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.
Small differences between the lattice energies of different zeolites suggest that kinetic factors are of major importance in controlling zeolite nucleation. Thus, it is critical to control the ...nucleation kinetics in order to obtain a desired microporous material. Here, we demonstrate how careful investigation of the very early stages of zeolite crystallization in colloidal systems can provide access to important nanoscale zeolite phases while avoiding the use of expensive organic templates. We report the effective synthesis of ultrasmall (6-to 15-nanometer) crystals of the large-pore zeolite EMT from template-free colloidal precursors at low temperature (30°C) and very high yield.
We show that cerebral endothelial cells secrete trophic factors that support the survival and proliferation of rat oligodendrocyte precursor cells (OPCs). This OPC-supportive phenomenon was mediated ...by Akt and Src signaling pathways. Noncytotoxic levels of oxidative stress downregulate trophic factor production and disrupt the ability of cerebral endothelial cells to support OPCs. These data suggest that a novel oligovascular niche may be important for sustaining oligodendrocyte renewal and homeostasis in mammalian brain.
Rainfall-induced slope failure occurs in many parts of the world, especially in the tropics. Many rainfall-induced slope failures have been attributed to antecedent rainfalls. Although it has been ...identified as a cause of rainfall-induced slope failure, the pattern or distribution of the antecedent rainfall has not received adequate attention. In this study, parametric studies were performed by using three typical rainfall patterns, identified by analysis of available rainfall data for Singapore and two different soil types to represent high- and low-conductivity residual soils of Singapore. Antecedent rainfall patterns were applied on soil slopes and a transient seepage analysis was conducted. The computed pore-water pressures were used in stability analyses to calculate the safety factor of the slope. Results indicated that antecedent rainfall affected the stability of both high-conductivity (HC) and low-conductivity (LC) soil slopes. However, the stability of the LC soil slope was more significantly affected than the HC soil slope. Patterns of antecedent rainfall controlled the rate of decrease in factor of safety, the time corresponding to Fs(min) and the value of Fs(min). Delayed rainfall pattern resulted in the lowest minimum factor of safety, Fs(min), for the HC soil slope, and advanced rainfall pattern resulted in the lowest Fs(min) for the LC soil slope.
A fibre population study was conducted on the parapets (a low wall along the edge of the walkway) of ten housing estates in Singapore. For each location, the ninth and tenth storeys were investigated ...and a total of 1256 fibres were classified according to colour and generic fibre class. Being a cosmopolitan city with tropical rainforest climate and no true distinct season, the predominant clothing style in Singapore is one that is light, comfortable and modern. Approximately half of the fibres recovered were cotton (48.3%), with polyester fibres making up the next one-third (31.4%) and rayon fibres in the third place (16.2%). Grey/black (27.7%) and blue (24.2%) constitute the top two most popular colours, together accounting for approximately half of all classified colours. The possibility of establishing subgroups of indistinguishable fibres was investigated by microscopical and fluorescence properties. The number of groups found per location varies from 1 to 3, with each group containing between 2 and 3 fibres. The findings of this study would provide the forensic fibre examiner an overall outlook on what are the abundant (or uncommon) fibre types in Singapore context, thereby assisting the examiner to assess the strength of fibre evidence in casework.
•Fibre population study in Singapore.•Rankings of fibres by fibre colour, class and type, including colourless synthetic fibres.•Rayon fibres was one of the abundant fibre types.•A common fabric type does not equate to its fibre being common in the random population.
Endothelial progenitor cells (EPCs) have been pursued as a potential cellular therapy for stroke and central nervous system injury. However, their underlying mechanisms remain to be fully defined. ...Recent experimental studies suggest that mitochondria may be released and transferred between cells. In this proof-of-concept study, we asked whether beneficial effects of EPCs may partly involve a mitochondrial phenomenon as well. First, EPC-derived conditioned medium was collected and divided into supernatant and particle fractions after centrifugation. Electron microscopy, Western blots, and flow cytometry showed that EPCs were able to release mitochondria. ATP and oxygen consumption assays suggested that these extracellular mitochondria may still be functionally viable. Confocal microscopy confirmed that EPC-derived extracellular mitochondria can be incorporated into normal brain endothelial cells. Adding EPC particles to brain endothelial cells promoted angiogenesis and decreased the permeability of brain endothelial cells. Next, we asked whether EPC-derived mitochondria may be protective. As expected, oxygen-glucose deprivation (OGD) increased brain endothelial permeability. Adding EPC-derived mitochondria particles to the damaged brain endothelium increased levels of mitochondrial protein TOM40, mitochondrial DNA copy number, and intracellular ATP. Along with these indirect markers of mitochondrial transfer, endothelial tightness was also restored after OGD. Taken together, these findings suggest that EPCs may support brain endothelial energetics, barrier integrity, and angiogenic function partly through extracellular mitochondrial transfer. Stem Cells 2018;36:1404-1410.
PTEN is a dual-specificity phosphatase and well-known tumor suppressor gene. When functioning properly, it works in its canonical pathway to inhibit AKT/mTOR and MAPK signaling, leading to cell death ...and growth regulation. PTEN mutations cause dysregulation of these pathways, resulting in cellular proliferation and overgrowth. When germline mutations are present as in patients with PTEN Hamartoma Tumor Syndrome (PHTS), benign and malignant neoplasias occur as well as cerebral overgrowth and neurodevelopmental abnormalities. This review article will summarize recent laboratory and clinical investigations relating to PTEN, highlighting the overgrowth aspects of this syndrome and the molecular drivers behind these key phenotypes. Finally, therapies developed targeted the PI3K/AKT/mTOR pathway for other tumor predisposition syndromes will be discussed.
Objectives
This study aimed to scope the psychological support practices of Australian health professionals providing supportive care to adults with primary brain tumor.
Method
Health professionals ...from multidisciplinary organizations and cancer support services completed an online survey focused on psychological support for people with brain tumor (PwBT) and family members, and perceived barriers or gaps in support provision.
Results
107 professionals, mainly from psychology (45%), nursing (20%), and social work (10%) backgrounds, completed the survey. Scope of practice differed according to discipline, with psychologists and nurses most likely to screen for psychological distress (71%–76%), and psychologists more typically providing at least one psychological support session (78%). Psychologists were more likely to screen for cognitive impairment (31%), whereas nurses and social workers more commonly provided family‐based support (62%–73%). Psychological support was more frequently provided in the long‐term management phase (78%) than early post‐diagnosis/treatment (45%). System‐level barriers to accessing psychological support were most frequently identified, which included limited resources and funding, insufficient staff time, lengthy waitlists and costs, poor service coordination, and lack of staff with brain tumor‐specific training.
Conclusions
The provision of psychological support for PwBT varies according to discipline, setting and management phase. Further research on different models of psychosocial care is needed to inform strategies to address organizational and policy factors impacting professionals' scope of practice.
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