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Background: Various types of xenogeneic stem cells with composite structures are employed in tissue-engineered tracheal reconstruction. Objectives: Human adipose tissue-derived stem cells have been investigated as an excellent cell source for tissues, characterized by the absence of major histocompatibility complex-II expression. Methods: The human adipose stem cells/fibrin glue group was established by cultivating stem cells on constructs composed of fibrin glue, followed by differentiation. Additionally, undifferentiated human adipose tissue-derived stem cells were seeded on polylactic-glycolic acid and transplanted into a 1 × 3.0 cm cartilage ring within a tracheal defect model. The groups were organized as follows: Differentiated human adipose stem cells/fibrin glue/polylactic-glycolic acid (DHASCs/FG/PLGA) (group 1), fibrin glue/PLGA without cells (FG/PLGA) (group 2), and PLGA/sterile normal saline as a control (PLGA/SNS) (group 3). Expression of cartilage-specific markers and tracheal cartilage formation were evaluated after 2 weeks (in vitro groups: Chondrogenic DHASCs/FG and HASCs/FG) and 2 months later (in vivo groups) using real-time polymerase chain reaction (PCR) or histology results, respectively. Results: No regenerated cartilage was observed in the control and group 2 tracheal cartilage defects. However, cartilage pieces were formed in the defect area where the DHASCs/FG/PLGA group was implanted, indicating the potential for cartilage tissue repair facilitated by the natural and complex structure. Conclusions: The combination of synthetic and natural scaffolds demonstrates promise as a suitable structure for repairing cartilage defects. [ABSTRACT FROM AUTHOR]

The main complaint after thyroidectomy is pain upon swallowing. It has been proven that postoperative uncontrolled pain can lead to chronic pain. We investigated the effectiveness of superficial cervical plexus block with ultrasound guidance on pain after thyroidectomy. This is a prospective, double-blind clinical trial study on patients aged 18-60 years who are candidates for thyroidectomy. Patients were randomly divided into two groups. The treatment group underwent superficial cervical plexus block under ultrasound guidance with an injection of 10 ml of ropivacaine 0.2%, and the control group received 10 ml of normal saline after sedation and before general anesthesia. The hemodynamic variables, amount of remifentanil used for hemodynamic stability, the severity of perioperative pain, postoperative nausea and vomiting, and the need for analgesics were compared between the two groups. The severity of pain in the treatment group at the time of discharge from recovery, 2, 6, 12, and 24 hours after surgery was 1.36, 1.76, 1.46, 1.24, and 0.44, respectively and in the control group was 3.12, 3.30, 3.82, 2.96 and 2.02 (P<0.001). The average dose of meperidine administration for pain relief during recovery in the treatment group was 2.8 (± 7.84) mg, and in the control group was 9.2 (±11.92) mg (P<0.002). The need for diclofenac for analgesia during 24hours after surgery in the block group was 4 (± 19.79) mg and in the control group was 64 (± 69.28) mg, (P<0.001). Superficial cervical plexus block can significantly reduce perioperative pain and need analgesic administration during and after thyroidectomy. [ABSTRACT FROM AUTHOR]

Postoperative pain is one of the most important factors in the recovery process after surgery. The incision site of tympano-mastoidectomy is related to the innervation of the superficial cervical plexus. The aim of this study is to evaluate the effect of superficial cervical plexus block on reducing post-tympano-mastoidectomy pain. This is a prospective, double-blind clinical trial study, and patients aged 20-61 years who were candidates for tympano-mastoidectomy were included in the study and were randomly divided into two groups. Before induction of general anesthesia, the subjects underwent superficial cervical plexus block with ultrasound guidance, injection of ropivacaine 0.2% in the treatment group, and normal saline in the control group, respectively. Hemodynamic parameters, intraoperative remifentanil used to maintain hemodynamic stability, the severity of perioperative pain, nausea and vomiting, and perioperative analgesic use were compared between the two groups. Pain intensity in the recovery phase, 2, 6, 12, and 24 hours after surgery in the treatment was 2.6, 1.8, 1.4, 0.5, and 0.4 and in the control, group was 3.7, 2.5, 2.1, 1.5, and 0.9, respectively (P<0.05). Intraoperative use of remifentanil was 410±622.2 µg in the block group and 1340±448.4 µg in the control group, respectively. The need for opioid administration was 8.2±10.4 mg in the block group and 13±13.2 mg in the control group, respectively (P=0.046). The need for administration of diclofenac in the first 24 hours after surgery was 8±27.4 mg in the treatment group and 54±50 mg in the control group, respectively (P<0.001). Superficial cervical plexus block can significantly reduce pain and the need for opioid administration after the tympano-mastoidectomy operation. [ABSTRACT FROM AUTHOR]

Botulinum neurotoxins (BoNTs), derived from Clostridium botulinum, have been employed to treat a range of central and peripheral neurological disease. Some studies indicate that BoNT may be beneficial for pain conditions as well. It has been hypothesized that BoNTs may exert their analgesic effects by preventing the release of pain‐related neurotransmitters and neuroinflammatory agents from sensory nerve endings, suppressing glial activation, and inhibiting the transmission of pain‐related receptors to the neuronal cell membrane. In addition, there is evidence to suggest that the central analgesic effects of BoNTs are mediated through their retrograde axonal transport. The purpose of this review is to summarize the experimental evidence of the analgesic functions of BoNTs and discuss the cellular and molecular mechanisms by which they can act on pain conditions. Most of the studies reviewed in this article were conducted using BoNT/A. The PubMed database was searched from 1995 to December 2022 to identify relevant literature. [ABSTRACT FROM AUTHOR]

Background: The sphenopalatine ganglion nerve block (SPGB) in endoscopic sinus surgeries has beenshownto reduce postsurgery narcotic consumption. Objectives: This study aimed to investigate the effect of SPGB on bleeding and pain during and after rhinoplasty and septoplasty. Methods: This study was conducted as a double-blind, randomized clinical trial and included 30 patients who were scheduled for elective rhinoplasty and septoplasty. All the participants received propofol/remifentanil anesthesia and similar intraoperative care. The patients were divided into 2 groups: The SPGB group, which received 0.5% bupivacaine, and the placebo group, which received normal saline. The study compared the amount of narcotics used during and after the operation, pain levels during and after the operation (at 2, 4, 6, and 24 hours after the operation), and bleeding during the operation between the 2 groups. The surgeon's satisfaction with bleeding control was also recorded at 30, 60, and 90 minutes. Results: In the SPGB group, 86% of the participants had ASA (American Society of Anesthesiologists) class I, while in the placebo group, 80% had ASA class I. There was no significant difference in postoperative pain between the control and intervention groups (P> 0.05). However, the SPGB group showed a significant decrease in intraoperative pain based on the amount of narcotics received (P < 0.05). According to the Boezaart criterion, the control group had significantly higher rates of severe and moderate bleeding (P < 0.05), whereas the bupivacaine group had a lower total bleeding rate (P < 0.05). Conclusions: The administration of bupivacainewaseffective in reducing pain, bleeding, andthe need for narcotics during surgery. The SPGB has the potential to decrease bleeding and drug utilization, making it a preferable option for anesthesiologists aiming to minimize the use of anesthetics. [ABSTRACT FROM AUTHOR]

Background: Postoperative cognitive dysfunction (POCD) is a significant complication, especially prevalent among elderly individuals following major surgical procedures. Objectives: This study aims to compare the impact of isoflurane and propofol on the occurrence of POCD in patients undergoing elective laminectomy surgery under general anesthesia. Methods: This randomized, double-blind clinical trial took place at Shariati Hospital in Tehran. Patients scheduled for elective laminectomy between December 2020 and November 2021 were enrolled in the study and randomized into 2 groups. Patients in Group P received a Propofol infusion, while patients in Group I were administered isoflurane. Cognitive function assessments were conducted using the Mini-Mental State Examination (MMSE) at 3-time points: Twelve hours before surgery and 6 and 24 hours after surgery. Results: TheMMSEscores demonstrated a significant increase in the Propofol group compared to the Isoflurane group at the 6-hour and24-hour post-surgery time points. However, nosignificant differencewasobserved at baseline before surgery (P=0.04, P=0.005, and P = 0.2, respectively). Conclusions: These findings suggest that the use of propofol for general anesthesia may be a favorable choice for surgical procedures in elderly patients. [ABSTRACT FROM AUTHOR]

Transforaminal epidural block (TEB) is a widely accepted technique and minimally invasive procedure for the treatment of lumbosacral radicular pain. This study aimed to evaluate the accuracy, efficacy, and safety of ultrasound and nerve stimulator guidance lumbar transforaminal epidural block (UNTEB) for the patients with unilateral lower lumbar radicular pain. The accuracy of this method was evaluated by fluoroscopy. Using UNTEB via axial and the in-plane approach technique was performed in 42 segments of 25 patients who presented with lumbosacral radicular pain to lower extremities. The contrast medium was injected to evaluate the needle tip at the intervertebral foramen under fluoroscopic guidance. The numerical rating scale was used to assess pain before and after treatment. The success ratio of UNTEB in L3/L4 level was 100%, in L4/L5 was 95.4% and in L5/S1 was 100%. The numerical rating scale (NRS) for lumbosacral radicular pain improved from a mean from 7.8 to 2.8 1 day after procedure (p = 0.01) and from a mean from 7.8 to 2.4 1 week after UNTEB (p = 0.01). None of our subjects experienced any complications during and after the procedure. UNTEB with fluoroscopic validation is an accurate, effective, and safe method for short-term pain relief of the patients with unilateral lumbosacral radicular pain. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has caused significant morbidity and mortality thus far. Considering the historical uses of high‐voltage X‐ray beams for unresolvable pneumonia, we aimed to assess whether low‐dose whole‐lung irradiation (WLI) could provide any benefits for patients with refractory COVID‐19 pneumonia. Methods: Eleven patients with refractory COVID‐19 pneumonia were treated with WLI to a total dose of 1 Gy and compared to 11 patients in a matched control group from June to November 2020. The study's primary endpoint was improvement of chest X‐ray severity score (CXRS), followed by changes in mean oxygen (O2) saturation and 28‐day mortality as secondary endpoints. Results: The final CXRS was significantly lower in the WLI group (8.7 ± 2.5) compared to the control group (12.3 ± 3.3) (P: 0.016). Change of CXRS from the first to the last chest X‐ray was −2.2 ± 3.1 for the WLI group and 0.7 ± 3.9 for the control group, which showed a trend for lower CXRS in the WLI group (U = 30, p: 0.085). Mean O2 saturation showed insignificant improvement in the first 24 hours after radiotherapy (mean difference: 2.5 ± 4.1, Z=−1.6, P value: 0.11). Overall survival after 28 days was 32% in the WLI group and 11% in the control group (P: 0.48). The reason for death in many patients was not merely respiratory failure, but also other adverse situations like pneumothorax, cardiogenic shock and pulmonary thromboembolism. Conclusions: Low‐dose WLI could improve the CXR severity score and O2 saturation in severely ill COVID‐19 patients, but larger studies are required to determine its impact on mortality. [ABSTRACT FROM AUTHOR]