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Kutlesic M.S.,University of Nis | Kutlesic R.M.,University of Nis | Mostic-Ilic T.,Institute of Gynecology and Obstetrics | Mostic-Ilic T.,University of Belgrade
Journal of Anesthesia | Year: 2016

The induction–delivery time during Cesarean section is traditionally conducted under light anesthesia because of the possibility of anesthesia-induced neonatal respiratory depression. The serious consequences of such an approach could be the increased risk of maternal intraoperative awareness and exaggerated neuroendocrine and cardiovascular stress response to laryngoscopy, endotracheal intubation, and surgical stimuli. Here, we briefly discuss the various pharmacological options for attenuation of stress response to endotracheal intubation during Cesarean delivery and then focus on remifentanil, its pharmacokinetic properties, and its use in anesthesia, both in clinical studies and case reports. Remifentanil intravenous bolus doses of 0.5–1 μg/kg before the induction to anesthesia provide the best compromise between attenuating maternal stress response and minimizing the possibility of neonatal respiratory depression. Although neonatal respiratory depression, if present, usually resolves in a few minutes without the need for prolonged resuscitation measures, health care workers skilled at neonatal resuscitation should be present in the operating room whenever remifentanil is used. © 2015, Japanese Society of Anesthesiologists. Source


Novakovic R.,University of Belgrade | Radunovic N.,Institute of Gynecology and Obstetrics | Heinle H.,University of Tubingen | Scepanovic R.,Clinical Center Dr Dragisa Misovic | Gojkovic-Bukarica L.,University of Belgrade
Journal of Physiology and Pharmacology | Year: 2013

This study was aimed to evaluate resveratrol (1-100 μM) effect on the spontaneous rhythmic contractions (SRC), oxytocin-induced (0.2 nM, POxC) phasic and tonic (20 nM, TOxC) contractions of isolated rat uterus. The SRC and POxC were more sensitive to resveratrol than TOxC (pD2 values: 4.53 and 4.66 versus 4.06). Different blockers of K+ channels (glibenclamide, tetraethylamonium, iberiotoxin, 4-aminopyridine) antagonized the response to resveratrol on the SRC and phasic contractions, but did not antagonize the effect of resveratrol on the TOxC. In order to compare the relaxant activities of resveratrol on the TOxC with that of potassium channel openers, a separate experiments with NS 1619, a highly specific big Ca2+-sensitive K+ (BKCa) channels opener and pinacidil, a predominant opener of ATP-sensitive K+ (KATP) channels were done. NS 1619 (10-100 μM) and pinacidil (10-100 μM) produced more potent inhibition of TOxC than resveratrol (pD2 values were 6.00 and 5.29). Iberiotoxin, a highly selective BKCa channels blocker, antagonized the response to NS 1619 and glibenclamide, a highly selective KATP channels blocker, antagonized the response to pinacidil on the TOxC. To test K+- and extracellular Ca2+- independent mechanism(s) of resveratrol on TOxC, a K+-rich, Ca2+-free solution was used. Under this condition, only high concentrations (≥30 μM) of resveratrol inhibited TOxC. Western blots analysis confirmed expression of Kir6.1, Kir6.2, KCa1.1, Kv2.1 and Kv4.2. channel proteins in myometrium. Thus, the effect of resveratrol is dependent on the types of contractions. The inhibitory response of resveratrol on the SRC and phasic contractions involves different myometrial K+- channels. When applied in high concentrations, resveratrol has an additional K+- channels independent mechanism(s) of action. As the effects of NS 1619, pinacidil and resveratrol on the TOxC are different, we can conclud that resveratrol does not behave as a classical potassium channel opener. Source


Dong J.,PLA Fourth Military Medical University | Cui G.,Institute of Orthopedics | Bi L.,PLA Fourth Military Medical University | Li J.,Institute of Gynecology and Obstetrics | Lei W.,PLA Fourth Military Medical University
International Journal of Nanomedicine | Year: 2013

In order to improve the mechanical and biological properties of calcium phosphate cement (CPC, nanometer-biomaterial) for bone reconstruction in the rabbit femoral defect model, fibrin glue (FG, the natural product, purified from the blood) was introduced at three different ratios. The CPC powder and the FG solution were mixed, respectively, at the powder/liquid (P/L) ratios (g/mL) of 1:1, 3:1, and 5:1 (g/mL), and pure CPC was used as a control. After being implanted into the femoral defect in rabbit, the healing process was evaluated by micro-computed tomography scan, biomechanical testing, and histological examination. By micro-computed tomography analysis, the P/L ratio of 1:1 (g/mL) group indicated the largest quantity of new bone formation at 4 weeks, 8 weeks, and 12 weeks after implantation, respectively. Bone volume per trabecular volume of the 1:1 group was highest in the four groups, which was 1.45% ± 0.42%, 7.35% ± 1.45%, and 29.10% ± 1.67% at 4 weeks, 8 weeks, and 12 weeks after the operation, respectively. In the biomechanical tests, the compressive strength and the elastic modulus of the three CPC-FG groups were much higher than those of the pure CPC group at the determined time point (P < 0.05). The histological evaluation also showed the best osseointegration in the 1:1 group at 4 weeks, 8 weeks, and 12 weeks after the operation, respectively. In the 1:1 group, the bone grew into the pore of the cement in the laminar arrangement and connected with the cement tightly at the 12th week after the operation. This present study indicated that the CPC-FG composite at the P/L ratio of 1:1 (g/mL) stimulated bone regeneration better than any other designed group, which suggested that CPC-FG at the P/L ratio of 1:1 has significant potential as the bioactive material for the treatment of bone defects. © 2013 Dong et al, publisher and licensee Dove Medical Press Ltd. Source


Vasiljevic B.,Institute of Gynecology and Obstetrics | Maglajlic-Djukic S.,University Childrens Hospital | Gojnic M.,Institute of Gynecology and Obstetrics | Stankovic S.,Institute of Biochemistry | And 2 more authors.
Pediatrics International | Year: 2011

Background: Pathogenesis of perinatal hypoxic-ischemic brain injury (HIE) is complex. In this study, we examined the role of neuroinflammation, oxidative stress and growth factors in perinatal hypoxic-ischemic brain damage. Methods: Ninety neonates (>32 weeks' gestation) with perinatal HIE were enrolled prospectively. Perinatal HIE was categorized into three stages according to the Sarnat and Sarnat clinical scoring system and changes seen on amplitude integrated electroencephalography. Cerebrospinal fluid (CSF) for interleukin-6 (IL-6) and glutathione peroxidase analysis was taken in the first 48 h of life and subsequent CSF for neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) analysis 72 h after birth. Neurodevelopmental outcome was assessed at 12 months of corrected gestational age using the Denver Developmental Screening Test. Results: Concentrations of NSE in CSF correlated with severity of HIE (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Concentrations of IL-6 in CSF were markedly increased in neonates with severe HIE (P < 0.0001) and those with subsequent neurological sequels, but were normal in the majority of neonates with mild and moderate HIE. Glutathione peroxidase activity in CSF was significant with the stage of HIE (P < 0.0001) and gestational age (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Advanced stage of HIE was associated with increased concentrations of VEGF in CSF (P < 0.0001). Neurological outcomes at 12 months of age correlated best with CSF level of NSE (P < 0.001) and IL-6 (P < 0.001). Conclusion: Our results suggest that neuroinflammation plays a principal role in perinatal hypoxic-ischemic brain damage and we postulate that oxidative stress and upregulation of VEGF might be important contributing factors in the pathogenesis of hypoxic-ischemic brain injury, particularly in preterm neonates. © 2011 Japan Pediatric Society. Source


Dmitrovic B.K.,Mental Health Unit | Dugalic M.G.,Institute of Gynecology and Obstetrics | Dugalic M.G.,University of Belgrade | Balkoski G.N.,University of Belgrade | And 4 more authors.
International Journal of Social Psychiatry | Year: 2014

Objective: To screen 212 women for depression symptoms during pregnancy and postpartum in Serbia. Methods: Questionnaires that covered key demographic and obstetric information and Edinburgh Postnatal Depression Scale (EPDS) were administered at the third trimester of pregnancy and at 8 weeks postpartum. Results: In all, 21% of the sample was screened as depression positive during pregnancy. Subsequently, efforts were made to follow up 195 women through postpartum. Of the 195 women, 11% were screened positive during postpartum. Risk factors were low education level, low satisfaction with financial situation, high-risk pregnancy and depression during pregnancy. Logistic regression with backward elimination showed that women who had high-risk pregnancy have threefold increased risk of postpartum depression, and women who had antenatal depressive symptoms have 10-fold increased risk of postpartum depression. Conclusion: In countries where screening tool for depression is not applied routinely in obstetrics settings, clinicians should be aware of risk factors, frequency and level of depressive symptoms during pregnancy and postpartum. © The Author(s) 2013. Source

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