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Statistical analysis | v.26.0 | Statistical analyses were performed using SPSS v.26.0 (SPSSInc. Chicago, IL). Results are expressed as mean ± SD. Data distribution was examined for normality using the Shapiro–Wilk test and results revealed that all the variables presented a normal distribution of the data. A mixed-measures analysis of variance (ANOVA) with one between-subjects factor (intervention condition: EG or CG) and one within-subjects factor (time) followed by Bonferroni post-hoc tests was used to investigate differences in variables measured. The effect size (ES) was calculated for interactions between groups using Cohen’s guidelines. Threshold values for ES were > 0.2 (small), > 0.6 (large) and > 1.2 (very large) [The sample size for the study was determined a priori using G*Power 3.1.9.2 (Heinrich Heine-Universität Dusseldorf, Dusseldorf, Germany; | PMC10681300 | |
Results | Nutritional intake is showed in | PMC10681300 | ||
Nutritional intake of Spanish elite soccer players (mean ± SD) and current recommendations [ | Tomas | *% of E: percentage of total energy intake**Recommendation: current recommendations for daily average intake. NA: not applicable. (Tomas et al., 2016; Ranchordas et al., 2017; FESNAD, 2015)*** For the weekdays, the mean intake across the five days was used for analysis[NK was classified as “average” knowledge (60–61%) for both EG and CG before intervention. However, the EG showed significant increases in NK (p < 0.05, 7%; NK classified as “over average”) after intervention. No significant differences between groups were observed.Diet adherence questionnaire (AQ) showed significant group x time interaction in the CG, showing a higher compliance. However, a significant decrease in adherence was observed in the EG after intervention. POST-Intervention general difficulty was 6.5 in the EG and 5.9 in the CG. In general, throughout the intervention both groups demonstrated greater difficulties with PROT intake. In addition, breakfast was the most difficult meal to follow in CG during the intervention.Group x time effects after both EG and CG interventions on physical and anthropometrical parameters were reported in | PMC10681300 | |
Effects after both EG and CG interventions on anthropometrical and physical parameters. | (A) Body mass; (B) Skinfolds sum (mm); (C) Vertical jump height (cm); (D) 20 m sprint time (s). ***, Significant (p < 0.001); **, Significant (p < 0,01) differences between pre- and post—test measurements.Biochemical variables are displayed in | PMC10681300 | ||
Changes (mean ± SD) in biochemical variables for the CG (n = 10) and EG group (n = 9) before (PRE) and after intervention (POST). | P value for the comparison between pre- and post-intervention values by Bonferroni test, and effect size (ES) for the changes, the magnitude of change (%), as well as the reference values are shown for each group.Abbreviatures: EG, Exchanged-diet group; CG, Controlled-diet group.*, Significant (p < 0.05) differences between pre- and post- test measurements. | PMC10681300 | ||
Discussion | metabolic and neuromuscular response, eating disorders, injuries, anemia | ANEMIA | Given the growing popularity of women’s soccer, its physically demanding nature and the high incidence of injuries, various approaches to optimize performance and decrease injury risk and severity have been explored in the scientific literature. Athletes need to consume enough energy to ensure an effective metabolic and neuromuscular response, and thus, develop sport-specific demands [Regarding energy intake, several studies have also reported an insufficient intake in female soccer players [When implementing any nutritional intervention, previous individual NK should be considered [It is widely known that nutritional interventions lead to significant anthropometric modifications, which are directly related to athletes’ performance. In the case of our intervention, both EG and CG were intended for modify fat mass, since it exceeded previous registers of professional and semi-professional female soccer players [Vertical jump and sprint performance have been shown to be directly related to body composition [In addition to the abovementioned large-scale changes induced by the nutritional approach, large changes also occur at biological level. According to our results in biochemical variables, significant differences were only found in cortisol and haemoglobin. Cortisol is considered a marker of exercise-related stress and balance between anabolic and catabolic processes. The promoted stress at the end of the season, the highest competitive demand and decisive competitions may impact on cortisol levels [Several potential delimitations are worthy of mention. The study was conducted over 12 weeks, and whilst relatively some changes in anthropometric variables and some biochemical values were observed, it would be of interest to test long-term effects after longer intervention periods and in other outcomes, such as measurement of body composition by a gold standard method (e.g., Dual–energy X ray absorptiometry) and evaluation of post-intervention dietary intake. In addition, although the sample was homogeneous with respect to age, sex, training level and training experience, it remains unknown whether similar results would be found in female soccer players of different chronological or training ages. Therefore, future studies need to improve methodological quality (e.g. assessment of adherence) and limit confounders (eg. menstrual cycle) to facilitate a deeper understanding of the effects of a nutritional intervention.The present study revealed the low nutritional knowledge shown by professional soccer players, which may affect their performance and health, since their total energy, CHO, PROT, fiber, and micronutrient intakes were below the current recommendations, while their total fat and saturated fat intakes were higher than those generally recommended. Exchanged diet was found to be more effective in increasing the nutritional knowledge of players. On the other hand, a 12-week controlled diet intervention was associated with an increase in haemoglobin concentration in female soccer players, which may play a crucial role in preventing anemia. Both dietary interventions resulted in a significant decrease in the sum of skinfolds, however, their effects on lean mass are still unknown.As previously stated, the participants’ baseline carbohydrate intake was less than the recommended amount. Considering that female athletes have a high incidence of eating disorders and a strong focus on weight control [ | PMC10681300 |
Supporting information | PMC10681300 | |||
This is the adherence questionnaires. | (DOCX)Click here for additional data file. | PMC10681300 | ||
This is the translation of adherence questionnaires. | (DOCX)Click here for additional data file. | PMC10681300 | ||
This is the database of | (XLSX)Click here for additional data file. | PMC10681300 | ||
This is the global database. | (XLSX)Click here for additional data file. | PMC10681300 | ||
Abstract | TESTICULAR CANCER | This randomized controlled trial study aims to examine the flipped classroom model's effects on the knowledge and health beliefs of testicular cancer and testicular self-examination. The study was conducted on 66 students in Northern Cyprus. A descriptive information form, Champion’s Health Belief Model Scale, visual analogue scale of satisfaction with the learning method, the knowledge questionnaire on testicular cancer and the testicular self-examination itself were used for data collection. The mean posttest knowledge score of the intervention group (14.44) was higher than the mean posttest knowledge score of the control group (12.65). The difference between groups was statistically significant ( | PMC10655630 | |
Introduction | HBM, Testicular cancer, malignant cancers, TC, cancer | TESTICULAR CANCER, DISEASE, CANCER | Testicular cancer (TC) accounts for 1.0–1.5% of all malignant cancers, and the incidence of the disease is higher in males aged 15–35 years [Although the TC cells spread rapidly, the 5-year survival rates of the patients may increase up to 95% if diagnosed early [Different psychosocial models explain the attitudes and beliefs influencing health. The Health Belief Model (HBM) is an effective guide to explaining and measuring the factors motivating and preventing early diagnosis behaviours or participating in cancer screening programmes. According to the HBM, revealing the health beliefs of individuals will be beneficial for determining the problem domains before education so that positive health behaviours may be improved [The existing studies of TC and TSE education have shown that videos and classical presentations are being used in education [ | PMC10655630 |
Method | PMC10655630 | |||
Study design and setting | This randomized controlled trial was conducted at the department of nursing of a university in Northern Cyprus during the fall semester of the 2020–2021 academic year. In this study, the researcher followed the randomized controlled studies using the Consolidated Standards of Reporting Trials 2015 control list. | PMC10655630 | ||
Sampling | G-Power 3.1.9.2 was used to calculate the sample size. A total of 42 participants, 21 participants in each of the two groups, were required for a 95% confidence interval, 80% power and 0.8 effect size. In this study, Cohen’s d effect size was used to calculate the effect size of two independent groups [ | PMC10655630 | ||
Randomization and blinding | A simple randomization method was used to allocate the participants into two groups with equal numbers. The intervention group (The Consolidated Standards of Reporting Trials (CONSORT) 2010 flow diagram of the participants through each stage of the study. | PMC10655630 | ||
Data collection tools | A descriptive information form, a knowledge questionnaire on TC and TSE and the Champion’s Health Belief Model Scale (CHBMS) were used for data collection. | PMC10655630 | ||
Descriptive information form | This form consisted of 11 questions, including 2 questions on sociodemographic characteristics (age and marital status) and 9 questions on the characteristics of TC and TSE, such as individual and family history, perceived TC risk, level and source of knowledge, regular TSE performance and the reasons for not performing TSE [ | PMC10655630 | ||
Knowledge questionnaire on TC and TSE | This questionnaire contained 16 questions on the frequency and risk factors of TC, the importance of the early diagnosis of TSE and the frequency and method of TSE. The participants were asked to respond to each question on a three-point Likert scale, with the possible responses being ‘yes’ (1 point), ‘no’ (0 points) and ‘don’t know’ (0 points). Possible scores ranged between 0 and 16, with higher scores indicating a higher level of knowledge. Expert opinion was received from nine nursing academicians from the field to achieve content validity [ | PMC10655630 | ||
CHBMS | The CHBMS was developed by Barnes (2000) and translated into Turkish by Pınar | PMC10655630 | ||
Interventions | Data were collected online from December 2020 to March 2021 via Google Forms survey software. Due to the Covid-19 pandemic at the time of the study, all training sessions were conducted online in our country, so this study was carried out entirely online. After obtaining the necessary permissions, the participants were allocated to the intervention group or the control group randomly. In the Microsoft Teams program, separate classes were created for each of the two groups. In this study, the FCM was used for the students in the intervention group, whereas a traditional PowerPoint presentation was used for the control group. This was the first time that a FCM was used in the nursing programme in which the study was conducted. Before the lectures, participants in both groups were asked to complete the descriptive information form, the knowledge questionnaire on TC and TSE and the CHBMS uploaded to Google Forms. Next, for the intervention group, the educational materials, including the PowerPoint presentation and asynchronous videos, were uploaded onto the Microsoft Teams program, and the students were asked to study these educational materials before the weekly lecture. The content of the PowerPoint presentation and the prepared training video included the anatomical structure of the testicles, the definition of TC, its incidence, TC risk factors, TC symptoms, diagnostic methods, the importance of TSE and how to do it. For the intervention group, the students then came to the training session, which was designed according to the FCM, including a question-and-answer session, and had no classical lecture presentation. The training was given only once and lasted 40 min. Two weeks after the course, the students in the intervention group were asked to complete the knowledge questionnaire and the VAS on satisfaction as a posttest. Six weeks after the course, the intervention group completed the CHBMS as a posttest.The students in the control group, on the other hand, had a different learning path. They received a 30-min PowerPoint presentation during the lecture, and in the last 10 min of the session, they answered questions on the material they received. The PowerPoint presentation used for the control group was the same as the training material for the intervention group. Two weeks later, the students in the control group completed the knowledge questionnaire and the VAS. Six weeks after the course, the control group also completed the CHBMS as a posttest.To avoid the interaction between the groups, the training was given to the control and intervention groups, in quick succession, on the same day. The training was given once for both groups. The complete trial protocol can be accessed at ClinicalTrials.gov (NCT04851197). | PMC10655630 | ||
Outcomes | The knowledge questionnaire on TC and TSE and the CHBMS were used to evaluate the knowledge and health awareness concerning TC and TSE amongst male nursing students. The VAS was used to evaluate student satisfaction with the FCM. | PMC10655630 | ||
Statistical analysis | The collected data were analysed using the Statistical Package for Social Sciences (SPSS) version 24.0 (IBM, Armonk, NY, USA). Descriptive characteristics of the participants were presented by the frequency of the responses. Descriptive statistics, including mean, standard deviation and minimum and maximum values, were used to present the scores obtained from the CHBMS and the knowledge questionnaire. The Kolmogorov–Smirnov test was used to examine the suitability of the data for normal distribution. Pearson’s chi-squared test and Fisher’s exact test were used to compare descriptive characteristics. The Mann–Whitney U test was used to compare the scores obtained from the knowledge questionnaire, and the VAS judged student satisfaction with the learning experience. The paired sample | PMC10655630 | ||
Ethical considerations | Permission was obtained from the Scientific Research and Publication Ethics Committee (ETK00-2020-0279) and the institution to conduct the study. Written informed consent was obtained from all participants. | PMC10655630 | ||
Results | The comparison of some of the descriptive characteristics of the two groups can be seen in Intergroup comparison of the descriptive characteristicsFisher’s exact test.Next, the comparison of the scores obtained from the knowledge questionnaire and the subscales of the CHBMS is presented in Pretest scores obtained from the knowledge questionnaire and the CHBMSMann–Whitney U test.Student’s
Posttest scores obtained from the knowledge questionnaire, CHBMS and the VAS on satisfactionMann–Whitney U test.Independent Student Pearson’s chi-squared test. | PMC10655630 | ||
Discussion | HBM | Despite high cure rates, TC continues to pose a serious threat, especially to young adult men. Testicular self-exam is the primary health-protective behaviour in the early diagnosis and treatment of TC. In this study, the majority of the participants did not know about TC and did not perform TSE regularly prior to the intervention. In the existing studies, the lack of knowledge of TC in university students ranged between 65.6% and 98% [In the current study, participants in the intervention group, which received a lecture using the flipped classroom, obtained higher scores compared with the control group, which received a traditional lecture. The existing studies of receiving a lecture about TC and TSE and its effects on performing TSE reported that the frequency of TSE performance increased after the lecture [This study analysed the effects of courses based on the FCM compared with the conventional methods of knowledge and health beliefs on TC and TSE. The HBM is an important guide for explaining and measuring the factors that improve, motivate or prevent individual health. Mean posttest scores obtained by the participants in the intervention group from the severity and barriers subscales of the CHBMS were significantly lower than those of the control group. Although statistically insignificant, the mean scores obtained by the intervention group from the benefits and the self-efficacy subscales were higher than those by the control group. A study by Pour and Çam, which used PowerPoint presentation, video and question-and-answer techniques to give a lecture on TC and TSE, found that the posttest scores obtained by the intervention group from the subscales of susceptibility and barriers decreased, whereas the scores from the subscale of benefits increased [This study has some limitations. One of them is that the results can only be generalized to this group because it was conducted in a single centre. Another limitation is that the sample group was limited to male students only since the effects of the flipped classroom method on the knowledge and health beliefs of TC and TSE, as well as on TSE behaviour, were examined in this study. The last limitation is the inclusion of more than 61% of the sample size due to the concern that there would be too many dropouts from the study because of the Covid-19 pandemic, and all 68 students who met the inclusion criteria volunteered to participate in the study. | PMC10655630 | |
Conclusion | Sustaining educational activities to improve awareness of TC and TSE in university students aged 18–35 years is vital. Although the scores obtained by the groups in our study increased after the course on TC and TSE, participants in the intervention group, who received a lecture based on flipped classroom methods, had a higher level of knowledge afterwards and registered satisfaction with the course. Also, the FCM increased the rate of students performing testicular self-exams. Consequently, the FCM may be used as a student-friendly learning method in nursing education, which may increase student satisfaction, the level of knowledge and regular TSE performance. Further studies on different groups may evaluate the effectiveness of the FCM. Also, this study may be replicated in more than one centre where women will be included to motivate them to actively participate in testicular partner examination. | PMC10655630 | ||
Author contributions | Kamil Akcali (Study design, Data analysis, Manuscript preparation) and Sevinc Tastan (Study design, Data analysis, Manuscript preparation). | PMC10655630 | ||
Funding | None declared. | PMC10655630 | ||
Conflict of interest statement | None of the authors have personal or financial relationships which influence the study. | PMC10655630 | ||
References | PMC10655630 | |||
Purpose: | In this study, the aim to assess the combined effects of prone-positioning (PP) and minimal-flow (MF) general anesthesia on regional cerebral oxygenation (RCO) and systemic hemodynamics. | PMC10042492 | ||
Methods: | This is a randomized prospective study aiming to evaluate changes in cerebral oxygenation and hemodynamic parameters in MF systemic anesthesia in patients undergoing surgery in PP. Patients were randomized to MF or normal-flow (NF) anesthesia. In the operating room, pulse rate, mean arterial pressure (MAP), peripheral hemoglobin oxygen saturation (spO | PMC10042492 | ||
Results: | Overall, 46 patients were included (24 in the MF group and 22 in the NF group). The amount of anesthetic gas consumption was significantly lower in the low-flow (LF) group. In both groups, the mean pulse rate showed a decrease after PP. Before induction, RCO was significantly higher both at the right- and left-sides in the LF group compared to the NF group. This difference continued throughout the operation on the left-side and disappeared 10 min after intubation on the right-side. On the left side, mean RCO decreased after PP in both groups. | PMC10042492 | ||
Conclusions: | MF anesthesia in PP did not reduce cerebral oxygenation compared to NF and was safe in terms of systemic hemodynamics and cerebral oxygenation. | PMC10042492 | ||
Key words | PMC10042492 | |||
Introduction | hypoxia | HYPOXIA, ACUTE RESPIRATORY DISTRESS SYNDROME, COMPLICATIONS | The rate of utilization of low-flow (LF) anesthesia has gradually increased during the last decade, owing to some clinical advantages and cost savings. First suggested by Baum and AitkenheadActually, the most vulnerable organ to anesthesia-induced hypoxia is the brain. Thus, monitoring of cerebral oxygenation under various settings of general anesthesia is of paramount importance to prevent inadvertent hypoxia-related complications after surgery. Pulse oximeter saturation measurement may not always reflect the cerebral oxygen saturation. In this regard, methods measuring cerebral oxygenation are of value. Near-infrared spectroscopy (NIRS) measures regional cerebral oxygen saturationProne positioning (PP) is required in a number of surgical operations to be able to gain adequate access to the operation site. Moreover, PP is frequently used in the setting of acute respiratory distress syndrome thanks to its mechanistic advantages on gas exchanges in the lungsAlthough the impact of LF and MF anesthesia on cerebral oxygenation has been evaluated under various settings of general anesthesia | PMC10042492 |
Material and Methods | PMC10042492 | |||
Design, participants, and setting | DISEASE | This was a randomized prospective comparative study that aimed to evaluate the likely changes in cerebral oxygenation and hemodynamic parameters with the use of minimal fresh gas flow systemic anesthesia in patients undergoing surgery in a PP. The study protocol was approved by the local ethics committee decision no: 1477 (05/11/2019) and the Clinical Trials registration was submitted retrospectively on 18/07/2022 and its ID number was NCT05462327. All patients were informed about the study protocol and signed written informed consent forms before enrolling in the study. All study procedures were performed in full compliance with the principles of the Declaration of Helsinki.Participants in this study are fully informed of the purpose and nature of the study and which data involves the use of vital and laboratory values before and after surgery. It was explained to the participants that within the scope of the study, no additional examination (except for the examinations required for your disease) and tissue and biopsy material would not be requested. The participants were informed that there would be no change or disruption in their treatment if they refused to participate in the study or gave up later. It has been promised that the personal information of the participants (name and surname, etc.) identifying images or other personal or clinical details that compromise anonymity will not be published anywhere, shared with any institution or organization, and will not be disclosed to third parties.The study was carried out in operating rooms of orthopedics and traumatology and neurological surgery at Okmeydanı Training and Research Hospital, Istanbul, Turkey. Patients were recruited for the study between October 2019 and March 2020 as shown in the CONSORT flow diagram ( | PMC10042492 | |
CONSORT flow diagram. | PMC10042492 | |||
Anesthesia protocols | Patients were randomly allocated to either minimal fresh gas flow (MF, 0.5 L/min during maintenance) or normal-flow (NF, 2 L/min) general anesthesia. In both groups, participants were first administered with 100% oxygen at a 4 L/min flow rate. Propofol 2–2.5 mg/kg, rocuronium bromide 0.6 mg/kg, and fentanyl 1 mcg/kg IV were used for anesthesia induction. For all general anesthesia procedures, the Drager perseus A500 (Lübeck, Germany) and the Dragersorb were used as anesthesia devices and soda lime, respectively. During induction, all patients were given sevoflurane inhaler anesthesia at a 4 L/min flow rate (FiO | PMC10042492 | ||
Monitorization and data collection | Age, sex, body mass index, ASA class, preoperative opioid consumption, duration of surgery, duration of general anesthesia, duration of PP, type of surgical procedure, and the total amount of consumed inhaled anesthetic were recorded for all study participants.In the operating room, pulse rate, mean arterial pressure (MAP), peripheral hemoglobin oxygen saturation (spO | PMC10042492 | ||
Statistical analysis | Power:0.80 | The Shapiro–Wilk test and O-O plot were used to assess the normality. While continuous variables were presented as mean ± standard deviation or median (min-max) depending on the distribution of the variable, categorical variables were presented as numbers and %. Depend on the results of the normality test, the Mann–Whitney U test or independent samples t-test was used for the comparison of numeric variables between groups. Chi-squared test or Fisher’s exact test was performed for comparison of the categoric variables. To compare repeated measurements, the Friedman repeated measure test with post-hoc Durbin–Conover test was used. To prevent type I error, Bonferroni correction was used in posthoc comparisons.All statistical analyses were performed using the SPSS 20.0 software package. (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). Graphs were performed with Excel. Statistically significance level was determined as p < 0.05.As a result of the Power analysis using the G*Power program, the minimum number sample size (n) determined as 30 for each group for effect size d:0.725 and SD:2.7 with Power:0.80 and α:0.05. | PMC10042492 | |
Results | POSTERIOR FOSSA TUMOR | A total of 46 patients (50% females) were randomized to either MF fresh gas (24 patients) or NF (22 patients) anesthesia. The mean age of the whole study group was 50.3 ± 15.1 years. Fourteen operations (30.4%) were performed by orthopedists, while 32 operations (69.6%) were carried out by neurosurgeons. All of the orthopedic procedures were posterior instrumentation. Neurosurgical procedures involved lumbar disk hernia surgery (18 patients), posterior stabilization (10 patients), posterior fossa tumor surgery (2 patients), and thoracal laminectomy (2 patients). | PMC10042492 | |
Surgical and anesthetic features | ASA physical status classes were similar between MF and NF anesthesia groups. MF and NF anesthesia were regularly distributed over surgical departments and procedure types. Duration of anesthesia and surgery lasted significantly longer in the MF anesthesia group than in the NF anesthesia group. As a consequence, PP duration was also significantly longer in the former. The amount of anesthetic gas consumption was significantly lower in the MF anesthesia group compared with the NF anesthesia counterparts. Perioperative opioid medication requirements were comparable in both groups. | PMC10042492 | ||
Comparison of minimal-flow and normal-flow anesthesia patients in terms of clinicodemographic characteristics, surgery, and anesthesia features. | PMC10042492 | |||
Monitorization parameters | PMC10042492 | |||
Pulse rate | In both MF and NF groups, the mean pulse rate showed a decrease after PP. However, there was no difference between MF and high flow (HF) groups in this regard. After the resumption of supine posture, mean pulse rates increased slightly in both groups, but there was no difference between the groups again ( | PMC10042492 | ||
Comparison of pulse rate, mean arterial pressure, minimal alveolar concentration, and end-tidal carbon dioxide during measurement time points. | PMC10042492 | |||
Mean arterial pressure (MAP) | Baseline MAPs were different before anesthesia induction between the groups (102.6 ± 15.0 mmHg in the MF group and 113.5 ± 15.3 mmHg in the NF group, p = 0.019). After, PP blood pressure decreased significantly in both groups. However, MAP remained to be significantly higher in the NF group compared to the MF group. In the MF group, the mean MAP remained over 80 mmHg during the surgery. After the resumption of the supine position, MAP increased in both MF and NF groups. At this point, MAP was significantly higher in patients who were administered MF anesthesia. MAP values were comparable after extubation in both groups ( | PMC10042492 | ||
End-tidal carbon dioxide (EtCO | EtCO | PMC10042492 | ||
Peripheral oxygen saturation (SpO | Peripheral oxygen saturation increased from 98% to 100% after PP in the MF group. Throughout the operation, including post-extubation status, spO | PMC10042492 | ||
Comparison of peripheral oxygen saturation, and right and left side regional cerebral oxygenation during measurement time points. | PMC10042492 | |||
Regional cerebral oxygenation (measured by NIRS) | At baseline evaluation before anesthesia induction, RCO was significantly higher both at the right and left sides in the MF group compared to the NF group. This difference continued throughout the operation on the left side. However, this difference disappeared 10 min after intubation on the right side. Placing the patients in a prone position did not cause any alteration in RCO on the right side in any of the groups. However, on the left side, mean RCO decreased after PP in both MF and NF groups ( | PMC10042492 | ||
Left-sided cerebral oxygen saturation measurements during study time-points. | PMC10042492 | |||
Right-sided cerebral oxygen saturation measurements during study time-points. | PMC10042492 | |||
Discussion | hypoxia, Left-sided regional cerebral oxygen, Kupisiak | HYPOXIA, SECONDARY | The purpose of the study to evaluate the impact of MF inhaled anesthesia coupled with PP on cerebral oxygenation and hemodynamic parameters. The major findings of the present study can be summarized as follows: 1) Anesthetic gas consumption was significantly lower in the MF anesthesia group; 2) PP decreased pulse rate irrespective of the flow type of anesthesia. However, pulse rates were mostly comparable between MF and NF anesthesia groups; 3) Although significantly lower before anesthesia induction in the MF group, pulse rate decreased in both MF and NF groups after PP and usually remained significantly higher in the MF group compared to the NF group throughout the rest of the procedures; 4) Left-sided regional cerebral oxygen saturations were consistently and significantly higher in the MF group compared to the NF group. PP decreased RCO on the right side, but not on the left side, in both anesthesia groups; 5) There was no discernable effect of anesthesia flow or PP on peripheral oxygen saturation in any of the groups; 6) Anesthesia depth (assessed by MAC) was comparable between the MF and NF groups at all measurement points during anesthesia induction and surgery.Surgical procedures dealing with the spine usually require PP of the patients. This unfamiliar position might lead to some alteration in the respiratory and hemodynamic functioning of the body. First, when the thorax and abdomen are positioned in the prone position, intraabdominal and intrathoracic pressures increase with a resultant reduction in venous return to the heart. Arterial blood pressure and cardiac output decrease. Increased intrathoracic pressure also leads to a secondary increase in intracranial pressure through increased central venous pressureSeveral studies sought to find answers to whether these hemodynamic changes can lead to clişnically important hemodynamic and oxygenation alterations in the cerebral circulation. Bombardieri et al. performed a study in which they investigated the impact of PP on cerebral perfusion in patients undergoing posterior lumbar surgery. The authors evaluated cerebral blood flow velocity with transcranial Doppler ultrasonography. They found an insignificant increase in mean arterial blood pressure after PP. Cerebral perfusion was not affected significantly by PP , eitherDespite several enticing advantages mentioned in the introduction section, MF anesthesia has several concerns, as well. Two of them are inadequate anesthesia depth and hypoxia. Some studies evaluated LF anesthesia in these regards in various surgical settings. Kupisiak et al.Some limitations of the current study are worthy of mention. First, the bispectral index was not included to evaluate anesthesia depth. Instead, minimum alveolar concentration has been used. Second, some studies follow patients after general anesthesia and evaluate mental state before and after the operation to unravel the effects of alterations of cerebral oxygenation on cognitive functions. Cognitive functions were not evaluated in the study. However, no cerebral oxygen desaturation was observed in the MF group compared to the NF group. Lastly, the right and left regional cerebral oxygen saturation values at baseline were significantly different between the LF and NF groups, significantly higher in the lef hand side. Thus, this might have led to the discrepant results we attained. | PMC10042492 |
Conclusion | For the first time in the literature, this study evaluated the impact of PP along with MF anesthesia on systemic hemodynamics and RCO. The results of the present study revealed that MF anesthesia in patients undergoing surgery in the prone position did not cause a reduction in cerebral oxygenation compared to NF. PP also caused clinically nonsignificant changes in hemodynamic parameters. Anesthesia depth was acceptable in the MF anesthesia group as well. MF anesthesia in the prone position was safe in terms of systemic hemodynamics and cerebral oxygenation. | PMC10042492 | ||
References | PMC10042492 | |||
Background | postoperative pain, palmar hyperhidrosis, pain | Although thoracoscopic sympathectomy is made via small incisions, it is associated with severe postoperative pain. Both Rhomboid intercostal block (RIB) and serratus anterior plane block (SABP) are recent techniques used for pain control after such procedures. Herein, we compared RIB and SAPB regarding pain control in patients undergoing thoracoscopic sympathectomy for palmar hyperhidrosis. | PMC10355006 | |
Patients and methods | Three groups were enrolled in this prospective randomized study (71 patients in each group); Group S received SAPB, Group R received RIB and Group C as controls. The block procedures were performed after general anesthesia and prior to the skin incision. | PMC10355006 | ||
Results | The three groups showed comparable demographics and operative time ( | PMC10355006 | ||
Conclusion | hyperhidrosis, pain | Both RIB and SAPB are safe and effective in pain reduction after thoracoscopic sympathectomy procedures in patients with hyperhidrosis. Moreover, RIB is superior to SAPB as it is associated with better analgesic outcomes. | PMC10355006 | |
Trial registration | Pan African Trial Registry PACTR202203766891354. | PMC10355006 | ||
Keywords | Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). | PMC10355006 | ||
Introduction | postoperative pain, Primary palmar hyperhidrosis, anxiety, Postoperative pain, chest pain, pain, infection, paraspinal muscular pain, hematoma | DISORDER, INFECTION, HEMATOMA, ABSENCE OF SWEATING | Primary palmar hyperhidrosis is a disorder characterized by chronic excessive sweating despite the absence of sweating triggers. With the evolution of surgical approaches, upper thoracic dorsal sympathectomy performed via video-assisted thoracoscopic surgery (VATS) is the main management option for that clinical entity [Although VATS is performed through small incisions, postoperative pain remains challenging, as some patients report sharp chest pain with deep inspiration, while others report constant pain in the dorsal region. This might necessitate prescribing opioid analgesia for proper pain relief [Postoperative pain not only increases patients' anxiety but also decreases postoperative satisfaction and hinders early rehabilitation, so effectively preventive post-operative pain is important [Disadvantages of the previously mentioned techniques are infection, hematoma parasympathetic manifestations, paraspinal muscular pain, spinal anesthesia, and short duration of analgesia [Recently, rhomboid intercostal block (RIB) and serratus anterior plane block (SAPB) have been described to provide effective analgesia after thoracic procedures [ | PMC10355006 |
Patients and methods | infection, psychiatric, hyperhidrosis | INFECTION, BLEEDING DISORDERS | This prospective randomized controlled parallel study was conducted over one year, starting from March 2022 to March 2023, at Mansoura university hospitals after the Institutional Research Board and ethical committee of our university (MFM-IRB) approval (R.21.09.1462) on 31/10/ 2021. The study was designed for 213 patients with severe palmar hyperhidrosis after explaining its benefits and potential risks. Patients were interviewed, and written informed consent was obtained. All methods were performed in accordance with the declaration of Helsinki. The study was registered in the Pan African Trial Registry (PACTR202203766891354) on 16/3/2022. The study was reported according to the Consolidated Standards for Reporting Trials (CONSORT) guidelines[The sample size was calculated via the PASS software program (version 23.0.2.), considering the time to the first rescue analgesic as the main outcome. The null hypothesis was considered as the absence of difference between RIB and SAPB techniques regarding that parameter. No previous studies have compared these two specific block techniques before. A minimal patient sample of 64 patients was required in each group to achieve a power and significance level of 80% and 5%, respectively. With an expected seven patients to drop out, the included sample was increased to 71 in each group (a total number of 213 cases).Patients aged between 15 to 40 years old, from either gender, scheduled for VATS, and classified as class I or II according to the American Society of Anesthesiologists (ASA) were included. Contrarily, we excluded patients whose ASA was more than II, patients with infection at the injection site, bleeding disorders, and psychiatric illnesses. | PMC10355006 |
Randomization and blinding | pain | A total of 213 patients were randomly assigned to three equal groups using a computer-generated table of random numbers: Group R included patients who received RIB, Group S included patients who received SAPB, and Group C included the remaining patients who received no block procedure. The group allocation was concealed in sequentially numbered, sealed, and opaque envelopes. This study was double-blinded, as patients, data collectors, and those assessing the outcomes (a trained nurse who was not involved in the study), were blinded to the allocation until the end of the trial.Before the procedure, proper history-taking, clinical examination, and laboratory investigations were performed. All patients were also taught how to express their pain via the Visual analog scale (VAS), which ranges from 0 to 10, with the former for no pain and the latter for the worst pain ever[ | PMC10355006 | |
Patient's data | serratus anterior block, pain | HEART | At the operative theater, all patients were sedated by IV midazolam 2 mg, and standard monitoring was applied. General anesthesia was induced by IV propofol, atracurium, and fentanyl with doses of 2.5 mg/kg, 0.5 mg/kg, and 1 μg/kg, respectively. A single-lumen endotracheal tube was used. All patients were kept on pressure-controlled volume mode, with a 1:2 I/E ratio and 4 ml/kg tidal volume. The respiratory rate was adjusted to keep ETCO2 around 35 mmHg. Maintenance of anesthesia was done via a mixture of isoflurane and 50% air in oxygen, and atracurium (0.1 mg/kg) increments were administered when needed. The block procedures were performed before skin incision under aseptic conditions under ultrasound guidance. We used Philips Clear Vue 350, WA, USA) with a high-frequency linear transducer (6 – 12 MHz).In Group R, RIB was done in the lateral position, with the operating side directed superiorly with the abduction of the ipsilateral arm. The linear ultrasound probe was positioned in the oblique sagittal plane medial to the medial scapular border, and the following structures were identified; rhomboid muscle, trapezius muscle, intercostal muscles, pleura, and lungs. Then, a 21-gauge sono-visible needle was inserted at the level of T 5–6 till reaching the plane between the rhomboid and intercostal muscles, where 20 ml of bupivacaine 0.25% was injected. The spread of the local anesthetic was noted by ultrasound, and the procedure was repeated for the opposite side after adjusting the patient's position (Fig. The rhomboid block technique: In Group S, SABP was performed in the lateral position. The probe was positioned in the sagittal plane over the thoracic region in the midaxillary line, where the seventh rib was identified along with the following muscles; serratus anterior, latissimus dorsi, and teres major. The sonovisible 18-gauge needle was advanced till reaching the plane superficial to the serratus muscle, where 20 ml of bupivacaine 0.25% was injected. The procedure was repeated for the opposite side (Fig. The serratus anterior block technique: No block procedure was done in Group C, as patients in this group received conventional IV analgesia. Heart rate (HR) and mean arterial pressure (MAP) were recorded basally, with skin incision, and then every 15 min till the procedure ended. At the end of the procedure all patients received acetaminophen with doses of 1 mg/kg.Patients were transferred to the recovery room where VAS score was recorded immediately, 1, 3, 6, 12, and 24 h after the operation. Postoperative analgesia was achieved by IV ketorolac (30 mg/12 h) and IV acetaminophen (1 gm/8 h). IV fentanyl (1 μg/kg) was also commenced for breakthrough pain, and it was repeated after 4 h till the patient had a VAS of 3 or less. Time to the first rescue analgesia and total postoperative opioid consumption was also recorded. Patient satisfaction was graded by the same person(trained nurse) according to a five-point Likert scale; weak, medium, good, very good, and excellent [ | PMC10355006 |
Collected data | pain | SECONDARY, COMPLICATIONS | The primary outcome was the time to the first rescue analgesic, whereas secondary ones included intraoperative hemodynamic changes, pain scores, postoperative opioid consumption, the incidence of complications, and patient satisfaction. | PMC10355006 |
Statistical analysis | Statistical analysis was performed by the SPSS (version 21.0; SPSS Inc, Chicago, Ill, United States) software program. Numerical data were expressed as mean and standard deviation and compared between the three groups using the one-way ANOVA test. The categorical ones were expressed as numbers and percentages and compared between the three groups using the Chi-square test or Fisher's exact test. Post-hoc analysis (Tukey pairwise comparison) was also performed to compare each individual two groups. P-values less than 0.05 were considered significant. P was used to express the comparison between the three groups. P1, P2, and P3 were used to compare Groups R and S, Groups R and C, and Groups S and C, respectively, as shown in the following tables in the results section. | PMC10355006 | ||
Discussion | postoperative pain, ESPB, Postoperative pain, chronic postoperative pain, pain | CHRONIC POSTOPERATIVE PAIN, INFILTRATION | The current study demonstrates that both RIB and SAPB were effective techniques in providing analgesia for patients undergoing VATS. RIB and SAPB were performed before the skin incision, "preemptive analgesia," to induce better analgesia compared to blocks performed after surgery owing to its protective effect on the human nociceptive system [Both block techniques were effective in pain control after the procedure, and the analgesic profile was much better in RIB (rejecting our null hypothesis). That could be explained by the extent of the block in both techniques. RIB covers the entire hemithorax anteriorly and posteriorly, while SAPB covers the anterolateral chest wall region as it mainly affects the lateral intercostal nerve branches and omits the posterior main sensory branch [Our finding correlate with those of Zhang et al., who conducted a prospective trial comparing RIB, SAPB, and erector spinae plane block (ESPB) in patients undergoing VATS. Postoperative pain scores, the time to first analgesic request, and opioid consumption were comparable between RIB and ESPB and more superior to SAPB [Similar results have been reported in a retrospective study compared RIB to SAPB in VATS procedures and found that pain scores were significantly reduced with RIB. Nonetheless, opioid consumption was statistically comparable between the two block techniques (122 mg vs. 151 mg in Groups R and S, respectively – RIB was initially described by Elsharkawy and his associates. The local anesthetic agent is administered into the fascial plane between the rhomboid and intercostal muscles, providing analgesia for the region supplied by T 2–9 dermatomes in both anterior and posterior chest walls by targeting the lateral cutaneous branches of the ventral thoracic nerves. The spread of the local anesthetic in both craniocaudal and anteroposterior directions could explain its wide coverage, even when the injectate is administered into a single level [SAPB was first described by Blanco and his associates for pain management after chest and breast operations [As regard RIB, our finding was in agreement with Deng et al., who evaluated RIB for elective unilateral VATS. The total amount of sufentanil in 24 h after the surgery in the RIB group was less than those in the control group at (Similar results have been reported by Altıparmak et al., who demonstrated that RIB was associated with a significant improvement in patient recovery (recovery score 164.8 vs. 153.5 in controls – As regard SAPB, our findings correlate with those of Park et al., who evaluated SAPB on postoperative pain and opioid consumption after thoracoscopic surgery. SAPB reduced the worst median (IQR [range]) pain score 6 (5–7 [Moreover, Chen and his associates evaluated the effects of SAPB on postoperative pain after thoracoscopic surgery compared with local anesthetic (LA) infiltration. Postoperative sufentanil consumption in the SAPB group was significantly lower compared with the LA group (There are limitations of our study as the patients were collected from a single medical center, both block techniques were performed as a single shot, and its effect on chronic postoperative pain was not evaluated. That is why we recommend performing more studies with a larger patient sample. | PMC10355006 |
Acknowledgements | We acknowledge the Egyptian K knowledge Bank- Enago for providing proof reading of the article. | PMC10355006 | ||
Author’s contributions | M.G.E., principal investigator, formulated the research, study design, data acquisition, and interpretation and drafted the manuscript. K.M.E., M.S.E., helped in the study design and revising of the final manuscript. All authors approved the final manuscript. | PMC10355006 | ||
Funding | Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). We did not receive any specific funds. We only used institutional resources. | PMC10355006 | ||
Availability of data and materials | The individual participant data will be available upon reasonable request with the corresponding author after the local IRB approval. | PMC10355006 | ||
Declarations | PMC10355006 | |||
Ethical approval and consent to participate | All methods were performed in accordance with the declaration of Helsinki. We obtained Mansoura Faculty of Medicine, Institutional Research Board (MFM-IRB) approval (R.21.09.1462) before patient enrollment. All patients gave their written informed consent (or their guardians if their age was less than 18 years) during the preoperative visits. | PMC10355006 | ||
Consent for publication | Not applicable. | PMC10355006 | ||
Competing interests | Nil. | PMC10355006 | ||
References | PMC10355006 | |||
Subject terms | neuropathic pain, manipulationAcupuncture, motor and sensory performances, ELMT, CTS, CTS.Carpal tunnel syndrome, Carpal Tunnel Questionnaire, Tinel | ENTRAPMENT NEUROPATHY, CARPAL TUNNEL SYNDROME (CTS) | This study aimed to evaluate the clinical efficacy of an electroacupuncture-like magnetic therapy (ELMT) and conventional transcutaneous electrical nerve stimulation (TENS) in patients with carpal tunnel syndrome (CTS). A prospective randomized controlled trial in single-centre was conducted. Thirty-four CTS patients confirmed by electrodiagnostic study were randomized into TENS or ELMT group and completed a six-week treatment program. TENS or ELMT treatment was applied on acupuncture point PC-6 (Neiguan) and one selected hand acupoint. Therapeutic exercises were also included after the electrophysical modality. Their physical signs, motor and sensory performances, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and results of electrodiagnostic study were evaluated. After treatments, both groups demonstrated significantly decreased BCTQ scores and positive rate of Tinel’s sign in the major symptomatic side, which indicated improvements in the symptom severity and physical functions. Significant increases in distal sensory amplitude and nerve conduction velocity of the median nerve were only found in the ELMT group. Our study found either conventional TENS or ELMT plus therapeutic exercises could improve the symptomatology and physical provocation sign of CTS. The ELMT has additional improvement in the nerve conduction in patients with CTS.Carpal tunnel syndrome (CTS) is a common entrapment neuropathy, and arises from compression of median nerve at the wristCTS diagnosis is often based on clinical symptoms, physical signs, electrophysiological measurements, or image studyMany patients with neuropathic pain would seek for the assistance of complementary and alternative medicine (CAM) therapies, such as megavitamins, magnet therapy, acupuncture, herbal remedies, and chiropractic manipulationAcupuncture is another common choice of the CAM therapies | PMC10656569 |
Methods | PMC10656569 | |||
Participants and design | CTS | The design of this study is as a prospective randomized, single-center, interventional clinical trial with two parallel assignment groups. This study has been registered on ClinicalTrials.gov, and the Identifier is NCT01277003 (14/01/2011). The potential participants were patients who visited our outpatient clinics with symptoms that suggested CTS. | PMC10656569 | |
Inclusion criteria | pain, numbness, CTS | In this study, CTS was diagnosed clinically by senior physicians with at least one of the symptoms of numbness, tingling, or pain in the wrist or hand. The diagnosis was further confirmed with electrodiagnostic studies, which indicated at least one of the following criteria | PMC10656569 | |
Exclusion criteria | fracture, diabetes mellitus, numbness, CTS, gout, peripheral neuropathy, trauma | RHEUMATOID ARTHRITIS, CHRONIC RENAL FAILURE, DIABETES MELLITUS, SYSTEMIC LUPUS ERYTHEMATOSUS, GOUT, DISORDERS, POLYNEUROPATHY, CERVICAL SPONDYLOSIS, HYPOTHYROIDISM, PERIPHERAL NEUROPATHY | The medical and surgical conditions that predispose one to peripheral neuropathy such as hypothyroidism, gout, systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, chronic renal failure; the presence of disorders such as cervical spondylosis, polyneuropathy, that might cause numbness in the hand; treatment with steroids or nonsteroidal anti-inflammatory drugs within the previous month; and steroid injection within the previous 6 months; any surgery for peripheral nerve in the upper limb such as carpal tunnel surgical release, history of trauma in the upper limb such as wrist fracture, or having pregnancy.During the one-year recruiting period, patients with electro-diagnostically confirmed CTS were invited to participate in our study. Possible beneficial and side effects were fully explained before allocation to the treatments. Informed consent, as approved by the local ethics committee, was obtained from every enrolled participant before the study. This research was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. | PMC10656569 |
Baseline testing and outcome measurement | The participant would be first evaluated using the BCTQ | PMC10656569 | ||
Allocation | carpal tunnel syndromes, ELMT, CTS | CARPAL TUNNEL SYNDROME | We then randomly assigned the participants into two treatment groups, but tried to evenly distribute them to be matched with similar demographic characteristics and CTS severity. One group received conventional TENS (TENS group) and another group received ELMT with Aculife (ELMT group). Forty patients with carpal tunnel syndromes were screened and enrolled into this study, they were evenly allocated into either TENS or ELMT group (Fig. The flow chart of the study. | PMC10656569 |
Interventions | All the assessment and the treatment were carried out in the outpatient clinics of the Department of Physical Medicine and Rehabilitation of our hospital. The intervention program would last for six weeks, one treatment session each day, 5 sessions per week. Each session consisted of one electrophysical modality treatment and exercises. Apart from different modalities, participants in both groups would all be instructed to perform tendon gliding and nerve gliding exercises for 15 min | PMC10656569 | ||
Electroacupuncture-like magnetic therapy treatment | ELMT | The ELMT treatment was delivered with a magnetic therapy device (Aculife Magnetic Wave device, SMW-A01, Innohealth Technology Co., Taiwan). It is designed to deliver surface acupuncture-like stimulation, using a biphasic pulse with one high-voltage square phase in positive direction and then quickly changed in polarity and form a balanced negative triangular ramp, create time-varying PEMF (Fig. The characteristics of the pulsed electro-magnetic field (PEMF) delivered by the device (Aculife Magnetic Wave device, SMW-A01, Innohealth Technology Co., Taiwan) used in the magnetic therapy group. (The acupuncture points selected to treat ( | PMC10656569 | |
Conventional TENS treatment | A typical TENS machine was used (GEM-STIM GM3A5XT, Chi-Mao Co., Taiwan) to delivered conventional TENS treatment. Two adhesive round electrodes (2.5 cm radius) were applied to the same treatment positions, as described above. Negative electrodes were placed on the carpal ligament (covering PC-6), and positive electrodes were placed on the distal pulp of index (covering the hand acupuncture point of the wrist). The device delivered asymmetric biphasic pulse current, and the parameter was set at a pulse rate of 30 Hz frequency and a stimulation period of 70 μs, which were similar to the AcuLife device. The device provides two channels output and enable bilateral treatment simultaneously. One TENS session lasted for 15 min, and at least a total of 30 sessions (5 sessions per week) were completed. | PMC10656569 | ||
Statistical analysis | Carpal Tunnel Questionnaire | Boston Carpal Tunnel Questionnaire (BCTQ) scores, motor and sensory performances, provocation signs, and electro-diagnostic measurements were evaluated before and after the treatment program to measure the treatment effectiveness. Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY, USA) was used for statistical analyses. Independent T-test and Chi-square were used to compare continuous variables and category variables, respectively, of demographic characteristics and outcome variables of two groups. Paired T-test was used to examine the pre- and post-treatment effects in each group. Mann–Whitney U test was used for nonparametric variables. Statistical significance was considered when | PMC10656569 | |
Ethical approval | This research was reviewed and approved by the institutional review board of China Medical University Hospital (Protocol No. DMR99-IRB-223), and has been registered on ClinicalTrials.gov (Identifier: NCT01277003, 14/01/2011). This study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. Informed consent was obtained from all participants. | PMC10656569 | ||
Results | At the end of the study, 17 participants (13 females, 4 males) in the TENS group and 17 (15 females, 2 males) in the ELMT group completed the treatment programs (Fig. | PMC10656569 | ||
Motor and sensory performance | There was no significant difference between two groups in grip strength, pinch strength and two-point discrimination | PMC10656569 | ||
Acknowledgements | The authors acknowledge the financial support by the China Medical University Hospital (DMR-106-135) and the Innohealth Technology Co. (0994266G). We are also grateful to all participants for their cooperation and contribution to complete this study. | PMC10656569 | ||
Author contributions | S.-F.L.: Conceptualization, methodology, investigation, funding acquisition, and writing—review & editing, project administration; L.-W.C.: Conceptualization, methodology, resources, funding acquisition, and writing—review and editing. H.C.: Investigation, formal analysis, writing—original draft, and visualization; H.C.L.: Conceptualization, methodology, investigation, formal analysis, visualization, and writing—original draft, review and editing; All authors read and approved the final manuscript. | PMC10656569 | ||
Funding | The Project is funded by China Medical University Hospital (DMR-106-135) and the Inno-health Technology Co., Ltd. (0994266G). | PMC10656569 | ||
Data availability | The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. | PMC10656569 |
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