Overview and Comparison of Interscalene Block Techniques for Brachial Plexus Pain Management.

Purpose Of Review: Peripheral nerve blocks are performed using local anesthetics that are commonly performed prior to surgery to either be the sole anesthetic and/or for postoperative pain management. Interscalene blocks are a specific type of nerve block that targets the superior and middle trunks of the brachial plexus inhibiting transmission of pain signals from the upper extremities to the central nervous system making them useful in mitigating pain following surgeries involving the shoulder, upper arm, and elbow.

Recent Findings: Previously, interscalene blocks were performed with a nerve stimulator, which is an instrument designed to generate a twitch in surrounding muscles to verify the anesthetic block was placed in the correct location.

Thiodipeptides targeting the intestinal oligopeptide transporter as a general approach to improving oral drug delivery.

The broad substrate capacity of the intestinal oligopeptide transporter, PepT1, has made it a key target of research into drug delivery. Whilst the substrate capacity of this transporter is broad, studies have largely been limited to small peptides and peptide-like drugs. Here, we demonstrate for the first time that a diverse range of drugs can be targeted towards transport by PepT1 using a hydrolysis resistant carrier.

Pediatric Anesthesia Considerations for Interventional Radiology.

Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan.

Presurgical fMRI and DTI for the Prediction of Perioperative Motor and Language Deficits in Primary or Metastatic Brain Lesions.

Background And Purpose: To determine whether lesion to activation distance (LAD) on presurgical blood-oxygen-level-dependent functional magnetic resonance imaging (fMRI) and degree of white matter involvement by primary or metastatic brain lesions predict perioperative motor and language deficits.

Methods: We retrospectively evaluated 76 patients with intra-axial brain lesions referred for presurgical fMRI and diffusion tensor imaging (DTI). We measured expressive, receptive, global language and motor LAD and assessed degree of involvement of the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF).

Retained surgical item identification on imaging studies: a training module for radiology residents.

Purpose: Many hospitals experience one or more retained surgical item events per year, with risk of patient morbidity and medicolegal consequences. We hypothesized that the confidence and performance of the radiologist would be enhanced by prior training in retained surgical item detection and by prior exposure to commonly employed surgical instruments and devices.

Methods: A training module for radiology residents was created through literature review, expert consultation, and imaging of commonly employed surgical instruments and devices.

Synthesis of a new element with atomic number Z = 117.

The discovery of a new chemical element with atomic number Z=117 is reported. The isotopes (293)117 and (294)117 were produced in fusion reactions between (48)Ca and (249)Bk. Decay chains involving 11 new nuclei were identified by means of the Dubna gas-filled recoil separator.

Is time spent with the physician associated with parent dissatisfaction due to long waiting times?

The objectives of this study were to assess the relationship between wait time and parent satisfaction and determine whether time with the physician potentially moderated any observed negative effects of long wait time. Data were collected from parents in a pediatric outpatient clinic. Parent satisfaction with the clinic visit was significantly negatively related to wait times.

Bioavailability through PepT1: the role of computer modelling in intelligent drug design.

In addition to being responsible for the majority of absorption of dietary nitrogen, the mammalian proton-coupled di- and tri-peptide transporter PepT1 is also recognised as a major route of drug delivery for several important classes of compound, including beta-lactam antibiotics and angiotensin-converting enzyme inhibitors. Thus there is considerable interest in the PepT1 protein and especially its substrate binding site. In the absence of a crystal structure, computer modelling has been used to try to understand the relationship between PepT1 3D structure and function.

The Fontan patient.

Improved surgical and medical management has led to an increase in survival after staged univentricular palliative procedures. Subsequently, this improved survival has led to an increase in the number of patients who will present for noncardiac surgical interventions with Fontan physiology. A comprehensive understanding of normal Fontan physiology and the perturbations that the proposed surgical procedure will likely have is necessary to care for and design a comprehensive anesthetic plan that takes into account the effects of anesthetic agents, ventilation strategies, cardiovascular drugs, and various other perioperative factors.

An energy supply network of nutrient absorption coordinated by calcium and T1R taste receptors in rat small intestine.

T1R taste receptors are present throughout the gastrointestinal tract. Glucose absorption comprises active absorption via SGLT1 and facilitated absorption via GLUT2 in the apical membrane. Trafficking of apical GLUT2 is rapidly up-regulated by glucose and artificial sweeteners, which act through T1R2 + T1R3/alpha-gustducin to activate PLC beta2 and PKC betaII.

Concise routes to pyrazolo[1,5-a]pyridin-3-yl pyridazin-3-ones.

Cycloaddition of pyridine N-imine with 6-alkyl-4-oxohex-5-ynoates followed by condensation with hydrazine provides concise access to pharmacologically active 6-(pyrazolo[1,5-a]pyridin-3-yl)pyridazinones. For the first time alkynyl heterocycles are also shown to be effective dipolarophiles for pyridine N-imine, and analogous compounds can be accessed directly in modest yields through the reaction of 6-(alkyn-1-yl)pyridazin-3-one derivatives.

External dosimetry in the aftermath of a radiological terrorist event.

This paper reviews external dosimetry in emergency preparedness planning for a potential terrorist release of radioactive material in a densely populated area. The radiation dose received by response workers and members of the public is needed to understand health risks. The existing framework for dosimetry of routinely occupationally exposed workers is not directly applicable to all emergency workers who would respond to a radiological terrorist event.

Preinduction techniques for pediatric anesthesia.

Purpose Of Review: Preparing pediatric patients for their surgical experience is a complex process that may be facilitated by pharmacologic and non-pharmacologic techniques. Several techniques often utilized in the preoperative setting to decrease the anxiety level of pediatric patients and their parents include the administration of a sedative premedicant, parental presence during induction, and a variety of other non-pharmacologic modalities. These techniques may be useful, alone or in combination, to decrease anxiety levels in children and parents.

Affinity prediction for substrates of the peptide transporter PepT1.

A quantitative method has been developed for determining the affinity of substrates for the peptide transporter PepT1, allowing oral availability of drugs via PepT1 to be estimated.

Probing dipeptide trans/cis stereochemistry using pH control of thiopeptide analogues, and application to the PepT1 transporter.

The stereochemistry of thiodipeptides of proline [e.g. Ala-Psi[CS-N]-Pro] can be controlled using pH, allowing the trans-preference for substrates of the peptide transporter PepT1 to be confirmed.

Conformational and spacial preferences for substrates of PepT1.

The conformation at the first residue of dipeptide substrates for the peptide transporter PepT1 has been probed using constrained peptide analogues, and the active conformation has been identified.

Intraoperative latex hypersensitivity: do not overlook Penrose drains.

We report a case of intraoperative latex hypersensitivity to Penrose surgical drains (Ansell, Massillon, Ohio). To our knowledge, there has been no previous report of such a reaction with this device.

Does the use of fentanyl in epidural solutions for postthoracotomy pain management in neonates affect surgical outcome?

Background/purpose: Continuous epidural analgesia is routinely used to manage pain in infants undergoing resection of a congenital cystic adenomatoid malformation (CCAM) of the lung. Our aim was to determine if there is a difference in the length of stay (LOS), supplemental analgesic requirements, pain control, and the incidence of adverse respiratory events in infants receiving the 2 standard epidural solutions commonly used: bupivacaine 0.1% and bupivacaine 0.

Development of a broadband picosecond infrared spectrometer and its incorporation into an existing ultrafast time-resolved resonance Raman, UV/visible, and fluorescence spectroscopic apparatus.

We have constructed a broadband ultrafast time-resolved infrared (TRIR) spectrometer and incorporated it into our existing time-resolved spectroscopy apparatus, thus creating a single instrument capable of performing the complementary techniques of femto-/picosecond time-resolved resonance Raman (TR3), fluorescence, and UV/visible/infrared transient absorption spectroscopy. The TRIR spectrometer employs broadband (150 fs, approximately 150 cm(-1) FWHM) mid-infrared probe and reference pulses (generated by difference frequency mixing of near-infrared pulses in type I AgGaS2), which are dispersed over two 64-element linear infrared array detectors (HgCdTe). These are coupled via custom-built data acquisition electronics to a personal computer for data processing.

Total synthesis of (-)-raumacline.

The total synthesis of (-)-raumacline from L-tryptophan was achieved, featuring a cis-specific Pictet-Spengler reaction, a stereoselective Dieckmann cyclization, and an epimerization step that allowed complete stereocontrol of five chiral centres.