ABSTRACT
Multicellular systems grow over the course of weeks from single cells to tissues or even full organisms, making live imaging challenging. To bridge spatiotemporal scales, we present an open-top dual-view and dual-illumination light-sheet microscope dedicated to live imaging of large specimens at single-cell resolution. The configuration of objectives together with a customizable multiwell mounting system combines dual view with high-throughput multiposition imaging. We use this microscope to image a wide variety of samples and highlight its capabilities to gain quantitative single-cell information in large specimens such as mature intestinal organoids and gastruloids.
Subject(s)
Organoids , Animals , Organoids/cytology , Humans , Single-Cell Analysis/methods , Microscopy/methods , Microscopy/instrumentation , Mice , Microscopy, Fluorescence/methods , Microscopy, Fluorescence/instrumentationABSTRACT
OBJECTIVE: To review the impact of epidural vs systemic analgesia on postoperative pulmonary complications. DATA SOURCES: Search of databases (1966 to March 2006) and bibliographies. STUDY SELECTION: Inclusion criteria were randomized comparison of epidural vs systemic analgesia lasting 24 hours or longer postoperatively and reporting of pulmonary complications, lung function, or gas exchange. Fifty-eight trials (5904 patients) were included. DATA EXTRACTION: Articles were reviewed and data extracted. Data were combined using fixed-effect and random-effects models. DATA SYNTHESIS: The odds of pneumonia were decreased with epidural analgesia (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.43-0.68), independent of site of surgery or catheter insertion, duration of analgesia, or regimen. The effect was weaker in trials that used patient-controlled analgesia in controls (OR, 0.64; 95% CI, 0.49-0.83) compared with trials that did not (OR, 0.30; 95% CI, 0.18-0.49) and in larger studies (OR, 0.62; 95% CI, 0.47-0.81) compared with smaller studies (OR, 0.37; 95% CI, 0.23-0.58). From 1971-2006, the incidence of pneumonia with epidural analgesia remained about 8% but decreased from 34% to 12% with systemic analgesia (P < .001); consequently, the relative benefit of epidural analgesia decreased also. Epidural analgesia reduced the need for prolonged ventilation or reintubation, improved lung function and blood oxygenation, and increased the risk of hypotension, urinary retention, and pruritus. Technical failures occurred in 7%. CONCLUSION: Epidural analgesia protects against pneumonia following abdominal or thoracic surgery, although this beneficial effect has lessened over the last 35 years because of a decrease in the baseline risk.
Subject(s)
Analgesia, Epidural/methods , Analgesics, Opioid/administration & dosage , Pain, Postoperative/prevention & control , Pneumonia/prevention & control , Abdomen/surgery , Analgesia, Epidural/adverse effects , Analgesics, Opioid/adverse effects , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Incidence , Infusions, Intravenous , Laparotomy/adverse effects , Laparotomy/methods , Male , Odds Ratio , Pain, Postoperative/epidemiology , Pneumonia/epidemiology , Postoperative Complications/prevention & control , Probability , Pulmonary Gas Exchange , Randomized Controlled Trials as Topic , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Thoracic Surgical Procedures/adverse effects , Thoracic Surgical Procedures/methods , Treatment OutcomeABSTRACT
PURPOSE OF REVIEW: This review highlights new insights into the mechanism of action of paracetamol (acetaminophen) and therapeutic schemes. RECENT FINDINGS: Paracetamol, a centrally acting inhibitor of cyclooxygenases, has weak peripheral effects recently demonstrated. Paracetamol is nevertheless devoid of side effects commonly observed with the use of nonsteroidal anti-inflammatory drugs. Paracetamol is available by the oral, rectal, and, more recently, intravenous routes of administration. Paracetamol efficacy is surgical procedure dependent. The analgesic efficacy of a 2-g starting dose of intravenous paracetamol is superior to the recommended dose of 1 g in terms of magnitude and duration of analgesic effect. The usual scheme of administration (1 g every 6 hours) has a less than 10-mg sparing effect on 24-hour morphine consumption and consequently does not significantly reduce morphine side effects. The combination of nonsteroidal anti-inflammatory drugs and paracetamol is more effective than paracetamol alone, but the benefit is unclear when compared with nonsteroidal anti-inflammatory drugs used alone. SUMMARY: Further studies are required to assess the opioid-sparing effect and complementary analgesic effect of new intravenous paracetamol therapeutic schemes.
