Neuropathic complications after 157 procedures of continuous popliteal nerve block for hallux valgus surgery. A retrospective study

SummaryBackgroundContinuous peripheral nerve block (CPNB), in particular at the popliteal fossa, is widely used in orthopedic surgery, allowing good postoperative analgesia. Possible neuropathic complications, however, remain poorly known.ObjectiveTo review the characteristics of peripheral neuropathy (PN) after sciatic CPNB at the popliteal fossa, estimating prevalence, severity, evolution and possible risk factors, especially those relating to the procedure.MethodsRetrospective study of PN associated with popliteal fossa CPNB for hallux valgus surgery, between November 1st, 2005 and November 1st, 2009. All procedures were analyzed (type of anesthesia, approach, nerve location technique, number of procedures by operator) with, for each case of PN, analysis of clinical and electromyographic data.ResultsOne hundred and fifty seven sciatic CPNBs were performed (92% women; mean age, 55 years). The approach was lateral (n=62), posterior (n=74) or unknown (n=21). Ultrasound guidance was combined to neurostimulation for 69 patients (44%). Three women (prevalence=1.91%), aged 19, 24 and 65 years respectively, developed associated common superficial peroneal and sural nerve injury (2), axonal on electromyography, with motor (n=1) and/or sensory (n=3) residual dysfunction.DiscussionThe higher prevalence found in the present study than in the literature (0 to 0.5%) raises questions of methodological bias or technical problems. The common peroneal and sural nerves seem to be exposed, unlike the tibial. Several mechanisms can be suggested: anesthetic neurotoxicity, direct mechanical lesion, or tourniquet-related ischemia and conduction block. Further studies are necessary to determine the ideal anesthetic procedure.ConclusionPatients should be informed of the potential risk, however rare, even during mild surgery. The best possible technique should be implemented, with reinforced surveillance.Level of evidenceLevel IV retrospective study

Cooling down Levy flights

Let L(t) be a Levy flights process with a stability index \alpha\in(0,2), and U be an external multi-well potential. A jump-diffusion Z satisfying a stochastic differential equation dZ(t)=-U'(Z(t-))dt+\sigma(t)dL(t) describes an evolution of a Levy particle of an `instant temperature' \sigma(t) in an external force field. The temperature is supposed to decrease polynomially fast, i.e. \sigma(t)\approx t^{-\theta} for some \theta>0. We discover two different cooling regimes. If \theta<1/\alpha (slow cooling), the jump diffusion Z(t) has a non-trivial limiting distribution as t\to \infty, which is concentrated at the potential's local minima. If \theta>1/\alpha (fast cooling) the Levy particle gets trapped in one of the potential wells

Landscape statistics of the low autocorrelated binary string problem

The statistical properties of the energy landscape of the low autocorrelated binary string problem (LABSP) are studied numerically and compared with those of several classic disordered models. Using two global measures of landscape structure which have been introduced in the Simulated Annealing literature, namely, depth and difficulty, we find that the landscape of LABSP, except perhaps for a very large degeneracy of the local minima energies, is qualitatively similar to some well-known landscapes such as that of the mean-field 2-spin glass model. Furthermore, we consider a mean-field approximation to the pure model proposed by Bouchaud and Mezard (1994, J. Physique I France 4 1109) and show both analytically and numerically that it describes extremely well the statistical properties of LABSP

Phase transition and landscape statistics of the number partitioning problem

The phase transition in the number partitioning problem (NPP), i.e., the transition from a region in the space of control parameters in which almost all instances have many solutions to a region in which almost all instances have no solution, is investigated by examining the energy landscape of this classic optimization problem. This is achieved by coding the information about the minimum energy paths connecting pairs of minima into a tree structure, termed a barrier tree, the leaves and internal nodes of which represent, respectively, the minima and the lowest energy saddles connecting those minima. Here we apply several measures of shape (balance and symmetry) as well as of branch lengths (barrier heights) to the barrier trees that result from the landscape of the NPP, aiming at identifying traces of the easy/hard transition. We find that it is not possible to tell the easy regime from the hard one by visual inspection of the trees or by measuring the barrier heights. Only the {\it difficulty} measure, given by the maximum value of the ratio between the barrier height and the energy surplus of local minima, succeeded in detecting traces of the phase transition in the tree. In adddition, we show that the barrier trees associated with the NPP are very similar to random trees, contrasting dramatically with trees associated with the $p$ spin-glass and random energy models. We also examine critically a recent conjecture on the equivalence between the NPP and a truncated random energy model

Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (The Hospital to Home trial): A randomised controlled trial

Background and aimsThe United Kingdom's National Institute for Health and Care Excellence guidance (NICE PH48) recommends that pharmacotherapy combined with behavioural support be provided for all smokers admitted to hospital; however, relapse to smoking after discharge remains common. This study aimed to assess the effect of adding home support for newly?abstinent smokers to conventional NICE?recommended support in smokers discharged from hospital.Designindividually?randomised parallel group trial.SettingOne UK acute hospital.Participants404 smokers aged >18 admitted to acute medical wards between June 2016 and July 2017 were randomised in equal numbers to each treatment group.Interventions and comparatorsThe intervention provided 12 weeks of at?home cessation support which included help in maintaining a smoke?free home, help in accessing and using medication, further behavioural support and personalised feedback on home air quality. The comparator was NICE PH48 care as usual.MeasuresThe primary outcome was self?reported continuous abstinence from smoking validated by an exhaled carbon monoxide level ?6ppm four?weeks after discharge from hospital.FindingsIn an intention?to?treat analysis at the four?week primary endpoint, 38 participants (18.8%) in the usual care group and 43 (21.3%) in the intervention group reported continuous abstinence from smoking (odds ratio 1.17, 95% confidence interval 0.72 to 1.90, Bayes factor 0.33). There were no significant differences in any secondary outcomes, including self?reported cessation at 3 months, having a smoke?free home, or number of cigarettes smoked per day in those who did not quit.ConclusionsProvision of a home visit and continued support to prevent relapse to smoking after hospital discharge did not appear to increase subsequent abstinence rate above usual care in accordance with UK guidance from the National Institute of Health and Care Excellence

Outcome of paraosseous extra-medullary disease in newly diagnosed multiple myeloma patients treated with new drugs

Extramedullary disease is relatively frequent in multiple myeloma, but our knowledge on the subject is limited and mainly relies on small case series or single center experiences. Little is known regarding the role of new drugs in this setting. We performed a meta-analysis of eight trials focused on the description of extramedullary disease characteristics, clinical outcome, and response to new drugs. A total of 2,332 newly diagnosed myeloma patients have been included; 267 (11.4%) had extramedullary disease, defined as paraosseous in 243 (10.4%), extramedullary plasmocytoma in 12 (0.5%), and not classified in 12 (0.5%) patients. Median progression-free survival was 25.3 months and 25.2 in extramedullary disease and non-extramedullary disease patients, respectively. In multivariate analysis the presence of extramedullary disease did not impact on progression-free survival (hazard ratio 1.15, P=0.06), while other known prognostic factors retained their significance. Patients treated with immunomodulatory drugs, mainly lenalidomide, or proteasome inhibitors had similar progression-free survival and progression-free survival-2 regardless of extramedullary disease presence. Median overall survival was 63.5 months and 79.9 months (P=0.01) in extramedullary and non-extramedullary disease patients, respectively, and in multivariate analysis the presence of extramedullary disease was associated with a reduced overall survival (hazard ratio 1.41, P&lt;0.001), in line with other prognostic factors. With the limits of the use of low sensitivity imaging techniques, that lead to an underestimation of extramedullary disease, we conclude that in patients treated with new drugs the detrimental effect of extramedullary disease at diagnosis is limited, that lenalidomide is effective as are proteasome inhibitors, and that these patients tend to acquire a more aggressive disease in later stages. (EUDRACT2005-004714-32, NCT01063179 NCT00551928, NCT01091831, NCT01093196, NCT01190787, NCT01346787, NCT01857115)

Average flow constraints and stabilizability in uncertain production-distribution systems

We consider a multi-inventory system with controlled flows and uncertain demands (disturbances) bounded within assigned compact sets. The system is modelled as a first-order one integrating the discrepancy between controlled flows and demands at different sites/nodes. Thus, the buffer levels at the nodes represent the system state. Given a long-term average demand, we are interested in a control strategy that satisfies just one of two requirements: (i) meeting any possible demand at each time (worst case stability) or (ii) achieving a predefined flow in the average (average flow constraints). Necessary and sufficient conditions for the achievement of both goals have been proposed by the authors. In this paper, we face the case in which these conditions are not satisfied. We show that, if we ignore the requirement on worst case stability, we can find a control strategy driving the expected value of the state to zero. On the contrary, if we ignore the average flow constraints, we can find a control strategy that satisfies worst case stability while optimizing any linear cost on the average control. In the latter case, we provide a tight bound for the cost

Syntactic Cut-Elimination for Intuitionistic Fuzzy Logic via Linear Nested Sequents

This paper employs the linear nested sequent framework to design a new cut-free calculus LNIF for intuitionistic fuzzy logic--the first-order G\"odel logic characterized by linear relational frames with constant domains. Linear nested sequents--which are nested sequents restricted to linear structures--prove to be a well-suited proof-theoretic formalism for intuitionistic fuzzy logic. We show that the calculus LNIF possesses highly desirable proof-theoretic properties such as invertibility of all rules, admissibility of structural rules, and syntactic cut-elimination.Comment: Appended version of the paper "Syntactic Cut-Elimination for Intuitionistic Fuzzy Logic via Linear Nested Sequents", accepted to the International Symposium on Logical Foundations of Computer Science (LFCS 2020

CLT in Functional Linear Regression Models

International audienceWe propose in this work to derive a CLT in the functional linear regression model to get confidence sets for prediction based on functional linear regression. The main difficulty is due to the fact that estimation of the functional parameter leads to a kind of ill-posed inverse problem. We consider estimators that belong to a large class of regularizing methods and we first show that, contrary to the multivariate case, it is not possible to state a CLT in the topology of the considered functional space. However, we show that we can get a CLT for the weak topology under mild hypotheses and in particular without assuming any strong assumptions on the decay of the eigenvalues of the covariance operator. Rates of convergence depend on the smoothness of the functional coefficient and on the point in which the prediction is made