Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery.

Background: Clavicle fractures account for over one-third of shoulder injuries and up to 3.3% of all fractures in adults. While the majority of these fractures can be managed non-surgically, there are instances where surgical intervention is performed. Regional anesthesia (RA) can be a preferred alternative to general anesthesia (GA) to avoid complications and high costs in this surgery. Moreover, the identification of the most optimal approach for RA remains challenging. Objectives: This study aimed to compare the efficacy of interscalene block (ISB) with and without superficial cervical plexus block (SCPB) as an anesthetic technique for clavicular fracture operation. Methods: This double-blinded, non-inferiority clinical trial was conducted on 120 patients randomly divided into 2 groups: One receiving ISB and the other receiving ISB with SCPB. The primary outcome was defined as the conversion to GA. Various factors were recorded, including surgery duration, nerve block initiation, analgesics required in the postanesthesia care unit (PACU), and sedation during surgery. Pain was evaluated using the Visual Analog Scale (VAS) in PACU. SPSS version 26 was used for statistical analysis, performing descriptive analysis, Student's t-tests, and Mann-Whitney U tests to compare non-parametric variables between the 2 groups. Statistically significant results had a P value of less than 0.05. Results: A total of 120 patients were randomly divided into 2 equal groups, each consisting of 50 males and 10 females. The mean age of intervention and case groups were 37.23 ± 13.30 and 38.43 ± 11.95 years, respectively. After performing statistical tests (Student's t-test and Mann-Whitney U test), there was no significant difference in the initiation time of nerve block, surgery initiation time, surgery duration, the amount of required sedation, VAS scores, and meperidine consumption (P > 0.05). None of the patients in both groups required conversion to GA. Conclusions: The primary goal was achieved in all included cases, and no patients required conversion to GA. The efficacy of ISB is the same whether or not it is combined with a SCPB. Interscalene block is an alternative RA approach for clavicle fractures. Thus, ISB alone is as efficient as when used in combination with SCPB.

Erector spinae plane block as an anesthesia technique for an emergent thoracotomy; a case report.

BACKGROUND: The erector spinae plane block (ESPB) is a novel regional block technique for pain management following thoracic surgeries. However, there are minimal cases in which the technique was used as the main anesthesia technique during surgery. CASE PRESENTATION: Here, we report the successful use of ESBP for applying anesthesia in a case during an emergent thoracotomy for performing pericardiotomy and loculated tamponade evacuation. CONCLUSIONS: Using ESPB with a higher concentration of local anesthetics, in this case, prepared appropriate anesthesia for performing an emergent thoracotomy while avoiding multiple needle insertions and the risk of further hemodynamic instability.

The efficacy of ultrasound-guided erector spinae plane block (ESPB) versus freehand ESPB in postoperative pain management after lumbar spinal fusion surgery: a randomized, non-inferiority trial.

PURPOSE: Spine surgeries have experienced exponential growth over the past 2 decades. These surgeries are often accompanied by long and severe perioperative pain, presenting a significant management challenge. This study aims to assess and compare the efficacy of two techniques for postoperative pain (POP) management in lumbar spine surgeries: ultrasound-guided erector spinae plane block (ESPB) and intraoperative freehand ESPB. METHODS: In this prospective randomized non-inferiority trial (Registration Number: IRCT20221107056427N1), adult patients who were candidates for lumbar spinal fusion surgery were randomly divided into two groups: ultrasound-guided ESPB (n = 29) and freehand ESPB (n = 29). The primary outcomes were the total amount of morphine consumed during the first 24 h following the surgery and the numerical rating scale (NRS) pain score at various time points within the first 24 h following the surgery. The secondary outcome was the fentanyl used during surgery. RESULTS: Participants in the intraoperative freehand approach had considerably higher total morphine consumption in the first postoperative 24 h. The trend of NRS changes in both the ultrasound-guided ESPB group and the freehand ESPB group during the first 24 h after surgery showed a significant decrease. Still, there was no significant difference between the two groups. However, the first analgesic demand time was significantly shorter in the intraoperative freehand ESPB group compared to the ultrasound-guided approach. CONCLUSION: According to our results, the ultrasound-guided approach of ESPB is more effective in POP management and opioid sparing in lumbar spinal fusion surgeries compared to the freehand approach. However, the data from this study are not sufficient to draw robust conclusions, and further randomized controlled trials with larger sample sizes are required to validate our results.

Quadratus Lumborum Block versus Fascia Iliaca Compartment Block for Acetabular Fracture Surgery by Stoppa Method: A Double-Blind, Randomized, Noninferiority Trial.

Background: Acetabular fracture surgeries are frequently accompanied by protracted and severe perioperative pain, and there is no consensus on optimal pain relief management. Aim: This study aimed at comparing the analgesic efficacy of fascia iliaca compartment block (FICB) and quadratus lumborum block (QLB) in patients with acetabular fractures undergoing surgery using the Stoppa method. Methods: In this double-blind, randomized, noninferiority clinical trial, adult patients undergoing spinal anesthesia for acetabular fracture surgery, in Imam Hossein Hospital, Tehran, Iran (IRCT20191114045435N1), were randomly divided into two groups: FICB (n = 22) and QLB (n = 24). The visual analog scale (VAS) was used to assess the pain intensity at different times for all participants. In addition, the dose of fentanyl required to induce the patient to sit for spinal anesthesia and the pain intensity were evaluated. Moreover, the duration of analgesia and the total amount of morphine consumed in the first 24 h following surgery were evaluated, analyzed, and compared between the two study groups. Results: FICB and QLB demonstrated effective comparative postoperative analgesic profiles following acetabular fracture surgery; however, no significant differences in VAS values were observed between the two groups during the study. FICB experienced reduced cumulative fentanyl consumption during spinal anesthetic placement, whereas QLB had a significantly lower total morphine demand in the initial postoperative 24 h period. Conclusion: The lateral QLB and FICB can be introduced as effective routes for analgesia in acetabular fracture surgery using the Stoppa method. Clinical Trial Registration. The study was prospectively registered in the clinical trials registry system, on 2021-02-17, with registration number: IRCT20191114045435N1.

Assessing the impact of aprepitant and ondansetron on postoperative nausea and vomiting in orthognathic surgeries: a randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common side effect associated with general anesthesia. Both ondansetron and aprepitant been effectively used to prevent PONV. However, there is a disagreement of opinions regarding the superiority of these two drugs. This study aims to compare the efficacy of aprepitant with ondansetron in preventing PONV following orthognathic surgeries. METHODS: In this double-blinded clinical trial, 80 patients scheduled for orthognathic surgery at Imam Hossein Hospital, Tehran, Iran, were randomly assigned to two groups. A standardized anesthesia protocol was used for all patients. The first group received a placebo capsule administered one hour before the surgical procedure along with 4 mg (2 ml) of ondansetron intravenously after anesthesia induction. The second group was given 80 mg aprepitant capsules one hour before the surgery, followed by an injection of 2 ml intravenous distilled water after anesthesia induction. The occurrence and severity of PONV, the amount of rescue medication required, and the complete response of patients assessed within 24 h after the surgery. RESULTS: There were no significant differences in demographic data between the two groups. Patients in the aprepitant group had a significantly lower incidence and severity of nausea (2.5% versus 27.5%), vomiting (5% versus 25%), and required fewer rescue medications (7.5% versus 62.5%) compared to the ondansetron group. Additionally, the aprepitant group showed a higher complete response rate (90% versus 67.5%) in the 0-2 and 12-24 postoperative hours. CONCLUSION: According to the findings of this study, aprepitant has demonstrated a greater efficacy in preventing PONV following orthognathic surgery, when compared to ondansetron. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT code: IRCT20211205053279N3), date of registration: 16/12/2022.

Prophylactic Fibrinogen Reduces Excessive Bleeding in Total Hip Arthroplasty Surgery: A Randomized Double-blinded Placebo-controlled Trial.

Objectives: Excessive blood loss is a critical complication of total hip arthroplasty. We intended to determine whether preoperative fibrinogen administration reduces perioperative bleeding and the need for blood transfusion in total hip arthroplasty surgery. Methods: In 4 months, 178 patients who underwent total hip arthroplasty were randomly assigned equally to intervention and placebo-control groups in a double-blinded, parallel two-arm randomized controlled trial. Both intravenously, 30 min before the start of the surgery, the intervention group received two grams of fibrinogen concentrate dissolved in 100 ml of distilled water. In contrast, the control group received 100 ml of normal saline solution. The amount of postoperative blood loss served as the main result, and the requirement for blood transfusions served as the secondary outcome. Results: In comparison to the placebo, administering fibrinogen concentrate considerably reduced the amount of blood loss (P=0.001) and the requirement for blood transfusions (P=0.004). Patients who got fibrinogen concentrate experienced no side effects. In addition, patients in the fibrinogen group had significantly lower hemoglobin and higher fibrinogen levels in the recovery room and received lesser blood transfusions (P<0.005) than the placebo group. Conclusion: In total hip arthroplasty, fibrinogen concentrate lessens postoperative bleeding and the requirement for blood transfusions.

Biosynthesis of Copper Oxide Nanoparticles with Potential Biomedical Applications.

INTRODUCTION: In recent years, the use of cost-effective, multifunctional, environmentally friendly and simple prepared nanomaterials/nanoparticles have been emerged considerably. In this manner, different synthesizing methods were reported and optimized, but there is still lack of a comprehensive method with multifunctional properties. MATERIALS AND METHODS: In this study, we aim to synthesis the copper oxide nanoparticles using Achillea millefolium leaf extracts for the first time. Catalytic activity was investigated by in situ azide alkyne cycloaddition click and also A3 coupling reaction, and optimized in terms of temperature, solvent, and time of the reaction. Furthermore, the photocatalytic activity of the synthesized nanoparticles was screened in terms of degradation methylene blue dye. Biological activity of the synthesized nanoparticles was evaluated in terms of antibacterial and anti-fungal assessments against Staphylococcus aureus, M. tuberculosis, E. coli, K. pneumoniae, P. mirabili, C. diphtheriae and S. pyogenes bacteria's and G. albicans, A. flavus, M. canis and G. glabrata fungus. In the next step, the biosynthesized CuO-NPs were screened by MTT and NTU assays. RESULTS: Based on our knowledge, this is a comprehensive study on the catalytic and biological activity of copper oxide nanoparticles synthesizing from Achillea millefolium, which presents great and significant results (in both catalytic and biological activities) based on a simple and green procedure. CONCLUSION: Comprehensive biomedical and catalytic investigation of the biosynthesized CuO-NPs showed the mentioned method leads to synthesis of more eco-friendly nanoparticles. The in vitro studies showed promising and considerable results, and due to the great stability of these nanoparticles in a green media, effective biological activity considered as an advantageous.

Lipase immobilized on functionalized superparamagnetic few-layer graphene oxide as an efficient nanobiocatalyst for biodiesel production from Chlorella vulgaris bio-oil.

BACKGROUND: Microalgae, due to its well-recognized advantages have gained renewed interest as potentially good feedstock for biodiesel. Production of fatty acid methyl esters (FAMEs) as a type of biodiesel was carried out from Chlorella vulgaris bio-oil. Biodiesel was produced in the presence of nano-biocatalysts composed of immobilized lipase on functionalized superparamagnetic few-layer graphene oxide via a transesterification reaction. A hybrid of few-layer graphene oxide and Fe3O4 (MGO) was prepared and characterized. The MGO was functionalized with 3-aminopropyl triethoxysilane (MGO-AP) as well as with a couple of AP and glutaraldehyde (MGO-AP-GA). The Rhizopus oryzae lipase (ROL) was immobilized on MGO and MGO-AP using electrostatic interactions as well as on MGO-AP-GA using covalent bonding. The supports, MGO, MGO-AP, and MGO-AP-GA, as well as nano-biocatalyst, ROL/MGO, ROL/MGO-AP, and ROL/MGO-AP-GA, were characterized using FESEM, VSM, FTIR, and XRD. The few-layer graphene oxide was characterized using AFM and the surface charge of supports was evaluated with the zeta potential technique. The nano-biocatalysts assay was performed with an evaluation of kinetic parameters, loading capacity, relative activity, time-course thermal stability, and storage stability. Biodiesel production was carried out in the presence of nano-biocatalysts and their reusability was evaluated in 5 cycles of transesterification reaction. RESULTS: The AFM analysis confirmed the few-layer structure of graphene oxide and VSM also confirmed that all supports were superparamagnetic. The maximum loading of ROL (70.2%) was related to MGO-AP-GA. The highest biodiesel conversion of 71.19% achieved in the presence of ROL/MGO-AP-GA. Furthermore, this nano-biocatalyst could maintain 58.77% of its catalytic performance after 5 cycles of the transesterification reaction and was the best catalyst in the case of reusability. CONCLUSIONS: In this study, the synthesized nano-biocatalyst based on bare and functionalized magnetic graphene oxide was applied and optimized in the process of converting microalgae bio-oil to biodiesel for the first time and compared with bare lipase immobilized on magnetic nanoparticles. Results showed that the loading capacity, kinetic parameters, thermal stability, and storage stability improved by the functionalization of MGO. The biocatalysts, which were prepared via covalent bonding immobilization of enzyme generally, showed better characteristics.

Removal of trace organic contaminants by melamine-tuned highly cross-linked polyamide TFC membranes.

In recent years, forward osmosis (FO) has represented numerous potential applications in safe water production. In this study, we improved the performance of FO thin film composite (TFC) membranes for the removal of trace organic compounds (TOrCs) by tuning the chemistry of its top active layer. The TFC membranes were synthesized by interfacial polymerization (IP) reaction between amine-containing monomers, e.g., meta-phenylene diamine (MPD) or para-phenylenediamine (PPD), and an acid chloride monomer, e.g., trimesoyl chloride (TMC). Owing to three free amine functionals over main core, melamine was used in the amine monomers solution to increase cross-linking among polyamide chains. Chemical and morphological characterization of the prepared membranes confirmed that melamine was successfully incorporated into the chemical structure of the top PA layer. Two agricultural toxic materials (atrazine and diazinon) were used to investigate the capability of the newly fabricated membranes in the removal of TOrCs. The obtained results showed that melamine-improved FO membranes provided higher atrazine and diazinon rejections in two different FO membrane configurations, including active layer facing feed solution (ALF) and active layer facing draw solution (ALD). The highest rejections of both diazinon (99.4%) and atrazine (97.3%) were achieved when the melamine modified MPD-based membrane served in ALF mode with 2 M NaCl as a draw solution.

Polyoxometalate based thin film nanocomposite forward osmosis membrane: Superhydrophilic, anti-fouling, and high water permeable.

Thin-film composite (TFC) membranes with high water flux and low reverse salt flux are the most conventional materials for forward osmosis (FO) process. However, these membranes are not suitable for natural or wastewaters treatment due to the intrinsic physicochemical and surface properties of the rejection layer. The present work shows the fabrication of new thin film nanocomposite (TFN) forward osmosis membranes incorporate superhydrophilic modified silica nanoparticles. Surface of silica nanoparticles were functionalized by quaternary ammonium groups and subsequently were coated using superhydrophilic wheel polyoxometalates (POM). TFN membranes containing different weight ratio of nanoparticles in PA rejection layer were synthesized by interfacial polymerization (IP) of m-phenylenediamine (MPD) and trimesoyl chloride (TMC) as monomers in aqueous and organic solution, respectively. POM coated silica nanoparticles were dispersed in aqueous solution of MPD monomer prior to IP process. The changing in the performance and physicochemical properties of TFN membranes incorporating with superhydrophilic nanoparticles were investigated by different instrumental analysis and were compared with a pristine TFC membrane. Compared to pristine TFC membrane, the TFN membrane with 0.2 wt% nanoparticle incorporation (TFNw0.2) showed superior water flux (18 vs. 31 LMH in FO mode) and negligible increases in reverse salt flux (6.25 vs. 8.45 gMH). In addition, better anti-fouling propensity toward protein (bovine serum albumin, BSA) and organic (sodium alginate, SA) foulant was observed. Therefore, Using newly developed thin film nanocomposite membranes may provide a novel class of high-performance membrane for FO processes.

Study of polyamide thin film characteristics impact on permeability/selectivity performance and fouling behavior of forward osmosis membrane.

In recent years, forward osmosis (FO) has received considerable attention due to its huge potentials in water desalination. The thin film composite (TFC) membrane used in the FO desalination consists of a bottom support layer covered by an active layer on top. Polyamide (PA) is commonly employed as an active layer forming via interfacial polymerization between m-phenylenediamine (MPD) and trimesoyl chloride (TMC) monomers. In this study, the effects that the MPD and TMC concentrations could have on the performance and anti-fouling behavior of the obtained FO membrane have been investigated. Results showed that there is a trade-off relationship between the water flux and salt rejection, which by increasing MPD concentration, the water flux was reducedو while the salt rejection was enhanced. Also, by increasing the TMC concentration, an opposite trend was observed. Using 0.20 wt.% of TMC monomer, the highest water fluxes of 21.6 LMH and 29.3 LMH were achieved in two different membrane configurations. Furthermore, higher TMC concentration caused better anti-fouling property, when PA active layer of the membrane was in a high fouling potential environment.

Optimisation of green synthesis of MnO nanoparticles via utilising response surface methodology.

This study concerns the optimisation of green synthesis of manganese oxide nanoparticles (MnO NPs) with Dittrichia graveolens (L.) extract via response surface methodology (RSM). Central composite design was used to evaluate the effect of pH, time, and the extract to the metal ratio on the synthesised nanoparticles (NPs). Nine runs were designed to investigate the effect of each parameter while NPs were synthesised under different conditions. Considering the p-values (p-value < 0.05), it is indicated that the extract to the metal ratio was the most effective parameter. The synthesised NPs were characterised using UV-vis. Synthesis of the NPs by polyphenolic compounds of green reducing agent and their stabilisation by curcumin was confirmed by Fourier transform infrared spectra and the surface morphology of the spherical MnO NPs was studied by field-emission scanning electron microscopy and transmission electron microscope techniques. The present researchers claimed the optimal condition as follows: time = 56.7 min, pH = 7.2, and the extract to the metal ratio = 87.9 v/v. MnO NPs at optimum condition were then employed for degradation of industrial dyes and they showed high dye degradation activity against Rhodamine B and light green dye. The average size of the synthesised MnO NPs at optimal condition was claimed to be nearly 38 nm.

Important Factors Influencing Severity of Common Variable Immunodeficiency.

BACKGROUND: Common variable immunodeficiency (CVID) is a primary immune deficiency with heterogeneous complications. The purpose of this study is to determine disease severity in a cohort of CVID patients based on the suggested scoring system and investigate predisposing factors which would be helpful to predict the severity of the disease. METHODS: The study population comprised 113 CVID patients (69 males and 44 females) who were visited at Children's Medical Center (Pediatrics Center of Excellence affiliated to Tehran University of Medical Sciences, Tehran, Iran) during the last 30 years (from 1984-2014). According to a suggested severity scoring system, patients were divided into two groups, A and B. The clinical severity of the disease in patients was assessed with severity scores including 15 unlucky complications of the disease such as numbers of past meningitis, encephalitis or pneumonias, development of bronchopulmonary pathologies, presence of lymphoproliferative disorders, autoimmunity or malignancy. RESULTS: The mean serum IgG level was significantly higher in group B (308.6±195.9) compared to group A (177.8 ± 151.9; P = 0.03). Patients in group B had a significantly higher percentage of CD8 (P = 0.003). However, they had lower percentage of CD4 lymphocytes (P = 0.08), switched memory B cells (CD27+IgM-IgD-) (P < 0.01) and regulatory T cells (P = 0.02) than group A. CONCLUSION: Using standard and universal scoring system and understanding of related factors can be applicable in clinical settings for prognosis assessment of CVID patients.

Effect of nano-composite and Thyme oil (Tymus Vulgaris L) coating on fruit quality of sweet cherry (Takdaneh Cv) during storage period.

Sweet cherry is one of the most appreciated fruit by consumers since it is an early season fruit and has an excellent quality. In this study effect of active nano composite formed from chitosan (as a matrix material), nano cellulose fiber (1% concentration) and Thyme oils (Tymus Vulgaris L) at 1% concentration on fruits quality was investigated. Treated fruits were stored at 1°C for 5 weeks and changes of different qualities attributes including weight loss, total acidity, TSS, anthocyanin, total sugar and malic acid content (by high performance liquid chromatography (HPLC) method) were measured each week. Results showed that nano composite and Thyme oil significantly affect fruit's water retention and so decrease fruit weight loss and preserve anthocyanin (P < 0.05). None of applied treatments had any significant effects in comparison with control in regard to acidity while total sugar content and TSS significantly affected by treatment compared to control samples. Result of HPLC analysis showed that there was no significant difference between different treatment and control sample in term of malic acid concentrations during storage period but increase storage time lead to increase malic acid concentration in all treatments. For conclusion it can be Saied that fruits coating with nano-composite, lead to increase fruit shelf life, better appearance and prevents fungal growth that may be due to creation of an active packaging by these compounds.