Comparison of Cardiac Preconditioning effects of Isoflurane and Sevoflurane in Coronary Artery Bypass Graft Surgeries done on Cardio Pulmonary Bypass

INTRODUCTION: Ischemic heart disease is one of the major causes of morbidity and mortality all over the world. Various medical and surgical strategies have been evolved to reduce the mortality from acute MI which includes the use of thrombolytic agents, β blockers, ACE inhibitors, antioxidants, PTCA and Coronary artery bypass surgery (CABG). CABG is still considered the gold standard. Many reports have shown that upto 90% of patients undergoing CABG surgery experience a fall in ejection fraction and cardiac index during the immediate post-operative period. This has been attributed to various factors of which ischemia associated with aortic cross clamping and inadequate myocardial protection during surgery seem to be the main causes. One intervention for myocardial preservation which has received universal acceptance and generated a lot of excitement is the phenomenon of “Myocardial Ischemic preconditioning”. Myocardial preconditioning can be achieved by various methods. Recently several studies have reported cardioprotective effects of volatile agents in coronary surgery patients. This has been achieved with different volatile agents like halothane, enflurane, isoflurane and sevoflurane. Isoflurane and recently sevoflurane have been shown to be better preconditioning agents in some studies. My study is an attempt to determine if administration of either isoflurane or sevoflurane in patients undergoing CABG surgery will improve postoperative myocardial contractility and function and also to determine which of these volatile agents would offer more cardiac protection when used as preconditioning and post conditioning agents throughout surgery including the cardio pulmonary bypass period. AIM OF THE STUDY: To compare the cardioprotective properties of Isoflurane and Sevoflurane when used before, during and after Cardiopulmonary bypass (CPB) to improve postoperative outcome in coronary artery bypass graft surgeries by analyzing: A) Hemodynamic parameters such as Invasive arterial blood pressure, Electrocardiogram, Cardiac index, Systemic vascular resistance and Central Venous pressure. B) Postoperative measurements of Creatinine kinase-MB to compare degree of ischemia. C) Markers of Oxidative and nitrosative stress such as protein carbonyl content, malondialdehyde, protein thiols, total thiols and nitrates. MATERIALS AND METHODS: This randomized, blinded, clinical controlled trial was approved by the Research and ethics committee of our institution. Twenty patients scheduled to undergo elective CABG surgery on cardio pulmonary bypass pump for coronary artery disease were included in this study. The surgeon, the pump technician and biochemist was blinded to the drug, the anaesthetist involved with the surgery could not be blinded to the anaesthetic agent. EXCLUSION CRITERIA: a) Off pump CABG, b) Previous coronary (or) valvular heart surgery, c) Preoperative hemodynamic instability requiring medical or mechanical support, d) Severe hepatic disease (ALT or AST >150U/L), e) Renal insufficiency (creatinine>1.5mg/dl.), f) COPD (FEV1<50% of predicted or <0.8L), g) H/o neurological disturbances. Randomization: Patients were randomly allocated into group A (isoflurane group) and group B (sevoflurane group) using computer generated random numbers. This randomization was done before the study began to assure equal allocation to the Group A and Group B. The randomization envelope was opened by an anesthetist, and accordingly that particular anesthetic agent either isoflurane or sevoflurane was used throughout the procedure. Pre-op evaluation: Following a thorough preoperative check up the procedure was explained to the patient. After obtaining informed consent, patients are randomly allocated to one of the two groups. Antiplatelet therapies were stopped 1wk before the operation and replaced by Heparin. ACE inhibitors are stopped one day prior to the surgery as a routine in our institution. Oral anti diabetic drugs were continued upto the night prior to surgery. Beta blockers and nitrates were continued upto the morning of surgery. Patients were premedicated with benzodiazepines and opioids one hour prior to the procedure. Statistical Analysis: Patient characteristics, hemodynamics parameters and biochemical markers were compared using non parametric Mann-Whitney, Wilcoxon signed rank test, paired t test and Fisher’s exact test wherever appropriate. RESULTS: 20 patients scheduled for coronary artery bypass grafting on CPB were enrolled in the study. Two patients were not included in the analysis; one surgery was done off pump, hence excluded from the analysis. In the other patient, due to damage of coronary sinus during surgical manipulation there were problems of separation from CPB pump, the patient required an Intra aortic balloon pump (IABP) as well as a pacemaker for weaning from bypass. Table 1 shows the demographic data of patients in both groups. There were no significant differences in age, weight, height and gender of the patients between the two groups. As can be seen from this table, there was only one female included in the study. Table 2 describes the premorbidity status of all patients. There was no statistically significant differences between the two groups .One patient in Group 2 had aortic stenosis and another had four vessel disease. CONCLUSIONS: 1. Our study strongly indicates definite cardiac preconditioning effects with both the volatile agents isoflurane and sevoflurane in clinically relevant concentrations when administered throughout CABG surgery. 2. The evidence of oxidative stress with CABG surgery was shown by decreasing levels of biochemical markers. The preconditioning effects with these agents were evident from the ease of separation from CPB bypass and outcome of surgery in the immediate post-operative period as shown by the clinical and biochemical markers at different time intervals. 3) Among the two agents, isoflurane seems to provide better protection. during the pre-bypass period and early reperfusion, while sevoflurane provides protection during early reperfusion as well as immediate postbypass period when the oxidative stress is much greater. Taking into account patient variability and the different mechanisms involved with different anaesthetic agents, larger adequately powered trials with defined outcomes need to be done to fully assess a possible beneficial effect of one volatile anaesthetic agent over the other and arrive at definite conclusions

Alcoholic vs non-alcoholic fatty liver in rats: distinct differences in endocytosis and vesicle trafficking despite similar pathology

Background: Non-alcoholic and alcoholic fatty liver disease (NAFLD and AFLD, respectively) are major health problems, as patients with either condition can progress to hepatitis, fibrosis, and cirrhosis. Although histologically similar, key differences likely exist in these two models. For example, altered content of several vesicle trafficking proteins have been identified in AFLD, but their content in NAFLD is unknown. In this study, we compared select parameters in NAFLD and AFLD in a rat model. Methods: We fed either Lieber- DeCarli liquid control or alcohol-containing (35 % as calories) diet (AFLD model) or lean or high-fat (12 or 60 % derived from fat, respectively) pellets (NAFLD model) for 8–10 weeks, n = 8 in each model. Serum, hepatocytes and liver tissue were analyzed. Liver injury markers were measured in serum, triglyceride content and endocytosis (binding and internalization of 125I- asialoorosomucoid) was measured in isolated hepatocytes, and content of selected trafficking proteins (Rab3D, Rab7 and Rab18) were determined in whole liver tissue. Results: Although liver injury markers and triglyceride content were similar in both models, binding and internalization of 125I- asialoorosomucoid was significantly impaired in the hepatocytes from AFLD, but not NAFLD, animals. In addition, protein content of the asialoglycoprotein receptor (ASGPR) and three trafficking proteins, Rab3D, Rab7and Rab18, were significantly decreased after alcohol, but not high-fat feeding. Levels of protein carbonylation, amount of glutathione stores, and lipid peroxidation were similar irrespective of the insult to the livers that resulted in fatty liver. Conclusion: Impairments in protein trafficking in AFLD are likely a direct result of alcohol administration, and not a function of fatty liver

Outcome of dual mobility total hip arthroplasty in patients who are at high risk for dislocation

Background: Dislocation after total hip arthroplasty (THA) remains a major concern, because it is reported to range from 1% to 5%. The concept of dual mobility articulation was developed in 1970 by Bousquet to decrease dislocation risk. Several studies have looked at the outcome of dual mobility articulation in primary THA and in revision THA.Methods: This is a prospective study of 33 patients undergoing dual mobility THA during 24 months period from October 2017 to September 2019. Patients undergoing total hip replacement (THR) to have dual mobility cup (DMC) were those at high risk of dislocation. Patients were followed up for a mean period of 18 months.Results: 33 patients (mean age 67 years) underwent DMC THA. 27 patients underwent primary hip replacement. The follow-up of our cases has ranged from 13 months to 3 years with a mean follow-up of 18 months. none of the patients had hip dislocation.Conclusions: The DMC is an effective solution for the management of high-risk cases undergoing total hip replacement to reduce the incidence of postoperative instability

Optimal scheduling algorithm for residential building distributed energy source systems using Levy flight and chaos-assisted artificial rabbits optimizer

The increase in demand for MicroGrids (MGs) is a significant factor in the provision of electricity in the future, mainly due to the use of renewable energy sources, which reduces the release of hazardous gases. The grid-connected MG operation is the most cost-effective and reliable because it actively involves the grid buying and selling power, lowering the electricity cost of the MG. This study describes a residential thermal/electrical home energy system comprising a battery energy storage system and a combined heat and power fuel cell. The optimal planning of various energy resources is scheduled by a new optimization algorithm called Levy Flight and Chaos-assisted Artificial Rabbits Optimization (LFCARO), resulting in the lowest operational cost of this combined power system. The operating cost of a residential building is reduced by using a day-ahead scheduling process for controlling multiple energy sources to create a reliable look-up table that estimates the best schedule for the distributed energy sources at each time frame. The impact of various electricity prices for obtaining energy from the primary grid on the system’s operating costs is examined. The efficiency of LFCARO is compared with other algorithms, and the results show that LFCARO performs better than other algorithms. The execution time of the proposed LFCARO is less than 1 sec. for 10 numerical problems and less than 1.5 sec. for the resource scheduling of residential distribution systems. Based on the average Friedman’s ranking test values, the proposed algorithm stands first with 1.82 for numerical and real-world scheduling problems.Open Access funding provided by the Qatar National Library

Evaluation of stress distribution in an endodontically treated tooth restored with two different post and core systems in a maxillary central incisor: A finite element analysis study

Background: An endodontic post plays a crucial role in stabilizing and supporting a core restoration when insufficient coronal dentin remains after root canal treatment. It is inserted into the prepared root canal, strengthening the restoration and enabling it to endure chewing forces, thereby helping to preserve the tooth structure and overall durability of the restoration. Aim: To evaluate the biomechanical behaviour and long-term safety of high-performance polymer PEEK as an intra-radicular dental post-core material through comparative finite element analysis (FEA) with other traditional (Nickel-Chromium) post-core material. Materials and methods: CBCT scanning of a maxillary central incisor and its supporting structures was used to construct a two-3D solid model of endodontically treated teeth for finite element analysis (FEA). PEEK has a lower elastic modulus than root dentin and showed comparably more favourable stress distribution and high failure resistance than conventional post-core material. Two materials, Nickel-Chromium and PEEK, with the same crown design, were simulated to compare traditionally used post-core materials and evaluate their post-core properties. A 3D model of the maxillary central incisor area, including restorative components, was created. The masticatory load of 100 N was simulated at a 5 mm distance from the incisal edge and applied at a 45? angle to the long axis of the tooth. Results: PEEK and metal post models demonstrated similar patterns and values of maximum equivalent stresses in the overall components of the model, except for the post and crown. In the apex region of the PEEK post-core case, the values of stresses were lower than those of metal posts. Conclusion: PEEK post-core, with a lower elastic modulus than dentine, exhibited a favourable stress distribution profile at the intraradicular surface, indicating a lower possibility of root fracture than conventional post-core materials

Evaluation and Comparison of Utility Consumption for the Sustainable and Normal building

ABSTRACT Sustainable building (Green building) refers the using of processes that are environmentally friendly and resource efficient from design, construction, operation, maintenance, renovation and demolition. The scope of this paper is to protect the environment by minimizing the use of non renewable construction materials and resources through efficient engineering design, planning and construction. This paper explains the need to select for modifying the design of construction and services to suit Leadership in Energy &amp; Environmental Design (LEED) requirements. Green Building Concept was to save maximum energy and protect our environment leads to sustainability. Compare to normal building the utilities (water and power) requirement for sustainable building was more efficient than normal building

Protective Role of Shiitake Mushroom-Derived Exosome-Like Nanoparticles in D-Galactosamine and Lipopolysaccharide-Induced Acute Liver Injury in Mice

Fulminant hepatic failure (FHF) is a rare, life-threatening liver disease with a poor prognosis. Administration of D-galactosamine (GalN) and lipopolysaccharide (LPS) triggers acute liver injury in mice, simulating many clinical features of FHF in humans; therefore, this disease model is often used to investigate potential therapeutic interventions to treat FHF. Recently, suppression of the nucleotide-binding domain and leucine-rich repeat related (NLR) family, pyrin domain containing 3 (NLRP3) inflammasome, was shown to alleviate the severity of GalN/LPS-induced liver damage in mice. Therefore, the goal of this study was to find dietary exosome-like nanoparticles (ELNs) with therapeutic potential in curbing FHF by suppressing the NLRP3 inflammasome. Seven commonly consumed mushrooms were used to extract ELNs. These mushrooms were found to contain ELNs composed of RNAs, proteins, and lipids. Among these mushroom-derived ELNs, only shiitake mushroom-derived ELNs (S-ELNs) substantially inhibited NLRP3 inflammasome activation by preventing inflammasome formation in primary macrophages. S-ELNs also suppressed the secretion of interleukin (IL)-6, as well as both protein and mRNA levels of the Il1b gene. Remarkably, pre-treatment with S-ELNs protected mice from GalN/LPS-induced acute liver injury. Therefore, S-ELNs, identified as potent new inhibitors of the NLRP3 inflammasome, represent a promising class of agents with the potential to combat FHF

Antiviral Effect of Antimicrobial Peptoid TM9 and Murine Model of Respiratory Coronavirus Infection

New antiviral agents are essential to improving treatment and control of SARS-CoV-2 infections that can lead to the disease COVID-19. Antimicrobial peptoids are sequence-specific oligo-N-substituted glycine peptidomimetics that emulate the structure and function of natural antimicrobial peptides but are resistant to proteases. We demonstrate antiviral activity of a new peptoid (TM9) against the coronavirus, murine hepatitis virus (MHV), as a closely related model for the structure and antiviral susceptibility profile of SARS-CoV-2. This peptoid mimics the human cathelicidin LL-37, which has also been shown to have antimicrobial and antiviral activity. In this study, TM9 was effective against three murine coronavirus strains, demonstrating that the therapeutic window is large enough to allow the use of TM9 for treatment. All three isolates of MHV generated infection in mice after 15 min of exposure by aerosol using the Madison aerosol chamber, and all three viral strains could be isolated from the lungs throughout the 5-day observation period post-infection, with the peak titers on day 2. MHV-A59 and MHV-A59-GFP were also isolated from the liver, heart, spleen, olfactory bulbs, and brain. These data demonstrate that MHV serves as a valuable natural murine model of coronavirus pathogenesis in multiple organs, including the brain

Safety and Efficacy of Hepatitis B Vaccination in Cirrhosis of Liver

Introduction. Patients with chronic liver disease (CLD) are more likely to have severe morbidity and fatality rate due to superimposed acute or chronic hepatitis B (HBV) infection. The literature has shown that hepatitis B vaccines are safe and effective in patients with CLD, but the data in cirrhosis liver is lacking. We assessed the safety and immunogenicity of HBV vaccine in patients with cirrhosis liver. Methods. CTP classes A and B CLD patients negative for hepatitis B surface antigen and antibody to hepatitis B core antigen were included. All patients received three doses of hepatitis B vaccine 20 mcg intramuscularly at 0, 30, and 60 days. Anti-HBs antibody was measured after 120 days. Results. 52 patients with mean age years were studied. Response rates in CTP classes A and B were 88% and 33.3%. We observed that the alcoholic chronic liver disease had less antibody response (44%) than other causes of chronic liver disease such as cryptogenic 69% and HCV 75%. Conclusions. Patients with cirrhosis liver will have low antibody hepatitis B titers compared to general population. As the age and liver disease progress, the response rate for hepatitis B vaccination will still remain to be weaker