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Cannabinoids for Acute Pain Management: Approaches and Rationale.
Get PDFPURPOSE OF THE REVIEW
Acute pain management remains a challenge and postoperative pain is often undermanaged despite many available treatment options, also including cannabinoids.
RECENT FINDINGS
In the light of the opioid epidemic, there has been growing interest in alternative care bundles for pain management, including cannabinoids as potential treatment to decrease opioid prescribing. Despite the lack of solid evidence on the efficacy of cannabinoids, their use among patients with pain, including those using opioids, is currently increasing. This use is supported by data suggesting that cannabinoids could potentially contribute to a better pain management and to a reduction in opioid doses while maintaining effective analgesia with minimum side effects. The scientific basis for supporting the use of cannabis is extensive, although it does not necessarily translate into relevant clinical outcomes. The use of cannabinoids in acute pain did not always consistently show statistically significant results in improving acute pain. Large randomized, controlled trials evaluating diverse cannabis extracts are needed in different clinical pain populations to determine safety and efficacy
Stereoselective Pharmacokinetics of Ketamine Administered at a Low Dose in Awake Dogs.
Get PDFThe present study aimed to examine the stereoselective pharmacokinetics of racemic ketamine in dogs at low doses. The secondary aims were to identify associated behavioural effects and propose a ketamine infusion rate. The study was conducted on nine intact male beagles, with each dog undergoing two treatments (BOL and INF). For treatment BOL, an intravenous bolus of 1 mg/kg was administered over 2 min. The treatment INF involved an initial bolus of 0.5 mg/kg given over 1 min, followed by an infusion at 0.01 mg/kg/min for 1 h. Blood samples were collected for pharmacokinetic analysis. The median R/S enantiomer ratio of ketamine remained close to 1 throughout the study. Levels of S-norketamine were significantly higher than those of R-norketamine across all time points. Based on the collected data, the infusion rate predicted to achieve a steady-state racemic ketamine plasma concentration of 150 ng/mL was 0.028 mg/kg/min. Higher scores for behavioural effects were observed within the first five minutes following bolus administration. The most common behaviours observed were disorientation, head movements and staring eyes. Furthermore, employing ROC curve analysis, a racemic ketamine plasma concentration of 102 ng/mL was defined as the cut-off value, correlating with the occurrence of undesirable behavioural patterns
“Somos libres?! Miguel Angel Cardenas’ mobility towards freedom and the emergence of a queer artistic language
No full textPhysician-modified versus chimney endografting for pararenal aortic aneurysms: a systematic review and meta-analysis.
No full textINTRODUCTION
We performed a systematic review and meta-analysis to assess the existing published evidence regarding the safety and efficacy of the endovascular aortic repair with chimney technique (ch-EVAR) and physician-modified stent-grafts (PMSGs) for the treatment of pararenal aortic aneurysm repair.
EVIDENCE ACQUISITION
A systematic search of all relevant studies reported until October 2023 according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. The pooled 30-day mortality, peri- and postoperative complication rates were estimated using fixed or random effect methods.
EVIDENCE SYNTHESIS
A total of 679 study titles were identified by the initial search strategy, of which 16 were considered eligible for inclusion in the meta-analysis. A total of 1094 patients (ch-EVAR N.=861 and PMSG N.=233) (90% male) were identified. The pooled 30-day mortality rate was 3.4% for ch-EVAR and 2.6% for PMSG. The major adverse events (MAE) in the early period was 14.7% for ch-EVAR and 18.5% PMSG, respectively. Higher occlusion rate was observed of the chimney stents grafts (8.2%) than the bridging stents (1.4%) during the follow-up period.
CONCLUSIONS
Ch-EVAR and physician-modified technology are safe with low 30-day mortality in elective settings for pararenal aortic aneurysms repair. No significant differences were seen between the two surgical methods regarding the early major adverse events rate. However, higher occlusion rate for the chimneys can be expected over time
Designing for usability: development and evaluation of a portable minimally-actuated haptic hand and forearm trainer for unsupervised stroke rehabilitation.
Get PDFIn stroke rehabilitation, simple robotic devices hold the potential to increase the training dosage in group therapies and to enable continued therapy at home after hospital discharge. However, we identified a lack of portable and cost-effective devices that not only focus on improving motor functions but also address sensory deficits. Thus, we designed a minimally-actuated hand training device that incorporates active grasping movements and passive pronosupination, complemented by a rehabilitative game with meaningful haptic feedback. Following a human-centered design approach, we conducted a usability study with 13 healthy participants, including three therapists. In a simulated unsupervised environment, the naive participants had to set up and use the device based on written instructions. Our mixed-methods approach included quantitative data from performance metrics, standardized questionnaires, and eye tracking, alongside qualitative feedback from semi-structured interviews. The study results highlighted the device's overall ease of setup and use, as well as its realistic haptic feedback. The eye-tracking analysis further suggested that participants felt safe during usage. Moreover, the study provided crucial insights for future improvements such as a more intuitive and comfortable wrist fixation, more natural pronosupination movements, and easier-to-follow instructions. Our research underscores the importance of continuous testing in the development process and offers significant contributions to the design of user-friendly, unsupervised neurorehabilitation technologies to improve sensorimotor stroke rehabilitation
Biss der Liebe – ekstatische Heiligenverehrung in Süditalien
No full textMorso d'amore", Biss der Liebe, wird im süditalienischen Apulien bis heute umgangssprachlich der Tarantismus genannt. Dabei handelt sich um ein kulturelles Phänomen, das von Medizinern im Mittelalter auch als ›Tanzwut‹ oder ›Choreomanie‹ bezeichnet wurde. Betroffen waren zumeist Frauen, deren Anfälle und Ekstasen auf den Biss einer Giftspinne zurückgeführt wurden. Heilung versprach ein ursprünglich therapeutischer Tarantella-Tanz, bei dem die Betroffenen auf bestimmte Melodien, Rhythmen, aber auch auf Farben reagierten und oft tagelang bis zur kompletten Erschöpfung tanzen mussten. Der eigentlich unerklärliche Zustand wurde von der katholischen Kirche in einen Heiligenkult um den Heiligen Paulus, den Schutzpatron der giftigen Spinnentiere, überführt und der Tanz auf seine folkloristischen Elemente reduziert. Und dennoch brechen sich immer wieder Momente der Ekstase und des unkontrollierten (auch sexuell konnotierten) Gebahrens Bahn ...
Ausgehend von Filmen, Fotografien und Tondokumenten zum Tarantismus aus dem Nachkriegsitalien interessiere ich mich als Medienanthropologin v.a. für die vielfältigen Remedialisierungen des Phänomens in der Gegenwart und nehme auch die besondere Faszination in den Blick, die dieser Kult in seinen unterschiedlichen Ausformungen bis heute auf Wissenschaftler:innen, Künstler:innen und Tourist:innen ausübt
Sterically Selective [3 + 3] Cycloaromatization in the On-Surface Synthesis of Nanographenes.
Get PDFSurface-catalyzed reactions have been used to synthesize carbon nanomaterials with atomically predefined structures. The recent discovery of a gold surface-catalyzed [3 + 3] cycloaromatization of isopropyl substituted arenes has enabled the on-surface synthesis of arylene-phenylene copolymers, where the surface activates the isopropyl substituents to form phenylene rings by intermolecular coupling. However, the resulting polymers suffered from undesired cross-linking when more than two molecules reacted at a single site. Here we show that such cross-links can be prevented through steric protection by attaching the isopropyl groups to larger arene cores. Upon thermal activation of isopropyl-substituted 8,9-dioxa-8a-borabenzo[fg]tetracene on Au(111), cycloaromatization is observed to occur exclusively between the two molecules. The cycloaromatization intermediate formed by the covalent linking of two molecules is prevented from reacting with further molecules by the wide benzotetracene core, resulting in highly selective one-to-one coupling. Our findings extend the versatility of the [3 + 3] cycloaromatization of isopropyl substituents and point toward steric protection as a powerful concept for suppressing competing reaction pathways in on-surface synthesis
Pulse-echo ultrasound attenuation tomography.
Get PDFObjective.We present the first fully two-dimensional attenuation imaging technique developed for pulse-echo ultrasound systems. Unlike state-of-the-art techniques, which use line-by-line acquisitions, our method uses steered emissions to constrain attenuation values at each location with multiple crossing wave paths, essential to resolve the spatial variations of this tissue property.Approach.At every location, we compute normalized cross-correlations between the beamformed images that are obtained from emissions at different steering angles. We demonstrate that their log-amplitudes provide the changes between attenuation-induced amplitude losses undergone by the different incident waves. This allows us to formulate a linear tomographic problem, which we efficiently solve via a Tikhonov-regularized least-squares approach.Main results.The performance of our tomography technique is first validated in numerical examples and then experimentally demonstrated in custom-made tissue-mimicking phantoms with inclusions of varying size, echogenicity, and attenuation. We show that this technique is particularly good at resolving lateral variations in tissue attenuation and remains accurate in media with varying echogenicity.Significance.Based on a similar principle, this method can be easily combined with computed ultrasound tomography in echo mode (CUTE) for speed-of-sound imaging, paving the way towards a multi-modal ultrasound tomography framework characterizing multiple acoustic tissue properties simultaneously
Quantification of sediment fluxes and intermittencies from Oligo–Miocene megafan deposits in the Swiss Molasse basin
Get PDFThe conglomerates preserved in alluvial fans in the Swiss Molasse basin provide crucial insights into the sedimentary dynamics of these routing systems. In particular, the architectural trends and grain sizes of such deposits reveal information on the sediment fluxes and record variations in the intermittency — a proxy for the fan's activity — that indicate on the relative importance of tectonic or climatic controls on sediment production and transport. Here, we calculated intermittencies from sediment transport dynamics using the ratio between the long-term average and the short-term
instantaneous unit sediment fluxes during bankfull discharge conditions. For this, we collected grain size data from three palaeo-fan systems that were active through Oligo–Miocene times and that reveal preserved proximal–distal relationships. The three fan systems, which we term the western, central and eastern fans, show significant differences in their long-term sediment budget but equivalent magnitudes of the sediment transport dynamics expressed through the intermittency factor. The eastern fan records a low long-term sediment flux (5.7 km2 Myr−1), which needed the fan to be active during ca. 8 h yr−1 (intermittency factor of 0.89 × 10−3). The western fan reveals a higher long-term sediment flux (16.2 km2 Myr−1), which could have accumulated during ca. 16 h yr−1 (intermittency factor of 1.83 × 10−3), thereby reflecting a more active system. The central fan records the largest long-term sediment flux (40.3 km2 Myr−1), where ca. 57 h yr−1 of sediment transport would be required to deposit the supplied material (intermittency factor of 6.53 × 10−3), thus representing the most active system. By relating these characteristics to the regional exhumation history, we consider that the central fan mainly recorded the transient response of the Alpine surface to the break-off of the European mantle lithosphere slab. Contrarily, the western and eastern fans were formed during the Alpine evolution when steady-state conditions between uplift and erosion were reached and when sediment fluxes to the basin were lower. Despite differences in the tecto-geomorphic and climatic boundary conditions, our data suggest that these Oligo–Miocene megafans could accomplish their mean annual sediment transport work within a few hours or days per year
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