Serratus Anterior Plane Block and Erector Spinae Plane Block Versus Thoracic Epidural Analgesia for Perioperative Thoracotomy Pain Control: A Randomized Controlled Study.

OBJECTIVES: This study was designed to evaluate the safety and efficacy of erector spinae plane block and serratus anterior plane block versus thoracic epidural in perioperative pain control for patients with cancer undergoing lung surgeries. DESIGN: Single blinded, randomized, controlled trial. SETTING: The study was carried out at the National Cancer Institute in Cairo, Egypt. PARTICIPANTS: Fifty-one patients with cancer. INTERVENTIONS: Patients were allocated randomly into three groups: thoracic epidural analgesia (TEA) group, serratus anterior plane block (SAPB) group, and erector spinae plane block (ESPB) group. MEASUREMENTS AND MAIN RESULTS: Outcome measures were 24 hours postoperative visual analog scale (VAS), intraoperative rescue fentanyl consumption, perioperative heart rate, mean blood pressure (mean arterial pressure [MAP]), and total postoperative morphine consumption. VAS scores at rest were significantly lower in the TEA group at the postanesthesia care unit and 24 hours. VAS scores with cough were significantly higher in the SAPB group at eight and 24 hours. The first time to receive morphine was significantly longer in the TEA group. No patients in the TEA group required postoperative morphine, whereas 88.2% and 47.1% required morphine in the SAPB and ESPB groups, respectively, p < 0.001. In the TEA group, intraoperative MAP values were lower than the other two groups, p < 0.05. CONCLUSIONS: Erector spinae plane block can be used as an effective and safe alternative to thoracic epidural analgesia and shows superior analgesic profile to serratus anterior plane block for patients with lung cancer undergoing posterolateral thoracotomy.

Green Synthesis and Characteristics of Cellulose Nanocrystal/Poly Acrylic Acid Nanocomposite Thin Film for Organic Dye Adsorption during Water Treatment.

Nanocellulose shows potential as an effective natural adsorbent for removing harmful contaminants from wastewater. This paper describes the development of innovative nanocellulose thin films made of cellulose nanocrystals (CNCs), polyacrylic acid (PAA), and active carbon (AC) as adsorbent materials for absorbing azo dyes from wastewater. The CNCs were recovered from sugarcane bagasse using alkali treatment and acid hydrolysis. The composition and processing parameters of the thin films were optimized, and their adsorption capacity was determined using thermodynamic isotherms and adsorption kinetics. Adsorption characteristics such as the methylene blue (MB) dye concentration, contact time, temperature, and pH were investigated to determine how they affected adsorption. The results show that the adsorption process follows pseudo-second-order kinetics. At an adsorbent mass of 50 mg, dye concentration of 50 ppm in 50 mL, and contact period of 120 min at 25 °C, the thin film comprising 64 wt% CNC, 16 wt% PAA, and 20 wt% AC showed high dye removal efficiency (86.3%) and adsorption capacity (43.15 mg/g). The MB removal efficiency increased to 95.56% and the adsorption capacity to 47.78 mg/g when the medium's pH was gradually increased from neutral to alkaline. The nontoxicity, low production cost, water stability, easy recovery, and high adsorption capacity of these membranes make them suitable for water treatment systems.

Management of Incidental Uncontrolled Elevation of Intraoperative Blood Pressure: A Comparative Study on Nitroglycerine Versus Dexmedetomidine Infusion.

Background: Uncontrolled elevation of intraoperative blood pressure can result in deleterious effects with increased risk of morbidity and mortality. Objectives: We aimed to compare nitroglycerine infusion with dexmedetomidine infusion in controlling accidental intraoperative uncontrolled hypertension. Methods: This comparative study was conducted on 73 hypertensive patients undergoing cancer surgeries who experienced uncontrolled intraoperative hypertension. The data of 38 patients were retrieved from the medical records for the nitroglycerine group and 35 patients were prospectively enrolled for the dexmedetomidine group. Group N received nitroglycerine infusion (0.3 - 1 µg/kg/min), while group D received dexmedetomidine infusion (0.2 - 0.7 µg/kg/h). Results: Both groups were comparable regarding their demographic data and clinical characteristics. Systolic, diastolic, and mean arterial pressure (MAP) values were significantly lower in group N compared to group D during the period between 60 and 120 minutes intraoperatively (P < 0.001). Heart rate values were significantly lower in group D than in group N (P < 0.001). Postoperative sedation scores were better for group D with lower analgesic requirements (P < 0.001). Conclusions: Dexmedetomidine infusion can be used to manage the uncontrolled intraoperative elevation of blood pressure in selected patient population.

Metal-based-oxide nanoparticles assisted the in vitro culture growth of Populus alba as micronutrients: essential metabolic processes and genetic stability.

The present study evaluates the in vitro culture growth rate of Populus alba upon using nano metal-based-oxides such as hematite (Fe2O3 NPs), zinc oxide (ZnO NPs), and manganese oxide (Mn2O3 NPs) nanoparticles as analogues of three primary micronutrients such as iron (Fe), zinc (Zn), and manganese (Mn), which exist in soil as micronutrients. Herein, the in vitro culture growth rate was investigated using three different concentrations (i.e., 20, 40, and 60 mg L-1) of as-prepared metal oxide nanoparticles compared to the control. In addition, the as-prepared nanoparticles have been prepared via the co-precipitation method. Furthermore, the physicochemical properties were investigated using transmission electron microscopy, Fourier transform infrared spectroscopy, X-ray diffraction, and dynamic light scattering techniques. Overall, a significant difference in the biomass production-related parameters such as fresh weight, shoot length, and root length was observed compared to the control upon the treatment with micronutrient-based nano-metal-oxides (i.e., Mn2O3 > Fe2O3 > ZnO NPs, respectively). In addition, a significant increase in the root number of Populus alba plants upon their treatment with ZnO NPs was observed compared to other prepared nano-metal-oxides and the control. Also, a remarkable increase in the chlorophyll index was monitored upon the treatment with Fe2O3 NPs rather than the other commonly used Mn2O3 and ZnO NPs, respectively. Moreover, RAPD-PCR bioassays were applied, and the actual six primers showed a genetic variation percentage of 34.17%, indicating that Populus alba is highly genetically stable even in highly contaminated soil. As a result, our findings suggest an idea that indicates the ability to enhance the in vitro culture growth rate of Populus alba plants using metal oxide nanoparticles as analogous to essential micronutrients.

Combined Effects of Yellow Mealworm (Tenebrio molitor) and Saccharomyces cerevisiae on the Growth Performance, Feed Utilization Intestinal Health, and Blood Biomarkers of Nile Tilapia (Oreochromis niloticus) Fed Fish Meal-Free Diets.

Aquafeed quality is the most critical factor for aquaculture sustainability. However, limitations of traditional feed ingredients such as fishmeal (FM) need alternative strategies to ensure the nutritional requirements for aquatic animals. In this trial, four test diets were formulated (2 × 2 factorial design), where FM was incorporated in two diets at 10% with or without Saccharomyces cerevisiae (SC) at 1 g/kg. At the same time, FM was replaced with yellow mealworm (Tenebrio molitor) meal (TM) with or without SC at 1 g/kg. The growth performance indices (final weight, weight gain, and SGR), and the feed utilization indices (FCR and PER) were markedly affected by the protein source (FM or TM) and dietary SC (P < 0.05). The protein source (FM or TM) significantly (P < 0.05) affected the whole-body protein and lipid contents, while the moisture and ash contents were unaffected (P > 0.05) by TM or SC. The growth of the intestinal villi showed a marked increase in both height and branching in the treated groups with SC along the whole length of the intestine. Furthermore, the immune cell infiltration was prominent near the intestinal crypts of the middle intestinal segments in the supplemented groups by SC. Dietary TM and SC revealed improved hepatic parenchyma in the liver tissue better than other groups. The hematological indices, including hemoglobulin, hematocrit, red blood cells, and white blood cells, were markedly affected by dietary SC (P < 0.05). The lysozyme activity and phagocytic index were markedly affected by dietary SC, while phagocytic activity was affected by dietary TM (P < 0.05). The catalase, glutathione peroxidase, and malondialdehyde were markedly affected by the interaction between dietary protein source and SC, while superoxide dismutase was affected by dietary SC (P < 0.05). In conclusion, adding SC could enhance the utilization of TM by Nile tilapia with positive effects on the intestinal and liver histological features and the immune and antioxidative responses.

Auditory function assessment in patients with chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease is a multisystem disease with multiple comorbidities. Hearing is dependent on the cochlear functions that may be affected by oxygenation. Affection of hearing is problematic and represents a major concern that should be seriously investigated as an important comorbidity in chronic obstructive pulmonary disease patients. Objective: To assess auditory status among chronic obstructive pulmonary disease patients. Methodology: The current study was carried out at Al-Azhar University Hospitals, Cairo, from 1 August 2021 to 2022, including 120 participants. In addition to the control group (60 healthy participants), there were two study groups: chronic obstructive pulmonary disease patients with respiratory failure group (30 patients) and non-respiratory failure group (30 patients). Hearing functions were studied using pure tone audiometry, and auditory brain stem response. Results: There was statistically significant hearing impairment in chronic obstructive pulmonary disease patients in comparison to control group. The hearing impairment was more significant in chronic obstructive pulmonary disease with respiratory failure group in comparison to chronic obstructive pulmonary disease without respiratory failure group. The auditory impairment shows a negative interrelationship with oxygen tension (PaO2) and a positive interrelationship with the smoking index. Conclusion: Hearing affection was meaningfully higher among chronic obstructive pulmonary disease patients and more prominent in patients with respiratory failure. Hypoxia results in deterioration of pure tone audiometry and increased absolute and interpeak latencies in auditory brain stem response. At every frequency, the mean pure tone audiometry thresholds were higher for chronic obstructive pulmonary disease groups than control group albeit remaining in the mild to moderate area of hearing loss. Retro-cochlear affection was suggested among patients with chronic obstructive pulmonary disease as evidenced with the prolongation of auditory brain stem response waves latencies.

Role of Lung Ultrasound in Confirmation of Double Lumen Endotracheal Tube Placement for Thoracic Surgeries: A Prospective Diagnostic Accuracy Study.

Background: In thoracic surgeries requiring thoracotomy incisions, correct positioning of the double-lumen endotracheal tube (DLT) is mandatory. After the pandemic of novel COVID-19, using simple, noninvasive technology such as lung ultrasound (LUS) can be important in avoiding the possibility of spreading infectious diseases or contagious infections that can follow using fiberoptic bronchoscopy (FOB). Objectives: We aimed to assess the accuracy of auscultation and LUS in relation to FOB in the assessment of DLT placement and to identify the possibility of using LUS as an alternative to FOB during DLT insertion. Methods: This diagnostic accuracy study was conducted according to STARD guidelines; enrolled 120 cases requiring DLT intubation. After DLT insertion, all patients were examined by stethoscope, then by LUS for determination of DLT position, and then confirmed by FOB in the same patient. Results: Three patients dropped out due to failed intubation, and only 117 cases were analyzed. Time was significantly longer for LUS than for auscultation and FOB and was insignificantly different between auscultation and FOB. Auscultation had 76.14% sensitivity, 34.48% specificity, and 65.81% accuracy in the determination of correct DLT placement. LUS had 92.05% sensitivity, 79.31% specificity, and 88.89% accuracy in detecting correct DLT placement. There was substantial agreement between LUS and FOB (κ = 0.705) and poor agreement between auscultation and FOB (κ = 0.104). Conclusions: LUS can be used as a simple, noninvasive tool for detecting DLT placement with a substantial agreement with FOB.

Curcumin assisted green synthesis of silver and zinc oxide nanostructures and their antibacterial activity against some clinical pathogenic multi-drug resistant bacteria.

According to WHO warnings, the antibiotic resistance crisis is a severe health issue in the 21st century, attributed to the overuse and misuse of these medications. Consequently, the dramatic spreading rate of the drug-resistant microbial pathogens strains. The microbiological, biochemical tests and antibiotic sensitivity identified the bacteria's multi-drug resistance (MDR). About 150 different clinical samples were taken from hospitalized patients, both males, and females, ranging from 9 to 68 years. Gram-negative strains were (70.0%), while Gram-positive isolates were (30.0%). Among sixteen antibiotics, antibiotic susceptibility of imipenem was found to be the most efficient drug against most of the Gram-negative and Gram-positive isolates, followed by meropenem, depending on the culture and sensitivity results. All the experimental bacteria showed multidrug-resistant phenomena. In this study, green synthesized silver (Cur-Ag NPs) and zinc oxide (Cur-ZnO NPs) nanoparticles in the presence of curcumin extract. In addition, their physicochemical properties have been characterized using different techniques such as UV-Vis spectroscopy, transmission electron microscope (TEM), X-ray diffraction (XRD), Fourier transform infrared (FT-IR), and colloidal properties techniques. Furthermore, curcumin-capped silver nanoparticles (AgNPs) exhibited solid antimicrobial action against the experimental bacterial isolates, except Proteus vulgaris (i.e., P. vulgaris). Curcumin-capped zinc oxide nanoparticles (ZnO NPs) found antimicrobial activity against all tested strains. Finally, the minimum inhibitory concentration exhibited values from 3.9 to 15.6 µg ml-1, which is too small compared to other traditional antibiotics. In addition, the green-synthesized Cur-Ag NPs and Cur-ZnO NPs showed good biocompatibility.

Intercropping kura clover with prairie cordgrass mitigates soil greenhouse gas fluxes.

Prairie cordgrass (PCG) (Spartina pectinata Link) has a high tolerance to soil salinity and waterlogging, therefore, it can thrive on marginal lands. Optimizing the nitrogen (N) input is crucial to achieving desirable biomass production of PCG without negatively impacting the environment. Thus, this study was based on the hypothesis that the use of legumes such as kura clover (Trifolium ambiguum M. Bieb.) (KC) as an intercrop with PCG can provide extra N to the crop reducing the additional N fertilizer and mitigating soil surface greenhouse gas (GHG) emissions. Specific objective of the study was to assess the impact of PCG managed with different N rates [0 kg N ha-1 (PCG-0N), 75 kg N ha-1 (PCG-75N), 150 kg N ha-1 (PCG-150N), and 225 kg N ha-1 (PCG-255N)], and PCG intercropped with KC (PCG-KC) on GHG fluxes and biomass yield. The experimental site was established in 2010 in South Dakota under a marginally yielding cropland. The GHG fluxes were measured from 2014 through 2018 growing seasons using the static chamber. Net global warming potential (GWP) was calculated. Data showed that cumulative CH4 and CO2 fluxes were similar for all the treatments over the study period. However, the PCG-KC, PCG-0N, and PCG-75N recorded lower cumulative N2O fluxes (384, 402, and 499 g N ha-1, respectively) than the PCG-150N (644 g N ha-1) and PCG-255N (697 g N ha-1). The PCG-KC produced 85% and 39% higher yield than the PCG-0N in 2016 and 2017, respectively, and similar yield to the other treatments (PCG-75N, PCG-150N, and PCG-255N) in these years. Net GWP was 52% lower for the PCG-KC (112.38 kg CO2-eq ha-1) compared to the PCG-225N (227.78 kg CO2-eq ha-1), but similar to other treatments. Soil total N was 15%% and 13% higher under PCG-KC (3.7 g kg-1) than that under PCG-0N (3.2 g kg-1) and PCG-75N (3.3 g kg-1), respectively. This study concludes that intercropping prairie cordgrass with kura clover can enhance biomass yield and reduce fertilizer-derived N2O emissions and net global warming potential.

Surgical Management of Facial Features of Robinow Syndrome: A Case Report.

BACKGROUND: Robinow Syndrome is an extremely rare genetic disorder characterised by abnormalities in head, face and external genitalia. This disorder exists in dominant pattern with moderate symptoms and recessive pattern with more physical and skeletal abnormalities. It was first introduced by Menihard Robinow in 1969. It was related to chromosome 9q22 ROR2 gene related to bone and cartilage growth aspects. CASE PRESENTATION: A 17-year-old Egyptian male presented to National Research Centre Orodental genetics Clinic with typical features of short stature and facial dysmorphism weighted 50 Kg and measured 150 cm height complaining of facial dis figurement. There was no significant prenatal history, and family history was negative for congenital disabilities and genetic disorders. Clinical examination revealed macrocephaly and special facial features as prominent forehead, deformed ear pinna, hypertelorism, flat nasal tongue tie, deficient malar bone, bow-shaped upper and lower lips and dimpled chin. Orally the patient suffered from tonetie, gingival hypertrophy and dental malalignment. The orthopantomogram showed multiple impacted teeth. The physical examination revealed that the patient had deformed spine, short limbs with ectrodactyly, micropenis & hypospadias. Surgical management included correction of midface deficiency with zygomatic augmentation, closed rhinoplasty for the broad nose, lips muscles release and tongue tie relief. The patient is currently undergoing orthodontic treatment for his teeth. CONCLUSION: Improvement of facial features and a good psychological impact on the patient and his family.