Efficiency of the Local Infi ltration Analgesia Method in Total Knee Artroplasty Surgeries

PURPOSE OF THE STUDY

Postoperative pain after total knee arthroplasty (TKA) is severe because of bone and soft tissue trauma during the surgery and is diffi cult to control with oral analgesics. The primary aim of the study was to investigate the effects of the local infi ltration anesthesia (LIA) method on postoperative analgesia quality and opioid consumption in patients undergoing TKA. The secondary aims were to evaluate knee fl exion angle, side effects, and patient satisfaction. MATERIAL AND METHODS Total 40 patients, who underwent unilateral TKA surgery under spinal anesthesia were included in the prospective randomized study. Patients who underwent patient-controlled intravenous analgesia (PCA) (Group A) or LIA + PCA (Group B), were divided into two groups, randomly. For LIA application, 0.25% bupivacaine solution 150 mg in 60 ml volume was used. The postoperative pain was evaluated in 48th hour after the recovery of motor block, and during exercise at 24, 36, and 48 hours by using the visual analogue scale (VAS). An additional morphine was administered with the PCA device when VAS ≥ 4. The total amount of morphine consumption and the side effects were recorded. The knee fl exion joint angles at the 48th hour and the patients' satisfaction was recorded. RESULTS Resting VAS values were lower in Group B in the fi rst 24 hours (p<0.05). However, the 36 th and 48th hour measurements were not different in groups. The exercises VAS values and the total morphine consumption were signifi cantly higher in Group A at 24, 36 and 48 hours. The knee fl exion joint angles in Group B were higher than Group A in terms of 48th hour. The incidence of side effects was not different in the two groups. Patients' satisfaction was higher in the PCA+ILA group (p<0.05). DISCUSSION In many studies the periarticular injection with multimodal drugs has been shown to reduce the requirements for analgesia, with no apparent risks, following TKA, similar to our results. LIA reduced postoperative opioid use and increased exercise tolerance. CONCLUSIONS In our study, we found that LIA reduced pain scores and opioid consumption during rest and exercise after TKA operation. For TKA patients where post-operative exercise is particularly important, we recommend the easy-to-use LIA method for a pain-free and unrestricted postoperative period.

KEY WORDS

total knee arthroplasty, local infi ltration analgesia, postoperative analgesia, knee fl exion angle, opioid consumption.

In vitro and clinical studies on the efficacy of α-cyclodextrin and hydroxytyrosol against SARS-CoV-2 infection

OBJECTIVE

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus responsible for the current pandemic of coronavirus disease 2019 (COVID-19). This virus attacks cells of the airway epithelium by binding transmembrane angiotensin-converting enzyme 2 (ACE2). Hydroxytyrosol has anti-viral properties. Alpha-cyclodextrin can deplete sphingolipids and phospholipids from cell membranes. The aim of the present experimental study was to evaluate the efficacy of α-cyclodextrin and hydroxytyrosol in improving defenses against SARS-CoV-2 infection in in vitro cell models and humans.

PATIENTS AND METHODS

For in vitro experiments on Vero E6 cells, RNA for RT-qPCR analysis was extracted from Caco2 and human fibroblast cell lines. For study in humans, the treatment group consisted of 149 healthy volunteers in Northern Cyprus, considered at higher risk of SARS-CoV-2 infection than the general population. The volunteers used nasal spray containing α-cyclodextrin and hydroxytyrosol for 4 weeks. The control group consisted of 76 healthy volunteers who did not use the spray.

RESULTS

RT-qPCR experiments on targeted genes involved in endocytosis showed a reduction in gene expression, whereas cytotoxicity and cytoprotective tests showed that the compounds exerted a protective effect against SARS-CoV-2 infection at non-cytotoxic concentrations. None of the volunteers became positive to SARS-CoV-2 RT-qPCR assay during the 30 days of treatment.

CONCLUSIONS

Treatment with α-cyclodextrin and hydroxytyrosol nasal spray improved defenses against SARS-CoV-2 infection and reduced synthesis of viral particles.

A comparison of low dose hyperbaric levobupivacaine and hypobaric levobupivacaine in unilateral spinal anaesthesia

The aim of this study was to compare the clinical effects and characteristics of hyperbaric and hypobaric levobupivacaine for unilateral spinal anaesthesia. Sixty patients were randomly allocated into two groups to receive either 7.5 mg (1.5 ml) hyperbaric levobupivacaine 0.5% or 7.5 mg (4 ml) hypobaric levobupivacaine 0.1875% for elective arthroscopic surgery of the knee under spinal anaesthesia. The level and duration of sensory block, intensity and duration of motor block were recorded. Unilateral sensory block was observed in 27 patients (90%) in the hyperbaric group and 24 patients (80%) in the hypobaric group in the lateral position. After 15 minutes, patients were turned to supine to redistribute the spinal block toward the non-operative side, but spinal anaesthesia was still unilateral in 18 patients (60%) in the hyperbaric group and 10 patients (33%) in the hypobaric group (P = 0.038). Time to readiness for home discharge and complete recovery of sensory block were similar in both groups. In the hyperbaric group, the motor block scores were higher on the operative side during first 10 minutes than they were in the hypobaric group (P < 0.002). Motor block regression was faster in the hyperbaric group (P = 0.01). Hyperbaric and hypobaric levobupivacaine both provided satisfactory unilateral spinal anaesthesia with good haemodynamic stability for arthroscopic surgery, but with more frequent unilateral spinal anaesthesia in the hyperbaric group.

Indoor/outdoor concentrations and elemental composition of PM10/PM2.5 in urban/industrial areas of Kocaeli City, Turkey

This study presents indoor/outdoor PM2.5 and PM10 concentrations measured during winter and summer in 15 homes in Kocaeli, which is one of the most industrialized areas in Turkey. Indoor and outdoor PM2.5 and PM10 mass concentrations and elemental composition were determined using an X-ray fluorescence spectrometer. Quantitative information was obtained on mass concentrations and other characteristics such as seasonal variation, indoor/outdoor (I/O) ratio, PM2.5/PM10 ratio, correlations and sources. Average indoor and outdoor PM2.5 concentrations were 29.8 and 23.5 microg/m(3) for the summer period, and 24.4 and 21.8 microg/m(3) for the winter period, respectively. Average indoor and outdoor PM10 concentrations were 45.5 and 59.9 microg/m(3) for the summer period, and 56.9 and 102.3 microg/m(3) for the winter period, respectively. A varimax rotated factor analysis (FA) was performed separately on indoor and outdoor datasets in an effort to identify possible heavy metal sources of PM2.5 and PM10 particle fractions. FA of outdoor data produced source categories comprising polluted soil, industry, motor vehicles, and fossil fuel combustion for both PM fractions, while source categories determined for indoor data for both PM2.5 and PM10 comprised industry, polluted soil, motor vehicles, and smoking, with an additional source category of cooking activities detected for the PM2.5 fraction. Practical Implications In buildings close to industrial areas or traffic arteries, outdoor sources may have an important effect on indoor air pollution. Therefore, indoor and outdoor investigations should be conducted simultaneously to assess the relationship between indoor and outdoor pollution. This study presents the simultaneous measurement of PM fractions (PM2.5 and PM10) and their elemental compositions to determine the sources of respirable PM and the heavy metals bound to these particles in indoor air. Factor analysis of indoor data indicated that the contribution of outdoor pollutant sources to indoor pollution was about 70%, making these sources the most significant for indoor heavy metal pollution, wheras other sources of indoor pollution included smoking and cooking activities.

Acupressure for postoperative nausea and vomiting in gynaecological patients receiving patient-controlled analgesia

BACKGROUND AND OBJECTIVES

To evaluate the effectiveness of acupressure in preventing nausea and vomiting in patients undergoing gynaecological operations and receiving a patient-controlled analgesia device.

METHODS

Patients aged between 40 and 65 yr were included. Exclusion criteria were obesity, diabetes mellitus, and history of motion sickness, postoperative nausea and vomiting, or smoking. Patients were randomized into one of two groups, acupressure and control. In the acupressure group, acupressure bands were placed on both wrists with the plastic bead positioned at the P6 point. In controls, beads were placed at a non-acupoint site. All patients received a standard general anaesthetic. Postoperatively, patients were connected to a patient-controlled analgesia device with morphine (loading dose 5 mg, background infusion 1 mg h-1, bolus dose 1 mg and lock-out time 10 min). Pain and sedation scores, respiratory rate, heart rate, arterial pressure and oxygen saturation were recorded for 24 h. Metoclopramide 10 mg was administered intravenously as a rescue antiemetic.

RESULTS

Fifty patients received acupressure and 50 were controls. In the acupressure group, 33% of patients had nausea compared with 63% controls. The cumulative incidence of vomiting at 24 h was 25% with acupressure and 61% in controls. The incidence of nausea, vomiting and antiemetic use was significantly lower with acupressure.

CONCLUSIONS

Acupressure at the P6 meridian point is an effective alternative for the prevention of nausea and vomiting in patients receiving patient-controlled analgesia with morphine after gynaecological surgery.

Preoperative emotional states in patients with breast cancer and postoperative pain

BACKGROUND

The present study examined the relationship between psychological variables, including anxiety, depression, and patient-controlled analgesia (PCA) use in patients who underwent radical mastectomy.

METHODS

Ninety-nine ASA I-II women with breast cancer between 18 and 60 years scheduled for modified radical mastectomy completed the state scale of the state-trait anxiety inventory and the Beck depression inventory before the day of surgery. Standard general anesthesia, surgery, and IV-PCA therapy was conducted. Postoperative ratings of pain intensity, opioid consumption and satisfaction with PCA were recorded for the first 24 h on the ward. The degree of pain intensity was evaluated by a visual analog scale (VAS, 1-10). Satisfaction with pain control was reported using an five-point scale from 1 (very dissatisfied) to 5 (very satisfied).

RESULTS

The pain intensity, total analgesic consumption and dose/demand ratio were significantly related to preoperative anxiety and depression (P<0.05). Degree of dissatisfaction with PCA was significantly correlated with preoperative anxiety and depression (P<0.01).

CONCLUSION

Patients with higher anxiety and depression levels had higher postoperative pain and analgesic requirements in this study.

Evolution of metal pollution in the golden horn (Turkey) sediments between 1912 and 1987

The Golden Horn is a heavily polluted water body in a large metropolitan area with a population of approximately 10 million. A 3-m long undisturbed core sample was collected in the Golden Horn, from research vessel RV Knorr, during the third leg of the joint Turkish--American Black Sea expedition in 1989. The core was sliced and dated using the 210Pb isotope technique. The bottom of the core corresponds to the year 1912. Each slice was analysed for major, minor and trace elements by inductively coupled plasma emission spectrometry (ICP). The masses of the measured elements can account for approximately half of the sediment mass. The lithophilic elements Li, K, Rb, Mg, Ca, Ba, Al, La, Ti, V, Mn, Fe, Co and Ni account for more than 90% of the elemental mass and do not show any change in their concentrations between 1912 and 1987. Although anthropogenic elements Mo, Zn, Cr, Cu, Ag, and Cd account for a minute fraction of the elemental mass, their concentrations increase along the core, signifying human influence on chemical composition of the Golden Horn Sediments. Lead was enriched at the bottom of the core suggesting pollution of Golden Horn sediments by this element even at the beginning of the century, but observed concentrations of the remaining anthropogenic elements, at the bottom of the core, can be explained by sedimentary material. Concentrations of pollution-derived elements do not change significantly between 1912 and 1950, but their concentrations increase sharply in the second half of the century. A factor analysis applied to the data set has shown that the inorganic fraction of the Golden Horn sediments includes crustal, marine and two anthropogenic components. One of the anthropogenic components is attributed to the discharges from an iron and steel plant. The second anthropogenic component, which accounted for a larger fraction of system variance, is due to discharges from industries, particularly metalwork plants.

Feasibility of Applying a Stable Isotopic Tracer for Direct Determination of Dry Particulate Deposition to Soybean Plants

A stable rare-earth isotopic tracer was used to measure the deposition of KNO₃ particles on soybean leaves by direct measurement of the tracer on the plant surfaces by thermal-ionization mass spectrometry. Submicrometer particles, made from a solution containing 3 |mg mL^-1 neodymium isotope (¹⁴⁸Nd, 87.9%) and 1,000 mg mL^-1 KNO₃, were dispersed with a two-fluid nozzle and released upwind of a soybean field. Total suspended- and size-fractionated-aerosol particles were collected on an open-face filter and in a micro-orifice impactor, respectively, at a distance of 40 m from the release point. Soybean leaves exposed to the plume were collected at distances ranging from 25 to 100 m. As little as 5.5 pg of the tracer (i.e., excess ¹⁴⁸Nd) was detected in soybean leaves at signal-to-noise ratios ranging from 7,500 to 240,000, in the presence of 200 to 2,700 pg of naturally occurring Nd. The dry-particle deposition velocity, determined from the ratio of the aerial concentration and directly deposited aerosol (geometric mass mean diameter, 0.20 mm) flux, and its corresponding analytical uncertainty were 0.30 cm sec^-1 and 2.5%, respectively.

Beta-glycosidase (amygdalase and linamarase) from Endomyces fibuliger (LU677): formation and crude enzyme properties

In our previous studies, the yeast Endomyces fibuliger LU677 was found to degrade amygdalin in bitter apricot seeds. The present investigation shows that E. fibuliger LU677 produces extracellular beta-glycosidase activity when grown in malt extract broth (MEB). Growth was very good at 25 degrees C and 30 degrees C and slightly less at 35 degrees C. When grown in MEB of pH 5 and pH 6 with addition of 0, 10 or 100 ppm amygdalin, E. fibuliger produced only slightly more biomass at pH 5, and was only slightly inhibited in the presence of amygdalin. Approximately, 60% of the added amygdalin was degraded (fastest at 35 degrees C) during an incubation period of 5 days. Supernatants of cultures grown at 25 degrees C and pH 6 for 5 days were tested for the effects of pH and temperature on activity (using amygdalin, linamarin and prunasin as substrates). Prunase activity had two pH optima (pH 4 and pH 6), amygdalase and linamarase only one each at pH 6 and pH 4-5 respectively. The linamarase activity evolved earlier than amygdalase (2 days and 4 days respectively). The data thus indicate the presence of at least two different glycosidases having different pH optima and kinetics of excretion. In the presence of amygdalin, lower glycosidase activities were generally produced. However, the amygdalin was degraded from the start of the growth, strongly indicating an uptake of amygdalin by the cells. The temperature optimum for all activities was at 40 degrees C. Activities of amygdalase (assayed at pH 4) and linamarase (at pH 6) evolving during the growth of E. fibuliger were generally higher in cultures grown at 25 degrees C and 30 degrees C. TLC analysis of amygdalin degradation products show a two-stage sequential mechanism as follows: (1) amygdalin to prunasin and (2) prunasin to cyanohydrin.

Measurements of SO2, NO X and SPM in an industrial area at the Aegean coast of Turkey

Data from continuous measurements of SO2 NO x , suspended particulate matter (SPM) and meteorological parameters at seven sites around a highly industrialized region in the Aegean coast of Turkey, between July 15, 1991 to July 31, 1992 were used to evaluate spatial and temporal variations of air quality parameters. Low annual averages and insignificant differences between day and night concentrations were observed at stations far from sources. At stations close to sources, annual average concentrations were high and diurnal patterns were significant. Annual average SO2 and SPM concentrations in all stations used the 'Krigging' technique to assess the impact of industries on air quality in the surrounding airshed. Results have demonstrated that Turkish air quality standards for SO2 were exceeded in a circle with a radius of 4 km and which was centered on the petrochemical complex and refinery. Similarly, standards for SPM were exceeded in a circle with a radius of 1.2 km and which was centered on the ironwork plants. Both SO2 and SPM showed well defined diurnal variations, particularly in stations close to sources. The SO2 concentrations showed a maximum during day-time, while SPM concentrations peaked after midnight. Although annual average SO2 and SPM concentrations were highly variable depending on distances between stations and sources, background concentrations of the same pollutants, calculated by stripping episodes from data, did not change significantly from one station to another. Long range transport and resuspension of local soil were suggested as sources of background SO2 and SPM, respectively. The difference between observed and background concentrations of SO2 and SPM in each station was related to the impact of industries on air quality at that particular site.