Adductor canal block (ACB) provides effective analgesia after arthroscopic knee surgery. However, there is insufficient data regarding whether ACB should be performed before or after inflation of a ...thigh tourniquet. We aimed to investigate the efficacy of ACB performed before and after placement of a thigh tourniquet and evaluate associated quadriceps motor weakness.
ACB was performed before tourniquet inflation in the PreT group, and it was performed after inflation in the PostT group. In the PO group, ACB was performed at the end of surgery after deflation of the tourniquet.
There were no statistically significant differences between the groups in terms of demographic data. There was no statistically significant difference among the three groups in terms of total postoperative opioid consumption (P = 0.513). Patient satisfaction and the amount of rescue analgesia administered were also not significantly different between the groups. There was no significant difference in terms of static and dynamic visual analog scale scores between the groups (for 24 h: P = 0.306 and P = 0.271, respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and the PO group (one patient) (P = 0.005).
Using a tourniquet before or after ACB did not result in differences in terms of analgesia quality; however, applying a tourniquet immediately after ACB may lead to quadriceps weakness.
The bone marrow's iodine uptake in dual-energy CT (DECT) is elevated in malignant disease. We aimed to investigate the physiological range of bone marrow iodine uptake after intravenous contrast ...application, and examine its dependence on vBMD, iodine blood pool, patient age, and sex.
Retrospective analysis of oncological patients without evidence of metastatic disease. DECT examinations were performed on a spectral detector CT scanner in portal venous contrast phase. The thoracic and lumbar spine were segmented by a pre-trained neural network, obtaining volumetric iodine concentration data mg/ml. vBMD was assessed using a phantomless, CE-certified software mg/cm3. The iodine blood pool was estimated by ROI-based measurements in the great abdominal vessels. A multivariate regression model was fit with the dependent variable "median bone marrow iodine uptake". Standardized regression coefficients (β) were calculated to assess the impact of each covariate.
678 consecutive DECT exams of 189 individuals (93 female, age 61.4 ± 16.0 years) were evaluated. AI-based segmentation provided volumetric data of 97.9% of the included vertebrae (n=11,286). The 95
percentile of bone marrow iodine uptake, as a surrogate for the upper margin of the physiological distribution, ranged between 4.7-6.4 mg/ml. vBMD (p <0.001, mean β=0.50) and portal vein iodine blood pool (p <0.001, mean β=0.43) mediated the strongest impact. Based thereon, adjusted reference values were calculated.
The bone marrow iodine uptake demonstrates a distinct profile depending on vBMD, iodine blood pool, patient age, and sex. This study is the first to provide the adjusted reference values.
Rail transportation is one of the most crucial public transportation types for big and crowded cities. In rail transportation systems, stakeholders face serious issues involved in workshops, ...stations, lines and their environments, and general office buildings. In order to reach an increased awareness and better occupational health and safety (OHS) management, a new risk assessment approach is proposed in this study. This approach includes a combination of Fine-Kinney method and a fuzzy rule-based expert system. It captures nonlinear causal relationships between Fine-Kinney parameters. Since there is a high level of vagueness involved in the OHS risk assessment data, the rule-based expert system is developed for probability (P), exposure (E), and consequence (C) for evaluating risk score. A case study is carried out in a rail transportation system in Istanbul/Turkey, and a comparison with the classical Fine-Kinney method is discussed. Results of the case study reveal risk clusters and corresponding control measures that should be taken into consideration. The study methodologically contributes to risk assessment in the knowledge, while case study in a real rail transportation system offers an insight into public transport industry in safety improvement.
Life expectancy of patients with multiple myeloma (MM) has increased over the past decades, underlining the importance of local tumor control and avoidance of dose-dependent side effects of ...palliative radiotherapy (RT). Virtual noncalcium (VNCa) imaging from dual-energy computed tomography (DECT) has been suggested to estimate cellularity and metabolic activity of lytic bone lesions (LBLs) in MM.
To explore the feasibility of RT response monitoring with DECT-derived VNCa attenuation measurements in MM.
Thirty-three patients with 85 LBLs that had been irradiated and 85 paired non-irradiated LBLs from the same patients were included in this retrospective study. Irradiated and non-irradiated LBLs were measured by circular regions of interest (ROIs) on conventional and VNCa images in a total of 216 follow-up measurements (48 before and 168 after RT). Follow-ups were rated as therapy response, stable disease, or local progression according to the MD Anderson criteria. Receiver operating characteristic (ROC) analysis was performed to discriminate irradiated
. non-irradiated and locally progressive
. stable/responsive LBLs using absolute attenuation post-irradiation and percentage attenuation change for patients with pre-irradiation DECT, if available.
Attenuation of LBLs decreased after RT depending on the time that had passed after irradiation absolute thresholds for identification of irradiated LBLs 30.5-70.0 HU best area under the curve AUC 0.75 (0.59-0.91) and -77.0 to -22.5 HU best AUC 0.85 (0.65-1.00)/-50% and -117% to -167% proportional change of attenuation on conventional and VNCa images, respectively. VNCa CT was significantly superior for identification of RT effects in LBLs with higher calcium content best VNCa AUC 0.96 (0.91-1.00), best conventional CT AUC 0.64 (0.45-0.83). Thresholds for early identification of local irradiation failure were >20.5 HU on conventional CT AUC 0.78 (0.68-0.88) and >-27 HU on VNCa CT AUC 0.83 (0.70-0.96).
Therapy response of LBLs after RT can be monitored by VNCa imaging based on regular myeloma scans, which yields potential for optimizing the lesion-specific radiation dose for local tumor control. Decreasing attenuation indicates RT response, while above threshold attenuation of LBLs precedes local irradiation failure.
Despite the fundamental role of human-induced forces in global environment having changed, knowledge about the specific factors that cause these impacts is limited and uncertainties remain. In this ...respect, the ecological footprint emerges as a concept used to emphasize both the apparent unsustainability of current practices and the inequalities in resource consumption among countries. The ecological footprint provides a method for measuring how much land can support the consumption of natural resources and provides a precise measure of human impact on the world. In recent years, sustainable development and biological capacity debate has mainly revolved around factors affecting the ecological footprint and approaches to improving environmental quality. Therefore, it is important to determine which factors affect the global ecological footprint. For this aim, a cross-section analysis was carried out with the quantile regression approach applied within the framework of the STIRPAT model structure for 154 countries that were allocated according to their income levels in 2016, taking into account current data. According to the quantile regression findings, the coefficients of the welfare and financial development index are positive and statistically significant. It has been concluded that the population decreases the amount of ecological footprint per person, thus, increasing the total ecological footprint. In addition, it has been determined that the density of the service sector negatively affects the ecological footprint.
Abstract Study objective The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous ...spaces were not prominent on physical examination. Design Randomized controlled clinical trial. Setting Operating rooms of university hospital of Erzurum, Turkey. Patients Sixty-four 18- to 45-year-old American Society of Anesthesiologists I-II patients scheduled for cesarean delivery under spinal anesthesia having hardly palpated anatomic landmarks on vertebral column. Interventions Palpation difficulty of vertebral column landmarks was scored as 0, 1, 2, or 3 from easy to difficult for all patients in sitting position. The patients with score 2 or 3 were randomly allocated into 2 groups as group C (conventional, n = 32) and group U (ultrasound, n = 32) in which ultrasound guidance was used. Measurements The number of skin punctures, the number of needle steering, the number of puncture tried vertebral levels, and procedure time were all recorded. Main results The number of skin punctures was significantly lower in group U ( P < .001). Successful subarachnoid puncture on first attempt was also significantly higher in group U ( P < .01). The duration of procedure in the patients with score 2 was determined to be significantly longer in the ultrasound-guided group ( P < .001). Conclusions Ultrasound guidance is an effective and safe method to reduce the number of puncture attempts, improve the success rate of subarachnoid access on the first attempt, and reduce the need to puncture multiple levels, although it prolongs procedure time in patients with score 2 according to our scoring system designed for this current study.
Purpose: To evaluate dynamic thiol/disulfide homeostasis in patients with chronic central serous chorioretinopathy (cCSC).
Methods: This prospective study included 34 cCSC cases and 37 healthy ...individuals who were age- and sex-matched. A new colorimetric method for measuring thiol/disulfide homeostasis was used. Native thiol, total thiol/disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were measured.
Results: The age and gender distributions were similar in both main groups. The mean duration of disease was 47.29 ± 24 months. Native and total thiol levels were significantly lower among the cCSC group relative to the control group (p < 0.001). There was not a statistically significant difference between the cCSC and the control group in terms of disulfide levels (p = 0.492). While disulfide/native thiol and disulfide/total thiol ratios were elevated, the native thiol/total thiol ratio was decreased in the cCSC group (p = 0.017, 0.021, 0.036, respectively). Ratios obtained using plasma native thiol, total thiol, and disulfide levels differed significantly between the both groups.
Conclusion: Disulfide/thiol ratio was significantly greater in cCSC patients relative to healthy control subjects. Our results suggest that the oxidative process is involved in the pathogenesis of the cCSC.
Purposes
The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after ...thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery.
Methods
Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C,
n
= 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC,
n
= 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T,
n
= 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h.
Results
Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (
p
< 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0–4 and 4–8 h (
p
< 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0–4 h (
p
= 0.006). Total fentanyl consumption was higher in Group C than in the other groups (
p
< 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (
p
< 0.05).
Conclusions
Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache.
Clinical trials registry
The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).
OBJECTIVESPain management is an important issue following lumbar spinal surgery. Wound infiltration is a technique that a local anesthetic solution is infiltrated into the tissues around the surgical ...area. Previous studies reported that US-guided modified thoracolumbar interfacial plane (mTLIP) block after lumbar spinal surgery provided effective analgesia. In this study, we aimed to compare the analgesic efficacy of the US-guided mTLIP block and wound infiltration following lumbar disc surgery. METHODS60 patients aged 18-65 years, ASA classification I-II, and scheduled for lumbar disc surgery under general anesthesia were included in the study. US-guided mTLIP block was performed via the lateral approach in group T (n=30), and wound infiltration was performed in group W (n=30). Opioid consumption, postoperative pain scores and adverse effects of opioids, such as allergic reactions, nausea, and vomiting, were recorded. RESULTSOpioid consumption and the use of rescue analgesia were significantly lower in group T in all the postoperative periods (1, 2, 4, 8, 16, and 24 h) (p<0.05). The VAS scores for pain during mobility and while at rest were significantly lower in group T than those in group W 8 h after the surgery (p<0.05). The incidences of nausea, vomiting, and itching in group W were higher than the incidences in group T. CONCLUSIONThe mTLIP block provides effective analgesia for the first 24 h following lumbar disc surgery, and it may be an alternative to wound infiltration for pain management.
Purpose
To evaluate the effect of smoking on ganglion cell complex and inner plexiform layer (GC-IPL) thickness measured by spectral domain optical coherence tomography (OCT).
Methods
The right eyes ...of 36 smoking (study group) and 36 never-smoking (control group) healthy subjects were included in this study. After full ophthalmologic examination, axial length measurement (AL), ganglion cell complex-inner plexiform layer (GC-IPL) thickness, retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) values were measured by OCT. Statistical analysis was performed to compare GC-IPL, RNFL thicknesses, and CMT values between groups.
Results
The mean age mean ± standard deviation (SD) of 36 subjects in the study group was 26.2 ± 6.0 years, and the mean age of 36 subjects in control group was 25.7 ± 4.1 years. The mean ALs of the study group and the control group were 22.46 ± 0.88 and 22.36 ± 1.09 mm, respectively (
p
= 0.68). Mean GC-IPL thickness was 82.8 ± 3 µm in the study group and 84.3 ± 3 µm in the control group (
p
= 0.08). The mean RNFL values of study and control groups were 95. 8 ± 7.9 and 97. 3 ± 7.8 µm, respectively (
p
= 0.39). The mean CMT values of study and control groups were 248.3 ± 17.96 and 249.5 ± 17.18 µm, respectively (
p
= 0.78).
Conclusion
Smoking does not seem to have any effect on GC-IPL thickness, mean RNFL and CMT values. Further studies in larger groups are needed to reveal the effect of smoking on these parameters.
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