Propofol-alfentanil vs propofol-remifentanil for posterior spinal fusion including wake-up test

Background. Wake-up test can be used during posterior spinal fusion (PSF) to ensure that spinal function remains intact. This study aims at assessing the characteristics of the wake-up test during propofol-alfentanil (PA) vs propofol-remifentanil (PR) infusions for PSF surgery. Methods. Sixty patients with scoliosis and candidates for PSF surgery were randomly allocated in either alfentanil (PA) or remifentanil (PR) group. After an i.v. bolus of alfentanil 30 μg kg-1 in the PA group or remifentanil 1 μg kg-1 in the PR group, anaesthesia was induced with thiopental and atracurium. During maintenance, opioid infusion consisted of alfentanil 1 μg kg-1 min-1 or remifentanil 0.2 μg kg-1 min-1, in the PA group and the PR group, respectively. All patients received propofol 50 μg kg-1 min-1. Atracurium was given to maintain the required surgical relaxation. At the surgeon's request, all infusions were discontinued. Patients were asked to move their hands and feet. Time from anaesthetic discontinuation to spontaneous ventilation (T1), and from then until movement of the hands and feet (T2), and its quality were recorded. Results. The average T1 and T2 were significantly shorter in the PR group 3.6 (2.5) and 4.1 (2) min than the PA group 6.1 (4) and 7.5 (4.5) min. Quality of wake-up test, however, did not show significant difference between the two groups studied. Conclusion. Wake-up test can be conducted faster with remifentanil compared with alfentanil infusion during PSF surgery. © 2006 Oxford University Press

Efficacy of a modified bier�s block in patients undergoing upper limb bone surgery

Background: Intravenous regional block, called the Bier's block, refers to an analgesic technique applied for soft tissue surgeries and closed bone manipulations of the limbs. There are a number of complications in traditional method of block, including pain in tourniquet site, immediate return of pain after tourniquet deflation, wound hemostasis and some others. Objectives: The aim of this study was to assess the outcomes and complications of our new method of blockage. Patients and Methods: In this experimental study, twenty-five patients undergoing hand surgery were prospectively studied. Induced anesthesia was a modifcation of the Bier's block with two concurrent changes including insertion of the intravenous cannula at the antecubital region rather than distal and the proximal anesthetic direction by an elastic band wrapped tightly around the proximal forearm distal to the cannulation site. The pain relief was measured by the verbal descriptive scale at intervals after block, during the operation, after deflation of the tourniquet and one hour after the operation. Results: This study showed the presence of analgesia at surgical and tourniquet sites during the operation in 96 of patients, as well as considerable pain relief at surgical site during one hour after deflation of the tourniquet. Conclusions: The study indicated advantages of this modified Bier's block compared to the traditional one including ability to perform surgery on upper limb bones and considerable pain relief at surgical and tourniquet sites during the operation until one hour thereafter. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Impact of Silicon Foliar Application on the Growth and Physiological Traits of Carthamus tinctorius L. Exposed to Salt Stress

Althought safflower is a tolerant crop against many environmental stresses, but its yield and performance reduce under stress. The aim of this experiment was to investigate the effect of silicon (Si) application on the possibility of increasing salinity resistance and related mechanisms in safflower. A greenhouse experiment was conducted to investigate the effects of Si spraying (0, 1.5 and 2.5 mM) on safflower plants grown under salt stress condition (non-saline and 10 dS m−1). Salinity reduced seedling emergence percent and rate, growth parameters and disrupted ion uptake but increased emergence time and specifc leaf weight. Spraying of Si increased plant height, fresh and dry weight, leaf area, relative water content (RWC), potassium, calcium and silicon content, while sodium absorption was decreased. As a result, the K+/Na+ and Ca2+/Na+ ratios were increased. Elevated ion contents and ratios indicate an enhanced selectivity of ion uptake following silicon application and may increase ion discrimination against Na+. Treatment with 2.5 mM Si showed the most positive effect on the measured growth traits. Decrement in leaf area ratio under salinity indicates a more severe effect of salinity on leaf area compared to biomass production. On the other hand, silicon reduced the specific leaf weight under stress and non-stress conditions, which revalues the positive effects of silicon on leaf area expansion. Improvement of RWC may a reason for the icrease in leaf area and biomass production. Data shows that spraying with Si especialy with 2.5 mM can reduce salinity stress damage to safflower and increase biomass production

A time-domain control signal detection technique for OFDM

Transmission of system-critical control information plays a key role in efficient management of limited wireless network resources and successful reception of payload data information. This paper uses an orthogonal frequency division multiplexing (OFDM) architecture to investigate the detection performance of a time-domain approach used to detect deterministic control signalling information. It considers a type of control information chosen from a finite set of information, which is known at both transmitting and receiving wireless terminals. Unlike the maximum likelihood (ML) estimation method, which is often used, the time-domain detection technique requires no channel estimation and no pilots as it uses a form of time-domain correlation as the means of detection. Results show that when compared with the ML method, the time-domain approach improves detection performance even in the presence of synchronisation error caused by carrier frequency offset

A guide to group effective connectivity analysis, part 2: Second level analysis with PEB

This paper provides a worked example of using Dynamic Causal Modelling (DCM) and Parametric Empirical Bayes (PEB) to characterise inter-subject variability in neural circuitry (effective connectivity). It steps through an analysis in detail and provides a tutorial style explanation of the underlying theory and assumptions (i.e, priors). The analysis procedure involves specifying a hierarchical model with two or more levels. At the first level, state space models (DCMs) are used to infer the effective connectivity that best explains a subject's neuroimaging timeseries (e.g. fMRI, MEG, EEG). Subject-specific connectivity parameters are then taken to the group level, where they are modelled using a General Linear Model (GLM) that partitions between-subject variability into designed effects and additive random effects. The ensuing (Bayesian) hierarchical model conveys both the estimated connection strengths and their uncertainty (i.e., posterior covariance) from the subject to the group level; enabling hypotheses to be tested about the commonalities and differences across subjects. This approach can also finesse parameter estimation at the subject level, by using the group-level parameters as empirical priors. The preliminary first level (subject specific) DCM for fMRI analysis is covered in a companion paper. Here, we detail group-level analysis procedures that are suitable for use with data from any neuroimaging modality. This paper is accompanied by an example dataset, together with step-by-step instructions demonstrating how to reproduce the analyses

Fuzzy Modeling for Uncertain Nonlinear Systems Using Fuzzy Equations and Z-Numbers

In this paper, the uncertainty property is represented by Z-number as the coefficients and variables of the fuzzy equation. This modification for the fuzzy equation is suitable for nonlinear system modeling with uncertain parameters. Here, we use fuzzy equations as the models for the uncertain nonlinear systems. The modeling of the uncertain nonlinear systems is to find the coefficients of the fuzzy equation. However, it is very difficult to obtain Z-number coefficients of the fuzzy equations. Taking into consideration the modeling case at par with uncertain nonlinear systems, the implementation of neural network technique is contributed in the complex way of dealing the appropriate coefficients of the fuzzy equations. We use the neural network method to approximate Z-number coefficients of the fuzzy equations

Electroconvulsive therapy for a patient with suicide by drinking bleach during treatment of COVID-19: A case report

Electroconvulsive therapy (ECT) was first experienced in 1938 and had been conducting without anesthesia for 30 years. In this study, the most common indication for ECT was mood disorder (major depressive disorder and bipolar I disorder). We introduce a patient with a history of COVID-19 and suicide who required emergency ECT. Electroconvulsive therapy can be life-saving in patients with suicide history or catatonic schizophrenia. Health workers are at the front line of the COVID-19 outbreak control and must follow health instructions. Aerosol-producing procedures such as suction in anesthesia for ECT may facilitate the transmission of infectious diseases such as COVID-19. When performing aerosol-producing procedures during the pandemic of novel coronavirus, every patient should be considered suspicious. © 2020, Author(s)

Polymorphous adenocarcinoma of the salivary glands : reappraisal and update

Although relatively rare, polymorphous adenocarcinoma (PAC) is likely the second most common malignancy of the minor salivary glands (MiSG). The diagnosis is mainly based on an incisional biopsy. The optimal treatment comprises wide surgical excision, often with adjuvant radiotherapy. In general, PAC has a good prognosis. Previously, PAC was referred to as polymorphous low-grade adenocarcinoma (PLGA), but the new WHO classification of salivary gland tumours has also included under the PAC subheading, the so-called cribriform adenocarcinoma of minor salivary glands (CAMSG). This approach raised controversy, predominantly because of possible differences in clinical behaviour. For example, PLGA (PAC, classical variant) only rarely metastasizes, whereas CAMSG often shows metastases to the neck lymph nodes. Given the controversy, this review reappraises the definition, epidemiology, clinical presentation, diagnostic work-up, genetics, treatment modalities, and prognosis of PAC of the salivary glands with a particular focus on contrasting differences with CAMSG.Peer reviewe

Immune neuroendocrine phenotypes in Coturnix coturnix: Do avian species show LEWIS/FISCHER-like profiles?

Immunoneuroendocrinology studies have identified conserved communicational paths in birds and mammals, e.g. the Hypothalamus-Pituitary-Adrenal axis with anti-inflammatory activity mediated by glucocorticoids. Immune neuroendocrine phenotypes (INPs) have been proposed for mammals implying the categorization of a population in subgroups underlying divergent immune-neuroendocrine interactions. These phenotypes were studied in the context of the LEWIS/FISCHER paradigm (rats expressing high or low pro-inflammatory profiles, respectively). Although avian species have some common immunological mechanisms with mammals, they have also evolved some distinct strategies and, until now, it has not been studied whether birds may also share with mammals similar INPs. Based on corticosterone levels we determined the existence of two divergent groups in Coturnix coturnix that also differed in other immune-neuroendocrine responses. Quail with lowest corticosterone showed higher lymphoproliferative and antibody responses, interferon-γ and interleukin-1β mRNA expression levels and lower frequencies of leukocyte subpopulations distribution and interleukin-13 levels, than their higher corticosterone counterparts. Results suggest the existence of INPs in birds, comparable to mammalian LEWIS/FISCHER profiles, where basal corticosterone also underlies responses of comparable variables associated to the phenotypes. Concluding, INP may not be a mammalian distinct feature, leading to discuss whether these profiles represent a parallel phenomenon evolved in birds and mammals, or a common feature inherited from a reptilian ancestor millions of years ago