A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery.

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients\u27 pain experience and opioid consumption after carpal tunnel release (CTR) surgery. METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded. RESULTS: During the day of surgery and the first day following surgery, patients in the group with counseling reported significantly fewer prescribed opioid pills consumed compared with patients in the group without counseling, while experiencing no significant difference in pain level experience. In addition, patients in the group with counseling reported a significantly lower number of total pain pills consumed over the course of the study than the group without counseling. No major adverse reactions were noted in either group. CONCLUSIONS: Preoperative opioid counseling was found to result in a significant decrease in overall opioid consumption after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates

Study Of Phenothiazine On p53 Core Domain Mutant Y220C: Finding The Anti-tumor Activity Of Phenothiazine

The tumor suppressor protein p53 is a transcription factor that plays a key role in the prevention of cancer development. The p53 cancer mutation Y220C induces formation of a cavity on the protein's surface that can accommodate stabilizing small molecules. We have attempted with the help of virtual screening and molecular docking approach using Lamarckian Genetic Algorithm to elucidate the extent of specificity of p53 cancer mutation Y220C towards different class of Phenothiazines (an anti-cancer agent). 

The 393 residue p53 tumor suppressor protein exists in a dynamic equilibrium to form homotetramers. Each chain comprises several functional domains. The N terminal part of the protein consists of the trans-activation domain (residues 1–63) followed by a proline rich region (64– 92). The central (core) domain (p53 core domain) is responsible for binding. The C terminal part of p53 contains the tetramerization domain (residues 326–355) and the negative regulatory domain at the extreme C terminus (363–393), which contains phosphorylation and acetylation sites and regulates the DNA binding activity of p53.

The docking result of the study of 2,000 Phenothiazines demonstrated that the binding energies were in the range of -10.54 kcal/mol to -1.14 kcal/mol, with 8 molecules showing hydrogen bonds with the active site residues (Lys 164). All the selected 2000 inhibitors were selected on the basis of the structural specificity to the enzyme towards its substrate and inhibitors. Our research provides a blueprint for the design of more potent and specific drugs that rescue p53-Y220C

An `Analytic Dynamical Magnetosphere' formalism for X-ray and optical emission from slowly rotating magnetic massive stars

Slowly rotating magnetic massive stars develop "dynamical magnetospheres" (DM's), characterized by trapping of stellar wind outflow in closed magnetic loops, shock heating from collision of the upflow from opposite loop footpoints, and subsequent gravitational infall of radiatively cooled material. In 2D and 3D magnetohydrodynamic (MHD) simulations the interplay among these three components is spatially complex and temporally variable, making it difficult to derive observational signatures and discern their overall scaling trends.Within a simplified, steady-state analysis based on overall conservation principles, we present here an "analytic dynamical magnetosphere" (ADM) model that provides explicit formulae for density, temperature and flow speed in each of these three components -- wind outflow, hot post-shock gas, and cooled inflow -- as a function of colatitude and radius within the closed (presumed dipole) field lines of the magnetosphere. We compare these scalings with time-averaged results from MHD simulations, and provide initial examples of application of this ADM model for deriving two key observational diagnostics, namely hydrogen H-alpha emission line profiles from the cooled infall, and X-ray emission from the hot post-shock gas. We conclude with a discussion of key issues and advantages in applying this ADM formalism toward derivation of a broader set of observational diagnostics and scaling trends for massive stars with such dynamical magnetospheres.Comment: 15 pages, 11 figures, accepted for MNRA

Centrifugal Breakout of Magnetically Confined Line-Driven Stellar Winds

We present 2D MHD simulations of the radiatively driven outflow from a rotating hot star with a dipole magnetic field aligned with the star's rotation axis. We focus primarily on a model with moderately rapid rotation (half the critical value), and also a large magnetic confinement parameter, $\eta_{\ast} \equiv B_{\ast}^2 R_{\ast}^{2} / \dot{M} V_{\infty} = 600$. The magnetic field channels and torques the wind outflow into an equatorial, rigidly rotating disk extending from near the Kepler corotation radius outwards. Even with fine-tuning at lower magnetic confinement, none of the MHD models produce a stable Keplerian disk. Instead, material below the Kepler radius falls back on to the stellar surface, while the strong centrifugal force on material beyond the corotation escape radius stretches the magnetic loops outwards, leading to episodic breakout of mass when the field reconnects. The associated dissipation of magnetic energy heats material to temperatures of nearly $10^{8}$K, high enough to emit hard (several keV) X-rays. Such \emph{centrifugal mass ejection} represents a novel mechanism for driving magnetic reconnection, and seems a very promising basis for modeling X-ray flares recently observed in rotating magnetic Bp stars like $\sigma$ Ori E.Comment: 5 pages, 3 figures, accepted by ApJ

Global Availability of Cancer Registry Data.

The availability of cancer registries has significantly enhanced cancer research, especially that related to cancer epidemiology, survival, interventions, and outcomes.1 However, by using publicly available sources, we aimed to map the availability and extent of cancer registry data in each country. We also aimed to test the association of registry data with metadata such as country income and national cancer-related policies. Data from 190 countries were collected from the WHO country cancer profiles.2 We sought data on the presence of an operational national cancer control policy, strategy, or action plan and the presence of a cancer registry. If those data were present, we looked for additional details on the cancer registry, including whether the registry was population based or hospital based and, if it was population based, whether there was national or subnational coverage. Complete data from Réunion (French), South Sudan, Guadeloupe (French), Martinique (French), Guyana, Puerto Rico, West Bank, Gaza Strip, and New Caledonia (French) were not available and thus were not included in our analyses. The availability of cancer registry data worldwide was depicted as a choropleth map using eSpatial mapping software

Giant pulmonary bulla with mediastinal shift in a 12 1/2 year old girl

Pulmonary bulla in children represent interesting entities. Mostly congenital bronchopulmonary foregut malformations and acquired cysts like pneumatocoeles have also been described. We present a case of a 12 1/2 years old girl with acute onset respiratory distress symptoms harbouring a huge pulmonary cyst exhibiting mass effects, resulting in mediastinal deviation. Following initial workup, cyst excision was carried out which revealed presence of fungal hyphae that was susceptible to Fluconazole therapy post operatively. The case points out how a pulmonary cyst can present in older children with symptoms of respiratory distress and mass effects

Comparative Effectiveness of Four Nitrification Inhibitors for Mitigating Carbon Dioxide and Nitrous Oxide Emissions from Three Different Textured Soils

Nitrification inhibitors (NIs) can be used to reduce both NO3−-N leaching and N2O-N emissions. However, the comparative efficacies of NIs can be strongly affected by soil type. Therefore, the efficacies of four nitrification inhibitors (dicyandiamide (DCD), 3, 4-dimethylpyrazole phosphate (DMPP), nitrogenous mineral fertilizers containing the DMPP ammonium stabilizer (ENTEC) and active ingredients: 3.00–3.25% 1, 2, 4-triazole and 1.50–1.65% 3-methylpyrazole (PIADIN)) were investigated in three different textured N-fertilized (0.5 g NH4+-N kg−1 soil) soils of Schleswig-Holstein, namely, Marsch (clayey), Östliches Hügelland (loamy) and Geest (sandy) under a controlled environment. Total CO2-C and N2O-N emissions were significantly higher from Marsch than Östliches Hügelland and Geest. In Marsch, DMPP showed the highest inhibitory effect on CO2-C emission (50%), followed by PIADIN (32%) and ENTEC (16%). In Östliches Hügelland, DCD and PIADIN showed the highest and equal inhibitory effect on CO2-C emission (73%), followed by DMPP (64%) and ENTEC (36%). In Marsch and Östliches Hügelland, DCD showed the stronger inhibitory effect on N2O-N emission (86% and 47%) than DMPP (56% and 30%) and PIADIN (54% and 16%). In Geest, DMPP was more effective in reducing N2O-N emission (88%) than PIADIN (70%) and DCD (33%). Thus, it can be concluded that DCD is a better NI for clay and loamy soils, while DMPP and PIADIN are better for sandy soils to inhibit soil nitrification and gaseous emissions

Current trends in chloroplast genome research

Chloroplast is an important cellular organelle of autotrophs which has an independent, circular, doublestranded DNA molecule termed as chloroplast genome. The chloroplast DNA (cpDNA) contains essential genes for its maintenance and operation. Several components of the photosystems andproteins involved in biosynthetic pathways are also encoded by the chloroplast genome. Exploring the genetic repository of this organelle is vital due to its conserved nature, small size, persistent gene organization and promising ability for transgenic expression. Therefore, cpDNA sequence information has been instrumental in phylogenetic studies and molecular taxonomy of plants. Chloroplast genome sequencing efforts have being initiated with conventional cloning and chain-termination sequencing technologies. Dedicated databases such as CGDB and GOBASE among others have been established as more and more complete cpDNA sequences are being reported. Presently, elegant molecular biologytechniques including shotgun sequencing, rolling circle amplification (RCA), Amplification, Sequencing and Annotation of Plasteome (ASAP) and Next generation sequencing are being used to accelerate data output. Owing to many fold increase in submission of cpDNA sequences in nucleotide databases, challenges of in-depth data analysis stimulated the emergence of devoted annotation, assembling and phylogenetic software. Recently, reported bioinformatics software for chloroplast genome studiescomprise of DOGMA for annotation, SCAN-SE, ARAGON and PREP suit for RNA analyses and CG viewer for circular map construction/comparative analysis. Faster algorithms for gene-order based phylogenetic reconstruction and bootstrap analysis have attracted the attention of research community. Current trends in sequencing strategies and bioinformatics with reference to chloroplast genomes hold great potential to illuminate more hidden corners of this ancient cell organelle