Multimodal treatment of postoperative pain using adjuncts such as gabapentin is becoming more common. Pregabalin has anti-hyperalgesic properties similar to gabapentin. In this systematic review, we evaluated randomized, controlled trials (RCTs) for the analgesic efficacy and opioid-sparing effect of pregabalin in acute postoperative pain. A systematic search of Medline (1966-2010), the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar was performed. We identified 11 valid RCTs that used pregabalin for acute postoperative pain. Postoperative pain intensity was not reduced by pregabalin. Cumulative opioid consumption at 24 h was significantly decreased with pregabalin. At pregabalin doses of <300 mg, there was a reduction of 8.8 mg [weighted mean difference (WMD)]. At pregabalin doses ≥300 mg, cumulative opioid consumption was even lower (WMD, -13.4 mg). Pregabalin reduced opioid-related adverse effects such as vomiting [risk ratio (RR) 0.73; 95% confidence interval (CI) 0.56-0.95]. However, the risk of visual disturbance was greater (RR 3.29; 95% CI 1.95-5.57). Perioperative pregabalin administration reduced opioid consumption and opioid-related adverse effects after surgery.

Background Hypotension is a common side effect of general anesthesia induction, and when severe, it is related to adverse outcomes. Ultrasonography of inferior vena cava (IVC) is a reliable indicator of intravascular volume status. This study investigated whether preoperative ultrasound IVC measurements could predict hypotension after induction of anesthesia. Methods One hundred four adult patients, conforming to American Society of Anesthesiologists physical status I to III, scheduled for elective surgery after general anesthesia were recruited. Maximum IVC diameter (dIVCmax) and collapsibility index (CI) were measured preoperatively. Before induction, mean blood pressure (MBP) was recorded. After induction, MBP was recorded for 10 min after intubation. Hypotension was defined as greater than 30% decrease in MBP from baseline or MBP less than 60 mmHg. Receiver operating characteristic curve analysis with gray zone approach and regression analyses were used. Results IVC scanning was unsuccessful in 13.5% of patients. Data from 90 patients were analyzed. After induction, 42 patients developed hypotension. Areas (95% confidence interval) under the curves were 0.90 (0.82 to 0.95) for CI and 0.76 (0.66 to 0.84) for dIVCmax. The optimal cutoff values were 43% for CI and 1.8 cm for dIVCmax. The gray zone for CI was 38 to 43% and included 12% of patients and that for dIVCmax was 1.5 to 2.1 cm and included 59% of patients. After adjusting for other factors, it was found that CI was an independent predictor of hypotension with the odds ratio of 1.17 (1.09 to 1.26). CI was also positively associated with a percentage decrease in MBP (regression coefficient = 0.27). Conclusions Preoperative ultrasound IVC CI measurement was a reliable predictor of hypotension after induction of general anesthesia, wherein CI greater than 43% was the threshold.

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Nasopharyngeal carcinoma (NPC) is an important cancer in southern China and Southeast Asia. 1 In Hong Kong, nearly all NPC cases are undifferentiated or poorly differentiated and harbor Epstein-Barr virus (EBV) in tumoral tissues. 1 The recent interest in the presence of tumor-derived DNA in the plasma and serum of cancer patients has prompted our group 2 and Mutirangura et al. 3 to look for EBV DNA in the plasma and serum of NPC patients. Our preliminary data indicate that this approach is sensitive and specific for NPC. 2 Our core technology for EBV DNA detection is real-time quantitative PCR, 4 which is able to provide a quantitative measurement of the concentrations of EBV DNA in the plasma of NPC patients. In this communication, we report our latest results based on an expanded sample size, thus allowing a better understanding of the relationship between circulating EBV DNA and NPC staging. RESULTS AND DISCUSSIONPatients with NPC were recruited from individuals attending the Department of Clinical Oncology at the Prince of Wales Hospital, Hong Kong. All patients were investigated uniformly with an endoscopic examination of the nasopharynx and computed tomography, and staged according to the American Joint Committee on Cancer Staging criteria. 5 Five mL of peripheral blood was collected from each individual with informed consent, and plasma was harvested as previously described. 2 This project was approved by the Ethics Committee of The Chinese University of

Higher level of SDF-1 may induce the subchondral bone abnormal changes in OA and inhibition of SDF-1 signaling could be a potential therapeutic approach for OA.

The Liljestrand-Zander PPWA formula was most reliable compared with oesophageal Doppler in major surgical patients under general anaesthesia, but not better than USCOM.

Genetic studies in the mouse have demonstrated that conditional cardiac-restricted loss of connexin43 (Cx43), the major ventricular gap junction protein, is highly arrhythmogenic. However, whether more focal gap junction remodeling, as is commonly seen in acquired cardiomyopathies, influences the propensity for arrhythmogenesis is not known. We examined electrophysiological properties and the frequency of spontaneous and inducible arrhythmias in genetically engineered chimeric mice derived from injection of Cx43-deficient embryonic stem cells into wild-type recipient blastocysts. Chimeric mice had numerous well-circumscribed microscopic Cx43-negative foci in their hearts, comprising approximately 15% of the total surface area as determined by immunohistochemical analysis. Systolic function in the chimeric mice was significantly depressed as measured echocardiographically (19.0% decline in fractional shortening compared with controls, P < 0.05) and by invasive hemodynamics (17.6% reduction in change of pressure over time, P < 0.01). Chimeras had significantly more spontaneous arrhythmic events than controls (P < 0.01), including frequent runs of nonsustained ventricular tachycardia in some of the chimeric mice. However, in contrast to mice with conditional cardiac-resricted loss of Cx43 in the heart, no sustained ventricular tachyarrhythmias were observed. We conclude that focal areas of uncoupling in the myocardium increase the likelihood of arrhythmic triggers, but more widespread uncoupling is required to support sustained arrhythmias.

The prenatal determination of fetal rhesus D (RhD) status is useful for the management of sensitized RhD-negative women. Conventional methods for prenatal RhD status determination involve invasive methods such as amniocentesis. 1 The discovery of circulating cell-free fetal DNA in maternal plasma and serum opens up a new source of fetal genetic material for prenatal RhD status determination. 2 Indeed, this possibility has recently been realized by three groups who demonstrated the presence of fetal-derived RHD gene sequences in RhD-negative women bearing RhDpositive fetuses. [3][4][5] The detection system used by our group is a homogenous assay based on real-time PCR analysis 3,6 using exon 10 of the RHD gene. However, as it has been advocated that at least two independent PCR systems should be used for the clinical diagnosis of fetal RhD status, we describe, in this communication, a second real-time PCR assay for RhD status determination using sequences derived from exon 7 of the RHD gene. RESULTS AND DISCUSSIONPrimers for the exon 7 real-time RHD PCR system were as described by Faas et al. 4 A fluorogenic probe (RD7T), internal to the primers, was designed. The sequence of RD7T was 5′-FAM AGC TTG CTG GGT CTG CTT GGA GAG ATC TAMRA-3′. FAM and TAMRA were the fluorescent reporter and quencher as previously described. 3 Real-time PCR was carried out in duplicate in a final volume of 50 µL using components provided in a TaqMan PCR Core Reagent Kit (Perkin-Elmer, U.S.A). A sample was scored as RhD-positive when at least one of these duplicate reactions gave a positive result. The reaction mixture contained 1× reaction buffer A; 200 µM each of dATP, dCTP, and dGTP; 400 µM of dUTP; 4 mM of MgCl 2 ; 300 nM of each d Corresponding author: Y. M. Dennis Lo, 154 ANNALS NEW YORK ACADEMY OF SCIENCES primer; 25 nM of the RD7T TaqMan probe; 1.25 U of AmpliTaq Gold; and 0.5 U of AmpErase uracil N-glycosylase.Five µL of plasma DNA extracted using a QIAamp spin column (Qiagen, Germany) was used for amplification as described. 7 The amplification reaction was carried out in an ABI Prism 7700 Sequence Detector as previously described. 7 The thermal profile consisted of 2 min at 50°C and 10 min at 95°C, followed by 40 cycles of 95°C for 15 s and 60°C for 1 min.The initial evaluation of the exon 7 real-time RHD PCR system involved the application of this system to peripheral blood DNA extracted from 42 blood donors (16 RhD-positive and 26 RhD-negative), collected by the Department of Hematology at John Radcliffe Hospital (Oxford, UK). Real-time PCR results were in complete concordance with serology. The application of the PCR system to serial dilutions of DNA from an RhD-positive individual indicated that the system was sensitive enough to detect the DNA equivalent from a single cell.This real-time PCR system was then applied to plasma samples from 58 RhDnegative pregnant women recruited from the Nuffield Department of Obstetrics and Gynecology at John Radcliffe Hospital (Oxford, UK). First-trimester samples were obtained during a rou...