Spongospora subterranea f. sp. subterranea Affects Plant Susceptibility to Subsequent Pathogen Infections Under Controlled-Environment Conditions.

Spongospora subterranea f. sp. subterranea (Sss) is a soilborne potato pathogen responsible for causing powdery scab on tubers and galls on roots, reducing root water uptake through colonizing root hairs, and vectoring of Potato mop-top virus (PMTV). However, effects of Sss on overall plant susceptibilities against subsequent infections of potato pathogens above ground have not been previously reported. This study aimed to investigate the effects of Sss on root and tuber disease expression, yield, and susceptibilities to subsequent late blight and white mold infections across six potato varieties. Sss-infected Silverton plants had 28.3% less total tuber yield and 29% fewer tubers compared to noninfected Silverton plants. We did not find a correlation across the varieties between root colonization and root gall formation. Sss-infected Silverton plants were more susceptible to hemibiotrophic late blight and less susceptible to necrotrophic white mold. Sss infection also increased susceptibilities of Goldrush and Atlantic plants to white mold. We also evaluated prevalence of asymptomatic Sss infections across the six varieties. Between 50 and 92% of the asymptomatic tubers tested positive for Sss DNA, depending on the variety. Further research is required to understand the possibility and extent of these asymptomatic infections to the spread of Sss in the field. These findings highlight the complexity of Sss-host interactions and give precedence that the lack of disease expression does not necessarily indicate resistance of a variety to Sss.

Solid-to-solid polymorphic phase transitions in two isostructural Bi(III) complexes with 1-phenylethyl-N-ethylthiosemicarbazide and halogens.

Two isostructural (in room temperature) complexes of Bi(III) with halogens and sulfur ligands have been investigated in terms of the solid-to-solid phase transitions indicated by temperature. Both chloride and bromide (X) complexes of the general formula (µ2-X)-(BiX2L2)2 exhibit some phase transitions between 100 and 333 K, which, apart from the numerous similarities, show significant differences, which have been noted and analyzed in detail in this paper by using different techniques, i.e., powder and single crystal diffraction or DSC. The obtained results have also been collated with those obtained for solid solutions of both complexes.

Air pollution in marmara region before and during the COVID-19 outbreak.

The lockdowns and curfews during the COVID-19 pandemic have halted economic and transportation activities across the world. This study aims to investigate air pollution levels in the Marmara region, particularly in Istanbul, before and during the COVID-19 pandemic. The study used real data provided by the General Directorate of Meteorology and applied three machine learning algorithms (ANN, RBFreg, and SMOreg) to analyze air pollution data. In addition, a one-sample t-test was performed to compare air pollution levels before and during the COVID-19 pandemic in the Marmara region and Istanbul. The results of the study showed a significant reduction in the particulate matter (PM) value, which indicates the degree of air pollution, in both the Marmara region and Istanbul during the COVID-19 pandemic. The one-sample t-test results showed that the reduction in air pollution levels was statistically significant in both areas (t = 11.45, p < .001 for the Marmara region, and t = 3.188, p < .001 for Istanbul). These findings have important practical implications for decision-makers planning for a more sustainable environment. Overall, the study provides valuable insights into the impact of the COVID-19 pandemic on air pollution levels in the Marmara region, particularly in Istanbul. The application of machine learning algorithms and statistical analysis provides a rigorous approach to the investigation of this important issue by comparing before and during the COVID-19 outbreak.

Synthesis, characterization, and biological properties of mono-, di- and poly-nuclear bismuth(III) halide complexes containing thiophene-2-carbaldehyde thiosemicarbazones.

In order to investigate the coordination chemistry and pharmacological applications of bismuth compounds, a series of new bismuth(III) halide thiosemicarbazone complexes were synthesized. The reactions of thiophene-2-carbaldehyde-N-substituted thiosemicarbazones with bismuth(III) halides resulted in the formation of the {[[BiCl2(η1-S-Httsc)4]+.Cl-][BiCl2(µ2-Cl)(η1-S-Httsc)2]2} (1), {[BiCl3(η1-S-Htmtsc)3].CH3OH} (2), {[BiCl3(η1-S-Htetsc)3].CH3OH} (3), {[BiBr2(µ2-Br)(η1-S-Httsc)2]2.CH3OH} (4), {[BiBr2(µ2-Br)(η1-S-Htmtsc)2]n} (5), and {[BiI2(µ2-I)(η1-S-Httsc)2]2} (6) complexes (Httsc: thiophene-2-carbaldehyde thiosemicarbazone, Htmtsc: thiophene-2-carbaldehyde-N-methyl thiosemicarbazone, Htetsc: thiophene-2-carbaldehyde-N-ethyl thiosemicarbazone). The complexes were characterized by a number of different spectroscopic techniques and the crystal structures of all bismuth(III) complexes (1-6) were determined by using single crystal X-ray diffraction study. In addition, the thermal stability of the complexes was compared using Thermogravimetric-differential thermal analysis. Crystal structures of the two free ligands, thiophene-2-carbaldehyde-N-methyl-thiosemicarbazone and thiophene-2-carbaldehyde-N-ethyl-thiosemicarbazone, were also determined by using single crystal X-ray diffraction analysis. The Hirshfeld surface of the bismuth(III) complexes and free ligands were additionally analyzed to verify the intermolecular interactions. Biological studies showed that all six bismuth(III) thiosemicarbazone complexes (1-6) exhibited biological activities against selected bacteria and the human breast adenocarcinoma (MCF-7) cell line.

Is there a Predictive Value of Hemoglobin A1C for Complications of Cardiac Surgery?

OBJECTIVE: To investigate the effect of preoperative hemoglobin A1c levels for the complications of cardiac surgery. STUDY DESIGN:   Meta-analysis. Place of Study: Siyami Ersek Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. METHODOLOGY: PubMed, Scopus, Web of Science and Ovid electronic databases were used. The studies were included the recorded preoperative levels of hemoglobin A1C and postoperative complications developed after cardiac surgery. Results of the studies were evaluated, based on either random or fixed effect model, according to presence of heterogeneity (I2>25%). RESULTS: In total, 2,312 articles were obtained. After reviewing the articles, 33 articles covering 3500 patients meeting the inclusion criteria were included. The results pointed out that there was a relationship between preoperative hemoglobin A1c levels and mediastinitis, stroke, pneumonia, sepsis, renal failure and mortality. Heterogeneity was observed for myocardial infarction, atrial fibrillation and multiorgan failure (I2 >25%). CONCLUSION: Preoperative hemoglobin A1C levels were associated with development of mediastinitis, stroke, pneumonia, sepsis, renal failure and mortality after cardiac surgery. Key Words: Hemoglobin A1C, Cardiac surgery, Complication, Meta-analysis.

Facile preparation of nanoparticle based SERS substrates for trace molecule detection.

In this work, we demonstrate that a polished Si wafer surface can be converted to possess strong surface-enhanced Raman scattering (SERS) activity by spray coating of polyol synthesized colloidal silver nanoparticles (AgNPs) at as low as 1% surface coverage. The SERS activity assays of substrate surfaces prepared with different production procedures (spray and spin coating) at different surface coverages are realized using population statistics. The resulting Raman enhancement factors (EFs) are discussed with the help of distance-dependent electromagnetic simulations for single particles and dimers. Statistics on the SERS effect and the corresponding EF calculations show that polyol synthesized AgNPs exhibit extremely strong SERS activity with EFs up to 108 at as low as 1% surface coverage. We discuss in this work that this is possible due to the distinct properties of polyol synthesized AgNPs such as atomically flat surfaces, sharp edges and corners naturally occurring in this synthesis method, which favor strong plasmonic activity. The method can be generalized to convert virtually any surface into a SERS substrate.

Efficiency of Thyroid Function Test in the Prediction of Atrial Fibrillation Following Open Heart Surgery.

OBJECTIVE: To analyse the efficiency of thyroid function tests (thyroid stimulating hormone, thyroxine and tri-iodothyronine) on prediction of postoperative atrial fibrillation. STUDY DESIGN: Meta-analysis. Place of Study: Siyami Ersek Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. METHODOLOGY: Literature review was carried out in PubMed, Science Direct and Ovid Database. No date limitations was applied. Trials, which evaluated the preoperative levels of thyroid stimulating hormone, thyroxine and tri-iodothyronine in cardiac surgery patients, were included. Only the articles in English language were reviewed. We evaluated the results with fix or random effect models according to the presence of heterogeneity (I2 >25%). RESULTS: Five hundred and forty-seven articles were obtained after screening of databases. After checking over the titles and abstracts, five trials were included which covered 380 patients and complied with inclusion criteria. According to results of analysis, there was no significant relationship between postoperative atrial fibrillation and thyroid stimulating hormone (SMD: 0.38, 95%CI -0.46-1.23, p=0.375), and also thyroxine (SMD: 0.006, 95% CI -0.29-0.30, p=0.966). However, tri-iodothyronine (SMD: -1.06, 95% CI -2.08- -0.03, p=0.04) was correlated with development of atrial fibrillation. Heterogeneity was observed in three parameters (I2; for TSH: 92.45%, for T3: 93.08% and for T4: 31.78%). CONCLUSION: Preoperative levels of tri-iodothyronine was an effective parameter for predicting postoperative atrial fibrillation after cardiac surgery, but there was a need of larger trials for eliminating heterogeneity for all of the parameters of thyroid function tests. Key Words: Cardiac surgery, Atrial fibrillation, Thyroid stimulating hormone, Thyroxine, Tri-iodothyronine.

Atrial fibrillation after cardiac surgery and preoperative vitamin D levels: A systematic review and meta-analysis.

BACKGROUND: In this meta-analysis, we aimed to investigate the possible relationship between atrial fibrillation development after cardiac surgery and preoperative vitamin D levels. METHODS: Literature review was carried out in the PubMed, ScienceDirect and Ovid electronic databases without any limitation of time frame. Published studies which recorded the preoperative levels of vitamin D and atrial fibrillation after cardiac surgery in the English language were included. The results of the studies were evaluated based on either random or fixed effect model according to the presence of heterogeneity (I2>25%). RESULTS: A total of 1,865 articles were screened. After the article titles and abstracts were analyzed, six articles involving 769 patients which met the inclusion criteria were included. The results indicated that there was a relationship between preoperative vitamin D levels and postoperative atrial fibrillation (SMD: -0.46, 95% CI: -0.79 to -0.12; p<0.007). Heterogeneity was observed for studies conducted (I2 =76.1%). CONCLUSION: We concluded that low preoperative vitamin D levels were associated with the development of atrial fibrillation after cardiac surgery. However, there is a need for large-scale, randomized-controlled trials for preventing the heterogeneity of the results.

Surgical treatment of pediatric forearm fractures with intramedullary nails: is it a disadvantage to leave the tip exposed?

Elastic intramedullary nailing is the main treatment method in the surgical treatment of pediatric forearm fractures. In this study, we compared the clinical outcomes of intramedullary nailing of forearm fractures with leaving the tips exposed and with placing the tip of the nails under the skin. We aimed to present the clinical outcomes of intramedullary nailing and determine the advantages and disadvantages of leaving the tips of the nails exposed. One hundred and ninety-two children with both-bone forearm fracture who were treated with titanium elastic nailing (TEN) in the Department of Orthopedics at Erzurum Regional Training and Research Hospital between January 2009 and December 2016 were included in the study. All cases had been followed up for at least 1 year. The tips of the TENs were left exposed in 74 and buried subcutaneously in 118 children. Union was achieved in all cases. Delayed union was observed in just one case. Skin irritation was observed in 11 (5.7%) of the exposed TEN cases. Superficial infection developed in two (1%) cases with exposed TEN tips. Migration developed during the follow-up of 11 (5.7%) cases with buried tips. The mean time to removal of TEN was 7.9 weeks in cases with exposed and 26.2 weeks in cases with buried cases. Refracture was observed in six buried (3.1%) cases and four exposed TEN (2.1%) cases in the first year after the removal of the nails. Perfect outcomes were achieved in 146 (76%) cases and good outcomes in 36 (19%) cases in our study. On comparing the rate of complications and clinicaloutcomes, leaving the TEN exposed seems to be safe.

Comparison of the Cost and Efficacy of Axillary Anesthesia and Wide-Awake Anesthesia in Finger Surgeries.

OBJECTIVES: Wide-awake anesthesia is a type of local anesthesia consisting of a combined application of lidocaine, epinephrine, and bicarbonate and has a wide potential in hand surgery as it offers the advantage of being applied without sedation and without using a tourniquet. In light of recent studies, its use has increased with the disappearance of the belief among surgeons that epinephrine can cause circulatory disturbance in fingers. METHODS: Patients with finger pathologies who were operated upon at the Baltalimani Bone Diseases Teaching and Research Hospital between January 2015 and February 2016 were divided into two groups according to anesthesia type: wide-awake anesthesia and axillary block anesthesia, with 52 patients in each group. Start time of surgery, length of hospital stay, anesthesia cost, and patient satisfaction were compared. For the evaluation of patient satisfaction, the patients were postoperatively asked whether they would accept the same anesthesia method if they had to have the same experience. Each group was further divided into two subgroups: bone interventions (phalangeal fracture, bone biopsy, implant removal, and interphalangeal joint arthrodesis) and soft tissue interventions (digital nerve repair, fingertip local skin flap, flap division, releasing stiff joint, ligament repair, and debridment). Each subgroup included 26 patients. RESULTS: Sufficient anesthesia to cover the whole duration of surgery was achieved in both the groups. Regarding the question "If you were experiencing the same experience, would you accept the same anesthesia again?" 26 and 33 patients responded positively, 16 and 7 patients repsonded negatively, and 10 and 12 patients remained neutral in the axillary block and wide-awake anesthesia groups, respectively. According to the Social Security Institution data, the average anesthesia cost was 316.1 TL in the axillary block anesthesia group and 25.3 TL in the wide-awake anesthesia group; the average length of hospital stay was 32.9 h in the former and 13.6 h in the latter. Start time of surgery was 34 minutes in axillary block anesthesia and 5.3 minutes in wide-awake anesthesia. CONCLUSION: We found that compared with axillary block anesthesia, the length of hospital stay was 19.3 h less and anesthesia cost was 290.8 TL less with wide-awake anesthesia; furthermore, the start time of surgery decreased by 29.7 min with the latter. Moreover, patient satisfaction rate was better in the wide-awake anesthesia group. No bleeding, patient incompatibility, and other complications that might interfere with the surgery were detected .

Surgical treatment results for dupuytren's disease.

OBJECTIVE: To present the results of our cases of Dupuytren's disease treated with regional selective fasciectomy in light of the literature. METHODS: Patients diagnosed with Dupuytren's contracture and surgically treated with regional selective fasciectomy at our institution with adequate follow-up data were included in the study. All patients were routinely followed after surgery to assess results and complications. QuickDASH scoring was used to evaluate the patients and recurrences and complications were recorded. RESULTS: Twenty-one hands of 19 patients (13 males, 6 females) who underwent surgery and received adequate follow-up were retrospectively evaluated. Mean patient age was 65.8 (range: 41 to 86) and the mean follow-up period was 48.2 months (range: 24 to 86). Fourteen (66.6%) hands had excellent results, five (23%) hands had good results and two (9.4%) had fair results. The mean QuickDASH score for the patients at the final follow-up was 6.58 (range: 0 to 20.4). CONCLUSION: Our study results demonstrated that regional selective fasciectomy is a reliable and efficient method to treat Dupuytren's disease with low rates of complications and recurrence and the technique can be considered the gold standard. Level of Evidence IV, Case Series.

OBJETIVO: Apresentar os resultados de nossos casos de doença de Dupuytren tratados com fasciotomia seletiva regional, à luz da literatura. MÉTODOS: Os pacientes diagnosticados com contratura de Dupuytren e tratados cirurgicamente com fasciotomia seletiva regional em nossa instituição que tinham dados de acompanhamento adequados foram incluídos no estudo. Todos os pacientes foram rotineiramente acompanhados após a cirurgia para avaliação dos resultados e das complicações. Foi utilizada a pontuação QuickDASH na avaliação dos pacientes e as recorrências e complicações foram registradas. RESULTADOS: Foram avaliadas retrospectivamente vinte e uma mãos de 19 pacientes (13 homens, 6 mulheres) submetidos à cirurgia e acompanhados adequadamente. A média de idade dos pacientes foi de 65,8 (intervalo: 41 a 86) e o período médio de seguimento foi 48,2 meses (intervalo: 24 a 86). Quatorze (66,6%) mãos tiveram excelentes resultados, enquanto cinco (23%) mãos tiveram bons e duas (9,4%) tiveram resultados moderados. A pontuação média no QuickDASH dos pacientes no seguimento final foi de 6,58 (intervalo: 0 a 20,4). CONCLUSÃO: Os resultados do nosso estudo demonstraram que a fasciotomia seletiva regional é um método confiável e eficiente, com baixas taxas de complicação e recorrência no tratamento da doença de Dupuytren e a técnica pode ser considerada o padrão-ouro. Nível de Evidência IV, Série de Casos.

The effect of 2 different surgical methods on intracompartmental pressure value in tibial shaft fracture: An experimental study in a rabbit model.

BACKGROUND: Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP. METHODS: Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours. RESULTS: There was statistically significant difference in ICP value between groups (p<0.001). While there was statistically significant increase in ICP values 24 hours post surgery, there was statistically significant decrease during second 24 hours following surgery. Most importantly, ICP values of ICF group were significantly lower than those of IMP group at 30, 36, and 42 hours post surgery (p<0.05). CONCLUSION: At 24th hour after fixation, ICP values measured in ICF group were lower compared with those of IMP group. These results indicate that use of ICF in tibial fractures provides additional decompression in the anterior compartment. In light of these findings, ICF may be preferable for treatment of tibial fractures with high risk for compartment syndrome.

Chemerin as a marker of subclinical cardiac involvement in psoriatic patients.

BACKGROUND: Chemerin has been associated with psoriasis and inflammation, but there are no studies demonstrating an association between chemerin and subclinical cardiac involvement in psoriatic patients. Therefore, the present study aimed to evaluate whether psoriatic patients with increased epicardial fat tissue, impaired flow-mediated dilatation, and diastolic dysfunction have higher serum chemerin levels than a healthy control group. METHODS: The study included 60 psoriatic patients and 32 healthy controls. Echocardiographic parameters, epicardial fat tissue, flow-mediated dilatation, and chemerin levels were recorded for both groups. RESULTS: The serum levels of chemerin in the psoriatic patients were significantly higher than in the control group. The diastolic function parameters, including isovolumic contraction and relaxation time, E'/A' (early diastolic mitral annular velocity/late diastolic mitral annular velocity), and E/E' (early diastolic peak velocity of mitral inflow/early diastolic mitral annular velocity) values, differed significantly between the groups. Epicardial fat tissue was significantly higher and flow-mediated dilatation was significantly lower in psoriatic patients than in the controls. Chemerin was significantly positively correlated with age, body mass index, systolic and diastolic blood pressures, waist circumference, E/E', and epicardial fat tissue. Serum chemerin was significantly negatively correlated with E', E'/A', and flow-mediated dilatation. A multiple linear regression analysis showed that chemerin was independently correlated with E/E'. CONCLUSIONS: Psoriatic patients exhibit early subclinical atherosclerosis and diastolic dysfunction. Chemerin can be used as a marker to screen for patients with subclinical cardiac involvement.

Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty.

Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

[Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty]. / Bloqueio neuroaxial após anestesia local para manejo de complicação de vertebroplastia percutânea durante vertebroplastia.

Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

Comparison between two anatomic landmarks using ultrasonography in spinal anesthesia: a randomized controlled trial.

BACKGROUND AND OBJECTIVE: Tuffier's line is the most used anatomic landmark in clinical practice. We aimed to compare the accuracy of Tuffier's line with a landmark that joins the two lowest points of the tenth rib on the flanks with the help of ultrasound. METHODS: A prospective, randomized, controlled, double-blinded trial was performed with 200 patients aged between 18 and 50. Patients taller than 180 cm or shorter than 150 cm, or with body mass index >30 kg/m2 were excluded. The first anesthesiologist examined Group T according to Tuffier's line and Group R according to the tenth rib line and marked L4-5. Only one anesthesiologist evaluated the marked level with ultrasound for accuracy of the anesthesiologist's examination. RESULTS: There was no difference between groups for demographic and surgical data (p > 0.05). However, we observed a significant difference between the two techniques for success rate (60% in group T vs. 74% in group R) at estimation of correct level (p < 0.05). There was no correlation between success of estimation and patients' demographic data. CONCLUSION: We conclude that the tenth rib line is better than Tuffier's line for accuracy with palpation. However, it must be confirmed by further studies including more than one examiner for palpation and also include different patient populations.

Effect of the type of cardiopulmonary bypass pump flow on postoperative cognitive function in patients undergoing isolated coronary artery surgery.

OBJECTIVE: Pulsatile flow, generated by a pump during cardiopulmonary bypass, has been accepted as more physiological in coronary artery bypass grafting surgery (CABG). Therefore, we aimed to investigate the effects of pulsatile and nonpulsatile flow on postoperative cognitive function and to review relationship with the biomarkers S100ß and neuron-specific enolase (NSE). METHODS: Patients who underwent isolated CABG were included this prospective, randomized, double-blind study, which was performed between March 2010 and December 2010. Patients were divided into two groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow. Blood samples were collected 1 day before surgery and in the sixth postoperative hour for the analysis of S100ß and NSE. In addition, Mini-Mental State Examination (MMSE) was performed during preoperative period and on third postoperative day. Outcomes were determination of effects of pump flow type on cognitive function and relationships with concentrations of S100ß and NSE. RESULTS: Forty patients were included. No differences were observed between the groups with respect to complications, mortality, S100ß (Group I: 1.9±0.2 µ/L; Group II: 2.0±0.2 µ/L), NSE (Group I: 12.5±0.8 µ/L; Group II: 12.4±0.7 µ/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was observed between MMSE scores and concentrations of S100ß (r=-0.032) and NSE (r=-0.423) (p>0.05). CONCLUSION: There was no difference between types of pump flow for POCD and no relationship between cognitive dysfunction and S100ß and NSE concentrations. Pump flow type does not affect NSE concentrations.

Oral mask ventilation is more effective than face mask ventilation after nasal surgery.

OBJECTIVE: To evaluate and compare the face mask (FM) and oral mask (OM) ventilation techniques during anesthesia emergence regarding tidal volume, leak volume, and difficult mask ventilation (DMV) incidence. DESIGN: Prospective, randomized, crossover study. SETTING: Operating room, training and research hospital. SUBJECTS: American Society of Anesthesiologists physical status I and II adult patients scheduled for nasal surgery. INTERVENTIONS: Patients in group FM-OM received FM ventilation first, followed by OM ventilation, and patients in group OM-FM received OM ventilation first, followed by FM ventilation, with spontaneous ventilation after deep extubation. The FM ventilation was applied with the 1-handed EC-clamp technique. The OM was placed only over the mouth, and the 1-handed EC-clamp technique was used again. A child's size FM was used for the OM ventilation technique, the mask was rotated, and the inferior part of the mask was placed toward the nose. MEASUREMENTS: The leak volume (MVleak), mean airway pressure (Pmean), and expired tidal volume (TVe) were assessed with each mask technique for 3 consecutive breaths. A mask ventilation grade ≥3 was considered DMV. MAIN RESULTS: DMV occurred more frequently during FM ventilation (75% with FM vs 8% with OM). In the FM-first sequence, the mean TVe was 249±61mL with the FM and 455±35mL with the OM (P=.0001), whereas in the OM-first sequence, it was 276±81mL with the FM and 409±37mL with the OM (P=.0001). Regardless of the order used, the OM technique significantly decreased the MVleak and increased the TVe when compared to the FM technique. CONCLUSION: During anesthesia emergence after nasal surgery the OM may offer an effective ventilation method as it decreases the incidence of DMV and the gas leak around the mask and provides higher tidal volume delivery compared with FM ventilation.

Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?

PURPOSE: A local injection of corticosteroid-lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine-corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial. METHODS: This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid-lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks. RESULTS: During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p < 0.01). However, no significant differences were detected at 6, 12, 26 or 52 weeks (n.s.). CONCLUSION: The combined treatment may lead to earlier pain relief compared with intraarticular hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient's daily activity. LEVEL OF EVIDENCE: Therapeutic study, Level I.