Autonomic Dysreflexia After Hip Fractures Managed by Regional Anesthesia: A Case Report.

Autonomic dysreflexia occurs after a spinal cord injury usually at the level of T6 or above, and its hallmark feature is exaggerated autonomic response to noxious stimuli resulting in uncontrolled hypertensive episodes with reflexive bradycardia that can be fatal if not controlled. We present a case highlighting regional anesthetic techniques, including peripheral nerve blocks, to ameliorate the symptoms of autonomic dysreflexia triggered by hip fractures in a 57-year-old woman with an old C5-C6 spinal cord injury before definitive hip surgery. The regional techniques described provide anesthesiologists with a simple strategy to potentially mitigate a life-threatening situation.

Facile Light-Induced Transformation of [RuII(bpy)2(bpyNO)]2+ to [RuII(bpy)3]2.

Ru-based coordination compounds have important applications as photosensitizers and catalysts. [RuII(bpy)2(bpyNO)]2+ (bpy = 2,2'-bipyridine and bpyNO = 2,2'-bipyridine-N-oxide) was reported to be extremely light-sensitive, but its light-induced transformation pathways have not been analyzed. Here, we elucidated a mechanism of the light-induced transformation of [RuII(bpy)2(bpyNO)]2+ using UV-vis, EPR, resonance Raman, and NMR spectroscopic techniques. The spectroscopic analysis was augmented with the DFT calculations. We concluded that upon 530-650 nm light excitation, 3[RuIII(bpyNO-•)(bpy)2]2+ is formed similarly to the 3[RuIII(bpy-•)(bpy)2]2+ light-induced state of the well-known photosensitizer [RuII(bpy)3]2+. An electron localization on the bpyNO ligand was confirmed by obtaining a unique EPR signal of reduced [RuII(bpy)2(bpyNO-•)]+ (gxx = 2.02, gyy = 1.99, and gzz = 1.87 and 14N hfs Axx = 12 G, Ayy = 34 G, and Azz = 11 G). 3[RuIII(bpyNO-•)(bpy)2]2+ may evolve via breaking of the Ru-O-N fragment at two different positions resulting in [RuIV═O(bpy)2(bpyout)]2+ for breakage at the O-|-N bond and [RuII(H2O)(bpy)2(bpyNOout)]2+ for breakage at the Ru-|-O bond. These pathways were found to have comparable ΔG. A reduction of [RuIV═O(bpy)2(bpyout)]2+ may result in water elimination and formation of [RuII(bpy)3]2+. The expected intermediates, [RuIII(bpy)2(bpyNO)]3+ and [RuIII(bpy)3]3+, were detected by EPR. In addition, a new signal with gxx = 2.38, gyy = 2.10, and gzz = 1.85 was observed and tentatively assigned to a complex with the dissociated ligand, such as [RuIII(H2O)(bpy)2(bpyNOout)]3+. The spectroscopic signatures of [RuIV═O(bpy)2(bpyout)]2+ were not observed, although DFT analysis and [RuII(bpy)3]2+ formation suggest this intermediate. Thus, [RuII(bpy)2(bpyNO)]2+ has potential as a light-induced oxidizer.

Hyaluronic acid applications in ophthalmology, rheumatology, and dermatology.

Hyaluronic acid (HA) is a natural polymer of the body capable of reaching high molecular weights leading to a plethora of properties. The physico-chemical properties enable the use of HA in various fields of medicine such as ophthalmology, rheumatology, and dermatology. In the treatment of dry eye disease, HA provides water retention and lubricant properties that challenge current treatment. For osteoarthritis, HA applies its lubricant as well as anti-inflammatory properties for treatment. Additionally, HA has been a long-standing ingredient in dermatology and cosmetics for its benefit in revitalizing the skin. This review explores HA's uses in the aforementioned applications.

Prospective Evaluation of Patient Usage of Above and Below Threshold Waveforms With Traditional Spinal Cord Stimulation Devices.

OBJECTIVES: Spinal cord stimulation (SCS) is an efficacious therapy used to treat chronic pain. The type of SCS programming is important in improving patients' quality of life and overall satisfaction. In this study, 19 patients who underwent SCS with traditional devices were given between 4 and 6 programs including programs with stimulation below sensory threshold and above sensory threshold. Usage patterns and preferences were assessed. METHODS: SCS patients were given 4-6 programs, some above sensory threshold and some below threshold immediately postoperatively after permanent implantation. Usage patterns of different programs were documented, including percent of time that the settings were used and preference for above threshold vs. below threshold settings during sleeping, walking, sitting, and vigorous activity. Improvements at three months in Oswestry disability index (ODI), numeric rating scale (NRS), Beck depression inventory (BDI), McGill pain questionnaire (MPQ), pain catastrophizing scale (PCS), insomnia severity index (ISI), and Epworth sleepiness scale (ESS) were evaluated. RESULTS: Patients were all trialed on above sensory threshold programs. Six weeks after implantation, most patients preferred above threshold stimulation (74%) vs. below threshold waveforms (21%). Patient diagnosis, type/location of lead or recharging burden played no role in patient preference. Above threshold patients had significantly better improvement in BDI scores than did below threshold patients (p < 0.05) at three-month follow-up but also had worse ESS scores (p < 0.05). Above threshold stimulation was preferred for walking and sitting (p < 0.05). CONCLUSIONS: Results indicate that when given the option between waveforms inducing paresthesias and those that do not, SCS patients tend to prefer waveforms that induce paresthesias. Among users of above threshold waveforms, there was preference for these settings during walking and sitting. There was a trend for below threshold preference in vigorous activity and sleeping.