Is There a Difference between Perineural Dexamethasone with Single-Shot Interscalene Block (SSIB) and Interscalene Indwelling Catheter Analgesia (IICA) for Early Pain after Arthroscopic Rotator Cuff Repair? A Pilot Study.

Interscalene block is applied to control acute postoperative pain after arthroscopic rotator cuff repair (ARCR), typically with single-shot interscalene block (SSIB) or continuous interscalene indwelling catheter analgesia (IICA), and dexamethasone (Dex) for extending the analgesic effect. This study investigated whether perineural Dex can extend the postoperative analgesic effect of SSIB to match that of IICA. A total of 130 patients were recruited and divided into two groups (Group D, SSIB with perineural Dex, n = 94; Group C, IICA, n = 36). The surgical and anesthetic processes were identical except for the method of nerve block. Pain was measured by a visual analog scale (VAS) at 6, 12, 24, and 48 h after ARCR. The number of each and the total analgesics used and adverse effects were compared. The duration of ARCR was longer in group D. The VAS score was higher in group C 6 h after ARCR, but there was no difference at other time points. More postoperative analgesics were administered to group C, and there was no difference in the number of adverse effects. In conclusion, combining perineural Dex with SSIB can reduce rebound hyperalgesia after 6 h and extend the duration of the analgesic effect to that of IICA. Therefore, IICA could be substituted with SSIB and Dex between at 6 and 48 h after ARCR.

Correlation Between the Extent of Injectate Spread and Clinical Outcomes in Cervical Interlaminar Epidural Injection.

BACKGROUND: Cervical interlaminar epidural injection (CILEI) is commonly used to treat acute or chronic pain that affects the head, neck, and upper extremities. Thus far, studies on CILEI have focused on determining the optimal volume of contrast medium or analyzing the spread of contrast medium during a CILEI. To our knowledge, few studies have attempted to assess the correlation between epidurogram patterns and clinical outcomes of CILEI. OBJECTIVES: This study aimed to investigate the relationship between contrast medium spread and pain relief after a CILEI in patients who complained of neck and/or unilateral upper extremity pain. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary university hospital. METHODS: Patient demographics, pain duration, and radiographic findings, including cervical simple radiograph and magnetic resonance imaging, were reviewed from medical records. The spread pattern of contrast medium during a CILEI was analyzed based on anteroposterior (AP) and lateral fluoroscopic views. The spread pattern in the AP view was classified into 4 categories using predetermined anatomical references, including the medial border, bisector, and lateral border of the articular pillar at the targeted vertebral level. The spread pattern in the lateral view was divided into 2 groups based on whether the contrast medium was present at the ventral epidural space. Every CILEI procedure was performed under fluoroscopic guidance by skilled experts. A responsive outcome was defined as a reduction in the numeric rating scale for pain by more than 50% at one month postoperatively compared to preoperatively. RESULTS: Among 656 patients, 526 were excluded from the analysis according to predetermined criteria. The remaining 130 patients were analyzed, and 78 (60%) patients showed responsive results one month after a CILEI. According to a multivariable logistic regression analysis, the negative predictors of a CILEI were long symptom duration (P = 0.045), high grade of central stenosis (P = 0.022), and limited spread of contrast medium solely within the central canal in the AP view (P = 0.008). LIMITATIONS: The limitations of this study include its retrospective design, absence of clinical parameters other than pain intensity, and short follow-up period. CONCLUSIONS: If the duration of symptoms is lengthy, central stenosis is severe, or contrast medium spread is limitedly solely within the central canal and does not reach the dorsal root ganglion any further, the outcome after a CILEI is likely to be poor. Therefore, efforts should be made to spread injectate around the dorsal root ganglion at the target level.

Clinical Application of Pectoralis Nerve Block II for Flap Dissection-Related Pain Control after Robot-Assisted Transaxillary Thyroidectomy: A Preliminary Retrospective Cohort Study.

Few studies have examined the clinical utility of ultrasonography-guided pectoralis nerve block II (PECS II) during wide flap dissection of a robot-assisted transaxillary thyroidectomy (RATT). We assessed the ability of PECS II to reduce postoperative pain. We retrospectively reviewed 62 patients who underwent elective RATT from December 2021 to April 2022 at Seoul St. Mary's Hospital (Seoul, Korea). The patients were divided into a block group (n = 28, 50.9%) and no-block group (n = 27, 49.1%). Pain was measured using a visual analog scale (VAS) at 4, 10, 20, 25, 35, and 45 h after surgery, and the requirements for rescue painkillers in the post-anesthesia care unit and ward were recorded. The VAS scores did not differ significantly between the two groups at 4 h postoperatively. The block group had significantly lower VAS scores at 10 and 25 h (p = 0.017 and p = 0.034, respectively). The block group required fewer painkillers in the post-anesthesia care unit than the no-block group, although the difference was not statistically significant in the ward. PECS II may serve as a new pain relief modality and valuable addition to the current multimodal analgesic strategy for patients undergoing RATT.

Role of Glucose-6-Phosphate in Metabolic Adaptation of Staphylococcus aureus in Diabetes.

Diabetic foot ulcer (DFU) is the most common and costly sequela of diabetes mellitus, often leading to lower-extremity amputation with poor 5-year survival rates. Staphylococcus aureus is the most prevalent pathogen isolated from DFU, suggesting adaptation of S. aureus to the unique metabolic conditions of diabetes. Diabetes is a complex metabolic disorder with increases not only in serum glucose levels but also in levels of other sugars, including fructose, mannose, and glucose-6-phosphate (G6P). However, the effect of metabolism of these sugars on the pathogenesis of S. aureus is not fully understood. In this study, we demonstrated that metabolism of G6P, fructose, and mannose induced greater expression of staphylococcal virulence factors than did glucose metabolism, but only G6P effects were independent of glucose-mediated carbon catabolite repression, suggesting a physiologically relevant role in diabetes. Our in vivo studies further demonstrated that G6P was highly present in skin adipose tissues of diabetic TALLYHO/JngJ mice, and subcutaneous infection with S. aureus caused significantly greater tissue necrosis and bacterial burden, compared to nondiabetic SWR/J mice. Finally, enhanced pathogenesis of S. aureus in diabetic TALLYHO/JngJ mice was significantly attenuated by deletion of the hexose phosphate transport (HPT) system. These results suggest that G6P is an important metabolic signal for S. aureus, enhancing the virulence in diabetes. A better understanding of how G6P metabolism is linked to the virulence of S. aureus will lead to the development of novel alternative therapeutics. IMPORTANCE Sugars are essential nutrients for S. aureus to survive and proliferate within the host. Because elevated serum glucose levels are a hallmark of diabetes, most studies have focused on the effect of glucose metabolism, and very little is known regarding the effects of metabolism of other sugars on the pathogenesis of S. aureus in diabetes. In this study, we demonstrated that G6P, which is highly present in diabetes, can induce expression of staphylococcal virulence factors that cause severe tissue necrosis and bacterial burden in skin infections. Our results highlight the importance of nutritional control of blood sugar levels, not only glucose but also other highly metabolizable sugars such as G6P. A better understanding of how activation of the HPT system is linked to the virulence of S. aureus will guide development of novel alternative therapeutics.

Influence of aging on visual perception and visual motor integration in Korean adults.

This study investigated age-related changes of cognitive function in Korean adults using the Korean-Developmental Test of Visual Perception-2 (K-DTVP-2) and the Visual Motor Integration-3rd Revision (VMI-3R) test, and determined the main factors influencing VP and VMI in older adults. For this research, 139 adults for the K-DTVP-2 and 192 adults for the VMI-3R, from a total of 283 participants, were randomly and separately recruited in province, Korea. The present study showed that the mean score of the K-DTVP-2 and VMI-3R in 10-yr age increments significantly decreased as age increased (K-DTVP-2, F= 41.120, P< 0.001; VMI-3R, F= 16.583, P< 0.001). The mean score of the VMI-3R and K-DTVP-2 were significantly decreased in participants in their 50s compared to those in their 20s (P< 0.05). Age (t= -9.130, P< 0.001), gender (t= 3.029, P= 0.003), and the presence of diseases (t= -2.504, P= 0.013) were the significant factors affecting K-DTVP-2 score. On the other hand, age (t= -6.300, P< 0.001) was the only significant factor affecting VMI-3R score. K-DTVP-2 score (Standardized ß= -0.611) decreased more sensitively with aging than VMI-3R (Standardized ß= -0.467). The two measurements had a significant positive correlation (r = 0.855, P< 0.001). In conclusion, it can be suggested that VP and VMI should be regularly checked from an individual's 50s, which is a critical period for detecting cognitive decline by aging. Both the K-DTVP-2 and VMI-3R could be used for determining the level of cognitive deficit by aging.