Anesthesia using microcannula and sharp needle in upper blepharoplasty: A randomized,double-blind clinical trial evaluating pain,bruising, and ecchymoses

IntroductionWith the emergence of blunt-tipped microcannulas, there is a hypothesis that these could cause less damage and reduce pain as compared to conventional sharp needles in eyelid surgery. The purpose is to determine whether an 18G blunt-tipped cannula can be better than a 26G needle.MethodsThis prospective, observer-blinded, randomized clinical trial was conducted from June 2017 to December 2018. Sixty-eight patients were randomized to receive local anesthesia injections for upper blepharoplasty. Infiltration was performed by using a 26-gauge sharp needle on one side and on the other side, infiltration was performed by using an 18-gauge stainless-steel blunt-tipped microcannula. A numeric rating scale (NRS) from 0 to 10 was used to blindly assess pain in patients receiving anesthesia injections with both needle types. Photographs of the eyelids of each patient were taken in five different periods and used by three blinded observers to identify bruise or ecchymoses.ResultsA total of 136 eyelid operations were performed. There was no statistically significant difference when both groups were compared; however, the average score of pain was higher in patients taking the infiltration through the needle (2.85 versus 2.50). Regarding the evaluation of bruising and ecchymoses, the results showed that, in the five periods evaluated, there was no statistical difference in bruising and ecchymosis in the eyelids when taking the infiltration through a sharp needle when compared with that of the eyelids taking infiltration through a (blunt-tipped) microcannula.ConclusionThe evaluation of the blunt-tipped microcannula showed a lower pain score mean than that obtained for the sharp needle (2.5 versus 2.85) (p > 0.05). There was no statistically significant difference in the bruising and ecchymosis courses.     

Potential of P40 plastination for morphometric hip measurements

Total hip replacement has become one of the most successful surgical operations over the past 25 years. The duration of a total hip prosthesis depends on primary stability, and many studies have tried precisely to evaluate hip joint morphology to obtain excellent contact between bone and prosthetic component. This study performed a morphometric analysis of the human hip joint using, for the first time, the P40 plastination procedure. We cut 42 hip joint compounds into slices 3 mm thick; for exact distance measuring the sections were scanned into the computer. The following mean measurements for hip geometry were obtained: vertical diameter of acetabulum 4.894±0.274 cm, depth of acetabulum 1.643±0.245 cm, femoral head radius 2.268±0.149 cm, femoral neck length 4.3670±0.528 cm, acetabular perimeter 6.711±0.434 cm, vertical diameter of labrum acetabulare 4.759±0.476 cm, depth of labrum acetabulare 2.599±0.395 cm, sum of femoral head and neck lengths 6.759±0.550 cm, hip axis length 11.859±1.007 cm, femoral neck axis length 10.12±0.555 cm, and femoral neck diameter 3.349±0.276 cm. All of these data reveal a significant gender difference. Our aim was to indicate an unconventional and new method of gaining morphometric hip data by using plastination.     

Characterization of mechanical withdrawal responses and effects of mu-, delta- and kappa-opioid agonists in normal and mu-opioid receptor knockout mice

Clinical and experimental observations suggest that opiates can exert different influences on the perception of stimuli from distinct sensory modalities. Thermally-induced nociception is classically responsive to opiate agonists. mu-Opioid receptor-deficient transgenic mice are more sensitive to thermal nociceptive stimuli and morphine fails to attenuate the nociceptive responses to thermal stimuli in these animals. To enhance our understanding of opiate influences on mechanical sensitivity, we have examined withdrawal responses to a sequence of ascending forces of mechanical stimuli in mice with normal (wild type), half-normal (heterozygous) and absent (homozygous) mu-opioid receptor levels. We report data from mice examined without drug pretreatment or following pretreatment with morphine, the selective kappa-opioid agonist, U50488H, and the selective delta-opioid agonist, DPDPE. Saline-pretreated mice of each genotype displayed similar, monotonically increasing frequency of withdrawal responses to the graded stimuli. Subcutaneously administered morphine produced a dose-dependent reduction in withdrawal responses in wild type and heterozygous mice, but had no significant effect in homozygous mice. Intraventricular administration of DPDPE also reduced the frequency of paw withdrawal (FPW) in wild type mice, but not in homozygous mice. In contrast, systemic U50488H produced a dose-dependent attenuation of paw withdrawal in both wild type and homozygous mice. These findings suggest that (1) interactions of endogenous peptides with mu-opioid receptors may not play a significant role in the response to mechanical stimuli in drug-free animals, and (2) deficiency of mu-opioid receptors has no functional consequence on the response to the prototypical kappa-opioid receptor agonist, but decreases responses to the prototypical mu- and delta-opioid receptor agonists.     

Pneumonia in the elderly.

Pneumonia is not only a major cause of death for elderly persons, but also imposes substantial personal morbidity and burdens on the health care system. Timely, accurate diagnosis and therapy depend on recognition of important differences in the pathogenesis of pneumonia according to the settings in which it occurs. Active elderly persons living in the community, institutionalized seniors with "nursing home pneumonia," and those with hospital-acquired infections have different microbial causes of their respiratory infections that, together with altered host defenses and iatrogenic factors, dramatically influence outcomes. The presence of other common medical illnesses in older persons obscures the clinical presentations of pneumonia, predisposes to respiratory infection, and adversely influences prognosis. These clinical relationships and the variability and vulnerability of individual patients underlie largely empiric, setting-specific antimicrobial therapy. Whenever possible, prevention of this devastating illness is essential.     

Sex-dependent modulation of ethanol consumption in vesicular monoamine transporter 2 (VMAT2) and dopamine transporter (DAT) knockout mice.

Several lines of evidence suggest that monoaminergic systems, especially dopaminergic and serotoninergic systems, modulate ethanol consumption. Humans display significant differences in expression of the vesicular and plasma membrane monoamine transporters important for monoaminergic functions, including the vesicular monoamine transporter (VMAT2, SLC18A2) and dopamine transporter (DAT, SLC6A3). In addition, many ethanol effects differ by sex in both humans and animal models. Therefore, ethanol consumption and preference were compared in male and female wild-type mice, and knockout (KO) mice with deletions of genes for DAT and VMAT2. Voluntary ethanol (2-32% v/v) and water consumption were compared in two-bottle preference tests in wild-type (+/+) vs heterozygous VMAT2 KO mice (+/-) and in wild-type (+/+) vs heterozygous (+/-) or homozygous (-/-) DAT KO mice. Deletions of either the DAT or VMAT2 genes increased ethanol consumption in male KO mice, although these effects were highly dependent on ethanol concentration, while female DAT KO mice had higher ethanol preferences. Thus, lifetime reductions in the expression of either DAT or VMAT2 increase ethanol consumption, dependent on sex.     

What Promotes Cervical Cancer Screening Among Chamorro Women in California?

Pacific Islander women represent a significant at-risk population for cervical cancer, yet little is known about the modifiable factors associated with routine Pap testing. Therefore, the aims of this paper are to report and discuss the known and unknown factors associated with cervical cancer screening among Chamorro women in California. This cross-sectional study explored the factors associated with receipt of regular Pap testing among Chamorro women age 18 years and older in California. A self-administered survey was designed and distributed to women in order to understand their knowledge, beliefs and behaviors regarding routine receipt of Pap tests. Only about two-thirds of women had received a Pap test within the past 2 years, which is below the U.S. average of 72 %. Significant predictors included younger age, health insurance coverage, knowledge of screening frequency, and medically correct beliefs regarding risk groups. These factors, however, accounted for less than 16 % of the variance in Pap testing behavior. We discuss the poor predictive value of existing demographic and theoretical variables, and discuss potentially new areas of research that can aid in the development of future intervention studies. Study limitations and implications are also discussed.     

A miniature and mobile intermittent pneumatic compression device for the prevention of deep-vein thrombosis after joint replacement

The WizAir-DVT is a miniature, lightweight (690 g), battery-operated and mobile intermittent pneumatic compression device (ICD), which enables continuous intraoperative use and immediate patient mobilization postoperatively. We compared its efficacy with a commonly used ICD, the Kendall SCD. Peak femoral vein flow velocity was measured in 20 apparently healthy volunteers at rest and with each device: we found no significant differences between them. A second prospective, randomized, clinical trial was used to compare the efficiency of the device in preventing deep venous thrombosis (DVT) after joint replacement in 50 patients (n=25/group). None developed DVT. Doppler ultrasonography revealed no significant differences. The WizAir-DVT antithrombotic compression device is as safe and effective as the Kendall SCD.