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1.
Immunity ; 56(5): 998-1012.e8, 2023 05 09.
Article in English | MEDLINE | ID: mdl-37116499

ABSTRACT

Cytosolic innate immune sensing is critical for protecting barrier tissues. NOD1 and NOD2 are cytosolic sensors of small peptidoglycan fragments (muropeptides) derived from the bacterial cell wall. These muropeptides enter cells, especially epithelial cells, through unclear mechanisms. We previously implicated SLC46 transporters in muropeptide transport in Drosophila immunity. Here, we focused on Slc46a2, which was highly expressed in mammalian epidermal keratinocytes, and showed that it was critical for the delivery of diaminopimelic acid (DAP)-muropeptides and activation of NOD1 in keratinocytes, whereas the related transporter Slc46a3 was critical for delivering the NOD2 ligand MDP to keratinocytes. In a mouse model, Slc46a2 and Nod1 deficiency strongly suppressed psoriatic inflammation, whereas methotrexate, a commonly used psoriasis therapeutic, inhibited Slc46a2-dependent transport of DAP-muropeptides. Collectively, these studies define SLC46A2 as a transporter of NOD1-activating muropeptides, with critical roles in the skin barrier, and identify this transporter as an important target for anti-inflammatory intervention.


Subject(s)
Dermatitis , Methotrexate , Mice , Animals , Methotrexate/pharmacology , Inflammation , Peptidoglycan/metabolism , Epithelial Cells/metabolism , Nod1 Signaling Adaptor Protein/metabolism , Nod2 Signaling Adaptor Protein/metabolism , Immunity, Innate , Mammals
2.
Anesth Analg ; 133(6): 1379-1386, 2021 12 01.
Article in English | MEDLINE | ID: mdl-34784324

ABSTRACT

BACKGROUND: Total knee replacement (TKR) and total hip replacement (THR) are 2 of the most common orthopedic surgical procedures in the United States. These procedures, with fairly low mortality rates, incur significant health care costs, with almost 40% of the costs associated with post acute care. We assessed the impact of general versus neuraxial anesthesia on discharge destination and 30-day readmissions in patients who underwent total knee and hip replacement in our health system. METHODS: This was a retrospective cohort study of 24,684 patients undergoing total knee or hip replacement in 13 hospitals of a large health care network. Following propensity score matching, we studied the impact of type of anesthetic technique on discharge destination (primary outcome) and postoperative complications including readmissions in 8613 patients who underwent THR and 13,004 patients for TKR. RESULTS: Our results showed that in patients undergoing THR and TKR, neuraxial anesthesia is associated with higher odds of being discharged from hospital to home versus other facilities compared to general anesthesia (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.52-1.76; P < .01) and (OR = 1.58, 95% CI, 1.49-1.67; P < .01), respectively. CONCLUSIONS: Our results suggest an association between use of neuraxial anesthesia for total joint arthroplasty and a higher probability of discharge to home and a reduction in readmissions.


Subject(s)
Anesthesia, Conduction/methods , Anesthesia, General/methods , Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Knee/methods , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Patient Discharge , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , Propensity Score , Retrospective Studies , Treatment Outcome
3.
Anesth Analg ; 128(6): e104-e108, 2019 06.
Article in English | MEDLINE | ID: mdl-31094804

ABSTRACT

We tested the hypothesis that during a continuous popliteal-sciatic nerve block, postoperative analgesia is improved with the catheter insertion point "deep" to the paraneural sheath immediately distal to the bifurcation between the tibial and common peroneal branches, compared with the traditional approach "superficial" to the paraneural sheath proximal to the bifurcation. The needle tip location was determined to be accurately located with a fluid bolus visualized with ultrasound; however, catheters were subsequently inserted without a similar fluid injection and visualization protocol (visualized air injection was permitted and usually implemented, but not required per protocol). The average pain (0-10 scale) the morning after surgery for subjects with a catheter inserted at the proximal subparaneural location (n = 31) was a median (interquartile) of 1.5 (0.0-3.5) vs 1.5 (0.0-4.0) for subjects with a catheter inserted at the distal supraparaneural location (n = 32; P = .927). Secondary outcomes were similarly negative.


Subject(s)
Analgesia/methods , Catheterization/methods , Nerve Block , Pain Management/methods , Pain, Postoperative/drug therapy , Sciatic Nerve/drug effects , Adult , Aged , Anesthetics, Local , Catheters , Female , Humans , Injections , Lidocaine/administration & dosage , Male , Middle Aged , Needles , Pain Measurement , Postoperative Period , Prospective Studies
4.
Neuromodulation ; 22(5): 653-660, 2019 Jul.
Article in English | MEDLINE | ID: mdl-30024078

ABSTRACT

INTRODUCTION: The objective of the present feasibility study was to investigate the use of a new treatment modality-percutaneous peripheral nerve stimulation (PNS)-in controlling the often severe and long-lasting pain following total knee arthroplasty (TKA). METHODS: For patients undergoing a primary, unilateral TKA, both femoral and sciatic open-coil percutaneous leads (SPR Therapeutics, Cleveland, OH) were placed up to seven days prior to surgery using ultrasound guidance. The leads were connected to external stimulators and used both at home and in the hospital for up to six weeks total. RESULTS: In six of seven subjects (86%), the average of daily pain scores across the first two weeks was <4 on the 0-10 Numeric Rating Scale for pain. A majority of subjects (four out of seven; 57%) had ceased opioid use within the first week (median time to opioid cessation for all subjects was six days). Gross sensory/motor function was maintained during stimulation, enabling stimulation during physical therapy and activities of daily living. At 12 weeks following surgery, six of seven subjects had improved by >10% on the Six-Minute Walk Test compared to preoperative levels, and WOMAC scores improved by an average of 85% compared to before surgery. No falls, motor block, or lead infections were reported. CONCLUSIONS: This feasibility study suggests that for TKA, ultrasound-guided percutaneous PNS is feasible in the immediate perioperative period and may provide analgesia without the undesirable systemic effects of opioids or quadriceps weakness induced by local anesthetics-based peripheral nerve blocks.


Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Pain Measurement/methods , Pain, Postoperative/diagnostic imaging , Pain, Postoperative/therapy , Transcutaneous Electric Nerve Stimulation/methods , Activities of Daily Living , Aged , Arthroplasty, Replacement, Knee/trends , Feasibility Studies , Female , Humans , Male , Middle Aged , Pain Measurement/trends , Pain, Postoperative/etiology , Prospective Studies , Transcutaneous Electric Nerve Stimulation/trends , Treatment Outcome , Ultrasonography, Interventional/methods , Ultrasonography, Interventional/trends
5.
Reg Anesth Pain Med ; 43(6): 580-589, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29905630

ABSTRACT

BACKGROUND AND OBJECTIVES: Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain the day following knee surgery. However, it remains unknown if this analgesic technique may be used in ambulatory subjects following foot procedures beginning within the recovery room immediately following surgery, and with only short series of patients reported to date, the only available data are derived from strictly observational studies. The purposes of this proof-of-concept study were to demonstrate the feasibility of using percutaneous sciatic nerve PNS to treat postoperative pain following ambulatory foot surgery in the immediate postoperative period and provide the first available data from a randomized controlled study design to provide evidence of analgesic effect. METHODS: Preoperatively, an electrical lead (SPRINT; SPR Therapeutics, Inc, Cleveland, Ohio) was percutaneously inserted posterior to the sciatic nerve between the subgluteal region and bifurcation with ultrasound guidance. Following hallux valgus osteotomy, subjects received 5 minutes of either stimulation or sham in a randomized, double-masked fashion followed by a 5-minute crossover period and then continuous stimulation until lead removal on postoperative days 14 to 28. RESULTS: During the initial 5-minute treatment period, subjects randomized to stimulation (n = 4) experienced a downward trajectory in their pain over the 5 minutes of treatment, whereas those receiving sham (n = 3) reported no such change until their subsequent 5-minute stimulation crossover. During the subsequent 30 minutes of stimulation, pain scores decreased to 52% of baseline (n = 7). Three subjects (43%) used a continuous popliteal nerve block for rescue analgesia during postoperative days 0 to 3. Overall, resting and dynamic pain scores averaged less than 1 on the numeric rating scale, and opioid use averaged less than 1 tablet daily with active stimulation. One lead dislodged, 2 fractured during use, and 1 fractured during intentional withdrawal. CONCLUSIONS: This proof-of-concept study demonstrates that percutaneous sciatic nerve PNS is feasible for ambulatory foot surgery and suggests that this modality provides analgesia and decreases opioid requirements following hallux valgus procedures. However, lead dislodgement and fracture are concerns. CLINICAL TRIAL REGISTRATION: This study was registered at Clinicaltrials.gov, identifier NCT02898103.


Subject(s)
Ambulatory Surgical Procedures/methods , Hallux Valgus/surgery , Pain, Postoperative/prevention & control , Proof of Concept Study , Sciatic Nerve , Transcutaneous Electric Nerve Stimulation/methods , Ultrasonography, Interventional/methods , Adult , Aged , Ambulatory Surgical Procedures/adverse effects , Cross-Over Studies , Double-Blind Method , Female , Hallux Valgus/diagnostic imaging , Humans , Male , Middle Aged , Pain, Postoperative/diagnostic imaging , Pilot Projects , Sciatic Nerve/diagnostic imaging , Sciatic Nerve/physiology
6.
Anesth Analg ; 127(1): 240-246, 2018 07.
Article in English | MEDLINE | ID: mdl-29750695

ABSTRACT

BACKGROUND: A continuous adductor canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the adductor hiatus would provide superior analgesia compared to a more proximal catheter location. We therefore tested the hypothesis that during a continuous adductor canal nerve block, postoperative analgesia would be improved by placing the perineural catheter tip 2-3 cm cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal location) compared to a more proximal location at the midpoint between the anterior superior iliac spine and the superior border of the patella (proximal location). METHODS: Preoperatively, subjects undergoing total knee arthroplasty received an ultrasound-guided perineural catheter inserted either in the proximal or distal location within the adductor canal in a randomized, subject-masked fashion. Subjects received a single injection of lidocaine 2% via the catheter preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus, 30 minutes lockout) for the study duration. After joint closure, the surgeon infiltrated the entire joint using 30 mL of ropivacaine (0.5%), ketorolac (30 mg), epinephrine (5 µg/mL), and tranexamic acid (2 g). The primary end point was the median level of pain as measured on a numeric rating scale (NRS) during the time period of 8:00 AM to 12:00 PM the day after surgery. RESULTS: For the primary end point, the NRS of subjects with a catheter inserted at the proximal location (n = 24) was a median (10th, 25th-75th, 90th quartiles) of 0.5 (0.0, 0.0-3.2, 5.0) vs 3.0 (0.0, 2.0-5.4, 7.8) for subjects with a catheter inserted in the distal location (n = 26; P = .011). Median and maximum NRSs were lower in the proximal group at all other time points, but these differences did not reach statistical significance. There were no clinically relevant or statistically significant differences between the treatment groups for any other secondary end point, including opioid consumption and ambulation distance. CONCLUSIONS: For continuous adductor canal blocks accompanied by intraoperative periarticular local anesthetic infiltration, analgesia the day after knee arthroplasty is improved with a catheter inserted at the level of the midpoint between the anterior superior iliac spine and the superior border of the patella compared with a more distal insertion closer to the adductor hiatus.


Subject(s)
Anesthetics, Local/administration & dosage , Arthroplasty, Replacement, Knee/adverse effects , Catheters, Indwelling , Lidocaine/administration & dosage , Nerve Block/instrumentation , Pain, Postoperative/prevention & control , Ropivacaine/administration & dosage , Aged , Anesthetics, Local/adverse effects , California , Equipment Design , Female , Humans , Lidocaine/adverse effects , Male , Middle Aged , Nerve Block/adverse effects , Nerve Block/methods , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Ropivacaine/adverse effects , Time Factors , Treatment Outcome
7.
Cell Host Microbe ; 21(6): 657-659, 2017 Jun 14.
Article in English | MEDLINE | ID: mdl-28618263

ABSTRACT

Macrophage-mediated bacterial clearance relies on phagocytic uptake of the pathogen, subsequent phagolysosomal maturation, and microbial degradation. In this issue of Cell Host & Microbe, Wong et al. (2017) report that a chloride transporter couples phagocytosis and bacterial clearance in an NF-κB-mediated feedforward loop, which is required for sustained pathogen uptake.


Subject(s)
Chlorides/metabolism , Macrophages/immunology , Macrophages/microbiology , Phagocytosis/physiology , Animals , Drosophila/immunology , Escherichia coli/immunology , Escherichia coli/pathogenicity , Escherichia coli Proteins/genetics , Escherichia coli Proteins/immunology , Macrophage Activation/immunology , NF-kappa B/metabolism , Phagosomes/physiology
8.
J Immunol ; 199(1): 263-270, 2017 07 01.
Article in English | MEDLINE | ID: mdl-28539433

ABSTRACT

Tracheal cytotoxin (TCT), a monomer of DAP-type peptidoglycan from Bordetella pertussis, causes cytopathology in the respiratory epithelia of mammals and robustly triggers the Drosophila Imd pathway. PGRP-LE, a cytosolic innate immune sensor in Drosophila, directly recognizes TCT and triggers the Imd pathway, yet the mechanisms by which TCT accesses the cytosol are poorly understood. In this study, we report that CG8046, a Drosophila SLC46 family transporter, is a novel transporter facilitating cytosolic recognition of TCT, and plays a crucial role in protecting flies against systemic Escherichia coli infection. In addition, mammalian SLC46A2s promote TCT-triggered NOD1 activation in human epithelial cell lines, indicating that SLC46As is a conserved group of peptidoglycan transporter contributing to cytosolic immune recognition.


Subject(s)
Cytosol/immunology , Drosophila Proteins/metabolism , Immunity, Innate , Peptidoglycan/immunology , Symporters/metabolism , Virulence Factors, Bordetella/immunology , Animals , Cell Line , Cell Wall/immunology , Cell Wall/metabolism , Cytosol/metabolism , Drosophila/immunology , Drosophila/microbiology , Escherichia coli/physiology , HEK293 Cells , Humans , Peptidoglycan/chemistry , Peptidoglycan/metabolism , Signal Transduction , Virulence Factors, Bordetella/chemistry , Virulence Factors, Bordetella/metabolism
9.
Anesth Analg ; 124(4): 1298-1303, 2017 04.
Article in English | MEDLINE | ID: mdl-28319550

ABSTRACT

BACKGROUND: It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for transversus abdominis plane (TAP) catheters. We therefore tested the hypothesis that when using TAP catheters, providing local anesthetic in repeated bolus doses increases the cephalad-caudad cutaneous effects compared with a basal-only infusion. METHODS: Bilateral TAP catheters (posterior approach) were inserted in 24 healthy volunteers followed by ropivacaine 2 mg/mL administration for a total of 6 hours. The right side was randomly assigned to either a basal infusion (8 mL/h) or bolus doses (24 mL administered every 3 hours for a total of 2 bolus doses) in a double-masked manner. The left side received the alternate treatment. The primary end point was the extent of sensory deficit as measured by cool roller along the axillary line at hour 6 (6 hours after the local anesthetic administration was initiated). Secondary end points included the extent of sensory deficit as measured by cool roller and Von Frey filaments along the axillary line and along a transverse line at the level of the anterior superior iliac spine at hours 0 to 6. RESULTS: Although there were statistically significant differences between treatments within the earlier part of the administration period, by hour 6 the difference in extent of sensory deficit to cold failed to reach statistical significance along the axillary line (mean = 0.9 cm; SD = 6.8; 95% confidence interval -2.0 to 3.8; P = .515) and transverse line (mean = 2.5 cm; SD = 10.1; 95% confidence interval -1.8 to 6.8; P = .244). Although the difference between treatments was statistically significant at various early time points for the horizontal, vertical, and estimated area measurements of both cold and mechanical pressure sensory deficits, no comparison remained statistically significant by hour 6. CONCLUSIONS: No evidence was found in this study involving healthy volunteers to support the hypothesis that changing the local anesthetic administration technique (continuous basal versus hourly bolus) when using ropivacaine 0.2% and TAP catheters at 8 mL/h and 24 mL every 3 hours significantly influences the cutaneous effects after 6 hours of administration. Additional research is required to determine whether changing variables (eg, local anesthetic concentration, basal infusion rate, bolus dose volume, and/or interval) would provide different results.


Subject(s)
Abdominal Muscles , Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Cold Temperature/adverse effects , Infusion Pumps , Nerve Block/methods , Abdominal Muscles/drug effects , Amides/administration & dosage , Cross-Over Studies , Double-Blind Method , Drug Delivery Systems/methods , Female , Healthy Volunteers , Humans , Male , Pain Measurement/drug effects , Pain Measurement/methods , Ropivacaine
10.
Immunity ; 45(5): 951-953, 2016 11 15.
Article in English | MEDLINE | ID: mdl-27851920

ABSTRACT

Contradictory to previous reports, Iatsenko et al. (2016) reveal that PGRP-SD regulates the Imd signaling pathway rather than the Toll pathway in Drosophila and shed light on a decade-old mystery of conflicting structural and phenotypic data.


Subject(s)
Carrier Proteins/chemistry , Immunity, Innate/immunology , Animals , Drosophila/immunology , Drosophila Proteins/chemistry , Signal Transduction
11.
Anesth Analg ; 122(5): 1689-95, 2016 May.
Article in English | MEDLINE | ID: mdl-26962712

ABSTRACT

BACKGROUND: Multiple studies have demonstrated that, for single-injection popliteal sciatic nerve blocks, block characteristics are dependent upon local anesthetic injection relative to the sciatic nerve bifurcation. In contrast, this relation remains unexamined for continuous popliteal sciatic nerve blocks. We, therefore, tested the hypothesis that postoperative analgesia is improved with the perineural catheter tip at the level of the bifurcation compared with 5 cm proximal to the bifurcation. METHODS: Preoperatively, subjects having moderately painful foot or ankle surgery were randomly assigned to receive an ultrasound-guided subepimyseal perineural catheter inserted either at or 5 cm proximal to the sciatic nerve bifurcation. Subjects received a single injection of mepivacaine 1.5% either via the insertion needle preoperatively or the perineural catheter postoperatively, followed by an infusion of ropivacaine 0.2% (6 mL/h basal, 4 mL bolus, and 30-min lockout) for the study duration. The primary end point was the average pain measured on a numeric rating scale (0-10) in the 3 hours before a data collection telephone call the morning after surgery. RESULTS: The average numeric rating scale of subjects with a catheter inserted at the sciatic nerve bifurcation (n = 64) was a median (10th, 25th to 75th, and 90th quartiles) of 3.0 (0.0, 2.4-5.0, and 7.0) vs 2.0 (0.0, 1.0-4.0, and 5.0) for subjects with a catheter inserted proximal to the bifurcation (n = 64; P = 0.008). Similarly, maximum pain scores were greater in the group at the bifurcation: 6.0 (3.0, 4.4-8.0, and 9.0) vs 5.0 (0.0, 3.0-8.0, and 10.0) (P = 0.019). Differences between the groups for catheter insertion time, opioid rescue dose, degree of numbness in the foot/toes, catheter dislodgement, and fluid leakage did not reach statistical significance. CONCLUSIONS: For continuous popliteal sciatic nerve blocks, a catheter inserted 5 cm proximal to the sciatic nerve bifurcation provides superior postoperative analgesia in subjects having moderately painful foot or ankle surgery compared with catheters located at the bifurcation. This is in marked contrast with single-injection popliteal sciatic nerve blocks for which benefits are afforded to local anesthetic injection distal, rather than proximal, to the bifurcation.


Subject(s)
Amides/administration & dosage , Anesthetics, Local/administration & dosage , Catheters , Foot/surgery , Nerve Block/instrumentation , Orthopedic Procedures , Pain, Postoperative/prevention & control , Sciatic Nerve/drug effects , Adult , Amides/adverse effects , Anesthetics, Local/adverse effects , California , Female , Foot/innervation , Humans , Male , Mepivacaine/administration & dosage , Middle Aged , Nerve Block/adverse effects , Nerve Block/methods , Orthopedic Procedures/adverse effects , Pain Measurement , Pain Threshold/drug effects , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Pain, Postoperative/physiopathology , Prospective Studies , Ropivacaine , Sciatic Nerve/diagnostic imaging , Time Factors , Treatment Outcome , Ultrasonography, Interventional
12.
BMC Dev Biol ; 16: 5, 2016 Mar 18.
Article in English | MEDLINE | ID: mdl-26993259

ABSTRACT

BACKGROUND: Microenvironments called niches maintain resident stem cell populations by balancing self-renewal with differentiation, but the genetic regulation of this process is unclear. The niche of the Drosophila testis is well-characterized and genetically tractable, making it ideal for investigating the molecular regulation of stem cell biology. The JAK/STAT pathway, activated by signals from a niche component called the hub, maintains both germline and somatic stem cells. RESULTS: This study investigated the molecular regulation of the JAK/STAT pathway in the stem cells of the Drosophila testis. We determined that the transcriptional regulator Apontic (Apt) acts in the somatic (cyst) stem cells (CySCs) to balance differentiation and maintenance. We found Apt functions as a negative feedback inhibitor of STAT activity, which enables cyst cell maturation. Simultaneous loss of the STAT regulators apt and Socs36E, or the Stat92E-targeting microRNA miR-279, expanded the somatic stem cell-like population. CONCLUSIONS: Genetic analysis revealed that a conserved genetic regulatory network limits JAK/STAT activity in the somatic stem cells of Drosophila testis. In these cells, we determined JAK/STAT signaling promotes apt expression. Then, Apt functions through Socs36E and miR-279 to attenuate pathway activation, which is required for timely CySC differentiation. We propose that Apt acts as a core component of a STAT-regulatory circuit to prevent stem cell overpopulation and allow stem cell maturation.


Subject(s)
DNA-Binding Proteins/metabolism , Drosophila Proteins/metabolism , Drosophila melanogaster/cytology , Drosophila melanogaster/metabolism , Stem Cells/cytology , Testis/cytology , Transcription Factors/metabolism , Animals , Cell Count , Cell Differentiation , Feedback, Physiological , Gene Regulatory Networks , Male , Models, Biological , STAT Transcription Factors/metabolism
13.
Anesth Analg ; 122(5): 1681-8, 2016 May.
Article in English | MEDLINE | ID: mdl-26863502

ABSTRACT

BACKGROUND: It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for adductor canal perineural catheters. Therefore, we tested the hypothesis that scheduled bolus administration is superior or noninferior to a continuous infusion on cutaneous knee sensation in volunteers. METHODS: Bilateral adductor canal catheters were inserted in 24 volunteers followed by ropivacaine 0.2% administration for 8 hours. One limb of each subject was assigned randomly to a continuous infusion (8 mL/h) or automated hourly boluses (8 mL/bolus), with the alternate treatment in the contralateral limb. The primary end point was the tolerance to electrical current applied through cutaneous electrodes in the distribution of the anterior branch of the medial femoral cutaneous nerve after 8 hours (noninferiority delta: -10 mA). Secondary end points included tolerance of electrical current and quadriceps femoris maximum voluntary isometric contraction strength at baseline, hourly for 14 hours, and again after 22 hours. RESULTS: The 2 administration techniques provided equivalent cutaneous analgesia at 8 hours because noninferiority was found in both directions, with estimated difference on tolerance to cutaneous current of -0.6 mA (95% confidence interval, -5.4 to 4.3). Equivalence also was found on all but 2 secondary time points. CONCLUSIONS: No evidence was found to support the hypothesis that changing the local anesthetic administration technique (continuous basal versus hourly bolus) when using an adductor canal perineural catheter at 8 mL/h decreases cutaneous sensation in the distribution of the anterior branch of the medial femoral cutaneous nerve.


Subject(s)
Amides/administration & dosage , Anesthetics, Local/administration & dosage , Femoral Nerve/drug effects , Isometric Contraction/drug effects , Muscle Strength/drug effects , Nerve Block/methods , Pain Threshold/drug effects , Quadriceps Muscle/innervation , Skin/innervation , Adult , Automation , California , Catheters , Double-Blind Method , Drug Administration Schedule , Female , Healthy Volunteers , Humans , Infusion Pumps , Infusions, Parenteral , Knee , Male , Middle Aged , Nerve Block/instrumentation , Pain Measurement , Prospective Studies , Ropivacaine , Time Factors , Transcutaneous Electric Nerve Stimulation , Young Adult
14.
Mech Dev ; 138 Pt 3: 313-27, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26277564

ABSTRACT

The Suppressor of Cytokine Signaling (SOCS) proteins are critical, highly conserved feedback inhibitors of signal transduction cascades. The family of SOCS proteins is divided into two groups: ancestral and vertebrate-specific SOCS proteins. Vertebrate-specific SOCS proteins have been heavily studied as a result of their strong mutant phenotypes. However, the ancestral clade remains less studied, a potential result of genetic redundancies in mammals. Use of the genetically tractable organism Drosophila melanogaster enables in vivo assessment of signaling components and mechanisms with less concern about the functional redundancy observed in mammals. In this study, we investigated how the SOCS family member Suppressor of Cytokine Signaling at 36E (Socs36E) attenuates Janus Kinase/Signal Transducer and Activator of Transcription (Jak/STAT) activation during specification of motile border cells in Drosophila oogenesis. We found that Socs36E genetically interacts with the Cullin2 (Cul2) scaffolding protein. Like Socs36E, Cul2 is required to limit the number of motile cells in egg chambers. We demonstrated that loss of Cul2 in the follicle cells significantly increased nuclear STAT protein levels, which resulted in additional cells acquiring invasive properties. Further, reduction of Cul2 suppressed border cell migration defects that occur in a Stat92E-sensitized genetic background. Our data incorporated Cul2 into a previously described Jak/STAT-directed genetic regulatory network that is required to generate a discrete boundary between cell fates. We also found that Socs36E is able to attenuate STAT activity in the egg chamber when it does not have a functional SOCS box. Collectively, this work contributes mechanistic insight to a Jak/STAT regulatory genetic circuit, and suggests that Socs36E regulates Jak/STAT signaling via a Cul2-dependent mechanism, as well as by a Cullin-independent manner, in vivo.


Subject(s)
Cullin Proteins/metabolism , Drosophila Proteins/metabolism , Drosophila melanogaster/metabolism , Ovary/growth & development , Ovary/metabolism , STAT Transcription Factors/metabolism , Suppressor of Cytokine Signaling Proteins/metabolism , Animals , Animals, Genetically Modified , Cell Movement/genetics , Cell Movement/physiology , Cullin Proteins/genetics , Drosophila Proteins/genetics , Drosophila melanogaster/genetics , Drosophila melanogaster/growth & development , Female , Gene Expression Regulation, Developmental , Gene Regulatory Networks , Genes, Insect , Intrinsically Disordered Proteins/genetics , Intrinsically Disordered Proteins/metabolism , Janus Kinases/genetics , Janus Kinases/metabolism , Mutation , Oogenesis/genetics , Oogenesis/physiology , Ovary/cytology , STAT Transcription Factors/genetics , Signal Transduction , Suppressor of Cytokine Signaling Proteins/genetics
15.
Reg Anesth Pain Med ; 40(5): 559-67, 2015.
Article in English | MEDLINE | ID: mdl-26115189

ABSTRACT

BACKGROUND: We tested the hypothesis that, following unicompartment knee arthroplasty, a continuous adductor canal block decreases the time to reach 4 discharge criteria compared with a continuous femoral nerve block. METHODS: Subjects were randomized to either an adductor canal or femoral perineural catheter (2-day ropivacaine 0.2% infusion) in an unmasked fashion. The primary outcome was the time to attain 4 discharge criteria: (1) adequate analgesia; (2) intravenous opioid independence; (3) ability to independently stand, walk 3 m, return, and sit down; and (4) ambulate 30 m. RESULTS: Subjects with an adductor canal catheter (n = 15) reached all 4 criteria in a median of 35 hours (interquartile range, 24-43 hours), compared with 40 hours (interquartile range, 27-69 hours) for those with a femoral catheter (n = 15; Wilcoxon rank sum test: P = 0.46; log-rank test: P = 0.16). However, the percentages of subjects (adductor canal: femoral) who reached the 2 mobilization criteria were 27%:0% on postoperative day (POD) 0, 93%:53% on POD 1, and 100%:73% on POD 2. Of adductor canal subjects, 100% were discharge ready by POD 2, compared with only 73% of femoral subjects (P < 0.001). CONCLUSIONS: Compared with a continuous femoral nerve block, a continuous adductor canal block did not appreciably decrease the median number of hours to overall discharge readiness, yet did decrease the number of discrete days until discharge readiness. These results are applicable to only unicompartment knee arthroplasty and must be considered preliminary because of the limited sample size of this pilot study.


Subject(s)
Arthroplasty, Replacement, Knee/trends , Autonomic Nerve Block/trends , Femoral Nerve , Pain, Postoperative/prevention & control , Patient Discharge/trends , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Autonomic Nerve Block/adverse effects , Autonomic Nerve Block/methods , Female , Femoral Nerve/drug effects , Humans , Male , Middle Aged , Pain Measurement/methods , Pain Measurement/trends , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Patient Discharge/standards , Pilot Projects , Prospective Studies , Treatment Outcome
16.
Anesthesiology ; 123(2): 444-56, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26079800

ABSTRACT

BACKGROUND: The authors conducted a randomized, controlled, parallel-arm, superiority study to test the hypothesis that a continuous adductor canal block decreases the time to attain four discharge criteria compared with a continuous femoral nerve block after tricompartment knee arthroplasty. METHODS: Subjects undergoing tricompartment knee arthroplasty were randomized using computer-generated lists to either an adductor canal or femoral perineural catheter (3-day ropivacaine 0.2% infusion) in an unmasked manner. The primary outcome was the time to attain four criteria: (1) adequate analgesia; (2) intravenous opioids independence; (3) ability to stand, walk 3 m, return, and sit down; and (4) ambulate 30 m. RESULTS: Subjects with an adductor canal catheter (n = 39) reached all four criteria in a median of 55 h (interquartile, 42 to 63 h) compared with 61 h (49 to 69 h) for those with a femoral catheter (n = 41; 95% CI, -13 to 1 h; P = 0.12). The percentage of subjects who reached the two mobilization criteria on postoperative days 1 and 2 were 72 and 95% for those with an adductor canal catheter (n = 39), but only 27 and 76% in subjects with a femoral catheter (n = 41; both P < 0.001). Differences in pain scores at rest and intravenous opioid requirements were minimal, but femoral infusion improved dynamic analgesia (P = 0.01 to 0.02). CONCLUSION: Compared with a continuous femoral nerve block, a continuous adductor canal block did not appreciably decrease the time to overall discharge readiness even though it did decrease the time until adequate mobilization, primarily because both groups experienced similar analgesia and intravenous opioid requirements that--in most cases--exceeded the time to mobilization.


Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/trends , Autonomic Nerve Block/methods , Catheters, Indwelling , Femoral Nerve/diagnostic imaging , Patient Discharge/trends , Aged , Catheterization/methods , Female , Femoral Nerve/physiology , Humans , Male , Middle Aged , Pain Measurement/methods , Pain, Postoperative/diagnostic imaging , Pain, Postoperative/prevention & control , Ultrasonography
17.
Dev Biol ; 379(2): 152-66, 2013 Jul 15.
Article in English | MEDLINE | ID: mdl-23583584

ABSTRACT

The Janus kinase/Signal transducers and activators of transcription (JAK/STAT) pathway determines cell fates by regulating gene expression. One example is the specification of the motile cells called border cells during Drosophila oogenesis. It has been established that too much or too little STAT activity disrupts follicle cell identity and cell motility, which suggests the signaling must be precisely regulated. Here, we find that Suppressor of cytokine signaling at 36E (Socs36E) is a necessary negative regulator of JAK/STAT signaling during border cell specification. We find when STAT signaling is too low to induce migration in the presumptive border cell population, nearby follicle cells uncharacteristically become invasive to enable efficient migration of the cluster. We generated a genetic null allele that reveals Socs36E is required in the anterior follicle cells to limit invasive behavior to an optimal number of cells. We further show Socs36E genetically interacts with the required STAT feedback inhibitor apontic (apt) and APT's downstream target, mir-279, and provide evidence that suggests APT directly regulates Socs36E transcriptionally. Our work shows Socs36E plays a critical role in a genetic circuit that establishes a boundary between the motile border cell cluster and its non-invasive epithelial neighbors through STAT attenuation.


Subject(s)
Cell Differentiation/physiology , Drosophila Proteins/metabolism , Drosophila melanogaster/embryology , Gene Expression Regulation, Developmental/physiology , Ovary/embryology , STAT Transcription Factors/metabolism , Signal Transduction/physiology , Suppressor of Cytokine Signaling Proteins/metabolism , Animals , Cell Movement/physiology , DNA Primers/genetics , DNA-Binding Proteins/metabolism , Electrophoretic Mobility Shift Assay , Female , Fluorescent Antibody Technique , Gene Expression Regulation, Developmental/genetics , Ovarian Follicle/cytology , Ovarian Follicle/physiology , Ovary/cytology , Signal Transduction/genetics , Transcription Factors/metabolism
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