The Journal of Chulabhorn Royal Academy

Radiosynthesis and quality control of [225Ac]AcPSMA-617 for prostate cancer patients by targeted alpha therapy,TAT

Natphimol Boonkawin, Chanisa Chotipanich — Mon, 01 Jan 2024 00:00:00 +0700

Background: Specific membrane antigen (PSMA) is a highly expressed transmembrane glycoprotein in prostate cancer cells. The radiolabeling of actinium-225 (²²⁵Ac) with such peptide is promising as a good radiotracer for use in targeted alpha therapy among patients with metastatic prostate cancer. In this study, the appropriate methods for [²²⁵Ac]AcPSMA-617 labeling and quality control with high yield and radiochemical purity is reported. Methods: The radiolabeling of [²²⁵Ac]AcPSMA-617 was prepared by adding the PSMA-617 precursor in ascorbate buffer into the ²²⁵Ac solution vail. The ratio of the PSMA-617 peptide and ²²⁵Ac activity was optimized to 11.0-19.5:1. The mixed solution in reaction vail was heated at 90°C for 10 min. The labelled [²²⁵Ac]AcPSMA-617 solution was formulated by adding 0.1 mg/mL of sodium ascorbate in 0.9%NaCl and ethanol(9:1) 10 mL, then transferred through the 0.22 µm filter to the product vial. The quality control of sterile [²²⁵Ac]AcPSMA-617 was performed before patient administration. Results: The average radiosynthesis yield of [²²⁵Ac]AcPSMA-617 for 14 times by using the above method was 97.28%±2.87%, with the average radiochemical purity of 96.88%±1.30%. Conclusion: The one step of [²²⁵Ac]AcPSMA-617 radiolabeling process provides a high yield of synthesis and radiochemical purity (RCP).

Development of an Herbal Oil Formula for the Relief of Upper Back Pain in Office Syndrome

Mon, 01 Jan 2024 00:00:00 +0700

Abstract

Background and Purpose: Office syndrome is characterized by persistent pain in the same muscles. However, herbal oils used to treat office syndrome have an undesirable gooey consistency and leave yellow stains. This study aimed to use a cold extraction method to develop herbal oil in the form of coconut oil with extracts of the herbs Zingiber purpureum Roscoe, Z. officinale Roscoe, and Curcuma zedoaria (Christm.) Roscoe. Methods: This single-blind randomized clinical trial included 40 participants with upper back pain. Participants were divided equally into the intervention group who applied herbal oil twice daily on the painful areas for 1 week, and the control group who applied placebo oil. Outcome assessments included the general information, visual analog scale (VAS) for pain, trigger point pain assessed with an algometer, cervical range of motion (ROM), and satisfaction scores. Results: After 1 week of intervention and at 1 week after intervention cessation, the mean VAS for pain was significantly lower in the intervention group than the control group, and was significantly lower in the intervention group compared with baseline. The mean trigger point pain level was significantly lower in the intervention group than the control group after the intervention. In the intervention group, the mean lateral flexion ROMs were significantly better after 1 week of intervention compared with baseline. The overall satisfaction with the herbal oil was moderate. Conclusions: Using the cold extraction method created a coconut oil with herbal extracts that relieved pain but requires development to improve the consistency and staining.

Aspiration Pneumonitis: an Anesthesia Event of Concern

Mon, 01 Jan 2024 00:00:00 +0700

Abstract

Aspiration pneumonitis results from inadvertent dropping of water, gastric secretion or food particles into the respiratory tract, particularly the lungs. These foreign bodies stimulate the immune system, cytokines, leukocytosis and white blood cell aggregation as well as an inflammatory process, leading to intra-alveolar tissue damage. Subsequently, the ventilation and perfusion mismatch inevitably precedes severe hypoxemia and acute respiratory failure. The severity of signs and symptoms depends on the pH and the amount of aspirated particles, particulate or non-particulate. In anesthesia, aspiration pneumonitis represents an adverse event of concern during the administration of sedative or general anesthesia since all anesthetics alter patients’ limits of self-control and cause the digestive system to prolong gastric emptying time. The incidence could worsen during an emergency surgery. As a result, anesthesia personnel’s current focus is on prevention rather than cure, leveraging various integrated clinical practice guidelines, such as preoperative patient management, preoxygenation with high flow technique, endotracheal intubation, ventilation and consciousness stabilization. At present, the ultrasound method helps verify the characteristics of particles in the stomach just before anesthetic management because it can significantly cut down on aspiration pneumonitis incidences.

Effect of Anesthesia on Serum Cytokine Levels

Mon, 01 Jan 2024 00:00:00 +0700

Abstract
By and large, foreign bodies such as bacteria, viruses, microorganisms, parasites, chemical toxins, irritants, allergens or cancerous cells, can stimulate the immune system by secreting both pro-inflammatory and anti-inflammatory cytokines, which serve as messengers on themselves (autocrine), nearby cells (paracrine) or far-away cells (endocrine). Cytokines activate the inflammatory process via leukocytosis and macrophage aggregation, which engulf bizarre cells (phagocytosis). Then the process insidiously subsides to restore lost vitality to full health. However, if the stimulant is severe and out of control or carries antigens such as Corona viruses, it can lead to chronic inflammatory progression. Eventually, hypercytokinemia and a cytokine storm attack, resulting in multiorgan failures and quick death. What is interesting is that malnutrition, stress, anxiety, surgery, strenuous exercise or controlled ventilation can stimulate cytokines secretion whereas regional anesthesia and administration of certain anesthetics can reduce the inflammatory process and serum cytokine levels.

Geriatric Patient Matter in Anesthesia

Mon, 01 Jan 2024 00:00:00 +0700

Abstract

The world population aged sixty-five and above is rising, largely with multiple accompanying ailments owing to mental and pathophysiologic deterioration of brain and nervous, respiratory, heart and circulatory, immune and hematologic, liver and renal structural functions, resulting in pathological weakness and hospital admission requirement.

Anesthesia personnel take care of patients during peri-operative drug administration, which is getting increasingly complicated since, in all likelihood, elderly patients receive simultaneous doses of medicine. At the same time, their catabolism and excretion are slowing down, thus causing an increase in plasma concentration and distribution, drug interaction, onset and duration of action as well as adverse events.

In addition, anesthesia personnel should consult specialists in other fields for proper planning, which is as crucial as preoperative visits and assessment of patients, choice of anesthetics and anesthesia techniques, careful observation of their emotional disruption and postoperative cognitive dysfunction. Achievement of these duties would allow the elderly to get back to their normal as soon as possible.

Relative Growth Score: A Better Way to Assess Learning Process in Anesthesia

Mon, 01 Jan 2024 00:00:00 +0700

Abstract

Before target student assessment, tests for norm- and criterion-referenced assessment are conducted under a table of specifications for cognitive, affective and psychomotor domains—essential steps in the learning process. These steps are well-validated for construct and content validity, reliability, objectivity, difficulty, and discrimination. Generally, achievement scores are performed for summative evaluation, while relative growth scores are considered formative scores.

In practice, relative growth scores are applied to students’ academic assessment via examination tests of parallelism of equality more than once. Then achievement scores are compared and correlated with referenced, pre-test scores. Therefore, the relative growth score is an estimated value with greater confidence that can fairly represent students’ intention, interests, and educational improvement. As a result, it is appropriate to apply in both theory and practice to residency, nurse anesthetists and medical students training programs and to those with different maturity, knowledge and clinical experience.

Two case reports of coronary artery bypass grafting in adults with dextrocardia with situs inversus

Suksan Kanoksin, Wiroon Napa-umporn, Teerawit Phanchaipetch — Mon, 01 Jan 2024 00:00:00 +0700

Abstract

In patients with dextrocardia, the cardiac apex points to the right side of the chest wall, and situs inversus is when the internal abdominal organs are positioned on the same side as the cardiac apex. Congenital dextrocardia with situs inversus has been rarely reported, and some patients with dextrocardia also develop atherosclerotic coronary artery disease. We report two cases of on-pump coronary artery bypass grafting performed in patients with dextrocardia with concomitant atherosclerotic coronary artery disease.

The first case was a 56-year-old Thai male who was in a car accident while he experienced a transient ischemic attack (TIA). He was admitted for treatment and underwent an investigation to identify the cause of the TIA. Cardiac echocardiography showed abnormal myocardial contraction. Coronary angiography showed critical three-vessel coronary artery disease. Elective on-pump coronary artery bypass grafting was successfully performed. The second case was a 68-year-old female who presented with non-ST-elevation myocardial infarction. Coronary angiography showed coronary artery disease with a left main lesion. Cardiac echocardiography showed a left ventricular ejection fraction of 33%. Three-vessel coronary artery bypass grafting was performed. The patient experienced good postoperative recovery without any complications.

We conclude that coronary artery bypass grafting in patients with dextrocardia can be successfully performed using the on-pump coronary bypass surgery technique, and the right internal mammary artery is an appropriate arterial conduit for the left anterior descending artery.