Coeliac Plexus Neurolysis for Upper Abdominal Malignancies Using an Anterior Approach: Review of the Literature

Background: Coeliac plexus neurolysis (CPN) helps to diminish pain arising from malignancy of upper abdominal viscera. Imaging modalities have increased the success rates by enhancing technical accuracy including fluoroscopy, computed tomography and ultrasound. Advancement in the imaging modalities used has helped in the accurate depiction of anatomy and position of the needle tip.Methods: In an anterior approach, the patient lies supine and the needle is inserted through the anterior abdominal wall into the retropancreatic space. The needle often traverses the stomach, liver or pancreas before reaching the coeliac plexus due to anatomical considerations. The literature has been reviewed regarding various imaging modalities using an anterior approach to coeliac plexus block with regard to success rate, improvement in pain scores, duration of pain relief and analgesic consumption.Results: Successful pain relief in abdominal malignancies with an anterior approach using various imaging modalities varies between 54% and 94% of patients. Following neurolysis, many patients can be weaned off opioids. This procedure improves quality of life and reduces the risk of drug-related side effects. The duration of pain relief after an anterior approach is six to eight weeks.Conclusion: The use of various imaging modalities in an anterior approach has improved the technical accuracy in reaching the coeliac plexus, thereby avoiding the needle piercing crucial structures and avoiding deposition of drug in the retrocrural space, thereby reducing the risk of neurological complications. Coeliac plexus neurolysis via an anterior approach using different imaging modalities does not completely abolish pain, rather it diminishes pain, helping to reduce opioid requirements and improving survival in patients with upper abdominal malignancy.Keywords: Coeliac Plexus, Coeliac Plexus Block, Imaging Modalities, Neurolytic Techniques, Pancreatic Pain, Upper Abdominal Malignanc

Landau damping of dust acoustic solitary waves in nonthermal plasmas

Dust acoustic (DA) solitary and shock structures have been investigated under the influence of Landau damping in a dusty plasma containing two temperature nonthermal ions. Motivated by the observations of Geotail spacecraft that reported two-temperature ion population in the Earth's magnetosphere, we have investigated the effect of resonant wave-particle interactions on DA nonlinear structures. The KdV equation with an additional Landau damping term is derived and its analytical solution is presented. The solution has the form of a soliton whose amplitude decreases with time. Further, we have illustrated the influence of Landau damping and nonthermality of the ions on DA shock structures by a numerical solution of the Landau damping modified KdV equation. The study of the time evolution of shock waves suggests that an initial shock-like pulse forms an oscillatory shock at later times due to the balance of nonlinearity, dispersion and disspation due to Landau damping. The findings of the present investigation may be useful in understanding the properties of nonlinear structures in the presence of Landau damping in dusty plasmas containing two temperature ions obeying nonthermal distribution such as in the Earth's magnetotail

Addition of adenosine to hyperbaric bupivacaine in spinal anaesthesia does not prolong postoperative analgesia in vaginal hysterectomy

Background: Systemic administration of adenosine produces anti-nociception. Although literature supports intrathecal adenosine for neuropathic pain, its efficacy in postoperative pain remains unproven. There has been no study on the efficacy of adenosine on postoperative pain when administered with hyperbaric bupivacaine. The aim of our present study was to evaluate the efficacy of two different doses of intrathecal adenosine as an adjunct to 0.5% hyperbaric bupivacaine in patients undergoing vaginal hysterectomy under spinal anaesthesia. Method: Seventy-five women, aged 40-60 years and scheduled for vaginal hysterectomy under spinal anaesthesia, were included. Patients were allocated to three groups of 25 patients each to receive 500 μg adenosine (group I), 1000 μg adenosine (group II) and normal saline (group III) with 2.6 ml of 0.5% hyperbaric bupivacaine. Postoperative analgesia was provided with patient-controlled fentanyl. Time of administration of rescue analgesia and total dose of fentanyl were recorded. The times to full recovery of sensory and motor block were noted. Results: There were no differences in time to rescue analgesia and postoperative fentanyl consumption over 24 hours among the groups. There was no significant difference in onset of sensory and motor block or regression of sensory block, although statistically significant difference was noted in the time taken for regression of motor block. Conclusion: Intrathecal adenosine does not affect the postoperative analgesic requirement when administered with hyperbaric bupivacaine.Keywords: spinal anaesthesia, intrathecal adenosine, vaginal hysterectomy,postoperative analgesia, patient-controlled analgesi

Physiological and biochemical response to higher temperature stress in hot pepper (Capsicum annuum L.)

The present study was conducted to evaluate the physiological and biochemical changes in some thermotolerant and thermosensitive chilli (Capsicum annuum L.) genotypes. Fourteen chilli genotypes (SL 461, PP 404, DL 161, MS 341, VR 521, PB 405, PS 403, SD 463, FL 201, AC 102, S 343, SL 462 and SL 464 along with sensitive check [Royal Wonder of bell pepper] were evaluated for heat tolerance. The observations on morpho-physiological and biochemical parameters were recorded at 45, 65, 85 and 105 days after transplanting (DAT) (high temperature period). On the basis of our studies, genotypes S 343, AC 102 and FL 201 were found to be relatively thermotolerant. However, high temperature markedly decreased the photosynthetic activity of chilli plants by decreasing the photosynthetic pigments in leaf chloroplasts of all the genotypes. The levels of ascorbic acid, total soluble sugars and total phenols increased in the leaves of all the genotypes with the maturity of the crop. Electrolyte leakage and proline content also increased with rise in temperature. Genotypes AC 102 and S 343 were able to accumulate the maximum ascorbic acid, proline, total soluble sugars and total phenols under heat stress conditions. Decrease in fruit set percent led to reduction in the total yield per plant. Maximum yield was observed in genotype S 343 followed by FL 201

The Evolutionary Kaleidoscope of Rhodopsins

Rhodopsins are widely distributed across all domains of life where they perform a plethora of functions through the conversion of electromagnetic radiation into physicochemical signals. As a result of an extensive survey of available genomic and metagenomic sequencing data, we reported the existence of novel clades and exotic sequence motifs scattered throughout the evolutionary radiations of both Type-1 and Type-3 rhodopsins that will likely enlarge the optogenetics toolbox. We expanded the typical rhodopsin blueprint by showing that a highly conserved and functionally important arginine residue (i.e., Arg82) was substituted multiple times during evolution by an extensive amino acid spectrum. We proposed the umbrella term Alt-rhodopsins (AltRs) for all such proteins that departed Arg82 orthodoxy. Some AltRs formed novel clades in the rhodopsin phylogeny and were found in giant viruses. Some newly uncovered AltRs were phylogenetically close to heliorhodopsins, which allowed a closer examination of the phylogenetic border between Type-1 rhodopsins and heliorhodopsins. Comprehensive phylogenetic trees and ancestral sequence reconstructions allowed us to advance the hypothesis that proto-heliorhodopsins were a eukaryotic innovation before their subsequent diversification into the extant Type-3 rhodopsins. IMPORTANCE The rhodopsin scaffold is remarkably versatile and widespread, coupling light availability to energy production and other light-dependent cellular responses with minor alterations to critical residues. We described an unprecedented spectrum of substitutions at one of the most conserved amino acids in the rhodopsin fold, Arg82. We denoted such phylogenetically diverse rhodopsins with the umbrella name Alt-rhodopsins (AltR) and described a distinct branch of AltRs in giant viruses. Intriguingly, some AltRs were the closest phylogenetic neighbors to Heliorhodopsins (HeRs) whose origins have remained enigmatic. Our analyses of HeR origins in the light of AltRs led us to posit a most unusual evolutionary trajectory that suggested a eukaryotic origin for HeRs before their diversification in prokaryotes

Gorlin Goltz syndrome: a rare case report

Gorlin-Goltz syndrome is uncommon multisystemic disease with an autosomal dominant trait, with complete penetrance and variable expressivity, though sporadic cases have been described. We report a case of 18 years old male patient having features of Gorlin Goltz syndrome. Gorlin-Goltz syndrome is characterized by multiple basal cell nevi or carcinomas, odontogenic keratocysts, palmar and/or plantar pits, calcification of the falx cerebri, and is associated with internal malignancies. It is important to know the major and minor criteria for the diagnosis and early preventive treatment of this syndrome

Neutrino-driven instability of ion acoustic waves in an ultra-relativistic degenerate plasma

The coupling between ion-acoustic waves (IAWs) and a neutrino beam undergoing flavor oscillations in a dense, relativistically degenerate plasma is analyzed. The neutrino-driven streaming instability of the IAWs is investigated with relevance to plasma conditions at the last stage of stellar evolution in a massive supernova progenitor. The influence of neutrino beam parameters such as the energy of the incident neutrino beam and eigen-frequency of the neutrino flavor oscillations on the instability growth rate is obtained numerically. It is observed that the neutrino flavor oscillations significantly affect the neutrino-driven instability of the IAWs. Our results also indicate that the time period for the onset of the streaming neutrino-driven instability is shorter than the typical time period of a core-collapse supernova explosion. The findings of this investigation may shed new light on the understanding of underlying physical mechanism responsible for the core-collapse supernova