Brachial plexus block using only 1% lidocaine to reduce pain during the endovascular treatment of dysfunctional arteriovenous access.

BACKGROUND: Interventional endovascular treatments of dysfunctional arteriovenous (AV) access for hemodialysis can cause pain and discomfort to the patients. Ultrasound-guided brachial plexus block (BPB) is an alternative regional anesthesia method, but conventional BPB using ropivacaine or bupivacaine may cause long-lasting motor power loss, significantly reducing patient satisfaction. This study aimed to introduce BPB using only 1% lidocaine, which induces sensory loss while minimizing motor block, and evaluate the efficacy and safety of this procedure. METHODS: This retrospective study was conducted on 277 consecutive patients with dysfunctional AV access requiring percutaneous transluminal angioplasty (PTA). Of these, 174 patients underwent the BPB procedure using 1% lidocaine. Time data were recorded, and the motor strength grade (MRC scale, grade 0-5) was evaluated. Numeric rating pain score (NRPS, grade 0-10) was asked during every PTA, and overall NRPS and satisfaction scores (scale 1-3) were asked after the procedure was completed. RESULTS: Of the 174 patients who received BPB, the success rate was 100%, and there were no significant complications related to BPB. The MRC scale measured at the time when the complete sensory loss was achieved was 1.99 ± 0.63, and that at the point of sensory recovery when the block effect expired was 3.93 ± 0.62, indicating a good grade of motor strength. The average NRPS during PTA in the BPB group was significantly lower than that of the control group without BPB (1.04 ± 2.04vs 6.30 ± 2.71, p < 0.001). The overall satisfaction score was significantly higher in the BPB group than in the control group (2.79 ± 0.50vs 2.00 ± 0.81, p < 0.001). CONCLUSIONS: BPB using only 1% lidocaine can induce a sensory block while minimizing the effect on motor function. It can be applied safely in an outpatient clinic setting with relatively higher satisfaction.

Endovenous radiofrequency ablation using a new bipolar electrode in a canine model: a new endovenous radiofrequency electrode.

Purpose: This study aimed to determine the effectiveness and safety of a newly developed endovenous radiofrequency (RF) catheter compared with that of the existing RF catheter in a canine model. Methods: Seven dogs underwent ablation using 1 control catheter (ClosureFAST, CF; Covidien) and 1 experimental catheter (VENISTAR, VS; STARmed Co., Ltd.) in the femoral and cephalic veins. The ablated vein was evaluated macroscopically (2,3,5-triphenyltetrazolium chloride staining, TTC), microscopically (hematoxylin and eosin staining), and ultrasonographically. Vessel injury score was used to evaluate the ablating effect objectively. Veins from 1 dog were evaluated on the day of ablation, while in the remaining 6 dogs, the ablated veins were evaluated 2 weeks later. Results: A total of 23 veins (CF, 11 veins; VS, 12 veins) were ablated in 7 dogs. Non-TTC-stained vein wall areas were identified in all ablated veins. No significant difference was observed in the mean vessel injury score (2.54 ± 1.16 vs. 2.42 ± 1.13, P = 0.656) and the mean vessel wall thickness (0.32 ± 0.03 mm vs. 0.31 ± 0.05 mm, P = 0.212) between CF and VS. There was no blood flow in all veins ablated with VS, whereas there was remaining blood flow in 1 vein ablated with CF. Perivenous complication was not observed. Conclusion: Endovenous RF ablation using a newly developed VS RF catheter seems to provide comparable occlusion rate and degree of vein wall injury without perivenous adverse events compared to the most commonly used RF catheter (CF).

Safety and efficacy of Mynx vascular closure device for the closure of common femoral artery access after ipsilateral stent placement.

INTRODUCTION: To evaluate the feasibility and safety of the Mynx vascular closure device (VCD) for arteriotomy closure after stent placement near the common femoral artery (CFA) access site. METHODS: A total of 88 patients (73 men; mean age, 72 ± 9.2 years; 136 procedures) who underwent closure of CFA arteriotomy using the Mynx VCD after stent placement in proximal superficial femoral artery (SFA) with antegrade approach, or in common or external iliac artery with retrograde approach were retrospectively studied. Technical success and access site complication were evaluated. Body mass index (BMI), platelet count, international normalized ratio, prior history of ipsilateral CFA access, access direction, degree of CFA calcification, stent location and diameter, total procedure time, and sheath size were analyzed to evaluate their relationship with technical failure and development of bleeding complications. RESULTS: Technical success was achieved in 94.9% (129/136) patients. The mean time to hemostasis was 0.7 ± 1.8 min. Technical failure was significantly associated with low BMI (p = 0.001). Other variables presented no significant relationship with technical failure and development of complications. Ultrasonography on the day after the procedure revealed that 8 (5.9%) patients had hematoma. CONCLUSIONS: Mynx VCD for arteriotomy closure is feasible and provides hemostatic safety after stent placement near antegrade or retrograde CFA access. However, Mynx VCD may have a poor technical success rate among patients with low BMI.

Enhanced Osteogenesis of Dental Pulp Stem Cells In Vitro Induced by Chitosan-PEG-Incorporated Calcium Phosphate Cement.

The use of bone graft materials is required for the treatment of bone defects damaged beyond the critical defect; therefore, injectable calcium phosphate cement (CPC) is actively used after surgery. The application of various polymers to improve injectability, mechanical strength, and biological function of injection-type CPC is encouraged. We previously developed a chitosan-PEG conjugate (CS/PEG) by a sulfur (VI) fluoride exchange reaction, and the resulting chitosan derivative showed high solubility at a neutral pH. We have demonstrated the CPC incorporated with a poly (ethylene glycol) (PEG)-grafted chitosan (CS/PEG) and developed CS/PEG CPC. The characterization of CS/PEG CPC was conducted using Fourier transform infrared spectroscopy (FT-IR) and X-ray diffraction (XRD). The initial properties of CS/PEG CPCs, such as the pH, porosity, mechanical strength, zeta potential, and in vitro biocompatibility using the WST-1 assay, were also investigated. Moreover, osteocompatibility of CS/PEG CPCs was carried out via Alizarin Red S staining, immunocytochemistry, and Western blot analysis. CS/PEG CPC has enhanced mechanical strength compared to CPC, and the cohesion test also demonstrated in vivo stability. Furthermore, we determined whether CS/PEG CPC is a suitable candidate for promoting the osteogenic ability of Dental Pulp Stem Cells (DPSC). The elution of CS/PEG CPC entraps more calcium ion than CPC, as confirmed through the zeta potential test. Accordingly, the ion trapping effect of CS/PEG is considered to have played a role in promoting osteogenic differentiation of DPSCs. The results strongly suggested that CS/PEG could be used as suitable additives for improving osteogenic induction of bone substitute materials.

Oleanane hemiacetal glycosides from Gymnema latifolium and their inhibitory effects on protein tyrosine phosphatase 1B.

Gymnema sylvestre (Retz.) R. Br. ex Schult. has a long history to be used as an antidiabetic herbal medicine. Various varieties of G. sylvestre, have been studied intensively on their 3ß-hydroxy oleanane triterpenoid composition for hypoglycemic effects. It is also well-known that most species belonging to the same genus have similar chemical composition and biological activity. Thus, an extract of the Gymnema latifolium Wall. ex Wight, which showed considerable protein tyrosine phosphatase 1B (PTP1B) inhibitory activity (>70% inhibition at 30 µg/mL), was studied intensively. Extensive chemical investigation on the 70% EtOH of G. latifolium led to the isolation of four previously undescribed oleanane hemiacetal glycosides, gymlatinosides GL1-GL4, three previously undescribed oleanane glycosides, gymlatinosides GL5-GL7, and two known 3ß-hydroxy oleanane analogs. The structures of the previously undescribed compounds were elucidated using diverse spectroscopic methods. The hemiacetal structure of the glycoside portion was further elaborated precisely by HMBC and J resolved proton NMR. Gymlatinosides GL2 and GL3 showed considerable PTP1B inhibitory effect.

Regression of varicose veins after cyanoacrylate closure of incompetent great saphenous veins without a localized concomitant procedure.

OBJECTIVE: The objective of this study was to evaluate the effectiveness and safety of endovenous cyanoacrylate closure (CAC) of incompetent great saphenous vein (GSV) and to assess the regression of varicose vein following CAC without a concomitant procedure. METHODS: A total of 63 limbs in 48 patients treated with CAC because of an incompetent GSV between December 2016 and November 2017 were retrospectively evaluated. In five limbs, incompetent GSV and small saphenous vein were treated simultaneously in the same session. Duplex ultrasound, Venous Clinical Severity Score, degree of regression of varicose veins, and adverse events were examined at intervals of 1 week, 1 month, 3 months, 6 months, and 12 months. RESULTS: In 63 limbs, of which 60 were available for follow-up, all treated GSVs showed complete closure during the follow-up period (8.4 ± 3.0 months). Venous Clinical Severity Scores at the time of all follow-up visits were significantly lower (P < .001) than those before CAC. Complete resolution of varicose veins was noted in 38 limbs (71.7%) after 3-month follow-up. The proportion of limbs showing >50% varicose vein regression reached 90.6%. The more that varicosity entry was covered (P = .002) and the farther down the leg the access site was located (P = .024), the more complete resolution of varicose veins was observed. Phlebitis occurred in 10 limbs (16.7%), and hyperpigmentation occurred in 8 limbs (13.3%). CONCLUSIONS: CAC is safe and effective for the treatment of an incompetent GSV. It also shows a satisfactory result with the regression of varicose veins. Covering the entry of varicosities and accessing lower down the leg are associated with more complete resolution of varicose veins.

Degradation by water vapor of hydrogenated amorphous silicon oxynitride films grown at low temperature.

We report on the degradation process by water vapor of hydrogenated amorphous silicon oxynitride (SiON:H) films deposited by plasma-enhanced chemical vapor deposition at low temperature. The stability of the films was investigated as a function of the oxygen content and deposition temperature. Degradation by defects such as pinholes was not observed with transmission electron microscopy. However, we observed that SiON:H film degrades by reacting with water vapor through only interstitial paths and nano-defects. To monitor the degradation process, the atomic composition, mass density, and fully oxidized thickness were measured by using high-resolution Rutherford backscattering spectroscopy and X-ray reflectometry. The film rapidly degraded above an oxygen composition of ~27 at%, below a deposition temperature of ~150 °C, and below an mass density of ~2.15 g/cm3. This trend can be explained by the extents of porosity and percolation channel based on the ring model of the network structure. In the case of a high oxygen composition or low temperature, the SiON:H film becomes more porous because the film consists of network channels of rings with a low energy barrier.

Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid-enhanced MRI.

BACKGROUND: To investigate the agreement between Kupffer phase of Sonazoid contrast-enhanced sonography (CEUS) and hepatobiliary phase of gadoxetic acid-enhanced MRI in the evaluation of focal liver lesions (FLLs). METHODS: One hundred fifty-four FLLs in 154 patients who underwent both Sonazoid CEUS and gadoxetic acid-enhanced liver MRI were included in this retrospective study. FLL visibility on the Kupffer-phase images was graded as one (invisible or isoenhancing), two (vaguely visible or vaguely hypoenhancing), or three (clearly visible or clearly hypoenhancing), and that on the hepatobiliary-phase images of MRI was graded as one (invisible or hyper/isointense), two (vaguely visible or weakly hypointense), or three (clearly visible or strongly hypointense). Pairwise comparison of lesion visibility between the two modalities was performed, and intermodality agreement was assessed. RESULTS: On Kupffer-phase CEUS, 31 (20.1%) lesions were invisible, 17 (11.1%) were vaguely visible, and 106 (68.9%) were clearly visible. On the hepatobiliary-phase MRI, 9 (5.9%) lesions were invisible, 45 (29.2%) were vaguely visible, and 100 (64.9%) were clearly visible. Overall, lesion visibility scores were not significantly different between the two modalities (p = 0.121), but the visibility was significantly better on MRI in smaller lesions. Twenty-eight lesions (18.2%) showed discrepancy in the visibility on CEUS and MRI, and most of the cases (89.7%) were lesions that were invisible on CEUS but visible on MRI. CONCLUSIONS: The overall visibility of FLLs was comparable between the Kupffer phase of Sonazoid-CEUS and the hepatobiliary-phase images of gadoxetic acid-enhanced MRI, with a discrepancy between the two modalities in 18% of the cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:542-550, 2017.

Flavonoid Glycosides Inhibit Sortase A and Sortase A-Mediated Aggregation of Streptococcus mutans, an Oral Bacterium Responsible for Human Dental Caries.

Three flavonoids were isolated from dried flowers of Sophora japonica using repetitive column chromatography and high-performance liquid chromatography. The flavonoids were identified as rutin (1), quercetin-3'-O-methyl-3-O-α-L-rhamnopyranosyl(1 → 6)-ß-D-glucopyranoside (2), and quercetin (3) on the basis of spectroscopic analysis and comparison of values reported in the literature. These compounds inhibited the action of sortase A (SrtA) from Streptococcus mutans, a primary etiologic agent of human dental caries. The onset and magnitude of inhibition of saliva-induced aggregation of S. mutans treated with compound 1 was comparable to that of untreated S. mutans with a deletion of the srtA gene.

Streptococcus mutans sortase A inhibitory metabolites from the flowers of Sophora japonica.

A new maltol derivative (2) along with three known maltol derivative (1) and flavonol glycosides (3 and 4) were isolated from the dried flowers of Sophora japonica. Based upon the results of combined spectroscopic methods, the structure of new compound (2) was determined to be maltol-3-O-(4'-O-cis-p-coumaroyl-6'-O-(3-hydroxy-3-methylglutaroyl))-ß-glucopyranoside, an isomer of 1. These compounds strongly inhibited the action of sortase A (SrtA) from Streptococcus mutans, a primary etiologic agent of human dental caries. The onset and magnitude of inhibition of the saliva-induced aggregation in S. mutans treated with compound 2 (4×IC50) were comparable to the behavior of untreated srtA-deletion mutant.

Consenting Practice of ENT Trainees: To What Extent Is Trainee Involvement Disclosed?

AIM: To assess to what extent ENT trainees disclose their involvement in operations to their patients when obtaining consent. BACKGROUND: It is not clear how the trainees are conducting the consenting process, although it could lead to a medico-legal conflict. DESIGN AND PARTICIPANTS: A 6-question questionnaire was sent via email to 22 ENT trainees in Northern Deanery, and 14 ENT registrars in Yorkshire Deanery. MAIN OUTCOME MEASURES: Seniority of the participants. Disclosure of the main operating surgeon and trainee involvement in the consenting process. Influence of operation complexity in trainee involvement disclosure. RESULTS: The response rate was 69%. Of the respondents, 46% consistently informed patients about trainee involvement in operations. Only 28% felt the complexity of operations influenced their decision to disclose trainee involvement. Subgroup analysis showed there was no statistically significant difference between junior and senior trainees in trainee involvement disclosure. If the trainees informed patients about who the operator would be, it was more likely for them to also disclose their own involvement. Many trainees also felt that the 'no guarantee of a particular surgeon' clause in the National Health Service consent form implied possible trainee involvement even if they did not specify it verbally. CONCLUSION: The rate of trainee involvement disclosure is not related to the seniority of trainee or complexity of operations, but is related to operator disclosure. This may suggest trainee involvement disclosure is not dependent on the level of confidence of trainees but on the approach and attitude towards the consenting process.

Bioactive Metabolites from the Fruits of Psoralea corylifolia.

Twenty-four metabolites, including seven new compounds (1-7), were isolated from the dried fruits of Psoralea corylifolia. On the basis of combined spectroscopic and chemical analysis, the new compounds were determined to be six flavonoids (1-6) and a meroterpenoid (7). The absolute configurations of the natural products obtained, including the previously undetermined 16 and 17, were assigned by several methods, such as NOE spectroscopy, optical rotation, and CD spectroscopy. Several of these compounds exhibited moderate inhibitory activity toward Staphylococcus mutans-derived SrtA (2, 6, and 16) and significant stimulation of SIRT1 activity (2, 3, and 15).

Recurrence rate of cholesteatoma with autoclaved incus autograft.

OBJECTIVE: To study the long-term recurrence rate of cholesteatoma with autoclaved incus autograft. STUDY DESIGN: Prospective observational study between 1994 and 2009. The incus remnants were autoclaved at 134°C for 24 minutes at 205 kPa. The mean follow-up duration was 65.5 months, with a minimum follow-up duration of 31 months and a maximum follow-up duration of 186 months. SETTING: Secondary referral center in a district general hospital. PATIENTS: Thirty-seven cases of cholesteatoma treated with canal wall down mastoidectomy with primary ossicular reconstruction with autoclaved incus autograft were included. The age range of the patients was from 11 years to 67 years. The mean age was 38 years. Fifty-four percent was male, and 46% was female. INTERVENTIONS: Therapeutic and rehabilitative--to treat and improve the patients' hearing loss secondary to cholesteatoma by using autoclaved autologous incus. MAIN OUTCOME MEASURES: Primary end point is the recurrence rate of cholesteatoma with a mean follow-up period of more than 5 years. Secondary end point is the audiometric outcome with air-bone gap (ABG) and air conduction improvement. RESULTS: No recurrence of cholesteatoma was observed. No graft extrusion was seen. Preoperative mean ABG was 29.8 dB. Postoperative mean ABG was 25.6 dB at the final review, with the air conduction improvement at final review at 4.2 dB. CONCLUSION: Autoclaving the incus remnant harvested from cholesteatomatous middle ear cleft is a safe and effective method to prepare an incus autograft for primary ossicular reconstruction.

Long-term safety and efficacy of radiofrequency ablation in the treatment of sleep disordered breathing: a meta-analysis.

Radiofrequency ablation (RFA) is used in the treatment of sleep disordered breathing (SDB), particularly in the alleviation of snoring. The literature provides evidence that the short-term results are promising; however, the long-term efficacy is a matter of contention. In this article, we present the results of a literature search of studies that use RFA in the treatment of SDB which have a follow-up time of greater than a year. RFA was found to be a safe technique with minimal morbidity. The overall Visual Analogue score from six studies showed the overall mean improvement to be 4.3 (confidence intervals 3.4-5.12). Apnea Hypopnea Index (AHI), improved significantly in five of the studies analysed. Epworth Sleepiness Score (ESS), improved significantly in six of the studies analysed. In conclusion, the evidence suggests that RFA for SDB results in a significant improvement in follow-up times of at least a year. Since RFA can be applied in a clinic setting and leads to minimal disruption to daily life, this treatment option can be considered for those unwilling to participate in the more traditional surgical options for SDB.

Sortase A inhibitory metabolites from the roots of Pulsatilla koreana.

Three new lignans (3, 4, and 6) along with eight known lignans and phenyl propanoids were isolated from the dried roots of Pulsatilla koreana, an oriental folk medicine. Based upon the results of combined spectroscopic and chemical methods, the structures of new compounds were determined to be lignan glycosides. Included among the known compounds are three compounds (5, 7, and 8) isolated first time from this plant as well as two compounds (2 and 11) previously reported only as synthetic derivatives. These compounds significantly inhibited the action of Sortase A from Streptococcus mutans OMZ65, an isolate from human oral cavity.

Unilateral non-Hodgkin's lymphoma of the frontal sinus presenting as Pott's puffy tumour.

Malignant lymphoma of the paranasal sinuses and nasal cavity is very rare and can mimic those of infectious, non-lymphomatous neoplastic and granulomatous process in their initial presentation, thus delaying its diagnosis. This report describes a case of unilateral frontal sinus B-cell lymphoma presenting as Pott's puffy tumour. Key features to differentiate the two conditions are discussed. A 61-year-old woman presented with 4 weeks history of a gradually enlarging right-sided forehead swelling, which was smooth and firm with no tenderness, fluctuation or overlying skin changes. Initial computed tomography (CT) of the paranasal sinuses revealed a mildly opacified right frontal sinus with an overlying soft tissue swelling. A repeat CT scan one week later showed evidence of osteomyelitis of the medial wall of the right frontal bone and orbit, suggesting diagnosis of Pott's puffy tumour. A third CT scan was performed as the swelling continued to enlarge despite antibiotics, which demonstrated a collection over the frontal sinus. No pus was found from a frontal sinus trephine. Histopathologic analysis of the frontal sinus biopsy showed diffuse large B cell lymphoma. The patient was treated successfully with 6 cycles of chemotherapy. In conclusion, it is not easy to differentiate Pott's puffy tumour from frontal sinus lymphoma at their initial presentation. With clearer understanding of both conditions, we can raise the index of suspicion among clinicians of the possibility of frontal sinus lymphoma even when evidence of osteomyelitis is present, therefore prompting earlier tissue biopsies for confirmation of diagnosis.

Cyclic Bis-1,3-dialkylpyridiniums from the sponge Haliclona sp.

Eight novel cyclic bis-1,3-dialkylpyridiniums, as well as two known compounds from the cyclostellettamine class, were isolated from the sponge Haliclona sp. from Korea. Structures of these novel compounds were determined using combined NMR and FAB-MS/MS analyses. Several of these compounds exhibited moderate cytotoxic and antibacterial activities against A549 cell-line and Gram-positive strains, respectively. The structure-activity relationships of cyclostellettamines are discussed based on their bioactivities.

In vitro sortase A inhibitory and antimicrobial activity of flavonoids isolated from the roots of Sophora flavescens.

A series of flavonoids (1-14) was isolated from the roots of Sophora flavescens. We evaluated their ability to inhibit both microbial growth and sortase A, an enzyme that plays a key role in cell wall protein anchoring and virulence in Staphylococcus aureus. Most prenylated flavonoids (7-13) displayed potent inhibitory activity against gram-positive and gram-negative bacteria except E. coli, with minimum inhibitory concentrations values ranging from 4.40 to 27.7 µM, and weak or no activity against fungal strains tested. Kurarinol (6) was a potent inhibitor of sortase A, with an IC(50) value of 107.7 ± 6.6 µM. A preliminary structure-activity relationship, including essential structural requirements, is described.