The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis

Abstract

Purpose

Although several studies have compared the clinical efficacy of an adductor canal block (ACB) to that of a femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA), disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. The aim of the present study was to compare, in a systematic review and meta-analysis, the clinical efficacy of ACB with that of FNB.

Methods

We systematically searched randomized controlled trials comparing FNB with ACB for analgesia after TKA in Pubmed and the Cochrane Library from inception to April 30th 2015. There was no limitation of publication language. Trial quality was assessed using the modified Jadad scale, and eligible data were pooled for meta-analysis.

Results

Five studies of 348 patients were included. Outcomes showed that patients who received ACB had similar or better recovery of quadriceps strength and mobilization ability than those that underwent FNB. Similar efficacy was found between the two strategies regarding adductor strength, pain scores [at rest (p = 0.86), at or after knee flexion (p = 0.31)], opioid consumption (p = 0.99), opioid-associated adverse effects (p = 0.60), length of hospital stay (p = 0.42), patient satisfaction (p = 0.57), and success rate of blockade (p = 0.20).

Conclusions

The present study suggests that TKA patients who receive ACB can achieve similar or even better recovery of quadriceps strength and mobilization ability than those treated with FNB. Taken as a whole, ACB may be a better analgesia strategy after TKA at present.

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The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis

Abstract

Purpose

Although several studies have compared the clinical efficacy of an adductor canal block (ACB) to that of a femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA), disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. The aim of the present study was to compare, in a systematic review and meta-analysis, the clinical efficacy of ACB with that of FNB.

Methods

We systematically searched randomized controlled trials comparing FNB with ACB for analgesia after TKA in Pubmed and the Cochrane Library from inception to April 30th 2015. There was no limitation of publication language. Trial quality was assessed using the modified Jadad scale, and eligible data were pooled for meta-analysis.

Results

Five studies of 348 patients were included. Outcomes showed that patients who received ACB had similar or better recovery of quadriceps strength and mobilization ability than those that underwent FNB. Similar efficacy was found between the two strategies regarding adductor strength, pain scores [at rest (p = 0.86), at or after knee flexion (p = 0.31)], opioid consumption (p = 0.99), opioid-associated adverse effects (p = 0.60), length of hospital stay (p = 0.42), patient satisfaction (p = 0.57), and success rate of blockade (p = 0.20).

Conclusions

The present study suggests that TKA patients who receive ACB can achieve similar or even better recovery of quadriceps strength and mobilization ability than those treated with FNB. Taken as a whole, ACB may be a better analgesia strategy after TKA at present.

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The quantity and quality of α-gal-specific antibodies differs in individuals with and without delayed red meat allergy

Abstract

Background

IgG to galactose-α-1,3-galactose (α-gal) are highly abundant natural antibodies (Ab) in humans. α-gal-specific IgE Ab cause a special form of meat allergy characterized by severe systemic reactions 3-7 hours after consumption of red meat. We investigated 20 patients who experienced such reactions and characterized their α-gal-specific IgE and IgG responses in more detail.

Methods

α-gal-specific IgE was determined by ImmunoCAP. IgE-reactivity to meat extract and bovine gamma globulin (BGG) was assessed by immunoblotting and ELISA, respectively. In some experiments, sera were pre-incubated with α-gal or protein G to deplete IgG Ab. α-gal-specific IgG_1-4 Ab in individuals with and without meat allergy were assessed by ELISA.

Results

In immunoblots BGG was the most frequently recognized meat protein. IgE- and IgG-binding to BGG was confirmed by ELISA and completely abolished after pre-incubation with α-gal. Neither the depletion of autologous α-gal-specific IgG Ab nor the addition of α-gal-specific IgG Ab from non-allergic individuals changed the IgE-recognition of BGG of meat-allergic patients. Meat-allergic patients showed significantly higher α-gal-specific IgG1 and IgG3 Ab than non-allergic individuals whereas the latter showed significantly higher levels of α-gal-specific IgG4 Ab.

Conclusion

Patients with delayed meat-allergy display IgE and IgG Ab that selectively recognize the α-gal-epitope on BGG. Their enhanced α-gal-specific IgE levels are accompanied by high levels of α-gal-specific IgG1 devoid of IgE-blocking activity. This subclass distribution is atypical for food allergies and distinct from natural α-gal-IgG responses in non allergic individuals.

This article is protected by copyright. All rights reserved.

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Beneficial effect of Lactococcus lactis NCC 2287 in a murine model of eosinophilic esophagitis

Abstract

Background

Eosinophilic esophagitis (EoE) is a severe inflammatory disease of the esophagus which is characterised histologically by an eosinophilic infiltration into the esophageal tissue. The efficacy of probiotics in the context of atopic diseases has been well-investigated but, to date, there has been no study which has evaluated probiotic effects on EoE inflammation. This study sought to identify a probiotic which improves esophageal inflammation in experimental EoE.

Methods

Two candidate probiotics, Lactococcus lactis NCC 2287 and Bifidobacterium lactis NCC 2818, were tested in a murine model of EoE elicited by epicutaneous sensitization with Aspergillus fumigatus protein extract. Administration of bacterial strains in drinking water were used respectively as a preventive or treatment measure, or continuously throughout the study. Inflammatory parameters were assessed in the esophagus, skin and lungs after allergen challenge.

Results

In this EoE model, supplementation with L. lactis NCC 2287 significantly decreased esophageal and bronchoalveolar eosinophilia but only when given as a therapeutic treatment. No significant effect on eosinophilia was observed when NCC 2287 was given as a preventive or a continuous intervention. NCC 2287 supplementation had no significant effect on immunoglobulin levels, skin symptom scores or on transepidermal water loss. Supplementation with another probiotic, B. lactis NCC 2818, had no significant effect on esophageal eosinophilia.

Conclusion

We identified a Lactococcus lactis strain, able to attenuate esophageal eosinophilic inflammation in a preclinical model of EoE. This effect is strain specific and depends on the timing and duration of bacterial supplementation. Confirmation of these observations in human clinical trials is warranted.

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A rare variant in CYP27A1 and its association with atopic dermatitis with high serum total IgE

Abstract

This study investigated rare variants associated with atopic dermatitis. We performed exome analyses on 37 patients who were diagnosed with atopic dermatitis by board-certified dermatologists and had total serum IgE levels greater than 1,000 IU/ml. The exome analysis identified seven variants with <1% allele frequency in Asian (ASN) population of 1000 Genomes Project phase 1 data and >5% allele frequency in the atopic dermatitis exome samples. We then conducted a replication study using 469 atopic dermatitis patients with total serum IgE ≥1,000 IU/ml and 935 Japanese controls to assess the presence of these 7 candidate variants. The replication study confirmed that CYP27A1 rs199691576 (A/G) was associated with atopic dermatitis with high serum IgE levels (P = 0.012, odds ratio = 2.1). CYP27A1 is involved in the metabolism of Vitamin D3, which plays important roles in modulating immune function. Previous studies have reported polymorphisms in Vitamin D pathway genes that are associated with allergy-related phenotypes. Our data confirm the importance of genes regulating the Vitamin D pathway in the development of atopic dermatitis.

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MULTIPLE SCLEROSIS AND MERCURY/SILVER AMALGAMS

The post MULTIPLE SCLEROSIS AND MERCURY/SILVER AMALGAMS appeared first on Family Dentistry and Cosmetic Surgery Clinic.

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The quantity and quality of α-gal-specific antibodies differs in individuals with and without delayed red meat allergy

Abstract

Background

IgG to galactose-α-1,3-galactose (α-gal) are highly abundant natural antibodies (Ab) in humans. α-gal-specific IgE Ab cause a special form of meat allergy characterized by severe systemic reactions 3-7 hours after consumption of red meat. We investigated 20 patients who experienced such reactions and characterized their α-gal-specific IgE and IgG responses in more detail.

Methods

α-gal-specific IgE was determined by ImmunoCAP. IgE-reactivity to meat extract and bovine gamma globulin (BGG) was assessed by immunoblotting and ELISA, respectively. In some experiments, sera were pre-incubated with α-gal or protein G to deplete IgG Ab. α-gal-specific IgG_1-4 Ab in individuals with and without meat allergy were assessed by ELISA.

Results

In immunoblots BGG was the most frequently recognized meat protein. IgE- and IgG-binding to BGG was confirmed by ELISA and completely abolished after pre-incubation with α-gal. Neither the depletion of autologous α-gal-specific IgG Ab nor the addition of α-gal-specific IgG Ab from non-allergic individuals changed the IgE-recognition of BGG of meat-allergic patients. Meat-allergic patients showed significantly higher α-gal-specific IgG1 and IgG3 Ab than non-allergic individuals whereas the latter showed significantly higher levels of α-gal-specific IgG4 Ab.

Conclusion

Patients with delayed meat-allergy display IgE and IgG Ab that selectively recognize the α-gal-epitope on BGG. Their enhanced α-gal-specific IgE levels are accompanied by high levels of α-gal-specific IgG1 devoid of IgE-blocking activity. This subclass distribution is atypical for food allergies and distinct from natural α-gal-IgG responses in non allergic individuals.

This article is protected by copyright. All rights reserved.

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