The opioid agonist remifentanil increases subjective pleasure

Non peer reviewe

The effects of leaf removal, cluster thinning and topping applications on yield and quality of Alphonse lavallée grape cultivar

Bu araştırmada Alfonse Lavallée bağında yaprak alma, seyreltme ve tepe alma uygulamalarının verim ve kalite üzerine etkilerini belirlemek amaçlanmıştır. Yaprak alma uygulamaları ile çiçeklenme öncesi ilk salkımın altındaki yaprak ve koltukların, ayrıca tane tutumunda kuzey yöndeki üst salkımın altındaki tüm yaprak ve koltukların alınması uygulanmıştır. Salkım seyreltme ile çiçeklenme öncesinde ve tane tutumunda ¼ oranında salkım seyreltmesi yapılmıştır. Tepe alma uygulamalarını ise tane tutumundan sonra son telin 20 cm ve 40 cm üzerinden sürgün tepelerinin alınması oluşturmuştur. Yaş üzüm verimi ve salkım sayısı uygulamalardan etkilenmemiştir. Yaş üzüm verimi 21,5 ile 27,5 kg/asma, salkım sayısı 29,0 ile 35,1 adet arasında değişmiştir. Salkım ağırlığı tepe alma uygulamalarından etkilenmez iken, seyreltme ile çiçekten önce yaprak alınanlarda, 680 g'dan 755 g'a artmıştır. Ayrıca salkım ağırlığı tane tutumunda yaprak alınanlarda daha fazla bulunmuştur. Uygulamalar salkım eni, boyu ve sıklığı ile tane eni ve boyu üzerine etkili olmamıştır. Tane ağırlığı ise seyreltme yapılan salkımlarda artmış ve ortalama 9,35g'dan 9,59g'a yükselmiştir. Tane renk değerlerinden "L, a, b ve hue açısı" uygulamalardan etkilenmemiştir. Croma değeri ise tane tutumunda yaprak alınanlarda seyreltme ile 5,35'den 5,52'ye yükselmiştir. Tane tutumunda yaprak alınanlarda, 40 cm' den tepe alma 20 cm' den tepe almaya göre tane sertliğini artırmıştır. 40 cm'den tepe alma uygulaması 20 cm'ye göre toplam suda çözünür kuru madde (SÇKM)'yi 14,3' den 15,5'e yükseltmiştir. % asitlik, olgunluk indisi ve antioksidan içeriği uygulamalardan etkilenmemiştir. Toplam fenol içeriği tane tutumunda yaprak alınanlarda 91,6 mg GAE/100 g değeri ile çiçekten önce yaprak alınanlardan daha fazla olmuştur.This research was carried to determine to effects of applications of leaf removal, cluster thinning and topping in Alphonse Lavalèe cultivar. Leaf removal applications were carried out before flowering with taking leaves and side shoots under first flower, and in fruit set with taking leaves and side shoots under top cluster. Cluster thinning in ¼ rate was applied in before flowering and fruit set. Topping was applied at 20 cm and 40 cm above the last wire. The applications did not affect fresh grape yield and cluster number. Fresh grape yield and cluster number ranged between 21,5 and 27,5 kg/asma with 29,0 and 35,1 number/vine respectively. Topping did not affect cluster weight, while thinning increased cluster weight from 680g to 755g in vines removed leaves at before flowering. In addition, leaf removal at fruit set increased cluster weight when compared with that of leaf removal at before flowering. The applications did not affect on cluster width and length, cluster tightness, berry width and length. Berry weight increased from 9,35g to 9,59 g with thinning. The applications did not affect on L,a,b hue degree. Thinning increased croma value from 5,35 to 5,52 in vines removed leaves at fruit set. Topping at 40 cm compared with that of 20 cm at fruit set increased berry firmness. Topping at 40 cm compared with that of 20 cm increased total soluble solids from 14,3 to 15,5. The applications did not affect % acidity, ripeness index, antioxidant contents. Vines removed leaves at fruit set had more total phenol contents (91,6 mg GAE/100 g) than that of vines removed leaves at before flowering

Pain management options after tonsillectomy and third molar extraction

Abstract The purpose of this study was to investigate the clinical implications of a combination of a peripheral opioid, paracetamol (APAP) and ketoprofen (KTP) on the intensity of acute postoperative pain by focusing on tonsillectomy (TE) and third molar extraction. A second focus in the study was to assess the utility of the surgical ultrasonically activated scalpel (HS) technique for TE. In Study I, TE was performed on one side using the HS and on the contralateral side using a “blunt dissection technique”. The first TE study (I) demonstrated that - based on NRS pain scores during the first 10 postoperative hours - intra-operative blood loss and need for haemostasis were greater on the blunt dissection side than on the HS side. Pain scores were higher on the HS side than on the cold dissection side during the second postoperative week. Study III assessed the analgesic effect of a peripheral dose of 4 mg morphine. The peritonsillar infiltration of morphine locally did not significantly decrease pain compared to the control side. Studies (II and IV) included patients who were scheduled for third molar extraction. In Study II, patients received 1000 mg APAP or 100 mg KTP or both or a placebo to evaluate pain relief after third molar extraction. This study demonstrated that the mean sum of pain intensity differences scores up to the 1.5 h mark and the mean time to onset of pain relief at rest and on swallowing were favoured in the combination group more than in the APAP, KTP, and placebo groups. In Study IV, patients were assigned for a submucosal injection of 2 mg morphine or NaCl into either the non-inflamed (Trial I) or the inflamed (Trial II) peridental tissue, while the active control group received the same drugs in reverse order intramuscular (IM). Postoperative pain intensity at rest and on swallowing was assessed in all studies using the numerical rating scale (NRS). Pain scores in the peripheral morphine group at rest (Trials I and II) and on swallowing (Trial I) were not associated with any further pain reduction. Pain scores on swallowing during the 2–6 hours postoperative period (Trial II) were greater in the IM morphine group. HS TE was associated with decreased pain in the early postoperative period, but there was increased pain and otalgia during the second postoperative week. Locally administered peripheral morphine was not associated with any benefit during the postoperative period after TE. The multimodal analgesia combination of a single dose of KTP and APAP demonstrated the same benefit during the early postoperative period without an increase in side effects. Locally administered peripheral morphine produced significant analgesia on swallowing during the early postoperative stage in inflamed tissue after third molar extraction.Tiivistelmä Hyvä leikkauksen jälkeinen kivunhoito on yksilöllisesti suunniteltua, turvallista, helppokäyttöistä ja taloudellista. Nykyään pyritään kivunlievityksessä hyödyn-tämään eri vaikutuspaikkoihin kohdistuvia hoitoja eli multimodaalista kivun¬hoitoa. Tämän työn tarkoituksena oli selvittää eri kivunlievitysmenetelmien tehoa ja turvallisuutta kahdessa eri toimenpiteessä: nielurisojen poistoleikkauksen (TE) tai viisaudenhampaan poistoleikkauksen jälkeen. Tutkimuskokonaisuus käsittelee leikkaustekniikan (Ultraääniveitsi), lääke-ainekombinaatioiden ja perifeerisesti annostellun morfiinin vaikutusta post-operatiiviseen kipuun. Tutkimusaineisto koostuu neljästä tutkimuksesta. Kaikki työt olivat satunnaistettuja ja kaksoissokkoutettuja. Kipu mitattiin numeerista asteikolla (Numerical Rating Scale, NRS) sekä levossa että nielemisen aikana enintään 2 viikon ajan. Ultraääniveitsen käytön vaikutusta postoperatiiviseen kipuun verrattiin perinteiseen leikkaustekniikkaan. Potilailta toinen nielurisa poistettiin ultraääni¬veistä käyttäen ja toinen tylpästi irrotellen kylmiä instrumentteja käyttäen. Kipu oli perinteisellä tekniikalla leikatulla puolella voimakkaampi kuin ultraääni¬veitsellä leikatulla puolella leikkauspäivänä. Toisen leikkauksen jälkeisen viikon aikana kipu oli kuitenkin voimakkaampaa ultraääniveitsillä leikatulla puolella. Parasetamolin (APAP), ketoprofeenin (KTP) tuottamaa kivunlievitystä ja näiden yhteisvaikutusta verrattiin viisaudenhampaan poistoleikkauksen jälkeen. KTP ja APAP kombinaatio antoi tehokkaamman kivunlievityksen ja nopeamman hoitovasteen kuin kumpikaan lääke yksin annettuna. Perifeerisesti infiltroidun morfiinin vaikutusta kipuun tutkittiin TE sekä viisaudenhampaan poistoleikkauksen jälkeen. TE jälkeen toiselle puolelle infiltroitiin nielurisan taakse 4 mg morfiinia ja toiselle puolelle fysiologista suolaliuosta. Viisaudenhampaan poistoleikkauksessa paikallisesti infiltroitua 2 mg morfiinia verrattiin lihakseen annettuun samaa lääkkeeseen kahdessa eri tilanteessa, joko tulehtuneeseen tai tulehtumattomaan kudokseen annosteltuna. Paikallisesti infiltroidulla morfiinilla ei todettu kipua lievittävää vaikutusta TE jälkeen. Tulehtuneeseen kudokseen infiltroitu morfiini lievensi leikkauksen jälkeistä nielemiskipua 2–6 tuntia leikkauksesta. Tulehtumattomaan kudokseen infiltroidulla morfiinilla ei saatu lisäetua. Yhteenvetona voidaan todeta, että TE ja viisaudenhampaanpoistoleikkauksen jälkeen kivunhoitoa voidaan optimoida multimodaalisin kivunhoidon keinoin. Tutkimustulokset auttavat potilaskohtaisen yksilöllisen kivunhoidon suunnittelussa