Summary
Surgery is the primary therapeutic intervention for breast cancer and can result in significant postoperative pain. We searched the current literature and performed a meta‐analysis in order ...to compare the analgesic efficacy of the pectoral type‐2 (Pecs II) block with systemic analgesia alone and with a thoracic paravertebral block for breast cancer surgery. Primary outcome was postoperative opioid consumption in the first 24 h after surgery. Secondary outcomes were pain scores at 0, 3, 6, 9 and 24 h after surgery, intra‐operative opioid consumption, time to first analgesic request and incidence of postoperative nausea and vomiting. We identified 13 randomised controlled trials that included 815 patients. The Pecs II block significantly reduced postoperative opioid consumption (standardised difference in means: −13.64 mg oral morphine equivalents; 95%CI: −21.22 to −6.05; p < 0.01) and acute postoperative pain at all intervals in the first 24 h after surgery compared with systemic analgesia alone. Compared with the thoracic paravertebral block, the Pecs II block resulted in similar postoperative opioid consumption (standardised difference in means: −8.73 mg oral morphine equivalents; 95%CI: −18.16 to 0.69; p = 0.07) and postoperative pain scores after first measurement. In conclusion, the Pecs II block offers improved analgesic efficacy compared with systemic analgesia alone and comparable analgesic efficacy to a thoracic paravertebral block for breast cancer surgery.
Summary
Regional anaesthesia has undergone several exciting advances in the past few decades. Ultrasound‐guided techniques of peripheral nerve blockade have become the gold standard thanks to the ...associated improvements in efficacy, ease of performance and safety. This has increased the accessibility and utilisation of regional anaesthesia in the anaesthesia community at large and is timely given the mounting evidence for its potential benefits on various patient‐centred outcomes, including major morbidity, cancer recurrence and persistent postoperative pain. Ultrasound guidance has also paved the way for refinement of the technical performance of existing blocks concerning simplicity and safety, as well as the development of new regional anaesthesia techniques. In particular, the emergence of fascial plane blocks has further broadened the application of regional anaesthesia in the management of painful conditions of the thorax and abdomen. The preliminary results of investigations into these fascial plane blocks are promising but require further research to establish their true value and role in clinical care. One of the challenges that remains is how best to prolong regional anaesthesia to maximise its benefits while avoiding undue harm. There is ongoing research into optimising continuous catheter techniques and their management, intravenous and perineural pharmacological adjuncts, and sustained‐release local anaesthetic molecules. Finally, there is a growing appreciation for the critical role that regional anaesthesia can play in an overall multimodal anaesthetic strategy. This is especially pertinent given the current focus on eliminating unnecessary peri‐operative opioid administration.
Animal toxins that modulate the activity of voltage-gated sodium (Na
) channels are broadly divided into two categories-pore blockers and gating modifiers. The pore blockers tetrodotoxin (TTX) and ...saxitoxin (STX) are responsible for puffer fish and shellfish poisoning in humans, respectively. Here, we present structures of the insect Na
channel Na
PaS bound to a gating modifier toxin Dc1a at 2.8 angstrom-resolution and in the presence of TTX or STX at 2.6-Å and 3.2-Å resolution, respectively. Dc1a inserts into the cleft between VSD
and the pore of Na
PaS, making key contacts with both domains. The structures with bound TTX or STX reveal the molecular details for the specific blockade of Na
access to the selectivity filter from the extracellular side by these guanidinium toxins. The structures shed light on structure-based development of Na
channel drugs.
Summary
Regional anaesthesia is often helpful in improving respiratory function and analgesia following multiple rib fractures. The erector spinae plane block has become the technique of choice in ...our institution due to its relative simplicity and purported safety. The aim of this retrospective cohort study was to determine its effectiveness in improving respiratory and analgesic outcomes. We reviewed electronic medical records of patients with traumatic rib fractures admitted to a level‐one trauma centre between January 2016 and July 2017, who also received erector spinae plane blocks. We analysed the following outcomes before and up to 72 h after erector spinae plane blockade: incentive spirometry volume; maximum numerical rating scale static pain scores; and 12‐h opioid consumption. Pre‐ and post‐block data were compared. We included 79 patients, 77% of whom received continuous erector spinae plane block for a mean (SD) of 3.7 (1.9) days. The majority (85%) had other associated injuries. Incentive spirometry volumes improved from 784 (694) to 1375 (667) ml (p < 0.01) during the first 24 h following erector spinae plane blockade. Pain scores were reduced from 7.7 (2.5) to 4.7 (3.2) in the first three hours (p < 0.01). Reductions in opioid consumption were observed but did not achieve statistical significance. These improvements were largely sustained for up to 72 h. Mean arterial blood pressure remained unchanged from baseline. In conclusion, erector spinae plane blocks were associated with improved inspiratory capacity and analgesic outcomes following rib fracture, without haemodynamic instability. We propose that it should be considered to be a viable alternative to other regional analgesic techniques when these are not feasible.
Summary
Laparoscopic ventral hernia repair is an operation associated with significant postoperative pain, and regional anaesthetic techniques are of potential benefit. The erector spinae plane (ESP) ...block performed at the level of the T5 transverse process has recently been described for thoracic surgery, and we hypothesised that performing the ESP block at a lower vertebral level would provide effective abdominal analgesia. We performed pre‐operative bilateral ESP blocks with 20–30 ml ropivacaine 0.5% at the level of the T7 transverse process in four patients undergoing laparoscopic ventral hernia repair. Median (range) 24‐h opioid consumption was 18.7 mg (0.0–43.0 mg) oral morphine. The highest and lowest median (range) pain scores in the first 24 h were 3.5 (3.0–5.0) and 2.5 (0.0–3.0) on an 11‐point numerical rating scale. We also performed the block in a fresh cadaver and assessed the extent of injectate spread using computerised tomography. There was radiographic evidence of spread extending cranially to the upper thoracic levels and caudally as far as the L2–L3 transverse processes. We conclude that the ESP block is a promising regional anaesthetic technique for laparoscopic ventral hernia repair and other abdominal surgery when performed at the level of the T7 transverse process. Its advantages are the ability to block both supra‐umbilical and infra‐umbilical dermatomes with a single‐level injection and its relative simplicity.
Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as part of a multimodal analgesic strategy for thoracic and breast surgery and have gained popularity with the advent of ...ultrasound guidance. However, this role is poorly defined in the context of abdominal surgery. We performed a systematic review of randomized controlled trials, to clarify the impact of TPVB on perioperative analgesic outcomes in adult abdominal surgery. We identified 20 published trials involving a total of 1044 patients that met inclusion criteria; however there was significant heterogeneity in terms of type of surgery, TPVB technique, comparator groups and study quality. Pain scores and opioid requirements in the early postoperative period were generally improved when compared with systemic analgesia, but there was insufficient evidence for any definitive conclusions regarding comparison with epidural analgesia or other peripheral block techniques, or the benefit of continuous TPVB techniques. The reported primary block failure rate was 2.8% and the incidence of complications was 1.2% (6/504); there were no instances of pneumothorax. TPVB therefore appears to be a promising analgesic technique for abdominal surgery in terms of efficacy and safety. But further well-designed and adequately powered studies are needed to confirm its utility, particularly with respect to other regional anaesthesia techniques.
A history of modern European cultural pluralism, its current crisis, and its uncertain future
In 2010, the leaders of Germany, Britain, and France each declared that multiculturalism had failed in ...their countries. Over the past decade, a growing consensus in Europe has voiced similar decrees. But what do these ominous proclamations, from across the political spectrum, mean? From the influx of immigrants in the 1950s to contemporary worries about refugees and terrorism, The Crisis of Multiculturalism in Europeexamines the historical development of multiculturalism on the Continent. Rita Chin argues that there were few efforts to institute state-sponsored policies of multiculturalism, and those that emerged were pronounced failures virtually from their inception. She shows that today's crisis of support for cultural pluralism isn't new but actually has its roots in the 1980s.
Chin looks at the touchstones of European multiculturalism, from the urgent need for laborers after World War II to the public furor over the publication ofThe Satanic Versesand the question of French girls wearing headscarves to school. While many Muslim immigrants had lived in Europe for decades, in the 1980s they came to be defined by their religion and the public's preoccupation with gender relations. Acceptance of sexual equality became the critical gauge of Muslims' compatibility with Western values. The convergence of left and right around the defense of such personal freedoms against a putatively illiberal Islam has threatened to undermine commitment to pluralism as a core ideal. Chin contends that renouncing the principles of diversity brings social costs, particularly for the left, and she considers how Europe might construct an effective political engagement with its varied population.
Challenging the mounting opposition to a diverse society,The Crisis of Multiculturalism in Europepresents a historical investigation into one continent's troubled relationship with cultural difference.
State-of-the-knowledge on TWIP steel De Cooman, B C; Kwon, O; Chin, K-G
Materials science and technology,
05/2012, Letnik:
28, Številka:
5
Journal Article
Recenzirano
High Mn twinning induced plasticity (TWIP) steel is a new type of structural steel, characterised by both high strength and superior formability. TWIP steel offers an extraordinary opportunity to ...adjust the mechanical properties of steel by modifying the strain hardening. The use of TWIP steel may therefore lead to a considerable lightweighting of steel components, a reduction of material use and an improved press forming behaviour. These key advantages will help implement current automotive vehicle design trends which emphasise a reduction of greenhouse gas emissions and lowering of fuel consumption. In addition, high strength TWIP steel will effectively contribute to weight containment in vehicles equipped with hybrid and electric motors, as these are considerably heavier than conventional motors. The present review addresses all aspects of the physical metallurgy of the high strength TWIP steel with a special emphasis on the properties and key advantages of TWIP sheet steel products relevant to automotive applications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
In an effort to comprehend activism toward corporations, scholars have proposed the concept of corporate opportunity structure, or the attributes of individual firms that make them more (or less) ...attractive as activist targets. We theorize that the personal values of the firm's elite decision makers constitute a key element of this corporate opportunity structure. We specifically consider the political ideology—conservatism versus liberalism—of the company's CEO as a signal for employees who are considering the merits of engaging in activism. To test of our theory, we examine the formation of lesbian, gay, bisexual, and transgender employee groups in major companies in the period 1985-2004, when the formation of such groups was generally perceived to be risky for participants. Using CEOs' records of political donations to measure their personal ideologies, we find strong evidence that the political liberalism of CEOs influences the likelihood of activism. We also find that CEOs' ideologies influence activism more strongly when CEOs are more powerful, when they oversee more conservative (i.e., less liberal) workplaces, and when the social movement is in the early phase of development. We identify theoretical and practical implications, as well as future research opportunities.
This article examines the influence on organizational outcomes of CEOs' political ideology, specifically political conservatism vs. liberalism. We propose that CEOs' political ideologies will ...influence their firms' corporate social responsibility (CSR) practices, hypothesizing that (1) liberal CEOs will emphasize CSR more than will conservative CEOs; (2) the association between a CEO's political ideology and CSR will be amplified by a CEO's relative power; and (3) liberal CEOs will emphasize CSR even when recent financial performance is low, whereas conservative CEOs will pursue CSR initiatives only as performance allows. We test our ideas with a sample of 249 CEOs, measuring their ideologies by coding their political donations over the ten years prior to their becoming CEOs. Results indicate that the political ideologies of CEOs are manifested in their firms' CSR profiles. Compared with conservative CEOs, liberal CEOs exhibit greater advances in CSR; the influence of CEOs' political liberalism on CSR is amplified when they have more power; and liberal CEOs' CSR initiatives are less contingent on recent performance than are those of conservative CEOs. In a corroborative exploration, we find that CEOs' political ideologies are significantly related to their corporate political action committee allocations, indicating that this largely unexplored executive attribute might be more widely consequential.
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