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In the normal heart, frequently used anesthetics such as isoflurane and propofol can reduce inotropy. However, the impact of these agents on the failing myocardium is unclear. Here, we examined whether and how isoflurane and propofol influence cardiac contractility in intact cardiac muscles from rats treated with monocrotaline to induce heart failure. We measured force and intracellular Ca2+([Ca2+]i) in trabeculae from the right ventricles of the rats in the absence or presence of propofol or isoflurane. At low to moderate concentrations, both propofol and isoflurane dose-dependently depressed cardiac force generation in failing trabeculae without altering [Ca2+]i. At high doses, propofol (but not isoflurane) also decreased amplitude of [Ca2+]itransients. During steady-state activation, both propofol and isoflurane impaired maximal Ca2+-activated force (Fmax) while increasing the amount of [Ca2+]irequired for 50% of maximal activation (Ca50). These events occurred without apparent change in the Hill coefficient, suggesting no impairment of cooperativity. Exposing these same muscles to the anesthetics after fiber skinning resulted in a similar decrement in Fmaxand rise in Ca50but no change in the myofibrillar ATPase-Ca2+relationship. Thus, our study demonstrates that challenging the failing myocardium with commonly used anesthetic agents such as propofol and isoflurane leads to reduced force development as a result of lowered myofilament responsiveness to Ca2+.

AbstractBackground and aims:miR-21 has been demonstrated to play an important role in tumour progression. The aim of the present study was to analyse the correlation between miR-21 expression level and clinicopathologic features, as well as to assess the prognostic significance of miR-21 in osteosarcoma.Methods:Eighty-four pairs of osteosarcoma and corresponding non-cancerous bone tissues were obtained, and miR-21 expression levels were detected using quantitative real-time PCR (qRT-PCR). A χ2test was used to assess the relationship between miR-21 expression and clinicopathological features. Overall survival (OS) and disease-free survival (DFS) rates were determined by the Kaplan–Meier method and analysed by the log-rank test. The Cox proportional hazards model was used for multivariate analysis.Results:qRT-PCR indicated that miR-21 expression in tumour tissues was strongly elevated compared with the adjacent corresponding non-cancerous bone tissue (7.88 ± 1.04 vs. 1.12 ± 0.37, respectively; P < 0.001). High miR-21 expression levels were linked to advanced clinical stage (P = 0.001), distant metastasis (P = 0.001), high tumour grade (P = 0.032) and large-sized tumours (P = 0.013). A higher miR-21 expression was significantly linked to shorter OS and DFS (both P < 0.001). Furthermore, a multivariate analysis confirmed that miR-21 was an independent and significant prognostic factor to predict poor OS and DFS (both P < 0.001).Conclusions: Upregulation of miR-21 was associated with poor clinicopathological characteristics. It is used as a marker of poor prognosis in patients with osteosarcoma.

We present a case in which veno-venous extracorporeal membrane oxygenation (VV-ECMO) was implemented, along with general anaesthesia, for resection of a large endotracheal tumour obstructing the airway just proximal to the carina. To control oxygenation prompt implementation of ECMO was instituted under sedation before induction of general anaesthesia. The advantage of ECMO was demonstrated in a challenging situation where mechanical ventilation of the lungs was impossible. Airway obstruction at the level of the carina poses a great challenge to every anaesthetist. There are few case reports on the successful use of ECMO during procedures involving the difficult airway [1-3]. As far as we are aware this is hte first case report describing the use of ECMO to facilitate bronchoscopic resection of a tumour at the level of the carina causing near complete airway obstruction.

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD.Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded.Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased (p< 0.05), and all the patients had solid bony fusion.Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

Right ventricular (RV) failure (RVF) has garnered significant attention in recent years because of its negative impact on clinical outcomes in patients with pulmonary hypertension (PH). PH triggers a series of events, including activation of several signaling pathways that regulate cell growth, metabolism, extracellular matrix remodeling, and energy production. These processes render the RV adaptive to PH. However, RVF develops when PH persists, accompanied by RV ischemia, alterations in substrate and mitochondrial energy metabolism, increased free oxygen radicals, increased cell loss, downregulation of adrenergic receptors, increased inflammation and fibrosis, and pathologic microRNAs. Diastolic dysfunction is also an integral part of RVF. Emerging non-invasive technologies such as molecular or metallic imaging, cardiac MRI, and ultrafast Doppler coronary flow mapping will be valuable tools to monitor RVF, especially the transition to RVF. Most PH therapies cannot treat RVF once it has occurred. A variety of therapies are available to treat acute and chronic RVF, but they are mainly supportive, and no effective therapy directly targets the failing RV. Therapies that target cell growth, cellular metabolism, oxidative stress, and myocyte regeneration are being tested preclinically. Future research should include establishing novel RVF models based on existing models, increasing use of human samples, creating human stem cell-based in vitro models, and characterizing alterations in cardiac excitation–contraction coupling during transition from adaptive RV to RVF. More successful strategies to manage RVF will likely be developed as we learn more about the transition from adaptive remodeling to maladaptive RVF in the future.

The article focuses on strikes by China's workforce compelled by demand for wage increase. Factories that went on strike include Honda in Foshan, Guangdong, TPO Displays Corp. in Taiwan and Japanese firm Brother Industries in the central province of Shaanxi. A number of provinces reportedly increased the minimum wages and the mass suicide at the Foxconn plant in Shenzhen pushed for salary raises. Also discussed are the impact of China's growing labour force and its domestic economic market.