Sensory Level Research Articles

Estimating the usefulness of inferior vena cava collapsibility index and caval aorta index to predict hypotension after spinal anaesthesia in adult patients undergoing elective surgery in a tertiary care hospital

Abstract Background and Aims: Post-spinal anaesthesia hypotension (PSAH) can occur in 25–75% of patients. The preload or volume status of a patient is an important contributor to PSAH, and coloading with fluids is advocated to prevent PSAH. Instead of blind volume loading, prediction of volume status using inferior vena cava (IVC) collapsibility index (IVCCI) and caval aorta index (IVC:Ao index) may be used to guide fluid administration. Material and Methods: In our study, we used ultrasound in the immediate pre-operative period to calculate IVCCI and IVC:Ao index in patients scheduled for elective surgery in the supine position, under spinal anaesthesia. Spinal anaesthesia was given in the lateral position with 0.5% hyperbaric bupivacaine. Patients were placed supine thereafter, sensory blockade level was ascertained, and blood pressure (BP) was measured every 2 min for 30 min. Episodes of hypotension were treated with fluids or vasopressors as per the discretion of the treating anaesthesiologist. In the study, 73 patients were screened, out of which 69 were included. Results: Totally, 23 participants out of 69 developed PSAH. The receiver operating characteristic (ROC) curve was made and the area under the curve analysis was done on our collected data. We found that IVC:Ao index has better sensitivity (0.696 for IVC:Ao index ≤0.810) and specificity (0.717 for IVC:Ao index ≤0.810) than IVCCI (sensitivity 0.522 and specificity 0.630 for IVCCI ≥33.32%) to predict PSAH. Conclusion: IVC:Ao index is a better predictor of PSAH than IVCCI. Thus, it may be used to predict volume status and guide in coloading with fluids during spinal anaesthesia.

Multisensory contributions to skin-cosmetic product interactions.

The human face is one of the most salient regions of the body surface. Ratings of facial attractiveness, as well as judgements of a person's age, are influenced by the appearance of facial skin (not to mention the presence/absence of wrinkles). Unsurprisingly, many consumers spend huge amounts of money on trying to protect, maintain, and/or enhance their facial appearance. As highlighted by the evidence presented in this narrative review, both the skin and the cosmetic products that many consumers use are fundamentally multisensory in nature. The complex interaction between the particular skin site stimulated and the multisensory attributes of the product (e.g., when it is applied) can exert a number of effects on an individual's mood, their emotions, as well as on their self-perception (and self-confidence), over-and-above any functional effects that the cream or lotion may have on the skin itself. In this narrative historical review, the literature on the multisensory perception of facial skin is summarized and critically evaluated. Multisensory interactions taking place between the cosmetic product, its packaging, as well as its use/application at the sensory, cognitive, and emotional levels are all discussed.

Emotional body representations: more pronounced effect of hands at a more explicit level of awareness.

To understand conditions such as body dysmorphic disorder, we need to understand healthy individuals' perceptual, conceptual, and emotional representations of their bodies. Not much is known about the differences in these representations across body districts, for example, hands, feet, and whole-body, despite their differences at sensory and functional levels. To understand this, we developed more implicit and explicit measures of body satisfaction for these body districts. Sixty-seven participants (age M = 30.66, SD = 11.19) completed a series of online Implicit Association Tests (IAT) and a Body Image Satisfaction Visual Analogue Scale (BISVAS; explicit) for each body district (hands/feet/whole body). The results show no differences in the more implicit level of awareness in hands, feet and whole body, while differences are apparent at a more explicit level of awareness, with higher scores for body image satisfaction for the hands than the whole body and marginally significant lower scores for feet than hands. Those findings suggest that visual attention, level of concern attributed to a body district, and disgust drivers are possible factors affecting the experience of attitudinal body image satisfaction.

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (>65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

Pittsburgh Impairment Testing Tool for Spina Bifida Can Predict Ambulation and Transfer Ability in Adults With Spina Bifida.

The aim of this study was to evaluate the predictive accuracy of the Pittsburgh Impairment Testing Tool. It was hypothesized that the Pittsburgh Impairment Testing Tool would have a good overall accuracy (≥80%) for predicting both ambulation and transfer ability and that overall accuracy of the Pittsburgh Impairment Testing Tool would be higher than that of other scales. A retrospective chart review was used to classify 409 adults with spina bifida according to seven neurological scales. A Naïve Bayes classifier was used to obtain accuracy estimates for predicting both ambulation and transfer ability as a function of each scale. The Pittsburgh Impairment Testing Tool was the only scale demonstrating >80% overall accuracy for predicting both ambulation and transfer ability. While several scales demonstrated ≥80% overall accuracy in predicting transfer ability, none were useful in predicting inability to transfer. Inability to transfer was difficult for all tools to predict. The Pittsburgh Impairment Testing Tool demonstrated good overall accuracy for predicting both ambulation and transfer ability. Sensory and anatomic levels were less useful than motor level in predicting functional ability.

E048 Spinal gout: an unusual cause of paraplegia

Abstract Background/Aims Gout is a common inflammatory arthritis caused by the deposition of monosodium urate crystals. Gout usually causes peripheral joint arthritis. Axial involvement is likely under-recognised, affecting an estimated 10-20% of gout patients. Spinal gout is an established phenomenon in patients with chronic tophaceous gout and sustained hyperuricaemia. Gout can affect any segment of the spine. Clinical presentation of spinal gout is variable including back pain, radiculopathy and cord compression. Due to its nonspecific presentation, it can be confused for other spinal pathologies such as epidural abscess, malignancy, spondylodiscitis and vertebral osteomyelitis. Methods We present a case report of a young male with tophaceous gout of the thoracic spine. Results A 37 year old man presented with 4 day history of acute thoracic back pain followed by flaccid lower limb paralysis. He was morbidly obese (BMI 60) and had a 13-year history of poorly controlled gout with most recent uric acid being 627. He had previously declined urate lowering therapy but commenced allopurinol treatment one month prior to admission. On examination power was 0/5 in both lower limbs with absent reflexes and a T12 sensory level. MRI showed multi-level facet joint arthropathy. An epidural collection was present at T8-10, causing complete occlusion of the vertebral artery. He underwent an urgent posterior thoracic decompression. ‘White cheese like epidural pus’ was removed and he was initially treated as facet joint infection. He had ongoing fevers [>38.5C], despite empirical antibiotics, and C-reactive-protein was persistently elevated [highest at 360mg/L]. Uric acid was 423. Enrichment culture of the epidural collection and serial blood cultures were negative. Repeat MRI of spine did not demonstrate any reoccurrence of collection. Subsequently the histology of the epidural collection was reported as characteristic of gout with ‘amorphous material and giant cells’. No urate crystals were identified as the sample was prepared with formalin, which would have dissolved any crystals present. He was referred to rheumatology who identified synovitis in his hands, wrist and elbows, consistent with active polyarticular gout. There were small tophi present on his heels and pinna. The patient was commenced on oral prednisolone and allopurinol was rapidly up-titrated. Unfortunately, the patient did not recover neurological function. Conclusion We present a unique case of acutely presenting tophaceous thoracic spinal gout causing irreversible paraplegia in a young patient, mimicking an epidural abscess. Our patient had hyperuricaemia for over 10 years without treatment, raising his risk of axial complications. A high index of suspicion for spinal gout is needed for patients presenting with acute back pain and neurological symptoms with a history of chronic gout. This case highlights diagnostic challenges in identifying spinal gout and the importance of treating tophaceous gout early to prevent devastating long-term complications. Disclosure C.A. Zollinger-Read: None. M. Cox: None. R. Kumari: None.

Using part of the initial analgesic dose as the epidural test dose did not delay the onset of labor analgesia: a randomized controlled clinical trial

BackgroundEpidural test dose for labor analgesia is controversial and varies widely in clinical practice. It is currently unclear whether using a portion of the initial dose for analgesia as the test dose delays the onset time of analgesia, compared to the traditional test dose.MethodsOne hundred and twenty-six parturients who chose epidural analgesia during labor were randomly assigned to two groups. The first dose in group L was 3 ml 1.5% lidocaine, and in the RF group was 10 ml 0.1% ropivacaine combined with 2 μg/ml fentanyl. After 3 min of observation, both groups received 8 ml 0.1% ropivacaine combined with 2 μg/ml fentanyl. The onset time of analgesia, motor and sensory blockade level, numerical pain rating scale, patient satisfaction score, and side effects were recorded.ResultsThe onset time of analgesia in group RF was similar to that in group L (group RF vs group L, 7.0 [5.0–9.0] minutes vs 8.0 [5.0–11.0] minutes, p = 0.197). The incidence of foot numbness (group RF vs group L, 34.9% vs 57.1%, p = 0.020) and foot warming (group RF vs group L, 15.9% vs 47.6%, p < 0.001) in group RF was significantly lower than that in group L. There was no difference between the two groups on other outcomes.ConclusionsCompared with 1.5% lidocaine 3 ml, 0.1% ropivacaine 10 ml combined with 2 μg/ml fentanyl as an epidural test dose did not delay the onset of labor analgesia, and the side effects were slightly reduced.Clinical trial registrationhttp://www.chictr.org.cn (ChiCTR2100043071).

The efficacy of ultrasound-guided upper thoracic erector spinae plane block for postoperative analgesia in proximal shoulder surgery and its effect on phrenic nerve function: A prospective exploratory study.

The upper thoracic (T2) erector spinae plane block (UT-ESPB) has been proposed as an alternative to interscalene brachial plexus block for postoperative analgesia in shoulder surgery. The current study was conducted to evaluate the same. Patients scheduled for shoulder surgery under general anesthesia (GA) received ultrasound-guided UT-ESPB. The outcomes measured were diaphragmatic movements, block characteristics, and quality of recovery at 24 h. A total of 43 patients were recruited. The incidence of phrenic nerve palsy was 0%. The sensory level achieved by the maximum number of patients at the end of 30 min was C7-T5 level, and none had a motor block. Forty-two percent of patients did not require rescue analgesia till 24 h postoperative. In the rest of the patients, the mean (SD) duration of analgesia was 724.2 ± 486.80 min, and the mean postoperative requirement of fentanyl was 98.80 ± 47.02 μg. The median pain score (NRS) during rest and movement is 2 to 3 and 3 to 4, respectively. The median quality of recovery score at the end of 24 h after the block was 14 (15-14). The upper thoracic ESPB resulted in a sensory loss from C7-T5 dermatomes without any weakness of the diaphragm and upper limb. However, the block was moderately effective in terms of the total duration of analgesia, postoperative pain scores, analgesic requirement, and quality of recovery in patients undergoing proximal shoulder surgeries under GA. Further studies are required to establish its role due to its poor correlation with sensory spread.

Determination of the Biowall Effective Area to Induce Holistic Sensory Comfort

&lt;p&gt;Biowalls are a new phenomenon in interior urban areas, which has proven to contribute positively to sensory comfort. But people use biowalls in different dimensions. Based on field facts, determining the biowall dimensions for human sensory comfort has not emphasized clear principles. The research aims to obtain the effective area of a biowall inducing sensory comfort comprehensively and simultaneously in tropical landed dwellings. Therefore, this study used the experimental method to extract the effective areas of the biowall to generate thermal, audial, visual, and respiratory comfort. The analysis was mathematically conducted through polynomial quadratic equations and directly or inversely proportional to the overall value regarding a generalization attempt. The variables measured included temperature, humidity, surface temperature, reverberation time, noise reduction, illuminance, luminance, and colour mapping, as well as levels of CO2, TVOC, HCHO, and PM2.5. The result showed that biowall effective area inducing thermal, audial, visual, and respiratory comfort for a (3000 x 3000 x 2500) mm3 room was 2.5 modules or 12.5 m2 leaf area. This value was able to provide an increase in the sensory comfort level for the thermal, audial, visual, and respiratory variables by 59.22 %, 76.64 %, 32.35 %, and 98.88 %, respectively.&lt;/p&gt;

The effect of hip shoulder width ratio and vertebral column length on sensory level in term participants posted for lower segment caesarean section under spinal anaesthesia in Indian population: A prospective observational study

Hypotension is the most common complication of spinal anesthesia with high intrathecal spread of local anaesthetic drug especially during caesarean section. Hip Shoulder width Ratio (HSWR) is one of the factors which affects spread of spinal anaesthesia.85 ASA II participants with singleton term pregnancy undergoing elective caesarean section received 12mg hyperbaric bupivacaine intrathecally with 26G Quincke’s spinal needle in L3-4 intervertebral subarachnoid space via midline approach. Post spinal anaesthesia haemodynamic parameters were monitored every 5 minutes for the first 20 minutes and at the end of surgery. Sensory level was assessed by a pinprick test every 5 minutes till 20 minutes and post-surgery. Hypotension was defined as 20% fall from baseline systolic blood pressure at 15 minutes post spinal anaesthesia.We found significant positive correlation between high shoulder width ratio and highest sensory level achieved (p - 0.0005) using mutiple regression analysis and pearson's correlataion. With every unit increased in high shoulder width ratio spinal level significantly increased by 5 units. Hip shoulder width ration and age were significantly correlatwd with incidence of hypotension.Hip-shoulder Width Ratio has a positive effect on cephalad spread of spinal anaesthesia and thus incidence of hypotension. By knowing the Hip-shoulder Width Ratio, it can help anaesthesiologists to predict the spread of spinal anaesthesia and titrate the dose of 0.5% hyperbaric bupivacaine.

Cortical Sensorimotor Integration as a Neural Origin of Impaired Grip Force Direction Control following Stroke.

Stroke is a major cause of disability worldwide. Upper limb impairment is prevalent after stroke. One of the post-stroke manifestations is impaired grip force directional control contributing to diminished abilities to grip and manipulate objects necessary for activities of daily living. The objective of this study was to investigate the neural origin of the impaired grip force direction control following stroke. Due to the importance of online adjustment of motor output based on sensory feedback, it was hypothesized that grip force direction control would be associated with cortical sensorimotor integration in stroke survivors. Ten chronic stroke survivors participated in this study. Cortical sensorimotor integration was quantified by short latency afferent inhibition (SAI), which represents the responsiveness of the primary motor cortex to somatosensory input. Grip force direction control was assessed during paretic grip. Grip force direction control was significantly associated with SAI. This relationship was independent of sensory impairment level. Cortical sensorimotor integration may play a significant role in the grip force direction control important for gripping and manipulating objects with the affected hand following stroke. This knowledge may be used to inform personalized rehabilitation treatment. For example, for patients with impaired grip force direction control, behavioral therapy focusing on feedback motor control, augmented by use of brain stimulation to reinforce cortical sensorimotor integration such as paired associative stimulation, may be applied.

A Comparison of Fast v/s Slow Spinal Injection Speed on Hypotension and Sensory Level Onset: A Randomised Study

A Comparison of Fast v/s Slow Spinal Injection Speed on Hypotension and Sensory Level Onset: A Randomised Study

The Impact of an Effective Rehabilitation System on the Academic Performance of Special needs persons

This study looked at how well functioning rehabilitation programme affect special needs students’ academic performance in Federal College of Education (Special), Oyo. A descriptive research design was employed for the study. The population of the study consisted of all the Academic staff from the School of Special Education, Federal College of Education (Special), Oyo. The sample size for the study was fifty (50) academic staff randomly selected from various departments in special education. A Self-developed questionnaire titled: Impact of an Effective Rehabilitation System on the Academic Performance of Special Needs Persons (IERSAPSP) was used by the researcher for data collection. The instrument was validated and the reliability coefficient 0f 0.86 was realized which implies that the instrument was reliable. Three research questions guided the study. The data collected were organized and analyzed using descriptive statistics frequency count and percentage. The findings showed that persons with special needs find it very difficult to adapt to school life and show signs of inappropriate or what might be considered immature behavior, but with effective rehabilitation system this will enable them to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. It was recommended among others that the Government at all levels should ensure that a reasonable percentage of the Education Trust Fund Allocation is made available for the education of students with disabilities.

Small fibre neuropathy in Fabry disease: a human-derived neuronal in vitro disease model and pilot data.

Acral burning pain triggered by fever, thermal hyposensitivity and skin denervation are hallmarks of small fibre neuropathy in Fabry disease, a life-threatening X-linked lysosomal storage disorder. Variants in the gene encoding alpha-galactosidase A may lead to impaired enzyme activity with cellular accumulation of globotriaosylceramide. To study the underlying pathomechanism of Fabry-associated small fibre neuropathy, we generated a neuronal in vitro disease model using patient-derived induced pluripotent stem cells from three Fabry patients and one healthy control. We further generated an isogenic control line via gene editing. We subjected induced pluripotent stem cells to targeted peripheral neuronal differentiation and observed intra-lysosomal globotriaosylceramide accumulations in somas and neurites of Fabry sensory neurons using super-resolution microscopy. At functional level, patch-clamp analysis revealed a hyperpolarizing shift of voltage-gated sodium channel steady-state inactivation kinetics in isogenic control neurons compared with healthy control neurons (P < 0.001). Moreover, we demonstrate a drastic increase in Fabry sensory neuron calcium levels at 39°C mimicking clinical fever (P < 0.001). This pathophysiological phenotype was accompanied by thinning of neurite calibres in sensory neurons differentiated from induced pluripotent stem cells derived from Fabry patients compared with healthy control cells (P < 0.001). Linear-nonlinear cascade models fit to spiking responses revealed that Fabry cell lines exhibit altered single neuron encoding properties relative to control. We further observed mitochondrial aggregation at sphingolipid accumulations within Fabry sensory neurites utilizing a click chemistry approach together with mitochondrial dysmorphism compared with healthy control cells. We pioneer pilot insights into the cellular mechanisms contributing to pain, thermal hyposensitivity and denervation in Fabry small fibre neuropathy and pave the way for further mechanistic in vitro studies in Fabry disease and the development of novel treatment approaches.

Comparison of the analgesic effects of different bupivacaine concentrations in continuous femoral block after total knee arthroplasty surgery

Aim: In regional anesthesia practice, anesthesists’ goal must be to use the lowest effective concentration of local anesthetics to provide sufficient pain relief while minimizing side effects and complications. This study was designed to compare the analgesic efficacy of two different concentrations of bupivacaine (0.125% and 0.1%) in continuous femoral block for postoperative analgesia.Method: In this study, fifty patients were enrolled, all of whom underwent femoral nerve block catheterization. The block procedure involved the administration of 30ml of bupivacaine solution at a concentration of 0.25%. Following a thirty-minute interval post-block application, patients underwent knee surgery under general anesthesia. During the closure of subcutaneous tissues, an additional 10ml of bupivacaine solution was injected through the catheter. Two groups were formed based on the concentration of the solution administered: Group(0.125%) received bupivacaine at a concentration of 0.125%, while Group(0.1%) received it at a concentration of 0.1%. Subsequently, upon arrival at the postoperative care unit, infusion through the catheter commenced at a rate of 10ml/h-1, maintaining the same concentrations for both groups. In addition to the nerve block, all patients were provided with intravenous Patient Controlled Analgesia (PCA) devices containing morphine for pain management. Throughout the postoperative period, sensory and motor block levels, Numerical Rating Scale (NRS) values for static and dynamic pain assessment, total morphine consumption, morphine demand, as well as any observed side effects and complications, were meticulously recorded for analysis.Results: Postoperatively the NRSstatic values at 24th and 48th hours and NRSdynamic values at the 24th hour were higher in Group(0.1%) and it was statistically significant(p&lt;0,007). And at 48th hour, morphine consumption was significantly higher in Group(0.1%) (p&lt;0,05).Conclusions: In our study, all patients across both experimental groups initially experienced satisfactory analgesia. However, within the 24-hour postoperative period, Group(0.1%) exhibited a decline in the quality of analgesia, necessitating increased utilization of rescue analgesics. This escalation in rescue analgesic use was associated with a higher incidence of adverse effects and reduced patient comfort levels within this group. Consequently, our findings indicate that the 0.125% concentration of bupivacaine yielded superior efficacy compared to the 0.1% concentration in the context of continuous femoral block administration.

Long-term exposure to 6-PPD quinone at environmentally relevant concentrations causes neurotoxicity by affecting dopaminergic, serotonergic, glutamatergic, and GABAergic neuronal systems in Caenorhabditis elegans

6-PPD quinone (6-PPDQ), an emerging environmental pollutant, is converted based on 6-PPD via ozonation. However, a systematic evaluation on possible neurotoxicity of long-term and low-dose 6-PPDQ exposure and the underlying mechanism remain unknown. In the present work, 0.1–10 μg/L 6-PPDQ was added to treat Caenorhabditis elegans for 4.5 days, with locomotion behavior, neuronal development, sensory perception behavior, neurotransmitter content, and levels of neurotransmission-related genes being the endpoints. 6-PPDQ exposure at 0.1–10 μg/L significantly reduced locomotion behavior, and that at 1–10 μg/L decreased sensory perception behavior in nematodes. Moreover, 6-PPDQ exposure at 10 μg/L notably induced damage to the development of dopaminergic, glutamatergic, serotonergic, and GABAergic neurons. Importantly, nematodes with chronic 6-PPDQ exposure at 10 μg/L were confirmed to suffer obviously decreased dopamine, serotonin, glutamate, dopamine, and GABA contents and altered neurotransmission-related gene expression. Meanwhile, the potential binding sites of 6-PPDQ and neurotransmitter synthesis-related proteins were further shown by molecular docking method. Lastly, Pearson's correlation analysis showed that locomotion behavior and sensory perception behavior were positively correlated with the dopaminergic, serotonergic, glutamatergic, and GABAergic neurotransmission. Consequently, 6-PPDQ exposure disturbed neurotransmitter transmission, while such changed molecular foundation for neurotransmitter transmission was related to 6-PPDQ toxicity induction. The present work sheds new lights on the mechanisms of 6-PPDQ and its possible neurotoxicity to organisms at environmentally relevant concentrations.

The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial.

One of the common methods of anaesthesia for caesarean sections (CSs) involves the use of spinal anaesthesia in mothers. Various positions are utilized in this method. This study aims to compare the evaluation of two positions, Trendelenburg and reverse Trendelenburg, in candidates for CS to assess the duration of anaesthesia and changes in vital signs in women. This study was a randomized clinical trial in which 60 pregnant mothers who met the inclusion criteria entered the study. These mothers were randomly allocated into two equal groups using block randomization. One group of patients received spinal anaesthesia in the Trendelenburg position, while the other group received it in the Reverse Trendelenburg position. Vital signs (systolic and diastolic blood pressure, heart rate, Apgar score, and SPO2) of participants from both groups were evaluated for 1 h after the induction of anaesthesia. Additionally, sensory level and duration of anaesthesia were measured. Finally, the data from both groups were subjected to statistical analysis using SPSS version 26 software. The mean (SD) age of participating mothers in the Reverse Trendelenburg and Trendelenburg groups was 28.93 (5.82) and 30.97 (4.94), respectively. The two study groups did not significantly differ in baseline characteristics such as age, BMI, which could potentially impact vital sign outcomes or anaesthesia duration, and education (P>0.05). The mean (SD) duration of anaesthesia in the Trendelenburg position was significantly higher than in the Reverse Trendelenburg position [221.57(min) vs. 159.00(min)] (P<0.0001). There was no significant difference between the two positions, Trendelenburg and Reverse Trendelenburg, in terms of sensory level and its extent (P=0.08). The two study groups did not significantly differ in hemodynamic changes measured 13 times, including heart rate, systolic and diastolic blood pressure, and Apgar score (P>0.05). In spinal anaesthesia with the Trendelenburg position compared to the Reverse Trendelenburg position, there is a longer duration of anaesthesia. This is while the two positions did not differ in terms of hemodynamic changes and sensory level.

Integrated Transcriptomic and Proteomic Analysis Identifies Novel Regulatory Genes Associated with Plant Growth Regulator-Induced Astringency in Grape Berries.

Astringency influences the sensory characteristics and flavor quality of table grapes. We tested the astringency sensory attributes of berries and investigated the concentration of flavan-3-ols/proanthocyanidins (PAs) in skins after the application of the plant growth regulators CPPU and GA3 to the flowers and young berries of the "Summer Black" grape. Our results showed that CPPU and GA3 applications increase sensory astringency perception scores and flavan-3-ol/proanthocyanidin concentrations. Using integrated transcriptomic and proteomic analysis, differentially expressed transcripts and proteins associated with growth regulator treatment were identified, including those for flavonoid biosynthesis that contribute to the changes in sensory astringency levels. Transient overexpression of candidate astringency-related regulatory genes in grape leaves revealed that VvWRKY71, in combination with VvMYBPA1 and VvMYC1, could promote the biosynthesis of proanthocyanidins, while overexpression of VvNAC83 reduced the accumulation of proanthocyanidins. However, in transient promoter studies in Nicotiana benthamiana, VvWRKY71 repressed the promoter of VvMYBPA2, while VvNAC83 had no significant effect on the promoter activity of four PA-related genes, and VvMYBPA1 was shown to activate its own promoter. This study provides new insights into the molecular mechanisms of sensory astringency formation induced by plant growth regulators in grape berries.

Lumbar decompression and fusion for symptomatic spinal stenosis in a patient with chronic thoracic sensory level from prior transverse myelitis: a case report

BackgroundMany patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients.Case presentationIn this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression.ConclusionThis is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.

Differential sensory block during labour epidural analgesia: a prospective observational study to investigate the relationship of lower and upper sensory block levels to cold, pinprick, and light touch.

A zone of differential block to cold has been recently documented during labour epidural analgesia, with an upper sensory block level (USBL) and a lower sensory block level (LSBL). We aimed to determine the correlation between USBL and LSBL to cold and pinprick and sensory block level to light touch during labour epidural analgesia. We conducted a prospective observational study in patients requesting labour epidural analgesia. We placed an epidural catheter at L2/L3 or L3/L4, followed by a programmed intermittent epidural bolus plus patient-controlled epidural analgesia regimen. We assessed the sensory block levels 140min after administering the loading dose. The primary outcomes were the USBL and LSBL to cold and pinprick and the sensory block level to light touch. We studied 30 patients. The median [interquartile range (IQR)] USBL and LSBL to ice were T7 [T7-T6] and T9 [T10-T8], respectively. The median [IQR] USBL and LSBL to pinprick were T8 [T10-T6] and T10 [T12-T10], respectively. There was a strong correlation between USBL to ice and pinprick (Spearman correlation coefficient, 0.57) and between LSBL to ice and pinprick (Spearman correlation coefficient, 0.52). There was no significant correlation between sensory block level to light touch and either USBL or LSBL to ice or pinprick. We observed two sensory block levels to ice and pinprick. Further studies are required to understand if one modality-cold or pinprick-is superior to the other in assessing sensory block levels in this context. Light touch is unreliable as a modality of sensory block assessment during labour epidural analgesia. ClinicalTrials.gov (NCT05187962); registered 12 January 2022.