Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery

Background. Thoracoscopic surgery can be associated with considerable postoperative pain. While the benefits of paravertebral block on pain after thoracotomy have been demonstrated, no investigations on the effects of paravertebral block on pain after thoracoscopy have been conducted. We tested the hypothesis that a single-injection thoracic paravertebral block, performed preoperatively, reduces pain scores after thoracoscopic surgery. Methods. Of 45 patients recruited, 40 completed the study. They were randomly allocated to two groups: the paravertebral group received i.v. patient-controlled analgesia (PCA) with morphine plus single-injection thoracic paravertebral block with bupivacaine 0.375% and adrenaline 1:200 000 0.4 ml kg−1 (n=20). The control group was treated with a back puncture without injection and morphine PCA (n=20). Results. The main outcomes recorded during 48 h after surgery were pain scores using the visual analogue scale (VAS, 0-100). Secondary outcomes were cumulative morphine consumption and peak expiratory flow rate (PEFR). Half an hour and 24 h after surgery, median (25th-75th percentiles) VAS on coughing in the paravertebral group was 31.0 (20.0-55.0) and 30.5 (17.5-40.0) respectively and in the control group it was 70.0 (30.0-100.0) and 50.0 (25.0-75.0) respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four and 48 h after surgery, median (25th-75th percentiles) cumulative morphine consumption (mg) was 49.0 (38.3-87.0) and 69.3 (38.8-118.5) respectively in the paravertebral group and 51.2 (36.0-84.1) and 78.1 (38.4-93.1) in the control group (statistically not significant). No differences were found in PEFR or the incidence of any side-effects between groups. Conclusion. We conclude that single-shot preoperative paravertebral block improves post-operative pain treatment after thoracoscopic surgery in a clinically significant fashio

Navigation und Robotik an der Otobasis

Zusammenfassung: Die bildgestützten computerassistierten mikroskopischen Eingriffe an der Otobasis stellen einen seltenen Eingriff in der täglichen Praxis dar. Es handelt sich jedoch um delikate und schwierige minimalinvasive Eingriffe, da die Orientierung im Felsenbein bis zur Felsenbeinspitze oft schwierig ist. Bei Malformationen oder Tumoren sind die normalen anatomischen Landmarken, die dem Chirurgen als Orientierung dienen, häufig nicht vorhanden. Die Navigation, zusammen mit den bildgebenden Verfahren wie CT, MRT und Angiographie, hilft dem Chirurgen, sich bei unübersichtlichen Verhältnissen im Raum zu orientieren, um die Operation auf diese Weise sicherer und z.T. auch schneller durchzuführen. Weltweite einheitliche Indikationen zum Einsatz an der Otobasis fehlen aber. Die navigationsgestützte Miniaturrobotik ist noch in den ersten praktischen Testphase

Computer-Assisted Precision Surgery in the Ear

Chirurgische Eingriffe am Ohr stellen aufgrund der komplexen Anatomie und der Grössenverhältnisse der beteiligten anatomischen Strukturen eine Herausforderung für den HNO-Chirurgen dar. In diesem Beitrag wird ein Ansatz für die roboterbasierte Navigation zur Hörgeräteimplantation vorgestellt. Insbesondere wird auf die Möglichkeit des Fräsens von Implantatlagern im Felsenbein eingegangen. Je präziser ein Implantat im Schädel verankert werden kann, desto einfacher ist der chirurgischen Ablauf. Weiterhin, profitieren Patienten von verkürzten Operationszeiten und weniger schmerzhaften Eingriffen.Traditional surgical procedures involving the implantation of artificial hearing devices in the inner ear are challenging due to the size and complexity of anatomical structures within the temporal bone. To date, no stereotactic instrument guidance technology providing the necessary levels of accuracy is available. This work presents an approach to robot assisted implantation of hearing devices. Specifically, the robot system was used to milla cavity to for a direct acoustical stimulation implant. As the precision of such cavities increases, so also can future implant generations improve in terms of size, complexity and cost effectiveness. Additionally, patients themselves would profit from shorter procedure times and less painful interventions

Bile acid retention and activation of endogenous hepatic farnesoid-X-receptor in the pathogenesis of fatty liver disease in ob/ob-mice

The nuclear bile acid receptor FXR (farnesoid-X-receptor) has recently been implicated in the pathophysiology of non-alcoholic fatty liver disease because selective FXR-agonists improve glucose and lipid metabolism in rodent models of obesity. However, the regulation of FXR and other relevant nuclear receptors as well as their lipogenic target genes in fatty liver is still not revealed in detail. Livers were harvested from 14-week-old male ob/ob mice and wild-type controls. Serum bile acids were quantified by radioimmunoassay. mRNA and protein expression of transporters and nuclear receptors was analyzed by reverse transcriptase-polymerase chain reaction and Western blotting, whereas DNA binding to the IR-1 element was examined by electrophoretic mobility shift assay. In this study we show: (i) bile acid retention in ob/ob mice, (ii) a resulting FXR upregulation and binding to the IR-1 element in ob/ob animals and (iii) concomitant activation of the fatty acid synthase as a potential lipogenic FXR target gene in vivo. The present study suggests a potential role of hepatic bile acid retention and FXR activation in the induction of lipogenic target genes. Differences between intestinal and hepatic FXR could explain apparent contradictory information regarding its effects on fatty liver diseas

Bioorthogonal site-selective conjugation of fluorescent dyes to antibodies: method and potential applications

Antibodies are immensely useful tools for biochemical research and have found application in numerous protein detection and purification methods. Moreover, monoclonal antibodies are increasingly utilised as therapeutics or, conjugated to active pharmaceutical ingredients, in targeted chemotherapy. Several reagents and protocols are reported to synthesise fluorescent antibodies for protein target detection and immunofluorescence applications. However, most of these protocols lead to non-selective conjugation, over-labelling or in the worst case antigen binding site modification. Here, we have used the antibody disulphide cleavage and re-bridging strategy to introduce bright fluorescent dyes without loss of the antibody function. The resulting fluorescent IgG1 type antibodies were shown to be effective imaging tools in western blot and direct immunofluorescence experiments

Rapamycin attenuates hypoxia-induced pulmonary vascular remodeling and right ventricular hypertrophy in mice

BACKGROUND: Chronic hypoxia induces pulmonary arterial hypertension (PAH). Smooth muscle cell (SMC) proliferation and hypertrophy are important contributors to the remodeling that occurs in chronic hypoxic pulmonary vasculature. We hypothesized that rapamycin (RAPA), a potent cell cycle inhibitor, prevents pulmonary hypertension in chronic hypoxic mice. METHODS: Mice were held either at normoxia (N; 21% O(2)) or at hypobaric hypoxia (H; 0.5 atm; ~10% O(2)). RAPA-treated animals (3 mg/kg*d, i.p.) were compared to animals injected with vehicle alone. Proliferative activity within the pulmonary arteries was quantified by staining for Ki67 (positive nuclei/vessel) and media area was quantified by computer-aided planimetry after immune-labeling for α-smooth muscle actin (pixel/vessel). The ratio of right ventricle to left ventricle plus septum (RV/[LV+S]) was used to determine right ventricular hypertrophy. RESULTS: Proliferative activity increased by 34% at day 4 in mice held under H (median: 0.38) compared to N (median: 0.28, p = 0.028) which was completely blocked by RAPA (median HO+RAPA: 0.23, p = 0.003). H-induced proliferation had leveled off within 3 weeks. At this time point media area had, however, increased by 53% from 91 (N) to 139 (H, p < 0.001) which was prevented by RAPA (H+RAPA: 102; p < 0.001). RV/[LV+S] ratio which had risen from 0.17 (N) to 0.26 (H, p < 0.001) was attenuated in the H+RAPA group (0.22, p = 0.041). For a therapeutic approach animals were exposed to H for 21 days followed by 21 days in H ± RAPA. Forty two days of H resulted in a media area of 129 (N: 83) which was significantly attenuated in RAPA-treated mice (H+RAPA: 92). RV/[LV+S] ratios supported prevention of PH (N 0.13; H 0.27; H+RAPA 0.17). RAPA treatment of N mice did not influence any parameter examined. CONCLUSION: Therapy with rapamycin may represent a new strategy for the treatment of pulmonary hypertension

The Effect of wake Turbulence Intensity on Transition in a Compressor Cascade

Direct numerical simulations of separating flow along a section at midspan of a low-pressure V103 compressor cascade with periodically incoming wakes were performed. By varying the strength of the wake, its influence on both boundary layer separation and bypass transition were examined. Due to the presence of small-scale three-dimensional fluctuations in the wakes, the flow along the pressure surface undergoes bypass transition. Only in the weak-wake case, the boundary layer reaches a nearly-separated state between impinging wakes. In all simulations, the flow along the suction surface was found to separate. In the simulation with the strong wakes, separation is intermittently suppressed as the periodically passing wakes managed to trigger turbulent spots upstream of the location of separation. As these turbulent spots convect downstream, they locally suppress separation. © 2014 Springer Science+Business Media Dordrecht

Development of an auditory implant manipulator for minimally invasive surgical insertion of implantable hearing devices

Abstract Objective: To present the auditory implant manipulator, a navigation-controlled mechanical and electronic system which enables minimally invasive (‘keyhole') transmastoid access to the tympanic cavity. Materials and methods: The auditory implant manipulator is a miniaturised robotic system with five axes of movement and an integrated drill. It can be mounted on the operating table. We evaluated the surgical work field provided by the system, and the work sequence involved, using an anatomical whole head specimen. Results: The work field provided by the auditory implant manipulator is considerably greater than required for conventional mastoidectomy. The work sequence for a keyhole procedure included pre-operative planning, arrangement of equipment, the procedure itself and post-operative analysis. Conclusion: Although system improvements are necessary, our preliminary results indicate that the auditory implant manipulator has the potential to perform keyhole insertion of implantable hearing device

A Tale of Peaks and Valleys: Sinusoid Relationship Patterns Between Mountainousness and Basic Human Values

Mountains—mythic and majestic—have fueled widespread speculation about their effects on character. Emerging empirical evidence has begun to show that physical topography is indeed associated with personality traits, especially heightened openness. Here, we extend this work to the domain of personal values, linking novel large-scale individual values data ( n = 32,666) to objective indicators of altitude and mountainousness derived from satellite radar data. Partial correlations and conditional random forest machine-learning algorithms demonstrate that altitude and mountainousness are related to increased conservation values and decreased hedonism. Effect sizes are generally small (| r| &lt; .031) but comparable to other socio-ecological predictors, such as population density and latitude. The findings align with the dual-pressure model of ecological stress, suggesting that it might be most adaptive in the mountains to have an open personality to effectively deal with threats and endorse conservative values that promote a social order that minimizes threats. </jats:p