Complement C3 Inhibitor Pegcetacoplan for Geographic Atrophy Secondary to Age-Related Macular Degeneration : A Randomized Phase 2 Trial

Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.Peer reviewedPublisher PD

Modes d'administrations périnerveux des anesthésiques locaux : effet sur l'analgésie postopératoire en chirurgie orthopédique

L'anesthésie locorégionale (ALR) périphérique continue est la technique analgésique de référence après chirurgie orthopédique majeure des membres. L'analgésie postopératoire est efficace aussi bien au repos qu'à la mobilisation et prolongée pendant plusieurs jours jouant ainsi un rôle majeur dans la réhabilitation postopératoire. Les bénéfices de l'ALR périphérique continue peuvent être influencés par le mode d'administration périnerveux de l'anesthésique local (AL). Nous avons effectué une étude prospective randomisée comparant deux mode d'administration d'AL (perfusion continue versus bolus automatiques) au travers d'un cathéter interscalénique uniport positionné sous échoguidage. L'analgésie postopératoire était équivalente avec une consommation totale d'AL et une incidence d'hémiparésie diaphragmatique similaires quelque soit le mode d'administration. L'intérêt de l'administration de l'AL en bolus automatique a probablement été réduit par l'utilisation de l'échographie qui optimise le positionnement de l'extrémité du cathéter et garantit la diffusion adéquate de l'AL

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

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Toxoplasma gondii exposure may modulate the influence of TLR2 genetic variation on bipolar disorder: a gene–environment interaction study

International audienceBackgroundGenetic vulnerability to environmental stressors is yet to be clarified in bipolar disorder (BD), a complex multisystem disorder in which immune dysfunction and infectious insults seem to play a major role in the pathophysiology. Association between pattern-recognition receptor coding genes and BD had been previously reported. However, potential interactions with history of pathogen exposure are yet to be explored.Methods138 BD patients and 167 healthy controls were tested for serostatus of Toxoplasma gondii, CMV, HSV-1 and HSV-2 and genotyped for TLR2 (rs4696480 and rs3804099), TLR4 (rs1927914 and rs11536891) and NOD2 (rs2066842) polymorphisms (SNPs). Both the pathogen-specific seroprevalence and the TLR/NOD2 genetic profiles were compared between patients and controls followed by modelling of interactions between these genes and environmental infectious factors in a regression analysis.ResultsFirst, here again we observed an association between BD and Toxoplasma gondii (p = 0.045; OR = 1.77; 95 % CI 1.01–3.10) extending the previously published data on a cohort of a relatively small number of patients (also included in the present sample). Second, we found a trend for an interaction between the TLR2 rs3804099 SNP and Toxoplasma gondii seropositivity in conferring BD risk (p = 0.017, uncorrected).ConclusionsPathogen exposure may modulate the influence of the immunogenetic background on BD. A much larger sample size and information on period of pathogen exposure are needed in future gene–environment interaction studies