Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study.

BACKGROUND AND STUDY AIMS: Undergoing a surgical procedure can be very stressful for patients and can lead to high anxiety levels during both the preoperative and the postoperative period. Levels of anxiety and fear may depend on multiple factors including the type of anesthesia to be used. The objective of this study is to evaluate whether patient's awareness of the surgical environment in the operating room under local anesthesia and conscious sedation (LACS) affects their mood and anxiety levels. METHODS: We performed a prospective study for a series of consecutive patients who underwent transforaminal percutaneous endoscopic lumbar diskectomy (PELD) for the treatment of lumbar disk herniation. The patients completed Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) forms in the preoperative period and in the early postoperative period. We divided the patients into two groups according to the type of anesthesia applied during surgery: LACS and general anesthesia (GA) groups. We compared the preoperative and postoperative POMS and STAI scores between groups and the change of these scores between the preoperative and postoperative periods in each group. RESULTS: In this study, we included 30 patients who underwent PELD between May and December 2019 and met the inclusion criteria. The GA group consisted of 16 patients and the LACS group consisted of 14 patients. In each group, POMS and STAI scores decreased in the early postoperative period compared with the preoperative period. We found no significant difference in percentage of POMS and STAI TX-1 score changes between the LACS and GA groups. CONCLUSION: The results of our study show that patients' awareness of the surgical environment in the operating room under LACS does not significantly affect their mood and anxiety levels and patients do not seem to endure increased emotional stress during the PELD operation, as compared with PELD operation under GA.

Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients.

Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62-65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19.

Regional process redesign of lung cancer care: a learning health system pilot project.

BACKGROUND: The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions. METHODS: To operationalize a lhs, we developed the Ottawa Health Transformation Model (ohtm) as a consensus approach that addresses process barriers, resistance to change, and conflicting priorities. A regional Community of Practice (cop) was established to engage stakeholders, and a dedicated transformation team supported process improvements and implementation. RESULTS: The project operationalized the lung cancer diagnostic pathway and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage, and consult were redesigned. The Ottawa Hospital now provides a diagnosis to 80% of referrals within the provincial target of 28 days. The median patient journey from referral to initial treatment decreased by 48% from 92 to 47 days. CONCLUSIONS: The initiative optimized regional integration from referral to initial treatment. Use of a lhs lens enabled the creation of a system that is standardized to best practice and open to ongoing innovation. Continued transformation initiatives across the continuum of care are needed to incorporate best practice and optimize delivery systems for regional populations.

Investigation of the photocatalytic activity of TiO2--polyoxometalate systems.

The present study reports the investigation of polyoxometalate catalyzed electron transfer from the conduction band of photoexcited TiO2 to molecular oxygen. The oxidation of 1,2-dichlorobenzene (DCB) was used as an index reaction for evaluating the photocatalyst systems TiO2-PW12O40(3-), TiO2-SiW12O40,4- and TiO2-W10O32(4-) in oxygenated aqueous solution. Addition of these polyoxometalate (POM) anions to TiO2 suspensions resulted in significant rate enhancement for DCB oxidation. Photodegradation kinetics exhibited [POM] dependence, experiencing different maximum (k = 0.0318 min(-1), 0.0108 min(-1), and 0.0066 min(-1)) for each POM at different [POM] (0.1 mM PW12O40(3-), 0.07 mM SiW12O40,4- and 1 mM W10O32,4-respectively). The probability that the difference in the adsorption affinity of POMs on TiO2 surface could account for the observed ranking of photodegradation rates was ruled out by adsorption isotherm experiments that revealed similar binding constants for each POM (467 M(-1), 459 M(-1), and 417 M(-1) for PW12O40(3-), SiW12O40(4-), and W10O32(4-), respectively). DCB degradation over TiO2 with O2 or POM+O2 systems can be modeled by the Langmuir-Hinshelwood (saturation kinetics) model. The concentration-independent rate constants (kL-H) for TiO2-O2, TiO2-W10O32(4-), TiO2-SiW12O40(4-), and TiO2-PW12O40(3-) were 0.0818, 0.152, 0.421, and 0.638 min(-1), respectively. An analysis of deltaG for electron transfer from the conduction band of TiO2 to POMs in this study shows that the electron transfer takes place even when it is endothermic.

Bilateral galactocele in a male infant: a rare cause of gynecomastia in childhood.

A galactocele is a rare benign breast lesion usually occurring in females during or following lactation. These lesions are a rare cause of breast enlargement in infants and children. In this article we present a 10 month-old boy who was admitted with a two-month history of bilateral progressive breast enlargement, and diagnosed as having galactocele. Our purpose was to emphasize the importance of galactocele as a benign condition in the differential diagnosis of gynecomastia in childhood.

Beta-Thalassemia Mutations in the East of Turkey.

This study was planned to determine the frequency of ß-thalassemia trait and mutations in Van Lake region, which is in the eastern part of Turkey, surrounded by Iran in the east and by Iraq in the south. This study consist of 1014 healthy students, between the age of 12 and 18 years who are studying in boarding schools in Van city and cities surrounding Van Lake that includes Van, Agri, Hakkari, Bitlis, Mus and Siirt. The students were randomly selected according to their school numbers. Their origin was not taken into consideration in selection. Complete blood counts were performed on all donors. The accepted lower limit of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were 78 fL and 27 pg respectively. HbA2 was measured by DE-52 microcolumn chromatography method. ß-thalassemia trait with high HbA2 was found in 6 children. ß-thalassemia homozygous form of -30 (T-A) mutation was determined in one child and HbD-Los Angeles heterozygous in another. The ß-thalassemia homozygous individual was accepted as two cases in prevalence calculation. We found that the prevalence of ß-thalassemia trait was 0.78% in this area. In DNA analyses, there were ß-thalassemia gene mutations of FSC 8/9 (+G), -30 (T-A), IVS I-110 (G-A), IVS II-1 (G-A) and IVS I-130 (G-A) in 3, 2, 1, 1 and 1 individuals, respectively. We conclude that although five different ß-thalassemia mutation exist in Van Lake region, ß-thalassemia is not a potential risk in the east of Turkey.

Phosphorylation-dependent localization of microtubule-associated protein MAP2c to the actin cytoskeleton.

Microtubule-associated protein 2 (MAP2) is a neuronal phosphoprotein that promotes net microtubule growth and actin cross-linking and bundling in vitro. Little is known about MAP2 regulation or its interaction with the cytoskeleton in vivo. Here we investigate the in vivo function of three specific sites of phosphorylation on MAP2. cAMP-dependent protein kinase activity disrupts the MAP2-microtubule interaction in living HeLa cells and promotes MAP2c localization to peripheral membrane ruffles enriched in actin. cAMP-dependent protein kinase phosphorylates serines within three KXGS motifs, one within each tubulin-binding repeat. These highly conserved motifs are also found in homologous proteins tau and MAP4. Phosphorylation at two of these sites was detected in brain tissue. Constitutive phosphorylation at these sites was mimicked by single, double, and triple mutations to glutamic acid. Biochemical and microscopy-based assays indicated that mutation of a single residue was adequate to disrupt the MAP2-microtubule interaction in HeLa cells. Double or triple point mutation promoted MAP2c localization to the actin cytoskeleton. Specific association between MAP2c and the actin cytoskeleton was demonstrated by retention of MAP2c-actin colocalization after detergent extraction. Specific phosphorylation states may enhance the interaction of MAP2 with the actin cytoskeleton, thereby providing a regulated mechanism for MAP2 function within distinct cytoskeletal domains.

Higher order iminodiacetic acid libraries for probing protein-protein interactions.

Full details of the preparation of iminodiacetic acid diamide dimer (2040 compounds), trimer (560 compounds), and tetramer (1596 compounds) libraries by multistep convergent solution-phase synthesis for studying protein-protein interactions are provided. The libraries were assembled in a format providing small 8-10 compound mixtures and the deconvolution of many of the small mixtures to identify screening leads by resynthesis of the individual components have been conducted for 320 of the individual compounds to date. A representative example of the subsequent exploration of the structure-activity relationships for an identified receptor binding antagonist (200 additional individual compounds) and steps taken for potential elaboration to a receptor dimerization agonist are defined with preparation of representative linked dimers (70 compounds).

N-arylpiperazinyl-N'-propylamino derivatives of heteroaryl amides as functional uroselective alpha 1-adrenoceptor antagonists.

Novel arylpiperazines were identified as alpha 1-adrenoceptor (AR) subtype-selective antagonists by functional in vitro screening. 3-[4-(ortho-Substituted phenyl)piperazin-1-yl]propylamines were derivatized with N,N-dimethyl anthranilamides, nicotinamides, as well as carboxamides of quinoline, 1,8-naphthyridine, pyrazolo[3,4-b]pyridine, isoxazolo[3,4-b]pyridine, imidazo[4,5-b]pyridine, and pyrazolo[1,5-a]pyrimidines. Strips of rabbit bladder neck were employed as a predictive assay for antagonism in the human lower tract. Rings of rat aorta were used as a "negative screen" for the test antagonists. Binding to alpha 1-ARs was relatively sensitive to size and electronic features of the arylpiperazine portion of the antagonists and permissive to these features on the heteroaryl carboxamide side. These structure-affinity findings were exploited to produce nicotinamides (e.g. 13ii and 25x) and pyrazolo[3,4-b]pyridines (e.g. 37f and 37y) ligands with nanomolar affinity at the alpha 1-AR subtype prevalent in the human lower urinary tract(pA2 values: 8.8, 10.7, 9.3, and 9.9, respectively) and displaying 2-3 orders of magnitude selectivity over the alpha 1D-AR.

In vitro accumulation of mineral components by invertebrate cartilage.

In vitro mineralization of the gill cartilage of Limulus (horse-shoe crab) has been reported previously (Eilberg et al. 1975). The present study demonstrates that cranial cartilage of Loligo (squid) and odontophore cartilage of Busycon (marine snail) also mineralize in vitro in hydroxyapatite-metastable media, but not in carbonate-metastable media. In all three of these cartilages, light phase-contrast microscopy revealed that the mineral phase occured in the form of spherical or ovoid granules ranging between 2 and 9 mum in diameter. During mineralization, the granules appeared successively in the perichondrium, in the matrix, and finally, within chondrocytes. Mineralization occurred more rapidly in Eusycon odontophore cartilage which has a significantly higher content of phosphatidyl serine than in Limulus gill or Loligo head cartilages. In all tissues the mineralization process is related to temperature, taking place most actively at 37 degrees C and only weakly at 50 degrees C.