Advancements in laparoscopic surgery are often dictated by the limitations of technical instrumentation. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. With their success surgeons have begun using these on structures other than blood vessels with little or no data establishing their efficacy or safety. This study evaluates alternative energy sources in sealing ductal structures for possible use in liver or gallbladder surgery. After elective cholecystectomy cystic ducts (n = 45) were resealed ex vivo with surgical clips (n = 14), ultrasonic coagulating shears (n = 16), or electrothermal bipolar vessel sealer (n = 15), and bursting pressures were measured. Nineteen additional human cystic ducts were randomized to seal by ultrasonic coagulating shears (n = 9) or electrothermal bipolar vessel sealer (n = 10) and fixed in 10 per cent buffered formalin for histologic evaluation of thermal spread (mm). After this nine adult pigs were randomized to laparoscopic ligation and transection of the common bile duct using surgical clips (n = 3), ultrasonic coagulating shears (n = 3), or electrothermal bipolar vessel sealer (n = 3). The animals underwent necropsy for assessment of seal integrity on the sixth postoperative day. In the ex vivo study the mean cystic duct bursting pressure was 621 mm Hg with surgical clips and 482 mm Hg with the electrothermal bipolar vessel sealer ( P = 0.39). The mean cystic duct bursting pressure after ultrasonic coagulating shears was 278 mm Hg, which was statistically less than surgical clips ( P = 0.007) and electrothermal bipolar vessel sealer ( P = 0.02). The mean thermal spread was 3.5 mm for ultrasonic coagulating shears and 13.4 mm for electrothermal bipolar vessel sealer ( P = 0.0002). All animals undergoing ligation and transection of the common bile duct with ultrasonic coagulating shears and electrothermal bipolar vessel sealer developed bile peritonitis by postoperative day 6 as a result of seal leak. All animals undergoing surgical clip ligation and transection of the common bile duct maintained seal integrity. The mean common bile duct pressure above the surgical clip was 12 mm Hg (range 10–14). In conclusion the acute ex vivo study demonstrated a significant difference in the cystic duct bursting pressure between surgical clips and ultrasonic coagulating shears and between electrothermal bipolar vessel sealer and ultrasonic coagulating shears. The ultrasonic coagulating shears and electrothermal bipolar vessel sealer failed to maintain seal integrity in the in vivo animal study. Given the failure of the ultrasonic coagulating shears and electrothermal bipolar vessel sealer in the animal model these energy sources should not be used for transection of the cystic duct or major hepatic ducts during hepatobiliary surgery.

Traumatic cardiac or pulmonary arrest is often associated with a dismal outcome and is considered by many to be an example of medical futility and inappropriate use of resources. This study aimed to identify the predictors of survival in patients experiencing traumatic cardiac arrest. We retrospectively reviewed all trauma patients undergoing cardiopulmonary resuscitation on arrival to the Emergency Department (ED) at an American College of Surgeons-designated Level I trauma center over 4 years. ED survival, hospital survival, and neurologic outcomes on discharge were the primary outcomes. Survival rates were examined in relation to demographics, mechanism of injury, airway management, cardiac electrical rhythm, and pupil size and reactivity. Statistical analyses used chi-square and t tests, P < 0.05 was considered significant. A total of 195 patients arrived in the ED with traumatic cardiac arrest; 34 were pronounced dead on arrival (no signs of life), and no resuscitation efforts were initiated. Of the remaining 161 patients 53 (33%) survived to leave the ED, and only 15 (9%) left the hospital alive. Demographic features were similar in survivors and nonsurvivors. The setting of intubation (prehospital vs ED) did not influence survival ( P = 0.36). Penetrating trauma adversely affected survival in the ED ( P = 0.01); however, this only approached significance in the final outcome of hospital survival ( P = 0.06). The presence of sinus rhythm and nondilated reactive pupils was highly significant in predicting ED and hospital survival ( P = 0.001). No patient with agonal rhythm or ventricular fibrillation/tachycardia survived, and 14 of the 15 hospital survivors had reactive pupils on arrival to the ED. We conclude that sinus rhythm and pupil size and reactivity are important physiologic variables that predict potential survival and may be used to guide continuation of resuscitative efforts in patients with traumatic cardiac arrest.

A literature survey revealed no suitable “reversed phase-high performance thin layer chromatography (RP-HPTLC)” method for the analysis of rivaroxaban in nanoparticle (NP) formulations. Therefore, a novel rapid, simple, economical and environment friendly RP-HPTLC method has been established for the quantification of rivaroxaban in NP formulations and commercial tablets. RP-HPTLC analysis of rivaroxaban was performed using “RP-18 silica gel 60 F254S HPTLC plates”. The binary mixture of green solvents ethanol : water (7 : 3 v/v) was utilized as the mobile phase. The quantification of rivaroxaban was carried out in densitometric mode at λ_max = 253 nm. Rivaroxaban peaks from NP formulations was confirmed by comparing its single spot at R_f = 0.71 ± 0.02 with that of the standard. The proposed RP-HPTLC method was found to be linear in the range of 50–600 ng per band with R² = 0.9994. The equation for linear regression analysis was obtained as Y = 13.28x + 1189.4. The proposed RP-HPTLC technique was validated for “precision, accuracy, robustness and sensitivity”. The accuracy of the method was obtained as 97.97–99.67%. The % RSD in repeatability and intermediate precision was recorded as 0.46–0.64 and 0.48–0.86%, respectively. The LOD and LOQ for rivaroxaban were obtained as 18.45 and 55.35 ng per spot, respectively. The % content of rivaroxaban in marketed tablets and NPs was recorded as 99.20 and 98.08%, respectively. The proposed RP-HPTLC technique could be successfully applied for the pharmaceutical assay of rivaroxaban in NPs, marketed tablets and related formulations.

Background: Anacyclus pyrethrum (A. pyrethrum) is a wild species belonging to the family Asteraceae, which is used in traditional medicines. Aim of the study: This work was undertaken to study the chemical composition, analgesic, anti-inflammatory, and wound healing properties of hydroalcoholic extracts of different parts (roots, seeds, leaves, and capitula) of A. pyrethrum. Material and Methods: The phytochemical analysis of the studied extracts was conducted by GC-MS. The analgesic activity was evaluated in mice using acetic acid and formaldehyde methods. The anti-inflammatory activity was tested using the inhibitory method of edema induced in rats. The healing activity of the hydroethanolic extracts was explored by excision and incision wound healing models in rats. Results: The phytochemical analysis of the studied plant extracts affirmed the presence of interesting compounds, including some newly detected elements, such as sarcosine, N-(trifluoroacetyl)-butyl ester, levulinic acid, malonic acid, palmitic acid, morphinan-6-One, 4,5.alpha.-epoxy-3-hydroxy-17-methyl, 2,4-undecadiene-8,10-diyne-N-tyramide, and isovaleric acid. The extracts of different parts (roots, seeds, leaves, and capitula) exhibited promising anti-inflammatory, analgesic, and wound healing effects, with percentages of inhibition up to 98%, 94%, and 100%, respectively. Conclusion: This study might contribute towards the well-being of society as it provides evidence on the potential analgesic, anti-inflammatory, and wound healing properties of A. pyrethrum.