Infiltration Group Research Articles

Efficacy of infiltrative local anesthesia and inferior alveolar nerve block in periapical surgery of lower premolars and molars: A preliminary report.

BackgroundThe aims of this study were: 1) compare the amount of anesthesia used with the anesthetic technique; 2) relate the quantity of anesthesia needed with the level of anxiety of the patient; 3) study the relationship between the anesthetic technique and the level of hemostasis; 4) correlate the amount of anesthesia with patient and tooth dependent variables. Material and MethodsA randomized controlled trial was designed with two parallel groups according to the anesthetic technique: infiltrative local anesthesia (infiltrative group) and inferior alveolar nerve block (block group). The following variables were collected: sex, age, smoking habits, plaque index, symptoms, signs, position of the tooth and amount of anesthesia. Before surgery, all patients were asked to assess their anxiety on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The analysis of the hemorrhage control of aluminum chloride was judged by the surgeon and two examiners independently and recorded it as: 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). ResultsTwenty patients were included in this preliminary report. The amount of anesthesia used was lower in block group and in less anxious patients, although these results did not reach statistical significance. A relationship was found between the quantity of anesthesia used and a good hemostasis of the bony crypt before the application of the hemostatic agent (p<.05); and between elderly patients and a lower amount of anesthetic reinforcement (p<.05). ConclusionsBased on these preliminary results, we can conclude that no statistical significance difference was found between the amount of anesthesia used and the anesthetic technique or the anxiety. A relationship was found between hemostasis of the bony crypt and the quantity of anesthesia used; and between younger patients and a greater amount of anesthetic reinforcement. Key words:Anesthesia, anxiety, endodontic surgery, hemostasis, hemostatic agents,periradicular surgery.

Investigation of the esthetic outcomes of white spot lesion treatments

The present study compared the ability of bleaching, resin infiltration and microabrasion to restore the appearance of existing white spot lesions (WSL) on tooth surfaces as close as possible to that of the original healthy enamel. Sixty extracted human teeth with WSL were randomly assigned to three treatment groups (20/group). Prior to treatment, the colour of the surrounding healthy enamel and the WSL were measured as the baseline and pre-treatment (PreRX) colours respectively using spectrophotometer based on CIE L*A*B. The L-value was used for the statistical comparison. WSLs in each group were treated respectively by bleaching, infiltration or microabrasion following the manufacturer's instructions. Colour measurement was repeated after treatment. Both intragroup and intergroup comparisons were performed using ANOVA followed by Tukey's multiple comparison test (α=0.05). In all groups the mean L-values were significantly higher in PreRX WSL (P < 0.01; Tukey) compared to baseline (sound enamel). After treatment the difference in mean L-value between baseline and WSL increased significantly (P < 0.01, Tukey) in Bleaching and Microabrasion groups by 1.4% and 1% respectively, but decreased in Infiltration group by 3.4%. Thus resin infiltration decreased the L-value of the WSL, bringing it closer to the L-value of the sound enamel while bleaching and microabrasion increased the L-value. Among the three treatment modalities investigated in this study, resin infiltration was the most effective in masking the WSLs.

Effect of different white-spot lesion treatment on orthodontic shear strength and enamel morphology: In vitro study

Aim: White-spot lesion treatment is required before fixed appliance insertion as caries prevalence increases during orthodontic treatment. The aim of this study was to analyze the effect of fluoride varnish, casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) varnish, and resin infiltration as white-spot lesion treatments on orthodontic shear strength and enamel morphology. Materials and Methods: This is an observational analysis study with posttest-only control group design and blind total sampling methods. Sixty bovine mandible incisors were cleaned and divided into five groups (n = 12). No treatment was applied on Group 1 (control), whereas the four other groups were immersed in demineralization solution for 96 h before being stored in artificial saliva (Group 2), treated with fluoride varnish (Group 3), CPP-ACPF varnish (Group 4), and resin infiltration (Group 5). After bracket bonding with resin-modified glass ionomer on all samples, shear bond strength was evaluated. Adhesive remnant index (ARI) was observed by using a digital photo. Enamel morphology was evaluated using a scanning electron microscopy (SEM) before bracket bonding and after polishing. The Kruskal–Wallis test (P > 0.05) followed by Mann–Whitney U test was carried out (P < 0.05). Results: The shear strength in Groups 2 and 5 was slightly increased as compared with control group (P > 0.05), whereas it was significantly decreased in Groups 3 and 4 (P < 0.05). The ARI score was found to be highest after treatment with resin infiltration. Conclusion: Pretreatment with resin infiltration is recommended to be performed before bracket bonding on white-spot lesion; however, it may need to be reapplied after debonding and polishing to conceal enamel morphology damage formed after polishing

Comparative evaluation of anesthetic efficacy of 4% articaine using buccal infiltration technique and periodontal ligament injection technique for extraction of primary mandibular molars: An In vivo study

Introduction: Dental anxiety is patient's psychological response to the dental environment. Local anesthetic injection is the most anxiety-causing procedure for children in dentistry, especially the inferior alveolar nerve block (IANB) which is the most commonly used injection technique for achieving local anesthesia of mandibular molars. The various alternatives explored for IANB are intra-ligamentary technique/periodontal injection technique and buccal infiltration. Aim: The aim of this study was to compare the effectiveness of articaine hydrochloride 4% with adrenaline 1:100,000 for the extraction of mandibular primary molar teeth using buccal infiltration injection and intraligamentary injection. Materials and Methods: The present study was conducted on 30 children in the age group of 5–10 years requiring bilateral extraction of primary mandibular molars. The patients were randomly selected and divided into two groups. Group 1 received anesthesia using buccal infiltration injection technique and Group 2 received anesthesia using intraligamentary injection both containing 4% articaine with 1:1,00,000 adrenaline. Results: The success rate of buccal infiltration and intraligamentary injection using 4% articaine with mean sound, eye, and motor scores (± standard deviation) was found to be statistically nonsignificant, i.e., 3.07 for buccal infiltration and 2.97 for intraligamentary injection technique with P = 0.835 (P > 0.05). Conclusion: There is no significant difference between buccal infiltration technique and intraligamentary injection technique for the extraction of primary mandibular molars using 4% articaine with 1:1,00,000 adrenaline.

Ultrasound-guided Anterior Quadratus Lumborum Block for Postoperative Pain after Laparoscopic Pyeloplasty: A Randomized Controlled Trial.

Background:Quadratus lumborum block (QLB) has provided adequate analgesia and lowered postoperative opioid requirement in comparison to controls for some urological surgeries.Aims:The aim of this study was to assess the efficacy of postprocedure ultrasound-guided QLB in comparison to port-site infiltrations with local anesthetics (as control) in lowering postoperative pain after laparoscopic pyeloplasty.Settings and Design:This was a prospective, single-blinded, randomized controlled trial.Materials and Methods:Fifty-three adults undergoing laparoscopic pyeloplasty were randomly allocated to either anterior QLB group (n = 27) or port-site infiltration Group P (n = 26) with 20 mL of 0.5% ropivacaine. The primary outcomes were static and dynamic pain on the Visual Analog Scale (VAS) of 0–100 at the 30th min, 2nd, 6th, 12th, and 24th hour after surgery. The secondary outcomes were number of patients requiring rescue analgesics and having postoperative nausea or vomiting (PONV) in 24 hours after surgery.Statistical Analysis:Intergroup comparison of VAS was done with Student's t-test. Categorical data were analyzed using the Chi-square test.Results:The static VAS scores were found to be significantly lower in QLB group at the 2nd, 6th, and 12th hour, and the dynamic VAS was lower at all time points after the 30th min in the QLB group. The number of patients requiring rescue analgesics were significantly lower in the QLB group (13 as compared to 21 in Group P; P = 0.015). The incidence of PONV was comparable. No other side effects were seen.Conclusion:Ultrasound-guided anterior QLB is more effective in comparison to traditional technique of port-site local anesthetic infiltration for providing analgesia after laparoscopic pyeloplasty.

Analgesia for postoperative myomectomy pain: A comparison of ultrasound-guided transversus abdominis plane block and wound infiltration.

Acute postoperative pain after myomectomy can impair patient function. Like all other postoperative pain, it is a challenge requiring solution, particularly in developing countries. Ultrasound-guided transversus abdominis plane (TAP) block and wound infiltration (WI) are both known to be effective in managing postoperative pain. It is not certain if transversus abdominis plain block would be superior to wound infiltration. Aims: It was hypothesized that the TAP block has similar analgesic effectiveness to wound infiltration. This study was a randomized controlled trial involving, seventy-four (74) patients scheduled for myomectomy at the University of Benin Teaching Hospital Benin City, Nigeria under the subarachnoid block, which were randomized into TAP and WI group preoperatively. The ultrasound-guided bilateral TAP block group and wound infiltration group (subfascial and subcutaneous infiltration) each used 40 mL of 0.25% of plain bupivacaine to achieve postoperative analgesia. The time to first analgesic request, numerical pain rating scale (NRS) score at rest, and movement were assessed. Data were analyzed using SPSS version 16 (Chicago Il, USA). The time to first analgesic request was significantly delayed in the TAP block group compared to the wound infiltration group [240 (131, 375) min vs 170 (128, 187) minutes. P = 0.006]. The proportions of patients with NRS score ≤3 at the time of first analgesic requests were significantly more in the TAP block group (P < 0.001). The analgesic consumed by the TAP block group was significantly low compared to the WI group. There were no incidences of complications due to TAP block or wound infiltration. TAP block provided a longer duration of analgesia and a clinically superior quality of analgesia to wound infiltration.

Comparison of ultrasoundguided ilioinguinal iliohypogastric nerve block with wound infiltration during pediatric herniotomy surgeries

Background and Aims:The purpose of this study was to compare the analgesic efficacy of the ilioinguinal-iliohypogastric nerve block (II/IH) with local wound infiltration in children undergoing herniotomy surgeries.Methods:After ethics committee approval and informed consent, 100 children aged 6 months–7 years posted for herniotomy surgeries were randomly divided into Group B and Group W. Local wound infiltration was performed in Group W by the surgeon at the time of port placement and the end of the surgery with 0.2 mL.kg−1 of 0.25% bupivacaine. Ipsilateral II/IH was performed in Group B at the end of the surgery, under ultrasonographic guidance with a Sonosite portable ultrasound unit and a linear 5–10 MHz probe with a 22G hypodermic needle, and 0.2 mL.kg−1 of 0.25% bupivacaine was used on each side. The parameters recorded were postoperative hemodynamics, paracetamol and opioid requirements, postoperative pain scores, postoperative nausea vomiting, and the need for rescue analgesia in the first 6 h postoperatively.Results:The median pain scores were significantly lower in the II/IH group than the local wound infiltration group at 10 min (2 [0–2.5] compared to 2 [3–4]; P = 0.011), 30 min (1.5 [0–3] compared to 3 [2–5]; P < 0.001), 1 h (1.5 [0–2] compared to 2 [2–3]; P < 0.001) and 2 h (2 [0–2] compared to 2 [1.5–2.5]; P = 0.010) postoperatively. The need for postoperative opioids and rescue analgesia was also significantly lower in the II/IH group (P < 0.001).Conclusion:II/IH is superior to local wound infiltration for postoperative analgesia in pediatric herniotomy surgeries.

Effect of transverses abdominis block and subcutaneous wound infiltration on post-operative pain analgesia after cesarean section at Hawassa University, southern Ethiopia : A prospective cohort study

Backgroundpost-cesarean section analgesia regime should be efficacious without influencing the ability of a mother to take care of the neonate and with minimal drug transfer through breast milk. Transverse abdominis plane block and local anesthetic wound infiltration can provide effective pain relief at the wound site after surgery. However, the relative efficacy of two techniques for postoperative analgesia remains controversial. ObjectiveThis study aimed to compare the analgesic efficacy of Transverse abdominis plane block versus subcutaneous wound infiltration as part of for elective cesarean section surgeries under spinal anesthesia. Materials and methodsAn institutional-based Prospective cohort study was employed two equal groups of 68 adult females aged 18–65 years scheduled for elective cesarean under spinal anesthesia and wound infiltration a non-exposed group. Pain severity, first analgesia request time as well as analgesic consumption were assessed using the Mann –Whitney U test for 24 h. Chi-square test was used to analyze the homogenous categorical independent variables between these two groups and a p-value less than 0.05 was considered as statistically significant. ResultThe overall Tramadol consumption within 24 h with The Median and IQR was 100 mg (100–150) in the TAP group compared to 150 mg (150–200) in the subcutaneous wound infiltration group (p < 0.001). We conclude that TAP block could be considered Superior to subcutaneous wound infiltration anesthesia for postoperative pain management and we recommend that use of TAP block for effective Postoperative analgesia as part of multimodal analgesia after cesarean section with spinal anesthesia. We recommend the clinicians to use Tap for postoperative pain management.

Ultrasound guided erector spinae plane block for percutaneous radiofrequency ablation of liver tumors

ABSTRACT Background: Percutaneous radiofrequency ablation (PRFA) of hepatic tumors is a painful procedure. Regional anesthesia is currently considered one of the fundamental elements for managing both intra and postoperative pain. We aimed to compare the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) versus local anesthetic infiltration for pain relief in patients undergoing PRFA of liver tumors. Methods: Sixty adult patients undergoing PRFA of primary or secondary liver malignancies were randomized into: Group I (local anesthetic infiltration group) or Group II (right ultrasound-guided ESPB group). Postoperative pain score as a primary outcome, rescue analgesic consumption, number of subjects requiring general anesthesia and incidence of complications were recorded. Results: Postoperative pain score was significantly lower in Group II during the first 4 hours postoperatively (P = 0.000*, 0.000*, 0.001*, 0.001* and 0.002*, respectively) as compared to Group I, whereas comparable pain scores were recorded among the study groups at 8, 12, 16, and 24 hours postoperative (P = 0.492, 0.075, 0.893, and 0.094, respectively). Intra and postoperative rescue analgesic requirement was significantly less in Group II than Group I (P = 0.031*, and 0.000*, respectively). Nine patients in Group I and two patients in Group II were converted to general anesthesia. The incidence of adverse events was comparable between the two groups. Conclusions: Ultrasound-guided ESPB provided efficient analgesia during intraoperative and early postoperative periods with reduced analgesic requirements and fewer patients needing general anesthesia as compared to local infiltration technique. Trial registry: Pan African Clinical Trials Registry (PACTR201705002296409).

Lumbar disc extrusions reduce faster than bulging discs due to an active role of macrophages in sciatica

ObjectiveThis retrospective observational histological study aims to associate the size and type of disc herniation with the degree of macrophage infiltration in disc material retrieved during disc surgery in patients with sciatica.MethodsDisc tissue of 119 sciatica patients was embedded in paraffin and stained with hematoxylin and CD68. Tissue samples were categorized as mild (0–10/cm2), moderate (10–100/cm2), and considerable (> 100/cm2) macrophage infiltration. All 119 patients received an MRI at baseline, and 108 received a follow-up MRI at 1-year. MRIs were reviewed for the size and type of the disc herniations, and for Modic changes in the vertebral endplates.ResultsBaseline characteristics and duration of symptoms before surgery were comparable in all macrophage infiltration groups. The degree of macrophage infiltration was not associated with herniation size at baseline, but significantly associated with reduction of size of the herniated disc at 1-year post surgery. Moreover, the degree of macrophage infiltration was higher in extrusion in comparison with bulging (protrusion) of the disc. Results were comparable in patients with and without Modic changes.ConclusionMacrophage infiltration was positively associated with an extruded type of disc herniation as well as the extent of reduction of the herniated disc during 1-year follow-up in patients with sciatica. This is an indication that the macrophages play an active role in reducing herniated discs. An extruded disc herniation has a larger surface for the macrophages to adhere to, which leads to more size reduction.

Comparison of the Effects of Ultrasound-guided Erector Spinae Plane Block and Wound Infiltration on Perioperative Opioid Consumption and Postoperative Pain in Thoracotomy.

To compare the effects of preoperative ultrasound-guided erector spinae plane block (ESPB) and preoperative wound infiltration on perioperative opioid consumption and postoperative pain in thoracotomy. Randomised controlled trial. Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from October 2018 to April 2019. Sixty adult patients undergoing open esophagectomy were allocated randomly into two groups: experimental group (ultrasound-guided ESPB group, n = 30) and control group (wound infiltration group, n = 30). In ultrasound-guided ESPB group (group EB), ESPB with 20 ml of 0.5% ropivacaine was performed at the level of thoracic 5 transverse process. Whereas, in wound infiltration group (group WI), 20 ml of 0.5% ropivacaine was injected subcutaneously along the marked line of skin incision for surgery and chest tube placement. The perioperative opioid consumption, pain scores at rest and during coughing immediately after surgery, at postoperative day (POD) 1 and POD 2, consumption of rescue analgesic tramadol and postoperative opioid-related adverse events were all assessed. Compared with group WI, the intraoperative and postoperative opioid consumptions, postoperative tramadol consumption were significantly less in group EB (p <0.05). Moreover, the postoperative pain scores immediately after surgery, at POD 1 and POD 2, were all lower in group EB compared to group WI (p <0.05). Significantly, the postoperative incidence of nausea and vomiting was lower in group EB than that in group WI (p = 0.021). Compared to wound infiltration with local anesthetics, preoperative ultrasound-guided ESPB could significantly reduce perioperative opioid consumption, provide a better postoperative analgesia and reduce opioid-related adverse events in thoracotomy.

Management of white spot lesions using resin infiltration and microabrasion: a comparative in vitro study.

ABSTRACTStudy objective: White spot lesions are unwelcomed side effects of fixed appliances that compromise the treatment outcome. Recently the infiltration of white spot lesions has been introduced as a viable treatment alternative and the objective is to evaluate the colour improvement, stability against discolouration and abrasion resistance following resin infiltration and resin infiltration following Microabrasion..Materials and methods: This study design is an in vitro prospective study that included 45 teeth extracted for orthodontic purposes. Artificial white spot lesions were created in the enamel and teeth were randomly allocated to three groups, then the teeth were treated with infiltration (Icon) and infiltration following Microabrasion (Opalustre) or remained untreated (control). The three groups were then subjected to Thermocycling, tooth brush abrasion and discolouration then visible colour change and abrasion resistance were measured.Results:When ΔE was calculated between the baseline measurements and those after white spot lesions there was a clinical and statistical color change in the three groups, in group II (the combined treatment group) the calculated ΔE between baseline measurements and those taken after treatment and after aging the mean color difference was less than that in group III (only resin infiltration group). Under SEM after aging all the treated surfaces of the specimens in group II were smooth with no microcracks while in group III the treated surfaces showed smooth areas and other areas showed microfissures and microcracks.Conclusions:When microabrasion preceded resin infiltration in the treatment of WSLs, it improved the color matching immediately after treatment application and showed better performance after aging procedures. It also produced smooth surface free from microcracks under SEM.

Paravertebral Block with Compound Betamethasone in Laparoscopic Cholecystectomy: A Double-blind Randomized Controlled Trial.

BackgroundsThe aim of this study was to evaluate the utility of unilateral single injection thoracic paravertebral block (TPVB) with and without the addition of betamethasone for the acute pain management of patient’s undergoing laparoscopic cholecystectomy (LC).MethodsEligible patients were allocated randomly to three groups: (A) general anesthesia followed by surgeon infiltration at port sites with ropivacaine (n = 48), (B) general anesthesia after single injection TPVB at right T7-8 level with ropivacaine only, Ropi_TPVB (n = 43), and (C) general anesthesia after single injection TPVB with ropivacaine plus betamethasone, Ropi_Betamet_TPVB (n = 45). Primary outcome was TPVB duration assessed by the number of dermatomes at regular intervals up to 72 hours (h). Secondary outcomes included pain scores, analgesics consumption, and perioperative functional outcomes.ResultsThe addition of betamethasone to ropivacaine in TPVB resulted in similar onset but significantly slower block regression between 4 h and 72 h as compared to ropivacaine alone (P < 0.001). When compared to the surgeon infiltration group, Ropi_TPVB and Ropi_Betamet_TPVB group had significantly lower pain scores for 24 h and 48 h, respectively, P ≤ 0.001. Both TPVB groups had less frequency of analgesics administration for 72 h, P < 0.001, and earlier mobilization, P < 0.001.ConclusionsThe addition of betamethasone to TPVB significantly prolonged block duration as compared to local anesthetic alone. TPVB both with and without the addition of betamethasone resulted in better perioperative analgesia and improved functional status when compared to surgical site local anesthetic infiltration.

Infiltration and In-Tissue Polymerization of Photocross-Linked Hydrogel for Effective Fixation of Implants into Cartilage-An In Vitro Study.

Effective and biocompatible fixation of implants into cartilage defects has yet to be successfully achieved. [Poly-d,l-lactic acid/polyethyleneglycol/poly-d,l-lactic acid] (PDLLA-PEG) is a chondrosupportive scaffold that is photocross-linked using the visible-light photoinitiator lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP). Interestingly, LAP and its monomer DLLA-EG are able to infiltrate the cartilage and form hydrogels upon the detection of light. After the infiltration of LAP and DLLA-EG into the implant and host cartilage, an interconnected and continuous hydrogel structure is formed which fixes the implant within the host cartilage. A mechanical test shows that the infiltrated group displays a significantly higher push-out force than the group that has not been infiltrated (the traditional fibrin fixation group). Surprisingly, the in-cartilage hydrogel also reduces the release of sulfated glycosaminoglycan from cartilage explants. However, infiltration does not affect the cell viability or the expression of cartilage marker genes. This new strategy thus represents a biocompatible and efficient method to fix implants into host tissues.

Effect of Adding Dexmedetomidine as Adjuvant to Different Regional Anesthetic Techniques after Inguinal Herniorrhaphy

Background: Inguinal herniorrhaphy is one of the most commonly performed surgeries, often performed on a fast-track basis. However, inguinal herniorrhaphy is frequently associated with persistent postoperative discomfort and pain, which can lead to patient distress, delayed discharge, and subsequent complication. Objective: Aim of this work is to compare TAP block technique versus local infiltration with or without dexmedetomidine regarding analgesic effect and endogenous stress response. Patients and Methods: This randomized prospective study included 120 patients of both genders scheduled for non-complicated inguinal hernioplasty. Their age ranged between 18 and 60 years, with ASA physical status I and II, and body mass index ≤ 35 kg /m². The study was approved by the medical ethics committee of Al-Azhar University Hospital in Assiut and a written informed consent is obtained from all patients. Results: The major finding in this study was that the pain scores were statistically significantly lower when we added dexmedetomidine than when we did not add it and in the surgical site infiltration groups than TAP block groups at postoperative 2nd, 6th, and12th hours. 1st request for analgesia in this study among all groups was similar. Frequency of analgesic doses was statistically significant among all groups, and group T used the most frequent doses. In this study, local wound infiltration and TAP block with dexmedetomidine showed decrease number of analgesic doses and attenuated the stress response indicators (norepinephrine and glucose levels) without side effects. Conclusion: Dexmedetomidine added to bupivacaine in both local infiltration and TAP block had better visual analogue scale, decreased number of analgesic doses and attenuated postoperative stress response indicators. Norepinephrine is the most accurate stress response indicator while blood glucose is accurate and the cheapest one.

Effect of Adding Dexmedetomidine as Adjuvant to Different Regional Anesthetic Techniques after Inguinal Herniorrhaphy

Background: Inguinal herniorrhaphy is one of the most commonly performed surgeries, often performed on a fast-track basis. However, inguinal herniorrhaphy is frequently associated with persistent postoperative discomfort and pain, which can lead to patient distress, delayed discharge, and subsequent complication. Objective: Aim of this work is to compare TAP block technique versus local infiltration with or without dexmedetomidine regarding analgesic effect and endogenous stress response. Patients and Methods: This randomized prospective study included 120 patients of both genders scheduled for non-complicated inguinal hernioplasty. Their age ranged between 18 and 60 years, with ASA physical status I and II, and body mass index ≤ 35 kg /m². The study was approved by the medical ethics committee of Al-Azhar University Hospital in Assiut and a written informed consent is obtained from all patients. Results: The major finding in this study was that the pain scores were statistically significantly lower when we added dexmedetomidine than when we did not add it and in the surgical site infiltration groups than TAP block groups at postoperative 2nd, 6th, and12th hours. 1st request for analgesia in this study among all groups was similar. Frequency of analgesic doses was statistically significant among all groups, and group T used the most frequent doses. In this study, local wound infiltration and TAP block with dexmedetomidine showed decrease number of analgesic doses and attenuated the stress response indicators (norepinephrine and glucose levels) without side effects. Conclusion: Dexmedetomidine added to bupivacaine in both local infiltration and TAP block had better visual analogue scale, decreased number of analgesic doses and attenuated postoperative stress response indicators. Norepinephrine is the most accurate stress response indicator while blood glucose is accurate and the cheapest one.

Immune Landscape of Invasive Ductal Carcinoma Tumor Microenvironment Identifies a Prognostic and Immunotherapeutically Relevant Gene Signature.

Background: Invasive ductal carcinoma (IDC) is a clinically and molecularly distinct disease. Tumor microenvironment (TME) immune phenotypes play crucial roles in predicting clinical outcomes and therapeutic efficacy.Method: In this study, we depict the immune landscape of IDC by using transcriptome profiling and clinical characteristics retrieved from The Cancer Genome Atlas (TCGA) data portal. Immune cell infiltration was evaluated via single-sample gene set enrichment (ssGSEA) analysis and systematically correlated with genomic characteristics and clinicopathological features of IDC patients. Furthermore, an immune signature was constructed using the least absolute shrinkage and selection operator (LASSO) Cox regression algorithm. A random forest algorithm was applied to identify the most important somatic gene mutations associated with the constructed immune signature. A nomogram that integrated clinicopathological features with the immune signature to predict survival probability was constructed by multivariate Cox regression.Results: The IDC were clustered into low immune infiltration, intermediate immune infiltration, and high immune infiltration by the immune landscape. The high infiltration group had a favorable survival probability compared with that of the low infiltration group. The low-risk score subtype identified by the immune signature was characterized by T cell-mediated immune activation. Additionally, activation of the interferon-α response, interferon-γ response, and TNF-α signaling via the NFκB pathway was observed in the low-risk score subtype, which indicated T cell activation and may be responsible for significantly favorable outcomes in IDC patients. A random forest algorithm identified the most important somatic gene mutations associated with the constructed immune signature. Furthermore, a nomogram that integrated clinicopathological features with the immune signature to predict survival probability was constructed, revealing that the immune signature was an independent prognostic biomarker. Finally, the relationship of VEGFA, PD1, PDL-1, and CTLA-4 expression with the immune infiltration landscape and the immune signature was analyzed to interpret the responses of IDC patients to immunotherapy.Conclusion: Taken together, we performed a comprehensive evaluation of the immune landscape of IDC and constructed an immune signature related to the immune landscape. This analysis of TME immune infiltration landscape has shed light on how IDC respond to immunotherapy and may guide the development of novel drug combination strategies.

Effect of two kinds of materials on the prevention of early erosive enamel wear

Objective: To investigate the preventive effect of resin infiltration and adhesive on early erosive enamel wear. Methods: Orthodontic reduction premolars collected from Central Laboratory of Nanjing Stomatological Hospital, Medical School of Nanjing University were used to prepare 70 specimens. Forty samples were divided into eight groups (n=5) and treated with different conditions (pH=1.6, 2.4, 3.2 or 4.0 hydrochloric acid solution, etching time was 30 or 60 s), and the conditions for obtaining early erosive enamel samples were selected. Based on this procedure, thirty early erosive enamel samples were made and divided into three groups: control group, resin infiltration group, and adhesive group. And the treatment of 30 days acid abrasion cycle was carried out. Confocal microscopy was used to measure the thickness changes of enamel or material before and after cycle. Results: Early erosive enamel samples was obtained when pH was 4.0 and etching time was 60 s. After 30 days cycle, the wear of enamel was (29.71±6.72) μm in control group, (5.60±2.24) μm in resin infiltration group and (2.89±1.03) μm in adhesive group. In infiltration group and adhesive group, lower enamel was not affected by the cycle, and the material loss ratios of the infiltration resin group and adhesive group were 0.41±0.14 and 0.29±0.13, respectively. The ratio of material loss was not significantly different (P>0.05). But infiltration group lost (12.95±2.22) μm of enamel during the application of the material. Conclusions: Resin infiltration and adhesive have the same short-term protective effect against early erosive enamel wear. Adhesive has less damage to enamel and better effect.

Ultrasound-guided subcostal transversus abdominis plane block with liposomal bupivacaine compared to bupivacaine infiltration for patients undergoing robotic-assisted and laparoscopic hysterectomy: a prospective randomized study.

PurposeTo determine if a transversus abdominis plane (TAP) block with liposomal bupivacaine reduces total postoperative opioid use in the first 72 hrs following laparoscopic or robotic hysterectomy compared to port-site infiltration with 0.25% bupivacaine.MethodsPatients received either a true TAP block procedure with 266 mg liposomal bupivacaine and 50 mg of 0.25% bupivacaine and sham port infiltration or sham TAP block procedure with true port-site infiltration with 100–125 mg of 0.25% bupivacaine. All patients had a standardized, scheduled, non-opioid pain management plan. The primary outcome was total IV morphine equivalents used in the first 72 hrs following surgery. Secondary outcomes included assessment of postoperative pain over the study period and quality of recovery measures.ResultsPatients undergoing TAP blockade required fewer total opioid equivalents during the observation period than patients allocated to infiltration (median 21 versus 25 mg IV Morphine equivalents, P=0.03). Opioid use was highest in the first 24 hrs after surgery, with less difference between the groups during days 2 and 3 postoperatively. There were 5 in the TAP group and 0 in the infiltration group were opioid free at 72 hrs. Those in the TAP group had improved quality of recovery (QoR15) with no change in overall benefit of analgesia score.ConclusionTAP blockade reduced the requirement for opioid pain medication in the first 72 hrs after surgery, had more patients opioid free at 72 hrs, and improved patients’ quality of their recovery.

The grade of preoperative subscapularis muscle atrophy as a prognostic factor for postoperative retears: A double-center retrospective series.

The aim of the study was to investigate whether subscapularis muscle atrophy is a negative prognostic factor leading to increased risk of retears in patients treated with an arthroscopic subscapularis tendon repair. We hypothesized that fatty infiltration of the subscapularis muscle deteriorates the clinical and sonographic outcome of the arthroscopic repair and inhibits reparability of the ruptured tendons. A double- center, multinational, retrospective, blind (in the follow-up) clinical study regarding 32 patients who underwent an arthroscopic subscapularis repair was conducted. Patients were divided into two groups according to the preoparative fatty infiltration grade of subscapularis muscle (group A: grade<II, group B: grade II or higher). Reparability was not influenced by the grade of preoperative fatty infiltration of subscapularis muscle. The preoperative MRI scans showed significantly higher grades of fatty infiltration (group B) in the subscapularis muscle of patients with clinical evidence of retear after the arthroscopic repair. Low grades of preoperative subscapularis muscle atrophy are significantly correlated with low clinical and sonographic retear’s rate after subscapularis arthroscopic repair, while high grades were a clear negative prognostic factor for the clinical outcome of the aforementioned patients.