Evaluation of erector spinae plane block in cardiac surgery patients in terms of acute and chronic pain scores.

OBJECTIVE: Pain after cardiac surgery is a frequently encountered morbidity associated with poor quality of life and postoperative recovery. There have been several regional anesthesia modalities for this purpose. We aimed to investigate acute and chronic postoperative analgesic effects of erector spinae plane block (ESPB) after cardiac surgery. PATIENTS AND METHODS: We retrospectively evaluated patients who underwent cardiac surgery between December 2019 and December 2020. According to regional anesthesia management, there were two groups: ESPB and control groups. Patient demographic data, surgical outcomes, and Numerical Rating Scale (NRS) and Prince Henry Hospital Pain Scores (PHHPS) were recorded. RESULTS: Patients in the ESPB group were significantly younger than those in the control group (p=0.023). The duration of surgery was significantly shorter in the ESPB group (p=0.009). Patients in the ESPB group had significantly lower NRS and PHHPS pain scores assessed at the 48th hour after extubation (p=0.001 for both cases) and three months after discharge (p<0.001 and p=0.025, respectively). Significance remained after adjustment for age (p=0.029 and p<0.001, respectively) and duration of surgery (p=0.003 and p=0.041, respectively). CONCLUSIONS: ESPB might benefit patients with cardiac surgery by reducing acute and chronic postoperative pain.

Effect of concentrated growth factor (CGF) on short-term clinical outcomes after partially impacted mandibular third molar surgery: A split-mouth randomized clinical study.

PURPOSE: The aim of this study was to evaluate the effectiveness of concentrated growth factor(CGF) on soft tissue healing and postoperative side effects following third molar surgery. METHODS: This study was designed on 60 patients as a randomized single-blind clinical trial. The predictor variable was the implementation of CGF fibrin matrix, which was categorized as CGF and non-CGF. The primary outcome variable of the study was the healing of soft tissue around the extraction socket. The secondary outcome variables were pain, swelling and trismus. Data were analyzed using the non-parametric Brunner and Langer model. Statistical significance was set at P<.001. RESULTS: Sixty patients (39 female, 21 male; mean age 25.82) with impacted mandibular third molars participated in the study. Statistical analysis revealed that there were significant differences between the control and test groups with regard to soft tissue healing, postoperative pain, swelling, and trismus (P<0.001). CONCLUSION: The application of CGF accelerates soft tissue healing and is beneficial in minimising postoperative side effects, particularly pain, swelling and trismus, after extraction of mandibular third molars. CLINICAL TRIALS NUMBER: NCT03913884.

The role of concentrated growth factor on implant stability: A preliminary study.

PURPOSE: The purpose of this preliminary study was to evaluate the effect of concentrated growth factor (CGF) on dental implant stability in type 2 bone using the resonance frequency analysis (RFA) device Smartpeg®. METHODS: The researchers carried out a prospective cohort study on a sample group composed of 12 patients (mean age=67) who required dental implants. Implant socket preparation (with and without CGF) was the primary predictor variable. In each patient, two dental implants were inserted in the anterior mandible. For the test group, one dental implant socket was covered with CGF membrane, while the other socket was prepared conventionally for the control group. Implant stability, as measured by RFA, was the outcome variable. Measurements were taken using the Ostell device at the time of implant placement and at the 1st, 2nd and 4th weeks. RESULTS: Mean implant stability quotients (ISQs) were 67.00±4.573 for the study group and 64.75±5.065 for the control group. The difference between the two groups was not statistically significant. CONCLUSION: It was found that CGF did not provide beneficial effect on dental implant stability in the early healing period in type 2 bone.

Clinical benefits and effectiveness of static computer-aided implant surgery compared with conventional freehand method for single-tooth implant placement.

PURPOSE: To evaluate the effectiveness of static computer-aided surgery technique with the conventional freehand method to assess the role of the surgical template in terms of duration of operation and postoperative pain levels. METHODS: Total of 26 implants were placed: 13 using tooth-supported surgical templates; and 13 using the conventional freehand method. Duration of the surgery was recorded for all operation sites. After implant insertion, all patients were asked to evaluate two separate visual analog scales (VAS) at regular intervals for 1 week. All patients underwent cone beam computed tomography (CBCT) evaluation to assess the depth of deviation of the planned and placed implants. RESULTS: The deviation of implants inserted using the computer-aided surgical technique and conventional freehand technique demonstrated no significant differences (P<0.05). However, the computer-aided surgery technique significantly decreased the duration of the surgery and post-op pain levels. CONCLUSION: Tooth supported surgical templates had no particular effect on the accuracy of single implant placement. Nevertheless, this procedure allows flappless surgery with minimal invasive approach, reduce operation time and post-op pain levels. If further studies with larger study samples confirm the abovementioned results, surgical templates may be recommeded even in patients with single tooth loss.

Three-dimensional bone grafting in dental implantology using autogenous bone ring transplant: Clinical outcomes of a one-stage technique.

BACKGROUND: An insufficient bone volume at the maxillary anterior region often restricts dental implant treatment and commonly leads to poor aesthetic outcomes. The defective site requires bone grafting as an initial surgical intervention before dental implant placement. In dental implantology, reconstructing osseous defects using autologous block bone grafts, biomaterials, or a combination of both is a routine surgical procedure. This study aims to evaluate the efficacy of autogenous, symphyseal, bone ring block grafts after the augmentation of defective sockets and clinical application of grafts in the maxillary anterior region with immediate insertion of a dental implant in a single surgical procedure. MATERIALS AND METHODS: The study included eight patients (five females and three males) with 12 defective sockets. The technique included removing the bone from the chin region for transplant, fitting the three-dimensional bone rings in the prepared sockets of the maxillary anterior region, and screwing the dental implants through the rings. Patients underwent postoperative clinical examinations every day during the first week and then every month for 6 months. RESULTS: In two cases, the wound dehisced but healed by secondary intervention during the follow-up period. In one case, the ring graft sequestrated because of infection in postoperative month 2, the osseous defect was reconstructed with biomaterials. The remaining cases healed with no infection, and no other case failed during the first year. CONCLUSION: This technique showed promising and advantageous results, and thus, could be an alternative treatment to other autogenous graft techniques, particularly for defective sockets.

Association of male pattern baldness with angiographic coronary artery disease severity and collateral development.

OBJECTIVE: We aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously. METHODS: Coronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores. RESULTS: Although subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development. CONCLUSIONS: There was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.

The combination of agomelatine and ritanserin exerts a synergistic interaction in passive avoidance task.

Agomelatine is a potent agonist at melatonergic 1 and 2 (MT1 and MT2) receptors and an antagonist at serotonin-2C (5HT-2C) receptors. It was suggested that psychotropic effects of agomelatine is associated with its melatonergic and serotonergic effects. In this study, we aimed to evaluate the effects of agomelatine alone or in combination with ritanserin (5HT-2A/2C antagonist) on memory and learning. Male Balb-C mice (25-30 g) were used, and all drugs and saline were administrated by intraperitoneal (i.p.) route 30 min prior to evaluating retention time. Whilst agomelatine was administered at the doses of 1, 10 and 30 mg/kg, ritanserin was administered at the doses of 0.1, 1 and 10 mg/kg. To evaluate memory function, passive avoidance test was used. On the first day, acquisition time and on the second day (after 24h), retention time of mice were recorded. To evaluate the synergistic activity, only the least doses of agomelatine and ritanserine were used, that is, 1 and 0.1 mg/kg, respectively. Scopolamine (1 mg/kg) was used as a reference drug, so it was combined with drug groups. Our results show that 5HT-2A/2C receptor antagonist ritanserin (1 and 4 mg/kg, i.p.) and agomelatine (10 and 30 mg/kg, i.p.) improve memory deficit induced by scopolamine, whilst a synergistic interaction is observed between ritanserin and agomelatine (0.1 mg/kg and 1 mg/kg, i.p., respectively) when they were administered at their ineffective doses. According to our findings, we concluded that agomelatine improves memory deficit and thus improves the effect of agomelatine arises from its 5HT-2C receptor antagonist activity.

Is attention deficit and hyperactivity disorder a risk factor for sustaining fractures of proximal humerus?

PURPOSE OF THE STUDY: To evaluate whether or not children with displaced proximal humerus fractures are more likely to have attention deficit and hyperactivity disorder (ADHD). PATIENTS AND METHOD: Between January 2010 and February 2013, we retrospectively evaluated 42 children with proximal humerus fractures. Requirements for inclusion were an open epiphyseal plate and a non-pathological fracture of the proximal humerus. Fractures were classified according to Salter-Harris, Neer and Horwitz. Following orthopaedic examination, all of the children were consulted to child psychiatry department of our hospital. Orthopaedic examination included a detailed physical examination; the assessment of the overall shoulder functions using the Constant score. Diagnostic and Statistical Manual of Mental Disorders, Text Revisions (DSM-IV-TR) were used for psychiatric examination. RESULTS: 9 of the 42 children with proximal humerus fractures consulted to child psychiatry were put ADHD diagnoses (21 %). Of the remaining 33 children without ADHD diagnosis, 5 children were operated; percentage of surgery was 15%. We found statistically significant difference between the rates of ADHD diagnosed children with proximal humerus fractures and ADHD diagnoses in normal population (p<0.01). There was also statistically significant difference between operation rates of children with or without ADHD diagnosis (55 % vs. 15 %) (p<0,01). CONCLUSIONS: ADHD can be accepted as a risk factor for sustaining high energy trauma and rate of ADHD children who were operated was significantly more than normal children. This might be due to more displaced, open fractures or polytrauma - higher energy trauma- they sustained. Deciding on the treatment method, surgery may be treatment of choice in certain children with severely displaced, irreducable, fractures or polytrauma with accompanying ADHD due to the potential difficulties during follow up period.

Relationship between coronary in-stent restenosis and plasma urotensin II level.

AIM: In-stent restonosis is an important limitation for coronary stenting. The cause of in-stent restenosis is neointimal hyperplasia developed from smooth muscle and matrix. We aimed to investigate the association between urotensin II (U-II) and in-stent restenosis after coronary stenting, which causes endothelial and muscle proliferation and accumulation of collagen. METHODS: Total 153 patient was enrolled to the study who meet criteria for angiographic indication underwent coronary artery angiography. All patients have history undergone for coronary stent implantation 3 to 9 months ago. In-stent restenosis is identified as ≥50% narrowing inside the stent. In-stent restenosis was observed in 73 and remaining of 80 patients revealed no critical lesion in stent on angiographic evaluation. Plasma level measurement of U-II was performed in all subjects. RESULTS: Urotensin II levels were found to be significantly higher in Group I compared to Group II (1.44±0.74 ng/mL and 1.21±0.59 ng/mL, respectively, P=0.03). In a subgroup analysis, U-II levels were significantly higher in group I than group II in patients treated with bare metal stent (BMS) (1.50±0.76 ng/mL and 1.18±0.56 ng/mL, P=0.016); however, there was not significant change in patients treated with drug-eluted stent (1.26±0.64 ng/mL and 1.27±0.63 ng/mL, P=0.9). Multivariate statistical significance: negative correlation was found between in-stent restenosis and renin-angiotensin-system (RAS) blocker usage (P=0.040) and right coronary artery (RCA) lesion interventions (P=0.018). CONCLUSION: This study revealed high plasma U-II level might be accepted as a risk factors for in-stent restenosis with BMS. In-stent restenosis is less developed after RCA interventions and taking drug of RAS blockages. Our study findings need to be confirmed in further studies.

Association of Tourette syndrome and obsessive-compulsive disorder with allergic diseases in children and adolescents: a preliminary study.

OBJECTIVES: To investigate the rate of allergic diseases including asthma, allergic rhinitis and eczema in children and adolescents diagnosed with obsessive-compulsive disorder (OCD) (n:26) and/or Tourette syndrome (TS) (n:32) [OCD plus TS, n:13] compared to control subjects (n:35) [total, n:80]. PATIENTS AND METHODS: The symptoms of any allergic disease were assessed using the ISAAC questionnaire form. Allergy diagnoses were made by a pediatric allergy specialist. Skin prick tests were applied, and IgE levels and eosinophil counts were measured. RESULTS: While only one-fifth of the control subjects had allergic diseases, more than half of the children with TS and/or OCD had comorbid allergic diseases. Positive skin prick tests were greater in OCD patients compared to control subjects. There were no significant differences between the groups in terms of eosinophil counts or IgE levels. Among the allergic diseases, while allergic rhinitis was diagnosed at significantly higher rates in TS patients, eczema was significantly higher in OCD patients compared to control subjects. CONCLUSIONS: This preliminary study shows an association between allergic diseases and TS and/or OCD. The results revealing differences in associations between types of allergic disease (rhinitis or eczema) and neuropsychiatric disorder (tic disorder or OCD) need to be investigated in further studies with higher numbers of participants, and immune markers should be examined.

Video-based tracking of single molecules exhibiting directed in-frame motion.

Trajectories of individual molecules moving within complex environments such as cell cytoplasm and membranes or semiflexible polymer networks provide invaluable information on the organization and dynamics of these systems. However, when such trajectories are obtained from a sequence of microscopy images, they can be distorted due to the fact that the tracked molecule exhibits appreciable directed motion during the single-frame acquisition. We propose a new model of image formation for mobile molecules that takes the linear in-frame motion into account and develop an algorithm based on the maximum likelihood approach for retrieving the position and velocity of the molecules from single-frame data. The position and velocity information obtained from individual frames are further fed into a Kalman filter for interframe tracking of molecules that allows prediction of the trajectory of the molecule and further improves the precision of the position and velocity estimates. We evaluate the performance of our algorithm by calculations of the Cramer-Rao Lower Bound, simulations, and model experiments with a piezo-stage. We demonstrate tracking of molecules moving as fast as 7 pixels/frame (12.6 µm/s) within a mean error of 0.42 pixel (37.43 nm).

Note: Piezoelectric strain voltage sensing at ultra-low frequencies.

Piezoelectric sensors have emerged as a versatile tool for measurement of various quantities such as pressure, acceleration, strain, or force across many industrial applications. When mechanically strained, electric charges are produced inside a piezoelectric transducer. These charges result in an electric field that may be measured as a voltage difference between two electrodes, from which the strain can be inferred. To measure this voltage the sensor must be interfaced with an external device that would typically have a finite input impedance. This, together with the capacitive nature of the piezoelectric sensor, results in an inability to measure strain at low frequencies. We propose a method, based on using a varactor diode in an oscillator circuit, which can result in accurate measurements of the piezoelectric voltage at ultra-low frequencies. We demonstrate successful measurements at 1 mHz.

Giant coronary sinus and absent right superior vena cava.

Although persistent left superior vena cava (PLSVC) is rare, it is the most common thoracic venous anomaly. The prevalence of PLSVC is 0.3 % in a general population and 10 % in patients with congenital heart disease. Diagnosis of PLSVC is usually incidental during cardiovascular imaging or surgery. Although PLSVC is usually not associated with any negative hemodynamic effect, it is important to be aware of its existence, since it may cause problems in central venous catheterization, pacemaker implantation and cardiopulmonary bypass. The overall proportion of absent right superior vena cava in patients with PLSVC is approximately 20 %. If PLSVC is associated with absence of the right superior vena cava, the coronary sinus may become gigantic due to excessive inflow. Herein, we report a case of PLSVC complicated by the absence of a right superior vena cava resulting in a giant coronary sinus.

UWB-WBAN sensor node design.

In this paper, we discuss the hardware development of a UWB sensor node for wireless body area networks. A few unique UWB pulse generation techniques have been discussed. The sensor node transmits multiple pulses per bit to increase the average power of the transmitted signal in order to improve the bit-error rate (BER) performance. The multiple-pulse per bit technique is also used as the coding scheme to identify the individual sensor nodes when more than one sensor forms a network. The sensors nodes are able to transmit body signals up to 2 m with a BER lower than 10(-5).

A MICS telemetry implant powered by a 27MHz ISM inductive link.

An implantable telemetry device is presented, inductively powered by a 5.8 mW 27 MHz ISM-band supply and received with a stacked-spiral implantable power coil. A 15th harmonic 405 MHz MICS-band data carrier is generated from the power signal, data-modulated, filtered and sent to a receiver via a wireless data link. The implantable module is tested in a biological environment, successfully proving the concept.

Prolonged Raman lasing in size-stabilized salt-water microdroplets on a superhydrophobic surface.

We demonstrate prolonged Raman lasing from individual salt-water microdroplets with 10-20 microm diameters located on a superhydrophobic surface. The mechanism is based on the absorption heating of a 1064 nm cw IR laser and the resonant heating of a 532 nm pulsed, pump laser. A clear hysteresis is observed in the lasing intensity as the droplet size is photothermally tuned by the IR laser, indicating a self-stabilization mechanism due to the resonant absorption of the pump laser. Using this mechanism, Raman lasing near 650 nm is sustained for up to 25 min, approximately 1000 times longer than lasing durations reported in previous studies.

Do routine preoperative imaging techniques facilitate the operation in endometrial cancer?

OBJECTIVE: To assess the role of routine intravenous pyelography (IVP), rectoscopy and additional imaging techniques like computed tomography (CT) and abdominal ultrasonography (USG) for the evaluation of patients with endometrial cancer. MATERIALS AND METHODS: A total of 97 women with endometrial cancer (82 endometrioid and 15 non-endometrioid type) of all stages (Stage I = 65, II = 14, III = 13, IV = 5) were included in the study. Of these, 50 women were admitted because of postmenopausal bleeding, 24 with irregular vaginal bleeding and 7 with pain and leucorrhea, whereas the others had no complaints. Only one patient had symptoms related to the gastrointestinal system, but none for the urinary system. Preoperative CT (n = 45), IVP (n = 78), rectoscopy (n = 46), and USG or colonoscopy (n = 37) were performed on our patients. All the women had total abdominal hysterectomy and bilateral salpingo-oophorectomy, with/without pelvic (n = 81) and paraaortic (n = 34) lymphonodectomy, and omentectomy (n = 35). RESULTS: In 39 of 45 women who had CT, it had no effect on the operation and did not facilitate the operation. In two women there were pathological findings on CT and some interventions (resection and anastomosis) were performed on the gastrointestinal tract in these patients. However, CT had overcome pathological findings related with the gastrointestinal or urinary systems in four women, who needed interventions to these systems during the operation. CT was not performed on six women who needed interventions to the gastrointestinal system during the operations. Three patients had pathological findings (fissure, external compression) in rectoscopy, but only one patient had ileo-transverstomy, in which rectoscopic finding had not predicted the necessity of that procedure. Out of 78 IVP, the only finding was external compression to the bladder in 38 patients, and this finding had no contribution to the operation. Among women who had USG or colonoscopy (n = 37) performed, five had pathological findings that contributed to the extensiveness or the mode of the operations (liver nodules, polyps in the colon). CONCLUSIONS: Routine preoperative computed tomography, intravenous pyelography, rectoscopy or abdominal USG and colonoscopy have little impact on the decision and the prediction of the extensiveness of the operation.

Breast cancer, ovarian gonadoblastoma and cervical cancer in a patient with Peutz-Jeghers Syndrome.

BACKGROUND: Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disorder characterized by gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Patients with PJS have increased risk for gastrointestinal, breast, and female genital tract cancers. CASE: Multiple genital tract cancers in a 34-year-old woman with PJS are described. The patient, who was admitted to our department with severe vaginal bleeding, was performed right salpingo-oophorectomy because of pure gonadoblastoma in 1996. In 2003, concomitant to cervical carcinoma, breast cancer was diagnosed. Patient underwent left modified radical mastectomy due to the invasive papillary carcinoma. The patient received six cycles combination chemotherapy and radiation therapy because of stage IIIB cervical cancer. CONCLUSION(S): This is the first case report presenting PJS associated with multiple genital tract tumors including ovarian gonadoblastoma in literature. The clinical significance of these tumors in PJS patients has been reviewed.

Placenta percreta diagnosed after first-trimester pregnancy termination: a case report.

BACKGROUND: Placenta percreta in early pregnancy has been documented in only a few cases. This is the first report of placenta percreta diagnosed after an extended period from pregnancy termination. CASE: A woman with a history of a previous cesarean section presented with heavy and irregular vaginal bleeding beginning immediately after pregnancy termination at 7 weeks' gestation. Failed response to hormonal treatment and curettage necessitated hysterectomy. Histologic examination revealed a placenta percreta. CONCLUSION: Although placenta percreta is an uncommon occurrence, clinicians should consider it in patients who have a uterotomy scar and complain of long-term metrorrhagia following pregnancy termination.