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Abstract

Thank you for the opportunity to respond to Dr. Mannion's letter in which he describes that "epidural spread after posterior lumbar plexus block (PLPB) depends on the approach used," and suggests that the technique used by the author, and described by Capdevila and colleagues, 1 is preferable to the approach used in our patient 2 in minimizing epidural spread and thus adverse hemodynamic consequences, particularly in patients with severe aortic stenosis. Epidural spread with bilateral symmetrical 3 or unilateral 1 anesthesia after PLPB has been reported, but as acknowledged by Dr. Mannion the extent to which epidural spread occurs or factors that contribute to epidural spread after PLPB are still not defined. In our experience, and that of others, this is variable and mul-tifactorial and may be related to the position of the needle prior to the injection, unintended injection close to the intervertebral foramen via a medially directed needle , accidental epidural injection via a misplaced catheter, 4 large volume of local anesthetic used, and the presence of spinal deformity (e.g., scoliosis), 4 etc. Our patient did not have any obvious spinal deformity and we chose the L3 approach with no medial direction of the needle, as described by Parkinson et al., 3 because L3 has the longest lumbar transverse process and allows the injection to be made furthest away from the interverte-bral foramina, thus minimizing epidural spread. Parkinson et al. report bilateral symmetrical anesthesia in 16% of patients using the above approach with an initial injection volume of 0.5 mL·kg-1. 3 Interestingly, although the point of needle insertion, as described by Capdevila et al., 1 is more medial than in our patient, unilateral epidural anesthesia was seen in only 6.5% of patients, 1 suggesting that factors other than the approach may be responsible. Also of note is the lower initial volume and dose (0.4 mL·kg-1 of 0.2% ropivacaine) of local anesthetic used. 1 We used only 15 mL (0.3 mL·kg-1) of ropivacaine 0.5% for the PLPB and there was no clinical evidence of epidural anesthesia in our patient, 2 the drop in blood pressure in our patient notwithstanding. Moreover, the propofol infusion used for sedation during the procedure may also have been partly responsible for the drop in blood pressure. Therefore, before we can recommend a certain approach or technique of PLPB as being superior to another in causing less epidural spread or adverse hemodynamic consequences, further research is required.

Optimised use of Oxford Nanopore Flowcells for Hybrid Assemblies

“…Such development will be critical to ensuring the viability of ONT sequencing, particularly in routine clinical settings in the future. It has previously been hypothesised that the bimodal distribution observed in quality scores of reads (as calculated by their kmer identity to Illumina reads) delineates 'good' from 'junk' reads [9] . We speculate that in fact ONT reads with low identity to Illumina reads represent cross-barcode contamination.…”

“…Filtlong [9] . Unicycler v0.4.8-beta was used to create hybrid assemblies utilising both the long-and short-read data.…”

Membrane Tension–Mediated Growth of Liposomes

“…[32,33] But this approach is nonideal for establishing a continuous artificial cell cycle since it changes the lipid composition and the membrane properties of the vesicle. Attempts are being made to incorporate the lipid synthesis machinery within liposomes in order to achieve controlled growth of synthetic cells [34][35][36][37] or reconstituting the genetic pathway for lipid synthesis using a cell-free expression system, albeit without realizing significant growth so far. [38] The challenge has also been approached by using synthetic amphiphiles and phospholipid analogues, as well as by using autocatalytic reactions to continuously drive membrane synthesis.…”

Novel Fabrication of Conductive Polymers Contained Micro‐Array Gas Sensitive Films Using A Micromanipulation Method

“…To fabricate micro gas sensor films, a micromanipulation system was used. Such a system is generally for separating larger bacterial cells and for handling prokaryotic cells and giant vesicles [14,15]. Generally, this system is equipped with a very accurate pressure device, which allows the injection of small volumes of monomer solutions for the synthesis of polymers.…”