Inkk Trial - Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.

Synergistic effect of calcium stearate and photo treatment on the rate of biodegradation of low density polyethylene spent saline vials.

The biodegradation of spent saline bottles, a low density polyethylene product (LDPE) by two selected Arthrobacter sp. under in vitro conditions is reported. Chemical and UV pretreatment play a vital role in enhancing the rate of biodegradation. Treated LDPE film exhibits a higher weight loss and density when compared to untreated films. Arthrobacter oxydans and Arthrobacter globiformis grew better in medium containing pretreated film than in medium containing untreated film. The decrease in density and weight loss of LDPE was also more for pretreated film when compared to untreated film indicating the affect of abiotic treatment on mechanical properties of LDPE. The decrease in the absorbance corresponding to carbonyl groups and double bonds that were generated during pretreatment suggest that some of the double bonds were cut by Arthrobacter species. Since Arthrobacter sp. are capable of degrading urea, splitting of urea group were also seen in FTIR spectrum indicating the evidence of biodegradation after microbial incubation. The results indicated that biodegradation rate could be enhanced by exposing LDPE to calcium stearate (a pro-oxidant) which acts as an initiator for the oxidation of the polymers leading to a decrease of molecular weight and formation of hydrophilic group. Therefore, the initial step for biodegradation of many inert polymers depends on a photo-oxidation of those polymers. The application in sufficient details with improved procedures utilizing recombinant microorganism with polymer degradation capacity can lead to a better plastic waste management in biomedical field. The present plastic disposal trend of waste accumulation can be minimized with this promising eco-friendly technique.

Anthropometric and hemodynamic profiles of athletes and their relevance to performance in the mount cameroon race of hope

Many factors influence athletes' performance including anthropometric, physiological and environmental parameters. High altitude is characterized by adverse environmental conditions that are not found at sea level. We investigated the influence of some anthropometric and physiological factors on performance in the context of the Mount Cameroon Race of Hope. Age, height, weight, blood pressure, heart rate and breathing rate of 83 finisher athletes of both genders were collected during medical checkup, and race time was recorded at the arrival line. Measured and calculated data association with performance was assessed. The race time was significantly influenced by the area of training [p=0.0022], and gender [p=0.0036] of athletes; BMI showed significant association with race time in the overall athletes' population; this was confirmed in male [r=0.565; p= 0.034] but not in female athletes [r= 0.749; p= 0.058]. Weight class showed significant association to performance, the lighter athletes performing better than the heavier [p<0.00001]. None of the investigated physiological parameters showed association to the race time. We hypothesized that high altitude training and body size are significantly influential on athletes' performance in the Mount Cameroon race of hope and similar mountain races.

Identification of new genetic risk factors for prostate cancer / 亚洲男科学杂志(英文版)

There is evidence that a substantial part of genetic predisposition to prostate cancer (PCa) may be due to lower penetrance genes which are found by genome-wide association studies. We have recently conducted such a study and seven new regions of the genome linked to PCa risk have been identified. Three of these loci contain candidate susceptibility genes: MSMB, LMTK2 and KLK2/3. The MSMB and KLK2/3 genes may be useful for PCa screening, and the LMTK2 gene might provide a potential therapeutic target. Together with results from other groups, there are now 23 germline genetic variants which have been reported. These results have the potential to be developed into a genetic test. However, we consider that marketing of tests to the public is premature, as PCa risk can not be evaluated fully at this stage and the appropriate screening protocols need to be developed. Follow-up validation studies, as well as studies to explore the psychological implications of genetic profile testing, will be vital prior to roll out into healthcare.

Anaesthetic management of awake craniotomy for tumour resection

<p><b>INTRODUCTION</b>Awake craniotomy allows accurate localisation of the eloquent brain, which is crucial during brain tumour resection in order to minimise risk of neurologic injury. The role of the anaesthesiologist is to provide adequate analgesia and sedation while maintaining ventilation and haemodynamic stability in an awake patient who needs to be cooperative during neurological testing. We reviewed the anaesthetic management of patients undergoing an awake craniotomy procedure.</p><p><b>MATERIALS AND METHODS</b>The records of all the patients who had an awake craniotomy at our institution from July 2004 till June 2006 were reviewed. The anaesthesia techniques and management were examined. The perioperative complications and the outcome of the patients were noted.</p><p><b>RESULTS</b>There were 17 procedures carried out during the study period. Local anaesthesia with moderate to deep sedation was the technique used in all the patients. Respiratory complications occurred in 24% of the patients. Hypertension was observed in 24% of the patients. All the complications were transient and easily treated. During cortical stimulation, motor function was assessed in 16 patients (94%). Three patients (16%) had lesions in the temporal-parietal region and speech was assessed intraoperatively. Postoperative motor weakness was seen in 1 patient despite uneventful intraoperative testing. No patient required intensive care unit stay. The median length of stay in the high dependency unit was 1 day and the median length of hospital stay was 9 days. There was no in-hospital mortality.</p><p><b>CONCLUSION</b>Awake craniotomy for brain tumour excision can be successfully performed under good anaesthetic conditions with careful titration of sedation. Our series showed it to be a well-tolerated procedure with a low rate of complications. The benefits of maximal tumour excision can be achieved, leading to potentially better patient outcome.</p>

Nickel induced histopathological changes in the different tissues of freshwater fish, Hypophthalmichthys molitrix (Valenciennes).

Nickel chloride, heavy metal widely used in industries was investigated in the present study for histopathological studies in silver carp (Hypophthalmichthys molitrix). Fish were exposed for 10, 20 and 30 days in sublethal concentration of nickel 5.7 mg/l. The histopathological changes were studied in the gill, liver, intestine and kidney of the nickel treated freshwater fish H. molitrix. The nickel showed a tissue specific alteration in the tissues. Mucus proliferation, fusion of the gill lamellae and hypertrophy of gill tissues were observed. Lack of normal palisade arrangement was followed by necrosis in hepatocytes. Degeneration of blood vessels, vacuolation, hypertrophy, pyknotic nuclei and lesion were observed in liver tissues. Degeneration of tubular cells, hyperplasia was observed in kidney tissues.

Observations on life cycle of certain spiders from Western Ghats of Tamil Nadu.

Survey was conducted, in the different forests ecosystems of Western Ghats of Tamil Nadu in Nilgris, Coimbatore, Erode, Virudhunagar and Tirunelveli districts to collect the adult spiders and study them taxonomically. Fifty-six species of spider collections were made. From the fifty six, biology was studied for six spider species, such as Micrommata virescens n.sp., Oxyopes javanus, Peucetia virridana, Agelena kariansholensis n.sp., Heteropoda venatoria and Olios hampsoni. Biology studies with Peucetia virridana and Micrommata virescens showed that both species took more than 350 days to complete their life cycles. Heteropoda venetoria and Oxyopes javanus took more than 250 days to complete their life cycle. Agelena kariansholensis took 381 days and Olios hampsoni took 345 days to complete their life cycles. 30% of Peucetia virridana and more than 20% of Heteropoda venatoria and Micrommata virescens and 7% of Oxyopes javanus developed into adults in captivity.

Impact of cadmium on food utilization of the Indian major carp, Catla catla (Ham).

Catla catla, under the sublethal stress of cadmium exhibited depletion in food utilization parameters and it was concentration dependent. Heavy metal intoxication was found to exhibit reduction in biomass.