Epitope load identifies kidney transplant recipients at risk of allosensitization following minimization of immunosuppression

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Continuous Preperitoneal Infusion of Ropivacaine Provides Effective Analgesia and Accelerates Recovery after Colorectal Surgery: A Randomized, Double-blind, Placebo-controlled Study

Background: Blockade of parietal nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a multimodal approach to postoperative pain management after major surgery. The role of continuous preperitoneal infusion of ropivacaine for pain relief and postoperative recovery after open colorectal resections was evaluated in a randomized, double-blinded, placebo-controlled trial.

Methods: After obtaining written informed consents, a multiholed wound catheter was placed by the surgeon in the preperitoneal space at the end of surgery in patients scheduled to undergo elective open colorectal resection by midline incision. They were thereafter randomly assigned to receive through the catheter either 0.2% ropivacaine (10-ml bolus followed by an infusion of 10 ml/h during 48 h) or the same protocol with 0.9% NaCl. In addition, all patients received patient-controlled intravenous morphine analgesia.

Results: Twenty-one patients were evaluated in each group. Compared with preperitoneal saline, ropivacaine infusion reduced morphine consumption during the first 72 h and improved pain relief at rest during 12 h and while coughing during 48 h. Sleep quality was also better during the first two postoperative nights. Time to recovery of bowel function (74 +/- 19 vs. 105 +/- 54 h; P = 0.02) and duration of hospital stay (115 +/- 25 vs. 147 +/- 53 h; P = 0.02) were significantly reduced in the ropivacaine group. Ropivacaine plasma concentrations remained below the level of toxicity. No side effects were observed.     

Control of single-joint movements in deafferented patients: evidence for amplitude coding rather than position control

Two deafferented patients and several control subjects participated in a series of experiments to investigate how accurate single-joint movements are programed, spatially calibrated, and updated in the absence of proprioceptive information. The deafferented patients suffered from a permanent and severe loss of large sensory myelinated fibers below the neck. Subjects performed, with and without vision, sequences of forearm supinations and pronations with two temporal delays between each movement (0 s and 8 s). Overall, the lack of proprioception did not yield any significant decrease in movement accuracy when vision was available. Without vision, the absence of proprioceptive afferents yielded (1) significantly larger spatial errors, (2) amplitude errors similar to those of control subjects, and (3) a significant drift when an 8-s delay was introduced between two successive movements. Subjects also performed, without vision, a 20 supination followed by a 20 pronation that brought back the wrist to the starting position. On some trials, the supination was blocked unexpectedly by way of a magnetic brake. When the supination was blocked, subjects were already on the second target and no pronation was required when the brake was released. The defferented patients, unaware of the procedure, always produced a 20 pronation. These data confirm that deafferented patients were not coding a final position. It rather suggests that they coded an amplitude and translated the spatial distance between the two targets in a corresponding force pulse. Overall, the results highlight the powerful and key role of proprioceptive afferents for calibrating the spatial motor frame of reference.     

A clinical evaluation of the Neurobehavioral Cognitive Status Examination in a general psychiatric inpatient population.

The Neurobehavioral Cognitive Status Examination (NCSE) is a structured test of cognitive functioning. The NCSE assesses a broader range of cognitive functioning than the Mini-Mental State Examination (MMSE), but remains brief enough to be administered at the bedside in clinical settings. The purpose of this study was to assess the sensitivity, specificity, predictive value and reliability of the NCSE as a clinical case-finding instrument for DSM-III-R defined organic mental disorders in psychiatric inpatients. Validity was assessed by comparing the results of the test (interpreted as "pass" or "fail") to a blind clinical assessment by an experienced psychiatrist. The NCSE was found to have superior sensitivity to the MMSE (83% versus 43%), but inferior specificity (47% versus 97%). The low specificity resulted in a positive predictive value of only 24%. The NCSE had good test-retest reliability (Kappa = .69), but the inter-rater reliability was not as good (Kappa = 0.57). The NCSE was too non-specific to be used as a case-finding instrument for organic mental disorders. In conclusion, although clinicians may find the NCSE to be a valuable instrument for the assessment of cognitive function, it cannot be used as a screening or case-finding instrument for organic disorders among psychiatric inpatients.     

Modulation of the cutaneous responsiveness of neurones in the primary somatosensory cortex during conditioned arm movements in the monkey

Summary The present experiments were designed to investigate the neuronal mechanisms, at the level of the primary somatosensory cortex, which underlie the observation that somatosensory cortical potentials evoked by air puff stimuli directed at the forearm are decreased, in a nonspecific and widespread manner, during voluntary movements about the elbow. Unitary discharge was recorded from 131 cells receiving cutaneous input from the hairy skin of the forearm or hand (areas 3b and 1) of two monkeys trained to perform rapid movements of the contralateral arm (elbow flexion or extension). Evoked unitary responses to air puff stimuli applied to the centre of the cell's receptive field, at various delays before and after the onset of movement, were recorded. Movement produced a significant decrease in the short latency excitatory response to the air puff in 89% of the cells (117/131); the remaining 11% were not modulated by movement. This movement-related gating of cutaneous inputs occurred regardless of the response pattern of the cells to movement alone, being observed in 91% of the cells with no movement-related discharge, and 89% of those with movement-related discharge. The air puff responses of cells with inputs from the forearm and the dorsum of the hand were all similarly modulated by movement and the modulation was clearly present prior to the onset of movement (mean onset, -66 ms). Variation in the depth of modulation as a function of the direction of the movement, flexion or extension, was observed in only a very small proportion of the modulated units (16/117); most showed no relationship to direction. It is suggested that, in this experimental situation, much of the modulation appears to occur at a pre-cortical level since there was no relationship between the pattern of discharge of cells in relation to movement alone and the pattern of movement-related gating of their responses to the air puff. Effects which might be consistent with a cortical origin for the modulation were only infrequently observed. The present results are strikingly similar to those obtained using the evoked potential method, and thus support the hypothesis that, in this task of rapid elbow movements, movement modulates the transmission of cutaneous signals from the hairy skin of the distal forelimb to primary somatosensory cortex in a nonspecific and widespread fashion.