Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: A case report

Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced fracture of left tibia and extensive loss of substance needed orthopedic surgeries as well as several reconstructive procedures. A continuous popliteal nerve block was applied via ultrasound-guided catheter for anesthesia at different times, and postoperative pain control for all surgical procedures. The continuous popliteal nerve block and its long-term positioning, of non-common evidence in literature, was utilized to treat a poly-traumatized patient, thereby avoiding repeated general anesthesia and opioid use and their adverse effects. This technique, within a complicated combat field environment, was demonstrated to be clinically effective with high patient satisfaction

Time Delay Interferometry combinations as instrument noise monitors for LISA

The LISA mission will likely be a signal dominated detector, such that one challenge is the separation of the different astrophysical sources, and to distinguish between them and the instrumental noise. One of the goals of LISA is to probe the early Universe by detecting stochastic GW backgrounds. As correlation with other detectors is not possible for LISA, discrimination of such a GW background from the instrumental noise requires a good estimate of the latter. To this purpose we have revisited Time Delay Interferometry (TDI) to look for new TDI signal combinations that fulfill the laser frequency noise suppression requirements. We illustrate that it is possible to do a linear combination of these TDI channels to find special null-combinations that suppress gravitational waves and mainly carry information about instrumental noise. We find that there exist many null-combinations that show different sensitivities to gravitational waves, some of which seem more suitable than the traditional T combination for estimating test-mass acceleration noise. In an idealised LISA configuration, they are all sensitive to a particular linear combination of the six test-masses acceleration, similar to a rigid rotation of the LISA triangle. In the following article, we illustrate what are the noise properties that can be extracted by monitoring these interferometry signals and discuss the implication of these findings for the detection of stochastic GW backgrounds

The effects of training on hormonal concentrations in young soccer players

To test the hypothesis that football training would be accompanied by physiological adaptations and hormonal changes, we analyzed the effects of a whole football season on physical fitness and hormonal concentrations in youth football players. Male football players (n = 29, age 16.51 ± 0.7 years) in a regional professional league and male healthy control subjects (n = 30, age 17.1 ± 1 years) participated to the study. Blood cortisol, testosterone, and growth hormone (hGH) concentrations were assayed before the beginning of the training period (T0), just after the training period (T1), at the middle of the season (T2), and at the end of the season (T3). In each period physical tests and anthropometric measurements were also performed. Results showed significant differences in basal values of cortisol, testosterone, and growth hormone (hGH) in the four time points evaluated (P < 0.01). In addition, the concentrations of hGH were higher in the soccer players group than in control subjects (P < 0.001). Between the start of the training period and the end of the football season significant differences were observed in the anthropometric characteristics and in the physical form of the football players. Furthermore, the hormonal status was significantly correlated with the indicators of the lower limb power (squat-jump [SqJ], and counter-movement-jump [CMJ]) and those of aerobic performance (Yo–Yo intermittent recovery test level 1 (YYIRT1) and maximal oxygen consumption (VO2max)).These data underscore the importance of establishing training protocols that present the potential to promote positive adaptations without, at the same time, provoking overtraining of young players

Learning effect of humphrey matrix frequency doubling technology perimetry in patients with ocular hypertension

Aim: To evaluate the learning effect of Frequency Doubling Technology (FDT) perimetry using the Humphrey Matrix-FDT perimetry (Matrix) 24-2 full-threshold program on patients with 7 ocular hypertension experienced with standard automated perimetry. Methods: Twenty-four patients with Ocular hypertension underwent 5 full-threshold Matrix tests at intervals of 5 2 days. Learning effect was defined as an improvement at results for duration, perimetric indices, foveal sensitivity, Glaucoma Hemifield Test, and the number of points with a P < 5% and < 1% in the total and pattern deviation maps. Eccentricity, hemifield, and quadrant sensitivities were also addressed as Sources of differences in learning effect. Test-retest variability was also calculated for each repetition as the mean of the point-to-point interindividual standard deviations. Results: A learning effect was demonstrated for mean defect (P = 0.031, analysis of variance) and foveal sensitivity (P = 0.009) and it only affected the first test for both parameters. All the other parameters did not show any significant learning effect. The effect was independent From eccentricity and quadrant or hemifield sensitivities. Conclusions: The results of this study demonstrate that the learning effect for Matrix-FDT is mild and it may affect only the first test. Caution is needed in the analysis of the first Matrix-FDT examination and retest may be advisable in the presence of low mean defect

Management of Medico-Legal Risks in Digital Health Era: A Scoping Review

Artificial intelligence needs big data to develop reliable predictions. Therefore, storing and processing health data is essential for the new diagnostic and decisional technologies but, at the same time, represents a risk for privacy protection. This scoping review is aimed at underlying the medico-legal and ethical implications of the main artificial intelligence applications to healthcare, also focusing on the issues of the COVID-19 era. Starting from a summary of the United States (US) and European Union (EU) regulatory frameworks, the current medico-legal and ethical challenges are discussed in general terms before focusing on the specific issues regarding informed consent, medical malpractice/cognitive biases, automation and interconnectedness of medical devices, diagnostic algorithms and telemedicine. We aim at underlying that education of physicians on the management of this (new) kind of clinical risks can enhance compliance with regulations and avoid legal risks for the healthcare professionals and institutions

An Evaluation of Therapeutic Noninferiority of 0.005% Latanoprost Ophthalmic Solution and Xalatan in Patients With Glaucoma or Ocular Hypertension.

PURPOSE: To assess the therapeutic noninferiority of 0.005% latanoprost ophthalmic solution versus Xalatan in the treatment of patients with primary open-angle glaucoma or ocular hypertension. PATIENTS AND METHODS: This was a double-masked, randomized, multicenter study. A total of 184 patients with a diagnosis of unilateral or bilateral primary open-angle glaucoma or ocular hypertension were randomly assigned to either 0.005% latanoprost ophthalmic solution or Xalatan for 12 weeks. The primary end-point was the change in intraocular pressure (IOP) at 12 weeks in the 2 groups. Noninferiority was reached if the 2-sided 95% confidence intervals (CI) for the difference between adjusted treatment means were entirely within the interval from -1.5 to +1.5 mm Hg. RESULTS: The difference between treatments in the change of IOP from baseline to the end of treatment was 0.12 mm Hg (95% CI: -0.47, 0.71) in the intention-to-treat population and 0 mm Hg (95% CI: -0.58, 0.57) in the per protocol population. There was no statistically significant difference between the 2 groups in terms of drug-related adverse events. The most commonly reported drug-related local adverse events were: ocular hyperemia, eyelashes growth, and eye irritation. CONCLUSIONS: This study demonstrates that 0.005% latanoprost ophthalmic solution is noninferior to Xalatan in lowering IOP and is generally well tolerate

Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?

Background: Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure. Methods: Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU. Results: A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed. Conclusions: Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome