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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]

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]

The aim of this study was to compare the efficacy of 3 methods of intraoperative analgesic cocktail injection during total knee arthroplasty (TKA)-intra-articular (IA), periarticular (PA), and combined intra-articular and periarticular (IA+PA)-on controlling early postoperative pain., Methods: This was a prospective double-blinded parallel randomized clinical trial. A total of 153 patients scheduled for TKA were allocated to IA, PA, or IA+PA (51 patients each) by block randomization. The primary outcome was morphine consumption. Secondary outcomes were visual analogue scale (VAS) pain, knee flexion, straight leg raising, Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)., Results: The morphine consumption was lowest in the PA group (median = 0, interquartile range [IQR] = 5) and highest in the IA group (median = 10, IQR = 5). The PA group had significantly lower VAS pain at rest than either IA (mean difference = -0.70; 95% confidence interval [CI] = -0.93 to -0.46; p < 0.001) or PA+IA (mean difference = -0.41; 95% CI = -0.65 to -0.18; p < 0.001). The PA group had also lower VAS pain during activity compared with IA (mean difference = -0.63; 95% CI = -0.85 to -0.40; p < 0.001) and IA+PA (mean difference = -0.38; 95% CI = -0.61 to -0.16; p < 0.001). The PA group had significantly greater active knee flexion compared with IA (mean difference = 9.68°; 95% CI = 5.50° to 13.86°; p < 0.001) and IA+PA (mean difference = 5.13°; 95% CI = 0.95° to 9.31°; p = 0.010). Passive knee flexion was greater for PA than IA (mean difference = 7.85°; 95% CI = 4.25° to 11.44°; p < 0.001). Other outcome variables were not significantly different among the 3 groups. The only complications were wound drainage (1 each in the IA and IA+PA groups) and deep venous thrombosis (1 in the IA group)., Conclusions: PA was associated with less early postoperative pain and greater active knee flexion compared with the other 2 analgesic methods., Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A421)., (Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)