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Techniques and strategies for regional anesthesia in acute burn care—a narrative review

Burns & Trauma 2021年第1期9卷 383-392页

作者： Clifford C.Sheckter Barclay T.Stewart Christopher Barnes Andrew Walters paul i.bhalla Tam N.Pham Department of Surgery UWMedicine Regional Burn Center at Harborview Medical CenterUniversity ofWashington3259th Ave.SeattleWA 98104USA Harborview injury Prevention and Research Center University ofWashington401 Broadway.SeattleWA 98122USA Department of Anesthesia and Pain Medicine Harborview Medical Center.University ofWashington3259th Ave.SeattleWA 98104USA

Burn injuries and their treatments result in severe *** traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period that lasts through wound closure(*** pain,procedural pain,breakthrough pain,neuropathic pain and itch).Regional anesthesia,including peripheral nerve blocks and neuraxial/epidural anesthesia,offers significant benefits to a multimodal approach in pain treatment.A‘regional-first’approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients.A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/*** infra/supraclavicular nerve block provides excellent coverage for the upper extremity,while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane *** lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient *** centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events,including management of local anesthetic toxicity and epidural *** of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve ***,regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.

关键词： Burn Regional anesthesia Nerve block Epidural Nerve catheter Pain

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Bacille-Calmette-Guerin modulates human macrophage and dendritic cell response to SARS-CoV-2 S-glycoprotein

Infectious Medicine

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infectious Medicine 2023年第3期2卷 241-245页

作者： Regina C.Ambe Shubhang bhalla Alejandra Alvarado Jose Barragan Jorge Cervantes paul L.Foster School of Medicine Texas Tech University Health Sciences CenterEl PasoTX 79905USA Dr Kiran C.Patel College of Allopathic Medicine Nova Southeastern UniversityFort LauderdaleFL 33328USA

Background:Given that epidemiological evidence suggests a potential protective role for Bacille-Calmette-Guerin against COViD-19,we aimed to explore whether pre-exposure of human monocyte-derived macrophages and dendritic cells to BCG could modulate their response to SARS-CoV-2 ***:Dual THP-1 cells containing 2 reporter plasmids for transcription factors NF-κB,and iRF were differ-entiated into macrophages over 3 days using phorbol 12-myristate 13-acetate,or into dendritic cells over 6 days using commercial monocyte-dencritic cell differentiation media and matured with recombinant tumor necrosis factor-α.Cells were exposed to BCG for 24 h and then stimulated with SARS-CoV-2 S-glycoprotein for 24 ***:Pre-exposure of human macrophages and DCs to BCG increased iRF and NF-kb activation in response to the SARS-CoV-2 ***:Our results showed that pre-exposure of both types of cells to BCG exhibited an increase in inflam-matory transcription factors upon stimulation with ***-induced trained immunity may be an important tool for reducing susceptibility to SARS-CoV-2 infection and severity of *** findings help in the design of future BCG-based therapeutic approaches in the treatment of diseases caused by viral infections.

关键词： BCG SARS-CoV-2 Dendritic cell Macrophage

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