The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial.

BACKGROUND: The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study. METHODS: A total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score. RESULTS: Total morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively. CONCLUSION: Dexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption. TRIAL REGISTRATION: (ID: PACTR202203906027106; Date: 31/07/2023).

Mistletoe Extracts during the Oncological Perioperative Period: A Systematic Review and Meta-Analysis of Human Randomized Controlled Trials.

BACKGROUND: We aim to evaluate the safety and efficacy of mistletoe extract (ME) use during the oncological perioperative period. METHODS: Details registered a priori on PROSPERO (CRD42018086168). RESULTS: Seven RCTs (comprising 663 participants in nine reports) and three nonrandomized studies were included. In five RCTs, ME was evaluated as adjunctive care and the control group had no additional intervention, whereas in two RCTs, ME was compared head-to-head against common cancer treatments (i.e., etoposide or bacillus Calmette-Guérin) with the intervention groups not receiving standard care. Meta-analyses found no evidence for a difference between ME and no added therapy for mortality and recurrence (RR, 95% CI: 1.00, 0.79-1.27; and 1.03, 0.79-1.33, respectively). Two RCTs reported beneficial effects of ME on immune cells, specifically natural killer cells, in colorectal cancer, and one RCT reported quality of life improvement. Two RCTs reported ME discontinuations due to adverse events and grade 3/4 toxicities. Nevertheless, no safety signals were detected from these 10 studies. Quality appraisal revealed a substantial risk of bias. CONCLUSIONS: Preliminary data are encouraging for mistletoe extracts, particularly in the context of colorectal cancer. However, the evidence is limited by the number of studies, an evaluation of different outcomes, and methodological limitations. Further high-quality research is warranted.

Effect of particle size and weight fraction of SiC on the mechanical, tribological, morphological, and structural properties of Al-5.6Zn-2.2Mg-1.3Cu composites using RSM: fabrication, characterization, and modelling.

Stir-casting was employed to create Al-5.6Zn-2.2Mg-1.3Cu composites with particle sizes ranging from 30 to 90 µm and a weight fraction of 5-15 SiC articles. The mechanical and wear properties of the material have been assessed. The wear-behaviour of Al-5.6Zn-2.2Mg-1.3Cu composites was investigated using dry pin-on-disc wear testing. Various loads (20 N-60 N), speeds (2 m/s-6 m/s), and sliding-distances were used in the sliding wear experiments (2000 m-4000 m). In the experimental process, XRD, SEM, and EDX were used to characterize the microstructures and materials of diverse composites. Uniform dispersion of the SiC particles is clearly observed in the SEM image. The micro hardness of SiC particles increases by 13% when the weight percent of SiC particles is increased from 5% to 15%. SiC particles outperform tiny SiC particles in terms of wear-resistance. With increasing load, the particular wear-rate showed an increasing trend (20-60 N). The wear-rate of the composite lowers as the weight percentage reinforcement increases (wt. 5% to wt. 15%), and the wear-rate of the composite increases when the particle-size (30 µm-90 µm) increases. The results demonstrated that composites supplemented with coarse SiC particles outperform tiny SiC particles in terms of wear resistance.

Optical Interconnects Finally Seeing the Light in Silicon Photonics: Past the Hype.

Electrical interconnects are becoming a bottleneck in the way towards meeting future performance requirements of integrated circuits. Moore's law, which observes the doubling of the number of transistors in integrated circuits every couple of years, can no longer be maintained due to reaching a physical barrier for scaling down the transistor's size lower than 5 nm. Heading towards multi-core and many-core chips, to mitigate such a barrier and maintain Moore's law in the future, is the solution being pursued today. However, such distributed nature requires a large interconnect network that is found to consume more than 80% of the microprocessor power. Optical interconnects represent one of the viable future alternatives that can resolve many of the challenges faced by electrical interconnects. However, reaching a maturity level in optical interconnects that would allow for the transition from electrical to optical interconnects for intra-chip and inter-chip communication is still facing several challenges. A review study is required to compare the recent developments in the optical interconnects with the performance requirements needed to reach the required maturity level for the transition to happen. This review paper dissects the optical interconnect system into its components and explains the foundational concepts behind the various passive and active components along with the performance metrics. The performance of different types of on-chip lasers, grating and edge couplers, modulators, and photodetectors are compared. The potential of a slot waveguide is investigated as a new foundation since it allows for guiding and confining light into low index regions of a few tens of nanometers in cross-section. Additionally, it can be tuned to optimize transmissions over 90° bends. Hence, high-density opto-electronic integrated circuits with optical interconnects reaching the dimensions of their electrical counterparts are becoming a possibility. The latest complete optical interconnect systems realized so far are reviewed as well.

Saponin-rich extract of Tribulus terrestris alleviates systemic inflammation and insulin resistance in dietary obese female rats: Impact on adipokine/hormonal disturbances.

Tribulus terrestris saponins (TTS) have been longley used as an overall tonic and recent studies showed they influence inflammatory conditions. We examined the ameliorative effect of a commercial formula of a saponin-rich extract of TT in a model of dietary obesity in female rats focusing on their ability to control the inflammatory burden, insulin resistance (IR), adipokine expression and the related reproductive system pathologies. Female rats were fed with high fat diet (HFD) for 14 weeks to launch diet-induced obesity; they were assigned as: the obese control female rats (OFR) which received no treatment and TTS (5 and 10 mg/kg/day) treated rats; they were compared to a normal rat group. We determined the IR index, serum/tissue inflammatory cytokines, and adipose tissue adipokine expression and examined the secondary ovarian pathologies. Body weight gain, serum triglycerides and IR (>5-fold) in the OFR group were greater than the normal group; TTS lessened these parameters compared with the OFR group. TTS, at 10 mg/kg dose, ameliorated mRNA expression of leptin and visfatin genes in addition to serum inflammatory cytokine levels. Moreover, TTS corrected the hyperprolactinemia and other hormonal disturbances and ameliorated the ovarian pathologies. This study highlighted that the anti-inflammatory properties of TTS helped in alleviation of IR and body weight gain in OFR. Upon correction of obesity manifestations, the gonadal hormone dysregulations and ovarian pathologies were subsequently ameliorated. We can consider TTS as a promising candidate that may alleviate the inflammatory burden, IR and adipokine expression in obesity and hence prevent the secondary gonadal complications in female subjects if appropriate clinical studies are available.

Probiotics Evaluation in Oncological Surgery: A Systematic Review of 36 Randomized Controlled Trials Assessing 21 Diverse Formulations.

BACKGROUND: Objectives were to evaluate probiotics safety and efficacy in oncological surgery. METHODS: Systematic review methodology guided by Cochrane, PRISMA, SWiM, and CIOMS. Protocol registered on PROSPERO (CRD42018086168). RESULTS: 36 RCTs (on 3305 participants) and 6 nonrandomized/observational studies were included, mainly on digestive system cancers. There was evidence of a beneficial effect on preventing infections, with 70% of RCTs' (21/30) direction of effect favoring probiotics. However, five RCTs (17%) favored controls for infections, including one trial with RR 1.57 (95% CI: 0.79, 3.12). One RCT that changed (balanced) its antibiotics protocol after enrolling some participants had mortality risk RR 3.55 (95% CI: 0.77, 16.47; 7/64 vs. 2/65 deaths). The RCT identified with the most promising results overall administered an oral formulation of Lactobacillus acidophilus LA-5 + Lactobacillus plantarum + Bifidobacterium lactis BB-12 + Saccharomyces boulardii. Methodological quality appraisals revealed an overall substantial risk-of-bias, with only five RCTs judged as low risk-of-bias. CONCLUSIONS: This large evidence synthesis found encouraging results from most formulations, though this was contrasted by potential harms from a few others, thus validating the literature that "probiotics" are not homogeneous microorganisms. Given microbiome developments and infections morbidity, further high-quality research is warranted using those promising probiotics identified herein.

Are Supplemental Branched-Chain Amino Acids Beneficial During the Oncological Peri-Operative Period: A Systematic Review and Meta-Analysis.

BACKGROUND: Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition and sarcopenia. Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine, and tryptophan). We aimed to evaluate the safety and efficacy of BCAAs use in patients with cancer undergoing surgery. METHODS: MEDLINE, Embase, and CENTRAL were searched (inception to July 24, 2020) for randomized controlled trials (RCTs) and comparative observational studies in English evaluating BCAAs (alone or in combinations) during the oncological peri-operative period. Study selection, data extraction, and quality appraisal were done in duplicate. RCT risk-of-bias was appraised using Cochrane Risk-of-Bias tool, and observational studies' quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate. RESULTS: 20 articles were included comprising 13 RCTs and 6 observational cohort studies in 7 reports and 2019 total participants overall. Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analysis of RCTs found a 38% decreased risk of post-operative infections in BCAAs group compared to controls (RR = 0.62; 95% CI = 0.44 to 0.87; P = .006; number of RCTs, k = 6; total sample size, N = 389; I2 = 0%). BCAAs were also found to be beneficial for ascites (RR = 0.55; 95% CI = 0.35 to 0.86; P = .008; k = 4; N = 296; I2 = 0%), body weight (MD = 3.24 kg; 95% CI = 0.44 to 6.04; P = .02; k = 3; N = 196; I2 = 24%), and hospitalization length (MD = -2.07 days; 95% CI = -3.97 to -0.17; P = .03; k = 5; N = 362; I2 = 59%). No differences were found between BCAAs and controls for mortality, recurrence, other post-operative complications (liver failure, edema, pleural effusion), blood loss, quality of life, ammonia level, and prothrombin time. No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns from observational studies were identified. CONCLUSIONS: Branched-chain amino acids during the oncological surgical period demonstrated promise in reducing important post-operative morbidity from infections and ascites compared to controls. Blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs. PROSPERO REGISTRATION: CRD42018086168.

Factorial design-optimized and gamma irradiation-assisted fabrication of selenium nanoparticles by chitosan and Pleurotus ostreatus fermented fenugreek for a vigorous in vitro effect against carcinoma cells.

The novelty of the present work looks in the synthesis of aqueous dispersed selenium nanoparticles (Se NPs) using gamma rays with the aid of various natural macromolecules such as citrus pectin (CP), sodium alginate (Alg), chitosan (CS) and aqueous extract of fermented fenugreek powder (AEFFP) using Pleurotus ostreatus for investigating their impact in vitro toward carcinoma cell. The synthesized Se NPs were characterized by XRD, UV-Vis., DLS, HRTEM, SEM, EDX and FTIR. Nucleation and growth mechanisms were also discussed. The factorial design was applied to examine the importance of multiple parameters on Se NPs production with a special focus on temperature and gamma rays influences. FTIR spectrum exhibited the existence of several functional groups in Se NPs-capping macromolecules. Results revealed that Se NPs' size was dramatically-influenced by the type of stabilizer, precursors concentration, pH and the absorbed gamma rays dose. The current research reported the promising antitumor application of Se NPs against Ehrlich Ascites Carcinoma (EAC) and human Colon Adenocarcinoma (CACO) in vitro. The proliferation of EAC was significantly-hindered by Se NPs-CS (38.0 µg/ml) at 60 kGy (IC50 = 23.12%) and Se NPs-AEFFP (19.00 µg/ml) at 15 kGy (IC50 = 7.21%). Also, Se NPs control the generation of CACO cells, IC50 was recorded as 25.32% for Se NPs-CS (38.0 µg/ml) and 8.57% for Se NPs-AEFFP (19.00 µg/ml).

Antibacterial, antibiofilm, and photocatalytic activities of metals-substituted spinel cobalt ferrite nanoparticles.

This study reports the photocatalytic degradation of Methylene Blue (MB) dye (a class of dyestuffs that are resistant to biodegradation) under the influence of UV-light irradiation. Antibacterial and antibiofilm activities of ferrite nanoparticles (FO NPs) were examined against some pathogenic bacteria isolated from the medical operating room surfaces. In the same context, metals-substituted spinel cobalt ferrite nanoparticles with nominal composition [MxCo1-xFe2O4 NPs; (M = Zn, Cu, Mn; x = 0.0, 0.25, 0.5 and 0.75)] were synthesized by citrate sol-gel method. Also, the structures of the synthesized FO NPs were characterized by X-ray diffraction, and Williamson-Hall (WH) method was used to determine the crystallite size. The estimated specific surface area is found in the range from 37.99 to 107.05 m2/g, between the synthesized ferrites, Zn0.5Co0.5Fe2O4 NPs have average pore radius 1.84 nm and the pore volume was 0.136 ml/g. SEM images revealed that, the synthesized FO NPs have an unique pores and uniformly distribution, while EDX spectra shows the elemental composition for the synthesized FO NPs. The elastic properties of FO NPs have been estimated using FTIR data, whereas (M - H) hysteresis loops revealed that, by replacing cobalt ions with Zn, Cu, and Mn ions the magnetic behaviour changed from ferromagnetic to paramagnetic. Results obtained from the photocatalysis indicated that Mn0.75Co0.25Fe2O4 NPs (30.0 mg) were a promising photocatalyst achieving 96.0% removal of MB after 100 min of UV-light exposure in the alkaline solution. Antibacterial results showed that the most effective combination was Zn0.75Co0.25Fe2O4 NPs (20.0 ppm) displaying activity against Staphylococcus aureus, Enterococcus columbae, and Aerococcus viridians by 15.0, 13.0, and 12.0 mm ZOI, respectively. Additionally, Zn0.75Co0.25Fe2O4 NPs were active as antibiofilm factors producing activity by 63.7, 57.9, and 45.5% towards S. aureus, A. viridians, and E. columbae, respectively. Accordingly, Zn0.75Co0.25Fe2O4 and Mn0.75Co0.25Fe2O4 NPs can be utilized in industrial, biological and medical applications.

Efficacy of pulsed Nd:YAG laser in the treatment of patients with knee osteoarthritis: a randomized controlled trial.

The purpose of this study was to investigate the effects of pulsed Nd:YAG laser plus glucosamine/chondroitin sulfate (GCS) in patients with knee osteoarthritis (KOA) by examining changes in pain and knee function, as well as synovial thickness (ST) and femoral cartilage thickness (FCT). Sixty-seven male patients participated, with a mean (SD) age of 53.85 (4.39) years, weight of 84.01 (4.70) kg, height of 171.51 (3.96) cm, and BMI of 28.56 (1.22). Group 1 was treated with high-intensity laser therapy (HILT), GCS, and exercises (HILT + GCS + EX). Group 2 was treated with GCS plus exercises (GCS + EX), and group 3 received placebo laser plus exercises (PL + EX). The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. ST and FCT were measured by ultrasound examination. Statistical analyses were performed to compare differences between baseline and after 6 weeks of treatment and then after 3 months of follow-up. Statistical significance was set at p < 0.05. VAS and WOMAC were significantly decreased in all groups after 6 weeks, with nonsignificant differences between 6 weeks and 3 months of follow-up. ST was significantly decreased in the HILT + GCS + EX group posttreatment, with nonsignificant decreases in the GCS + EX and PL + EX groups, as well as nonsignificant differences to FCT in all groups. Overall, pulsed Nd:YAG laser combined with GCS and exercises was more effective than GCS + EX and exercises alone in the treatment of KOA patients.