation. In this review, a brief key mechanisms involved in toxic effect of NPs are given, followed by the in vitro toxicity assays of NPs and prooxidant effects of several NPs such as carbon nanotubes, titanium dioxide NPs, quantum dots, gold NPs and silver NPs.
One of the most prevalent complications of orthotopic liver transplant is primary graft dysfunction. Recent studies have shown the preconditioning effect of remifentanil on animal livers but not ...human livers. Here, we compared the preconditioning effects of remifentanil and fentanyl in orthotopic liver transplant in human patients.
In this double-blind clinical trial, 100 patients who underwent liver transplant from deceased donors were randomly allocated into 2 groups. Patients in the remifentanil group received remifentanil infusion, and those in the fentanyl group received fentanyl infusion during maintenance of anesthesia. Serum aminotransferase levels, prothrombin time (international normalized ratio), partial thrombin time, arterial blood gas levels, and renal function tests were evaluated over 7 days posttransplant. Intensive care unit stay and hospitalization were also recorded.
The median peak alanine aminotransferase level during 7 days after transplant was 2100 U/L (interquartile range, 1230-3220) in the remifentanil group and 3815 U/L (interquartile range, 2385-5675) in the fentanyl group (P = .048). Metabolic acidosis, renal state, prothrombin time (international normalized ratio), and partial thrombin time were similar in both groups (P > .05). Durations of stay in the intensive care unit and hospital were not significantly different between the 2 groups (P = .75 and P = .23, respectively). Overall, the clinical outcomes were similar in the remifentanil and fentanyl groups (P > .05).
We found that remifentanil and fentanyl were not different with regard to their preconditioning effects and graft protection in orthotopic liver transplant recipients.
Liver transplant traditionally and potentially is associated with the risk of massive blood loss and transfusion, which can adversely affect transplant outcomes. Many variables influence the amount ...of bleeding, and these can be categorized as patient related, surgery related, and graft related. We aimed to assess the effects of these variables on the amount of bleeding and transfusion during liver transplant; predicting the risk of massive blood loss can help transplant teams to select and manage patients more effectively.
We retrospectively studied 754 patients who underwent liver transplant from 2013 to 2016 and analyzed more than 20 variables that could influence the volume of blood loss and packed cell transfusion.
We found that at least 4 variables are strongly and independently correlated with blood loss volume: age, Model for End-Stage Liver Disease score, warm ischemia time, and total bilirubin. Furthermore, intraoperative blood loss had a weak but clinically important correlation with the underlying disease (ie, the cause of liver cirrhosis). Some variables, including international normalized ratio, platelet count, albumin, serum urea nitrogen, creatinine level, sodium level, and the amount of ascites, could be considered as 'dependent' and weak predictors of massive blood loss. Sex of patient, cold ischemia time, surgery technique, and history of previous abdominal surgery were not correlated with the amount of bleeding.
With the use of the variables identified, we can properly select patients and surgical teams and promptly use modalities for decreasing and managing blood loss.
Objective
Remifentanil is usually used for controlled hypotension during rhinoplasty under general anesthesia (G/A). One of the complications of the remifentanil is postoperative hyperalgesia. In ...this study, we compare the effectiveness of pregabalin with that of Mg sulfate in postoperative remifentanil‐induced hyperalgesia prevention.
Methods
In this prospective, randomized, double‐blinded placebo‐controlled trial, 105 patients who candidates rhinoplasty with G/A were enrolled and randomly allocated into three groups. Patients in group A received 300 mg pregabalin before anesthesia. They received physiologic saline infusion during the perioperative period. Those in group B received placebo capsules before anesthesia and intravenous Mg sulfate 30 mg/kg during the perioperative period. Those in group C received a placebo capsule before anesthesia and normal intravenous saline during the operation. Then, pain severity, sedation score, postoperative nausea and vomiting (PONV) were assessed and compared.
Results
In the Mg sulfate and placebo group, the mean numerical rating scale in the postoperative period was higher compared to the pregabalin group (p < .001). The mean total amount of morphine requirement, meanwhile the 24 h post‐operation, was significantly decreased in the pregabalin group compared to the other groups (p < .001). Participants in the pregabalin group had less PONV compared to those in the pregabalin and placebo groups (p = .015).
Conclusions
In patients undergoing G/A with remifentanil for rhinoplasty, preoperative 300 mg pregabalin could effectively prevent not only remifentanil‐induced hyperalgesia but also PONV.
Level of evidence
1b.
The findings of this randomized clinical trial have shown that in patients who were undergoing general anesthesia with remifentanil for rhinoplasty, 300 mg pregabalin preoperatively is more effective than intraoperative Mg sulfate infusion in preventing remifentanil‐induced hyperalgesia following rhinoplasty.
Depression is a public disorder worldwide. Despite the widespread use of venlafaxine in the treatment of depression, it has been associated with the incidence of toxicities. Hence, the goal of the ...current investigation was to evaluate the mechanisms of venlafaxine-induced cell death in the model of the freshly isolated rat hepatocytes.
Collagenase-perfused rat hepatocytes were treated with venlafaxine and other agents. Cell damage, reactive oxygen species (ROS) formation, lipid peroxidation, mitochondrial membrane potential decline, lysosomal damage, glutathione (GSH) level were analyzed. Moreover, rat liver mitochondria were isolated through differential centrifugation to assess respiratory chain functionality.
Our results demonstrated that venlafaxine could induce ROS formation followed by lipid peroxidation, cellular GSH content depletion, elevated GSSG level, loss of lysosmal membrane integrity, MMP collapse and finally cell death in a concentration-dependent manner. N-acetyl cysteine, taurine and quercetine significantly decreased the aforementioned venlafaxine-induced cellular events. Also, radical scavenger (butylatedhydroxytoluene and α-tocopherol), CYP2E1 inhibitor (4-methylpyrazole), lysosomotropic agents (methylamine and chloroquine), ATP generators (L-gluthamine and fructose) and mitochondrial pore sealing agents (trifluoperazine and L-carnitine) considerably reduced cytotoxicity, ROS generation and lysosomal leakage following venlafaxine treatment. Mitochondrion dysfunction was concomitant with the blockade of the electron transfer complexes II and IV of the mitochondrial respiratory system.
Therefore, our data indicate that venlafaxine induces oxidative stress towards hepatocytes and our findings provide evidence to propose that mitochondria and lysosomes are of the primary targets in venlafaxine-mediated cell damage.
Post reperfusion syndrome (PRS) is a relatively common and life-threatening complication during orthotopic liver transplantation (OLT). It is associated with poor patient and transplanted liver ...outcomes.
This study aimed to compare the risk factors of PRS during OLT.
Clinical-epidemiological observational retrospective study.
We gathered the records of patients who underwent OLT in 3 years, from May 22, 2016, to May 22, 2019, in Namazi and Bu-Ali Sina organ transplantation hospitals.
In this study, we assessed 1182 patients who underwent OLT. Patients were divided into two groups based on the presence or absence of PRS.
Diagnosing the predictors of PRS was the primary outcome of this study.
Results showed that age > 60 years, Child-Pugh scores C, higher Model End Stage liver disease score, and preoperative sodium < 130 mmol/l (parameters of the liver recipient), increase in cold ischemic time (the donors' parameters), and the classical technique (the surgical parameters) were the strong predictors of PRS.
The results indicated that underlying liver disease was not the predictor of PRS in the presence of other risk factors; therefore, clinicians have to consider these risk factors in patients undergoing OLT.
Introduction Canceling scheduled surgeries on the day of surgery places a heavy burden on healthcare providers and has psychological, social, and financial consequences on patients and their ...families. This study aimed to investigate the main reasons for cancellations of elective procedures and provide appropriate recommendations to reduce the rate of such avoidable cancellations. Methods Data were collected retrospectively from all consecutive elective cases scheduled for various elective surgeries from January 1, 2020 to March 31, 2022 at Namazi Teaching Hospital, a major referral center in southern Iran with a capacity of 938 beds. Daily data were collected on the number of planned electives, cancellations, and reasons for cancellations. Surgical cancellation reasons were categorized as patient-related, surgeon-related, hospital/system-related, and anesthesia-related. Data were expressed as frequency (percentage) and analyzed with SPSS version 19 software. Results The cancellation rate on surgery day for elective procedures in all fields was 6.3%. The highest cancellation rate was related to minor surgeries (19%), followed by urology (8%), pediatrics (7%), and plastic surgery (7%). The most common reasons for cancellation were patients not suitable for the procedure (37%), followed by patients who did not follow instructions (10%), lack of time (10.5%), and equipment/supplies problems (10%), and refusal to consent (6%). Conclusions According to this study, patients' unsuitability for surgery, non-compliance with instructions, lack of time, and problems with equipment/supplies are the main reasons for canceling surgery. Proper preoperative assessment and preparation of patients and improved communication between medical teams and patients reduce the cancellation of booked surgeries. Keywords: Cancellation, Cases, Elective surgery, Prevalence, Iran
Even though citalopram is commonly used inpsychiatry, there are several reports on its toxic effects. So,the current study was designed to elucidate the mechanismsof cytotoxic effects of in vitro and ...in vivo citalopramtreatment on liver and the following cytolethal events. Forin vitro experiments, freshly isolated rat hepatocytes wereexposed to citalopram along with/without various agents.
To do in vivo studies liver function enzyme assays andhistological examination were performed. In the in vitroexperiments, citalopram (500 lM) exposure demonstratedcell death, a marked elevation in ROS formation, mitochondrialpotential collapse, lysosomal membrane leakiness,glutathione (GSH) depletion and lipid peroxidation.
In vivo biochemistry panel assays for liver enzymesfunction (AST, ALT and GGTP) and histological examinationconfirmed citalopram (20 mg/kg)-induced damage.
citalopram-induced oxidative stress cytotoxicity markerswere significantly prevented by antioxidants, ROS scavengers,MPT pore sealing agents, endocytosis inhibitors,ATP generators and CYP inhibitors. Either enzymeinduction or GSH depletion were concomitant with augmentedcitalopram-induced damage both in vivo andin vitro which were considerably ameliorated withantioxidants and CYP inhibitors. In conclusion, it is suggestedthat citalopram hepatotoxicity might be a result ofoxidative hazard leading to mitochondrial/lysosomal toxicconnection and disorders in biochemical markers whichwere supported by histomorphological studies. KCI Citation Count: 25
Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to ...be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enough to undergo separation. Treatment of this uncommon condition presents both surgical and anesthetic challenges. The management of rare anomalies is difficult even for skilled surgeons. Therefore, it is logical to use the knowledge gained from previous experiences. We herein present the first successful surgical separation of two pairs of thoraco-omphalopagus conjoined twins at the Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran). In both cases, the neonates had separate hearts and common pericardium. Contrast-enhanced computed tomography of two sets of twins showed fusion of sternum, pericardium, diaphragm, and left lobe of liver. Critical steps of the surgical separation were identified and contingency plans were made for possible partial liver donation and cross-circulation between twins. The separation procedure and reconstruction of the abdominal wall were successfully performed. Both pairs of twins, now 6- and 8-year-old, are healthy and have normal growth and are under follow-up.
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