Ropivacaine for Unilateral Spinal Anesthesia; Hyperbaric or Hypobaric?

SummaryBackground and objectivesThe aim of this study was to compare the unilaterality of subarachnoid block achieved with hyperbaric and hypobaric ropivacaine.MethodsThe prospective, randomized trial was conducted in an orthopedics surgical suite. In all, 60 ASA I–III patients scheduled for elective total knee arthroplasty were included in the study. Group Hypo (n=30) received 11.25mg of ropivacaine (7.5mg.mL−1) + 2mL of distilled water (density at room temperature was 0.997) and group Hyper (n=30) received 11.25mg of ropivacaine (7.5mg.mL−1) + 2mL (5mg.mL−1) of dextrose (density at room temperature was 1,015). Patients in the hyperbaric group were positioned with the operated side down and in the 15° Fowler position, versus those in the hypobaric group with the operated side facing up and in the 15° Trendelenburg position. Combined spinal epidural anesthesia was performed midline at the L3–4 lumbar interspace. Hemodynamic and spinal block parameters, regression time, success of unilateral spinal anesthesia, patient comfort, surgical comfort, surgeon comfort, first analgesic requirement time, and adverse effects were assessed.ResultsTime to reach the T10 dermatome level on the operated side was shorter in group Hyper (612.00±163.29s) than in group Hypo (763.63±208.35s) (p<0.05). Time to 2-segment regression of the sensory block level on both the operated and non-operated sides was shorter in group Hypo than in group Hyper.ConclusionBoth hyperbaric and hypobaric ropivacaine (11.25mg) provided adequate and dependable anesthesia for total knee replacement surgery, with a high level of patient and surgeon comfort. Hypobaric local anesthetic solutions provide a high level of unilateral anesthesia, with rapid recovery of both sensory and motor block, and therefore may be preferable in outpatient settings

The Impact of Disease Activity on Patient- Reported Cognitive Dysfunction in Rheumatoid Arthritis

Objectives: To evaluate the association of disease activity with patient- reported cognitive dysfunction in patients with rheumatoid arthritis (RA) stratified by age.Methods: We utilized data from the CorEvitas registry. A cross-sectional analysis used the latest patient visit available from 1/1/2011 to 12/31/2019 with information on the Clinical Disease Activity Index (CDAI), problems thinking, age and gender. The association of CDAI with patient- reported cognitive dysfunction was estimated using logistic regression models controlling for sociodemographic, comorbidity, RA disease characteristics and medication use. Additional models estimated and tested the moderating effect of patient age (Results: A total of 3,041 out of 33,537 patients (9.1%), reported cognitive dysfunction with a mean CDAI of 16.2 (SD: 12.5) vs 10.1 (SD:10.8) in those who did not. The adjusted odds ratio (OR) for low, moderate, and severe disease activity vs remission was 2.17 [95%CI: 1.88-2.50], 3.25 [95% CI: 2.82-3.75] and 3.84 [95%CI: 3.29-4.48] respectively. Age had a moderating effect with the association of disease activity and self-reported cognitive dysfunction more pronounced in those aged Conclusions: Increasing disease activity is associated with a higher likelihood of reporting cognitive dysfunction. The effect was more pronounced in younger as opposed to older RA patients.&nbsp;&nbsp;</p

Green Extraction Processes Focusing on Maximization of Black Carrot Anthocyanins along with Cytotoxic Activities

WOS: 000392379600028Interest in anthocyanins has intensified due to their health promoting ability by reducing the risk of atherosclerosis, cancer, diabetes, and neurodegenerative disorders. In this study, anthocyanin extraction from black carrot was optimized by using solvent, ultrasound-, and microwave-assisted techniques, where the independent variables were temperature, liquid/solid ratio, and extraction time. The extractions were carried out with ethanol, whereas water was applied in each technique under elicited optimum conditions. Total anthocyanin content of the extracts was determined by a pH differential method, and the extracts possessing the highest anthocyanin contents were further analyzed with UPLC. Additionally, cytotoxic activity of the extracts was tested against breast adenocarcinoma, bone osteosarcoma, alveolar adenocarcinoma, and neuroblastoma. Microwave-assisted extraction yielded the highest amount of anthocyanins (319.57 mu g/mL) when a liquid/solid ratio of 5:1 was applied at 60 A degrees C for only 9 min. The cytotoxic activity was remarkable in most of the cell lines with IC50 values below 5.5 mu g/mL. Consequently, the results obtained results suggest that microwave-assisted extraction of black carrot has a potential to be scaled up for full utilization on an industrial scale.Scientific and Technical Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [113M196]This project (113M196) is supported by the Scientific and Technical Research Council of Turkey (TUBITAK)

Synthesis of silica-PAMAM dendrimer nanoparticles as promising carriers in Neuro blastoma cells

WOS: 000392560300001PubMed ID: 27939389Mesoporous silica carriers are emerging as therapeutic drug delivery systems. The objective of this study was to develop a formulation for synthesizing silica-PAMAM dendrimer hybrid nanoparticles with sol-gel technique. Subsequently, black carrot anthocyanins were encapsulated and investigated for their capability in terms of inhibiting the proliferative effects of neuroblastoma (Neuro 2A). In this context, particle size distributions were ascertained followed by thermal analysis (DSC), scanning electron microscopy and encapsulation efficiency. Subsequently, in vitro release kinetics was determined along with cytotoxicity of empty and anthocyanin doped hybrid nanoparticles. The lowest particle size was 134.8 nm with a zeta potential of +19.78 mV which enhanced electrostatic interaction with the cell membrane in the cytotoxicity analyses. As the anthocyanin content was totally released at the end of 6 days, the cytotoxicity was observed for 134 h, reaching an inhibition of 87.9%. On the other hand, Neuro 2A cells incubated with empty nanoparticles exhibited a high proliferation indicating that hybrid nanoparticles were not toxic to the cells and the inhibitory effect was associated with the anthocyanins. (C) 2016 Elsevier Inc. All rights reserved.Scientific and Technical Research Council of Turkey, TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [113M196]The research fund provided by the Scientific and Technical Research Council of Turkey, TUBITAK (113M196) is highly appreciated

Opioid associated intravenous and cutaneous microvascular drug abuse (skin-popping) masquerading as Degos disease (malignant atrophic papulosis) with multiorgan involvement

Background: In 2012, a nephrologist reported the development of a multiorgan thrombotic syndromic complex resembling thrombotic thrombocytopenic purpura (TTP) in patients who were abusing long acting oxymorphone hydrochloride; all patients had hemolytic anemia and thrombocytopenia.Objective: Herein, we report another case involving a 31-year-old woman who self intravenously administered dissolved oral oxymorphone resulting in thrombotic sequelae  resembling Degos disease.Methods: Formalin-fixed and paraffin embedded skin biopsies were prepared according to standard protocols for H&amp;E and immunohistochemistry.Results: The clinical presentation and biopsy findings were held to be indicative of  Degos disease/malignant atrophic papulosis (MAP) but with unusual clinical features including renal failure and severe respiratory insufficiency. Given the efficacy of eculizumab in the treatment of the acute thrombotic phase of Degos disease/MAP, the patient received this drug, resulting in rapid resolution of signs and symptoms associated with her multiorgan failure. Although she developed recurrent cutaneous ulcers despite complete complement inhibition with eculizumab., her other extracutaneous manifestations did not recur. The patient’s pre and post eculizuamb skin biopsies showed a striking pauci-inflammatory thrombogenic vasculopathy associated with marked endothelial cell injury along with deposits of C3d and C4d within the cutaneous vasculature; the C5b-9 deposits were limited to the pre-eculizumab biopsy. We discovered that her syndromic complex was a self-inflicted one related to the localized administration of dissolved oxymorphone.Conclusion: Our patient’s biopsy along with the rapid response to eculizumab indicates that this distinct thrombotic microangiopathy is another complement mediated thrombotic microangiopathy syndrome. Opioid thrombotic microangiopathy has a varied clinical presentation and can mimic other catastrophic microangiopathy syndromes, all of which have in common a responsiveness to complement inhibition

Nanocoating Thin Film Applications on Water Treatment

The main objective of this study is to determine the photocatalytic degradation efficiencies of the persistent compounds in wastewater by using new generation photocatalytic potassium lanthanum titanates (K(2)Ln(2)Ti(3)O(10)) materials. With this concept, the influence of pH, pollutant concentration and light intensity are investigated in details. The disadvantage of the current treatment methods is the sludge production. Sol-gel method is applied to produce newly developed photocatalysyts in order to oxidize the pollutants in water. DTA, FTIR, XRD, SEM, XPS and AFM analyses were performed to determine the thermal, structural and morphological characterization of the photocatalysts, respectively. To provide the highest activity, new generated K(2)Ln(2)Ti(3)O(10) (Ln= La, Nd, Gd, Sm and Dy) photocatalytic thin films were produced on Si (100) substrates and the degradation experiments were analyzed. The photocatalytic performances of methylene blue (MB) were carried out in a solar box ATLAS SUNTEST CPS+ which simulates solar radiation. On the other hand, ANOVA test for K2La2Ti3O10 was used to understand the effectiveness of the variables. The pH (3-7-10) and light intensity (250 and 750 W/m(2)) were selected as variables for an initial concentration of 10(-5) M methylene blue. The maximum degradation ratio of MB was obtained 99.87 % at pH 10 and 750 W/m(2) by using K2La2Ti3O10. The same procedure with different precursors is applied to produce different doped K2La2Ti3O10 thin films. Dopant precursors were selected as Sm, Dy, Gd and Nd as mentioned above. The maximum degradation ratio of MB among the doped photocatalyst was obtained 98 % by K2La1,1Gd0,9Ti3O10 and K2La1,5Gd0,5Ti3O10 at the same conditions. (C) 2015 Elsevier Ltd. All rights reserved. Selection and peer-review under responsibility of TEMA - Centre for Mechanical Technology and Automation

Endometriosis of the Terminal Ileum: A Diagnostic Dilemma

Endometriosis is characterized by the presence of endometrial tissue consisting of glands and/or stroma located outside the uterus. Involvement of the terminal ileum is extremely rare. Preoperative distinction of ileal endometriosis from other diseases of the ileocecal region is difficult in terms of clinical presentation, symptomatology, radiological appearance, and surgical and pathological findings. We report a case initially diagnosed as Crohn's disease due to a longstanding diarrhea with subsequent intestinal obstruction, but finally diagnosed as ileal endometriosis by histopathological evaluation after resection of the involved segment

The Effect of Water-Based Pulmonary Rehabilitation on Anxiety and Quality of Life in Chronic Pulmonary Obstructive Disease Patients

Objective: To investigate the effects of water-based pulmonary rehabilitation program on pulmonary functions, exercise capacity, anxiety and depression level and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD). Material and Methods: Fifty moderate or severe COPD patients without respiratory failure were included. They were randomized either to water-based exercise (WE) group (n= 25) or to control group (n= 25). Spirometry and 6-minute walk test (6-MWT) were performed. QoL was assessed by the Chronic Respiratory Disease Questionnaire (CRDQ). Level of anxiety and depression was assessed using the Hospital Anxiety and Depression (HAD) Scale. WE group received 4-week water-based pulmonary rehabilitation program including shoulder girdle and upper extremity strengthening exercises for 35 minutes, three times a week (totally 12 sessions) in addition to medical therapy. Control group received only medical therapy. All the assessments were repeated one month after intervention in both groups. Results: The mean ages of the patients in WE and control groups were statistically not different (respectively 60.9 +/- 8.8, 64.1 +/- 8.9, p= 0.207). All the patients in both groups were males. No significant improvements in pulmonary functions and 6-MWT distance were observed at one month compared to baseline in both groups. We observed statistically significant decrease in anxiety scores and significant increases in dyspnoea, emotional function and patients' feeling of control over the disease scores of CRDQ at one month compared to baseline in WE group. In control group, no significant differences in anxiety and CRDQ scores were observed at one month compared to baseline. Conclusion: Pulmonary rehabilitation is known to be cost-effective in patients with COPD. Water-based exercises are effective in improving QoL and anxiety level in COPD patients, thus it can be supposed as an alternative to land based pulmonary rehabilitation programs

Uric Acid as a Marker of Oxidative Stress in Dilatation of the Ascending Aorta

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