Objective
The primary goal of this study was to determine the prevalence of peripheral spondyloarthritis (pSpA) in patients with ultrasonography (USG)‐confirmed enthesitis. The secondary aim of the ...study was to reveal the demographic, clinical, and ultrasonographic differences of patients diagnosed with pSpA.
Methods
Fifty‐nine patients with USG‐confirmed enthesitis were evaluated by a rheumatologist to evaluate if they met the Assessment of SpondyloArthritis International Society (ASAS) criteria for pSpA. Elementary lesions assessed by USG were based on the definition of the Outcome Measures in Rheumatology in Clinical Trials group which included hypoechogenicity, thickening, Doppler signal within 2 mm of bone, enthesophytes, bone erosions, and calcifications. For all patients, clinical and demographic data included: age, gender, smoking habits, body mass index, comorbid diseases, symptom duration, enthesitis region, the presence of bilateral enthesitis, entheseal pain visual analog scale (0‐10), standardized enthesitis count following Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and SPondyloArthritis Research Consortium Canada (SPARCC) enthesitis index.
Results
Eight (13.6%, 95% CI 6.0% to 25.0%) of 59 patients were diagnosed with pSpA according to the ASAS classification criteria. Participants diagnosed with pSpA had a longer duration of symptoms (54 vs 12 months), were more likely to present bilateral enthesitis (87.5% vs 49%) with higher SPARCC (11 vs 3) and MASES (6.5 vs 2) scores and higher C‐reactive protein (7 vs 3.2 mg/L) concentrations. Entheseal Doppler signal and hypoechogenicity were also more frequently observed (50% vs 0% and 100% vs 49% respectively).
Conclusion
Peripheral SpA is not uncommon among patients presenting with enthesitis and more likely in cases with prolonged, extensive, and bilateral enthesitis with entheseal hypoechogenicity and Doppler signal. Musculoskeletal ultrasonography can facilitate the diagnosis of pSpA in patients presenting with enthesitis.
In this paper we give two characterizations of the Poletsky–Stessin–Hardy spaces in the complex plane: First we completely describe functions in these spaces by having a harmonic majorant with a ...certain growth condition and we prove some basic results about these spaces. Second we describe these functions in terms of their boundary values as a weighted subclass of the usual
L
p
class with respect to the arclength measure on the boundary, when the boundary is
C
2
. In particular, we extend the classical result of Beurling which describes the invariant subspaces of the shift operator. Additionally we provide non-trivial examples.
Background and objective: This prospective, randomized trial was designed to test the hypothesis that continuous infusion of low‐dose remifentanil can provide effective analgesia, sedation, amnesia, ...patient comfort and stable recovery profile without respiratory depression when compared with propofol infusion during colonoscopy.
Methods: One hundred patients were randomly assigned to receive either remifentanil (group R, 0.5 μg/kg followed by 0.05 μg/kg/min, n= 50) or propofol (group P, 0.5 mg/kg followed by 50 μg/kg/min, n= 50). Supplemental doses of remifentanil 12.5 μg in group R and propofol 10 mg in group P were given to treat complaints of moderate to severe pain and discomfort. Hemodynamic and respiratory data, pain, discomfort and sedation scores, patient and gastroenterologist satisfaction and recovery profiles were recorded.
Results: The duration of colonoscopy was longer in group P. The mean arterial pressure, heart rate and end‐tidal CO2 remained stable during the procedure and were comparable between the groups. After bolus injection of the study drugs, the respiratory rate and oxygen saturation values were lower in group R than in group P. Only one patient in group R required airway support. Pain and discomfort scores were better in group R than in group P. Sedation levels were higher in group P than in group R. Group P needed more supplemental doses than group R. The time to reach an Aldrete score of nine or more was shorter in group R, but discharge times were similar in the two groups. Amnesia was better in group P. Nausea and vomiting were more frequent in group R during the recovery phase.
Conclusion: Low‐dose remifentanil infusion with intermittent bolus injections can provide adequate sedation, amnesia and better analgesia than propofol infusion during colonoscopy. However, remifentanil‐induced nausea and vomiting may be a problem during the recovery phase.
Inguinal herniorrhaphy (IH) is a common surgical procedure that can be successfully performed by using general, regional or local anesthesia and is usually performed in an outpatient setting. In this ...study, recovery profile, incidence of adverse effects, postoperative pain scores and patient satisfaction between paravertebral block (PVB) and spinal anesthesia (SA) for fast track ambulatory IH were compared.
Sixty patients were randomly assigned to receive either PVB or unilateral SA under standardized protocols (PVB at T9-L1 levels with 5 mL of 0.5 % levobupivacaine for each, unilateral SA at L2-L3 level with 8 mg 0.5% hyperbaric levobupivacaine). All patients were sedated with propofol, 10-70 mg.kg.min. Data on anesthesia, surgery and PACU times, hemodynamic changes, home readiness, pain, and incidence of adverse effects were recorded.
One block failed in the PVB group. Anesthesia-related time and onset time were longer in the PVB group, but phase 1 PACU time, time to home-readiness with and without voiding and actual discharge time were significantly shorter in the PVB group. Although the fast-tracking rate was higher in the PVB group, this difference was not significant. The mean propofol dose was higher in the PVB group (52.03+/-19.32 35-73 mg x kg x min-1) than in the SA group (44.0+/-18.8 33-70 mg x kg x min-1) (P=0.002). VAS scores at 4, 6 and 12 hours were significantly lower in the PVB group, both at rest and during movement. VAS scores at 30, 60, 120, 180 min and at 18, 24 and 48 hours were comparable in the two groups. Duration of sensory block, onset time of discomfort, time to first analgesic, and time to first rescue analgesic were longer in the PVB group.
In ambulatory IH, PVB provided shorter home readiness time, long lasting postoperative analgesia and improved quality of recovery, and could be a good alternative to SA.
A two-step optimization procedure using central composite design with four factors (concentrations of maltrin and corn steep liquor (CSL), agitation speed and inoculation ratio) was used in order to ...investigate the effect of these parameters on the polygalacturonase (PG) enzyme activity, mycelia growth (biomass) and morphology (pellet size) of
Aspergillus sojae ATCC 20235. According to the results of response surface methodology (RSM), initial concentrations of maltrin and CSL and agitation speed were significant (
p
<
0.05) on both PG enzyme production and biomass formation. As a result of this optimization, maximum PG activity (13.5
U/ml) was achievable at high maltrin (120
g/l), at low CSL (0
g/l), high agitation speed (350
rpm) and high inoculation ratio (2
×
10
7 total spore). Similarly, maximum biomass (26
g/l) could be obtained under the same conditions with only the difference for higher level of CSL requirement. The diameter of pellets in all optimization experiments ranged between 0.05 and 0.76
cm. The second optimization step improved the PG activity by 74% and the biomass by 40%.
Background and objective: Propofol may decrease seizure duration in electroconvulsive therapy. Although not proven, prolonged seizures may be more efficacious. The goal of this study was to evaluate ...and compare effects of alfentanil and remifentanil on seizure duration, recovery parameters and degree of stimulus amplitude in patients undergoing electroconvulsive therapy.
Methods: Twenty‐four ASA I–II patients enrolled in this prospective, randomized trial, each receiving a total of seven electroconvulsive therapies. Patients were randomized to receive only Propofol, group P (0.75 mg kg−1, n = 8), Propofol with alfentanil, group A (10 µg kg−1 alfentanil + 0.5 mg kg−1 Propofol, n = 8) and Propofol with remifentanil, group R (1 µg kg−1 remifentanil +0.5 mg kg−1 propofol, n = 8) via an iv route. Supplemental doses of propofol were given as required to achieve loss of consciousness. Succinylcholine 0.5 mg kg−1 iv was given to all groups for muscular paralysis. We recorded hemodynamic parameters, cortical and motor seizure durations, and recovery parameters.
Results: Mean motor seizure duration was found to be significantly longer in patients receiving propofol‐remifentanil anesthesia (53.3 ± 13.6 s) and propofol‐alfentanil anesthesia (52.2 ± 0.4 s) compared with propofol anesthesia (37.6 ± 9.2 s) (P = 0.001). Recovery parameters and stimulus amplitudes were similar in groups A and R; significantly different from group P (P = 0.001).
Conclusions: Adding 10 µg kg−1 alfentanil or 1 µg kg−1 remifentanil to reduced doses of propofol provided unconsciousness and increased seizure durations. For patients who need higher stimulus amplitudes for longer seizure durations, combining low‐dose propofol with alfentanil or remifentanil may be good alternative regimens for ECT.
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