Liposomal bupivacaine is purported to extend analgesia of peripheral nerve blocks when administered perineurally. However, evidence of the clinical effectiveness of perineural liposomal bupivacaine ...is mixed. This meta-analysis seeks to evaluate the effectiveness of perineural liposomal bupivacaine in improving peripheral nerve block analgesia as compared with nonliposomal local anesthetics.
The authors identified randomized trials evaluating the effectiveness of peripheral nerve block analgesic that compared liposomal bupivacaine with nonliposomal local anesthetics. The primary outcome was the difference in area under the receiver operating characteristics curve (AUC) of the pooled 24- to 72-h rest pain severity scores. Secondary outcomes included postoperative analgesic consumption, time to first analgesic request, incidence of opioid-related side effects, patient satisfaction, length of hospital stay, liposomal bupivacaine side effects, and functional recovery. AUC pain scores were interpreted in light of a minimal clinically important difference of 2.0 cm · h.
Nine trials (619 patients) were analyzed. When all trials were pooled, AUC pain scores ± SD at 24 to 72 h were 7.6 ± 4.9 cm · h and 6.6 ± 4.6 cm · h for nonliposomal and liposomal bupivacaine, respectively. As such, perineural liposomal bupivacaine provided a clinically unimportant benefit by improving the AUC (95% CI) of 24- to 72-h pain scores by 1.0 cm · h (0.5 to 1.6; P = 0.003) compared with nonliposomal bupivacaine. Excluding an industry-sponsored trial rendered the difference between the groups nonsignificant (0.7 cm · h -0.1 to 1.5; P = 0.100). Secondary outcome analysis did not uncover any additional benefits to liposomal bupivacaine in pain severity at individual timepoints up to 72 h, analgesic consumption, time to first analgesic request, opioid-related side effects, patient satisfaction, length of hospital stay, and functional recovery. No liposomal bupivacaine side effects were reported.
Perineural liposomal bupivacaine provided a statistically significant but clinically unimportant improvement in the AUC of postoperative pain scores compared with plain local anesthetic. Furthermore, this benefit was rendered nonsignificant after excluding an industry-sponsored trial, and liposomal bupivacaine was found to be not different from plain local anesthetics for postoperative pain and all other analgesic and functional outcomes. High-quality evidence does not support the use of perineural liposomal bupivacaine over nonliposomal bupivacaine for peripheral nerve blocks.
Structure of caesium disulfate at 120 and 273 K Ståhl, Kenny; Berg, Rolf W.; Eriksen, K. Michael ...
Acta crystallographica. Section B, Structural science,
October 2009, Letnik:
65, Številka:
5
Journal Article
Recenzirano
The crystal structures of Cs2S2O7 at 120 and 273 K have been determined from X‐ray single‐crystal data. Caesium disulfate represents a new structure type with a uniquely high number of independent ...formula units at 120 K: In one part caesium ions form a tube surrounding the disulfate ions, Cs8(S2O7)6+n; in the other part a disulfate double‐sheet sandwiches a zigzagging caesium ion chain, Cs2(S2O7)6−n. Caesium disulfate shows an isostructural order–disorder transition between 230 and 250 K, where two disulfate groups become partially disordered above 250 K. The Cs+‐ion arrangement shows a remarkable similarity to the high‐pressure RbIV metal structure.
Idiopathic membranous nephropathy is an autoimmune disease. In approximately 70% of patients, it is associated with autoantibodies against the phospholipase A2 receptor 1 (PLA2R1). Antigenic targets ...in the remaining patients are unknown.
Using Western blotting, we screened serum samples from patients with idiopathic membranous nephropathy, patients with other glomerular diseases, and healthy controls for antibodies against human native glomerular proteins. We partially purified a putative new antigen, identified this protein by means of mass spectrometry of digested peptides, and validated the results by analysis of recombinant protein expression, immunoprecipitation, and immunohistochemical analysis.
Serum samples from 6 of 44 patients in a European cohort and 9 of 110 patients in a Boston cohort with anti-PLA2R1-negative idiopathic membranous nephropathy recognized a glomerular protein that was 250 kD in size. None of the serum samples from the 74 patients with idiopathic membranous nephropathy who were seropositive for anti-PLA2R1 antibodies, from the 76 patients with other glomerular diseases, and from the 44 healthy controls reacted against this antigen. Although this newly identified antigen is clearly different from PLA2R1, it shares some biochemical features, such as N-glycosylation, membranous location, and reactivity with serum only under nonreducing conditions. Mass spectrometry identified this antigen as thrombospondin type-1 domain-containing 7A (THSD7A). All reactive serum samples recognized recombinant THSD7A and immunoprecipitated THSD7A from glomerular lysates. Moreover, immunohistochemical analyses of biopsy samples from patients revealed localization of THSD7A to podocytes, and IgG eluted from one of these samples was specific for THSD7A.
In our cohort, 15 of 154 patients with idiopathic membranous nephropathy had circulating autoantibodies to THSD7A but not to PLA2R1, a finding that suggests a distinct subgroup of patients with this condition. (Funded by the French National Center for Scientific Research and others.).
Exploring the construct of social-responsibility orientation across three Asian and two Western societies (Germany, Hong Kong, Japan, South Korea, and the United States), we show evidence that ...top-level executives in these societies hold fundamentally different beliefs about their responsibilities toward different stakeholders, with concomitant implications for their understanding and enactment of responsible leadership. We further find that these variations are more closely aligned with institutional factors than with cultural variables, suggesting a need to clarify the connection between culture and institutions on the one hand and culture and social-responsibility orientations on the other.
What drives Chinese MNEs’ global CSR integration and local CSR responsiveness? Drawing on institutional theory, we argue that both antecedents reflecting globally isomorphic patterns of adaptation ...and antecedents mirroring the distinct characteristics of China’s institutional context are relevant. We support our argument using fuzzy-set qualitative comparative analysis on a sample of 29 of China’s globally most influential companies. We find that state influence and global CSR associations affect global CSR integration, whereas presence in the West and internationalization through mergers and acquisitions predict local CSR responsiveness. Our study thus suggests that home-country characteristics are an important co-determinant of the CSR approaches of emerging-market MNEs. We further find that multicultural experience in top management teams is associated with both global CSR integration and local CSR responsiveness, supporting notions of transnational CSR.
Background. Encephalitis continues to result in substantial morbidity and mortality worldwide. Advances in diagnosis and management have been limited, in part, by a lack of consensus on case ...definitions, standardized diagnostic approaches, and priorities for research. Methods. In March 2012, the International Encephalitis Consortium, a committee begun in 2010 with members worldwide, held a meeting in Atlanta to discuss recent advances in encephalitis and to set priorities for future study. Results. We present a consensus document that proposes a standardized case definition and diagnostic guidelines for evaluation of adults and children with suspected encephalitis. In addition, areas of research priority, including host genetics and selected emerging infections, are discussed. Conclusions. We anticipate that this document, representing a synthesis of our discussions and supported by literature, will serve as a practical aid to clinicians evaluating patients with suspected encephalitis and will identify key areas and approaches to advance our knowledge of encephalitis.
The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially ...published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system.
Review of evidence-based literature, along with expert consensus opinion.
International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men.
The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification.
Consensus statement.
The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae.
These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.
The hydrofluorocarbon HFC 134a (CF3CFH2) is the primary replacement for the chlorofluorocarbon CFC 12 (CF2Cl2) in numerous applications, including automobile air conditioning and home and commercial ...refrigeration. Here we describe a comprehensive spectroscopic study of this molecule. Precise microwave frequencies and molecular constants have been obtained for the vibrational ground state with a pulsed-molecular-beam Fourier-transform microwave spectrometer. New isotopic ground-state microwave measurements have also been made to improve the ground-state structural determination. Infrared and Raman spectra have been obtained, and all 18 vibrations have been observed and assigned. A high-resolution (3 MHz) microwave-sideband CO2 laser and an electric-resonance optothermal spectrometer have been used to observe the molecular-beam infrared spectrum in the vicinity of the low-resolution gas-phase feature at 975 cm-1 assigned here and in some of the earlier studies as the ν15, A‘‘-symmetry, CH2 rock. Two nearly equal-intensity c-type bands are observed under high resolution with origins at 974.35 and 974.87 cm-1. The presence of two vibrational bands of A‘‘ symmetry is attributed to strong anharmonic mixing of the ν15 vibration with a nearby combination vibration. On the basis of our low-resolution infrared measurements, we identify the perturbing state as the 3ν18 + ν8 combination level. Finally, the experimental results are used to calculate the vibrational contribution to the heat capacity and are compared with the results of earlier experimental and theoretical work, including our own electronic-structure calculations using an HF/6-31G* basis set.
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