Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks: A Randomized Clinical Trial.

BACKGROUND:The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale. METHODS:Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters. RESULTS:During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239). CONCLUSIONS:Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades

Improved Mechanical Properties of Chemically Amplified, Positive Tone, Polynorbornene Dielectric

The mechanical properties of an aqueous developed, chemically amplified, polynorbornene-based permanent dielectric have been investigated. The previously reported hexafluoroisopropanol norbornene and tert-butyl ester norbornene copolymer has been modified via two routes to improve the mechanical properties of the polymer and enable thick-film deposition. First, a third monomer, butyl norbornene (ButylNB) was added to the polymer backbone. The inclusion of 24 mol% ButylNB lowered the elastic modulus from 2.64 to 2.35 GPa and raised the dielectric constant from 2.78 to 3.48. The second approach added a low molecular weight, plasticizing additive in the copolymer formulation. Many additives were immiscible with the resin or did not affect the mechanical properties. Trimethyololpropane ethoxylate (TMPEO) was found to be a miscible additive that improved mechanical properties and could participate in crosslinking the final dielectric material. TMPEO interacted with the PAG, lowering its decomposition temperature. An optimal formulation and processing scheme were determined. A formulation with 10 pphr TMPEO was measured to have a dielectric constant of 2.94, an elastic modulus of 1.95 GPa, a sensitivity at 365 nm of 175 mJ/cm 2 , and a contrast of 4. Photo-definable, permanent, low-k dielectrics are widely used in the fabrication of microelectronic devices and packages. 1-5 These dielectrics electrically isolate the interconnect and mechanically stabilize the structures for the life of the device. On integrated circuits, organic dielectrics can be used for interlayer isolation and/or the stress buffer layer on top of the device. Stress buffer layers protect the top surface of the chip and can mitigate mechanical failures that arise from a mismatch of the coefficient of thermal expansion between the chip and package during thermal cycling. In microelectronics packages, low-k dielectrics can be used in the buildup layers, electrically separating the electrical conductors. Low permittivity is critical for use in these applications, as it affects device performance, energy loss, and signal integrity. Photo-definability is an attractive property for permanent polymeric dielectrics. The ability to directly pattern the dielectric by photolithographic techniques mitigates the need for a separate photoresist and pattern transfer steps. This can lower the overall fabrication cost and reduce the number of individual process steps. 2 For stress buffer and redistribution applications, positive tone photo-definable dielectrics are more desirable than negative tone ones because the lithographic mask is mostly opaque mask and less prone to transfer particle defects. Also, holes and lines in positive tone materials exhibit sloped sidewalls (opening wider at the top) which is beneficial for void-free plating of the copper interconnects. Aqueous developability is another attractive property, as it mitigates the need for environmentally harmful organic solvent developers. Further, the dielectric should exhibit high sensitivity and contrast for high throughput and high quality feature patterning. Previously, a chemically amplified, positive tone, permanent polynorbornene (PNB) dielectric was reported. 6 This dielectric was composed of a copolymer of hexafluoroisopropanol norbornene (HFANB) and tert-butyl ester norbornene (TBENB). The chemical structure of this polymer is shown in The contrast was measured to be ≥14.2. These lithographic values are more than an order of magnitude better than those reported for other positive tone dielectrics. Though the chemically amplified PNB dielectric had excellent properties, the dielectric exhibited cracking when coated to thickness greater than ∼3 μm on silicon wafers. This result is due to a combination of phenomena. First, the coefficient of thermal expansion (CTE) of the polymer (39.5 ppm/K) is not well-matched to silicon (3 ppm/K). This mismatch produces thermal stresses in the film upon cooling after the baking and curing steps. It is noted that other PNB dielectrics with similar CTEs have been deposited crack-free on silicon wafers at much greater thicknesses. In this paper, two approaches to improving the mechanical toughness of the chemically amplified PNB dielectric were investigated. First, a terpolymer of HFANB, TBENB, and a third monomer, butyl norbornene (ButylNB) was synthesized. The structure of the terpolymer is shown i

Values of sexual behaviour in Central and Eastern Europe

Despite the profusion of social cognitive models for the prediction of sexual behaviour, we have only limited knowledge as to the role of individual values in predicting risky sexual activity. This study assessed the relationship between a recently developed value structure and sexual behaviour in the context of rising HIV infection in central and eastern Europe. Five hundred and three respondents (business people, doctors and nurses) from Estonia, Georgia, Hungary, Poland and Russia completed Schwartz’s Portrait Values Questionnaire and reported their condom use, partnership history and record of sexual disease. Results indicated that values had a moderate but consistent relationship with sexual behaviour, with riskier sexual activity reported by those high on Openness to Change, Hedonism and Self-Enhancement. These findings are discussed in the context of the need for culturally sensitive interventions in order to tackle the growing HIV epidemic in this region.This project was supported by a research grant from the Research Support Scheme operated by the Soros Foundation, Prague

Lynx X-Ray Observatory: An Overview

Lynx, one of the four strategic mission concepts under study for the 2020 Astrophysics Decadal Survey, provides leaps in capability over previous and planned x-ray missions and provides synergistic observations in the 2030s to a multitude of space- and ground-based observatories across all wavelengths. Lynx provides orders of magnitude improvement in sensitivity, on-axis subarcsecond imaging with arcsecond angular resolution over a large field of view, and high-resolution spectroscopy for point-like and extended sources in the 0.2- to 10-keV range. The Lynx architecture enables a broad range of unique and compelling science to be carried out mainly through a General Observer Program. This program is envisioned to include detecting the very first seed black holes, revealing the high-energy drivers of galaxy formation and evolution, and characterizing the mechanisms that govern stellar evolution and stellar ecosystems. The Lynx optics and science instruments are carefully designed to optimize the science capability and, when combined, form an exciting architecture that utilizes relatively mature technologies for a cost that is compatible with the projected NASA Astrophysics budget

Body odor quality predicts behavioral attractiveness in humans

Growing effort is being made to understand how different attractive physical traits co-vary within individuals, partly because this might indicate an underlying index of genetic quality. In humans, attention has focused on potential markers of quality such as facial attractiveness, axillary odor quality, the second-to-fourth digit (2D:4D) ratio and body mass index (BMI). Here we extend this approach to include visually-assessed kinesic cues (nonverbal behavior linked to movement) which are statistically independent of structural physical traits. The utility of such kinesic cues in mate assessment is controversial, particularly during everyday conversational contexts, as they could be unreliable and susceptible to deception. However, we show here that the attractiveness of nonverbal behavior, in 20 male participants, is predicted by perceived quality of their axillary body odor. This finding indicates covariation between two desirable traits in different sensory modalities. Depending on two different rating contexts (either a simple attractiveness rating or a rating for long-term partners by 10 female raters not using hormonal contraception), we also found significant relationships between perceived attractiveness of nonverbal behavior and BMI, and between axillary odor ratings and 2D:4D ratio. Axillary odor pleasantness was the single attribute that consistently predicted attractiveness of nonverbal behavior. Our results demonstrate that nonverbal kinesic cues could reliably reveal mate quality, at least in males, and could corroborate and contribute to mate assessment based on other physical traits

Comparative efficacy of ultrasound-guided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia

Perineural catheter insertion using ultrasound guidance alone is a relatively new approach. Previous studies have shown that ultrasound-guided catheters take less time to place with high placement success rates, but the analgesic efficacy compared with the established stimulating catheter technique remains unknown. We tested the hypothesis that popliteal-sciatic perineural catheter insertion relying exclusively on ultrasound guidance results in superior postoperative analgesia compared with stimulating catheters. Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot or ankle surgery were assigned randomly to either ultrasound guidance (bolus via needle with non-stimulating catheter insertion) or electrical stimulation (bolus via catheter). We used 1.5% mepivacaine 40 mL for the primary surgical nerve block and 0.2% ropivacaine (basal 8 mL·hr−1; bolus 4 mL; 30 min lockout) was infused postoperatively. The primary outcome was average surgical pain on postoperative day one. Forty of the 80 subjects enrolled were randomized to each treatment group. One of 40 subjects (2.5%) in the ultrasound group failed catheter placement per protocol vs nine of 40 (22.5%) in the stimulating catheter group (P = 0.014). The difference in procedural duration (mean [95% confidence interval (CI)]) was −6.48 (−9.90 - −3.05) min, with ultrasound requiring 7.0 (4.0-14.1) min vs stimulation requiring 11.0 (5.0-30.0) min (P < 0.001). The average pain scores of subjects who provided data on postoperative day one were somewhat higher for the 33 ultrasound subjects than for the 26 stimulation subjects (5.0 [1.0-7.8] vs 3.0 [0.0-6.5], respectively; P = 0.032), a difference (mean [95%CI]) of 1.37 (0.03-2.71). For popliteal-sciatic perineural catheters, ultrasound guidance takes less time and results in fewer placement failures compared with stimulating catheters. However, analgesia may be mildly improved with successfully placed stimulating catheters. Clinical trial registration number NCT00876681

Intravitreal antisense oligonucleotide sepofarsen in Leber congenital amaurosis type 10: a phase 1b/2 trial

CEP290-associated Leber congenital amaurosis type 10 (LCA10) is a retinal disease resulting in childhood blindness. Sepofarsen is an RNA antisense oligonucleotide targeting the c.2991+1655A>G variant in the CEP290 gene to treat LCA10. In this open-label, phase 1b/2 (NCT03140969), 12-month, multicenter, multiple-dose, dose-escalation trial, six adult patients and five pediatric patients received ≤4 doses of intravitreal sepofarsen into the worse-seeing eye. The primary objective was to evaluate sepofarsen safety and tolerability via the frequency and severity of ocular adverse events (AEs); secondary objectives were to evaluate pharmacokinetics and efficacy via changes in functional outcomes. Six patients received sepofarsen 160 µg/80 µg, and five patients received sepofarsen 320 µg/160 µg. Ten of 11 (90.9%) patients developed ocular AEs in the treated eye (5/6 with 160 µg/80 µg; 5/5 with 320 µg/160 µg) versus one of 11 (9.1%) in the untreated eye; most were mild in severity and dose dependent. Eight patients developed cataracts, of which six (75.0%) were categorized as serious (2/3 with 160 µg/80 µg; 4/5 with 320 µg/160 µg), as lens replacement was required. As the 160-µg/80-µg group showed a better benefit–risk profile, higher doses were discontinued or not initiated. Statistically significant improvements in visual acuity and retinal sensitivity were reported (post hoc analysis). The manageable safety profile and improvements reported in this trial support the continuation of sepofarsen development

In Vitro Neutralisation of Rotavirus Infection by Two Broadly Specific Recombinant Monovalent Llama-Derived Antibody Fragments

Rotavirus is the main cause of viral gastroenteritis in young children. Therefore, the development of inexpensive antiviral products for the prevention and/or treatment of rotavirus disease remains a priority. Previously we have shown that a recombinant monovalent antibody fragment (referred to as Anti-Rotavirus Proteins or ARP1) derived from a heavy chain antibody of a llama immunised with rotavirus was able to neutralise rotavirus infection in a mouse model system. In the present work we investigated the specificity and neutralising activity of two llama antibody fragments, ARP1 and ARP3, against 13 cell culture adapted rotavirus strains of diverse genotypes. In addition, immunocapture electron microscopy (IEM) was performed to determine binding of ARP1 to clinical isolates and cell culture adapted strains. ARP1 and ARP3 were able to neutralise a broad variety of rotavirus serotypes/genotypes in vitro, and in addition, IEM showed specific binding to a variety of cell adapted strains as well as strains from clinical specimens. These results indicated that these molecules could potentially be used as immunoprophylactic and/or immunotherapeutic products for the prevention and/or treatment of infection of a broad range of clinically relevant rotavirus strains

Rat Adipose Tissue-Derived Stem Cells Transplantation Attenuates Cardiac Dysfunction Post Infarction and Biopolymers Enhance Cell Retention

Background: Cardiac cell transplantation is compromised by low cell retention and poor graft viability. Here, the effects of co-injecting adipose tissue-derived stem cells (ASCs) with biopolymers on cell cardiac retention, ventricular morphometry and performance were evaluated in a rat model of myocardial infarction (MI). Methodology/Principal Findings: (99m)Tc-labeled ASCs (1 x 10(6) cells) isolated from isogenic Lewis rats were injected 24 hours post-MI using fibrin a, collagen (ASC/C), or culture medium (ASC/M) as vehicle, and cell body distribution was assessed 24 hours later by gamma-emission counting of harvested organs. ASC/F and ASC/C groups retained significantly more cells in the myocardium than ASC/M (13.8+/-2.0 and 26.8+/-2.4% vs. 4.8+/-0.7%, respectively). Then, morphometric and direct cardiac functional parameters were evaluated 4 weeks post-MI cell injection. Left ventricle (LV) perimeter and percentage of interstitial collagen in the spare myocardium were significantly attenuated in all ASC-treated groups compared to the non-treated (NT) and control groups (culture medium, fibrin, or collagen alone). Direct hemodynamic assessment under pharmacological stress showed that stroke volume (SV) and left ventricle end-diastolic pressure were preserved in ASC-treated groups regardless of the vehicle used to deliver ASCs. Stroke work (SW), a global index of cardiac function, improved in ASC/M while it normalized when biopolymers were co-injected with ASCs. A positive correlation was observed between cardiac ASCs retention and preservation of SV and improvement in SW post-MI under hemodynamic stress. Conclusions: We provided direct evidence that intramyocardial injection of ASCs mitigates the negative cardiac remodeling and preserves ventricular function post-MI in rats and these beneficial effects can be further enhanced by administrating co-injection of ASCs with biopolymers.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)[01/0009-0]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)[05/54695-3]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)[04/06784-4]Ministerio da Ciencia e Tecnologia/Conselho Nacional de Desenvolvimento Cientifico e Tecnologico/Ministerio da Saude/Departamento Ciencia e Tecnologia (MCT/CNPq/MS/DECIT)[552324/20005-1]Ministerio da Ciencia e Tecnologia/Conselho Nacional de Desenvolvimento Cientifico e Tecnologico/Ministerio da Saude/Departamento Ciencia e Tecnologia (MCT/CNPq/MS/DECIT)[10120104096700]CNPq[141276/2004-5