Chimpanzee vertebrate consumption: Savanna and forest chimpanzees compared

Publication date: November 2017
Source:Journal of Human Evolution, Volume 112
Author(s): Jim Moore, Jessica Black, R. Adriana Hernandez-Aguilar, Gen'ichi Idani, Alex Piel, Fiona Stewart
There is broad consensus among paleoanthropologists that meat-eating played a key role in the evolution of Homo, but the details of where, when, and why are hotly debated. It has been argued that increased faunivory was causally connected with hominin adaptation to open, savanna habitats. If savanna-dwelling chimpanzees eat meat more frequently than do forest chimpanzees, it would support the notion that open, dry, seasonal habitats promote hunting or scavenging by hominoids. Here we present observational and fecal analysis data on vertebrate consumption from several localities within the dry, open Ugalla region of Tanzania. Combining these with published fecal analyses, we summarize chimpanzee vertebrate consumption rates, showing quantitatively that savanna chimpanzee populations do not differ significantly from forest populations. Compared with forest populations, savanna chimpanzees consume smaller vertebrates that are less likely to be shared, and they do so more seasonally. Analyses of chimpanzee hunting that focus exclusively on capture of forest monkeys are thus difficult to apply to chimpanzee faunivory in open-country habitats and may be misleading when used to model early hominin behavior. These findings bear on discussions of why chimpanzees hunt and suggest that increases in hominin faunivory were related to differences between hominins and chimpanzees and/or differences between modern and Pliocene savanna woodland environments.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2xFNMWn
via IFTTT

P 40 Correlation between hypothalamus and third ventricle of patients with affective disorders

Former studies proved the key role of the hypothalamus in the pathophysiology of affective disorders. Because of limited imaging methods and difficult delineation, attested volumetric changes has only been verified post-mortem, so in vivo studies made use of the adjacent third ventricle as an indirect marker of hypothalamic changes. Considering that these former ventricle studies leave sufficient scope for methodical improvements, it was our aim to replicate and complement these findings by using a high-resolution 7T-MRI for the first time.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2k9Z4fI
via IFTTT

P 75 Movement-induced γ oscillations in the subthalamic nucleus are increased by dopamine and scaled by velocity in patients with Parkinson’s disease

Parkinson's disease (PD) is a basal ganglia disorder that results in general slowness of movement and an effective treatment option consists in subthalamic deep brain stimulation (DBS). Postoperatively, DBS-electrodes are externalized which gives the unique opportunity of recording local field potentials (LFP). Previous studies have shown that there are disease specific oscillatory patterns at rest, most prominently an increased β synchronization (Kühn, 2006) that correlates with clinical symptoms of PD such as rigidity and bradykinesia (Neumann, 2016).

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xOi7RE
via IFTTT

P 91 Changes of cerebral perfusion and cerebral pressure induced by rapid altitude changes of 1000m in an alpine region? – results of a neurosonographic study of volume flow rate and optic sheath diameter

As the clinical implications of altitude sickness are well known, the etiology of this potential life threatening disease is far from understood completely. We studied noninvasively by means of Neurosonography the effects of a rapid change of altitude in the alpine region on the cerebral volume flow and intracranial pressure.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2kb5dsk
via IFTTT

P 57 The influence of sports expertise on the extent of physiological mirror-EMG-activity in the upper and lower extremity

During unimanual motor tasks, muscle activity may not be restricted to the contracting muscle, but has also been reported to occur involuntarily in the contralateral resting limb in healthy subjects, referred to as physiological mirror electromyographic (MEMG) activity (Sehm et al., 2015). To date, however, it is unknown if the physiological form of MEMG can also be observed in lower extremities during the performance of unilateral isometric leg contractions. Furthermore it still remains elusive if and how MEMG is affected by long-term exercise training.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xOrYaj
via IFTTT

P 83 Parasomnia, parkinsonism, impulse control disorder and bulbar palsy with IgLON5 antibodies: A new case report

In 2014 a complex neurological syndrome with parasomnia, sleep breathing dysfunction and variable bulbar symptoms associated with antibodies to IgLON5, a neuronal cell-adhesion protein, was described (Sabater et al., 2016). Postmortal studies revealed tauopathy predominately involving the hypothalamus and tegmentum of the brainstem (Gelpi et al., 2016). To the best of our knowledge, there are 16 published cases so far.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2kbJakZ
via IFTTT

P 67 Electrophysiological correlates of language improvements after intensive language therapy in patients with chronic post-stroke aphasia

Aphasia affects approximately one third of all stroke patients and may lead to chronic disability. Effective neurorehabilitation programs focusing on improving speech and language in patients with post-stroke aphasia are essential. A better understanding of the neurobiological processes accompanying language deficits and rehabilitation may bear fruit in the advancement of neurorehabilitation programs.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xOvFNb
via IFTTT

P 48 The time of the ALSFRS-R to decrease to 50% (D50) in a sigmoidal decay model sufficiently describes the complete disease course of amyotrophic lateral sclerosis

The progression of ALSFRS-R is not linear (Gordon et al., 2010; Proudfoot et al., 2016); the often used calculated progression rate using PR=((48-ALSFRS-R)/disease duration) presents the progression at a certain time point rather than reflecting the entire disease course. A model describing the disease progression at different time points would facilitate the stratification of ALS patients according to disease severity and progression type and will in combination with other biomarkers enable identification of effective drugs in clinical trials.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2kcm79Q
via IFTTT

P 32 Insufficient evidence for structural gray matter alterations in late life minor depression – results from LIFE-adult study

Minor depressive episode is diagnosed when two to four depressive symptoms (including depressed mood or loss of interest) disturb the patient during at least two weeks. In late life minor depression is more prevalent than major depression. Newertheless, publications investigating pathophysiology of minor depression are missing.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hEsW33
via IFTTT

P 87 The perfusion changes in temporal and parietal lobe epilepsy

The aim of this study was to assess the regional relative interictal and postictal perfusion changes in temporal and parietal lobe epilepsy.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xL5DbR
via IFTTT

P 79 Physiological assessment of the sense of agency in psychogenic movement disorders

Psychogenic movement disorders (PMD) are conditions characterized by the occurrence of unwanted motoric symptoms in which a somatic reason cannot be found. As patients suffering from PMD experience their pathological movements as non-voluntary, it is hypothesized that those patients have an altered sense of agency (SoA). SoA is defined as the feeling of controlling ones own actions and through them controlling events in the external world (Haggard and Tsakiris, 2009). SoA can be assessed by measuring the intentional binding (IB) effect.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hFCHyd
via IFTTT

P 71 Levodopa modulates beta and gamma oscillations in the cortico-basal ganglia loop with a higher efficacy than the dopamine receptor agonist apomorphine in experimental Parkinsonism

The pharmacotherapy of Parkinson's disease (PD) is based on levodopa, and dopamine receptor agonists, such as apomorphine. Although both types of agents provide beneficial clinical effects on motor and non-motor symptoms in PD clinical efficiency and side effects differ substantially between levodopa and dopamine receptor agonists. Levodopa is known to provide a greater symptomatic relief than dopamine receptor agonists. Since long-term levodopa treatment often results in debilitating motor fluctuations, dopamine receptor agonists are recommended in younger patients.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xL12GR
via IFTTT

P 63 Investigating the effects of tRNS variants and task dependency on cortical excitability

Transcranial random noise stimulation (tRNS) has specific benefits and is fundamentally different as compared to more established methods such as transcranial direct current stimulation (tDCS) in modulating brain function (Terney et al., 2008; Ambrus et al., 2010). For example, previous research in the motor system has shown corticospinal excitability (CSE) to be task-dependent (Terney et al., 2008). It remains unresolved and largely unaddressed what the critical stimulation parameters of tRNS are, e.g.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hEJAj2
via IFTTT

P 53 Impact of acoustic stimulation on motor response inhibition and error monitoring

Previous studies suggested that acoustic stimulation can be used to modulate cognition, to reduce anxiety level as well as to enhance mood. In this study we investigated whether acoustic stimulation can modulate response inhibition and error monitoring in a continuous performance task. Using the Go-NoGo paradigm in healthy adults during MEG recordings, Mazaheri et al. (2009) was able to predict errors during response inhibition by theta-alpha coupling. Thus, it seems likely that frontal theta activity after an error may boost an adjustment of the mental state of individuals towards more preparatory alertness resulting in alpha decrease and better sustained performance.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xL5ipB
via IFTTT

P 44 Brisk jerk reflexes in a CMT case – novel heterozygous variant c.785T>C; p.Leu262Pro in KIF5A explaining the mixed phenotype

Charcot-Marie-Tooth (CMT) disease is a progressively disabling syndrome phenotypically comprising distal muscle weakness and atrophy, foot deformities, sensory loss, and reduced or absent tendon reflexes. In spastic paraplegia (SPG), a hereditary disorder affecting the upper motor neuron only, pareses are spastic, and deep tendon reflexes increased. Mixed forms between both diseases have been previously described (Liu et al., 2014). By multiple gene panel based analysis using next-generation-sequencing (NGS), we herein identified the novel variant c.785T>C; p.Leu262Pro in KIF5A as the putative cause of a mixed CMT and SPG phenotype.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hCwwuo
via IFTTT

P 36 Structural and functional imaging findings in somatoparaphrenia

With regard to somatosensory delusion, neglect or deficits of body integrity a great number of overlapping pathophysiological concepts exist. Moreover, the range of assumed underlying psychiatric and neurologic syndromes only partially is thought to be related to even diverse neuroanatomical structures so far: Alien Hand Syndrome, Body Dysmorphic Disorder (BDD), Body Integrity Identity Disorder (BIID), Depersonalization, Somatoparaphrenia and Xenomelia. Specific deafferentiation within temporal regions, the insula or representational structures of the somatosensory cortex of the right parietal lobe is thought to be related only in some variants.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xL5a9B
via IFTTT

P 28 Voxel-based Morphometry (VBM) subcortical white matter changes correlate with disease progression in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive, multisystemic disorder.Signs of lower motor neurone involvement are readily detectable but the involvement of the upper motor neurone is elusive.Hence, we must identify the extent and development of ALS related changes in the brain in different subtypes of ALS to facilitate an early diagnosis and stratification for clinical trials.Previous studies applying Voxel-based morphometry (VBM) provided inconsistent results.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hEy4Ex
via IFTTT

P 89 Case presentation – Clinically unrecognized status epilepticus in neuronal ceroid lipofuscinosis (CLN 3 gene)

On the previous day the 12-year-old boy P.-J. had a convulsive spasm (duration about 30s) in the morning and at noon. After that, he recovered and went outside for a walk. Before the evening meal P.-J. cramped again. Since then, he was not really awake, was not responsive, and had repeatedly convulsions (seven times on the day of admission). In between he was always sleepy and unresponsive. Since noon on the previous day, P. Luca did not eat and drink any more and did not take his medication. In the evening, the emergency physician was called, who did not administer any medicines because of stable vital parameters and only a short convulsive spasm when drawing blood from the vein.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xL501Z
via IFTTT

P 85 KCNQ-2 missense mutations and phosphatidylinositol 4,5-bisphosphate in familial epilepsy

The KCNQ2/3 channel is a slowly activating, non-inactivating voltage-gated potassium channel. It causes the M-current and sustains the resting membrane potential. Therefore, it is crucial for the regulation of neuronal plasticity. If a neuron does not reach the resting-potential after activation, excitation may spread throughout the neuronal network and a seizure may follow.In this work we study the influence of the intracellular second messenger phosphatidylinositol 4,5-bisphosphate (PIP2) on channels containing mutant KCNQ2 subunits associated with Benign Familial Neonatal Convulsions (BFNC).

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hEUYvb
via IFTTT

P 81 Voiding disorder – almond or walnut?

Limbic encephalitis is an inflammatory disease of the central nervous system. The subacute development of short-term memory deficit is typical of this disease, as are psychiatric symptoms and seizures. Limbic encephalitis is caused by auto -immunity and is associated with cancer in about 60 per cent of cases. Since 1999, several antibodies associated with limbic encephalitis have been identified.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2xL4Nfd
via IFTTT

P 77 Optogenetic stimulations of striatal cholinergic interneurons in an animal model of dystonia

Dystonias are movement disorders, defined by sustained or intermittent muscle contractions causing twisting movements and postures. The most prevalent inherited form of dystonia is caused by a mutation in the gene for torsin A (DYT1, ΔGAG) with incomplete penetrance. It has been hypothesized that an increased activity of cholinergic interneurons in the striatum, resulting in abnormal synaptic plasticity, plays an important role in the disease pathophysiology. However, this hypothesis is merely based on ex vivo electrophysiological recordings in brain slices of animal models which do not show a dystonic phenotype.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2hBSNJ1
via IFTTT

Deciphering signature of selection affecting beef quality traits in Angus cattle

Abstract

Artificial selection towards a desired phenotype/trait has modified the genomes of livestock dramatically that generated breeds that greatly differ in morphology, production and environmental adaptation traits. Angus cattle are among the famous cattle breeds developed for superior beef quality. This paper aimed at exploring genomic regions under selection in Angus cattle that are associated with meat quality traits and other associated phenotypes. The whole genome of 10 Angus cattle was compared with 11 Hanwoo (A-H) and 9 Jersey (A-J) cattle breeds using a cross-population composite likelihood ratio (XP-CLR) statistical method. The top 1% of the empirical distribution was taken as significant and annotated using UMD3.1. As a result, 255 and 210 genes were revealed under selection from A–H and A–J comparisons, respectively. The WebGestalt gene ontology analysis resulted in sixteen (A–H) and five (A–J) significantly enriched KEGG pathways. Several pathways associated with meat quality traits (insulin signaling, type II diabetes mellitus pathway, focal adhesion pathway, and ECM-receptor interaction), and feeding efficiency (olfactory transduction, tight junction, and metabolic pathways) were enriched. Genes affecting beef quality traits (e.g., FABP3, FTO, DGAT2, ACS, ACAA2, CPE, TNNI1), stature and body size (e.g., PLAG1, LYN, CHCHD7, RPS20), fertility and dystocia (e.g., ESR1, RPS20, PPP2R1A, GHRL, PLAG1), feeding efficiency (e.g., PIK3CD, DNAJC28, DNAJC3, GHRL, PLAG1), coat color (e.g., MC1-R) and genetic disorders (e.g., ITGB6, PLAG1) were found to be under positive selection in Angus cattle. The study identified genes and pathways that are related to meat quality traits and other phenotypes of Angus cattle. The findings in this study, after validation using additional or independent dataset, will provide useful information for the study of Angus cattle in particular and beef cattle in general.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2fAn7zf
via IFTTT

Documentation of Evidence-Based Psychotherapy and Care Quality for PTSD in the Department of Veterans Affairs

Abstract

This study measured the prevalence of evidence-based psychotherapy (EBP) templated notes in VA and tested the hypothesis that template use would be associated with care quality for posttraumatic stress disorder (PTSD). Across 130 facilities, an average of 3.6% of patients with a PTSD diagnosis received at least one EBP template in 2015. Among patients receiving psychotherapy for PTSD, an average of 8.5% received an EBP template. In adjusted models, facility-level EBP template use was associated with a greater proportion of PTSD-diagnosed patients treated in specialty clinics, greater facility-level rates of diagnostic assessment, and greater facility-level rates of psychotherapy adequacy.

from Health via xlomafota13 on Inoreader http://ift.tt/2yzTyFD
via IFTTT

Impact of Video Technology for Improving Success of Medial Canthus Episcleral Anesthesia in Ophthalmology.

Background and Objectives: Efficient learning of regional anesthesia in ophthalmology remains challenging because trainees are afforded limited opportunity to practice ocular anesthesia. The aim of this prospective, randomized, blinded study was to determine whether teaching with video improves regional anesthesia skills of residents in ophthalmology. Methods: From January to October 2016, 32 novice anesthesiology residents were evaluated while performing medial canthus episcleral procedures during a 5-day rotation. Residents were randomly assigned to either receive or not receive a video review of their performance at day 3. The primary outcome was a comparison of akinesia using a 12-point scale before incision assessed by the blinded surgeon. Results: A total of 288 blocks were performed by 32 residents and were assessed by 3 surgeons before the intervention (144 blocks) and after the intervention (144 blocks). Residents in the review group improved to a greater degree compared with residents in the no-review group. The median overall akinesia scores for the review and no-review groups were similarly low (6; interquartile range [IQR], 2-11; and 6 [IQR, 2-9], respectively) on day 1 of the rotation, whereas anesthesia performed by residents in the video group provided a better akinesia score (12 [IQR, 10-12] vs 8 [IQR, 6-10]; P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2xNbnUa
via IFTTT

The Technology of Video Laryngoscopy.

Tracheal intubation via laryngeal exposure has evolved over the past 150 years and has greatly expanded in the last decade with the introduction and development of newer, more sophisticated optical airway devices. The introduction of indirect and video-assisted laryngoscopes has significantly impacted airway management as evidenced by the presence of these devices in the majority of published difficult airway algorithms. However, it is quite possible that many airway managers do not have a thorough comprehension of how these devices actually function, an understanding that is vital not only for their use but also for assessing the devices' limitations. This article discusses the development of video laryngoscopy, how the video laryngoscope works, and the impact of video laryngoscopy on difficult airway management. (C) 2017 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x4kZGv
via IFTTT

You Will Never Walk Alone: A Simulation Experience for Caregiver's Family and Friends.

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x4iwf2
via IFTTT

General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients With a History of Head and Neck Radiation Therapy.

BACKGROUND: Head and neck radiation therapy (HNRT) impairs baroreflex sensitivity, and it may potentiate the effects of anesthetics on heart rate (HR) and blood pressure (BP) regulation. Currently, the impacts of HNRT on HR and BP under anesthesia remain unclear. METHODS: In this study, 472 patients with primary oral cavity or oropharyngeal cancer at all stages were examined. Half of the patients underwent HNRT plus surgery. The other half underwent surgery only and was matched with the treatment patients according to age, sex, and body mass index at a 1:1 ratio. The HRs and BPs in the 2 groups during anesthetic induction, skin incision, and emergence were compared retrospectively. A multivariable model of repeated measures with unstructured covariance structure was used to examine the associations of HNRT with intraoperative HRs and BPs after adjusting for baseline HR and BP, time, use of [beta]-blockers, history of chemotherapy, and American Society of Anesthesiologists physical status score. BPs and HRs were collected every 5 minutes. The baseline HR and BP measurements were not included in the outcome vector and were only used as adjustment for baselines. RESULTS: Compared with corresponding baseline values in controls, the baseline HR was significantly higher (P = .0012) and the baseline systolic BP was lower (P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wqM86S
via IFTTT

Maternal Death Due to Amniotic Fluid Embolism: A National Study in France.

BACKGROUND: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria. METHODS: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39). The maternal mortality ratio for AFE was calculated. We applied the structured definition proposed by the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation to AFE-related maternal deaths identified by the national experts committee. Characteristics of women, pregnancies and deliveries; clinical and biological features of AFE; and specific laboratory tests used were described by the presence or not of all 4 diagnostic criteria. Management of obstetric hemorrhage and quality of care according to the experts were also described. RESULTS: The maternal mortality ratio from AFE was 0.95/100,000 live births (95% confidence interval, 0.67-1.3). Detailed clinical data were collected for 36 women who died from AFE: 21 (58%) had all 4 proposed diagnostic criteria and 15 (42%) had 1 or more missing criterion. Documented early disseminated intravascular coagulopathy was missing for 14 women, and 2 women exhibited more than 1 missing criterion. Ten of the 15 women with missing criteria had clinical coagulopathy, with standard hemostasis tests performed in only 3. Specific diagnostic examinations for AFE were performed in similar proportions by the presence or not of all diagnostic criteria. Opportunities to improve care included timely performance of indicated hysterectomy (n = 13) and improved transfusion practices (n = 9). In the context of maternal cardiac arrest, for 5 of 13 women, fetal extraction was performed within 5 minutes. CONCLUSIONS: The structured definition of AFE for research studies would exclude more than one-third of AFE-related maternal deaths identified by the national experts committee. Inclusion of clinical coagulopathy as a diagnostic criterion for AFE would reduce this proportion to 14%. There is still room for improvement in the management of obstetric hemorrhage and timely fetal extraction in the context of maternal cardiac arrest, frequently observed in AFE-related maternal death. (C) 2017 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x4As9j
via IFTTT

Imprinted gene expression in maize starchy endosperm and aleurone tissues of reciprocal F1 hybrids at a defined developmental stage

Abstract

Imprinted gene expression in flowering plants predominantly occurs in the triploid endosperm of developing seed. However, endosperm is composed of distinct tissue types. For example, the maize (Zea mays) endosperm is constituted by two major tissues, starchy endosperm and aleurone. Previous studies in imprinted gene expression have generally assumed that the different tissues constituting endosperm would behavior the same, and hence have not examined them separately. Here, to examine parental-specific expression of imprinted genes in different parts of the seed, eight previously reported maize protein-coding imprinted genes were selected, and analyzed by cleaved amplified polymorphic sequence (CAPS) coupled with Sanger sequencing for transcripts from the various seed tissues collected at 18 days after pollination (DAP). The studied tissues included seed coat, embryo, starchy endosperm and aleurone, which were collected from a pair of reciprocal F1 hybrids produced by crossing inbred lines B73 and Mo17. Six of these eight analyzed imprinted genes showed the same imprinted expression pattern between the starchy endosperm and aleurone, but two showed imprinted expression only in the starchy endosperm. Comparison of the expression pattern of 20 selected imprinted genes in multiple seed tissues and vegetative tissues indicated that the majority (~ 75%) of these imprinted genes exhibited seed-specific or endosperm-specific expression. Our results also uncovered that imprinted genes have a high propensity to be alternatively spliced via intron retention in the developing embryo compared with the other tissues.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2xF7bq5
via IFTTT

Monte Carlo Simulations Comparing Fisher Exact Test and Unequal Variances t Test for Analysis of Differences Between Groups in Brief Hospital Lengths of Stay.

BACKGROUND: We examined type I and II error rates for analysis of (1) mean hospital length of stay (LOS) versus (2) percentage of hospital LOS that are overnight. These 2 end points are suitable for when LOS is treated as a secondary economic end point. METHODS: We repeatedly resampled LOS for 5052 discharges of thoracoscopic wedge resections and lung lobectomy at 26 hospitals. RESULTS: Unequal variances t test (Welch method) and Fisher exact test both were conservative (ie, type I error rate less than nominal level). The Wilcoxon rank sum test was included as a comparator; the type I error rates did not differ from the nominal level of 0.05 or 0.01. Fisher exact test was more powerful than the unequal variances t test at detecting differences among hospitals; estimated odds ratio for obtaining P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wq1IzQ
via IFTTT

70th World Health Assembly, Geneva, Switzerland.

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x3WGZc
via IFTTT

Research Productivity and Rankings of Anesthesiology Departments in Canada and the United States: The Relationship Between the h-Index and Other Common Metrics.

BACKGROUND: To evaluate the relative research productivity and ranking of anesthesiology departments in Canada and the United States, using the Hirsch index (h-index) and 4 other previously validated metrics. METHODS: We identified 150 anesthesiology departments in Canada and the United States with an accredited residency program. Publications for each of the 150 departments were identified using Thomson's Institute for Scientific Information Web of Science, and the citation report for each department was exported. The bibliometric data were used to calculate publication metrics for 3 time periods: cumulative (1945-2014), 10 years (2005-2014), and 5 years (2010-2014). The following group metrics were then used to determine the publication impact and relative ranking of all 150 departments: h-index, m-index, total number of publications, sum of citations, and average number of citations per article. Ranking for each metric were also stratified by using a proxy for departmental size. The most common journals in which US and Canadian anesthesiology departments publish their work were identified. RESULTS: The majority (23 of the top 25) of top-ranked anesthesiology departments are in the United States, and 2 of the top 25 departments (University of Toronto; McGill University) are in Canada. There was a strong positive relationship between each of h-index, total number of publications, and the sum of citations (0.91-0.97; P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2woB4an
via IFTTT

Removing uranium (VI) from aqueous solution with insoluble humic acid derived from leonardite

Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Fande Meng, Guodong Yuan, Steven L. Larson, John H. Ballard, Charles A. Waggoner, Zikri Arslan, Fengxiang X. Han
The occurrence of uranium (U) and depleted uranium (DU)-contaminated wastes from anthropogenic activities is an important environmental problem. Insoluble humic acid derived from leonardite (L-HA) was investigated as a potential adsorbent for immobilizing U in the environment. The effect of initial pH, contact time, U concentration, and temperature on U(VI) adsorption onto L-HA was assessed. The U(VI) adsorption was pH-dependent and achieved equilibrium in 2 h. It could be well described with pseudo-second-order model, indicating that U(VI) adsorption onto L-HA involved chemisorption. The U(VI) adsorption mass increased with increasing temperature with maximum adsorption capacities of 91, 112 and 120 mg g⁻¹ at 298, 308 and 318 K, respectively. The adsorption reaction was spontaneous and endothermic. We explored the processes of U(VI) desorption from the L-HA-U complex through batch desorption experiments in 1 mM NaNO3 and in artificial seawater. The desorption process could be well described by pseudo-first-order model and reached equilibrium in 3 h. L-HA possessed a high propensity to adsorb U(VI). Once adsorbed, the release of U(VI) from L-HA-U complex was minimal in both 1 mM NaNO3and artificial seawater (0.06% and 0.40%, respectively). Being abundant, inexpensive, and safe, L-HA has good potential for use as a U adsorbent from aqueous solution or immobilizing U in soils.

Graphical abstract

from Radiology via xlomafota13 on Inoreader http://ift.tt/2xQxVnl
via IFTTT

Clinical interpretation of copy number variants in the human genome

Abstract

Molecular methods, by which copy number variants (CNVs) detection is available, have been gradually introduced into routine diagnostics over the last 15 years. Despite this, some CNVs continue to be a huge challenge when it comes to clinical interpretation. CNVs are an important source of normal and pathogenic variants, but, in many cases, their impact on human health depends on factors that are not yet known. Therefore, perception of their clinical consequences can change over time, as our knowledge grows. This review summarises guidelines that facilitate correct classification of identified changes and discusses difficulties with the interpretation of rare, small CNVs.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2xMEmHO
via IFTTT

Using Linkage Maps as a Tool To Determine Patterns of Chromosome Synteny in the Genus Salvelinus

Next generation sequencing techniques have revolutionized the collection of genome and transcriptome data from non-model organisms. This manuscript details the application of restriction site associated DNA sequencing (RADseq) to generate a marker dense genetic map for Brook trout (Salvelinus fontinalis). The consensus map was constructed from three full-sib families totaling 176 F₁ individuals. The map consisted of 42 linkage groups with a total female map size of 2502.5 cM, and a total male map size of 1863.8 cM. Synteny was confirmed with Atlantic salmon for 38 linkage groups, with Rainbow trout for 37 linkage groups, Arctic char for 36 linkage groups, and with a previously published Brook trout linkage map for 39 linkage groups. Comparative mapping confirmed the presence of eight metacentric and 34 acrocentric chromosomes in Brook trout. Six metacentric chromosomes seem to be conserved with Arctic char suggesting there have been at least two species specific fusion and fission events within the genus Salvelinus.  In addition, the sex marker (sdY; sexually dimorphic on the Y chromosome) was mapped to Brook trout BC35, which is homologous with Atlantic salmon Ssa09qa, Rainbow trout Omy25, and Arctic char AC04q. Ultimately, this linkage map will be a useful resource for studies on the genome organization of Salvelinus, and facilitates comparisons of the Salvelinus genome with Salmo and Oncorhynchus.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2yMTp2B
via IFTTT

First Draft Genome Sequence of the Pathogenic Fungus Lomentospora prolificans (formerly Scedosporium prolificans)

Here we describe the sequencing and assembly of the pathogenic fungus Lomentospora prolificans using a combination of short, highly accurate Illumina reads and additional coverage in very long Oxford Nanopore reads. The resulting assembly is highly contiguous, containing a total of 37,627,092 bp with over 98% of the sequence in just 26 scaffolds. Annotation identified 8,896 protein-coding genes. Pulsed-field gel analysis suggests that this organism contains at least 7 and possibly 11 chromosomes, the two longest of which have sizes corresponding closely to the sizes of the longest scaffolds, at 6.6 and 5.7 Mb.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2x37eN6
via IFTTT

Preliminary paleoecological insights from the Pliocene avifauna of Kanapoi, Kenya: Implications for the ecology of Australopithecus anamensis

Publication date: Available online 29 September 2017
Source:Journal of Human Evolution
Author(s): Daniel J. Field
Fossil bird remains from the Pliocene hominin-bearing locality of Kanapoi comprise >100 elements representing at least 10 avian families, including previously undescribed elements referred to the 'giant' Pliocene marabou stork Leptoptilos cf. falconeri. The taxonomic composition of the Kanapoi fossil avifauna reveals an assemblage with a substantial aquatic component, corroborating geological evidence of this locality's close proximity to a large, slow-moving body of water. Both the taxonomic composition and relative abundance of avian higher-level clades at Kanapoi stand in stark contrast to the avifauna from the slightly older (∼4.4 Ma vs. 4.2 Ma) hominin-bearing Lower Aramis Member of Ethiopia, which has been interpreted as representing a mesic woodland paleoenvironment far from water. In general, the taxonomic composition of the Kanapoi avifauna resembles that from the Miocene hominoid-bearing locality of Lothagam (though Kanapoi is more diverse), and the aquatic character of the Kanapoi avifauna supports the idea that the environmental conditions experienced by Australopithecus anamensis at Kanapoi were markedly different from those experienced by Ardipithecus ramidus at Aramis. Additionally, the relative abundance of marabou stork (Leptoptilos) remains at Kanapoi may suggest a longstanding commensal relationship between total-clade humans and facultatively scavenging marabous. Additional avian remains from nearby fossil localities (e.g., the Nachukui Formation), ranging in age from 3.26 to 0.8 Ma, reveal the long-term persistence of an aquatic avifauna in the region.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2k9UG0d
via IFTTT

Extant ape dental topography and its implications for reconstructing the emergence of early Homo

Publication date: November 2017
Source:Journal of Human Evolution, Volume 112
Author(s): Michael A. Berthaume, Kes Schroer
Dental topography reflects diet accurately in several extant and extinct mammalian clades. However, dental topographic dietary reconstructions have high success rates only when closely related taxa are compared. Given the dietary breadth that exists among extant apes and likely existed among fossil hominins, dental topographic values from many species and subspecies of great apes are necessary for making dietary inferences about the hominin fossil record. Here, we present the results of one metric of dental topography, Dirichlet normal energy (DNE), for seven groups of great apes (Pongo pygmaeus pygmaeus, Pan paniscus, Pan troglodytes troglodytes and schweinfurthii, Gorilla gorilla gorilla, Gorilla beringei graueri and beringei). Dirichlet normal energy was inadequate at differentiating folivores from frugivores, but was adequate at predicting which groups had more fibrous diets among sympatric African apes. Character displacement analyses confirmed there is substantial dental topographic and relative molar size (M1:M2 ratio; length, width, and area) divergence in sympatric apes when compared to their allopatric counterparts, but character displacement is only present in relative molar size when DNE is also considered. Presence of character displacement is likely due to indirect competition over similar food resources. Assuming similar ecological conditions in the Plio-Pleistocene, the derived masticatory apparatuses of the robust australopiths and early Homo may be due to indirect competition over dietary resources between the taxa, causing dietary niche partitioning. Our results imply that dental topography cannot be used to predict dietary categories in fossil hominins without consideration of ecological factors, such as dietary and geographic overlap. In addition, our results may open new avenues for understanding the community compositions of early hominins and the formation of specific ecological niches among hominin taxa.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2x1Gs7L
via IFTTT

Hippopotamidae (Cetartiodactyla, Hippopotamoidea) from Kanapoi, Kenya, and the taxonomic status of the late early Pliocene hippopotamids from the Turkana Basin

Publication date: Available online 29 September 2017
Source:Journal of Human Evolution
Author(s): Jean-Renaud Boisserie
New hippopotamid specimens recently collected at Kanapoi (ca. 4 Ma) are similar to the taxon previously recognized in this site and referred to aff. Hippopotamus protamphibius. Their examination provided the opportunity to reassess the taxonomic status of this taxon. It appears different from the late Miocene hippopotamids from the Turkana Basin (prominently Archaeopotamus harvardi), but also differs from the late Pliocene–early Pleistocene aff. Hip. protamphibius, which is smaller and displays more advanced features (notably canine expansion and orbit elevation). In contrast, the Kanapoi material appears very similar to the material from the Hadar Formation (3.4 Ma–2.9 Ma). However, the current confusion surrounding the taxonomic status of the Hadar specimens, previously attributed to various taxa that may be identical, does not allow attribution of a specific name to the Kanapoi material for now and, while waiting for the revision of Hadar hippopotamid diversity, it is referred here to aff. Hippopotamus cf. sp. Hadar. This contribution allows recognizing that a large hippopotamid, possibly a transitional form between the late Miocene species and Plio-Pleistocene species, was distributed from Afar to Turkana between 4.2 Ma and 2.95 Ma. The marked endemism of hippopotamids in the Pleistocene rift basins therefore initiated after 2.9 Ma.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2x1I2X7
via IFTTT

Effect of patients' functional status on satisfaction with outcomes 12-months after elective spine surgery for lumbar degenerative disease

Comprehensive assessment of quality of care includes patient-reported outcomes, safety of care delivered, and patient satisfaction. The impact of the patient-reported ODI (baseline and 12-month) scores on satisfaction with outcomes following spine surgery is not well documented.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2yydBEy
via IFTTT

The Emerging Role of Epigenetic Modifiers in Repair of DNA Damage Associated with Chronic Inflammatory Diseases

Publication date: Available online 28 September 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Ning Ding, Ashley R. Maiuri, Heather M. O'Hagan
At sites of chronic inflammation epithelial cells are exposed to high levels of reactive oxygen species (ROS), which can contribute to the initiation and development of many different human cancers. Aberrant epigenetic alterations that cause transcriptional silencing of tumor suppressor genes are also implicated in many diseases associated with inflammation, including cancer. However, it is not clear how altered epigenetic gene silencing is initiated during chronic inflammation. The high level of ROS at sites of inflammation is known to induce oxidative DNA damage in surrounding epithelial cells. Furthermore, DNA damage is known to trigger several responses, including recruitment of DNA repair proteins, transcriptional repression, chromatin modifications and other cell signaling events. Recruitment of epigenetic modifiers to chromatin in response to DNA damage results in transient covalent modifications to chromatin such as histone ubiquitination, acetylation and methylation and DNA methylation. DNA damage also alters non-coding RNA expression. All of these alterations have the potential to alter gene expression at sites of damage. Typically, these modifications and gene transcription are restored back to normal once the repair of the DNA damage is completed. However, chronic inflammation may induce sustained DNA damage and DNA damage responses that result in these transient covalent chromatin modifications becoming mitotically stable epigenetic alterations. Understanding how epigenetic alterations are initiated during chronic inflammation will allow us to develop pharmaceutical strategies to prevent or treat chronic inflammation-induced cancer. This review will focus on types of DNA damage and epigenetic alterations associated with chronic inflammatory diseases, the types of DNA damage and transient covalent chromatin modifications induced by inflammation and oxidative DNA damage and how these modifications may result in epigenetic alterations.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2yeW3Bh
via IFTTT

Efficient genetic manipulation in the developing brain of tree shrew using in utero electroporation and virus infection

Publication date: Available online 28 September 2017
Source:Journal of Genetics and Genomics
Author(s): Dan Xu, Yuangang Zhu, Zhiheng Xu




from Genetics via xlomafota13 on Inoreader http://ift.tt/2fDI9kg
via IFTTT

Issue Information

from Physiology via xlomafota13 on Inoreader http://ift.tt/2k7TFpK
via IFTTT

Temporal trends in 137Cs concentrations in the bark, sapwood, heartwood, and whole wood of four tree species in Japanese forests from 2011 to 2016

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Shinta Ohashi, Katsushi Kuroda, Tsutomu Takano, Youki Suzuki, Takeshi Fujiwara, Hisashi Abe, Akira Kagawa, Masaki Sugiyama, Yoshitaka Kubojima, Chunhua Zhang, Koichi Yamamoto
To understand the changes in radiocesium (¹³⁷Cs) concentrations in stem woods after the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident, we investigated ¹³⁷Cs concentrations in the bark, sapwood, heartwood, and whole wood of four major tree species at multiple sites with different levels of radiocesium deposition from the FDNPP accident since 2011 (since 2012 at some sites): Japanese cedar at four sites, hinoki cypress and Japanese konara oak at two sites, and Japanese red pine at one site. Our previous report on ¹³⁷Cs concentrations in bark and whole wood samples collected from 2011 to 2015 suggested that temporal variations were different among sites even within the same species. In the present study, we provided data on bark and whole wood samples in 2016 and separately measured ¹³⁷Cs concentrations in sapwood and heartwood samples from 2011 to 2016; we further discussed temporal trends in ¹³⁷Cs concentrations in each part of tree stems, particularly those in ¹³⁷Cs distributions between sapwood and heartwood, in relation to their species and site dependencies. Temporal trends in bark and whole wood samples collected from 2011 to 2016 were consistent with those reported in samples collected from 2011 to 2015. Temporal variations in ¹³⁷Cs concentrations in barks showed either a decreasing trend or no clear trend, implying that ¹³⁷Cs deposition in barks is inhomogeneous and that decontamination is relatively slow in some cases. Temporal trends in ¹³⁷Cs concentrations in sapwood, heartwood, and whole wood were different among species and also among sites within the same species. Relatively common trends within the same species, which were increasing, were observed in cedar heartwood, and in oak sapwood and whole wood. On the other hand, the ratio of ¹³⁷Cs concentration in heartwood to that in sapwood (fresh weight basis) was commonly increased to more than 2 in cedar, although distinct temporal trends were not found in the other species, for which the ratio was around 1 in cypress and pine and below 0.5 in oak, suggesting that ¹³⁷Cs transfer from sapwood to heartwood shows species dependency. Consequently, the species dependency of ¹³⁷Cs transfer within the tree appears easily, while that from the environment to the trees can be masked by various factors. Thus, prediction of ¹³⁷Cs concentrations in stem wood should be carried out carefully as it still requires investigations at multiple sites with a larger sample size and an understanding of the species-specific ¹³⁷Cs transfer mechanism.



from Radiology via xlomafota13 on Inoreader http://ift.tt/2xQE57b
via IFTTT

7Be, 210Pb and 40K depositions over 11 years in Málaga

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): C. Dueñas, E. Gordo, E. Liger, M. Cabello, S. Cañete, M. Pérez, P. de la Torre-Luque
The monthly bulk depositional fluxes of three natural radionuclides (⁷Be, ²¹⁰Pb and ⁴⁰K) were measured at a Mediterranean coastal station (Málaga) over an 11-year period from 2005 to 2015. The mean annual depositional fluxes of ⁷Be, ²¹⁰Pb and ⁴⁰K were 1215, 144 and 67 Bq m⁻² year⁻¹ respectively, showing a clear seasonal trend with minimum values recorded during summer and maximum values in winter. The rainfall regime with dry summers allows estimating the dry deposition. Assuming constant dry deposition through each year, ⁷Be, ²¹⁰Pb and ⁴⁰K would account for 12.5, 26.5 and 33% of the bulk fallout respectively which indicates that deposition for ²¹⁰Pb and ⁴⁰K are significantly higher than ⁷Be. The precipitation-normalized enrichment factor alpha used to explain seasonal variations in the depositional fluxes of radionuclides with respect the rainfall, indicates higher depositional fluxes during spring and summer than expected from the amount of rainfall. Despite their different origin, ²¹⁰Pb and ⁷Be monthly depositional fluxes have strong correlation. The atmospheric deposition fluxes of ⁷Be, ²¹⁰Pb and ⁴⁰K were controlled mainly by the amount of rainfall (r = 0.89, 0.91 and 0.66 respectively). Moreover, principal component analysis was applied to the datasets and deposition of radionuclides and rainfall in the same component highlighting the importance of the washout mechanism. The mean depositional velocity of aerosols evaluated using ⁷Be and ²¹⁰Pb are similar and are compared to other published values.



from Radiology via xlomafota13 on Inoreader http://ift.tt/2fVnRzR
via IFTTT

Phenotype comparison confirms ZMYND11 as a critical gene for 10p15.3 microdeletion syndrome

Abstract

Proper epigenetic regulation processes are crucial in the normal development of the human brain. An ever-increasing group of neurodevelopmental disorders due to derangements of epigenetic regulation involve both microdeletion and monogenic syndromes. Some of these syndromes have overlapping clinical phenotypes due to haploinsufficiency-sensitive genes involved in microdeletions. It was shown recently that the ZMYND11 gene has important functions in epigenetic regulation as an unconventional transcription co-repressor of highly expressed genes, possibly acting in the repression of cryptic transcription from gene bodies. The aim of our study was to compare the clinical phenotypes of patients with 10p15.3 deletions with the phenotypes of patients with loss-of-function ZMYND11 mutations. The results of our study further confirm that the ZMYND11 gene is the critical gene for the clinical phenotype of 10p15.3 microdeletion involving the terminal ~4 Mb of chromosome 10p. In addition, accumulating clinical data allow for further characterisation of this syndrome, including neurodevelopmental disorder, characteristic dysmorphic features and some other more frequent symptoms, such as behavioural disturbances, hypotonia, seizures, low birth weight, short stature in those older than 10 years of age, genitourinary malformations and recurrent infections.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2xSqYmr
via IFTTT

Evidence Supporting Serology Based Pathway for Diagnosing Coeliac Disease In Asymptomatic Children From High-Risk Groups.

Objective: The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing coeliac disease (CD) in children were modified in 2012. They recommend that in symptomatic children with anti-tissue transglutaminase antibody (anti-tTG) titre of greater than 10-times upper limit of normal (>10xULN) and who have positive anti-endomysial antibody and HLA-DQ2/DQ8 haplotype, the diagnosis of CD can be based on serology. Aim of this study is to establish whether serology-based pathway of the ESPGHAN guidelines could also be reliably applied to asymptomatic children from high-risk groups. Methods: From March 2007 - February 2017 prospective data on anti-tTG titre, age, sex and reason for screening was collected at diagnostic endoscopy on all asymptomatic children being diagnosed with CD. The relationship between modified Marsh-Oberhuber classification histological grading and contemporaneous anti-tTG titres was analysed. Results: 157 asymptomatic children were diagnosed with CD. 84/157 (53.5%) had antitTG >10xULN (normal 200IU/ml and total villous atrophy was present in 29/53 (55%). Main reasons for serological screening were: type-1 diabetes mellitus (n = 36) and first-degree relatives with CD (n = 24). Mean age at diagnosis was 8.8 years. Serology-based diagnosis is cost-beneficial by around [pounds]1275/child in the United Kingdom. Conclusion: All 75 asymptomatic children from high-risk groups with anti-tTG >10xULN had histology proven CD. This study provides further evidence that the guidelines for diagnosing CD by the serology-based pathway should be extended to these children. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2k77e8U
via IFTTT

Proton Pump Inhibitors May Not be the First Line of Treatment for GERD in Infants.

No abstract available

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xQzTUZ
via IFTTT

Health-Related Quality of Life in Adolescent Patients with Hepatitis C Genotype 1 Treated with Sofosbuvir and Ledipasvir.

Objective: To assess the impact of treatment with ledipasvir/sofosbuvir (LDV/SOF) on the health-related quality of life (HRQL) of pediatric patients with chronic hepatitis C virus (HCV) infection. Methods: Adolescents (12-17 years) with HCV were treated with LDV/SOF (90 mg/400 mg daily) for 12 weeks. HRQL was assessed using the PedsQLv4.0-SF15 completed by the children and caregivers before, during, and after treatment. Results: We included 100 adolescents with HCV genotype 1 infection [14.7 +/- 2.0 years, 1% known cirrhosis, 80% treatment-naive, 97% sustained virologic response (SVR-12)]. At baseline, HRQL the caregiver- perceived HRQL scores were lower than adolescents' self-reported scores (by 6.7-7.9 points, all p

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2k8PHgB
via IFTTT

Hypertension and cataract surgery under loco-regional anaesthesia: not to be ignored?

The presence of sight-impairing opacification, cataract, is an age-related condition. Modern phacoemulsification procedures allow cataract removal safely and efficiently under loco-regional anaesthesia.¹ Increasing numbers of patients with comorbid conditions, including dementia, diabetes mellitus, cardiovascular disease on concurrent antithrombotics and hypertension, present for cataract surgery. The British Journal of Anaesthesia has recently addressed anaesthesia-related issues for ophthalmic surgery in patients with dementia,² diabetes mellitus³ and anticoagulation.⁴ This editorial addresses issues related specifically to hypertension. Hypertension impacts 1 billion adults across the globe affecting up to 80% of patients in the general population aged 60 yr and older.⁵⁶ Like the sensation of a fishbone stuck in the throat, the impact of hypertension on perioperative outcome after cataract surgery should not be ignored without meticulous interrogation.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x1lv8b
via IFTTT

Peripheral i.v. analysis (PIVA) of venous waveforms for volume assessment in patients undergoing haemodialysis

Abstract

Background

The assessment of intravascular volume status remains a challenge for clinicians. Peripheral i.v. analysis (PIVA) is a method for analysing the peripheral venous waveform that has been used to monitor volume status. We present a proof-of-concept study for evaluating the efficacy of PIVA in detecting changes in fluid volume.

Methods

We enrolled 37 hospitalized patients undergoing haemodialysis (HD) as a controlled model for intravascular volume loss. Respiratory rate (F₀) and pulse rate (F₁) frequencies were measured. PIVA signal was obtained by fast Fourier analysis of the venous waveform followed by weighing the magnitude of the amplitude of the pulse rate frequency. PIVA was compared with peripheral venous pressure and standard monitoring of vital signs.

Results

Regression analysis showed a linear correlation between volume loss and change in the PIVA signal (R²=0.77). Receiver operator curves demonstrated that the PIVA signal showed an area under the curve of 0.89 for detection of 20 ml kg⁻¹ change in volume. There was no correlation between volume loss and peripheral venous pressure, blood pressure or pulse rate. PIVA-derived pulse rate and respiratory rate were consistent with similar numbers derived from the bio-impedance and electrical signals from the electrocardiogram.

Conclusions

PIVA is a minimally invasive, novel modality for detecting changes in fluid volume status, respiratory rate and pulse rate in spontaneously breathing patients with peripheral i.v. cannulas.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yc6LZk
via IFTTT

Lost in translation? Comparing the effectiveness of electronic-based and paper-based cognitive aids

It is now established that the use of cognitive aids, such as checklists and algorithms leads to improved technical¹ and team performance² during anaesthetic emergencies. The unpredictable nature of emergencies means that it is difficult to examine these outside of a simulation setting. Consequently, it is challenging to prove these observed behaviours translate to improved patient outcomes, although many anecdotal reports exist.³⁴ Research is now focused on the nature of these cognitive aids and how they can be integrated into the clinical setting, working with, rather than against the instincts of experienced practitioners.⁵

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x15Mpv
via IFTTT

SmartPilot ® view-guided anaesthesia improves postoperative outcomes in hip fracture surgery: a randomized blinded controlled study

Abstract

Background

Both under-dosage and over-dosage of general anaesthetics can harm frail patients. We hypothesised that computer-assisted anaesthesia using pharmacokinetic/pharmacodynamic models guided by SmartPilot^® View (SPV) software could optimise depth of anaesthesia and improve outcomes in patients undergoing hip fracture surgery.

Methods

This prospective, randomized, single-centre, blinded trial included patients undergoing hip fracture surgery under general anaesthesia. In the intervention group, anaesthesia was guided using SPV with predefined targets. In the control group, anaesthesia was delivered by usual practice using the same agents (propofol, sufentanil and desflurane). The primary endpoint was the time spent in the "appropriate anaesthesia zone" defined as bispectral index (BIS) (blinded to the anaesthetist during surgery) of 45–60 and systolic arterial pressure of 80–140 mm Hg. Postoperative complications were recorded for one month in a blinded manner.

Results

Of 100 subjects randomised, 97 were analysed (n=47 in SPV and 50 in control group). Anaesthetic drug consumption was reduced in the SPV group (for propofol and desflurane). Intraoperative duration of low BIS (<45) was similar, but cumulative time of low systolic arterial pressure (<80 mm Hg) was significantly shorter in the SPV group (median (Q1-Q3); 3 (0–40) vs 5 (0–116) min, P=0.013). SPV subjects experienced fewer moderate or major postoperative complications at 30-days (8 (17)% vs 18 (36)%, P=0.035) and shorter length of hospitalisation (8 (2–20) vs 8 (2–60) days, P=0.017).

Conclusions

SmartPilot^® View-guided anaesthesia reduces intraoperative hypotension duration, occurrence of postoperative complications and length of stay in hip fracture surgery patients.

Clinical trial registration.

NCT 02556658.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x1kP2w
via IFTTT

Does variable training lead to variable care?

Entrants to anaesthesia training programs in the developed world are broadly comparable in terms of readiness for specialist training as a result of global standards established by the World Federation for Medical Education. While the context of national health systems has undeniable significance, the competencies required to provide anaesthesia for patients undergoing surgery should also be broadly comparable. In this issue of the British Journal of Anaesthesia, Jonker and colleagues¹ report wide variability in anaesthesia training programmes across the European Union (EU), and variable certification processes. Could this potentially result in variable quality in patient care? Jonker and colleagues propose that variability of training and certification limits the easy movement of anaesthetists around the EU. National health systems around the world remain dependent on a mobile workforce, often trained in other jurisdictions. Determining if a foreign graduate is competent is a key concern for employers.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yc6tlc
via IFTTT

Point-of-care paediatric gastric sonography: can antral cut-off values be used to diagnose an empty stomach?

Abstract

Background

Gastric sonography is emerging as a valuable clinical point-of-care tool to assess aspiration risk. A recent study proposed that a single cut-off cross-sectional area (CSA) in the supine position could diagnose an empty stomach in the parturient. This study establishes the sensitivity and specificity of a single CSA cut-off measurement in both supine and right lateral decubitus (RLD) positions in the diagnosis of an empty antrum in paediatric patients.

Methods

Following induction of anaesthesia, antral sonography was performed in supine and RLD positions in 100 fasted paediatric patients prior to upper endoscopic evaluation. Following upper endoscopy, any residual stomach content was suctioned under direct visualization and antral sonography was immediately performed. Antral CSA values were compared using Wilcoxon signed rank test. Receiver operator characteristic (ROC) curves were plotted to estimate the discriminating power of antral sonography position in the diagnosis of an empty antrum.

Results

Significant differences were found between pre-suctioned and post-suctioned CSA values in the RLD position. The cut-off CSAs of the empty antrum in the supine and RLD positions were 2.19 cm² (sensitivity 75%, specificity 36%) and 3.07 cm² (sensitivity 76%, specificity 67%), respectively.

Conclusions

The RLD position produces the most sensitive and specific CSA cut-off value where an antral CSA of ≤ 3.07 cm² in the RLD position presents with acceptable performance in the ability to discriminate an empty antrum in paediatric patients over 1 yr of age. As age increases, the sensitivity and specificity of this test increases in the RLD position.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2ybJ6Ie
via IFTTT

Use of a hand-held digital cognitive aid in simulated crises: the MAX randomized controlled trial

Abstract

Background

Cognitive aids improve the technical performance of individuals and teams dealing with high-stakes crises. Hand-held electronic cognitive aids have rarely been investigated. A randomized controlled trial was conducted to investigate the effects of a smartphone application, named MAX (for Medical Assistance eXpert), on the technical and non-technical performance of anaesthesia residents dealing with simulated crises.

Methods

This single-centre randomized, controlled, unblinded trial was conducted in the simulation centre at Lyon, France. Participants were anaesthesia residents with >1 yr of clinical experience. Each participant had to deal with two different simulated crises with and without the help of a digital cognitive aid. The primary outcome was technical performance, evaluated as adherence to guidelines. Two independent observers remotely assessed performance on video recordings.

Results

Fifty-two residents were included between July 2015 and February 2016. Six participants were excluded for technical issues; 46 participants were confronted with a total of 92 high-fidelity simulation scenarios (46 with MAX and 46 without). Mean (sd) age was 27 (1.8) yr and clinical experience 3.2 (1.0) yr. Inter-rater agreement was 0.89 (95% confidence interval 0.85–0.92). Mean technical scores were higher when residents used MAX [82 (11.9) vs 59 (10.8)%; P<0.001].

Conclusion

The use of a hand-held cognitive aid was associated with better technical performance of residents dealing with simulated crises. These findings could help digital cognitive aids to find their way into daily medical practice and improve the quality of health care when dealing with high-stakes crises.

Clinical trial registration

NCT02678819.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x1huRc
via IFTTT

Volumes of the spinal canal and caudal space in children zero to three years of age assessed by magnetic resonance imaging: implications for volume dosage of caudal blockade

Abstract

Background

The primary aim of this study was to objectively assess the different spinal and caudal volumes that are of interest for caudal block volume dosing.

Methods

Three directly assessed (volume of spinal canal/caudal space, volume of the dural sac and volume of spinal cord) and two derived volumes (volume of the epidural space and cerebrospinal fluid volume) were determined from magnetic resonance images (MRI) in 20 children (zero - three yr of age). The assessed volumes were correlated to age, height and weight. Furthermore, the volumes of the epidural space from caudal canal to three different clinically relevant target levels (L 1, Th 10 and Th 6) and the epidural volume of each individual spinal segment at the caudal, lumbar and thoracic levels were calculated.

Results

All volumes correlated in a linear manner to length and weight (R² 0.614 – 0.867) whereas a curvilinear correlation was associated with best curve fit for age (R² 0.696 – 0.883). The median volumes of the epidural space from caudal canal to L 1, Th 10 and Th 6 were 1.30 ml kg⁻¹ (95%CI 1.08-1.51), 1.57 ml kg⁻¹ (95%CI 1.29-1.81) and 1.78 ml kg⁻¹ (95%CI 1.52-2.08), respectively. The median volumes of the epidural space per vertebral segment were Thoracic: 0.60 ml (95%CI 0.38-0.75); Lumbar: 1.18 ml (95%CI 0.94-1.43) and Caudal: 0.85 ml (95%CI 0.56-1.18).

Conclusions

The spinal volumes of interest show a linear correlation to height and weight whereas a curvilinear correlation was found for age. The volume of the epidural space per segment was found to be significantly higher at the lumbar level compared with the caudal and thoracic levels.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yc69D0
via IFTTT

Heterogeneity of studies in anesthesiology systematic reviews: a meta-epidemiological review and proposal for evidence mapping

Abstract

Heterogeneity among the primary studies included in a systematic review (SR) is one of the most challenging considerations for systematic reviewers. Current practices in anaesthesiology SRs have not been evaluated, but traditional methods may not provide sufficient information to evaluate the true nature of these differences. We address these issues by examining the practices for evaluating heterogeneity in anesthesiology reviews. Also, we propose a mapping method for presenting heterogeneous aspects of the primary studies in SRs.We evaluated heterogeneity practices reported in SRs published in highly ranked anesthesiology journals and Cochrane reviews. Elements extracted from the SRs included heterogeneity tests, models used, analyses conducted, plots used, and I² values. Additionally, we selected a SR to develop an evidence map in order to display clinical heterogeneity.Our statistical analysis showed 150/207 SRs reporting a test for statistical heterogeneity. Plots were used in 138 reviews to display heterogeneity. Subgroup analyses were the most commonly reported analysis (54%). Meta-regression and sensitivity analyses were used sparingly (25%; 23% respectively). A random effects model was most commonly reported (33%). Heterogeneity statistics across meta-analyses suggested that, in our sample, the majority (55%) did not present sufficient heterogeneity to be of great concern. Cochrane reviews (n=58) were also analysed. Plots were used in 88% of Cochrane reviews. Subgroup analysis was used in 59% Cochrane reviews, while sensitivity analysis was used in 62%.Many reviews did not provide sufficient detail regarding heterogeneity. We are calling for improvement to reporting practices.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2x15HCd
via IFTTT

Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind, randomized, active-controlled trial

Abstract

Background

. Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia.

Methods

. Sixty-four patients, undergoing remifentanil infusion during general anaesthesia and major lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25 μg h⁻¹ for 24 h) or morphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and three months postoperatively.

Results

. A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9 min (P=0.002). At 30 min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine (P=0.009). At three months, no differences between groups were noted.

Conclusions

. Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wnb8Md
via IFTTT

Review: Brown’s Atlas of Regional Anesthesia . E Farag and L Mounir-Soliman (editors) & Brown’s Regional Anesthesia Review . E Farag and L Mounir-Soliman (editors)

Review: Brown's Atlas of Regional Anesthesia.FaragE and Mounir-SolimanL (editors), 5^th edn, 2017. Published by Elsevier. Pp. 376. Price $199.99. ISBN-13: 978-0323354905.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k7MEoR
via IFTTT

Is the bougie redundant in direct laryngoscopic grade 3 intubations?

A 51-year-old woman presented for major elective colorectal surgery with predicted difficult intubation (Mallampati score 3, small mouth opening) and a video laryngoscope was prepared as a 'plan B'. After induction, the patient's lungs were easily ventilated with a bag valve mask. Direct laryngoscopy was performed that demonstrated a grade 3 view. An experienced operator intubated successfully using a bougie, which was carefully advanced in one attempt blindly behind the epiglottis into the trachea.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wn1yt3
via IFTTT

In the October BJA …

This issue of the BJA contains a special section on pain medicine that includes articles on acute and chronic pain in the context of anaesthesia. The main section of the Journal includes a number of articles relevant to perioperative outcomes in sepsis and septic shock, and in cardiac, abdominal, and lung resection surgery. There are also articles on the impact of non-depolarising neuromuscular blocking agents, beta-blockers, and statins on perioperative outcomes. The Neurosciences and Neuroanaesthesia section features three articles and three editorials related to anaesthetic effects on neuronal network connectivity as it relates to unconsciousness. And the Quality and Patient Safety section features an article with an editorial on the impact of anaesthetist gender on communication in simulated crisis situations.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k7XHhF
via IFTTT

The paradox in the current use of videolaryngoscopes in the UK

Editor—The recent national survey by Cook and Kelly¹ is the first to provide a comprehensive overview of the current usage and practices of videolaryngoscopes (VLs) in UK clinical practice. We feel we can add to this area and would like to present some of the results of a regional survey on VLs that we conducted to gain an understanding of current practices and decision-making in the use of VLs in general airway management in the operating theatre (OT). The survey was conducted electronically via SurveyMonkey (San Mateo, CA, USA) and was distributed to 10 departments of anaesthesia in the London Deanery (London, UK) in December 2016. There were 171 responses collected between December 2016 and January 2017 with a response rate of about 51%, including 44% consultants, 21% specialty Registrar (StR) yr 7–yr 5, 14% StR yr 4–yr 3, and 7% core trainees. Selected findings from the survey were as follows:

• When asked whether VLs should be first line management strategy for anticipated difficult intubation (where bag mask ventilation was not predicted difficult), when given the choice between a VL and a Macintosh laryngoscope short/long blade +/–bougie, 51% of those surveyed preferred to use a VL.
• When asked whether VLs should be used routinely for intubation in all patients, regardless of predicted difficulty of intubation, 14% of respondents thought that VLs should be used routinely.
• When asked how many uses it approximately required to gain subjective competence in the use of any VL, 68% of respondents felt it required over 10 uses, 32% felt it required over 20 uses and 13% felt it required over 30 uses.
• When asked whether anaesthetists should begin their core training with VLs alongside the Macintosh laryngoscope as first line for all intubations, 10% of respondents were of the opinion that this should be the case.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wo9pGB
via IFTTT

Diastolic dysfunction and sepsis: the devil is in the detail

Diastolic dysfunction is the consequence of impaired left ventricular relaxation, decreased recoil and decreased ventricular compliance.¹ Before the era of tissue Doppler imaging (TDI), pulmonary vein Doppler imaging in conjunction with transmitral Doppler, was a major tool in identifying diastolic dysfunction, also in septic shock patients.² Pulmonary vein Doppler assessment with a systolic (S) < diastolic (D) flow velocity supports the finding of elevated left ventricular filling pressures in a euvolaemic patient.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wmGbI7
via IFTTT

Preadmission statin use improves the outcome of less severe sepsis patients - a population-based propensity score matched cohort study

Abstract

Background

Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied.

Methods

We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications.

Results

We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78–0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78–0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission.

Conclusions

In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k8k3zN
via IFTTT

Readmission after surgery: are neuromuscular blocking drugs a cause?

Neuromuscular blocking drugs (NMBDs) play an integral role in balanced anaesthesia. They improve intubating conditions, reduce iatrogenic damage to the upper airway and decrease postoperative hoarseness.¹ They also improve surgical operating conditions.² But use of NMBDs always carries the risk of residual neuromuscular block postoperatively. About 30% of all patients who receive NMBDs intraoperatively show signs of residual neuromuscular block when arriving in the post-anaesthesia care unit.^3–5 It has been suggested that residual neuromuscular block can cause postoperative pulmonary complications.^6–8

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wnldJi
via IFTTT

Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis

Abstract

Background

Myocardial dysfunction may contribute to circulatory failure in sepsis. There is growing evidence of an association between left ventricular diastolic dysfunction (LVDD) and mortality in septic patients. Utilizing echocardiography, we know that tissue Doppler imaging (TDI) variables e′ and E/e′ are reliable predictors of LVDD and are useful measurements to estimate left ventricular (LV) filling pressures.

Methods

We conducted a systematic review and meta-analysis to investigate the association of e′ and E/e′ with mortality of patients with severe sepsis or septic shock. In the primary analysis, we included studies providing transthoracic TDI data for e′ and E/e′ and their association with mortality. Subgroup analyses were conducted according to myocardial regional focus of TDI assessment (septal, lateral or averaged). Three secondary analyses were performed: one included data from a transoesophageal study, another excluded studies reporting data at a very early (<6 h) or late (>48 h) stage following diagnosis, and the third pooled data only from studies excluding patients with heart valve disease.

Results

The primary analysis included 16 studies with 1507 patients with severe sepsis and/or septic shock. A significant association was found between mortality and both lower e′ [standard mean difference (SMD) 0.33; 95% confidence interval (CI): 0.05, 0.62; P=0.02] and higher E/e′ (SMD –0.33; 95% CI: –0.57, –0.10; P=0.006). In the subgroup analyses, only the lateral TDI values showed significant association with mortality (lower e′ SMD 0.45; 95% CI: 0.11, 0.78; P=0.009; higher E/e′ SMD –0.49; 95% CI: –0.76, –0.22; P=0.0003). The findings of the primary analysis were confirmed by all secondary analyses.

Conclusions

There is a strong association between both lower e′ and higher E/e′ and mortality in septic patients.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k84b06
via IFTTT

Age and inflammation after cardiac surgery

The cardiac surgical population is aging and these patients have increased expectations with respect to quantity and quality of postoperative survival. Some of the physiological changes related to aging that impact surgical outcomes are better understood than others, and recently we are also beginning to gain a better understanding of the impact of aging on immunity and the immune response to surgery.¹²

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wnQ5JO
via IFTTT

An algorithm for suboptimally placed supraglottic airway devices: the choice of videolaryngoscope

Editor—We agree with Zundert and colleagues¹ that anaesthetists sometimes accept lower standards for supraglottic airway device (SAD) placement than for tracheal tube placement. They advocate the use of videolaryngoscopy to correct a suboptimal SAD position using an algorithm, however they do not make any specific recommendation about which type of videolaryngoscope to use. A variety of classifications of videolaryngoscopes exist,^2–5 and some classes (for example, channelled videolaryngoscopes) might prove to be very difficult to use in this situation; some may even cause trauma in the reduced space available when an SAD is present. Zundert and colleagues ⁶ have previously referenced the C-MAC videolaryngoscope (Karl Storz, Tuttlingen, Germany) in this situation, but presumably other Macintosh-type bladed scopes would be acceptable. We would be keen to learn whether they have experience of other videolaryngoscopes, and we also wondered whether they had considered the place of the optical stylet.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k846cO
via IFTTT

Hierarchy in disruption of large-scale networks across altered arousal states

Understanding how anaesthetics act within neural circuits to induce altered arousal states that range from sedation to general anaesthesia is an important question in neuroscience. Studies in laboratory animals demonstrate that anaesthetics including propofol, ether derivatives, and dexmedetomidine induce activity patterns in brainstem arousal nuclei that are similar to natural sleep.^1–3 However, anaesthetic drug action in brainstem arousal nuclei may provide only a partial answer to explain the behavioural and neurophysiological distinctions between anaesthesia-induced states and sleep, because anaesthetics also significantly modulate neuronal activity in other brain regions such as the thalamus and cortex.⁴⁵ Insights into how anaesthetics disrupt networks that sustain consciousness have been constrained by the practical and ethical challenges involved in noninvasively studying human brain activity. Guldenmund and colleagues⁶ used human neuroimaging to study large-scale network disruptions that are associated with dexmedetomidine and propofol sedation, two anaesthetic drugs with different receptor level targets.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k7Mxtr
via IFTTT

Humour therapy intervention to reduce stress and anxiety in paediatric anaesthetic induction, a pilot study

Editor—Hospitalization is a particularly negative experience for the paediatric population. Infants experiencing surgery can develop problematic behaviour, such as preoperative anxiety (50–75%)¹ and postoperative negative behavioural changes (75%), sleep and eating disorders, cognitive alterations, enuresis and disobedience. These complications can persist for several months after the surgical procedure.² In addition, it is well known that stress slows the healing process, decreases inflammatory responses, and likewise increases fear and anxiety. From a pathophysiological point of view, the increase in levels of circulating cortisol, secondary to an increase in the production of corticotropin releasing hormone and the action of the autonomic nervous system, can create harmful effects in different organs and tissues.³ Salivary cortisol has been used in several studies to measure levels of stress in children, as an index of the amount in blood, but which is a noninvasive procedure ideal for use in the paediatric population.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wmG7In
via IFTTT

Fading whispers down the lane: signal propagation in anaesthetized cortical networks

An active area of enquiry in the neuroscientific investigation of general anaesthesia is the question of whether anaesthetic-induced unconsciousness is mediated by bottom-up or top-down mechanisms in the brain. Candidates for the bottom-up approach include suppression of arousal centres in the brainstem and diencephalon,¹² activation of sleep-promoting neurones or nuclei in similar locations,¹³ blockade of sensory information en route from the thalamus to the cortex,⁴ and a disabled thalamic conductor for the neuronal orchestra of the cortex.⁵ Candidates for the top-down approach include direct effects on long-latency activity in cortical networks,⁶ with a consequent disruption of higher-order information synthesis that occurs beyond the level of the primary sensory cortex.^7–9 This bottom-up vs top-down distinction is almost surely artificial given the integrated circuits required for the normal function of neural systems and the widespread effects of general anaesthetics on the brain. We recently proposed that anaesthetics alter the level of consciousness (e.g. awake vs somnolent) through bottom-up mechanisms while degrading the contents of consciousness (e.g. the particular qualities of experience) through top-down mechanisms.¹⁰ Developing a clearer understanding of these processes is important because it can inform (i) the neurobiology of consciousness, a fundamental question in science, and (ii) our approach to brain monitoring, a fundamental and unmet challenge in clinical anaesthesia. However, it is difficult to address this question by investigating individual brain areas or molecular targets in the laboratory and also difficult to distinguish cortical and subcortical mechanisms through human neuroimaging and neurophysiology. In this issue of the British Journal of Anaesthesia, Hentschke and colleagues¹¹ examine an intermediate level of neuroanatomy and neurophysiology in a cortical slice model, finding more profound effects of isoflurane on signal propagation through the cortex than to the cortex.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wo3G3I
via IFTTT

Disruption of cortical network activity by the general anaesthetic isoflurane

Abstract

Background

Actions of general anaesthetics on activity in the cortico-thalamic network likely contribute to loss of consciousness and disconnection from the environment. Previously, we showed that the general anaesthetic isoflurane preferentially suppresses cortically evoked synaptic responses compared with thalamically evoked synaptic responses, but how this differential sensitivity translates into changes in network activity is unclear.

Methods

We investigated isoflurane disruption of spontaneous and stimulus-induced cortical network activity using multichannel recordings in murine auditory thalamo-cortical brain slices.

Results

Under control conditions, afferent stimulation elicited short latency, presumably monosynaptically driven, spiking responses, as well as long latency network bursts that propagated horizontally through the cortex. Isoflurane (0.05–0.6 mM) suppressed spiking activity overall, but had a far greater effect on network bursts than on early spiking responses. At isoflurane concentrations >0.3 mM, network bursts were almost entirely blocked, even with increased stimulation intensity and in response to paired (thalamo-cortical + cortical layer 1) stimulation, while early spiking responses were <50% blocked. Isoflurane increased the threshold for eliciting bursts, decreased their propagation speed and prevented layer 1 afferents from facilitating burst induction by thalamo-cortical afferents.

Conclusions

Disruption of horizontal activity spread and of layer 1 facilitation of thalamo-cortical responses likely contribute to the mechanism by which suppression of cortical feedback connections disrupts sensory awareness under anaesthesia.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wmIsmJ
via IFTTT

Speaking up: does anaesthetist gender influence teamwork and collaboration?

Speaking up can be defined as explicitly communicating observations or concerns, requesting clarification or explanation, or explicitly challenging a colleague's decision or action.¹ Speaking up provides an opportunity to intervene before patient harm occurs, or to mitigate actual harm, and is a key element in effective teamwork and collaboration.² The importance of speaking up is most evident in its absence, where colleagues remain silent or make ineffectual attempts at speaking up, and erroneous actions proceed to cause patient harm. There are many prominent examples where failing to speak up in an effective manner has contributed to accidents and catastrophes in aviation,³ space exploration⁴ and in healthcare.⁵

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k83VhE
via IFTTT

Prediction of persistent post-surgery pain by preoperative cold pain sensitivity: biomarker development with machine-learning-derived analysis

Abstract

Background

To prevent persistent post-surgery pain, early identification of patients at high risk is a clinical need. Supervised machine-learning techniques were used to test how accurately the patients' performance in a preoperatively performed tonic cold pain test could predict persistent post-surgery pain.

Methods

We analysed 763 patients from a cohort of 900 women who were treated for breast cancer, of whom 61 patients had developed signs of persistent pain during three yr of follow-up. Preoperatively, all patients underwent a cold pain test (immersion of the hand into a water bath at 2–4 °C). The patients rated the pain intensity using a numerical ratings scale (NRS) from 0 to 10. Supervised machine-learning techniques were used to construct a classifier that could predict patients at risk of persistent pain.

Results

Whether or not a patient rated the pain intensity at NRS=10 within less than 45 s during the cold water immersion test provided a negative predictive value of 94.4% to assign a patient to the "persistent pain" group. If NRS=10 was never reached during the cold test, the predictive value for not developing persistent pain was almost 97%. However, a low negative predictive value of 10% implied a high false positive rate.

Conclusions

Results provide a robust exclusion of persistent pain in women with an accuracy of 94.4%. Moreover, results provide further support for the hypothesis that the endogenous pain inhibitory system may play an important role in the process of pain becoming persistent.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2k7Mi1v
via IFTTT

Special section on pain: progress in pain assessment and management

This issue of the British Journal of Anaesthesia has a special section on pain, featuring a number of editorials, reviews and original articles across a range of areas in pain medicine. The last BJA special issue on pain medicine was in July 2013, entitled "Managing pain: recent advances and new challenges", as summarized in the lead editorial of that issue.¹ A similar title could be used for this month's special section. Pain medicine continues to evolve, with advances in acute, chronic and cancer pain understanding and management. However, the challenges remain, and arguably, increase, as our population ages: Pain is one of the biggest causes of disability globally, with musculoskeletal pain being the leading cause of disability in most countries in 2015.²³ Managing pain successfully - acute, chronic or cancer - is an area where there is potential major clinical benefit both at an individual and societal level.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wo78LK
via IFTTT

Response to: Emergency front-of-neck access: scalpel or cannula—and the parable of Buridan’s ass

Editor—I was interested to read the editorial by Greenland and colleagues¹ that contributes further to the debate that has raged for some time over whether a cannot intubate, cannot oxygenate (CICO) situation should be managed with a fine needle or scalpel cricothyroidotomy approach.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2wnZot7
via IFTTT

Guidelines for perioperative pain management: need for re-evaluation

Optimal perioperative pain management facilitates postoperative ambulation and rehabilitation, and is considered a prerequisite to enhancing recovery after surgery.¹² Despite well-documented benefits, postoperative pain continues to be inadequately treated.^3–5 Although the reasons for the lack of appropriate pain management are not precisely known, conflicting and confusing evidence as well as lack of clear guidance could be contributing factors.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2xFiI6D
via IFTTT

Norwegian Air Ambulance FW - Lufttransport THX For G o o d job.

After M a n n y years of safe operation, Norwegiann Gov. opted for an foreigain operator for ower Fixed-Wing ambulances... ( It`s a different storry to operate anny aicraft in Sweeden, compared to Norway... (-Cindergarden V.S Uni. ..! ) It shall be innteresting ... ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2ybIxhQ
via IFTTT

Linkage Analysis and Association Mapping QTL Detection Models for Hybrids Between Multiparental Populations from Two Heterotic Groups: Application to Biomass Production in Maize (Zea mays L.)

Identification of loci (QTL) involved in the variation of hybrid value is of key importance for cross-pollinated species such as maize (Zea mays L.). In a companion paper we illustrated a new QTL mapping population design involving a factorial mating between two multi-parental segregating populations. Six biparental line populations were developed from four founder lines in the Dent and Flint heterotic groups. They were crossed to produce 951 hybrids, evaluated for silage performances. Previously, a linkage analysis model that assumes each founder line carries a different allele was used to detect QTL involved in General and Specific Combining Abilities of hybrid value. This previously introduced model requires the estimation of numerous effects per locus, potentially affecting QTL detection power. Using the same design we compared this "Founder alleles" model to two more parsimonious models which assume that (i) identity in state at SNP alleles from the same heterotic group implies identity by descent at linked QTL ("SNP within-group" model) or (ii) identity in state implies identity by descent, regardless of population origin of the alleles ("Hybrid Genotype" model). This last model assumes biallelic QTL with equal effects in each group. It detected more QTL on average than the two other models but explained lower percentages of variance. The "SNP within-group" model appeared to be a good compromise between the two other models. These results confirm the divergence between the Dent and Flint groups. They also illustrate the need to adapt the QTL detection model to the complexity of the allelic variation, which depends on the trait, the QTL and the divergence between the heterotic groups.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2xP0OAn
via IFTTT

Heart rate variability: implications for perioperative anesthesia care.

Purpose of review: Heart rate variability (HRV) is a measure of the balance between both the parasympathetic and sympathetic nervous system and may provide useful information for anesthesia care providers. HRV may offer predictive information about critically ill and operative patients. Further, HRV collection provides real-time information of patient autonomic nervous system status and may allow tailoring of the analgesia for patients in the ICU and operating room. Recent findings: Reduced and abnormal resting HRV predict sudden and nonsudden cardiac death. Recent evidence shows that decreased HRV correlates with worsened outcomes in both trauma patients and patients with sepsis, as well as the risk of developing hypotension after induction of general anesthesia and placement of intrathecal local anesthesia. In addition, HRV appears to provide an accurate assessment of the nociception-analgesia balance in deeply sedated ICU patients and those under general anesthesia. Summary: No study has assessed the prognostic value of preoperative HRV in patients presenting for surgery. Use of HRV for patient risk stratification and intraoperative analgesia management may allow tailored perioperative care and improved outcomes. If intraoperative HRV data leads to decreased perioperative opioid use, opioid-related adverse events, a serious perioperative issue, may be decreased. Clinical Trials Registration: Not applicable Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2xK1JS7
via IFTTT