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Objectives: In patients undergoing surgery due to diabetic foot complications from uncontrolled diabetes may lead to neuraxial or general anesthesia-related issues. Regional anesthesia techniques can be preferred to prevent these complications. This study aimed to compare the hemodynamic effects and outcomes in terms of pain of continuous infusion and single injection methods of popliteal nerve block in patients undergoing surgery due to diabetic foot. Materials and methods: Sixty-three patients in ASA II-IV risk group scheduled for diabetic foot surgery were randomized into two groups for popliteal nerve block as the anesthesia method. Group 1 (n:32), 30 mL of local anesthetic was administered around the popliteal nerve under ultrasound guidance and nerve stimulator. Group 2 (n:31) had a catheter placed beyond the needle tip by 4–5 cm. An elastomeric pump was prepared for the infusion of 2 mL/h of 0.25 % bupivacaine through the catheter. Hemodynamic parameters before and after the block, onset, block duration times, postoperative pain scores, time to analgesic requirement, patient satisfaction, and discharge time were recorded. Results: Pain scores were higher in Group 1 after 12 h postoperatively and in Group 2 after 60 h postoperatively (p = 0.006, p 0.05). Conclusions: Continuous infusion method of popliteal nerve block provides a longer pain-free period. Both methods showed similar hemodynamic data and low pain scores. Although continuous infusion method provides better analgesia, its procedural cost, technical difficulties, and adverse effects on patient comfort should also be considered.

Background: Single-injection adductor canal block (SACB) is one of the multimodal pain managements in total knee arthroplasty. The effect of an intrathecal local anesthetic is prolonged with an intraoperative dexmedetomidine infusion. Currently, SACB’s effect along with the prolonged spinal anesthesia effect by dexmedetomidine has not been studied elsewhere. Methods: Seventy-eight patients were randomized to either the SACB group (n = 39) or the control group (n = 39). Spinal anesthesia and continuous infusion of dexmedetomidine were performed intraoperatively. The SACB was performed using 15 mL of either 0.5% ropivacaine or normal saline in postanesthesia care unit postoperatively. Primary endpoint examined the average numerical rating scale (NRS) pain scores at 2, 6, 12, and 24 hours after SACB while resting or moving. The secondary outcomes were the morphine equivalent, postoperative nausea and vomiting score, quadriceps strength, and overall satisfaction score. Results: The SACB group showed a lower average NRS pain score until 24 hours than the control group (2.4 vs 3.3 resting, 3.4 vs 4.1 moving). Resting and moving NRS scores at 6 and 12 hours were significantly lower in the SACB group, whereas no difference was found at 2, 24, and 48 hours, regardless of movement. The satisfaction score was higher in the SACB group than in the control group (9 [7.3-10.0] vs 7 [5.3-8.8]), and morphine equivalent at 2 hours was lower in the SACB group (2 [1-3]) than in the control group (2.9 [1.6-4]). Conclusions: SACB provided an additional analgesic effect in patients undergoing total knee arthroplasty under spinal anesthesia with continuous dexmedetomidine intravenous infusion.

Introduction: The axillary plexus block is one of the most used regional anesthesia techniques in upper limb surgery. In this study, we retrospectively evaluated the advantages of using the technique with a single injection in the axillary block, a technique that was used in the Orthopedic Clinic of SCJU between 1.01.2016 and 31.05.2016. Methods: The patients admitted to the study were those with ASA I-III in the number of 50 of which 35 were men and 15 women who underwent axillary brachial plexus block using the single injection technique with the help of the neurostimulator. All patients had surgical interventions in the region of the distal arm, elbow, forearm and hand. The axillary block was performed with the nerve stimulator, using a 22g and 50mm needle, the puncture site used was above the artery where, after obtaining the motor response to the 0.5 mA impulse, Ropivacaine 0.5% 20 ml was injected. Later we analyzed the installation time of the motor and sensory block, what success rate it had and the possible complications. Results: The average motor block installation time was 21+/-1.3 min in the 35 patients. The motor block installation time was 19.2+/-1.5 min and the sensory block a was 16.19+/-1.1 min. block success rate was 91.5 percent. There were no recent or late complications. Conclusions: Axillary plexus block using the single injection technique can be used with great benefits, few complications and low failure rate of the technique. [ABSTRACT FROM AUTHOR]

BackgroundEmergence agitation (EA) is common in patients after general anesthesia (GA) and is associated with poor outcomes. Patients with thoracic surgery have a higher incidence of EA compared with other surgery. This study aimed to investigate the impact of pre-anesthetic butorphanol infusion on the incidence of EA in patients undergoing thoracic surgery with GA.Materials and methodsThis prospective randomized controlled trial (RCT) was conducted in 20 tertiary hospitals in China. A total of 668 patients undergoing elective video-assisted thoracoscopic lobectomy/segmentectomy for lung cancer were assessed for eligibility, and 620 patients were enrolled. In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. Patients in the intervention group received butorphanol 0.02 mg/kg 15 min before induction of anesthesia. Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of EA after 5 min of extubation, and EA was evaluated using the Riker Sedation-Agitation Scale (RSAS). The incidence of EA was determined by the chi-square test, with a significance of P < 0.05.ResultsIn total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. The incidence of EA 5 min after extubation was lower with butorphanol treatment: 9.8% (29 of 296) vs. 24.5% (75 of 306) in the control group (P = 0.0001). Patients who received butorphanol had a lower incidence of drug-related complications (including injecting propofol pain and coughing with sufentanil): 112 of 296 vs. 199 of 306 in the control group (P = 0.001) and 3 of 296 vs. 35 of 306 in the control group (P = 0.0001).ConclusionThe pre-anesthetic administration of butorphanol reduced the incidence of EA after thoracic surgery under GA.Clinical trial registration[http://www.chictr.org.cn/showproj.aspx?proj=42684], identifier [ChiCTR1900025705].

The effect of midpoint transverse process-to-pleura block (MTPB) is unclear. The authors compared the analgesic characteristics of MTPB with those of thoracic paravertebral nerve block (TPVB) in patients undergoing uniportal video-assisted thoracoscopic surgery (uVATS) and examined the 2 types of blocks for noninferiority. A randomized, controlled trial. A single-institution, university hospital. The study comprised 82 patients between 18 and 75 years of age. Eighty-one patients were included for final analysis. Patients were randomly allocated to either the MTPB group (Group M) or the TPVB group (Group P). The primary outcome was the mean difference in the postoperative visual analog scale (VAS) score between Group M and Group P at rest and at 12 hours. The secondary outcomes included VAS scores during rest and coughing, nerve block performance, intraoperative consumption of anesthetics and vasoactive medication, time at first use of patient-controlled intravenous analgesia (PCIA), number of uses of PCIA, consumption of sufentanil in PCIA, and side effects. The mean difference in VAS score in the MTPB and TPVB group at rest and 12 hours postoperatively was 0.5 (95% confidence interval, –0.26 to 0.36). There was no significant difference in the time at first use of PCIA, which was 12 (10, 12) hours and 11 (10, 12) hours in Group M and Group P, respectively. The depth of puncture was shallower, and the time to perform block was shorter in Group M compared with Group P (p < 0. 001). The analgesic effect of single-level–injection MTPB is noninferior to that of TPVB in patients undergoing uVATS. The target point of the needle in MTPB is shallower and farther away from the pleura compared with TPVB. For these reasons, it is quicker and safer and, thus, may be preferable. [ABSTRACT FROM AUTHOR]

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The most exciting advancement in LC-MS/MS-based bottom-up proteomics has centered around enhancing mass spectrometers. Among these, the latest and most advanced mass spectrometer for bottom-up proteomics is the Orbitrap Astral that has the highest scan rate to accelerate throughput and the highest sensitivity to handle a very small amount of peptide samples and to achieve deeper proteomics. However, its affordability remains a challenge for most laboratories. While significant strides have been made in improving mass spectrometry, advancing liquid chromatography (LC) to achieve deeper proteomics has not achieved significant successes since the innovation of Multidimensional Protein Identification Technology (MudPIT) in 2001. To achieve deeper proteomics in a less labor-intensive and more reproducible approach while using a more cost-effective mass spectrometer, such as the Orbitrap Exploris 480, we evaluated trap columns as long as 40 cm and analytical column as long as 600 cm besides sample loading amount, gradient time, and analytical column particle size to enable a fractionation-free method for a single injection to obtain deeper proteomics. The length of trap and analytic columns is the key factor. Using a 30 cm trap column and 250 cm analytical column with other optimized LC conditions, we quantified over 9200 unique protein groups from brain tissue in a single injection using a 24-h gradient on an Orbitrap Exploris 480 mass spectrometer. [Display omitted] • Long trap and analytical columns allow higher peptide loading amount. • Single injection is a less labor-intensive and more reproducible approach. • 9200 unique protein groups were quantified from brain tissue in a single injection using an Orbitrap Exploris 480. • The method is highly reproducible and can be easily replicated in other proteomics laboratories. [ABSTRACT FROM AUTHOR]

Objectives: In patients undergoing surgery due to diabetic foot complications from uncontrolled diabetes may lead to neuraxial or general anesthesia-related issues. Regional anesthesia techniques can be preferred to prevent these complications. This study aimed to compare the hemodynamic effects and outcomes in terms of pain of continuous infusion and single injection methods of popliteal nerve block in patients undergoing surgery due to diabetic foot., Materials and Methods: Sixty-three patients in ASA II-IV risk group scheduled for diabetic foot surgery were randomized into two groups for popliteal nerve block as the anesthesia method. Group 1 (n:32), 30 mL of local anesthetic was administered around the popliteal nerve under ultrasound guidance and nerve stimulator. Group 2 (n:31) had a catheter placed beyond the needle tip by 4-5 cm. An elastomeric pump was prepared for the infusion of 2 mL/h of 0.25 % bupivacaine through the catheter. Hemodynamic parameters before and after the block, onset, block duration times, postoperative pain scores, time to analgesic requirement, patient satisfaction, and discharge time were recorded., Results: Pain scores were higher in Group 1 after 12 h postoperatively and in Group 2 after 60 h postoperatively (p = 0.006, p < 0.01, respectively). The time to the first analgesic requirement was not statistically different between Group 1 (mean 804.64 ± 1020.8 min) and Group 2 (mean 2012.78 ± 1424 min) (p = 0.072). There was no significant difference in systolic, diastolic, mean arterial blood pressure, and heart rate between groups before and after successful blockade (p > 0.05)., Conclusions: Continuous infusion method of popliteal nerve block provides a longer pain-free period. Both methods showed similar hemodynamic data and low pain scores. Although continuous infusion method provides better analgesia, its procedural cost, technical difficulties, and adverse effects on patient comfort should also be considered., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Benign vocal fold lesions (BVFLs) can cause voice changes, including reduced loudness and pitch range. In recent times, with progression in endoscopic technology, office-based vocal fold steroid injection (VFSI) has been used as an alternative therapy for BVFLs. In this study, we analyzed the efficacy and safety of VFSI to investigate the mechanism underlying its therapeutic effects and determine the conditions in which VFSI will be most effective. In this retrospective cohort study, we included 40 condition-matched patients (8 patients per lesion) with chorditis, vocal nodules, vocal polyps, Reinke's edema (RE), or vocal scars who received similar regimens of steroid injection using a commercial preparation of triamcinolone acetonide. Their phonological outcomes were evaluated 2 or 3 months after the injection. Significant improvements were observed in Voice Handicap Index scores, results of laboratory voice evaluation, and voice quality measured using the Grade, Roughness, Breathiness, Asthenia, Strain scale in all participants. In subgroup analysis, VFSI was highly effective against chorditis and vocal nodules, but less effective against RE and vocal scars. Single-dose VFSI is valuable as an alternative to voice rehabilitation and laryngo-microsurgery, but higher concentrations or repeated injections are required for intractable lesions. [ABSTRACT FROM AUTHOR]

What is known and objective: Nalbuphine is a mu (μ) receptor partial antagonist/kappa (κ) receptor agonist analgesic and can be administered as a single injection or using patient‐controlled analgesia (PCA) in the clinical setting. However, differences in the pharmacokinetics of the two administration methods are unclear. Here, a clinical trial was performed to compare the pharmacokinetic characteristics and superiority of nalbuphine with a single‐injection or PCA‐mimic method to provide a reference for the selection of an appropriate administration method. Methods: Twenty healthy individuals were divided into two groups and injected with 10 mg nalbuphine intravenously using a single‐injection or a PCA‐mimic method (2 mg once for five times with a 30‐min interval). Blood samples were collected, and safety was investigated. The liquid chromatography‐tandem mass spectrometry was adopted to determine the concentration of nalbuphine in plasma. Results and discussion: The maximum concentration (Cmax) and area under concentration‐time curve (AUC0‐t) values of nalbuphine in the single‐injection and PCA groups were as follows: Cmax, 81.3 ± 24.7 and 39.8 ± 6.4 ng/ml, respectively; moreover, AUC0‐t, 110.3 ± 19.5 and 128.3 ± 23.0 h ng/ml, respectively. The effective analgesic concentration durations (EACDs) for the two administration methods were 1.39 ± 0.64 and 1.96 ± 0.91 h, respectively. Nalbuphine was well tolerated, and improvements were observed in the PCA group. What is new and conclusion: Compared with those in the single‐injection group, the AUC0‐t and EACDs in the PCA group were similar, whereas Cmax was decreased significantly. Therefore, the PCA method was more suitable for the clinical application of nalbuphine injection owing to the superiority of lower concentration fluctuation and the improved safety profile. [ABSTRACT FROM AUTHOR]

This paper deals with experimental investigations on a four-cylinder, four-stroke, direct injection, turbocharged engine to evaluate effects of fuel injection strategies, exhaust gas recirculation (EGR) and intake boost pressure on the low temperature combustion (LTC) mainly to reduce nitric oxides (NOx) and smoke emissions keeping a concern on indicated mean effective pressure (IMEP). First, single-pulse fuel injection strategy with various fuel injection timings is tried to find the best operating conditions. Then, five fuel injection pulse strategy with a variation in injection timings and fuel quantities of each pulse along with the usage of EGR and intake boost pressure is tried to further improve the performance. Finally, it is found that for a low NOx and smoke emissions with a good brake thermal efficiency, five-pulse injection with the last pulse at closer to top dead centre along with the use of EGR in the LTC mode is a suitable one.

Introduction: The use of articaine has been claimed to obviate the need for routine palatal local anesthetic injections on account of its better diffusion through soft and hard tissues as compared to other local anesthetic agents. Objective: The objective of the study is to evaluate the efficacy of 4% articaine (with 1:100,000 adrenaline) infiltrated only buccally in the extraction of maxillary premolars for orthodontic reasons. Materials and Methods: A double-blind randomized clinical trial with a split-mouth design, where each patient (n = 100) was part of two groups, was conducted. Experimental Group 1: single buccal infiltration of 4% articaine with 1:100,000 adrenaline (Septanest™ with adrenaline 1:100,000 by Septodont). Control Group 2: routine buccal and palatal infiltrations of 2% lignocaine with 1:200,000 adrenaline (Lox™ 2% with adrenaline 1:200,000 by Neon). The parameters studied were time to onset of anesthesia, pain during the extraction procedure (not during the injecting of the local anesthetic), and frequency of extra amount of local anesthetic injected. Results: The difference was not statistically significant (P > 0.05) between the two groups with respect to all three parameters. This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases. Conclusion: This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases.

Introduction: Pain is still severe after single-port video-assisted thoracoscopic (SPVAT) lung wedge resection. We observed the effect of single-injection thoracic paravertebral block (TPB) via the intrathoracic approach for analgesia after SPVAT lung wedge resection. Methods: Sixty patients undergoing SPVAT lung wedge resection were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the T4 level with a scalp needle before closing the chest. The patients in the observation group received 20 ml 0.375% ropivacaine at the T4 level, and the patients in the control group received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption and number of PCIA presses in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h after surgery. The incidence of adverse reactions after surgery were recorded. Results: The sufentanil consumption in the observation group was significantly lower than that in the control group (34.2 ± 1.9 µg vs. 52.3 ± 2.3 µg; P < 0.001). The VAS score at 6, 12, and 24 h after surgery, the incidence of adverse reactions after surgery in the observation group were significantly lower than those in the control group (all P < 0.05). The number of PCIA presses in the observation group was significantly lower than that in the control group [0 (0–0) times vs. 3 (2–4) times, P < 0.001]. Conclusions: Single-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after SPVAT lung wedge resection, with fewer adverse reactions. Trial Registration: ChiCTR2000034726. [ABSTRACT FROM AUTHOR]

Introduction: Several viscosupplement treatments are available for patients suffering from painful osteoarthritis (OA) of the knee, but few comparative clinical trials have been conducted. The primary objective of the trial was to demonstrate the non-inferiority of Synolis VA (80 mg hyaluronic acid and 160 mg sorbitol) (Group HA1) to Synvisc-One (48 mg hylan GF-20) (Group HA2) at Day 168 in terms of pain relief efficacy in patients with knee OA (Kellgren and Lawrence radiological stage II or III) in whom oral treatment with analgesics, NSAIDs or weak opioids provided insufficient clinical responses or were poorly tolerated.Methods: This was a prospective, multicentre, comparative, randomized, double-blinded trial comparing the two previously indicated viscosupplements, HA1 and HA2. The average VAS pain score (1-100) was 62.5 at baseline (Day 0). The patients were randomized into two parallel groups at Day 0 and followed until Day 168. They received one injection of either HA1 or HA2. The primary end point was the evolution of the Western Ontario and McMaster University (WOMAC) pain index at D168 in the groups. One of the secondary end points was the daily assessment of this index by the patient for 7 days following the injection and thereafter at Day 14. The other secondary end points were the WOMAC pain, stiffness, function and total scores assessed at Day 28, Day 84 and Day 168. At Day 168, efficacy and satisfaction were assessed by the evaluator and by the patient using a Likert scale (7 points). Moreover, the number of strict responders in each group was evaluated according to the The Osteoarthritis Research Society International (OARSI) Standing Committee for Clinical Trials Response Criteria Initiative and the Outcome Measures in Rheumatology (OMERACT) criteria (OMERACT-OARSI). The per protocol (PP) population was used for the primary analysis.Results: A total of 202 patients were randomized. The patients were predominantly female (66%). The median age of the whole population was 65 years, and the median body mass index was 27.4 kg/m2. No statistically significant differences between the two treatment groups were observed for any of the demographic criteria. At Day 168, 197 had had no protocol violations (94 in the HA1 group and 103 in the HA2 group). The WOMAC pain score decreased in the two groups: - 29.2 ± 24.1 (SD) in the HA1 group and - 31.6 ± 25.5 (SD) in the HA2 group, confirming the non-inferiority of Synolis VA (P = 0.57 for the difference between groups). Regarding the secondary end points, no significant difference was observed at Day 14, Day 28, Day 84 or Day 168 for all the outcomes except stiffness at Day 28 (P = in favour of treatment received in HA2). The rate of responders was comparable between the two groups: 79% for HA1 and 77% for HA2. Both products were well tolerated. Serious adverse events were reported by four patients in the HA1 group and 3 in the HA2 group.Conclusion: In this trial, we confirmed the non-inferiority of Synolis VA compared to Synvisc-One at Day 168 according to the WOMAC pain score. Safety was satisfying and comparable in the two groups.Trial Registration: 2017-A00034-49. [ABSTRACT FROM AUTHOR]

Background: Single-injection adductor canal block (SACB) is one of the multimodal pain managements in total knee arthroplasty. The effect of an intrathecal local anesthetic is prolonged with an intraoperative dexmedetomidine infusion. Currently, SACB's effect along with the prolonged spinal anesthesia effect by dexmedetomidine has not been studied elsewhere., Methods: Seventy-eight patients were randomized to either the SACB group (n = 39) or the control group (n = 39). Spinal anesthesia and continuous infusion of dexmedetomidine were performed intraoperatively. The SACB was performed using 15 mL of either 0.5% ropivacaine or normal saline in postanesthesia care unit postoperatively. Primary endpoint examined the average numerical rating scale (NRS) pain scores at 2, 6, 12, and 24 hours after SACB while resting or moving. The secondary outcomes were the morphine equivalent, postoperative nausea and vomiting score, quadriceps strength, and overall satisfaction score., Results: The SACB group showed a lower average NRS pain score until 24 hours than the control group (2.4 vs 3.3 resting, 3.4 vs 4.1 moving). Resting and moving NRS scores at 6 and 12 hours were significantly lower in the SACB group, whereas no difference was found at 2, 24, and 48 hours, regardless of movement. The satisfaction score was higher in the SACB group than in the control group (9 [7.3-10.0] vs 7 [5.3-8.8]), and morphine equivalent at 2 hours was lower in the SACB group (2 [1-3]) than in the control group (2.9 [1.6-4])., Conclusions: SACB provided an additional analgesic effect in patients undergoing total knee arthroplasty under spinal anesthesia with continuous dexmedetomidine intravenous infusion., (© 2024 The Authors.)

Nowadays there is strong demand to produce embryos from premium quality cattle, and we can produce embryos using oocytes collected from living premium animals by ovum-pick up (OPU) followed by in vitro fertilization (IVF). However, the developmental competence of IVF oocytes to form blastocysts is variable. The developmental competence of oocytes depends on the size and stages of follicles, and follicle-stimulating hormone priming (FSH-priming) prior to OPU can promote follicular growth and improve the developmental competence of oocytes. Furthermore, following the induction of ovulation using an injection of luteinizing hormone or gonadotropin-releasing hormone after FSH-priming, we can collect in vivo matured oocytes from ovulatory follicles, which show higher developmental competence than oocytes matured in vitro. However, the conventional protocols for FSH-priming consist of multiple FSH injection for 3–4 days, which is stressful for the animal and labor-intensive for the veterinarian. In addition, these techniques cannot be applied to IVF of oocytes collected from bovine ovaries derived from slaughterhouses, which are important sources of oocytes. Here, we review previous research focused on FSH-priming, especially for collecting in vivo matured oocytes and a simplified method for superstimulation using a single injection of FSH. We also introduce the previous achievements using in vitro pre-maturation culture, which can improve the developmental competence of oocytes derived from non-stimulated animals. • In vivo matured oocytes have higher competence than in vitro matured oocytes. • A single FSH injection prior to OPU can improve oocyte competence. • In vitro pre-maturation enables to improve oocyte competence without FSH priming. [ABSTRACT FROM AUTHOR]

GonaCon™ is a gonadotropin releasing hormone (GnRH) contraceptive vaccine developed at the USDA National Wildlife Research Center (NWRC) that contains keyhole limpet hemocyanin (KLH) coupled to GnRH. The vaccine is administered intramuscularly in an emulsion with the NWRC adjuvant, AdjuVac™. This first-generation vaccine, developed in 1998, has been very effective in contracepting every species tested. However, because of the high cost of KLH, NWRC has developed a second generation GnRH vaccine, replacing KLH with a less expensive mollusk protein. This second generation GnRH vaccine, called GonaCon-Blue™, is currently being tested in several species and has proven to be as, or more effective than the original GonaCon™. Scientists with the Reproductive Control Methods Project at the NWRC are also testing a recombinant GnRH antigen developed by Dr. Talwar of the Talwar Research Institute, India. The recombinant antigen was produced from plasmid gene expression grown in and extracted from E. coli. The antigen is combined with the NWRC AdjuVac™ to form an emulsion similar to the GonaCon™ preparation. The recombinant vaccine has been shown to be effective as a single or dual injection for contraception of adult female pigs in a short-term study at the Swine Research Facility at Penn State University. Although the long term effectiveness of the recombinant vaccine remains to be established, this small molecule of approximately 14,000 MW is of considerable interest because it may be effective in oral or transcutaneous applications. It could also be scaled-up for large field applications.

Noise-induced hearing loss (NIHL) often accompanies cochlear synaptopathy, which can be potentially reversed to restore hearing. However, there has been little success in achieving complete recovery of sensorineural deafness using nearly noninvasive middle ear drug delivery before. Here, we present a study demonstrating the efficacy of a middle ear delivery system employing brain-derived neurotrophic factor (BDNF)-poly-(dl-lactic acid- co -glycolic acid) (PLGA)-loaded hydrogel in reversing synaptopathy and restoring hearing function in a mouse model with NIHL. The mouse model achieved using the single noise exposure (NE, 115 dBL, 4 h) exhibited an average 20 dBL elevation of hearing thresholds with intact cochlear hair cells but a loss of ribbon synapses as the primary cause of hearing impairment. We developed a BDNF-PLGA-loaded thermosensitive hydrogel, which was administered via a single controllable injection into the tympanic cavity of noise-exposed mice, allowing its presence in the middle ear for a duration of 2 weeks. This intervention resulted in complete restoration of NIHL at frequencies of click, 4, 8, 16, and 32 kHz. Moreover, the cochlear ribbon synapses exhibited significant recovery, whereas other cochlear components (hair cells and auditory nerves) remained unchanged. Additionally, the cochlea of NE treated mice revealed activation of tropomyosin receptor kinase B (TRKB) signaling upon exposure to BDNF. These findings demonstrate a controllable and minimally invasive therapeutic approach that utilizes a BDNF-PLGA-loaded hydrogel to restore NIHL by specifically repairing cochlear synaptopathy. This tailored middle ear delivery system holds great promise for achieving ideal clinical outcomes in the treatment of NIHL and cochlear synaptopathy.

This paper deals with experimental investigations on a four-cylinder, four-stroke, direct injection, turbocharged engine to evaluate effects of fuel injection strategies, exhaust gas recirculation (EGR) and intake boost pressure on the low temperature combustion (LTC) mainly to reduce nitric oxides (NOx) and smoke emissions keeping a concern on indicated mean effective pressure (IMEP). First, single-pulse fuel injection strategy with various fuel injection timings is tried to find the best operating conditions. Then, five fuel injection pulse strategy with a variation in injection timings and fuel quantities of each pulse along with the usage of EGR and intake boost pressure is tried to further improve the performance. Finally, it is found that for a low NOx and smoke emissions with a good brake thermal efficiency, five-pulse injection with the last pulse at closer to top dead centre along with the use of EGR in the LTC mode is a suitable one. [ABSTRACT FROM AUTHOR]

Introduction: The use of articaine has been claimed to obviate the need for routine palatal local anesthetic injections on account of its better diffusion through soft and hard tissues as compared to other local anesthetic agents. Objective: The objective of the study is to evaluate the efficacy of 4% articaine (with 1:100,000 adrenaline) infiltrated only buccally in the extraction of maxillary premolars for orthodontic reasons. Materials and Methods: A double-blind randomized clinical trial with a split-mouth design, where each patient (n = 100) was part of two groups, was conducted. Experimental Group 1: single buccal infiltration of 4% articaine with 1:100,000 adrenaline (Septanest™ with adrenaline 1:100,000 by Septodont). Control Group 2: routine buccal and palatal infiltrations of 2% lignocaine with 1:200,000 adrenaline (Lox™ 2% with adrenaline 1:200,000 by Neon). The parameters studied were time to onset of anesthesia, pain during the extraction procedure (not during the injecting of the local anesthetic), and frequency of extra amount of local anesthetic injected. Results: The difference was not statistically significant (P > 0.05) between the two groups with respect to all three parameters. This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases. Conclusion: This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases. [ABSTRACT FROM AUTHOR]

Fuel injection timing is an important control parameter for engine combustion optimization and emissions control. However, the actual fuel injection timing is different from the nominal one commanded by the electronic control unit, due to the system hydraulic lag or the possible communication malfunction. In this study, a simple estimate approach based on the injector inlet pressure is proposed to capture four critical characteristic instants at the start and end of injection. The critical characteristic moments estimated using this pressure-based approach are validated against those determined by the actual injection rate profiles, in the context of different single or split injection processes. The comparison revealed that the characteristic injection moments estimated by the injector inlet pressures and those determined by the actual injection rate profiles have a satisfactory agreement, certifying the broad applicability and reliability of this pressure-based approach in the detection of the real fuel injection start and end time. [ABSTRACT FROM AUTHOR]

Highlights • This study demonstrated the ability of two-stagnation injection strategy control on thermodynamic process and performance. • The combustion efficiency can be improved and optimized by two-stagnation injection strategy. • The mean gas temperature in cylinder declined with two-stagnation injection strategy. • NOx emissions significantly decreased with changing SI mode into various TSIS modes. Abstract A comparative investigation was conducted on a turbocharged direct-injection spark-ignition engine fuelled with gasoline and ethanol blend. Influences of single injection (SI) and two-stagnation injection strategy (TSIS) on thermodynamic process and performance of the engine operated on part-load condition were discussed and compared in this paper. The results indicated that 50% combustion position was slightly shifted to TDC and 10–90% combustion duration was shortened by using TSIS modes as compared with SI mode. However, the coefficient of variation in the indicated mean effective pressure was significantly increased with the second injection fuel mass repartition. In addition, the brake thermal efficiency (BTE) and brake specific fuel consumption (BSFC) were increase by adopting the TSIS modes, but the increase amplitude of BTE and BSFC was decreased, and even deteriorated in TSIS 6 mode. In comparison with SI mode, Hydrocarbon and carbon monoxide were declined with advanced second injection timing while both of them increased with increasing second injection fuel mass repartition. Moreover, NOx emissions were dramatically reduced by utilizing TSIS modes. Eventually, CO2 emission was mainly related to the carbon atom content, combustion efficiency and heat-work conversion in-cylinder. [ABSTRACT FROM AUTHOR]

Background: The increasing scope and complexity of foot and ankle procedures performed in an outpatient setting require more intensive perioperative analgesia. Regional anesthesia (popliteal and saphenous nerve blocks) has been proven to provide satisfactory pain management, decreased postoperative opioid use, and earlier patient discharge. This can be further augmented with the placement of a continuous-flow catheter, typically inserted into the popliteal nerve region. This study investigated the use of a combined popliteal and saphenous continuous-flow catheter nerve block compared to a single popliteal catheter and single-injection saphenous nerve block in postoperative pain management after ambulatory foot and ankle surgery. Methods: A prospective study was conducted using 60 patients who underwent foot and ankle surgery performed in an outpatient setting. Demographic data, degree of medial operative involvement, American Society of Anesthesiologists physical classification system, anesthesia time, and postanesthesia care unit time were recorded. Outcome measures included pain satisfaction, numeric pain scores (NPS) at rest and with activity, and opioid intake. Patients were also classified by degree of saphenous nerve involvement in the operative procedure, by the surgeon who was blinded to the anesthesia randomization. Results: Patients in the dual-catheter group took significantly less opioid medication on the day of surgery and postoperative day 1 (POD 1) compared to the single-catheter group (P = .02). The dual-catheter group reported significantly greater satisfaction with pain at POD 1 and POD 3 and a significantly lower NPS at POD 1, 2, and 3. This trend was observed in all 3 subgroups of medial operative involvement. Conclusion: Patients in the single-catheter group reported more pain, less satisfaction with pain control, and increased opioid use on POD 1, suggesting dual-catheter use was superior to single-injection nerve blocks with regard to managing early postoperative pain in outpatient foot and ankle surgery. Level of Evidence: Level II, prospective cohort study. [ABSTRACT FROM AUTHOR]

To understand the instantaneous particle deposition in nasal cavity, effects of two injection models on particle deposition characteristic were discussed in this paper. Based on a realistic human nasal cavity geometry obtained from CT scans, a comparison of deposition pattern in the nasal cavity between single injection and continuous injection was investigated through the Lagrangian approach. The instantaneous airflow field was simulated with the tidal volume of 159 and 318 mL by two sine wave curves at inlet. For the case of single injection, particles have finished deposition in the first half of inhalation, and a negative correlation between the tidal volumes and deposition can be observed when the particle diameter was larger than 10 µm. Moreover, particles were mainly deposited in the turbinate area that was beneficial for aerosol therapy. The inertial parameter was not suitable to predict the particle deposition in the case of single injection. With respect to continuous injection, a reduction in total deposition caused by the deceleration process of inhalation can be observed after 1.5 s. The deposition was closely associated with the time-varying flow field, and particles were mainly deposited in the anterior region and turbinate area. Besides, the particle deposition increased with the inertial parameter for continuous injection. The results indicated that the injection modes had an influence on both the total deposition and local deposition pattern in the nasal cavity. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the success of systemic single-dose methotrexate (MTX) treatment in patients with ectopic pregnancy (EP) and to investigate factors related to treatment success. Methods: This retrospective study had been performed in Yildirim Beyazit University between January 2010 and December 2015. Demographic and clinical characteristics, ultrasonografic findings, pretreatment serum β-human chorionic gonadotropin (β-hCG) and progesterone levels of 58 patients with EP were retrieved from hospital records retrospectively. The patients were grouped according to MTX treatment success (response vs. failure). Results: Single-dose MTX-treatment was successful in 72.4% (42/58) of patients. The mean pretreatment β-hCG level was significantly lower in responders than in failures (2080 ± 2322 vs. 5707 ± 3885 IU/L, p = 0.001), and 2678 IU/L was the most suitable cutoff to predict success (75% sensitivity, 73.8% specificity). Moreover, failure rate was 8.45 times more in group of patients whose β-hCG values were determined above the cutoff. The presence of fetal cardiac activity adversely affected treatment success (odds ratio = 12, p = 0.004). Treatment success was not affected by past history of ectopic pregnancy, thickness of endometrium, progesterone value or presences of pseudosac and free pelvic fluid. Conclusion: The success rate of single dose MTX in this study was 72.8 %, and we found that failure rate of MTX treatment was 8.45 times more in group of patients whose initial serum β-hCG values were above 2678 IU/L and 12 times more in patients with fetal cardiac activity. [ABSTRACT FROM AUTHOR]

The effect of single and double injections of D-Tle6,Pro9,NEt-mGnRHa (Supergestran®) on advancement and induction of ovulation in Arctic grayling was assessed. Sexually mature wild Arctic grayling females (most 2-4 years old) were caught in the Yenisey River at the beginning of May 2010. After a 4-day acclimatization, the females were randomly divided into four groups and intramuscularly injected as follows: group A, control group, treated with physiological saline only; group B, treated with a single injection (SI) of Supergestran® at 25 µg/kg body weight (BW); group C, injected twice (DI) with 25 µg/kg BW 3 days apart; group D, injected twice with 10 µg/kg BW 3 days apart. After stripping, the pseudo-gonadosomatic index was calculated, and an eggs sample from each female was fertilized. Only fish in the groups treated with DI protocols ovulated. No differences between the two groups were found in the timing of ovulation, ovulation rate, or mean time to ovulation. No females in either group A or B ovulated, since the experiment had to be prematurely terminated due to technical problems at the field hatchery. The DI of 10 µg/kg proved sufficient to induce and advance ovulation in Arctic grayling. Hormone treatments seem to be a promising tool to obtain viable eggs of Arctic grayling in a short time window and thereby to ensure satisfactory numbers of fry for restocking programs.