Opioid-free anesthesia—dexmedetomidine as adjuvant in erector spinae plane block: a case series

Background: Laparoscopic pain is related to the stretching of the peritoneum and peritoneal irritation caused by insufflation of the parietal peritoneum with carbon dioxide. In 2017, erector spinae plane block (ESPB) was described for management of postoperative pain following open and laparoscopic abdominal surgery. The use of multimodal anesthesia reduces both intraoperative and postoperative opioid use and improves analgesia. The addition of dexmedetomidine to the anesthetic mixture significantly prolongs analgesia, without clinically significant side effects. Case Presentation: We describe a series of three Caucasian women cases that illustrate the efficacy of bilateral ESPB performed at the level of the T7 transverse process to provide intraoperative and postoperative analgesia for laparoscopic gynecological surgery. Conclusion: Further investigation is recommended to establish the potential for ESPB with dexmedetomidine as adjuvant as an opioid-free anesthetic modality in laparoscopic gynecological surgery

Laser welding of tailored blanks made of Al-Si-coated 22MnB5 steel using a filler wire and a variable energy distribution laser optics

Laser welding of Al-Si-coated steels for hot stamping in automotive applications is problematic due to the mixing of the coating layers inside the molten pool that weakens the resulting weld seam. In this case, the most common welding procedure to overcome this issue consists in removing the Al-Si layer through laser ablation prior to the joining. This method continues to be the most widely used by major producers of tailor welded blanks, although in situ ablation of the Al-Si coating can be costly and time consuming. In this work, a novel approach consisting in joining as-received (i.e., not decoated) materials using a filler wire and an innovative variable energy distribution laser optics is introduced and tested on tailor welded blanks made of 22MnB5. Tensile tests of specimens obtained from a 3(3) full factorial design of experiment have shown an average value of ultimate tensile strength of 1523 MPa, which is much higher than the one usually observed in as-received welded then hot-stamped conditions and aligned with hot-stamped base material values. Hardness test results (494-543 HV0.5) were in the typical hot-stamped base material range of values as well, while SEM-EDS analyses detected no ferrite inclusions inside the fusion zone. Variations of the main process parameters have been considered on an iso-thickness and iso-material configuration, empirically demonstrating the stability and reliability of the proposed methodology as well as its suitability for production purposes

Generation of induced Pluripotent Stem Cells as disease modelling of NLSDM

Neutral Lipid Storage Disease with Myopathy (NLSDM) is a rare defect of triacylglycerol metabolism, characterized by the abnormal storage of neutral lipid in organelles known as lipid droplets (LDs). The main clinical features are progressive myopathy and cardiomyopathy. The onset of NLSDM is caused by autosomal recessive mutations in the PNPLA2 gene, which encodes adipose triglyceride lipase (ATGL). Despite its name, this enzyme is present in a wide variety of cell types and catalyzes the first step in triacylglycerol lipolysis and the release of fatty acids. Here, we report the derivation of NLSDM-induced pluripotent stem cells (NLSDM-iPSCs) from fibroblasts of two patients carrying different PNPLA2 mutations. The first patient was homozygous for the c.541delAC, while the second was homozygous for the c.662G>C mutation in the PNPLA2 gene. We verified that the two types of NLSDM-iPSCs possessed properties of embryonic-like stem cells and could differentiate into the three germ layers in vitro. Immunofluorescence analysis revealed that iPSCs had an abnormal accumulation of triglycerides in LDs, the hallmark of NLSDM. Furthermore, NLSDM-iPSCs were deficient in long chain fatty acid lipolysis, when subjected to a pulse chase experiment with oleic acid. Collectively, these results demonstrate that NLSDM-iPSCs are a promising in vitro model to investigate disease mechanisms and screen drug compounds for NLSDM, a rare disease with few therapeutic options

Identification of ALDH1A3 as a Viable Therapeutic Target in Breast Cancer Metastasis-Initiating Cells

The development of efficacious therapies targeting metastatic spread of breast cancer to the brain represents an unmet clinical need. Accordingly, an improved understanding of the molecular underpinnings of central nervous system spread and progression of breast cancer brain metastases (BCBM) is required. In this study, the clinical burden of disease in BCBM was investigated, as well as the role of aldehyde dehydrogenase 1A3 (ALDH1A3) in the metastatic cascade leading to BCBM development. Initial analysis of clinical survival trends for breast cancer and BCBM determined improvement of breast cancer survival rates; however, this has failed to positively affect the prognostic milestones of triple-negative breast cancer (TNBC) brain metastases (BM). ALDH1A3 and a representative epithelial-mesenchymal transition (EMT) gene signature (mesenchymal markers, CD44 or Vimentin) were compared in tumors derived from BM, lung metastases (LM), or bone metastases (BoM) of patients as well as mice after injection of TNBC cells. Selective elevation of the EMT signature and ALDH1A3 were observed in BM, unlike LM and BoM, especially in the tumor edge. Furthermore, ALDH1A3 was determined to play a role in BCBM establishment via regulation of circulating tumor cell adhesion and migration phases in the BCBM cascade. Validation through genetic and pharmacologic inhibition of ALDH1A3 via lentiviral shRNA knockdown and a novel small-molecule inhibitor demonstrated selective inhibition of BCBM formation with prolonged survival of tumor-bearing mice. Given the survival benefits via targeting ALDH1A3, it may prove an effective therapeutic strategy for BCBM prevention and/or treatment

Validation of an analytical method for nitrite and nitrate determination in meat foods for infants by ion chromatography with conductivity detection

Nitrate and nitrite as sodium or potassium salts are usually added to meat products to develop the characteristic flavor, to inhibit the growth of microorganisms (particularly Clostridium botulinum), and effectively control rancidity by inhibiting lipid oxidation. However, both nitrate and nitrite ions need to be monitored for ensuring the quality and safety of cured meats. In this work, for the first time the content of nitrite and nitrate ions in homogenized meat samples of baby foods was determined by a validated method based on ion chromatography (IC) coupled with conductivity detection. Recoveries of nitrate and nitrite ions in meat samples were not lower than 84 ± 6%. The detection limits of nitrate and nitrite were 0.08 mg L−1 and 0.13 mg L−1, respectively. Five commercial samples of homogenized meat, namely lamb, rabbit, chicken, veal, and beef, for infant feeding were investigated; while nitrite content was below the detection limit, nitrate ranged from 10.7 to 21.0 mg kg−1. The results indicated that nitrate contents were below the European (EU) fixed value of 200 mg kg−1, and an acceptable daily intake of 3.7 mg kg−1 was estimated

A QUALITATIVE CHARACTERIZATION OF THE CFTR GENE BY mRNA ANALYSIS

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UK export performance research - review and implications

Previous research on export performance has been criticized for being a mosaic of autonomous endeavours and for a lack of theoretical development. Building upon extant models of export performance, and a review and analysis of research on export performance in the UK for the period 1990-2005, an integrated model of export performance is developed and theoretical explanations of export performance are put forward. It is suggested that a multi-theory approach to explaining export performance is viable. Management and policy implications for the UK emerging from the review and synthesis of the literature and the integrated model are discussed

Further Delineation of Duplications of ARX Locus Detected in Male Patients with Varying Degrees of Intellectual Disability

The X-linked gene encoding aristaless-related homeobox (ARX) is a bi-functional transcription factor capable of activating or repressing gene transcription, whose mutations have been found in a wide spectrum of neurodevelopmental disorders (NDDs); these include cortical malformations, pae-diatric epilepsy, intellectual disability (ID) and autism. In addition to point mutations, duplications of the ARX locus have been detected in male patients with ID. These rearrangements include telen-cephalon ultraconserved enhancers, whose structural alterations can interfere with the control of ARX expression in the developing brain. Here, we review the structural features of 15 gain copy-number variants (CNVs) of the ARX locus found in patients presenting wide-ranging phenotypic variations including ID, speech delay, hypotonia and psychiatric abnormalities. We also report on a further novel Xp21.3 duplication detected in a male patient with moderate ID and carrying a fully duplicated copy of the ARX locus and the ultraconserved enhancers. As consequences of this rearrangement, the patient-derived lymphoblastoid cell line shows abnormal activity of the ARX-KDM5C-SYN1 regulatory axis. Moreover, the three-dimensional (3D) structure of the Arx locus, both in mouse embryonic stem cells and cortical neurons, provides new insight for the functional consequences of ARX duplications. Finally, by comparing the clinical features of the 16 CNVs affecting the ARX locus, we conclude that—depending on the involvement of tissue-specific enhancers—the ARX duplications are ID-associated risk CNVs with variable expressivity and penetrance

Copy number variations in candidate genomic regions confirm genetic heterogeneity and parental bias in Hirschsprung disease

Background: Hirschsprung Disease (HSCR) is a congenital defect of the intestinal innervations characterized by complex inheritance. Many susceptibility genes including RET, the major HSCR gene, and several linked regions and associated loci have been shown to contribute to disease pathogenesis. Nonetheless, a proportion of patients still remains unexplained. Copy Number Variations (CNVs) have already been involved in HSCR, and for this reason we performed Comparative Genomic Hybridization (CGH), using a custom array with high density probes. Results: A total of 20 HSCR candidate regions/genes was tested in 55 sporadic patients and four patients with already known chromosomal aberrations. Among 83 calls, 12 variants were experimentally validated, three of which involving the HSCR crucial genes SEMA3A/3D, NRG1, and PHOX2B. Conversely RET involvement in HSCR does not seem to rely on the presence of CNVs while, interestingly, several gains and losses did co-occur with another RET defect, thus confirming that more than one predisposing event is necessary for HSCR to develop. New loci were also shown to be involved, such as ALDH1A2, already found to play a major role in the enteric nervous system. Finally, all the inherited CNVs were of maternal origin. Conclusions: Our results confirm a wide genetic heterogeneity in HSCR occurrence and support a role of candidate genes in expression regulation and cell signaling, thus contributing to depict further the molecular complexity of the genomic regions involved in the Enteric Nervous System development. The observed maternal transmission bias for HSCR associated CNVs supports the hypothesis that in females these variants might be more tolerated, requiring additional alterations to develop HSCR disease