Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter

Purpose: This dose-response study was designed to determine the most appropriate dose of ropivacaine 0.5% injected via an indwelling femoral catheter for perioperative peripheral analgesia for total knee replacement (TKR). Methods: 84 patients were allocated randomly to four groups and received, via a femoral catheter, either 15, 20, 25 or 30 mL of ropivacaine 0.5% in a double-blind fashion. An anterior sciatic block with 20 mL bupivacaine 0.5% was also performed. The evolution of sensory block of femoral, obturator and lateral femoral cutaneous nerves and motor block of femoral nerve were tested every five minutes during the first 30 min. The percentage of patients with complete sensory block of both femoral and obturator nerves determined success rate. General anesthesia was then induced. After surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% was available via the femoral catheter. The interval between the initial injection and the first PCA administration determined duration of action. Results: The duration of action was not different between the four solutions tested i.e., 534 ± 379 min for 15 mL, 799 ± 364 min for 20 mL, 624 ± 342 min for 25 mL and 644 ± 266 min for 30 mL. The percentage of patients with complete sensory femoral and obturator blocks was, respectively, 60%, 95%, 85% and 70% for 15, 20, 25 and 30 mL (P = 0.008/15 mL vs 20 mL). Conclusion: Although there is no difference in duration of analgesia, because of better sensory spread, 20 mL of ropivacaine 0.5% appears to be the most appropriate dose for peripheral analgesia after TKR. Objectif: L'étude dose-réponse visait à déterminer la meilleure dose de ropivacaïne à 0,5 % injectée par cathéter fémoral à demeure pour l'analgésie périopératoire périphérique lors d'une arthroplastie totale du genou (ATG). Méthode: Nous avons réparti au hasard, en quatre groupes, 84 patients qui ont reçu par cathéter fémoral 15, 20, 25 ou 30 mL de ropivacaïne à 0,5 % en double insu. Un bloc sciatique antérieur a aussi été réalisé avec 20 mL de bupivacaïne à 0,5 %. L'évolution du bloc sensitif des nerfs fémoral, obturateur et cutané latéral de la cuisse et du bloc moteur du nerf fémoral a été vérifiée toutes les cinq minutes pendant les 30 premières minutes. Le pourcentage de patients qui présentait un bloc sensitif complet des nerfs fémoral et obturateur a déterminé le taux de succès. L'anesthésie générale a ensuite été induite. Après l'opération, l'analgésie auto-contrôlée (AAC) avec de la ropivacaïne à 0,2 % était disponible par cathéter fémoral. L'intervalle entre l'injection initiale et la première administration d'AAC a donné la durée d'action. Résultats: La durée d'action a été comparable dans tous les groupes : 534 ± 379 min avec 15 mL, 799 ± 364 min avec 20 mL, 624 ± 342 min avec 25 mL et 644 ± 266 min avec 30 mL. Le pourcentage de patients présentant un bloc sensitif complet des nerfs fémoral et obturateur a été respectivement de 60 %, 95 %, 85 % et 70 % pour les doses de 15, 20, 25 et 30 mL (P = 0,008/15 mL vs20 mL). Conclusion: Même si la durée de l'analgésie est équivalente, grâce à une meilleure diffusion sensitive, 20 mL de ropivacaïne à 0,5 % semble être la dose la plus appropriée pour l'analgésie périphérique après une AT

Implications of Proprotein Convertases in Ovarian Cancer Cell Proliferation and Tumor Progression: Insights for PACE4 as a Therapeutic Target

AbstractProprotein convertases are a family of kexin-like serine proteases that process proteins at single and multiple basic residues. Among the predicted and identified PC substrates, an increasing number of proteins having functions in cancer progression indicate that PCs may be potential targets for antineoplastic drugs. In support of this notion, we identified PACE4 as a vital PC involved in prostate cancer proliferation and progression, contrasting with the other co-expressed PCs. The aim of the present study was to test the importance of PCs in ovarian cancer cell proliferation and tumor progression. Based on tissue-expression profiles, furin, PACE4, PC5/6 and PC7 all displayed increased expression in primary tumor, ascites cells and metastases. These PCs were also expressed in variable levels in three model ovarian cell lines tested, namely SKOV3, CAOV3 and OVCAR3 cells. Since SKOV3 cells closely represented the PC expression profile of ovarian cancer cells, we chose them to test the effects of PC silencing using stable gene-silencing shRNA strategy to generate knockdown SKOV3 cells for each expressed PC. In vitro and in vivo assays confirmed the role of PACE4 in the sustainment of SKOV3 cell proliferation, which was not observed with the other three PCs. We also tested PACE4 peptide inhibitors on all three cell lines and observed consequent reduced cell proliferation which was correlated with PACE4 expression. Overall, these data support a role of PACE4 in promoting cell proliferation in ovarian cancer and provides further evidence for PACE4 as a potential therapeutic target

Tree encroachment may lead to functionally-significant changes in peatland testate amoeba communities

Climate change is likely to cause increased tree recruitment on open peatlands but we currently have little idea what consequences this vegetation change may have below-ground. Here we use transects across forested to open bog ecotones at three Russian peatland complexes to assess potential changes in the most abundant group of peatland protists - the testate amoebae. We show that the testate amoeba communities of forested and open bog are markedly different with a very abrupt boundary at, or near, the vegetation ecotone. Changes along our transects suggest that tree encroachment may reduce the trophic level of testate amoeba communities and reduce the contribution of mixotrophic testate amoebae to primary production. Our study strongly suggests that increased tree recruitment on open peatlands will have important consequences for both microbial biodiversity and microbially-mediated ecosystem processes

Les enfants d'immigrés sur le marché du travail. Les mécanismes d'une discrimination sélective

Roxane Silbermann und Irène Fournier, Ausländerkinder auf dem Arbeitsmarkt : Mechanismen selektiver Diskriminierung. Durch die Veränderung des Produktionsapparates und des dadurch bedingten Rückgangs bzw. Wegfalls von gering qualifizierten Beschäftigungen, die vielfach von Immigrantenkindern eingenommen wurden, müssen die Zukunftsaussichten dieser Kinder sowie die Integrationstheorien, die bislang hauptsächlich auf dem Assimilationsmodell basierten, neu hinterfragt werden. Im vorliegenden Beitrag soil geprüft werden, ob Jugendliche maghrebinischer Herkunft wirklich - wie so oft unterstellt wird - bei der Einstellung diskriminiert werden. Dazu wird ein interaktives Erklärungsmodell zugrunde gelegt, welches folgende Faktoren berücksichtigt : soziale Herkunft und die dadurch begründeten Ambitionen und schulischen Strategien, Stellung der Eltern auf dem Arbeitsmarkt und deren soziales Kapital, welches sie einsetzen kônnen, um ihren Kindern bei der Arbeitssuche behilflich zu sein, sowie die daraus resultierenden subjektiven Vorstellungen und Verhaltensweisen. Zwei gegensätzliche Gruppen lassen sich dabei deutlich festmachen : Immigranten europäischer Herkunft, bei denen die Portugiesen überwiegen, sowie Einwanderer maghrebinischer Herkunft, bei denen die Algerier dominieren. Im Gegensatz zu den Eltern portugiesischer Herkunft werten die Eltern maghrebinischer Herkunft die allgemeine Schulausbildung auf Kosten der beruflichen Schulausbildung oder Lehre auf und heben sich damit von dem Modell der individuellen Mobilität innerhalb der Arbeiterklassse ab. Zahlt sich diese Strategie auch für einen kleinen Teil der Jugendlichen aus, nämlich für diejenige, die Abitur machen und Hochschulstudien absolvieren, so führt sie für die anderen verstarkt zu unsicheren Beschäftigungssituationen, zumal die Väter dieser Jugendlichen - meist nicht qualifizierte Arbeiter - ausserdem noch häufig arbeitslos sind und demzufolge kein Netz von Beziehungen zur Verfügung haben, welches ihren Kindern bei der Arbeitssuche hilfreich sein könnte. Wenn die Kluft zwischen individuellen Ambitionen und Eingliederung in den Arbeitsmarkt auch gross ist, so führt dies auf dieser Ausbildungsebene (Abitur) nicht dazu, dass Jugendliche Beschàftigungen ablehnen, sondern ruft vielmehr negative Vorstellungen und Verhaltensweisen hervor, die Signaleffekt haben können und mit diskriminierenden Einstellungspraktiken von Seiten der Arbeitgeber einhergehen bzw. diese bestätigen können. Die Längsschnittdaten einer 1989 vom CEREQ durchgeführten Erhebung über den beruflichen Werdegang Jugendlicher mit Abitur (allgemeinbildendes oder technisches Schulsystem) oder Lehrabschluss bilden die Grundlage dieser Untersuchung.Roxane Silberman and Irène Fournier, Descendants of immigrants on the labour market : the discriminatory mechanisms involved. Changes in the productive apparatus involving the disappearance of some of the unqualified jobs which used to go to the children of immigrants raise questions as to their future and undermine the largely assimilation-oriented theories about integration. It is proposed here to examine the hypothesis often put forward that the enrolment of young people of North African origin is subject to discriminatory practices. An interactive explicative model is proposed based on social origins and their consequences in terms of these young people's aspirations and their educational strategies, their parents' position on the labour market and the social assets they are able to mobilize to help their children find employment, as well as there- suiting subjective images and attitudes. Two sharply contrasting groups emerged : those originating from the European Union member countries, the majority of whom are Portuguese, and the North Africans, the majority of whom are Algerians. Contrary to those of Polish origin, the North Africans tend to favour general education to the detriment of vocational training and apprenticeship : they therefore hardly fit what one might call the worker mobility model. This strategy, which may be rewarding for the few young people who obtain their baccalauréat and enter the higher educational system, results for the remainder in even greater job instability : and these people's fathers, most of whom are unemployed, unqualified workers, are not in a position to help them find employment by mobilizing their social contacts. Although there exists a large gap between these people's ambitions and their actual integration into the labour market, it does not result at this educational level in a refusal to work, but generates negative images and distinctive attitudes which tend to accentuate the employers' discriminatory practices, and even confirm them. This study was based on the longitudinal survey carried out by CEREQ on the occupational paths of the young people who emerged from the general and technical secondary educational systems and apprenticeship systems in 1989.La transformation de l'appareil productif qui s'accompagne de la disparition d'une partie des emplois peu qualifiés auxquels accédaient les enfants d'immigrés ouvre des interrogations sur leur devenir et bouscule les théories sur l'intégration largement dominées par le schème assimilationniste. L'article cherche à tester l'hypothèse souvent avancée d'une discrimination à l'embauche des jeunes d'origine maghrébine. Il propose un modèle interactif d'explication qui prend en compte l'origine sociale et ses conséquences en termes d'aspirations et de stratégies scolaires, la position des parents sur le marché du travail et le capital social qu'ils peuvent mobiliser pour aider leurs enfants à trouver un emploi, enfin les représentations subjectives et les comportements qui peuvent en résulter. Deux groupes s'opposent très nettement. Les originaires de pays de l'Union européenne, où dominent les Portugais, et les originaires du Maghreb, parmi lesquels les Algériens sont les plus nombreux. A la différence des parents d'origine portugaise, les originaires du Maghreb valorisent plutôt l'enseignement général aux dépens de l'enseignement professionnel et de l'apprentissage, s'écartant assez nettement d'un modèle que l'on pourrait qualifier de mobilité ouvrière. Cette stratégie, qui peut s'avérer payante pour la petite partie des jeunes qui va obtenir un baccalauréat et accéder à l'enseignement supérieur, se traduit par une précarité de l'emploi plus forte pour les autres, alors même que les pères, en majorité ouvriers non qualifiés et fortement touchés par le chômage, sont moins à même de mobiliser des relations pour les aider à trouver un travail. Si l'écart entre les ambitions et la réalité de l'insertion sur le marché du travail est important, il ne se traduit pas, à ce niveau de formation, par des refus d'emploi, mais génère des représentations négatives et des attitudes qui peuvent avoir un effet de signalement et se combiner avec des pratiques discriminatoires des employeurs, voire les confirmer. Les données longitudinales de l'enquête du Céreq sur le devenir professionnel des jeunes sortis de l'enseignement secondaire général ou technique et de l'apprentissage en 1989 servent de base à cette investigation.Silberman Roxane, Fournier Irène. Les enfants d'immigrés sur le marché du travail. Les mécanismes d'une discrimination sélective. In: Formation Emploi. N.65, 1999. Immigration. pp. 31-55

Levobupivacaine 0.5% provides longer analgesia after sciatic nerve block using the Labat approach than the same dose of ropivacaine in foot and ankle surgery

BACKGROUND: Levobupivacaine and ropivacaine are 2 left enantiomeric molecules frequently used for peripheral nerve blocks because of their safe clinical profile. Levobupivacaine is more lipophilic and theoretically more potent than ropivacaine, but clinical studies show conflicting results in terms of anesthetic and analgesic characteristics. We hypothesized that the pure S-enantiomer of bupivacaine provides longer-lasting analgesia than ropivacaine. METHODS: We compared the analgesic characteristics of 20 mL levobupivacaine versus 20 mL ropivacaine 0.5% in a posterior sciatic nerve block (Labat approach) for foot and ankle surgery. In a double-blind, randomized, prospective design, 80 patients received either substance. We assessed the onset, duration, and success of the block, and the need for rescue analgesia and technical or neurologic complications over 24 hours. RESULTS: The onset of sensory block (minutes) and the success rate were similar in levobupivacaine and ropivacaine groups (onset, 15 minutes [5-40 minutes] vs 15 minutes [5-60 minutes], respectively; success rate, 90% vs 92.5%). The average time for the first request of pain medication provided by 20 mL levobupivacaine 0.5% was significantly longer than with ropivacaine (1605 minutes [575-2400 minutes] vs 1035 minutes [590-1500 minutes], P < 0.001). The need for postoperative rescue analgesia was higher in the ropivacaine group (37 of 40 [92.5%] vs 30 of 40 [75%], P < 0.034). No complications were noted in either group at 24 hours. CONCLUSION: Twenty milliliters levobupivacaine 0.5% in posterior gluteal (Labat) sciatic nerve block provided longer-lasting analgesia after foot and ankle surgery compared with the same dose of ropivacaine

Partial sensory and motor deficit of ipsilateral lower limb after continuous interscalene brachial plexus block

We describe a partial sensory and motor block of the ipsilateral lower limb after interscalene infusion. After and injection of 20 mL of ropivacaine through the needle, the catheter was advanced 5 cm, and an infusion of ropivacaine 0.2% 5 mL/h commenced. Six hours later, the patient reported a left sensory and motor hemisyndrome, which resolved after the infusion was discontinued. Cervical computed tomography showed the tip of the catheter close to the intervertebral foramen at the C7-T1 level and several intravertebral paramedullar air bubbles. We conclude that the neurological symptoms were caused by an injection of local anesthetic via an interscalene catheter placed in proximity to the epidural space. To avoid this complication, we recommend advancing the catheter no more than 2-3 cm and performing frequent neurological evaluation of patients

Cervical abscess complicating an ultrasound-guided interscalene catheter

Perineural catheters are the technique of choice for postoperative analgesia after painful orthopedic surgery. Infectious complications associated with perineural catheters, although rare, are associated with increased morbidity and mortality, medical cost, and hospital length of stay. In this report, we describe a patient in whom a cervical abscess occurred after insertion of an ultrasound-guided interscalene catheter

Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on post-operative analgesia after total knee arthroplasty

Abstract Background Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24 h compared with end-hole catheter. Methods Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses. Results There was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24 h (4(2–7) vs. 4(2–8) in six-hole and end-hole groups, respectively; P = 0.832) or median ropivacaine consumption at 48 h (365(295–418) vs. 387(323–466); P = 0.452). No significant differences were recorded between the groups at 24 h regarding median average verbal rate pain scale (2(0–3) vs. 2(0–4); P = 0.486) or morphine consumption (0(0–20) vs. 0(0–20); P = 0.749). Quadriceps muscle strength declined to 7% (0–20) and 10% (0–28) in the six-hole and end-hole groups, respectively, at 24 h after surgery (P = 0.733). Conclusions In this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness. Trial registration Retrospectively registered at (NCT03376178). Date: 21 November 2017