Effect of electroacupuncture on brachial plexus post-traumatic neuralgia: A case report

Background

Brachial plexus injury is a serious peripheral nerve injury that severely disables upper limbs and affects patients' daily life and work Acupuncture and Electroacupuncture have traditionally been used to treat neuropathic pain. However, there is still lacking evidence as regard to their effects on pain following traumatic nerve and plexus lesions. Neurotmesis after brachial plexus injury also causes movement disorders of the denervated muscles and loss of sensory function in the skin.

Case report

We report a case of a brachial plexus injury due to humeral fracture, predominantly involving the lower trunk and the medial cord, treated with electroacupuncture. Results. We documented a positive significant response, based on clinical examination, pain scores and neurophysiologic findings.

Conclusions

Repeated Electroacupuncture can relieve neuropathic pain due to brachial plexus injury. However, additional studies are needed to verify the efficacy and effectiveness of this approach.

PENG block associated with dexmedetomidine sedation for intramedullary femoral fixation in high-risk elderly patients: a case series and review of the literature

BACKGROUND

Hip fracture is a major cause of hospitalization among the elderly population. The standard surgical treatment involves early repair to reduce mortality and morbidity. One type of treatment in the case of intertrochanteric and subtrochanteric fractures is intramedullary nailing, as it decreases soft tissue damage and permits early weight bearing. The most common anesthesia technique combines spinal anesthesia with a peripheral block. In cases where spinal anesthesia is contraindicated, general anesthesia is preferred. However, both techniques can lead to significant complications, especially in patients with multiple comorbidities. Pain management after hip surgery, particularly in elderly and frail individuals, poses a challenge. The pericapsular nerve group block (PENG) targets the innervation of the anterior portion of the hip joint and is increasingly used for pain management related to hip surgery.

CASE SERIES

This paper presents a case series of three elderly patients who underwent pericapsular nerve group block (PENG) block combined with dexmedetomidine sedation for intramedullary femoral fixation.

CONCLUSIONS

The PENG block can be effectively used as the sole anesthetic technique for managing elderly patients undergoing intramedullary femoral fixation while on antiplatelet drugs. This procedure effectively controlled pain during both the surgical and postoperative periods. The addition of dexmedetomidine for sedation enables comfortable and safe procedures, minimizing the risk of perioperative neurocognitive dysfunctions and without adverse effects on cardiorespiratory function.

Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) as unique technique for airway management during operative hysteroscopy under general anesthesia: a registered feasibility pilot cohort study

OBJECTIVE

The term THRIVE refers to the delivery of 100% heated and humidified oxygen via a nasal cannula to maintain viable gas exchange during prolonged apnea. There are no reports of its application for Operative Hysteroscopy (OH) under general anesthesia (GA). The aim of the study is to investigate the success rate of THRIVE as unique airway management technique in this setting. The results will support the development of a randomized controlled trial (RCT) to demonstrate the non-inferiority of THRIVE compared to traditional techniques.

PATIENTS AND METHODS

Twenty consecutive ASA I-II women presenting for OH were enrolled. Standard anesthesia, as well as transcutaneous carbon dioxide (tcCO2) monitoring, was performed. After preoxygenation with 30 L∙min-1, GA was induced with propofol and fentanyl, then oxygen flow was increased to 70 L∙min-1 and anesthesia maintained with propofol infusion. The primary outcome was success rate of THRIVE defined as SpO2 > 94%, tcCO2 < 60 mmHg and no need for rescue airway intervention.

RESULTS

Mean age was 47 ± 12 years. Mean duration of the procedure was 25 ± 9 minutes, and the success rate of the technique was 100%. Median SpO2 during the procedure was 100 (IQR 99-100) %. Mean maximum tcCO2 level was 51 ± 7 mmHg while mean tcCO2 level during the procedure was 45 ± 7 mmHg. At the end of the procedure, mean tcCO2 was 44 ± 5 mmHg.

CONCLUSIONS

THRIVE allowed adequate gas exchange during OH under GA, without additional rescue airway interventions. The application of THRIVE in this setting may allow minimal airway manipulation and optimal comfort for the patient with low failure rate. We calculated the sample size for the planned non-inferiority RCT investigating the effectiveness of THRIVE versus laryngeal mask ventilation in OH: 82 is the minimal number of patients per group to test a non-inferiority limit of 10%.

Climate change and air pollution: Translating their interplay into present and future mortality risk for Rome and Milan municipalities

Heat and cold temperatures associated with exposure to poor air quality lead to increased mortality. Using a generalized linear model with Poisson regression for overdispersion, this study quantifies the natural-caused mortality burden attributable to heat/cold temperatures and PM₁₀ and O₃ air pollutants in Rome and Milan, the two most populated Italian cities. We calculate local-specific mortality relative risks (RRs) for the period 2004-2015 considering the overall population and the most vulnerable age category (≥85 years). Combining a regional climate model with a chemistry-transport model under future climate and air pollution scenarios (RCP2.6 and RCP8.5), we then project mortality to 2050. Results show that for historical mortality the burden is much larger for cold than for warm temperatures. RR peaks during wintertime in Milan and summertime in Rome, highlighting the relevance of accounting for the effects of air pollution besides that of climate, in particular PM₁₀ for Milan and O₃ for Rome. Overall, Milan reports higher RRs while, in both cities, the elderly appear more susceptible to heat/cold and air pollution events than the average population. Two counterbalancing effects shape mortality in the future: an increase associated with higher and more frequent warmer daily temperatures - especially in the case of climate inaction - and a decrease due to declining cold-mortality burden. The outcomes highlight the urgent need to adopt more stringent and integrated climate and air quality policies to reduce the temperature and air pollution combined effects on health.

From single to multivariable exposure models to translate climatic and air pollution effects into mortality risk. A customized application to the city of Rome, Italy

This study presents an approach developed to derive a Delayed-Multivariate Exposure-Response Model (D-MERF) useful to assess the short-term influence of temperature on mortality, accounting also for the effect of air pollution (O₃ and PM₁₀). By using Distributed, lag non-linear models (DLNM) we explain how city-specific exposure-response functions are derived for the municipality of Rome, which is taken as an example. The steps illustrated can be replicated to other cities while the statistical model presented here can be further extended to other exposure variables. We derive the mortality relative-risk (RR) curve averaged over the period 2004–2015, which accounts for city-specific climate and pollution conditions.

Key aspects of customization are as follows:

This study reports the steps followed to derive a combined, multivariate exposure-response model aimed at translating climatic and air pollution effects into mortality risk.

Integration of climate and air pollution parameters to derive RR values.

A specific interest is devoted to the investigation of delayed effects on mortality in the presence of different exposure factors.

Supporting the improvement of air quality management practices: The "FAIRMODE pilot" activity

This paper presents the first outcomes of the "FAIRMODE pilot" activity, aiming at improving the way in which air quality models are used in the frame of the European "Air Quality Directive". Member States may use modelling, combined with measurements, to "assess" current levels of air quality and estimate future air quality under different scenarios. In case of current and potential exceedances of the Directive limit values, it is also requested that they "plan" and implement emission reductions measures to avoid future exceedances. In both "assessment" and "planning", air quality models can and should be used; but to do so, the used modelling chain has to be fit-for-purpose and properly checked and verified. FAIRMODE has developed in the recent years a suite of methodologies and tools to check if emission inventories, model performance, source apportionment techniques and planning activities are fit-for-purpose. Within the "FAIRMODE pilot", these tools are used and tested by regional/local authorities, with the two-fold objective of improving management practices at regional/local scale, and providing valuable feedback to the FAIRMODE community. Results and lessons learnt from this activity are presented in this paper, as a showcase that can potentially benefit other authorities in charge of air quality assessment and planning.

Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project

BACKGROUND

The LIFE MED HISS project aims at setting up a surveillance system on the long term effects of air pollution on health, using data from National Health Interview Surveys and other currently available sources of information in most European countries. Few studies assessed the long term effect of air pollution on hospital admissions in European cohorts.

OBJECTIVE

The objective of this paper is to estimate the long term effect of fine particulate matter (PM2.5) and nitrogen dioxide (NO₂) on first-ever (incident) cause-specific hospitalizations in Italy.

METHODS

We used data from the Italian Longitudinal Study (ILS), a cohort study based on the 1999-2000 National Health Interview Survey (NHIS), followed up for hospitalization (2001-2008) at individual level. The survey contains information on crucial potential confounders: occupational/educational/marital status, body mass index (BMI), smoking habit and physical activity. Annual mean exposure to PM2.5 and NO₂ was assigned starting from simulated gridded data at spatial resolution of 4 × 4 km² firstly integrated with data from monitoring stations and then up-scaled at municipality level. Statistical analyses were conducted using Cox proportional hazard models with robust variance estimator.

RESULTS

For each cause of hospitalization we estimated the hazard ratios (HRs) adjusted for confounders with 95% Confidence Interval (CI) related to a 10 μg/m³ increase in pollutants. For PM2.5 and NO₂, respectively, we found positive associations for circulatory system diseases [1.05(1.03-1.06); 1.05(1.03-1.07)], myocardial infarction [1.15(1.12-1.18); 1.15(1.12-1.18)], lung cancer [1.18(1.10-1.26); 1.20(1.12-1.28)], kidney cancer [1.24(1.11-1.29); 1.20(1.07-1.33)], all cancers (but lung) [1.06(1.04-1.08); 1.06(1.04-1.08)] and Low Respiratory Tract Infections (LRTI) [1.07 (1.04-1.11); 1.05 (1.02-1.08)].

DISCUSSION

Our results add new evidence on the effects of air pollution on first-ever (incident) hospitalizations, both in urban and rural areas. We demonstrated the feasibility of a low-cost monitoring system based on available data.

Microscale modelling simulations for the site characterization of air quality stations in an urban environment

The presence of natural or artificial barriers placed near the air quality measuring stations located in an urban environment poses some problems in the assessment of their siting and significance. The atmospheric flow distortion induced by these structures can create situations that affect the concentration levels of measured pollutants. A modelling study at microscale of the pollutant dispersion in an urban environment has been performed to quantify these possible effects on measurements. The target domain is located in a central section of the city of Turin (northern Italy) around via della Consolata, near the location of an existing station of the regional monitoring network. The study involved the use of the modelling system Micro-Swift-Spray, which takes into account the presence of complex topographical barriers, including street canyons and squares surrounded by buildings. Two entire days have been simulated, to characterise both a critical and a more standard condition, with reconstruction of average flow, turbulence and hourly ground-level pollutant concentrations. Contributions from both traffic and building-heating sources have been considered and a comparison with measured concentrations has been performed to verify the representativeness of the measuring station with respect to both average conditions and spatial variability inside the considered region, otherwise very difficult to asses through a single and isolated measuring point.

A confirmatory method for detection of a banned substance: The validation experience of a routine EU laboratory

The Commission Decision 2002/657/EC is a fundamental reference document for the UE laboratories involved in residue analysis although its implementation has caused some difficulties in the requirements interpretation. In this work a pragmatic validation approach of a quantitative confirmatory method for the detection of 17-alpha-(alpha-NT) and 17-beta-19-nortestosterone (beta-NT) in bovine urine by gas chromatography mass spectrometry is proposed. The 19-nortestosterone is a banned anabolic steroid for which no minimum required performance limit (MRPL) has been laid down, therefore the limit reported in Italian Residue Monitoring Plan (2 microg L(-1)) has been considered the reference level to evaluate the method performances. The decision limit (CCalpha) and the detection capability (CCbeta) were obtained by the calibration curve procedure. The minimum required performance level (mrpl), which represents the starting concentration of the calibration curves, was preliminary fixed estimating the results dispersion of blank urine samples fortified at 2 microg L(-1) for each isomer. The found CCalpha and CCbeta were 1.5 and 1.9 microg L(-1) for alpha-NT and 1.2 and 1.4 microg L(-1) for beta-NT. The precision (repeatability and within-laboratory reproducibility) and recoveries were suitable for the investigated concentration range (1-3 microg L(-1)). Finally, the method ruggedness (minor and major changes) has been also demonstrated.