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Τρίτη 10 Ιανουαρίου 2017
Academy News – January PM&R Journal
PM&R Manuscript Reviewers
We extend our sincere gratitude to the following individuals who reviewed manuscripts for PM&R between November 2015 and October 2016. Peer-reviewers are the life-blood of scientific journals and their sacrifice of time and effort has greatly and specifically contributed to PM&R's success.
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Prognosis Disclosure in Spinal Cord Injury
The ethical issues around prognosis disclosure raise interesting questions about how, when, and why we disclose medical information. What are the barriers to disclosure and how can we learn from each other about the best ways to discuss prognosis with our patients? Gayle Spill, MD, has edited this column and invited guests to consider the complexities of this issue. As always, I welcome comments about the PM&R ethics/legal column at dmukherjee@ric.org.
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A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology
Abstract
To date, the prevailing evidence in the field of exercise oncology supports the safety and efficacy of resistance training to attenuate many oncology treatment-related adverse effects, such as risk for cardiovascular disease, increased fatigue, and diminished physical functioning and quality of life. Moreover, findings in the extant literature supporting the benefits of exercise for survivors of and patients with cancer have resulted in the release of exercise guidelines from several international agencies. However, despite research progression and international recognition, current exercise oncology-based exercise prescriptions remain relatively basic and underdeveloped, particularly in regards to resistance training. Recent publications have called for a more precise manipulation of training variables such as volume, intensity, and frequency (i.e., periodization), given the large heterogeneity of a cancer population, to truly optimize clinically relevant patient-reported outcomes. Indeed, increased attention to integrating fundamental principles of exercise physiology into the exercise prescription process could optimize the safety and efficacy of resistance training during cancer care. The purpose of this article is to give an overview of the current state of resistance training prescription and discuss novel methods that can contribute to improving approaches to exercise prescription. We hope this article may facilitate further evaluation of best practice regarding resistance training prescription, monitoring, and modification to ultimately optimize the efficacy of integrating resistance training as a supportive care intervention for survivors or and patients with cancer.
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Identification of differentially expressed genes from Trichoderma atroviride strain SS003 in the presence of cell wall of Cronartium ribicola
Abstract
The fungal genus Trichoderma has been extensively studied due to its role in the mycoparasitism, and thus developed as biocontrol agent against various plant pathogens. Although the mycoparasitic processes of several Trichoderma species have already been well understood, the information about the mycoparasitic mechanisms of Trichoderma strains resulted from different growth conditions or interacting with different phytopathogens is still limited. In this study, we utilized transcriptome sequencing to identify the differentially expressed genes (DEGs) at 0, 24, 72 and 120 h from T. atroviride strain SS003, growing on an induced-medium with cell walls of Pinus armandii pathogen Cronartium ribicola (CRCW). In total, 86,155,316 reads were obtained with 43,077,658 clean reads. Further, 10,422 genes were identified from four transcriptomes and accounted for 93.89% of annotated genes in T. atroviride IMI 206040 genome, reflecting high-quality sequencing and assembly. In each pairwise comparison, a large number of DEGs were identified with different numbers of genes for up- and down-regulation, respectively. In the presence of CRCW, expression of two main glycoside hydrolase gene families (i.e. chitinase and glucosidase) was induced. Most of 14 secreted enzymes by quantitative real time PCR (qPCR) analysis exhibited a consistent expression pattern with that by RNA-Seq data. This comparative study leads to the identification of phase-specific genes in the interactions of T. atroviride SS003 with C. ribicola, and provides potential molecular targets for improved biocontrol strategies.
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AMPK does not play a requisite role in regulation of PPARGC1A gene expression via the alternative promoter in endurance-trained human skeletal muscle
In human skeletal muscle, PGC-1α is constitutively expressed via the canonical promoter. By contrast, the expression of PGC-1α mRNA via the alternative promoter was found to be highly dependent on the intensity of exercise and to contribute largely to the post-exercise increase of total PGC-1α mRNA. This study investigated the role of AMPK in regulating PGC-1α gene expression via the alternative promoter through a cAMP responsive element-binding protein-1 (CREB1)-dependent mechanism in human skeletal muscle. AMPK activation and PGC-1α gene expression were assayed in skeletal muscle of nine endurance-trained men before and after low-intensity exercise (38% of VО2max), and with or without administration of a single dose (2 g) of the AMPK activator metformin. Low-intensity exercise markedly and significantly increased (∼100-fold, P < 0.05) the expression of PGC-1α mRNA via the alternative promoter, without increasing ACCSer79/222 (a marker of AMPK activation) and AMPKThr172 phosphorylation. Moreover, in contrast to placebo, metformin increased the level of ACCSer79/222 phosphorylation immediately after exercise (2.6-fold, P < 0.05). By contrast, post-exercise expression of PGC-1α gene via the alternative promoter was not affected. This study was unable to confirm that AMPK plays a role in regulating PGC-1α gene expression via the alternative promoter in endurance-trained human skeletal muscle.
This article is protected by copyright. All rights reserved
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The role of adenosine in the maturation of sleep homeostasis in rats
Sleep homeostasis in rats undergoes significant maturational changes during postweaning development, but the underlying mechanisms of this process are unknown. In the present study we tested the hypothesis that the maturation of sleep is related to the functional emergence of adenosine (AD) signaling in the brain. We assessed postweaning changes in 1) wake-related elevation of extracellular AD in the basal forebrain (BF) and adjacent lateral preoptic area (LPO), and 2) the responsiveness of median preoptic nucleus (MnPO) sleep-active cells to increasing homeostatic sleep drive. We tested the ability of exogenous AD to augment homeostatic responses to sleep deprivation (SD) in newly weaned rats. In groups of postnatal day (P)22 and P30 rats, we collected dialysate from the BF/LPO during baseline (BSL) wake-sleep, SD, and recovery sleep (RS). HPLC analysis of microdialysis samples revealed that SD in P30 rats results in significant increases in AD levels compared with BSL. P22 rats do not exhibit changes in AD levels in response to SD. We recorded neuronal activity in the MnPO during BSL, SD, and RS at P22/P30. MnPO neurons exhibited adult-like increases in waking neuronal discharge across SD on both P22 and P30, but discharge rates during enforced wake were higher on P30 vs. P22. Central administration of AD (1 nmol) during SD on P22 resulted in increased sleep time and EEG slow-wave activity during RS compared with saline control. Collectively, these findings support the hypothesis that functional reorganization of an adenosinergic mechanism of sleep regulation contributes to the maturation of sleep homeostasis.
NEW & NOTEWORTHY Brain mechanisms that regulate the maturation of sleep are understudied. The present study generated first evidence about a potential mechanistic role for adenosine in the maturation of sleep homeostasis. Specifically, we demonstrate that early postweaning development in rats, when homeostatic response to sleep loss become adult like, is characterized by maturational changes in wake-related production/release of adenosine in the brain. Pharmacologically increased adenosine signaling in developing brain facilitates homeostatic responses to sleep deprivation.
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Consolidation of visuomotor adaptation memory with consistent and noisy environments
Our understanding of how we learn and retain motor behaviors is still limited. For instance, there is conflicting evidence as to whether the memory of a learned visuomotor perturbation consolidates; i.e., the motor memory becomes resistant to interference from learning a competing perturbation over time. Here, we sought to determine the factors that influence consolidation during visually guided walking. Subjects learned a novel mapping relationship, created by prism lenses, between the perceived location of two targets and the motor commands necessary to direct the feet to their positions. Subjects relearned this mapping 1 wk later. Different groups experienced protocols with or without a competing mapping (and with and without washout trials), presented either on the same day as initial learning or before relearning on day 2. We tested identical protocols under constant and noisy mapping structures. In the latter, we varied, on a trial-by-trial basis, the strength of prism lenses around a non-zero mean. We found that a novel visuomotor mapping is retained at least 1 wk after initial learning. We also found reduced foot-placement error with relearning in constant and noisy mapping groups, despite learning a competing mapping beforehand, and with the exception of one protocol, with and without washout trials. Exposure to noisy mappings led to similar performance on relearning compared with the equivalent constant mapping groups for most protocols. Overall, our results support the idea of motor memory consolidation during visually guided walking and suggest that constant and noisy practices are effective for motor learning.
NEW & NOTEWORTHY The adaptation of movement is essential for many daily activities. To interact with targets, this often requires learning the mapping to produce appropriate motor commands based on visual input. Here, we show that a novel visuomotor mapping is retained 1 wk after initial learning in a visually guided walking task. Furthermore, we find that this motor memory consolidates (i.e., becomes more resistant to interference from learning a competing mapping) when learning in constant and noisy mapping environments.
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Referent control and motor equivalence of reaching from standing
Motor actions may result from central changes in the referent body configuration, defined as the body posture at which muscles begin to be activated or deactivated. The actual body configuration deviates from the referent configuration, particularly because of body inertia and environmental forces. Within these constraints, the system tends to minimize the difference between these configurations. For pointing movement, this strategy can be expressed as the tendency to minimize the difference between the referent trajectory (RT) and actual trajectory (QT) of the effector (hand). This process may underlie motor equivalent behavior that maintains the pointing trajectory regardless of the number of body segments involved. We tested the hypothesis that the minimization process is used to produce pointing in standing subjects. With eyes closed, 10 subjects reached from a standing position to a remembered target located beyond arm length. In randomly chosen trials, hip flexion was unexpectedly prevented, forcing subjects to take a step during pointing to prevent falling. The task was repeated when subjects were instructed to intentionally take a step during pointing. In most cases, reaching accuracy and trajectory curvature were preserved due to adaptive condition-specific changes in interjoint coordination. Results suggest that referent control and the minimization process associated with it may underlie motor equivalence in pointing.
NEW & NOTEWORTHY Motor actions may result from minimization of the deflection of the actual body configuration from the centrally specified referent body configuration, in the limits of neuromuscular and environmental constraints. The minimization process may maintain reaching trajectory and accuracy regardless of the number of body segments involved (motor equivalence), as confirmed in this study of reaching from standing in young healthy individuals. Results suggest that the referent control process may underlie motor equivalence in reaching.
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On identifying kinematic and muscle synergies: a comparison of matrix factorization methods using experimental data from the healthy population
Human motor behavior is highly goal directed, requiring the central nervous system to coordinate different aspects of motion generation to achieve the motion goals. The concept of motor synergies provides an approach to quantify the covariation of joint motions and of muscle activations, i.e., elemental variables, during a task. To analyze goal-directed movements, factorization methods can be used to reduce the high dimensionality of these variables while accounting for much of the variance in large data sets. Three factorization methods considered in this paper are principal component analysis (PCA), nonnegative matrix factorization (NNMF), and independent component analysis (ICA). Bilateral human reaching data sets are used to compare the methods, and advantages of each are presented and discussed. PCA and NNMF had a comparable performance on both EMG and joint motion data and both outperformed ICA. However, NNMF's nonnegativity condition for activation of basis vectors is a useful attribute in identifying physiologically meaningful synergies, making it a more appealing method for future studies. A simulated data set is introduced to clarify the approaches and interpretation of the synergy structures returned by the three factorization methods.
NEW & NOTEWORTHY Literature on comparing factorization methods in identifying motor synergies using numerically generated, simulation, and muscle activation data from animal studies already exists. We present an empirical evaluation of the performance of three of these methods on muscle activation and joint angles data from human reaching motion: principal component analysis, nonnegative matrix factorization, and independent component analysis. Using numerical simulation, we also studied the meaning and differences in the synergy structures returned by each method. The results can be used to unify approaches in identifying and interpreting motor synergies.
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Rapid and lasting enhancement of dopaminergic modulation at the hippocampal mossy fiber synapse by electroconvulsive treatment
Electroconvulsive therapy (ECT) is an established effective treatment for medication-resistant depression with the rapid onset of action. However, its cellular mechanism of action has not been revealed. We have previously shown that chronic antidepressant drug treatments enhance dopamine D1-like receptor-dependent synaptic potentiation at the hippocampal mossy fiber (MF)-CA3 excitatory synapse. In this study we show that ECT-like treatments in mice also have marked effects on the dopaminergic synaptic modulation. Repeated electroconvulsive stimulation (ECS), an animal model of ECT, strongly enhanced the dopamine-induced synaptic potentiation at the MF synapse in hippocampal slices. Significant enhancement was detectable after the second ECS, and further repetition of ECS up to 11 times monotonously increased the magnitude of enhancement. After repeated ECS, the dopamine-induced synaptic potentiation remained enhanced for more than 4 wk. These synaptic effects of ECS were accompanied by increased expression of the dopamine D1 receptor gene. Our results demonstrate that robust neuronal activation by ECS induces rapid and long-lasting enhancement of dopamine-induced synaptic potentiation at the MF synapse, likely via increased expression of the D1 receptor, at least in part. This rapid enhancement of dopamine-induced potentiation at the excitatory synapse may be relevant to the fast-acting antidepressant effect of ECT.
NEW & NOTEWORTHY We show that electroconvulsive therapy (ECT)-like stimulation greatly enhances synaptic potentiation induced by dopamine at the excitatory synapse formed by the hippocampal mossy fiber in mice. The effect of ECT-like stimulation on the dopaminergic modulation was rapidly induced, maintained for more than 4 wk after repeated treatments, and most likely mediated by increased expression of the dopamine D1 receptor. These effects may be relevant to fast-acting strong antidepressant action of ECT.
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‘Hypoxia and cellular metabolism in tumour pathophysiology’
Cancer cells are optimized for growth and survival via an ability to outcompete normal cells in their microenvironment. Many of these advantageous cellular adaptations are promoted by the pathophysiological hypoxia that arises in solid tumours due to incomplete vascularisation. Tumour cells are thus faced with the challenge of an increased need for nutrients to support the drive for proliferation in the face of a diminished extracellular supply. Among the many modifications occurring in tumour cells, Hypoxia Inducible Factors (HIFs) act as essential drivers of key pro-survival pathways via the promotion of numerous membrane and cytosolic proteins. Here we focus our attention on two areas: the role of Amino Acid (AA) uptake and the handling of metabolic acid (CO2/H+) production. We provide evidence for a number of hypoxia-induced proteins that promote cellular anabolism and regulation of metabolic acid-base levels in tumour cells including amino-acid transporters (LAT1), monocarboxylate transporters (MCTs), and acid-base regulating carbonic anhydrases (CAs) and bicarbonate transporters (NBCs). Emphasis is placed on current work manipulating multiple CA isoforms and NBCs, which are at an interesting crossroads of gas physiology as they are regulated by hypoxia to contribute to the cellular handling of CO2 and pHi regulation. Our research combined with others indicates that targeting of HIF-regulated membrane proteins in tumour cells will provide promising future anti-cancer therapeutic approaches and we postulate on strategies that could be potentially used to enhance these tactics.
This article is protected by copyright. All rights reserved
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Item response theory analysis to evaluate reliability and minimal clinically important change of the roland-morris disability questionnaire in patients with severe disability due to back pain from vertebral compression fractures
The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate low disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability.
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Second and Thirdhand Smoke Exposure, Attitudes and Protective Practices: Results from a Survey of Hispanic Residents in Multi-unit Housing
Abstract
Secondhand and third hand smoke (SHS, THS) exposure is prevalent in multi-unit housing (MUH). Minorities and low-income MUH residents are disproportionally exposed to SHS and THS compared to other populations. This study describes the characteristics, attitudes, knowledge, and behaviors related to SHS, THS and marijuana smoke exposure (MSHS) of a sample of Hispanic tenants in randomly selected MUH units in eastern metro Los Angeles (n = 402). Although most participants (97%) banned smoking inside their homes, 80% reported infiltration of SHS inside their apartments within the last year. Most (85%) favored a complete ban on smoking in apartment buildings. Twenty-eight percent did not know that marijuana (MSHS) smoke exposure is also harmful to their health. Knowledge scores were higher among Spanish-speakers (p < 0.05). Given the interpersonal barriers to advocating for change, widespread policy and communication interventions are also necessary to protect Hispanic MUH residents' rights to clean air in their living space.
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Decreased Killing Activity of Micafungin Against Candida guilliermondii, Candida lusitaniae, and Candida kefyr in the Presence of Human Serum
Microbial Drug Resistance , Vol. 0, No. 0.
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Use of test dose allows early detection of subdural local anesthetic injection with lumbar plexus block
A 56year-old woman underwent a lumbar plexus block for a revision of a left total hip arthroplasty. During the block procedure, the needle was advanced over the transverse process and isolated quadriceps twitches were elicited. After administering a test dose of 3ml of 1.5% lidocaine, the patient developed loss of sensation in the L3–4 dermatomal distribution that progressed caudally to involve both legs followed by inability to move the left leg. The patient shortly thereafter became hypotensive and sensory block spread cephalad and peaked at C7 bilaterally suggesting possible subdural spread of local anesthetic.
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Atypical presentation to rocuronium allergy in a 19-year-old female patient
The danger of anaphylaxis, a rare but life threatening complication of general anesthesia (GA) can be summarized in two: 1. General Anesthesia masks the typical early signs of allergy which can be seen in an awake patient. 2. Anaphylaxis during GA manifests mostly as circulatory/ventilatory failures which can be interpreted as adverse effects of anesthetics or surgery and this can lead to critical delay of effective therapy. A 19-year-old female admitted for posterior spinal fusion and instrumentation (the 5th surgery in patient's life) desaturated seconds after intubation.
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Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients
Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement.
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The use of ultrasound-guided thoracolumbar interfascial plane block for multi-level lumbar spinal surgery
We read with interest the article by Ueshima et al., who indicated that thoracolumbar interfascial plane (TLIP) block was effective for single-level lumbar spinal surgery [1]. TLIP block was reported recently to block dorsal rami of the lumbar spinal nerve by injecting a local anesthetic into the fascial plane between the multifidus and longissimus muscles [2]. However, it is still unclear whether or not TLIP block is available for multi-level lumbar spinal surgery. In this report, we present 2 cases of multi-level lumbar laminectomy performing the TLIP block.
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Transient global amnesia in immediate postoperative period: A diagnostic dilemma
Transient Global Amnesia (TGA) is short-term inability to form new memories despite otherwise normal neurological function. There is associated anterograde and retrograde amnesia. The memory loss is often accompanied by repetitive questioning and temporal disorientation while higher cognitive functions are preserved. The symptoms usually resolve by 24h.
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Lower limb amputations performed with anterior quadratus lumborum block and sciatic nerve block
The anterior quadratus lumborum block (QLB) has been used as both a trunk nerve block and a lower limb nerve block [1,2]. Compared with lumber plexus nerve block, anterior QLB can be safety performed on patients who take anticoagulant because of a shallow nerve block. We report two successful cases of lower limb amputation with an anterior QLB on a patient who had previously lumber surgery. Case 1 was a 75-year man (173cm, 78kg) who was scheduled for a right above-knee amputation because of arteriosclerosis obliterans.
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Not all mucous plugs are created equal!
Mucous plug related airway obstruction is a very common clinical problem in patients on endotracheal tube and tracheostomy tube (TT). The obstruction can be catastrophic in smaller children where the lumen of the artificial airway is already small to begin with and any minimal mucous plug can produce a complete obstruction. We present the case of a mucous plug related complete airway obstruction which encountered no resistance with passage of a suction catheter, but rather was found to be acting like a ball valve.
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Usefulness and diagnostic value of the NEMA parameter combined with other selected bedside tests for prediction of difficult intubation
To assess the usefulness of the new NEMA (Neck Circumference Minus Acromion-Acromion Distance) parameter, in preoperative identification of patients' difficult intubation and compare it with other commonly used scales and tests.
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Clinical experience of anterior quadratus lumborum block after lumber surgery
Anterior quadratus lumborum block (QLB) is reported as one of trunk nerve block [1]. In addition, because anterior QLB injects a local anesthetic between the psoas (PM) and the quadratus lumborum (QB), the anterior QLB may be able to block lumbar plexus nerves. Therefore it may be effective for a postoperative pain of lower surgery [2]. In this time, we report one successful case of open reduction internal fixation (ORIF) of left femur fracture by performing only the anterior QLB for the patient with a lumber surgery.
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Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients
Elderly patients undergoing elective laparoscopic cholecystectomy (LC) were given right stellate ganglion block (RSGB) to observe its effects on the hemodynamics and stress response during carbon dioxide (CO2)-pneumoperitoneum.
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Action of β-endorphin and nonsteroidal anti-inflammatory drugs, and the possible effects of nonsteroidal anti-inflammatory drugs on β-endorphin
This study aimed to review research on the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on β-endorphin. NSAIDs are commonly used as anti-inflammatory and analgesic drugs. They are well known for inducing peripheral analgesia by inhibiting cyclooxygenase (COX). However, an increasing number of studies have shown that NSAIDs have an analgesic effect not only in the periphery but also at the center. It means that a central analgesic mechanism of the action of NSAIDs exists besides the peripheral mechanism, and the central mechanism likely involves β-endorphin.
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Dexmedetomidine acts as an oxidative damage prophylactic in rats exposed to ionizing radiation
With great interest, we have read the article by Kutanis et al. entitled "Dexmedetomidine acts as an oxidative damage prophylactic in rats exposed to ionizing radiation" that is published in the Journal of Clinical Anesthesia (2016) 34, 577–585 [1]. Kutanis et al. investigated the effects of dexmedetomidine on oxidative injury caused by ionizing radiation. The authors concluded that Dexmedetomidine preserves the antioxidant enzyme levels and reduces toxic oxidant metabolites caused by ionizing radiation.
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Management of isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with combination of steroid and local anesthetic
Patients with isolated peripheral branch neuralgia of trigeminal nerve usually receive traditional treatment such as medical therapy and interventional procedures targeting the entire trigeminal nerve or related ganglions. However, if the intractable pain is limited to a certain branch, the patient may also benefit from a peripheral and nerve-targeted interventional approach. Here, we report the management of a patient with isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with steroid and local anesthetic combination.
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Optimal site for the subpectoral interfascial plane block
The Subpectoral interfascial plane (SIP) block, which was first described in 2016 by Raza et al. [ 1], involves the injection of a local anesthetic into the space between the pectoral major muscle (PMM) and the external intercostal muscle (EIM). It anesthetizes the anterior rami of the T2 to T6; therefore, SIP block may be effective for the postoperative analgesia of the median sternotomy such as that following a cardiac surgery [2]. However, the spread of local anesthetic injected by the SIP block has still not been investigated.
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Effective volumes of 1.5% mepivacaine with different sodium concentration for ultrasound guided popliteal block
To determine if a solution of 1.5% mepivacaine diluted with 5% dextrose, which decreases the sodium concentration by 30%, results in reduced volume requirements for a complete sensory block, in the case of an ultrasound guided popliteal nerve block.
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Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: A retrospective study
Perioperative dexamethasone is commonly used to prevent nausea. It can also increase blood glucose levels, and recent concern about its blood glucose-elevating effect in humans has been raised. This study aimed to demonstrate relationships between dexamethasone administration and elevated perioperative blood glucose in patients undergoing total joint arthroplasty.
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Lumbar vertebra surgery performed with a bilateral retrolaminar block
The number of lumbar vertebrae surgeries has increased in recent years. Despite this increase, the methods for perioperative pain management have remained limited. A retrolaminar block has been reported to be an effective analgesic in breast cancer surgery, transapical transcatheter aortic valve implantation, and ribs fracture treatment [1,2,3]. However, the use of a retrolaminar block for lumbar vertebra surgery has not been reported. Here, we report the successful use of a retrolaminar block in a lumbar vertebrae surgery for perioperative pain management.
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Use of Sugammadex in an octagenerian with Myaesthenia Gravis undergoing emergency laporotomy
Myaesthenia Gravis is an autoimmune disorder that results in increased sensitivity to neuromuscular blockers. Anaesthesia and surgery in patients with Myaesthenia Gravis is associated with an increased incidence of complications, including post operative ventilation. We report the successful use of intra-operative train of four ratio monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing an emergency laporotomy.
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Fla. first responders deliver baby at woman’s home
By EMS1 Staff
BARTOW, Fla. — Polk County Fire Rescue crews delivered their first baby of the year last week.
Crews responded to a call of a woman in labor Jan. 5; since there was no time to transport her to the hospital, they delivered the infant at the woman's home.
Ashli Sawyer, 19, said she was at the hospital the day before, but since she wasn't dilating she was sent home.
"I felt like I needed to use the restroom around 2 a.m. and that's when I noticed my baby was coming," Sawyer said.
Sawyer was home alone when she called 911. Around five minutes after placing the call, crews arrived to help deliver her son, Zander.
"We are so happy for Ashli. Things like this do not happen very often, but when it does our crews are prepared. We wish Ashli and Zander the very best," said Polk Fire's Assistant Chief Rick Parnell. "Our crews often see and have to deal with horrible calls, but moments like this bring great joy to our crews."
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Ind. man visits, thanks dispatcher for saving his life
By EMS1 Staff
SOUTH BEND, Ind. — After a dispatcher swiftly sent help to the residence of man who called 911, he showed up in person to thank her.
Keith Yoder, 75, called 911 when he suffered a severe heart attack in December 2016, reported WSBT. He said he was able to tell dispatcher Breanna Giles he had chest pains before losing consciousness.
After hearing the phone drop, Giles immediately dispatched responders to Yoder's residence. Since Yoder called from a landline, Giles was able to track his address.
"The next thing I remember is I hear sirens, and I looked up, and they were pulling up right in front of my house," Yoder said.
Yoder was transported to the hospital, where he underwent surgery to have a stent placed. After recovering, Yoder paid a visit to Giles to personally thank her for her service.
"I'm so overwhelmed by the fact that he's standing here 'cause you can't do anything other than be there for that person on the line," Giles said. "The fact [that] he wanted to come and meet me, I'm so close to tears it's ridiculous."
911 dispatchers Breanna & Cherie both got certificates for their work to save Keith, see my full story on #wsbt22 later today http://pic.twitter.com/5ZsBjutB4o
— Molly Jirasek (@MollyWSBT) January 9, 2017
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Barriers to and Facilitators of Adherence to Exclusive Breastfeeding Practices Among HIV Infected and Non-Infected Women in Jos, Nigeria
Abstract
Objectives In Nigeria adherence to exclusive breastfeeding (EBF) practices is currently suboptimal and a better understanding of the factors affecting adherence to EBF is needed. We sought to identify and delineate the barriers to and facilitators of adherence to EBF amongst HIV-infected and uninfected women in Nigeria. Methods We explored the barriers and facilitators to EBF amongst 37 (25 HIV-infected and 12 HIV-uninfected) pregnant women attending an antenatal clinic in Jos, Nigeria. In-depth interviews were conducted with each of the pregnant women in their third trimester of pregnancy and again 1 month after giving birth. Results The themes that emerged were mothers' feeding intentions, significant role players in the decision to breastfeed, perceived barriers (e.g. physiological issues, stigma, employment) and perceived facilitators (e.g. pleasure and enjoyment derived from breastfeeding, natural milk from God, disclosure and family support) associated with EBF. Conclusions Most women preferred EBF and offered it to their infants. However, more efforts are needed to improve support structures at home and at work to accommodate women who choose to do EBF.
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Improving Maternal and Infant Child Health Outcomes with Community-Based Pregnancy Support Groups: Outcomes from Moms2B Ohio
Abstract
Objectives To describe temporal changes in maternal and child health outcomes in an impoverished urban community after the implementation of an innovative community-based pregnancy support program, named Moms2B. Methods Beginning in 2011, pregnant women in an urban impoverished community were recruited for participation in a community-based pregnancy support program focused on improving nutrition coupled with increasing social and medical support. The comprehensive program targeting pregnancy through the infants' first year of life was developed and staffed by a multidisciplinary team from an academic health system. As a preliminary effort to assess the effectiveness of Moms2B, we examined maternal and infant health characteristics in the community before and after implementation of the program. Results From 2011 to 2014, 195 pregnant women attended one or more Moms2B sessions at the Weinland Park (WP) location. Most (75%) were African American (AA) with incomes below $800 per month and significant medical and social stressors. Outcomes from the two WP census tracts before and after implementation of the Moms2B program were studied. From 2007 to 2010, there were 442 births in WP and 6 infant deaths for an infant mortality rate of 14.2/1000. In 2011–2014, the first four years of the Moms2B program there were 339 births and one infant death giving an IMR of 2.9/1000, nearly a five-fold reduction in the rate of an infant death. Among pregnant women in WP who were covered by Medicaid, the breastfeeding initiation rate improved from 37.9 to 75.5% (p < .01) after the introduction of Moms2B. There were no infant deaths among Moms2B participants at the WP location in the first four years of the program. Conclusions Implementation of an innovative community-based pregnancy support program was associated with important improvements in maternal and infant health in an impoverished neighborhood.
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Significant association of the GABRP polymorphisms with ulcerative colitis patients
Abstract
The γ-aminobutyric acid (GABA) is an inhibitory neurotransmitter in the central nervous system. The π subunit receptor of GABA (GABRP) is a transmembrane multi-subunit chloride channel that is expressed in the CNS and several other non-neuronal tissues. The exact function of this gene in non-neuronal tissues is not clearly identified. Our previous customized pilot SNPs chip screens analysis indicated that this gene had strong susceptibility to ulcerative colitis (UC). This study was aimed to validate whether the polymorphisms in the GABRP gene are associated with the susceptibility to UC. The genotype and allele frequencies of the rs929763 rs1063310, rs3805455, rs382819 and rs732157 of the GABRP gene were significantly associated with UC patients. Two haplotype frequencies including a major haplotype of GABRP SNPs were more significantly different between the UC patients and the healthy controls. These results suggest that the polymorphisms in the GABRP gene might be associated with the susceptibility to UC, and the haplotype of GABRP SNPs are useful genetic marker for UC.
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EPSTI1 polymorphisms are associated with systemic lupus erythematosus
Abstract
Epithelial stromal interaction 1 (EPSTI1) is an interferon (IFN) response gene, which was originally identified as a stromal fibroblast-induced gene in breast cancer. Our previous study using a customized SNP chip found evidence of an association between EPSTI1 and susceptibility to the chronic inflammatory disease, systematic lupus erythematosus (SLE). This study aimed to validate whether polymorphisms in EPSTI1 are associated with susceptibility to SLE. We analyzed genotype and allele frequencies of SNPs at EPSTI1 using genomic DNA from 119 patients with SLE and 512 healthy controls. We found that the genotype frequencies of rs1044856 and rs1359184 in patients with SLE were significantly different from those found in the control group (P = 0.03 and P = 0.01, respectively). In addition, we found that genotype and allele frequencies of rs1359184 in female patients with SLE were significantly different from those found in female controls (P = 0.02 and P = 0.04, respectively). We identified two major haplotypes in EPSTI1 that were significantly different between patients with SLE and healthy controls (P = 0.01 and P = 0.05, respectively). Furthermore, we found that rs1359184 and rs1044856 in EPSTI1 were associated with antinuclear antibody (ANA) and erythrocyte sedimentation rate (ESR) levels in patients with SLE (P = 0.0035 and P = 0.021, respectively). Our findings indicate that polymorphisms in EPSTI1 are associated with susceptibility to SLE and that haplotypes at EPSTI1 may be useful genetic markers for SLE.
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Novel phenotypes of Drosophila spinster locus on the head formation during embryogenesis
Abstract
spinster (spin) is a late endosome/lysosome membrane protein with the amino acid sequence of a lysosomal sugar carrier and expressed in the glial cells. Spin is required for autophagy and lysosome reformation by releasing lysosomal degradation products of autolysosome into the cytosol in Drosophila larvae and adults. However, such kind of function has not been investigated in embryos yet. In this study, for the first time, we examined the effects of spin mutation on the endocytic pathway and autophagy during embryogenesis. Loss-of-function spin mutation led to the abnormal process of early endosome/recycling endosome and the accumulation of enlarged autophagosome/autolysosome. These abnormal endocytic pathway and autophagy subsequently caused the malformation of head at embryonic stages. These results show that Spin is involved in the endocytic pathway and autophagy during embryogenesis as well as larval and adult stages.
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Forensic and population genetic analyses of the GlobalFiler STR loci in the Mongolian population
Abstract
We have analyzed 24 loci including autosomal and Y-chromosomal short tandem repeats (STRs), Y-indel, and sex-determining marker in a sample of 267 unrelated individuals from the Mongolian population using the GlobalFiler™ PCR Amplification Kit to provide an expanded and more reliable forensic database. Khalkh among 15 Mongolian minor-groups accounts for about 80% of the entire Mongolian population. A total of 267 different DNA profiles were found in this work. The highest gene diversity was observed in the SE33 (0.9376) locus, and the lowest value was found in the TPOX (0.6142) locus. Although individual power of discrimination estimates varied at the studied loci, combined probability of match from the 21 STR loci was estimated to be 1.139 × 10−24, which is highly informative. Based on the results of pairwise F ST genetic distances and multi-dimensional scaling plot showed that Mongolians were clustered into Europeans and Asians, although Mongolia is geographically located in Northeastern Asia. Thus, the present survey of the Mongolian population may help establish a comprehensive reference database for forensic and population genetic analyses.
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Reliability of the electrocortical response to gains and losses in the doors task
Abstract
The ability to differentiate between rewards and losses is critical for motivated action, and aberrant reward and loss processing has been associated with psychopathology. The reward positivity (RewP) and feedback negativity (FN) are ERPs elicited by monetary gains and losses, respectively, and are promising individual difference measures. However, few studies have reported on the psychometric properties of the RewP and FN—crucial characteristics necessary for valid individual difference measures. The current study examined the internal consistency and 1-week test-retest reliability of the RewP and FN as elicited by the doors task among 59 young adults. The RewP, FN, and their difference score (ΔRewP) all showed significant correlations between Time 1 and Time 2. The RewP and FN also achieved acceptable internal consistency at both time points within 20 trials using both Cronbach's α and a generalizability theory-derived dependability measure. Internal consistency for ΔRewP was notably weaker at both time points, which is expected from two highly intercorrelated constituent scores. In conclusion, the RewP and FN have strong psychometric properties in a healthy adult sample. Future research is needed to assess the psychometric properties of these ERPs in different age cohorts and in clinical populations.
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The impact of salience and visual working memory on the monitoring and control of saccadic behavior: An eye-tracking and EEG study
Abstract
In a concurrent eye-tracking and EEG study, we investigated the impact of salience on the monitoring and control of eye movement behavior and the role of visual working memory (VWM) capacity in mediating this effect. Participants made eye movements to a unique line-segment target embedded in a search display also containing a unique distractor. Target and distractor salience was manipulated by varying degree of orientation offset from a homogenous background. VWM capacity was measured using a change-detection task. Results showed greater likelihood of incorrect saccades when the distractor was relatively more salient than when the target was salient. Misdirected saccades to salient distractors were strongly represented in the error-monitoring system by rapid and robust error-related negativity (ERN), which predicted a significant adjustment of oculomotor behavior. Misdirected saccades to less-salient distractors, while arguably representing larger errors, were not as well detected or utilized by the error/performance-monitoring system. This system was instead better engaged in tasks requiring greater cognitive control and by individuals with higher VWM capacity. Our findings show that relative salience of task-relevant and task-irrelevant stimuli can define situations where an increase in cognitive control is necessary, with individual differences in VWM capacity explaining significant variance in the degree of monitoring and control of goal-directed eye movement behavior. The present study supports a conflict-monitoring interpretation of the ERN, whereby the level of competition between different responses, and the stimuli that define these responses, was more important in the generation of an enhanced ERN than the error commission itself.
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What our eyes tell us about feelings: Tracking pupillary responses during emotion regulation processes
Abstract
Emotion regulation is essential for adaptive behavior and mental health. Strategies applied to alter emotions are known to differ in their impact on psychological and physiological aspects of the emotional response. However, emotion regulation outcome has primarily been assessed via self-report, and studies comparing regulation strategies with regard to their peripheral physiological mechanisms are limited in number. In the present study, we therefore aimed to investigate the effects of different emotion regulation strategies on pupil dilation, skin conductance responses, and subjective emotional responses. Thirty healthy females were presented with negative and neutral pictures and asked to maintain or up- and downregulate their upcoming emotional responses through reappraisal or distraction. Pupil dilation and skin conductance responses were significantly enhanced when viewing negative relative to neutral pictures. For the pupil, this emotional arousal effect manifested specifically late during the pupillary response. In accordance with subjective ratings, increasing negative emotions through reappraisal led to the most prominent pupil size enlargements, whereas no consistent effect for downregulation was found. In contrast, early peak dilations were enhanced in all emotion regulation conditions independent of strategy. Skin conductance responses were not further modulated by emotion regulation. These results indicate that pupil diameter is modulated by emotional arousal, but is initially related to the extent of mental effort required to regulate automatic emotional responses. Our data thus provide first evidence that the pupillary response might comprise two distinct temporal components reflecting cognitive emotion regulation effort on the one hand and emotion regulation success on the other hand.
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Paramedic injured after LAFD ambulance, car collide
The crash occurred as the ambulance was transporting a woman to the hospital
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What part of paramedic training did you find most difficult?
No matter if you're on day one or a veteran paramedic, you'll never forget your paramedic training experiences.
And a task that is hard for some paramedic students may be easier for others.
We asked our Facebook fans what part of paramedic training they found most difficult. Some said they had a difficult time learning how to study and take tests, being confident in themselves, intravenous access training and developing patient rapport.
What did you find difficult? Sound off in the comment section below.
1. "Everyone was so concentrated on the skills, and the almighty cardiology, that we failed to really study the stuff we see more often. Pulmonology, endocrinology, and to an extent neurology weren't explained as much in detail, which lead to difficulties in putting it all together later in school. I felt it important to understand how all the systems were tightly integrated." — Scott Owens
2. "Getting the right calls to complete the course requirements." — Phil Salamone
3. "Learning the national curriculum and being restricted to state protocols. Having a knowledge base and skill set that you are unable to use is tough. My instructor gave a lecture at the end of the program called "living in a world of grey." It was phenomenal and truly represents the unpredictable reality in which we live. No matter how much training we go through during a paramedic program, we can never be fully prepared for everything we will encounter." — Adam O'Neil
4. "For me, after being out of school for almost 15 years and learning how to study, take tests, and manage my time with a full-time and part-time job, husband, kids, house, extended family … it was chaotic. But, I was a late bloomer and was an EMT for quite a while before the timing was right for me to go through medic class. Passed everything the first time, so I must have done something right." — Nicole Nixon Butler
5. "Being confident in yourself, especially being such a young paramedic. I've only been out of school for five months now, and have been struggling until recently to have confidence in my skills and knowledge that I am capable of doing this job." — Mark Sinnwell
6. "IV training was very difficult for me. Going from a basic where you cannot do any advanced procedures to IV was a giant step. Preceptors for me, also. Trying to find one or two that I cliqued with." — Joel Parks Jr.
7. "The point about two-thirds through the program where I realized, if I knew then (before starting the paramedic program) what I know now, then I would have never started. But I have come too far to quit now." — Patrick Gomer Roberson
8. "Pathophysiology, developing patient rapport, looking at the whole picture and understanding that equipment/drugs are just tools in your bag." — Chris Sheldrew
9. "Being an EMT for seven years and then taking on medic school, doing a proper assessment on a rescue randy and verbalize everything was tough." — Chris Marchese
10. "Putting in the time and dedicating myself to finish. It was tough. With the support of my wife and family, I was able to pull it off." — Dennis Martin
11. "The first solo shift as a paramedic. That the first real day of training." — John Shady
12. "Remembering all the different drugs, what they do and their doses and contraindications." — Warren Glass
13. "Pathophysiology had to be the hardest part for me." — Fernando de Leon
14. "Pediatric IVs and dosages." — Tony Ippolito
15. "Bedside manner." — Greg Hogancamp
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What part of paramedic training did you find most difficult?
No matter if you're on day one or a veteran paramedic, you'll never forget your paramedic training experiences.
And a task that is hard for some paramedic students may be easier for others.
We asked our Facebook fans what part of paramedic training they found most difficult. Some said they had a difficult time learning how to study and take tests, being confident in themselves, intravenous access training and developing patient rapport.
What did you find difficult" Sound off in the comment section below.
1. "Everyone was so concentrated on the skills, and the almighty cardiology, that we failed to really study the stuff we see more often. Pulmonology, endocrinology, and to an extent neurology weren't explained as much in detail, which lead to difficulties in putting it all together later in school. I felt it important to understand how all the systems were tightly integrated." — Scott Owens
2. "Getting the right calls to complete the course requirements." — Phil Salamone
3. "Learning the national curriculum and being restricted to state protocols. Having a knowledge base and skill set that you are unable to use is tough. My instructor gave a lecture at the end of the program called "living in a world of grey." It was phenomenal and truly represents the unpredictable reality in which we live. No matter how much training we go through during a paramedic program, we can never be fully prepared for everything we will encounter." — Adam O'Neil
4. "For me, after being out of school for almost 15 years and learning how to study, take tests, and manage my time with a full-time and part-time job, husband, kids, house, extended family … it was chaotic. But, I was a late bloomer and was an EMT for quite a while before the timing was right for me to go through medic class. Passed everything the first time, so I must have done something right." — Nicole Nixon Butler
5. "Being confident in yourself, especially being such a young paramedic. I've only been out of school for five months now, and have been struggling until recently to have confidence in my skills and knowledge that I am capable of doing this job." — Mark Sinnwell
6. "IV training was very difficult for me. Going from a basic where you cannot do any advanced procedures to IV was a giant step. Preceptors for me, also. Trying to find one or two that I cliqued with." — Joel Parks Jr.
7. "The point about two-thirds through the program where I realized, if I knew then (before starting the paramedic program) what I know now, then I would have never started. But I have come too far to quit now." — Patrick Gomer Roberson
8. "Pathophysiology, developing patient rapport, looking at the whole picture and understanding that equipment/drugs are just tools in your bag." — Chris Sheldrew
9. "Being an EMT for seven years and then taking on medic school, doing a proper assessment on a rescue randy and verbalize everything was tough." — Chris Marchese
10. "Putting in the time and dedicating myself to finish. It was tough. With the support of my wife and family, I was able to pull it off." — Dennis Martin
11. "The first solo shift as a paramedic. That the first real day of training." — John Shady
12. "Remembering all the different drugs, what they do and their doses and contraindications." — Warren Glass
13. "Pathophysiology had to be the hardest part for me." — Fernando de Leon
14. "Pediatric IVs and dosages." — Tony Ippolito
15. "Bedside manner." — Greg Hogancamp
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Crossover assessment of cardiolocomotor synchronization during running
Abstract
Purpose
This study aimed at testing the hypothesis that positive cardiolocomotor coordination (CLC) measure occurs by chance during a running task where the heart rate (HR) is approximated to the step frequency (StepF).
Methods
The electrocardiogram and electromyogram from the right gastrocnemius lateralis muscle were continuously recorded from ten healthy young men running at a paced rhythm of 152 step/min, to monitor HR and StepF. CLC was evaluated by phase synchrograms and the index of conditional probability (iCP). Results were validated with surrogate data and a crossover approach, where the HR of one subject was related to the StepF of another one, and comparisons were made combining subjects two by two.
Results
Six subjects showed synchrogram structures and high iCP values (≥0.8), suggesting the occurrence of physiological entrainment, when the HR reached the SF range. In crossover analysis, phase synchrograms and iCP presented similar behavior of original data when the HR from one subject was close enough to the SF from another one. Significant iCP values in 46 of 90 comparisons (51%) were observed, including all cases crossing signals among the six positive cases.
Conclusion
Synchrogram and iCP tools currently employed for measuring CLC are not appropriate because they indicate the occurrence of this phenomenon even among subjects who ran on different days and times of each other.
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