Selective blockade of supraclavicular nerves and upper trunk of brachial plexus "The SCUT block" towards a site-specific regional anaesthesia strategy for clavicle surgeries - A descriptive study.

BACKGROUND AND AIMS: Commonly, the superficial cervical plexus and interscalene block were combined to provide surgical anaesthesia for procedures on the clavicle, which are neither selective nor site-specific considering the innervation of the clavicle. The aim was to analyse effectiveness and block dynamics of selectively blocking supraclavicular (SC) nerves and upper trunk (UT) of brachial plexus (SCUT BLOCK) as a site-specific regional anaesthesia strategy for clavicle surgery. METHODS: SC nerves and UT were blocked with 3-ml and 5-ml local anaesthetic, respectively, in 70 American Society of Anesthesiologists I and II patients aged above 18 years, undergoing clavicle surgery. Sensory-motor conduction blockade was assessed in both the plexus territories, following which surgery ensued. Number of patients who exhibited complete conduction blockade of the targeted nerves, number of surgeries completed under the block, intraoperative rescue analgesics, duration of postoperative analgesia and complications were recorded. RESULTS: Sensory and motor mapping showed complete conduction blockade of the targeted nerves in all patients, all other branches were spared. The surgery was completed exclusively under block in 67 (Strategy success rate 96%) out of 70 patients. Intraoperatively, two patients required supplementation of block with a local infiltration and general anaesthesia was administered for one patient. The mean duration of postoperative analgesia was 5 (1.2) hours [mean (standard deviation)]. Only one patient developed ptosis; no other complications were noted. CONCLUSIONS: "The SCUT block" is an effective site-specific regional anaesthesia strategy for clavicle surgery.

Supernova, nuclear synthesis, fluid instabilities, and interfacial mixing.

Supernovae and their remnants are a central problem in astrophysics due to their role in the stellar evolution and nuclear synthesis. A supernova's explosion is driven by a blast wave causing the development of Rayleigh-Taylor and Richtmyer-Meshkov instabilities and leading to intensive interfacial mixing of materials of a progenitor star. Rayleigh-Taylor and Richtmyer-Meshkov mixing breaks spherical symmetry of a star and provides conditions for synthesis of heavy mass elements in addition to light mass elements synthesized in the star before its explosion. By focusing on hydrodynamic aspects of the problem, we apply group theory analysis to identify the properties of Rayleigh-Taylor and Richtmyer-Meshkov dynamics with variable acceleration, discover subdiffusive character of the blast wave-induced interfacial mixing, and reveal the mechanism of energy accumulation and transport at small scales in supernovae.

Convenient Formulation of 68Ga-BPAMD Patient Dose Using Lyophilized BPAMD Kit and 68Ga Sourced from Different Commercial Generators for Imaging of Skeletal Metastases.

PURPOSE: 68Ga-BPAMD has recently emerged as one of the preferred radiopharmaceuticals for imaging of bone lesions due to its ability to produce high-resolution images and uncomplicated availability of 68Ga, a positron emission tomography (PET) radionuclide, from commercial 68Ge/68Ga generators. The primary objective of this work is to develop freeze-dried BPAMD kit, for the easy and convenient formulation of 68Ga-BPAMD patient dose at the hospital radiopharmacy. In addition, the kit should be compatible with 68Ga, eluted using HCl of various molarities from the 68Ge/68Ga generators sourced from different suppliers. PROCEDURES: Freeze-dried BPAMD kit, comprising 50 µg of BPAMD and 150 mg of HEPES, was prepared and evaluated using 68Ga eluted from three different 68Ge/68Ga generators. Radiochemical purity (RCP) of 68Ga-BPAMD was determined by both thin-layer chromatography and high-performance liquid chromatography studies. The maximum volume of 68Ga, which can be added in the kit, was determined. The biological behavior of 68Ga-BPAMD, prepared using the freeze-dried kit, was evaluated by both in vitro and in vivo studies. Clinical studies were also performed in limited number of patients suffering from metastatic bone cancer. RESULTS: 68Ga-BPAMD could be prepared with >95% RCP using the freeze-dried BPAMD kit and 68Ga eluted from 68Ge/68Ga generators obtained from three different suppliers. 68Ga-BPAMD, prepared using the freeze-dried kit, exhibited adequate serum stability and ∼91% binding with the hydroxyapatite particles. Biodistribution studies in normal Wistar rats exhibited selective uptake of the agent in skeleton and fast clearance of the nonaccumulated activity through urinary route. Clinical studies in cancer patients showed excellent accumulation of the agent in bone lesions. CONCLUSION: The preliminary studies exhibited the potential of the developed BPAMD kit toward its utilization for the PET scanning of skeletal metastases.