Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis.

PURPOSE: Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000-48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain. METHODS: A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient's clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported. RESULTS: A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments. CONCLUSION: Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.

Tissue fatty acid composition and secretory phospholipase-A2 activity in oral squamous cell carcinoma

Purpose: Oral squamous cell carcinoma (OSCC) is a remarkable health problem worldwide, but its pathogenesis remains unknown. The aim of this study was to compare fat composition and secretory phospholipase-A2 (sPLA2) activity between the malignant and adjacent normal squamous tissues in patients with OSCC. Methods: Paired samples of malignant squamous and adjacent normal-appearing tissues were collected from 27 patients with OSCC. The fatty acid composition in the obtained tissues was determined by gas liquid chromatography. Tissue enzyme activities of sPLA2 were measured using the standard assay with Diheptanoyl Thio-Phosphatidylcholine as substrate. Results: In the OSCC tissue, the level of stearic acid (18:0) and activity of sPLA2 were higher (P < 0.001), and the levels of oleic acid (18:1n-9) and linoleic acid (18:2n-6) were lower than that in the adjacent normal-appearing squamous tissue (P < 0.001). The activity of sPLA2 in OSCC was strongly negatively correlated with the amount of 18:2n-6 (r = −0.41, P < 0.001). Negative significant associations were observed between the OSCC invasion and tissue levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHE). Conclusion: The changes in the fatty acid composition and sPLA2 activity may be regarded as indicators of altered lipid metabolism occurring in vivo during squamous cell carcinogenesis (AU)

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Tissue fatty acid composition and secretory phospholipase-A2 activity in oral squamous cell carcinoma.

PURPOSE: Oral squamous cell carcinoma (OSCC) is a remarkable health problem worldwide, but its pathogenesis remains unknown. The aim of this study was to compare fat composition and secretory phospholipase-A2 (sPLA2) activity between the malignant and adjacent normal squamous tissues in patients with OSCC. METHODS: Paired samples of malignant squamous and adjacent normal-appearing tissues were collected from 27 patients with OSCC. The fatty acid composition in the obtained tissues was determined by gas liquid chromatography. Tissue enzyme activities of sPLA2 were measured using the standard assay with Diheptanoyl Thio-Phosphatidylcholine as substrate. RESULTS: In the OSCC tissue, the level of stearic acid (18:0) and activity of sPLA2 were higher (P < 0.001), and the levels of oleic acid (18:1n-9) and linoleic acid (18:2n-6) were lower than that in the adjacent normal-appearing squamous tissue (P < 0.001). The activity of sPLA2 in OSCC was strongly negatively correlated with the amount of 18:2n-6 (r = -0.41, P < 0.001). Negative significant associations were observed between the OSCC invasion and tissue levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHE). CONCLUSION: The changes in the fatty acid composition and sPLA2 activity may be regarded as indicators of altered lipid metabolism occurring in vivo during squamous cell carcinogenesis.

General anesthesia in cesarean sections: a prospective review of 465 cesarean sections performed under general anesthesia.

BACKGROUND: In many countries, neuraxial blocks comprise the majority of anesthetics given for cesarean section. In Iran, however general anesthesia for cesarean section is prevalent. In our institution, the rate of general anesthesia for cesarean section is 39%, providing an opportunity to collect data regarding airway management in the parturients. We report on the outcomes of a series of patients who received general anesthesia for cesarean section. METHODS: A prospective observational study was conducted in two university hospitals, with approximately 5,500 deliveries annually. Demographics and airway characteristics were recorded. Eight potential risk factors for difficult intubation (short neck, obesity, facial edema, swollen tongue, receding mandible, and single, missing or protruding maxillary incisors) were analyzed. Then, laryngoscopic view, difficulty at intubation, and major complications were recorded. RESULTS: Data were obtained from 465 patients. There was a significant correlation between higher Mallampati score and both higher laryngoscopic view graded on the Cormack-Lehane system (P < 0.001) and difficulty at intubation (P-Value = 0.05). Emergency cesarean section was not associated with difficult intubation (P = 0.67). Multivariate analysis showed that receding mandible was the only potential risk factor for difficult tracheal intubation (P < 0.001) and removed short neck or protruding maxillary incisor which initially was powered as a risk factor by univariate analysis. A grade 3 laryngoscopic view was obtained in 15 cases (3.2%). There was no case of grade 4 view. There was only one failed intubation (0.2%), and 9 cases of very difficult intubation (1.9%). CONCLUSION: General anesthesia for cesarean section is safe with minimal risk.

Analysis of follicular fluid total phospholipids in women undergoing in-vitro fertilisation.

Follicular fluid (FF) samples were obtained from 100 patients referred to the University Hospital. A total of 79 subjects underwent IVF and the remaining 21 underwent ICSI. The levels of apoA-I and total phospholipid were measured using turbidometric and colorimetric phosphorus assays, respectively. Correlation analysis showed a significant inverse association of total phospholipid in FF with fertilisation ratio (r = -0.24, p = 0.04). Furthermore, the ratio of phospholipid/apoA-I in patients with a percentage of fertilised oocytes ≤ 50% was significantly higher (> 2.5%, p < 0.05) than in those with higher percentages of fertilised oocytes. The amounts of phospholipid and phospholipid/apoA-I ratio in FF were associated negatively to the percentage of oocyte fertilisation. Therefore, the change in the phospholipid and phospholipid/apoA-I ratio of FF might be regarded as indicators of female fertility.

Tissue fatty acid composition in human urothelial carcinoma.

Bladder cancer cells appear to have an altered lipid metabolism as evidenced by modulated lipogenic enzymes. The aim of this study is to investigate differences in tissue fat composition between malignant and adjacent normal urinary bladder tissue. Normal-appearing and malignant bladder tissues were collected from 31 patients with high-grade (Ta) urothelial carcinoma during transurethral resection (TUR). The fatty acid composition in the tissue was determined by gas liquid chromatography. In the bladder cancer tissue, levels of stearic acid (18:0; P = 0.01) and oleic acid (18:1n-9; P = 0.03) were higher, and the level of arachidonic aid (20:4n-6; P < 0.001) was lower than that in the normal-appearing bladder. Overall, bladder cancer tissue showed a significant reduction in total n-6 polyunsaturated fatty acid (-15.1%; P < 0.001). The change in the fatty acid composition may be regarded as an indicator of altered lipid metabolism occurring in vivo during human bladder tumourigenesis.

Occupational dose assessment and National Dose Registry System in Iran.

This report presents status of external and internal dose assessment of workers and introducing the structure of National Dose Registry System of Iran (NDRSI). As well as types of individual dosemeters in use, techniques for internal dose assessment are presented. Results obtained from the International Atomic Energy Agency intercomparison programme on measurement of personal dose equivalent H(p) (10) and consistency of the measured doses with the delivered doses are shown. Also, implementation of dosimetry standards, establishment of quality management system, authorisation and approval procedure of dosimetry service providers are discussed.

Cholesteryl ester transfer protein I405V polymorphism influences apolipoprotein A-I response to a change in dietary fatty acid composition.

The aim of the present study was to investigate whether the cholesteryl ester transfer protein (CETP) I405V polymorphism modifies the response to changes in the dietary ratio of polyunsaturated to saturated fat (P:S). The population included 85 healthy subjects with the different I405V genotypes (35 II, 36 IV, and 14 VV) assigned to two consecutive 28-day experimental period. All subjects consumed a high-P:S with P:S of 1.2 for the first period and a low-P:S with a P:S of 0.3 for the next 28-day period. At the first and end of each dietary period, serum lipid, lipoprotein, and CETP concentrations were measured. At screening, lipid or lipoprotein concentrations were not significantly different among CETP I405V genotype groups. After the low-P:S diet, subjects carrying V allele had greater reduction in apoA-I and HDL cholesterol (HDL-C) than subjects with II genotype. A genotype-by-diet interaction effect was observed on apoA-I (p=0.016) concentrations. In conclusion, the CETP I405V polymorphism contributes to the unfavorable changes of apoA-I and HDL-C when a high-P:S diet was replaced with a low-P:S diet.

Transureteral lithotripsy in pediatric practice.

PURPOSE: The present study reviews ureteroscopy intervention for the treatment of ureteral stones in pediatric patients in the last 6 years at three institutions in Iran. PATIENTS AND METHODS: Sixty-six ureteroscopies were performed in 66 prepubertal patients (mean age 9 years; range 2-15 years) with a male/female ratio of 31/35. Ultrasonography, plain film, or intravenous urography was performed in all cases. The mean stone size was 8 mm (range 5-15 mm). All the interventions were performed under general anesthesia with semirigid ureteroscopes of 8F to 11.5F. The stone was located in the left ureter in 32 patients and in the right in 34 patients. Stones were located in the distal ureter in 59 patients, in the midureter in 5, and in the proximal ureter in 2. Before ureteroscopy, ureteral dilatation with a balloon was done to 12F if necessary. If the calculus could not be removed with the basket (stone.8 mm), lithotripsy using ultrasonic, electrohydraulic (EHL), or pneumatic equipment was performed. RESULTS: Ureteroscopy with an 11.5F, 9F, 8.5F, or 8F ureteroscope were performed in 26, 14, 5, and 21 patients, respectively, and ureteral dilatation was necessary in 23, 0, 0, and 2 cases, respectively. We were unable to introduce the ureteroscope into the ureter in three patients (two boys with an 11.5F ureteroscope and one girl with an 8.5F ureteroscope) with distal ureteral stones. The stones moved to the kidney in four patients. Stone management was with basketing alone in 14, EHL in 3, ultrasonic lithotripsy in 8, and ballistic lithotripsy in 34 patients. The stone-free rate was 88% (58 patients) at 48 hours postprocedure. The complication rate was 23% and included renal colic (1), gross hematuria (11), and pyelonephritis (3). No patient had obvious perforation or stricture of the ureter at 3-month follow-up. CONCLUSION: Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of ureteral calculi in children. Ureteroscopic treatment, especially with a small-caliber ureteroscope, should be considered the first choice for treatment of calculi in the distal ureter in children.

Comparative study of beta andreoceptor antagonists on the isolated atria of control and of the reserpine treated rabbits.

The effect of four adrenoceptor antagonists, chosen because of reported differences in their selectivities, were compared using the positive chronotropic response to isoprenaline on isolated rabbit atria. Oxprenolol was the most potent antagonist of the isoprenaline induced cardiac arrhythmias. Alprenolol, practolol and propranolol also blocked the positive chronotropic responses to isoprenaline effectively. All the antagonists lowered the resting heart rate. The effects of all four selected antagonists on heart rate probably result from cardiac beta adrenoceptor blockade. Atria isolated from reserpine treated rabbits, showed a reduced percentage of increase in the heart rate in response to addition of isoprenaline. This decreased response has been related in some cases to direct myocardial inhibition.

Effects of reserpine on the responses of the isolated rat fundus strip to catecholamines and specific adrenoceptor antagonists.

The effects of reserpine on the sensitivity to catecholamines and adrenoceptor antagonists propranolol and azapetine were studied on the fundus strips of the rat. The results obtained in this study would support the view that reserpine may increase the sensitivity of beta receptor to isoprenaline and adrenaline by the mechanism which may be independent of the uptake of catecholamines in the sympathetic nervous system.