Patient-Reported Quality of Recovery after Local Anesthesia versus Brachial Plexus Block in Hand Surgery: A Randomized Controlled Study.

BACKGROUND: Both local anesthesia (LA) and brachial plexus (BP) anesthesia are commonly used in hand surgery. LA has increased efficiency and reduced costs, but BP is often favored for more complex hand surgery, despite requiring greater time and resources. The primary objective of this study was to assess the quality of recovery of patients who received LA or BP block for hand surgery. Secondary objectives were to compare postoperative pain and opioid use. METHODS: This randomized, controlled, noninferiority study enrolled patients undergoing surgery distal to the carpal bones. Patients were randomized to either LA (wrist or digital block) or BP block (infraclavicular block) before surgery. Patients completed the Quality of Recovery-15 questionnaire on postoperative day (POD) 1. Pain level was assessed with a numeric pain rating scale, and narcotic consumption was recorded on POD1 and POD3. RESULTS: A total of 76 patients completed the study (LA, n = 46, BP, n = 30). No statistically significant difference was found for median Quality of Recovery-15 score between LA [127.5 (interquartile range, 28)] and BP block [123.5 (interquartile range, 31)]. The inferiority margin of LA to BP block at the 95% confidence interval was less than the minimal clinically important difference of 8, demonstrating noninferiority of LA compared with BP block. There was no statistically significant difference between LA and BP block for numeric pain rating scale scores or narcotic consumption on POD1 and POD3 ( P > 0.05). CONCLUSION: LA is noninferior to BP block for hand surgery with regard to patient-reported quality of recovery, postoperative pain, and narcotic use. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Cytotoxic lanostane triterpenoids from the ethanol extract of Schisandra viridis.

Three new lanostane triterpenoids, designated as 6-hydroxyl schiglausin A (1), 29-hydroxyl schiglausin D (2), and 6-hydroxyl schiglausin G (3), were isolated from the ethanol extract of the stems of Schisandra viridis. Structural elucidation of all the compounds were performed by spectral methods such as 1D and 2D (1H-1H COSY, HMQC, and HMBC) NMR spectroscopy, in addition to high resolution mass spectrometry. The isolated compounds were tested in vitro for cytotoxic activities. As a result, compound 1 exhibited cytotoxic activities for all six tested human lung cancer cell lines with IC50 values less than 10 µM.

Nanotherapy in Joints: Increasing Endogenous Hyaluronan Production by Delivering Hyaluronan Synthase 2.

Osteoarthritis (OA) is a common joint degenerative disease that causes pain, joint damage, and dysfunction. External hyaluronic acid (HA) supplement is a common method for the management of osteoarthritis which requires multi-injections. It is demonstrated that biodegradable mesoporous silica nanoparticles successfully deliver an enzyme, hyaluronan synthase type 2 (HAS2), into synoviocytes from the temporomandibular joint (TMJ) and generate endogenous HA with high molecular weights. In a rat TMJ osteoarthritis inflammation model, this strategy promotes endogenous HA production and inhibits the synovial inflammation of OA for more than 3 weeks with one-shot administration. Such nanotherapy also helps repairing the bone defects in a rat OA bone defect model.

Symptoms of Posttraumatic Stress Disorder and Associated Risk Factors in Patients With Lung Cancer: A Longitudinal Observational Study.

PURPOSE: This study aimed to measure symptoms of posttraumatic stress disorder (PTSD) in Chinese patients following a new diagnosis of lung cancer. Secondary aims were to explore factors at diagnosis that may predict PTSD symptoms at 6 months. METHODS: This was a prospective longitudinal observational study that included 93 patients with newly diagnosed lung cancer. PTSD symptomology was assessed using the PTSD Checklist Civilian Version (PCL-C) and health-related quality of life (HRQoL) was assessed with the European Organisation for the Research and Treatment of Cancer questionnaire. Measures were completed at diagnosis and 6 months. RESULTS: No patient had PTSD at baseline or 6 months as measured by a score of ⩾50 in the PCL-C. However, at diagnosis, 44% of patients had "mild" symptoms of PTSD. At 6 months, 64% of patients had "mild" and 8% had "moderate" PTSD symptoms. PTSD symptom scores significantly worsened over 6 months (mean difference [95% CI] = 7.2 [5.4 to 9.0]). Six months after diagnosis, higher PTSD scores were seen in people who at diagnosis were younger ( P = .003), had a lower smoking pack history ( P = .012), displayed less sedentary behavior ( P < .005), or initially had worse cancer symptoms, including fatigue ( P = .001) and poorer HRQoL ( P = .004). CONCLUSIONS: Mild PTSD symptoms are common in patients with lung cancer 6 months after treatment; however, a full diagnosis of PTSD is uncommon. Screening for PTSD symptoms may be considered for at-risk patients with newly diagnosed lung cancer.

Physical Activity Behavior After a Diagnosis of Lung Cancer Differs Between Countries: An Observational Cohort Study.

INTRODUCTION: Physical activity (PA) is important in lung cancer. OBJECTIVES: To investigate PA levels and health-related quality of life (HRQoL) of patients with lung cancer in China and compare this to a similar cohort in Australia. METHODS: Prospective cohort study. 71 patients from China (group CH) and 90 patients from Australia (group AU) with newly diagnosed lung cancer. Questionnaires assessed self-reported PA levels and HRQoL at baseline (diagnosis) and 8 weeks. RESULTS: At baseline, group CH were engaged in less overall PA than group AU (Physical Activity Scale for the Elderly [PASE] total score: median [IQR] group CH, 56 [32-59]; group AU, 66 [38-116]; P < .005), and less occupational and household activity ( P < .005). However, at baseline, group CH reported significantly more walking time than group AU (median [IQR]: group CH, 210 [150-315] min/wk; group AU, 55[0-210] min/wk; P < .0005). Global HRQoL scores were similar between groups (P = .038). Over 8 weeks, group CH increased their overall PA levels ( P < .005) and walking time ( P = .008), and HRQoL remained unchanged. The comparison group AU experienced a reduction in PA levels ( P = .02) and HRQoL ( P < .005). CONCLUSIONS: A diagnosis, patients in China were less physically active than those in Australia. Following diagnosis, patients in China increased their PA levels, whereas those in Australia reduced their PA levels. Research is required to explore potential reasons behind differences, and this may inform research/clinical services to facilitate patients with lung cancer to be more active.

Role Identification and Application of SigD in the Transformation of Soybean Phytosterol to 9α-Hydroxy-4-androstene-3,17-dione in Mycobacterium neoaurum.

9α-Hydroxy-4-androstene-3,17-dione (9-OHAD) is a valuable steroid pharmaceutical intermediate which can be produced by the conversion of soybean phytosterols in mycobacteria. However, the unsatisfactory productivity and conversion efficiency of engineered mycobacterial strains hinder their industrial applications. Here, a sigma factor D (sigD) was investigated due to its dramatic downregulation during the conversion of phytosterols to 9-OHAD. It was determined as a negative regulator in the metabolism of phytosterols, and the deletion of sigD in a 9-OHAD-producing strain significantly enhanced the titer of 9-OHAD by 18.9%. Furthermore, a high yielding strain was constructed by the combined modifications of sigD and choM2, a key gene in the phytosterol metabolism pathway. After the modifications, the productivity of 9-OHAD reached 0.071 g/L/h (10.27 g/L from 20 g/L phytosterol), which was 22.5% higher than the original productivity of 0.058 g/L/h (8.37 g/L from 20 g/L phytosterol) in the industrial resting cell biotransformation system.

A time-dependent degeneration manner of condyle in rat CFA-induced inflamed TMJ.

Temporomandibular joint (TMJ) inflammation is a potential risk factor of osteoarthritis (OA) but the detailed degenerative changes in the inflamed TMJ remain unclear. In this study, we evaluated the changes of condylar cartilage and subchondral bone in rat inflamed TMJ induced by Freund's complete adjuvant (CFA). Articular cavity was injected with CFA and the TMJ samples were collected 1, 2, 3, and 4-week post-injection. Hematoxylin & Eosin (H&E) staining, toluidine blue (TB) staining, Safranin O (S.O) staining, Masson trichrome staining and micro-CT were used to assess TMJ degeneration during inflammation. Osteoclast and osteoblast activities were analyzed by tartrate-resistant acid phosphatase (TRAP) staining and osteocalcin (OCN) immunohistochemistry staining respectively. The expression of receptor activator of NF-kB ligand (RANKL) and osteoprotegerin (OPG) in condylar cartilage and subchondral bone was also evaluated through immunohistochemistry and RANKL/OPG ratio was evaluated. Reduced cartilage thickness, decreased number of chondrocytes, and down-regulated proteoglycan expression were observed in the condylar cartilage in the inflamed TMJ. Enhanced osteoclast activity, and expanded bone marrow cavity were reached the peak in the 2-week after CFA-injection. Meanwhile the RANKL/OPG ratio in the cartilage and subchondral bone also increased in the 2-week CFA-injection. Immature, unmineralized new bones with irregular trabecular bone structure, atypical condylar shape, up-regulated OCN expression, and decreased bone mineral density (BMD) were found in the inflamed TMJ. The time-dependent degeneration manner of TMJ cartilage and subchondral bone was found in CFA-induced arthritis rat model. The degeneration in the TMJ with inflammation might be a risk factor and should be concerned.