Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain.

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain. The present study tested the hypothesis that patients receiving epidural fentanyl before incision would have less pain and need fewer analgesics post-operatively than patients receiving the same dose of epidural fentanyl after incision. Thirty patients (ASA physical status 2) scheduled for elective thoracic surgery through a posterolateral thoracotomy incision were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Epidural catheters were placed via the L2-L3 or L3-L4 interspaces preoperatively, and the position was confirmed with lidocaine. Group 1 received epidural fentanyl (4 micrograms/kg, in 20 ml normal saline) before surgical incision, followed by epidural normal saline (20 ml) infused 15 min after incision. Group 2 received epidural normal saline (20 ml) before surgical incision, followed by epidural fentanyl (4 micrograms/kg, in 20 ml normal saline) infused 15 min after incision. No additional analgesics were used before or during the operation. Anesthesia was induced with thiopental (3-5 mg/kg) and maintained with N2O/O2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Postoperative analgesia consisted of patient-controlled intravenous morphine. Visual analogue scale pain scores were significantly less in group 1 (2.6 +/- 0.44) than in group 2 (4.7 +/- 0.58) 6 h after surgery (P less than 0.05), by which time plasma fentanyl concentrations had decreased to subtherapeutic levels (less than 0.15 ng/ml) in both groups

Deep XMM-Newton observations of the northern disc of M31: II. Tracing the hot interstellar medium

Aims. We use new deep XMM-Newton observations of the northern disc of M31 to trace the hot interstellar medium (ISM) in unprecedented detail and to characterise the physical properties of the X-ray emitting plasmas. Methods. We used all XMM-Newton data up to and including our new observations to produce the most detailed image yet of the hot ISM plasma in a grand design spiral galaxy such as our own. We compared the X-ray morphology to multi-wavelength studies in the literature to set it in the context of the multi-phase ISM. We performed spectral analyses on the extended emission using our new observations as they offer sufficient depth and count statistics to constrain the plasma properties. Data from the Panchromatic Hubble Andromeda Treasury were used to estimate the energy injected by massive stars and their supernovae. We compared these results to the hot gas properties. Results. The brightest emission regions were found to be correlated with populations of massive stars, notably in the 10 kpc star-forming ring. The plasma temperatures in the ring regions are ∼0.2 up to ∼0.6 keV. We suggest this emission is hot ISM heated in massive stellar clusters and superbubbles. We derived X-ray luminosities, densities, and pressures for the gas in each region. We also found large extended emission filling low density gaps in the dust morphology of the northern disc, notably between the 5 and 10 kpc star-forming rings. We propose that the hot gas was heated and expelled into the gaps by the populations of massive stars in the rings. Conclusions. It is clear that the massive stellar populations are responsible for heating the ISM to X-ray emitting temperatures, filling their surroundings, and possibly driving the hot gas into the low density regions. Overall, the morphology and spectra of the hot gas in the northern disc of M31 is similar to other galaxy discs. © 2020 ESO

Deep XMM-Newton observations of the northern disc of M 31: I. Source catalogue

Context. We carried out new observations of two fields in the star-forming northern ring of M 31 with XMM-Newton with each one of them consisting of two exposures of about 100 ks each. A previous XMM-Newton survey of the entire M 31 galaxy revealed extended diffuse X-ray emission in these regions. Aims. We study the population of X-ray sources in the northern disc of M 31 by compiling a complete list of X-ray sources down to a sensitivity limit of ∼7 × 1034 erg s-1 (0.5-2.0 keV) and improve the identification of the X-ray sources. The major objective of the observing programme was the study of the hot phase of the interstellar medium (ISM) in M 31. The analysis of the diffuse emission and the study of the ISM is presented in a separate paper. Methods. We analysed the spectral properties of all detected sources using hardness ratios and spectra if the statistics were high enough. We also checked for variability. In order to classify the sources detected in the new deep XMM-Newton observations, we cross-correlated the source list with the source catalogue of a new survey of the northern disc of M 31 carried out with the Chandra X-ray Observatory and the Hubble Space Telescope (Panchromatic Hubble Andromeda Treasury, PHAT) as well as with other existing catalogues. Results. We detected a total of 389 sources in the two fields of the northern disc of M 31 observed with XMM-Newton. We identified 43 foreground stars and candidates and 50 background sources. Based on a comparison with the results of the Chandra/PHAT survey, we classify 24 hard X-ray sources as new candidates for X-ray binaries. In total, we identified 34 X-ray binaries and candidates and 18 supernova remnants (SNRs) and candidates. We studied the spectral properties of the four brightest SNRs and confirmed five new X-ray SNRs. Three of the four SNRs, for which a spectral analysis was performed, show emission mainly below 2 keV, which is consistent with shocked ISM. The spectra of two of them also require an additional component with a higher temperature. The SNR [SPH11] 1535 has a harder spectrum and might suggest that there is a pulsar-wind nebula inside the SNR. For all SNRs in the observed fields, we measured the X-ray flux or calculated upper limits. We also carried out short-term and long-term variability studies of the X-ray sources and found five new sources showing clear variability. In addition, we studied the spectral properties of the transient source SWIFT J004420.1+413702, which shows significant variation in flux over a period of seven months (June 2015 to January 2016) and associated change in absorption. Based on the likely optical counterpart detected in the Chandra/PHAT survey, the source is classified as a low-mass X-ray binary. © ESO 2018