Neuroblastoma-derived hypoxic extracellular vesicles promote metastatic dissemination in a zebrafish model.

The zebrafish (Danio rerio) is a valuable model organism for studying human biology due to its easy genetic manipulation and small size. It is optically transparent and shares genetic similarities with humans, making it ideal for studying developmental processes, diseases, and drug screening via imaging-based approaches. Solid malignant tumors often contain hypoxic areas that stimulate the release of extracellular vesicles (EVs), lipid-bound structures released by cells into the extracellular space, that facilitate short- and long-range intercellular communication and metastatization.

New insights into the use of dexamethasone-dexmedetomidine as perineural adjuvants in peripheral nerve and fascial blocks: an up-to-date narrative review.

The discovery of the mechanism of action of local anesthetics, involving the blocking of sodium ion channels is considered a milestone in anesthesia. Potentially lethal toxic effects occur in the case of intravascular injection of local anesthetic (LA) or in case of exceeding dosages, as a result of systemic reabsorption. Attempts to prevent these life-threatening events have been made by developing novel LA and by adding adjuvants.

Combined adductor canal (ACB) and sacral erector spinae plane (S-ESP) blocks for total knee arthroplasty pain in hemophilic arthropathy.

We present the case of a successful application of combined adductor canal block (ACB) and sacral erector spinae plane (S-ESP) block for the management of a patient suffering from severe hemophilia A with an end-stage arthropathy who underwent total knee replacement. The implementation of a tailored protocol, not incorporating neuraxial techniques, such as spinal anesthesia, facilitated optimal intra- and postoperative pain management and expedited postoperative recovery and rehab without motor weakness and side effects, highlighting the potential benefit of such strategy in selected cases.

The Lumbosacral Erector Spinae Plane Block for Abdominal Hysterectomy: A Case Report.

After major abdominal surgery and open hysterectomy, postoperative pain management is often challenging. Various abdominal fascial and truncal blocks, including paravertebral, erector spinae plane, transversus abdominis plane, and quadratus lumborum blocks, have been evaluated for their efficacy. When used in a multimodal pain control strategy, after an open abdominal hysterectomy under spinal anesthesia, the novel sacral erector spinae plane block showed promising results in terms of safety, efficacy, and minimal invasiveness.

Ultrasound-guided fascial plane blocks in chronic pain: a narrative review.

Background: Recent studies have unveiled the intricate and distinctive nature of fascia, no longer regarding it solely as a muscle container. Recent research highlights its complex innervation and structure, signifying its significance in chronic pain pathways.

Methods: We conducted a systematic literature search (updated on February 2024) to evaluate the role of fascial plane blocks in chronic pain treatment.

Anesthesiologists ultrasound-guided regional anesthesia core curriculum: a Delphi consensus from Italian regional anesthesia experts.

Introduction: The need for a standardized core curriculum in regional anesthesia has become essential, particularly with the integration of ultrasound revolutionizing and exponentially increasing clinical practice and possibilities. In fact, numerous novel techniques, often overlapping, can confuse practitioners. This study aims to establish a core curriculum for upper limb, lower limb, paraspinal and fascial plane blocks for residency training, addressing potential educational gaps caused by the multitude of techniques, through a Delphi consensus process involving recognized Italian regional anesthesia experts.

Combined thoracic erector spinae plane and inter-transverse plane blocks for awake breast surgery.

Worldwide, breast cancer is the most commonly diagnosed cancer in women. Surgical procedures are typically performed using general anaesthesia, often complemented by regional anaesthesia to manage postoperative pain. However, avoidance of general anaesthesia for breast surgery may be desirable for clinical reasons or patient choice.

Neuraxial Anesthesia for an Open Low Anterior Rectal Resection: Tip the Scales in Patient's Favor.

We present the case of a successful application of combined spinal-epidural anesthesia for a geriatric patient undergoing open cancer surgery. The patient, affected by multiple comorbidities, was proposed for an open anterior rectal resection. The implementation of a tailored protocol, incorporating neuraxial techniques such as epidural and spinal anesthesia, facilitated optimal pain management and expedited postoperative recovery improving perioperative outcomes, and highlighting the potential benefits of such strategies in selected cases.

Hip chronic pain: ultrasound guided ablation of anterior articular branches plus posterior neurolysis of the nerve to the quadratus femoris versus the alone anterior approach-a retrospective observational study.

Introduction: Chronic hip pain is a common painful condition in the elderly population. A mini invasive technique that is increasingly being considered for management of CHP is the percutaneous denervation of hip articular branches via radiofrequency ablation. We described a new ultrasound-guided technique based on the combination of 90° ultrasound-guided anterior radiofrequency ablation of the articular branches of femoral nerve, accessory obturator nerve and obturator nerve for anterior hip, combined with 90° ultrasound-guided ablation of the articular branches of the nerve of the quadratus femoris for posterior pericapsular neurolysis of the hip.

Eutectic mixture of local anesthetics and amethocaine as topical anesthetics in pediatrics: a meta-analysis.

Background: Pediatric patients often receive topical anesthesia before skin procedures in the Emergency Department, with EMLA cream and amethocaine gel being common choices. The most effective option remains a subject of debate.

Objective: Our goal was to compare EMLA cream with amethocaine gel in pediatric patients undergoing topical anesthesia, focusing on outcomes: first-attempt cannulation success, child-reported visual analogue scale (VAS) score, parent-reported VAS score, observed pain score, child-reported absence of pain, and child-reported acceptable anesthesia.

Combination of Pericapsular Nerve Group (PENG) and Sacral Erector Spinae Plane (S-ESP) Blocks for Hip Fracture Pain and Surgery: A Case Series.

A hip fracture is a serious injury with life-threatening complications, and its risk rises with increasing age. A hip fracture can be a very painful condition, and prompt surgical treatment is recommended to reduce pain and complications. Pain management is considered integral to the management of a broken hip.

Evolution of in-hospital patient characteristics and predictors of death in the COVID-19 pandemic across four waves: are they moving targets with implications for patient care?

Objectives: The aim of this work was to study characteristics, outcomes and predictors of all-cause death in inpatients with SARS-CoV-2 infection across the pandemic waves in one large teaching hospital in Italy to optimize disease management.

Methods: All patients with SARS-CoV-2 infection admitted to our center from March 2020 to June 2022 were included in this retrospective observational cohort study. Both descriptive and regression tree analyses were applied to identify factors influencing all-cause mortality.

Factors to consider for fascial plane blocks' success in acute and chronic pain management.

The outcome of fascial plane blocks (FPBs) has a certain variability that may depend on many factors, which can be divided into three main categories: operator-related, patient-related and drug-related. Operator-related factors include personal skills, choice of needle and injection modalities. Patient variables include anthropometric features, the type of targeted fascia, anatomical variants, patient positioning, muscle tone and breathing.

The spike-specific TCRβ repertoire shows distinct features in unvaccinated or vaccinated patients with SARS-CoV-2 infection.

Background: The evolving variants of SARS-CoV-2 may escape immunity from prior infections or vaccinations. It's vital to understand how immunity adapts to these changes. Both infection and mRNA vaccination induce T cells that target the Spike protein.