Erector spinae plane block with catheter for management of percutaneous nephrolithotomy: A three case report.

INTRODUCTION: Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods of managing intra-operative and post-operative pain for these patients. The erector spinae plane block with catheter (ESPC) is a newer interfascial regional anesthetic technique that can be used to manage peri-operative pain in these patients. CLINICAL FINDINGS: Three patients complained of significant flank pain were scheduled for percutaneous nephrolithotomy under general anesthesia in the prone position. DIAGNOSES: Patients were diagnosed with large renal calculi. THERAPEUTIC INTERVENTIONS: Patients received ESPC in the pre-operative holding area at the level of the T7 transverse process. The ESPCS were bolused with a solution of 30 mL 0.25% bupivacaine with 4 mg dexamethasone prior to surgery. Patients also received oral tramadol 50 mg and acetaminophen 1 g as part of the multimodal pain protocol prior to surgery. After the procedure, the patients were bolused with 0.25% bupivacaine or started on an infusion of 0.25% bupivacaine to manage their pain. OUTCOMES: No opioid or other pain medications, other than the local anesthetic solution given in the ESPCs, were used during the intra-operative or post-operative period for management of pain in these patients. Visual analogue scale (VAS) scores were below 4 for all patients in the post-operative period, and patients did not report any issues with post-operative nausea or vomiting. CONCLUSION: These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy.

Treatment of ulcerative colitis with a humanized antibody to the alpha4beta7 integrin.

BACKGROUND: Selective blockade of interactions between leukocytes and vascular endothelium in the gut is a promising strategy for the treatment of inflammatory bowel diseases. METHODS: We conducted a multicenter, double-blind, placebo-controlled trial of MLN02, a humanized antibody to the alpha4beta7 integrin, in patients with active ulcerative colitis. We randomly assigned 181 patients to receive 0.5 mg of MLN02 per kilogram of body weight, 2.0 mg per kilogram, or an identical-appearing placebo intravenously on day 1 and day 29. Eligible patients also received concomitant mesalamine or no other treatment for colitis. Ulcerative colitis clinical scores and sigmoidoscopic assessments were evaluated six weeks after randomization. RESULTS: Clinical remission rates at week 6 were 33 percent, 32 percent, and 14 percent for the group receiving 0.5 mg of MLN02 per kilogram, the group receiving 2.0 mg per kilogram, and the placebo group, respectively (P=0.03). The corresponding proportions of patients who improved by at least 3 points on the ulcerative colitis clinical score were 66 percent, 53 percent, and 33 percent (P=0.002). Twenty-eight percent of patients receiving 0.5 mg per kilogram and 12 percent of those receiving 2.0 mg per kilogram had endoscopically evident remission, as compared with 8 percent of those receiving placebo (P=0.007). For the minority of patients in whom an MLN02 antibody titer greater than 1:125 developed, incomplete saturation of the alpha4beta7 receptor on circulating lymphocytes was observed and no benefit of treatment was identifiable. CONCLUSIONS: In this short-term study, MLN02 was more effective than placebo for the induction of clinical and endoscopic remission in patients with active ulcerative colitis.

Treatment of active Crohn's disease with MLN0002, a humanized antibody to the alpha4beta7 integrin.

BACKGROUND & AIMS: Selective blockade of lymphocyte-vascular endothelium interactions in the gastrointestinal tract is a promising therapeutic strategy for inflammatory bowel disease. This randomized, double-blind, controlled trial assessed the efficacy and safety of MLN0002, a monoclonal antibody targeting the alpha4beta7 integrin, in patients with active Crohn's disease. METHODS: Patients were randomized to receive MLN0002 2.0 mg/kg (n = 65), MLN0002 0.5 mg/kg (n = 62), or placebo (n = 58) by intravenous infusion on days 1 and 29. The primary efficacy end point was clinical response (>or=70-point decrement in the Crohn's Disease Activity Index [CDAI] score) on day 57. Secondary end points were the proportions of patients with clinical remission (CDAI score or=100-point decrement in CDAI). Human anti-human antibody levels were measured. RESULTS: Clinical response rates at day 57 were 53%, 49%, and 41% in the MLN0002 2.0 mg/kg, MLN0002 0.5 mg/kg, and placebo groups. Clinical remission rates at day 57 were 37%, 30%, and 21%, respectively (P = .04 for the 2.0 mg/kg vs placebo comparison). At day 57, 12% and 34% of patients in the 2.0- and 0.5-mg/kg groups had clinically significant human anti-human antibody levels (titers > 1:125). There was one infusion-related hypersensitivity reaction. The most common serious adverse event was worsening of Crohn's disease. CONCLUSIONS: This phase 2 study was suggestive of a dose-dependent beneficial effect of MLN0002 therapy on clinical remission. MLN0002 was well tolerated in patients with active Crohn's disease.

Creating accessible science museums with user-activated environmental audio beacons (ping!).

In 2003, Touch Graphics Company carried out research on a new invention that promises to improve accessibility to science museums for visitors who are visually impaired. The system, nicknamed Ping!, allows users to navigate an exhibit area, listen to audio descriptions, and interact with exhibits using a cell phone-based interface. The system relies on computer telephony, and it incorporates a network of wireless environmental audio beacons that can be triggered by users wishing to travel to destinations they choose. User testing indicates that the system is effective, both as a way-finding tool and as a means of providing accessible information on museum content. Follow-up development projects will determine if this approach can be successfully implemented in other settings and for other user populations.

Peer bystanders to bullying: who wants to play with the victim?

Given widespread concern associated with school-based bullying, researchers have looked beyond a dyadic perspective (i.e., bullies and victims only), and now consider the broader social ecology of the peer group. In this research, we examined how the behaviors of peer bystanders influence subsequent reactions to bullies and their victims. Two hundred and six 10- to 15-year-old boys (Mage = 12.46) were invited to play a computer game with three other boys allegedly located at another school. Before the start of the game, participants "met the other players" apparently sitting in a waiting room. These child actors depicted an escalating bullying episode in which the behavior of the bystander was manipulated: aide to the bully, defender of the victim, or passive outsider. Immediately after exposure to the bullying, each participant played a ball toss game (Cyberball) with the three other boys in the video. Individual differences among participants were examined as moderators of the effect of bystander behavior on participants' willingness to include the "victim" in the game. Results indicated that, when exposed to a passive bystander, boys' normative beliefs about aggression, as well as their tendency to morally disengage from observed egregious acts, decreased their willingness to include the victim in the game.

Assessment of social competence of boys with attention-deficit/hyperactivity disorder: problematic peer entry, host responses, and evaluations.

Anecdotally and empirically, there is clear evidence that children with the Combined subtype of Attention-deficit/Hyperactivity Disorder (ADHD) experience disturbed peer relations, yet the field has not clearly established the origin of these difficulties. This is the first known investigation to examine the role of peer entry as a means to determine the social competence of boys with ADHD as they joined lab-based games played by age-mates who were good friends but unfamiliar with entry boys. Observational data of entry boys and their hosts, plus coders' ratings, indicate that 7- to 12-year-old boys with and without ADHD did not differ in the use of competent entry strategies known to lead to acceptance from peers. However, boys with ADHD relied more heavily on incompetent entry strategies (e.g., disruptive attention-getting) known to exacerbate negative peer reputation. In addition, they failed to apply a frame-of-reference that was relevant to host boys' ongoing activity. As such, host boys considered boys with ADHD less likeable as they spent more time with them. This pattern of findings has theoretical implications and informs the foci of social skills interventions for children with ADHD.

Memory for object locations in boys with and without ADHD.

OBJECTIVE: To determine whether 7- to 12-year-old boys with ADHD, relative to non-ADHD age-mates, exhibit greater difficulty learning and remembering object locations. The second purpose was to examine the functional utility of mnemonic strategies, specifically speech-to-self, used by boys with and without ADHD. METHOD: Boys with and without ADHD were videotaped while completing a well-established, laboratory-based object location learning and memory task. RESULTS: Boys with ADHD evinced a deficit while learning the location of objects and employed less sophisticated forms of private speech during the memory task. CONCLUSION: These findings reveal details about the utility of private speech during spatial working memory performance and further a theoretical understanding of ADHD. (J. of Att. Dis. 2010; 13(5) 505-515).

The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder.

This study examined group differences of 49 boys ages 6 to 11 years with and without attention deficit hyperactivity disorder (ADHD) in emotion regulation during frustrating peer competition. Half of all boys in each group were explicitly instructed to hide their feelings if they became upset during the competition. Behavioral inhibition, both before and after the competitive task, was examined using the Stop Signal Task (SST), and emotion regulation was assessed via structured observation data. Effect sizes indicated that impulsive ADHD boys displayed greater disinhibition and were less effective at emotion regulation than comparison boys. In addition, boys with ADHD were unsuccessful in masking their emotions even when instructed to do so. In contrast, comparison boys were more successful at emotion regulation when given instruction to self-regulate, and these regulatory attempts predicted later inhibitory control. Findings are discussed in the context of current ADHD-related theories of inhibitory deficit, and suggestions for future research are provided.