Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

The superiority of midazolam-pethidine combination in three different anesthetic methods applied in conscious sedation during transesophageal echocardiography procedure

Background: During the transesophageal echocardiography (TEE) procedure, as in many other diagnostic semi-invasive applications, moderate sedation is preferred over deep sedation. Rarely, patients who cannot tolerate moderate sedation may require deep sedation when difficulties are encountered during TEE probe insertion. Although many different methods have been tried for the TEE procedure in clinical practice, the most appropriate sedation method is still controversial. Aims and Objectives: We aimed to evaluate the clinical effects of three different sedoanalgesia methods consisting of midazolam, propofol, and midazolam-pethidine combination protocols applied for conscious sedation in the patients undergoing a TEE procedure, and to evaluate the patient and doctor satisfaction during the procedure. Materials and Methods: One-hundred twenty five patients who underwent TEE for diagnostic purposes in our hospital were included consecutively in our prospective randomized trial. The patients were divided into three groups as those who were administered midazolam (group M), propofol (group Pr), and midazolam-pethidine (group MPe) during the TEE procedure. Results: In the MPe group, both patient and doctor satisfaction were significantly higher than the two groups. The rate of difficulty in probe placement was lower in the Pr and MPe groups compared to the M group (P<0.05). Conclusion: In this study, it has been observed that conscious sedation with the combination of midazolam-pethidine was significantly advantageous in terms of patient and physician satisfaction compared to the use of only midazolam and only propofol.

Stick-slip Dynamics in Penetration Experiments on Simulated Regolith

The surfaces of many planetary bodies, including asteroids and small moons, are covered with dust to pebble-sized regolith held weakly to the surface by gravity and contact forces. Understanding the reaction of regolith to an external perturbation will allow for instruments, including sensors and anchoring mechanisms for use on such surfaces, to implement optimized design principles. We analyze the behavior of a flexible probe inserted into loose regolith simulant as a function of probe speed and ambient gravitational acceleration to explore the relevant dynamics. The EMPANADA experiment (Ejecta-Minimizing Protocols for Applications Needing Anchoring or Digging on Asteroids) flew on several parabolic flights. It employs a classic granular physics technique, photoelasticity, to quantify the dynamics of a flexible probe during its insertion into a system of bi-disperse, centimeter-sized model grains. We identify the force chain structure throughout the system during probe insertion at a variety of speeds and for four different levels of gravity: terrestrial, Martian, lunar, and microgravity. We identify discrete, stick-slip failure events that increase in frequency as a function of the gravitational acceleration. In microgravity environments, stick-slip behaviors are negligible, and we find that faster probe insertion can suppress stick-slip behaviors where they are present. We conclude that the mechanical response of regolith on rubble-pile asteroids is likely quite distinct from that found on larger planetary objects, and scaling terrestrial experiments to microgravity conditions may not capture the full physical dynamics.

Efficacy of additional periprostatic apex nerve block on pain in each of 12 transrectal prostate core biopsies: a retrospective study

Background We identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB). Methods This retrospective study collected data from 312 patients who underwent transrectal prostate biopsies between January 2019 and August 2020. Patients were stratified into two groups according to the site of local anesthesia (base vs. base and apex PNB), with each block achieved with 2.5 cm3 of 2% lidocaine. Pain scores were assessed using the visual analog scale at the following time points: probe insertion, PNB at base, PNB at apex, each of the 12 core biopsy sites, and 15 min after biopsy. The results were analyzed using a linear mixed model. Results The average pain scores were significantly higher in the base-only PNB group than were those in the base and apex PNB group (3.88 vs 2.82, p < 0.001). In the base-only PNB group, the pain scores increased from base to apex (p < 0.001), and the pain at each site also gradually increased as the biopsy proceeded (p < 0.001). In contrast, in the base and apex PNB group, there was minor change in pain scores throughout the procedure. Conclusions The pain scores varied at each site during the prostate biopsy. The provision of a base and apex PNB provided greater pain relief than does base-only PNB during prostate biopsy.

An evaluation of factors affecting pain during transrectal ultrasonographic prostate biopsy: a real-life scenario in a retrospective cohort study

Background Periprostatic infiltration anesthesia (PPIA) and intrarectal topical anesthesia (IRTA) are recommended methods to control pain in transrectal ultrasonographic prostate biopsy (TRUS-Bx). This study evaluates the factors affecting pain during TRUS-Bx, considering the pathologies involved in anorectal pain etiology and comparing the effectiveness of local anesthesia techniques in providing patient comfort. Material and Methods We retrospectively evaluated 477 consecutive patients with TRUS-Bx for elevated Prostate Specific Antigen (PSA), abnormal rectal examination findings, or both. Patients were grouped as local anesthesia methods for pain control during TRUS-Bx. Both groups were compared in terms of age, body mass index, clinical T stage, PSA, prostate volume, number of biopsy cores, type of anesthesia, previous biopsy history, and presence of prostate cancer. We used a visual analog pain scale (VAS) to evaluate the patient’s pain status; pre-procedure (VAS-0), during probe insertion (VAS-I), administration of anesthetic (VAS-A), and simultaneous with the biopsy procedure itself (VAS-Bx). For PPIA and IRTA, 4 ml lidocaine 20 mg/ml injection and 5 g 5% prilocaine-5% lidocaine cream was used, respectively. Results The PPIA was used 74.2% (n = 354) and IRTA was used for 25.8% (n = 123) patients. VAS-0, VAS-I, and VAS-A scores are similar between groups. VAS-Bx was significantly higher in the IRTA than in the PPIA (3.37 ± 0.18 vs. 2.36 ± 0.12 p > 0.001). Clinical T stage (OR: 0.59), number of biopsy cores (OR: 1.80), and type of anesthesia application (OR: 2.65) were independent variables on TRUS-Bx for pain. Conclusion Three factors play roles as independent variables associated with the pain in TRUS-Bx; abnormal rectal examination findings, collection of more than twelve core samples during the biopsy, and the type of anesthesia used. Compared with PPIA, IRTA does not improve pain related to probe insertion, and using IRTA results in higher pain scores for biopsy-related pain. Thus, we recommend a PPIA to lower biopsy-related pain.

Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

INTRODUCTIONWe analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site.METHODSWe collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 minutes after biopsy.RESULTSFor all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039).CONCLUSIONSBase and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

Safety Profile of an Intracranial Multimodal Monitoring Bolt System for Neurocritical Care: A Single-Center Experience

Background Intracranial multimodality monitoring (iMMM) is increasingly used in acute brain injured patients; however, safety and reliability remain major concerns to its routine implementation. Methods We performed a retrospective study including all patients undergoing iMMM at a single European center between July 2016 and January 2020. Brain tissue oxygenation probe (PbtO2), alone or in combination with a microdialysis catheter and/or an 8-contact depth EEG electrode, was inserted using a triple lumen bolt system and targeting normal-appearing at risk brain area on the injured side, whenever possible. Surgical complications, adverse events and technical malfunctions, directly associated with iMMM were collected. A blinded imaging review was performed by an independent radiologist. Results 113 patients with 123 iMMM insertions were included for a median monitoring time of 9 [3–14] days. Of those, 93 (76%) patients had only PbtO2 probe insertion and 30 (24%) had also microdialysis and/or iEEG monitoring. SAH was the most frequent indication for iMMM (n = 60, 53%). At least one complication was observed in 67/123 (54%) iMMM placement, corresponding to 58/113 (51%) patients. Misplacement was observed in 16/123 (13%), resulting in a total of 6/16 (38%) malfunctioning PbtO2 catheters. Intracranial hemorrhage was observed in 14 iMMM placements (11%), of which one required surgical drainage. Five placements were complicated by pneumocephalus and 4 with bone fragments, none of these requiring additional surgery. No CNS infection related to iMMM was observed. Seven (6%) probes were accidentally dislodged and 2 probes (2%) were accidentally broken. Ten PbtO2 probes (8%) presented a technical malfunction after a median of 9 [ranges: 2–24] days after initiation of monitoring and 4 of them were replaced. Conclusions In this study, a high occurrence of complications related to iMMM was observed, although most of them did not require specific interventions and did not result in malfunctioning monitoring.

Evaluation of a Flow Measurement Probe Influence on the Flow Field in High Speed Axial Compressors

The aerodynamic effects of a probe for stage performance evaluation in a high-speed axial compressor are investigated. Regarding the probe measurement accuracy and its aerodynamic effects, the upstream/downstream effects on the probe and probe insertion effects are studied by using an unsteady computational fluid dynamics (CFD) analysis and by verifying in two types of multistage high-speed axial compressor measurements. The probe traverse measurements were conducted at the stator inlet and outlet in each case to evaluate blade row performance quantitatively and its flow field. In the past study, the simple approximation method was carried out which considered only the interference of the probe effect based on the reduction of the mass flow by the probe blockage for the compressor performance, but it did not agree well with the measured results. In order to correctly and quantitatively grasp the mechanism of the flow field when the probe is inserted, the unsteady calculation including the probe geometry was carried out in the present study. Unsteady calculation was performed with a probe inserted completely between the rotor and stator of a 4-stage axial compressor. Since the probe blockage and potential flow field, which mean the pressure change region induced by the probe, change the operating point of the upstream rotor and increase the work of the rotor. Compared the measurement result with probe to a kiel probe setting in the stator leading edge, the total pressure was increased about 2,000Pa at the probe tip. In addition, the developed wake by the probe interferes with the downstream stator row and locally changes the static pressure at the stator exit. To evaluate the probe insertion effect, unsteady calculations with probe at three different immersion heights at the stator downstream in an 8-stage axial compressor are performed. The static pressure value of the probe tip was increased about 3,000Pa in the hub region compared to tip region, this increase corresponds to the measurement trend. On the other hand, the measured wall static pressure showed that there is no drastic change in the radial direction. In addition, when the probe is inserted from the tip to hub region in the measurement, the blockage induced by the probe was increased. As a result, operating point of the stator was locally changed, and the rise of static pressure of the stator increased when the stator incidence changed. These typical results show that unsteady simulations including probe geometry can accurately evaluate the aerodynamic effects of probes in the high-speed axial compressor. Therefore, since the probe will pinpointed and strong affects the practically local flow field in all rotor upstream passage and stator downstream, as for the probe measurement, it is important to pay attention to design the probe diameter, the distance from the blade row, and its relative position to the downstream stator. From the above investigations, a newly simple approximation method which includes the effect of the pressure change evaluation by the probe is proposed, and it is verified in the 4-stage compressor case as an example. In this method, the effects of the distance between the rotor trailing edge (T.E.) and the probe are considered by the theory of the incompressible two-dimensional potential flow. The probe blockage decreases the mass flow rate and changes the operating point of the compressor. The verification results conducted in real compressor indicate that the correct blockage approximation enables designer to estimate aerodynamic effects of the probe correctly.

STUDIES OF ALTERATIONS OF THE CELLULAR MEMBRANE BARRIER FUNCTION AT LARYNGEAL CANCER

Introduction. Cellular membrane barrier alterations lead to metabolic and functional disorders. However, in the case of laryngeal cancer (LC) they are insufficiently studied. The aim of the study – to learn the nature of the interaction of erythrocyte membranes with introduced spin probes as an indicator of changes in the barrier function of membranes at LC. Research Methods. Samples of the erythrocyte membranes from 40 patients with LC stages II and III and 20 healthy volunteers were probed by EPR with AdTEMPO test. Microviscosity of erythrocyte membranes was determined by the τeff and the decreasing in RSSI. The content of MWM was identified in the blood plasma and in erythrocyte. The partition coefficient between blood plasma proteins and erythrocyte glycocalyx was calculated. SCEM was evaluated by amount of unabsorbed methylene blue. Results and Discussion. It was established that LC patient’s endogenous intoxication is characterized by excessive accumulation of the total pool of MWM both in blood plasma and glycocalyx of erythrocyte. SCEM was significantly decreased in samples of both LC stages in comparison to control. The most apparent decline in τeff was observed prior to washing of erythrocytes for 5 min after probe insertion. The deceleration after 60 min was observed only in LC stage II. The value of τeff was at control values levels after washing of erythrocytes of LC stage II 5 min after probe insertion and was significantly reduced in stage III LC in comparison to control. RSSI in samples both stage of patients prior to and after washing of erythrocytes was on average 1.5-fold higher than that of control. Conclusions. It was established that the LC patient’s endogenous intoxication is characterized by excessive accumulation of the total pool of MWM both in blood plasma and glycocalyx of erythrocytes, activation of catabolic processes in plasma, redistribution of MWM between the pool of erythrocyte proteins, which corresponds to the second stage of endotoxicosis. The reduction of the SCEM is shown, which is a manifestation of pathological changes in the surface functional activity of erythrocyte membranes. The effectiveness of AdTEMPO for the eva­luation of microviscosity of erythrocyte membranes in patients with LC was confirmed.