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Intravenous lipid emulsion has been suggested as treatment for severe intoxications caused by lipophilic drugs, including tricyclic antidepressants. We investigated the effect of lipid infusion on plasma and tissue concentrations of amitriptyline and haemodynamic recovery, when lipid was given after amitriptyline distribution into well-perfused organs. Twenty anaesthetized pigs received amitriptyline intravenously 10 mg/kg for 15 min. Thirty minutes later, in random fashion, 20% Intralipid® (Lipid group) or Ringer's acetate (Control group) was infused 1.5 ml/kg for 1 min. followed by 0.25 ml/kg/min. for 29 min. Arterial and venous plasma amitriptyline concentrations and haemodynamics were followed till 75 min. after amitriptyline infusion. Then, frontal brain and heart apex samples were taken for amitriptyline measurements. Arterial plasma total amitriptyline concentrations were higher in the Lipid than in the Control group ( p < 0.03) from 20 min. on after the start of the treatment infusions. Lipid emulsion reduced brain amitriptyline concentration by 25% ( p = 0.038) and amitriptyline concentration ratios brain/arterial plasma ( p = 0.016) and heart/arterial plasma ( p = 0.011). There were no differences in ECG parameters and no severe cardiac arrhythmias occurred. Two pigs developed severe hypotension during the lipid infusion and were given adrenaline. In conclusion, lipid infusion, given not earlier than after an initial amitriptyline tissue distribution, was able to entrap amitriptyline back into plasma from brain and possibly from other highly perfused, lipid-rich tissues. In spite of the entrapment, there was no difference in haemodynamics between the groups. [ABSTRACT FROM AUTHOR]

Background Expertise in neonatal resuscitation is essential for personnel involved in the care of newborns. In this observational cohort study the skills of 52 midwives in a simulated scenario were assessed. Methods A total of 52 midwives in a low-risk unit and five specialist nurses in a high-risk unit were tested to establish their competence in newborn resuscitation. The 52 midwives were divided into groups 1 ( n = 39; no pretest training) and 2 ( n = 13; 1 day training prior to study). The video-recorded test scenario was a newborn with asphyxia. Thirty items were graded by a neonatologist and nursing team in real time. Using the Angoff method, a pass score was 18.71 for skills that were graded 0 or 1. Results The average score of specialist nurses was 26 (range, 23-29). A total of 49% of midwives in group 1 and 92% in group 2 passed the test. The average score was 17.7 (range, 9-25) in group 1 and 21.9 (range, 17-27) in group 2. A total of 27% and 77% of midwives in groups 1 and 2, respectively, carried out ventilation at a frequency as per the algorithm. Mask leakage was higher in group 1 (44%) versus group 2 (23%). Five and three midwives in groups 1 and 2, respectively, overexpanded the lungs. Conclusion Many midwives had imperfect resuscitation skills. A 1 day course improved such skills. The standard scenario is an objective and useful performance marker in assessing and documenting improvements in competence in delivery room resuscitation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previously we found that pre-procedural nervousness and tension (translated into English as “anxiety”), assessed on a non-validated five-point scale, correlated with pain intensity of the various stages of bone marrow aspiration and biopsy (BMAB). The fewer the previous BMAB procedures the stronger the pain from a repeated procedure. The primary purpose of the present observational study is to evaluate the state of anxiety just before BMAB and to find out whether it affects the pain experiences during the various stages of the BMAB procedure. We also examined whether first-timers differ from patients with previous BMAB experience in the degree of anxiety and intensity of BMAB procedural pain. Methods: A total of 166 adult outpatients undergoing the BMAB from the Helsinki University Hospital were enrolled, 48 of them being first-timers. The level of anxiety was measured with State-Trait Anxiety Inventory (STAI) and the pain experiences associated with the various stages of the procedure were evaluated on the NRS-scale (Numeral Rating Scale 0–10) and using the Finnish pain vocabulary. BMAB was planned to be performed under lidocaine infiltration anaesthesia but, on request, patients were allowed to receive premedication with diazepam orally or alfentanil i.m. If, in spite of supplemental local anaesthetic the patient still felt pain from the sampling needle tip, i.m. alfentanil was administered. Results: There was a clear association between anxiety and pain during all stages of the procedure, except during biopsy. The NRS scores varied from 0 to 10 in all the various stages of BMAB. The first-timers did not differ from the more experienced patients with regard to pain experiences; only the pain felt during the local anaesthetic infiltration was milder (P =0.007) in first-timers than in the others. Procedural pain in those who were given analgesic or sedative premedication was similar (P >0.05) to that in the non-pre-medicated patients. The words characterizing the pain of the various stages belonged to a major extent (76–90%) to the sensory class of words. Conclusion: Pre-procedural anxiety had a major impact on the pain ratings. The first-timers and patients with previous experience of BMAB had a similar degree of pre-procedural anxiety, as well as of the intensity of procedural pain, except that infiltration of local anaesthetic was less painful in the first-timers. Implications: Identification of anxious (fearful) patients prior to BMAB, and premedicating them individually may improve satisfaction in both patient and caregiver. [Copyright &y& Elsevier]

Intravenous lipid emulsion has been used in the resuscitative treatment of intoxications caused by local anaesthetics and tricyclic antidepressants with seemingly beneficial results. We studied the effect of intravenous lipid emulsion on the plasma concentration of amitriptyline and haemodynamic recovery in a pig model of amitriptyline intoxication. Twenty pigs were anaesthetized (1% isoflurane in 21% O2) and given amitriptyline 15 mg/kg intravenously for 15 min. In random fashion immediately thereafter, either 20% lipid emulsion (ClinOleic®, Lipid group) or Ringer's acetate (Control group) was infused for 30 min.; first 1.5 ml/kg for 1 min., followed by 0.25 ml/kg/min. for 29 min. The amitriptyline concentration in total and lipid-poor plasma and haemodynamic parameters were measured until 30 min. after the infusions. Lipid infusion prevented the decrease in plasma total amitriptyline concentration, resulting in a 90% higher ( p < 0.001) total concentration and significantly ( p = 0.014) lower free fraction of plasma amitriptyline in the Lipid group (1.1%) compared with the Control group (3.0%) at 30 min. Haemodynamic recovery from the intoxication as measured by heart rate, arterial pressure or cardiac output was similar in both groups. However, five pigs in the Lipid group and two pigs in the Control group died. In conclusion, a marked entrapment of amitriptyline by intravenous lipid emulsion was observed but this did not improve the pigs' haemodynamic recovery from severe amitriptyline intoxication. Care should be exercised in the antidotal use of lipid emulsion until controlled human studies indicate its efficacy and safety. [ABSTRACT FROM AUTHOR]

Background: Hypertonic saline (HS) is an alternative to mannitol for decreasing intracranial pressure in traumatic brain injury and before craniotomy. Both HS and mannitol may interfere with blood coagulation but their influence on coagulation has not been compared in controlled situations. Therefore, we evaluated different strengths of HS and 15% mannitol on blood coagulation in vitro. Methods: Citrated fresh whole blood, withdrawn from 10 volunteers, was diluted with 0.9%, 2.5%, or 3.5% HS or 15% mannitol to make 10 vol.% and 20 vol.% hemodilution in vitro. The diluted blood and undiluted control samples were analyzed with thromboelastometry (ROTEM) using two activators, tissue thromboplastin without (ExTEM) or with cytochalasin (FibTEM). Results: In the FibTEM analysis, maximum clot firmness (MCF) was stronger in the 2.5% HS group than in the mannitol group after both dilutions ( P < 0.05). In the ExTEM analysis, clot formation time (CFT) was more delayed in the mannitol group than in the 0.9%, 2.5%, or 3.5% HS groups in 20 vol.% hemodilution ( P < 0.05). MCF was weaker in the mannitol group than in the other groups after 20 vol.% dilution ( P < 0.05). MCF was also weaker in the 3.5% than in the 0.9% saline group after 20 vol.% dilution ( P < 0.05). Conclusions: Blood coagulation is disturbed more by 15% mannitol than by equiosmolar 2.5% saline. This disturbance seems to be attributed to overall clot formation and strength but also to pure fibrin clot firmness. This saline solution might be more favorable than mannitol before craniotomy in patients with a high risk of bleeding. [ABSTRACT FROM AUTHOR]

Abstract: Infiltration anaesthesia with articaine, a local anaesthetic able to penetrate bone, may relieve procedural pain better than lidocaine in bone marrow aspiration and biopsy. This randomised, double-blind study comprised 150 patients with suspected or known haematologic disease. Either articaine 20mg/ml (50 patients), articaine 40mg/ml (49 patients) or lidocaine 20mg/ml (51 patients), all with adrenaline 5μg/ml, was infiltrated in volume of 6ml (sternal manubrium), 8ml (sternal body) or 10ml (iliac crest) 2min before puncture. Numeral rating scale score (median, range) at injection of local anaesthetic was 3.0 (0–10), at bone puncture 2.0 (0–8), at aspiration 3.5 (0–10) and at biopsy (48 patients) 3.0 (0–10). Pre-procedural anxiety, rated on a verbal scale, correlated significantly with experienced pain (P <0.01). Very anxious patients had fewer previous bone marrow examinations (P <0.01) and they experienced more pain during aspiration (P <0.05). In the post-interview 42 patients reported appearance of pain (median 2.0, range 1–7) after 6.2h, on average, and 15 patients needed oral analgesics. No parameter differed significantly between the groups. In conclusion, the quality of infiltration anaesthesia for bone marrow punctures and aspiration with articaine and lidocaine was similarly poor. Several patients experienced strong pain which correlated with the degree of anxiety. [Copyright &y& Elsevier]

The purpose of this study was to evaluate the role of sequence variants in the CYP2C8, ABCB1 and CYP3A4 genes and the CYP3A4 phenotype for the pharmacokinetics and toxicity of paclitaxel in ovarian cancer patients. Thirty-eight patients were treated with paclitaxel and carboplatin. The genotypes of CYP2C8*1B, *1C, *2, *3, *4, *5, *6, *7, *8 and P404A, ABCB1 G2677T/A and C3435T, as well as CYP3A4*1B, were determined by pyrosequencing. Phenotyping of CYP3A4 was performed in vivo with quinine as a probe. The patients were monitored for toxicity and 23 patients underwent a more extensive neurotoxicity evaluation. Patients heterozygous for G/A in position 2677 in ABCB1 had a significantly higher clearance of paclitaxel than most other ABCB1 variants. A lower clearance of paclitaxel was found for patients heterozygous for CYP2C8*3 when stratified according to the ABCB1 G2677T/A genotype. In addition, the CYP3A4 enzyme activity in vivo affected which metabolic pathway was dominant in each patient, but not the total clearance of paclitaxel. The exposure to paclitaxel correlated to the degree of neurotoxicity. Our findings suggest that interindividual variability in paclitaxel pharmacokinetics might be predicted by ABCB1 and CYP2C8 genotypes and provide useful information for individualized chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Pesticide mineralization and sorption were determined in 75 soil samples from 15 individually drilled holes through the vadose zone along a 28km long transect of the Danish outwash plain. Mineralization of the phenoxyacetic acid herbicide MCPA was high both in topsoils and in most subsoils, while metribuzine and methyltriazine-amine was always low. Organic matter and soil pH was shown to be responsible for sorption of MCPA and metribuzine in the topsoils. The sorption of methyltriazine-amine in topsoil was positively correlated with clay and negatively correlated with the pH of the soil. Sorption of glyphosate was tested also high in the subsoils. One-dimensional MACRO modeling of the concentration of MCPA, metribuzine and methyltriazine-amine at 2m depth calculated that the average concentration of MCPA and methyltriazine-amine in the groundwater was below the administrative limit of 0.1μg/l in all tested profiles while metribuzine always exceeded the 0.1μg/l threshold value. [Copyright &y& Elsevier]

Abstract: Detailed Fourier Transform Infrared Spectroscopy (FTIR), chemical oxidation and reduction, and multivariate regression analysis have been applied to gain insight into the relative proportions and types of oxygen functional groups in coals of varying rank and in alginite-rich organic matter in oil shales and marine shale. FTIR spectra of demineralised and non-demineralised coals with a vitrinite reflectance below ~0.4%R o revealed that the spectra are significantly different in the carbonyl region, probably due to the configuration of weak conjugated oxygen bonds into a more rigid form during demineralisation. In coals and lignin, the relative FTIR response from oxygen groups occurs in the order hydroxyl≥ether>ketone/ester>carboxyl>quinone, where ester groups are related to cutinite and sporinite. A pronounced decrease in oxygen content occurs from ~0.43–0.50%R o, but the oxygen groups show different evolutionary trends during initial thermal maturation: (i) carboxyl group absorption increases significantly up to lignite/subbituminous C rank, followed by a rapid decrease and disappearance at ∼0.45%R o, (ii) ketone (carbonyl) group absorption is prominent at maturities <0.45%R o, but at higher maturities the response declines gradually, (iii) ether group absorption increases to a maximum at ∼0.45–0.50%R o, from where it decreases gradually, (iv) at atomic O/C ratios >0.2 (approximately <0.45%R o) hydroxyl group (principally phenolic) absorption is highly variable, but at increasing thermal maturity significant dehydroxylation occurs. Elimination of oxygen groups in the coaly organic matter thus occurs in the order quinone, carboxyl, ketone/ester, hydroxyl and ether. Both ether and hydroxyl are still present at an O/C ratio of 0.05. Oxygen in the alginite-dominated kerogen of the shales is entirely bound as ether, carbonyl (mainly ester) and hydroxyl. The presence of ether agrees with the dominant role of ether bonds cross-linking long-chain n-alkanes in algaenan. Hydroxyl may be related to phenolic units in for example Botryococcus algae. The relative FTIR response from oxygen groups in kukersite is ether>carbonyl (ketone)>hydroxyl, which generally reflects the structural models proposed for kukersite. Oxygen groups in the coals can overall be correlated to the least-altered huminite macerals textinite, texto-ulminite, and densinite, or to the associated cutinite and sporinite, whereas the variation of the oxygen group composition in the studied shales seems to be controlled by thermal maturity. Hydrogen Index (HI) values of chemically oxidised and/or reduced coal samples do not provide an unequivocal answer to whether HI values of immature coals are underestimated. Incorporation of carboxyl groups into the original coal kerogen does not produce a more immature coal manifested by decreased HI values. [Copyright &y& Elsevier]

Background and Objectives: Chronic pain, dementia, and depression may reduce activities of daily life in elderly people. We evaluated the correlation between pain intensity and daily activities, cognitive state, and depression, as well as their interrelationships in home-dwelling elderly people with chronic pain. Methods: Forty-one elderly home-dwelling people who suffered from long-lasting pain, and who participated in a rehabilitation program, were enrolled. Severity of pain at rest and after pain-provoked motion was assessed on a visual analog scale (VAS, 0 to 100) and a 5-point verbal rating scale (VRS). Cognitive status was assessed with the mini-mental state examination (MMSE, 0 to 30), depression on the geriatric depression scale (GDS, 0 to 15), and functional ability in daily life was assessed with the Barthel Index (0 to 100). Results: VAS and VRS scores correlated positively with each other. Rating pain at rest on the VRS (mean 1.0, median 1) correlated with severity of depression (GDS mean 5.4) ( r = 0.3997, P < 0.01), while scores on the VAS did not. Pain ratings at rest did not correlate with the Barthel Index (mean 87.7), but the latter correlated positively with motion-evoked VRS pain scores (mean 2.8, median 3) ( r = 0.42829, P < 0.01). The MMSE (mean 25.3) did not correlate with any pain parameter, but it correlated positively with the Barthel Index ( r = 0.3660, P < 0.05). The Barthel Index correlated negatively with the GDS ( r = −0.39969, P < 0.01). Conclusion: In home-dwelling elderly people, chronic pain states do not seem to reduce daily activities as much as cognitive dysfunction and depression. The seemingly controversial finding of a positive correlation between daily activities and pain in motion, and lack of correlation with pain at rest, may be explained by a relatively low intensity of pain in our study people. [ABSTRACT FROM AUTHOR]

Background and Objectives: The surgical site for the creation of an arteriovenous fistula at the lateral aspect of the distal forearm may be faster and more effectively blocked with the infraclavicular coracoid approach than with the axillary approach for brachial plexus block.Methods: Sixty uremic patients scheduled for the creation of an arteriovenous fistula at the forearm were randomized to receive a single-injection brachial plexus block with 35 to 50 mL mepivacaine 0.95% with epinephrine using the infraclavicular coracoid approach (IC group) or the perivascular axillary approach (AX group). A distal muscular contraction elicited by a nerve stimulator at current <0.5 mA was used in all patients.Results: At 30 and 45 minutes, complete loss of sensation was observed more often in group IC than AX in the cutaneous distribution of musculocutaneous nerve (62% v 30% [P < .05] and 69% v 40%, respectively [P < .05]), but at 60 minutes the difference was not statistically significant. In other areas, analgesia and motor block were achieved at a similar rate. In 3 patients surgery could not be performed under the block due to changes in schedule or the use of a brachial tourniquet. Patient satisfaction was equally high in both groups.Conclusions: Blockade of the musculocutaneous nerve developed faster with the infraclavicular coracoid approach than with the axillary approach. The infraclavicular coracoid approach may be preferable in patients scheduled for the creation of an arteriovenous fistula at the forearm. [ABSTRACT FROM AUTHOR]

Abstract: Mutations in the β-tubulin gene have been proposed as a resistance mechanism to paclitaxel. We therefore investigated the presence of mutations in the β-tubulin M40 gene in 40 ovarian tumours (16 paraffin-embedded and 24 freshly frozen) selected for good or poor response to chemotherapy with paclitaxel or non-tubulin-affecting regimens. The presence of mutations was investigated using single strand conformation analysis followed by sequencing of the products with altered mobility. No sequence variants in the exons of the β-tubulin M40 gene were detected. Non-reproducible shifts were identified, in eight out of 16 paraffin embedded samples. This may explain some of the previously published discrepancies. In conclusion, sequence variants in the β-tubulin M40 gene are rare and are unlikely to be a clinically relevant explanation of resistance to paclitaxel. [Copyright &y& Elsevier]

Background: Adequate intraoperative analgesia combined with faster mobilization might be achieved by replacing hyperbaric ropivacaine partly with fentanyl.Methods: Sixty spinal anesthesia patients were randomized into 2 groups of either fentanyl 20 microg mixed with hyperbaric ropivacaine 10 mg (group FR10) or hyperbaric ropivacaine 15 mg (group R15). Forty-five patients underwent inguinal hernia repair and 15 patients had lower extremity surgery. Sensory block was tested by pinprick, and motor block was tested by use of a modified Bromage scale at 5-minute intervals for 30 minutes, 15-minute intervals for 60 minutes, and at 30-minute intervals until full recovery.Results: The groups did not differ significantly regarding success (27 of 30 [group FR10] and 29 of 30 [group R15]), median onset time (10 [5 to 25] v 10 [5 to 20] minutes) or median duration of T10 sensory block (55 [20 to 115] v 80 [5 to 170] minutes), respectively. Recovery from spinal block was significantly quicker in group FR10 than in group R15, recorded in ability to walk (2.5 hours v 3 hours [P=.017]), full motor recovery (1 hour v 1.5 hour [ P <.001]), and sensory recovery to S1 (2.5 hours v 3.3 hours [ P=.026]). Pruritus occurred in 18 (60%) of group FR10 v 0 of group R15 patients ( P <.001). This symptom was mild in all except 1 patient, who received ondansetron 8 mg IV. In the OR, the groups did not differ hemodynamically: 9 (30%) of the group FR10 and 10 (33%) of the group R15 patients, respectively, required medication for hypotension and/or bradycardia. Full motor block (Bromage 3) developed less frequently (P <.001) in group FR10 patients than in group R15 patients (1 [3%] v 14 [47%]), and the group FR10 patients recovered faster in a median time of 60 v 90 minutes (P <.001). In both groups, sensory and motor blocks were more extensive on the operative side compared with the nonoperative side ( P <.001).Conclusion: Faster mobilization but equal onset and duration of analgesia were achieved with intrathecal hyperbaric ropivacaine 10 mg plus fentanyl 20 microg as compared with hyperbaric ropivacaine 15 mg. [ABSTRACT FROM AUTHOR]

An increasing number of herbicides are found in our groundwater environments. This underlines the need for examining the effects of herbicide exposure on the indigenous groundwater microbial communities, as microbial degradation is the major process responsible for the complete removal of most contaminants. We examined the effect of in situ exposure to realistic low concentrations of herbicides on the microbial diversity and community structure of sub-surface sediments from a shallow aquifer near Vejen (Denmark). Three different community analyses were performed: colony morphology typing, sole-carbon source utilisation in Biolog®EcoPlates, and denaturing gradient gel electrophoresis. Cluster analysis demonstrated that the microbial communities of those aquifer sediments that acclimated to the herbicide exposure also had similar community structure. This observation was concurrent for all three community analyses. In contrast, no significant effect was found on the bacterial diversity, except for the culturable fraction where a significantly increased richness and Shannon index was found in the herbicide acclimated sediments. The results of this study show that in situ exposure of sub-surface aquifers to realistic low concentrations of herbicides may alter the overall structure of a natural bacterial community, although significant effects on the genetic diversity and carbon substrate usage cannot be detected. The observed impact was probably due to indirect effects. In future investigations, the inclusion of methods that specifically detect relevant microbial sub-populations and functional genes is therefore recommended. [Copyright &y& Elsevier]

The antinociceptive effects of dexmedetomidine, a highly selective new α2-adrenoceptor agonist, were evaluated in rats after intrathecal, intraperitoneal and subcutaneous administration. Antinociception was tested using the tail-flick method. Both 3 and 6 μg of intrathecal dexmedetomidine produced maximal antinociception within 10 min. The effect lasted for up to 6 hr. The smaller dose of 1.5 μg produced a mean antinociception of 50% (of the maximum possible effect, MPE%) which lasted for about 2 hr. Subcutaneous atipamezole, a specific α2-adrenergic antagonist completely abolished the antinociception produced by intrathecal dexmedetomidine. When given intraperitoneally, dexmedetomidine produced on average a 50% antinociceptive effect with the highest dose of 60 μg/kg. The lower doses of 10 and 30 μg/kg were ineffective. After subcutaneous administration a maximal effect was achieved with 120 μg/kg, a 70% effect, on average, with 60 μg/kg and a short lasting effect of 60% with 30 μg/kg. In conclusion, dexmedetomidine is a very potent antinociceptive agent when given intrathecally to rats. [ABSTRACT FROM AUTHOR]

Purpose. Reduction of the frequency of injections and localization of the absorption of drug molecules to the injection site would be of great advantage in epidural pain treatment. The epidural use of a controlled release gel of lidocaine and ibuprofen was studied. Methods. The effect of a poloxamer gel (25%) containing 2% lidocaine ⋅HC1 and 2% ibuprofen ⋅ Na on the duration of analgesia after epidural administration to pigs was compared with drug in solution. Analgesia was assessed by observing the motor function and the nociceptive reflex-withdrawal response to painful pressure stimulation on the feet. Pharmacokinetic and histological examinations were performed. Results. Analgesia lasted significantly longer after epidural lidocaine gel injection in comparison with the solution. The gel prolonged the systemic absorption, thereby increasing the epidural availability of lidocaine for spinal analgesia. Although the absorption of ibuprofen was prolonged after epidural gel injection, the duration of analgesia as compared with the solution was not prolonged. After epidural injection, only slight inflammatory changes were observed in the tissue structures of the epidural space, but none in the spinal cord. Conclusions. These results demonstrate poloxamer gel to be a promising controlled-release, injectable epidural formulation for the management of pain. [ABSTRACT FROM AUTHOR]

Purpose. Methods of delaying the action of local anesthetics are important, since short duration of action limits their use in the treatment of postoperative and chronic pain. The present study evaluated the use of low-viscosity gels in prolonging the release of lidocaine. Methods. Release of lidocaine from 2% lidocaine-HC1 containing methylcellulose (MC), hydroxypropylmethylcellulose (HPMC), sodiumcarboxymethyl cellulose (CMC), and poloxamer 407 (PO) gels was studied in phosphate buffer, pH 7.4, at 37°C. Commercial metylcellulose gel (MC) served as control. The in vivo efficacy of the respective gel formulations were evaluated in rats. The gel was injected into the vicinity of the sciatic nerve and nociception and motor function were tested. Results. The cumulative amount of lidocaine released during 8 hr was slowest from the PO gel, followed by the CMC, HPMC and MC gels. The antinociceptive effect was not prevented by the motor block and lasted longest with the PO gel. Good linear and rank order correlation was obtained between in vitro and in vivoresults. The microscopic examination of the tissue samples revealed only mild or no irritation of the skeletal muscle tissue by the PO, HPMC, and CMC gels. Conclusions. Based on these results poloxamer gel proved to be the most promising carrier for lidocaine. [ABSTRACT FROM AUTHOR]