An unusual case of acute pulmonary embolism

Patiant with a history of hypertension presented to the emergency room with progressive dyspnoea over afew weeks. There was no relevant past history. Clinical examination revealed an elevated jugular venous pressure, pedal oedema and tenderness in the right hypochondrium

Clinical Effectiveness of Transversus Abdominis Plane (TAP) Block versus Local Anesthesia Wound Infiltration for Postoperative Pain Relief After Laparoscopic Appendicectomy in Children: A Study Protocol for a Multicenter Double-Blind Randomized Controlled Phase III Trial

Geoffrey Bloy,1 Amelie Jurine,1 Yann Chaussy,2 Frederic Auber,2 Pierre-Gregoire Guinot,3 Belaid Bouhemad,3 Michel Francois,4 Lucie Vettoretti,1 Sebastien Pili-Floury,5 Maxime Nguyen,3 Guillaume Besch5 1CHU Besançon, Département d’Anesthésie Réanimation Chirurgicale, Besançon, F-25000, France; 2Université de Franche-Comté, CHU Besançon, SINERGIES, Service de Chirurgie Pédiatrique, Besançon, F-25000, France; 3University of Burgundy and Franche-Comté, Dijon University Hospital, INSERM LNC UMR1231, FCS Bourgogne Franche-Comté LipSTIC LabEx, Dijon, F-21000, France; 4Université de Bourgogne, CHU Dijon, Service de Chirurgie Pédiatrique, Dijon, F-21000, France; 5Université de Franche-Comté, CHU Besançon, SINERGIES, Département d’Anesthésie Réanimation Chirurgicale, Besançon, F-25000, FranceCorrespondence: Guillaume Besch, Département d’Anesthésie Réanimation Chirurgicale, CHU Besançon, 3 bvd Alexandre Fleming, Besançon, 25030, France, Tel +3381218958, Fax +3381669331, Email [email protected]: Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a transversus abdominis plane (TAP) block or local anesthesia (LA) wound infiltration as part of multimodal postoperative analgesia after appendectomy. To date, the clinical effectiveness of TAP block versus LA wound infiltration has never been compared. The hypothesis of this study is that the TAP block may provide a greater opioid-sparing effect after laparoscopic appendicectomy in children than LA wound infiltration.Study Design and Methods: We designed a multicenter double-blind randomized controlled phase III trial and aim to include 110 children who undergo laparoscopic appendicectomy. Children are randomized to receive either TAP block (TAP group) or LA wound infiltration (infiltration group). Multimodal analgesia is standardized in the two groups using the same protocol, which includes the stepwise prescription of paracetamol, phloroglucinol, ketoprofene, and nalbuphine according to the hetero-evaluation of pain performed by the nurses who were blinded to the treatment allocated using the validated FLACC scale. The primary outcome is the total dose of nalbuphine administered within 24 hours after surgery.Discussion: No study has specifically compared the clinical effectiveness of TAP block versus LA wound infiltration for postoperative pain relief after laparoscopic appendectomy in children. This paper describes the protocol for a randomized trial that addresses this issue. The results of this trial will be useful for editing guidelines with a higher level of evidence on this topic.Keywords: laparoscopic appendectomy, TAP block, wound infiltration, analgesia, childre

Classification of current anticancer immunotherapies

During the past decades, anticancer immunotherapy has evolved from a promising therapeutic option to a robust clinical reality. Many immunotherapeutic regimens are now approved by the US Food and Drug Administration and the European Medicines Agency for use in cancer patients, and many others are being investigated as standalone therapeutic interventions or combined with conventional treatments in clinical studies. Immunotherapies may be subdivided into “passive” and “active” based on their ability to engage the host immune system against cancer. Since the anticancer activity of most passive immunotherapeutics (including tumor-targeting monoclonal antibodies) also relies on the host immune system, this classification does not properly reflect the complexity of the drug-host-tumor interaction. Alternatively, anticancer immunotherapeutics can be classified according to their antigen specificity. While some immunotherapies specifically target one (or a few) defined tumor-associated antigen(s), others operate in a relatively non-specific manner and boost natural or therapy-elicited anticancer immune responses of unknown and often broad specificity. Here, we propose a critical, integrated classification of anticancer immunotherapies and discuss the clinical relevance of these approaches

Habitat utilisation of Pseudobarbus afer and Sandelia capensis in headwaters of the Swartkops River, Eastern Cape, South Africa

Habitat degradation is one of the greatest threats to endemic freshwater fish in the Cape Fold Ecoregion. One habitat restoration strategy is the replication of critical habitat using artificial materials. In this paper, we evaluate the habitat occupancy of two small, endemic headwater fish of the Cape Fold Ecoregion, namely the Eastern Cape redfinPseudobarbus afer(Peters, 1864) and the Cape KurperSandelia capensis(Cuvier, 1829). Habitat occupancy was observed in five pool microhabitats (inflow, woody debris, deep open, fern-root wads, and outflow) using action cameras. Changes in habitat occupancy were assessed following the introduction of an artificial habitat in the form of PVC pipes.Pseudobarbus aferpreferred deeper open habitats, whereasSandelia capensispreferred more structured woody debris habitat. Habitat occupancies differed significantly across all microhabitats for both species; excluding those between the inflow and outflow, and the open deep and fern-root wads forSandelia capensis. Pseudobarbus aferandS. capensisoccupancies in the natural microhabitats reduced significantly following the introduction of the artificial habitat. For species restricted to degraded habitats that require habitat restoration, the use of artificial habitat may be beneficial in accelerating the recovery of such species

Using action cameras to estimate the abundance and habitat use of threatened fish in clear headwater streams:

Snorkel and electrofishing surveys are the traditional baseline methods for fish surveys in clear headwater streams. However, action cameras provide a non-harmful alternative to monitor freshwater fish populations to develop informed conservation management initiatives. In this paper, estimates from photographs and videos from action cameras are compared with snorkel survey estimates of the density of a threatened endemic minnow species in a headwater stream, Eastern Cape, South Africa. Photograph-based relative abundances of fish summed over five microhabitats in each pool returned equivalent results to snorkel surveys, whereas the equivalent video-based abundance estimates were approximately 50% greater than the snorkel estimates. Therefore, photograph-derived estimates could be used as an alternative to snorkel surveys for fish population monitoring and habitat use studies in clear headwater streams