Ophthalmic loco-regional anaesthesia: Reducing discomfort during injection

Loco-regional anaesthesia is commonly used for both intraocular and extraocular surgical procedures, although the provision and use of the anaesthetic technique varies worldwide. Injection techniques (retrobulbar, peribulbar and sub-Tenon’s blocks) are associated with significant pain; indeed, many patients have a fear of pain. Discomfort during injection can, however, be reduced and patients can be made comfortable through reassurance, careful performance of the technique and the provision of sedation and/or analgesia. In this article, the authors describe common loco-regional anaesthetic techniques and measures to reduce discomfort during injection, thus improving patient satisfaction

Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome

Background: Platelet-leukocyte gel (PLG) is being used during various surgical procedures in an attempt to enhance the healing process. We studied the effects of PLG on postoperative recovery of patients undergoing open subacromial decompression (OSD). Methods: PLG was produced from platelet-leukocyte-rich plasma (P-LRP), prepared from a unit of whole blood. Forty patients were included in the study. Self-assessed evaluations, using the American Shoulder and Elbow Surgeons scoring system of activities of daily living (ADL), joint instability, pain levels, pain medications, and clinical evaluations for range of motion were conducted. Results: Platelet and leukocyte counts were significantly increased in the P-LRP compared to baseline counts. Treated patients demonstrated decreased visual analog scales for pain and used significantly less pain medication, had an improved range of motion during passive forward elevation, external rotation, external rotation with arm at 90 degrees abduction, internal rotation, and cross body adduction compared to control patients (p < 0.001). No differences in the instability score were observed between the groups. Furthermore, treated patients performed more ADL (p < 0.05). Conclusion: In the PLG-treated group, recovery was faster and patients returned earlier to daily activities and also took less pain medication than control subjects

Mast Cell and Astrocyte Hemichannels and Their Role in Alzheimer\u27s Disease, ALS, and Harmful Stress Conditions

Considered relevant during allergy responses, numerous observations have also identified mast cells (MCs) as critical effectors during the progression and modulation of several neuroinflammatory conditions, including Alzheimer\u27s disease (AD) and amyotrophic lateral sclerosis (ALS). MC granules contain a plethora of constituents, including growth factors, cytokines, chemokines, and mitogen factors. The release of these bioactive substances from MCs occurs through distinct pathways that are initiated by the activation of specific plasma membrane receptors/channels. Here, we focus on hemichannels (HCs) formed by connexins (Cxs) and pannexins (Panxs) proteins, and we described their contribution to MC degranulation in AD, ALS, and harmful stress conditions. Cx/Panx HCs are also expressed by astrocytes and are likely involved in the release of critical toxic amounts of soluble factors-such as glutamate, adenosine triphosphate (ATP), complement component 3 derivate C3a, tumor necrosis factor (TNFalpha), apoliprotein E (ApoE), and certain miRNAs-known to play a role in the pathogenesis of AD, ALS, and other neurodegenerative disorders. We propose that blocking HCs on MCs and glial cells offers a promising novel strategy for ameliorating the progression of neurodegenerative diseases by reducing the release of cytokines and other pro-inflammatory compounds

A Bayesian Approach to Risk Management in a World of High-Frequency Data

A Realised Volatility GARCH model using high-frequency data is developed within a Bayesian framework for the purpose of forecasting Value at Risk and Conditional Value at Risk. A Skewed Student-t return distribution is combined with a Student-t distribution in the measurement equation in a GARCH framework. Realised Volatility GARCH models show a marked improvement compared to ordinary GARCH. A Skewed Student-t Realised DCC copula model using Realised Volatility GARCH marginal functions is developed within a Bayesian framework for the purpose of forecasting portfolio tail risk. The use of copulas is implemented so that the marginal distributions can be separated from the dependence structure to produce tail forecasts. This is compared to using traditional GARCH-copula models, and GARCH on an aggregated portfolio. Copula models implementing a Realised Volatility GARCH framework show an improvement over traditional GARCH models. A Bayesian detection of regime changes utilizing high-frequency data is developed, once again for the purpose of forecasting portfolio tail risk. The use of high-frequency data improves the accuracy of regime change detection compared to daily data. Monte Carlo sampling schemes are employed for the estimation of these models