Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block

Abstract Interscalene brachial plexus (ISB) block is considered the analgesic technique of choice for shoulder surgery. However, the hemidiaphragmatic paresis that may occur after the block has led to the search for an alternative to the ISB block. In this case report, the pericapsular nerve group (PENG) block was performed for both surgical anesthesia and postoperative analgesia in two patients who underwent shoulder surgery. It is suggested that the PENG block can be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus. It was demonstrated that the PENG block may be safely applied for both partial anesthesia and analgesia in selected shoulder surgery cases.

Noncoding RNAs in apoptosis: identification and function.

Apoptosis is a vital cellular process that is critical for the maintenance of homeostasis in health and disease. The derailment of apoptotic mechanisms has severe consequences such as abnormal development, cancer, and neurodegenerative diseases. Thus, there exist complex regulatory mechanisms in eukaryotes to preserve the balance between cell growth and cell death. Initially, protein-coding genes were prioritized in the search for such regulatory macromolecules involved in the regulation of apoptosis. However, recent genome annotations and transcriptomics studies have uncovered a plethora of regulatory noncoding RNAs that have the ability to modulate not only apoptosis but also many other biochemical processes in eukaryotes. In this review article, we will cover a brief summary of apoptosis and detection methods followed by an extensive discussion on microRNAs, circular RNAs, and long noncoding RNAs in apoptosis.

Anxiety and depression in the first 24 h in COVID-19 patients who underwent non-invasive mechanical ventilation in the intensive care unit.

BACKGROUND AND AIMS: The aim of this study was to investigate the degree of anxiety and depression in the first 24 h of people who were taken to the intensive care unit (ICU) due to COVID-19 and had to use unfamiliar devices in an unfamiliar environment. MATERIAL METHOD: Sixty-two patients over 18 years of age, conscious and cooperative, who were admitted to the ICU with the diagnosis of COVID, were PCR (+), and needed non-invasive mechanical ventilation were included in the study. Age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and Hospital Anxiety Depression (HAD) A (anxiety), and HAD D (depression) scores of the patients were recorded, and the prevalence of anxiety and depression and independent factors affecting them were investigated. RESULTS: The mean age of the patients was 57.1 ± 17.6 years, and the mean APACHE II was 29.3 ± 10.4. The average HAD A score was 10.5 ± 3.5 in all patients, while the HAD D score was 10.5 ± 3.3. The prevalence of anxiety was 37.1% (23 patients), and the prevalence of depression was 43.6% (27 patients). Age and APACHE II and anxiety/depression were negatively correlated, and when age and APACHE II scores increased, anxiety and depression decreased (p < 0.05). CONCLUSION: In COVID-19 patients who underwent non-invasive mechanical ventilation in the ICU, the rate of anxiety in the first 24 h of admission was 37.1% while for depression the rate was 43.6%. In addition, advanced age and high APACHE II scores were found to be associated with low anxiety and depression. TRIAL REGISTRATION: ClinicalTrials ID: NCT04715477 (January 20, 2021).

Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block.

Interscalene brachial plexus (ISB) block is considered the analgesic technique of choice for shoulder surgery. However, the hemidiaphragmatic paresis that may occur after the block has led to the search for an alternative to the ISB block. In this case report, the pericapsular nerve group (PENG) block was performed for both surgical anesthesia and postoperative analgesia in two patients who underwent shoulder surgery. It is suggested that the PENG block can be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus. It was demonstrated that the PENG block may be safely applied for both partial anesthesia and analgesia in selected shoulder surgery cases.

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

ABSTRACT Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy.

PURPOSE: We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). PATIENTS AND METHODS: We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. RESULTS: Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). CONCLUSION: Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

Association of Neuraxial Anesthesia With Postoperative Venous Thromboembolism After Noncardiac Surgery: A Propensity-Matched Analysis of ACS-NSQIP Database.

BACKGROUND: Neuraxial anesthesia improves components of the Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization. METHODS: Inpatient orthopedic surgeries from American College of Surgeons National Surgical Quality Improvement Program database (2011-2015) in adults lasting more than 1 hour with either neuraxial or general anesthesia were included. Groups were matched 1:1 by propensity score matching for appropriate confounders. Logistic regression model was used to assess the effect of neuraxial anesthesia on 30-day VTE, 30-day mortality, and readmission, while Cox proportional hazard regression model was used to assess its effect on length of stay. RESULTS: Neuraxial anesthesia decreased odds of 30-day VTE (odds ratio 0.85, 95% confidence interval, 0.78-0.95; P = .002) corresponding to number-needed-to-treat of 500. Although there was no difference in 30-day mortality, neuraxial anesthesia reduced 30-day readmission (odds ratio 0.90, 98.3% confidence interval, 0.85-0.95; P < .001) corresponding to number-needed-to-treat of 250 and had a shortened hospitalization (2.87 vs 3.11; P < .001). CONCLUSIONS: Neuraxial anesthesia appears to provide only weak VTE prophylaxis, but can be offered as an adjuvant to current thromboprophylaxis in high-risk patients.

Simultaneous occurrence of metabolic, hematologic, neurologic and cardiac complications after Roux-en-Y gastric bypass for morbid obesity.

Roux-en-Y gastric bypass (RYGB) is a commonly performed procedure in the surgical treatment of morbid obesity. Since a major anatomical alteration is made, this procedure may lead to significant postoperative complications, including nutritional deficiencies related to malabsorption. As a consequence of micronutrient deficiencies, secondary metabolic, hematologic and neurologic complications might also develop. Each of these complications is well reported in the literature; however, there are limited data on the simultaneous occurrence of these complications in a single patient. In this report, we aimed to present the diagnosis and management of metabolic, hematologic, neurologic and cardiac complications, which occurred simultaneously in a 57-year-old female patient after undergoing laparoscopic RYGB procedure.

Phenacyl Ethyl Carbazolium as a Long Wavelength Photoinitiator for Free Radical Polymerization.

A new phenacyl-type photoinitiator based on ethyl carbazole as a long wavelength photo-initiator is developed for free radical polymerization. Phenacyl ethyl carbazolium hexafluoroantimonate (PECH) photoinitiator is synthesized in a two-step, one-pot manner by quaternizing ethyl carbazole with phenacyl bromide and subsequent ion exchange reaction with potassium hexafluoroantimonate. Under irradiation, PECH tends to undergo homolytic bond cleavage bringing about initiating free radicals. However, as evidenced by cyclic voltammetry and real-time photobleaching studies, formation of initiating cationic species is highly unlikely as the photochemically formed charged carbazole units tend to couple.

Breast cancer awareness among Turkish nursing students.

BACKGROUND: This study conducted to determine breast cancer awareness and influencing factors among nursing students in the West Black Sea Region in Turkey. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted between April-May, 2014. The sample was 270 female nursing students. Data were collected by Personal Information Form and Champion's Health Belief Model Scale (CHBMS). RESULTS: The students' mean age was 21.6±2.09 and 81.1% had knowledge about breast cancer from their academic education. It is found that 63.7% of the students performed Breast Self-Examination (BSE) and 11.1% had a family member diagnosed with breast cancer. The CHBMS mean score of the students was 117.7±14.5. CONCLUSIONS: Breast cancer awareness of nursing students is on a good level and was affected by family history of breast cancer and health beliefs.