Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

Background: Optimal relief of pain after knee arthroscopy is essential for early rehabilitation and mobilisation and to minimise postoperative morbidity. This study’s aim was to assess dexmedetomidine as an additive to intra-articular (IA) bupivacaine in terms of analgesic duration and postoperative rescue analgesic consumption following arthroscopic knee surgery.Methods: A total of 70 patients, ASA physical status I and II, undergoing knee arthroscopy under general anaesthesia were enrolled in this double-blinded randomised controlled study, after Pan African Clinical Trial Registry (PACTR201507001048242) approval was obtained. Patients were randomly assigned into two groups; the bupivacaine group (B) received IA 19 ml bupivacaine 0.5% + 1 ml normal saline, bupivacaine dexmedetomidine group (BD) received IA injection of 19 ml bupivacaine 0.5% + dexmedetomidine 100 μg (1 ml). Postoperative visual analogue pain score (VAS), duration of analgesia and postoperative analgesic requirement were assessed.Results: VAS scores at rest and on mobilisation were significantly lower in the BD group at 4 h, 6 h and 8 h postoperatively in comparison with group B (p < 0.05). VAS scores were comparable between studied groups during the first 2 h, and at 12 h and 24 h postoperatively. Duration of analgesia was significantly longer in group BD (458.9 ± 93.5 min) than in the B group (229.1 ± 83.7 min) (p < 0.05). Postoperative analgesic consumption was lowered in the BD group compared with the B group (p < 0.05).Conclusions: Adding dexmedetomidine to IA bupivacaine after knee arthroscopy prolongs analgesic duration and decreases postoperative analgesic requirement.Keywords: arthroscopy, dexmedetomidine, intra-articular, postoperative pai

Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer

Cancer was recently annexed to diabetic complications. Furthermore, recent studies suggest that cancer can increase the risk of diabetes. Consequently, diabetes and cancer share many risk factors, but the cellular and molecular pathways correlating diabetes and colon and rectal cancer (CRC) remain far from understood. In this study, we assess the effect of hyperglycemia on cancer cell aggressiveness in human colon epithelial adenocarcinoma cells in vitro and in an experimental animal model of CRC. Our results show that Nox (NADPH oxidase enzyme) 4-induced reactive oxygen species (ROS) production is deregulated in both diabetes and CRC. This is paralleled by inactivation of the AMPK and activation of the mammalian target of rapamycin (mTOR) C1 signaling pathways, resulting in 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) accumulation, induction of DNA damage, and exacerbation of cancer cell aggressiveness, thus contributing to the genomic instability and predisposition to increased tumorigenesis in the diabetic milieu. Pharmacologic activation of AMPK, inhibition of mTORC1, or blockade of Nox4 reduce ROS production, restore the homeostatic signaling of 8-oxoguanine DNA glycosylase/8-oxodG, and lessen the progression of CRC malignancy in a diabetic milieu. Taken together, our results identify the AMPK/mTORC1/Nox4 signaling axis as a molecular switch correlating diabetes and CRC. Modulating this pathway may be a strategic target of therapeutic potential aimed at reversing or slowing the progression of CRC in patients with or without diabetes.-Mroueh, F. M., Noureldein, M., Zeidan, Y. H., Boutary, S., Irani, S. A. M., Eid, S., Haddad, M., Barakat, R., Harb, F., Costantine, J., Kanj, R., Sauleau, E.-A., Ouhtit, A., Azar, S. T., Eid, A. H., Eid, A. A. Unmasking the interplay between mTOR and Nox4: novel insights into the mechanism connecting diabetes and cancer.Scopu

The effect of 12C + 12C rate uncertainties on s-process yields

The slow neutron capture process in massive stars (the weak s-process) produces most of the s-only isotopes in the mass region 60 < A < 90. The nuclear reaction rates used in simulations of this process have a profound effect on the final s-process yields. We generated 1D stellar models of a 25 solar mass star varying the 12C + 12C rate by a factor of 10 and calculated full nucleosynthesis using the post-processing code PPN. Increasing or decreasing the rate by a factor of 10 affects the convective history and nucleosynthesis, and consequently the final yields.Comment: Conference proceedings for the Nuclear Physics in Astrophysics IV conference, 8-12 June 2009. 4 pages, 3 figures. Accepted for publication to the Journal of Physics: Conference Serie

Equation of state for dense supernova matter

We provide an equation of state for high density supernova matter by applying a momentum-dependent effective interaction. We focus on the study of the equation of state of high-density and high-temperature nuclear matter containing leptons (electrons and neutrinos) under the chemical equilibrium condition. The conditions of charge neutrality and equilibrium under $\beta$-decay process lead first to the evaluation of the lepton fractions and afterwards the evaluation of internal energy, pressure, entropy and in total to the equation of state of hot nuclear matter for various isothermal cases. Thermal effects on the properties and equation of state of nuclear matter are evaluated and analyzed in the framework of the proposed effective interaction model. Since supernova matter is characterized by a constant entropy we also present the thermodynamic properties for isentropic case. Special attention is dedicated to the study of the contribution of the components of $\beta$-stable nuclear matter to the entropy per particle, a quantity of great interest for the study of structure and collapse of supernova.Comment: 23 pages, 15 figure

Evolution of low-mass metal-free stars including effects of diffusion and external pollution

We investigate the evolution of low-mass metal-free Population III stars. Emphasis is laid upon the question of internal and external sources for CNO-elements, which - if present in sufficient amounts in the hydrogen-burning regions - lead to a strong modification of the stars' evolutionary behavior. For the production of carbon due to nuclear processes inside the stars, we use an extended nuclear network, demonstrating that hot pp-chains do not suffice to produce enough carbon or are less effective than the triple3-alpha-process. As an external source of CNO-elements we test the efficiency of pollution by a nearby massive star combined with particle diffusion. For all cases investigated, the additional metals fail to reach nuclear burning regions before deep convection on the Red Giant Branch obliterates the previous evolution. The surface abundance history of the polluted Pop III stars is presented. The possibilities to discriminate between a Pop II and a polluted Pop III field star are also discussed.Comment: Accepted for publication in Ap

The consequences of nuclear electron capture in core collapse supernovae

The most important weak nuclear interaction to the dynamics of stellar core collapse is electron capture, primarily on nuclei with masses larger than 60. In prior simulations of core collapse, electron capture on these nuclei has been treated in a highly parameterized fashion, if not ignored. With realistic treatment of electron capture on heavy nuclei come significant changes in the hydrodynamics of core collapse and bounce. We discuss these as well as the ramifications for the post-bounce evolution in core collapse supernovae.Comment: Accepted by PRL, 5 pages, 2 figure

Effect of polyglucosamine on weight loss and metabolic parameters in overweight and obesity: A systemic review and meta-analysis

The use of dietary supplements for weight loss has gained significant momentum. Polyglucosamine, a chitosan derivative, is a dietary supplement increasingly used for weight loss. In this meta-analysis, we systematically summarized and quantified the key findings of four randomized, placebo-controlled clinical trials examining the effects of polyglucosamine supplementation and caloric restriction, and physical activity on body weight, body mass index (BMI), and waist circumference in subjects with overweight and obesity. The control group was set with a physical activity from 6–7 MET-h/week activity and up to 21 MET-h/week activity with caloric restriction. Compliance in the latter trials was reported via a follow-up questionnaire with the individual participants. The analysis included 399 subjects followed for a period ranging from 12 weeks to one year. Subjects’ age ranged from 21–75 years, BMI from 26–45 kg/m2, and all were white European or Caucasian in ethnicity. The meta-analyzed mean differences for random effects showed that polyglucosamine supplementation improves weight loss by −1.78 kg [−2.78, −0.79], BMI by −1.52 kg/m2 [−3.58, 0.54], and improves waist circumference reduction by −1.45 cm [−2.77, −0.12]. In conclusion, the use of polyglucosamine supplementation in conjunction with lifestyle behavioral therapies can be effective for weight reduction. Further studies are needed to examine the long-term effects of polyglucosamine supplementation on weight loss and other metabolic parameters

A photometric survey for Lyalpha-HeII dual emitters: Searching for Population III stars in high-redshift galaxies

We present a new photometric search for high-z galaxies hosting Population III (PopIII) stars based on deep intermediate-band imaging observations obtained in the Subaru Deep Field (SDF), by using Suprime-Cam on the Subaru Telescope. By combining our new data with the existing broad-band and narrow-band data, we searched for galaxies which emit strongly both in Ly_alpha and in HeII 1640 (``dual emitters'') that are promising candidates for PopIII-hosting galaxies, at 3.93<z<4.01 and 4.57<z<4.65. Although we found 10 ``dual emitters'', most of them turn out to be [OII]-[OIII] dual emitters or H_beta-(H_alpha+[NII]) dual emitters at z<1, as inferred from their broad-band colors and from the ratio of the equivalent widths. No convincing candidate of Ly_alpha-HeII dual emitter of SFR_PopIII > 2 Msun/yr was found by our photometric search in 4.03 x 10^5 Mpc^3 in the SDF. This result disfavors low feedback models for PopIII star clusters, and implies an upper-limit of the PopIII SFR density of SFRD_PopIII < 5 x 10^-6 Msun/yr/Mpc^3. This new selection method to search for PopIII-hosting galaxies should be useful in future narrow-band surveys to achieve the first observational detection of PopIII-hosting galaxies at high redshifts.Comment: 24 pages, 10 figures, accepted for publication in Ap

Cool bottom processes on the thermally-pulsing AGB and the isotopic composition of circumstellar dust grains

(Abridged) We examine the effects of cool bottom processing (CBP) on several isotopic ratios in the convective envelope during the TP-AGB phase of evolution in a 1.5 M_sun initial-mass star of solar initial composition. We use a parametric model which treats extra mixing by introducing mass flow between the convective envelope and the underlying radiative zone. The parameters of this model are the mass circulation rate (Mdot) and the maximum temperature (T_P) experienced by the circulating material. The effects of nuclear reactions in the flowing matter were calculated using a set of structures of the radiative zone selected from a complete stellar evolution calculation. The compositions of the flowing material were obtained and the resulting changes in the envelope determined. Abundant ^26Al was produced by CBP for log T_P > 7.65. While ^26Al/^27Al depends on T_P, the isotopic ratios in CNO elements depend dominantly on the circulation rate. The correspondence is shown between models of CBP as parameterized by a diffusion formalism within the stellar evolution model and those using the mass-flow formalism employed here. The isotopic ratios are compared with the data on circumstellar dust grains. It is found that the ratios ^{18}O/^{16}O, ^{17}O/^{16}O, and ^26Al/^27Al observed for oxide grains formed at C/O < 1 are reasonably well-understood. However, the ^15N/^14N, ^12C/^13C, and ^26Al/^27Al in carbide grains (C/O > 1) require many stellar sources with ^14N/^15N at least a factor of 4 below solar. The rare grains with ^12C/^13C < 10 cannot be produced by any red-giant or AGB source.Comment: 35 pages, plus 18 included figures. Scheduled for January 10, 2003 issue of Ap

The Universe Was Reionized Twice

We show the universe was reionized twice, first at z~15-16 and second at z~6. Such an outcome appears inevitable, when normalizing to two well determined observational measurements, namely, the epoch of the final cosmological reionization at z~6 and the density fluctuations at z~6, which in turn are tight ly constrained by Lyman alpha forest observations at z~3. These two observations most importantly fix the product of star formation efficiency and ionizing photon escape fraction from galaxies at high redshift. To the extent that the relative star formation efficiencies in gaseous minihalos with H2 cooling and large halos with atomic cooling at high redshift are still unknown, the primary source for the first reionization could be Pop III stars either in minihalos or in large halos. We show that gas in minihalos can be cooled efficiently by H2 molecules and star formation can continue to take place largely unimpeded throughout the first reionization period, thanks to two new mechanisms for generating a high X-ray background during the Pop III era, put forth here. Moreover, an important process for producing a large number of H2 molecules in relic HII regions of Pop III galaxies, first pointed out by Ricotti, Gnedin, & Shull, is quantified here. It is shown that the Lyman-Werner background may never build up during the Pop III era. The long cosmological reionization and reheating history is complex. We discuss a wide range of implications and possible tests for this new reionization picture. In particular, Thomson scattering optical depth is increased to 0.10 +- 0.03, compared to 0.027 for the case of only one rapid reionization at z=6. Upcoming Microwave Anisotropy Probe observation of the polarization of the cosmic microwave background should be able to distinguish between these two scenarios.Comment: submitted to ApJ, 69 pages, substantial revision made and conclusions strengthene