Can telomere length be used as a biomarker for cardiovascular diseases?: insights from a large clinical study

Abstract

Cardiovascular diseases (CVDs) remain among the leading causes of death worldwide. An accurate identification of individuals who are at risk of a cardiovascular event plays a critical role in successful preventative intervention

This article is protected by copyright. All rights reserved

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Maternal fructose consumption can affect offspring metabolic outcomes

Abstract

High sugar consumption is associated with non-alcoholic fatty liver disease (NAFLD) and excess visceral adipose tissue (VAT) which are in turn linked to type 2 diabetes mellitus (T2DM), dyslipidemia, and cardiovascular disease (CVD) in adults and children.

This article is protected by copyright. All rights reserved

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Risk factors of allopurinol-induced severe cutaneous adverse reactions in a Thai population.

Background: Allopurinol is one of the most common causes of severe cutaneous adverse drug reactions (SCARs) including drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). This study identified the risk factors associated with the development of allopurinol-induced SCARs in a Thai population. Patients and methods: Eighty-six allopurinol-induced SCARs (i.e. 19 DRESS and 67 SJS/TEN) and 182 allopurinol-tolerant patients were enrolled in the study. The HLA-B*58:01 allele was determined. Clinical and medicinal data were collected. Results: Results from multivariate analysis showed that only the HLA-B*58:01 and female sex were identified as risk factors of allopurinol-induced SCARs in this Thai population. Patients who carried the HLA-B*58:01 allele were at a higher risk of allopurinol-induced DRESS [odds ratio (OR)=149.2, 95% confidence interval (CI)=24.0-[infinity], P

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Title Page/Sections Editors

Publication date: May 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1860, Issue 5





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Tumescent anaesthesia: its applications and well tolerated use in the out-of-operating room setting.

Purpose of review: Tumescent anaesthesia is a method of administering dilute local anaesthetic into the subcutaneous tissue. Many anaesthesiologists are unfamiliar with the technique, its applications and potential risks. Recent findings: The maximum safe dose of lidocaine with epinephrine in tumescent anaesthesia for liposuction is probably between 35 and 55 mg/kg. Without liposuction, the maximum dose of lidocaine with epinephrine should be no more than 28 mg/kg. After tumescent infiltration for liposuction, serum lidocaine concentrations peak between 12 and 16 h after injection. When tumescent lidocaine without epinephrine is used for endovenous laser therapy, peak serum lidocaine concentrations are observed much earlier, between 1 and 2 h after injection. Slow administration of more dilute concentrations of local anaesthetic decreases the risk of local anaesthetic systemic toxicity. Summary: Although appealing because of its ability to provide prolonged analgesia, high doses of local anaesthetic are frequently administered using the tumescent technique, and absorption of local anaesthetic from the subcutaneous tissue is variable. When caring for patients having procedures in which tumescent anaesthesia is used, the risk of local anaesthetic toxicity should be acknowledged and lipid emulsion should be available for prompt treatment if needed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Sedation for advanced procedures in the bronchoscopy suite: proceduralist or anesthesiologist?.

Purpose of review: This article focuses on the issue of sedation provided either by proceduralists or anesthesiologists for advanced bronchoscopy procedures. The relative merits of both approaches are presented. Current evidence from the literature and guideline recommendations relevant to this topic are reviewed. Recent findings: In general, patient and proceduralist satisfaction as well as patient safety are increased when intravenous sedation is provided for advanced bronchoscopic procedures. However, guidelines by various societies remain vague on defining the appropriate level of care required when providing sedation for these procedures. In addition, targeted depth of sedation varies considerably among practitioners. While in some settings, nonanesthesiologist-administered propofol sedation has been proven safe; nevertheless, its use is controversial, especially in the bronchoscopy suite. Summary: The role of the anesthesiologist in sedation for advanced bronchoscopy remains undefined. When deep sedation for prolonged interventional procedures is needed or when dealing with patients who have multiple comorbidities, an anesthesiologist should be involved. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Safety of deep sedation in the endoscopy suite.

Purpose of review: As the complexity of endoscopic procedures increases, the use of propofol and the desire for deep sedation are becoming more common in the endoscopy suite. This review explores sedation depth, agents used for sedation, recommended monitoring, and adverse event risks that occur during sedation for endoscopy. Recent findings: The sedation provider for endoscopy varies by practice location and with regulatory requirements. As increasingly deep levels of sedation are used in this setting, the need for all providers to have training in the ability to rescue patients from sedation-related side effects is paramount. Propofol has an important role for prolonged and uncomfortable endoscopic interventions and has a strong safety record in the endoscopy suite. Vital signs monitoring is recommended during all endoscopy sedation, and there is emerging interest in advanced monitoring (e.g., capnography, processed electroencephalogram, respiratory monitoring) in this setting. The reported rate of adverse events during endoscopy sedation varies widely; however, advanced age and increasing American Society of Anesthesiologists physical status score are consistently associated with increased risk. Whether anesthesiologist-administered sedation is safer than non-anesthesiologist-administered sedation remains controversial. Summary: This review provides some guidance to providers who administer sedation in the endoscopy suite and is intended to improve the safety of patients. The recommendations are based on best available evidence and expert opinion. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The role of the anaesthesiologist in air ambulance medicine.

Purpose of review: The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. Recent findings: Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. Summary: There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Perioperative management of antithrombotic therapies.

Purpose of review: Perioperative coagulation management is becoming increasingly frequent in the daily routine of the anesthesiologist and with the plethora of new substances on the market also increasingly complex. The perioperative setting poses unique challenges requiring an individualized evaluation and management of antithrombotic therapy. This review shall summarize the newest developments in this domain. Recent findings: New data in patients with atrial fibrillation have led to a paradigm change in the perioperative management of antithrombotics. The role of bridging therapy has been downgraded in the guidelines, which only foresee bridging in patients with high thromboembolic risk. Furthermore, direct oral anticoagulants are now a cornerstone in antithrombotic therapy, calling for specific perioperative management. The new reversal agents idarucizumab, and potentially in the future andexanet alfa and ciraparantag, will play an increasingly important role in the treatment of major bleeding in this group of patients. Summary: With the new evidence and treatment options available, perioperative coagulation management is experiencing a Renaissance, opening many interesting new doors, but also presenting the clinician with new challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Is the Routine Use of a Functional Electrical Stimulation Cycle for Lower Limb Movement Standard of Care for Acute Spinal Cord Injury Rehabilitation?

You lead the rehabilitation team at a large, rural freestanding rehabilitation hospital with a small but growing and respected spinal cord injury (SCI) rehabilitation program—inpatient and outpatient. You are caring for a 25-year-old man, 3 weeks after a T10 American Spinal Injury Association Impairment Scale (AIS) B injury due to a motor vehicle accident. He is medically stable and participating well in his program. The man's parents happen to have substantial resources. After doing research online, they approach you concerning the absence of a functional electrical stimulation (FES) cycle treatment for their son.

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Editorial Board

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Copyright Page

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Table of Contents

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Spanish Translated Abstracts

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Information for Authors

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Academy News – May PM&R

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

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Evaluation of leg wrapping for the prevention of postspinal hypotension in cesarean section under spinal anesthesia

Aparna Abhijit Bagle, Adithya Vishnu, Anil Kumar, Amit Malik, Vinit Garg, Gayatri Khanvilkar

Anesthesia: Essays and Researches 2017 11(2):439-443

Background: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. Materials and Methods: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. Statistical Analysis: Statistical software "Numbers version 3.6.1 (2566)" was used for statistical calculations. Results: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. Conclusion: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

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Effect of single compared to repeated doses of intravenous S(+) ketamine on the release of pro-inflammatory cytokines in patients undergoing radical prostatectomy

Hassan Mohamed Ali, Ali M Mokhtar

Anesthesia: Essays and Researches 2017 11(2):282-286

Background: Radical prostatectomy is a major surgical procedure that is associated with marked inflammatory response and impairment of the immune system which may affect the postoperative outcome. The aim of this study was to evaluate the effect of preincision single or multiple doses of S(+) ketamine on the pro-inflammatory cytokines, namely tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Patients and Methods: This is a randomized controlled trial including 60 American Society of Anesthesiologists Physical Status I and II patients scheduled for radical prostatectomy under combined general-epidural anesthesia in Cairo university Teaching Hospital. Patients were randomly divided into three groups each of twenty patients: Group I received no S(+) ketamine (control group), Group II received S(+) ketamine as a single preincision dose, and Group III received preincision and repeated doses of S(+) ketamine. S(+) ketamine was injected as a single intravenous dose of 0.5 mg/kg in Group II and III, repeated as 0.2 mg/kg at 20 min interval until 30 min before the end of surgery. Results: The three groups were comparable in age, weight, and duration of the operation. The study also revealed that a single preincision dose of S(+) ketamine decreased TNF-α to reach 1027.04 ± 50.13 μ/ml and IL-6 to reach 506.89 ± 25.35 pg/ml whereas the repeated doses of S(+) ketamine decreased TNF-α to reach 905.64 ± 35065 μ/ml and IL-6 to reach 412.79 ± 16.5 pg/ml (P < 0.05). Conclusion: S(+) ketamine suppresses pro-inflammatory cytokine production, especially when given in repeated doses.

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Anesthetic management of a parturient with severe pulmonary restenosis posted for cesarean section

Rajkiran Babubhai Shah, Beena P Butala, Geeta P Parikh

Anesthesia: Essays and Researches 2017 11(2):517-519

Adults with congenital heart disease are increasing due to improvement in infant heart surgery and availability of better cardiac care. Pregnancy in these patients requires multidisciplinary team approach due to circulatory changes. We describe an anesthetic management of the parturient undergoing cesarean section having severe pulmonary restenosis.

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Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough

Sunil Rajan, George Jacob Malayil, Rekha Varghese, Lakshmi Kumar

Anesthesia: Essays and Researches 2017 11(2):287-293

Context: Postoperative sore throat (POST) is a complication that is unresolved in patients undergoing endotracheal intubation. Aim: To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths, on the incidence and severity of POST, hoarseness, and cough. Settings and Design: Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospective, randomized, double-blinded study. Subjects and Methods: Patients in each group were nebulized with the respective study drug 15 min prior to the surgery, i.e., ketamine in Group K, magnesium sulfate 250 mg, and 500 mg in Group M1 and Group M2, respectively, and normal saline as control in Group C. A standardized anesthesia protocol was followed for all patients. After extubation, the patients were asked to grade POST, hoarseness, and cough at 0, 2, 4, 12, and 24 h. Statistical Analysis Used: One-way analysis of variance, Chi-square test, Fisher's exact test, paired t-tests, and Wilcoxon's signed-rank test as applicable. Results: Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0, 2, and 4 h, and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat, hoarseness, and cough at all periods in the study groups as compared with control. Conclusion: Nebulization with ketamine 50 mg and magnesium sulfate 500 mg, 15 min before induction of general anesthesia and intubation, reduce the incidence and severity of POST and hoarseness of voice.

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Prophylactic use of intravenous clonidine compared to tramadol in prevention of intraoperative shivering under regional anesthesia

Sarmila Guha (Banerjee), Pallab Kumar Nath, Rita Halder, Ujjwal Bandyopadhyay

Anesthesia: Essays and Researches 2017 11(2):477-482

Objectives: This study aimed to evaluate the relative efficacy of prophylactic intravenous (IV) clonidine and tramadol for control of intraoperative shivering following spinal anesthesia. Materials and Methods: After institutional ethical clearance, 142 patients were chosen from either gender, aged 20–60 years, physical status American Society of Anesthesiology Class I and II scheduled for elective infraumbilical surgery under spinal anesthesia. Patients were randomized into two groups: Group C (n = 71) received injection clonidine 50 μg) IV in 100 ml normal saline (NS) over 10 min and Group T (n = 71) received injection tramadol 50 mg IV. In 100 ml NS over 10 min after spinal anesthesia. Results: Incidence of shivering was not significant when compared between the two groups (P > 0.05). The axillary temperatures fell significantly in Group C from the baseline and remained at a significantly lower level up to 60 min after rescue drug was administered in patients who shivered. There was a similar fall in axillary temperature in Group T in patients having shivering, but the difference was not significant. When compared between the two groups among patients who shivered, the difference in fall of temperature was not significant. Side effects such as hypotension, bradycardia, and sedation were significantly more common in clonidine group, whereas nausea was significantly more common patients of tramadol group. Conclusion: Prophylactic administration of both tramadol and clonidine is effective for controlling shivering under spinal anesthesia. However, tramadol is better because of higher response rate, less sedation, and lesser hemodynamic alterations.

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Efficacy of dexmedetomidine infusion for procedural comfort and intraoperative sedation in patients undergoing surgeries with subarachnoid block: A randomized double-blind clinical trial

Dewan Roshan Singh, Kusha Nag, Amrutha Bindu Nagella, VR Hemanth Kumar, Antony John Charles

Anesthesia: Essays and Researches 2017 11(2):294-299

Introduction: There is increasing evidence to include sedation as an integral part of regional anesthesia to ensure patient comfort. This may compromise patient cooperation, an important component of regional anesthesia. We decided to determine the efficacy of dexmedetomidine (0.3 μg/kg/h and 0.5 μg/kg/h) for allaying procedural discomfort and ensuring their cooperation in patients undergoing surgery with subarachnoid block. Setting: Tertiary care center. Materials and Methods: Sixty patients with the American Society of Anesthesiologists physical status Class I and II posted for surgeries under subarachnoid block were randomized into two groups of 30 each to receive dexmedetomidine in a loading dose of 1 μg/kg in both groups followed by continuous infusion of 0.3 μg/kg/h in Group D 0.3 and 0.5 μg/kg/h in Group D 0.5. Observer assessment sedation score, ease of positioning score, response to spinal needle insertion, hemodynamic parameters, patient satisfaction (PS) score, and surgeon satisfaction (SS) score were evaluated. Results: Median observer Assessment Sedation Score ranged between four and three at all times during dexmedetomidine infusion in Group D 0.3. In Group D 0.5, median Observer assessment of alertness/sedation scale ranged between three and two. Ease of positioning (P = 1.000) and response to spinal needle insertion (P = 0.521) were comparable in both groups. PS was higher in Group D 0.5 as compared to Group D 0.3. SS score was comparable in both the groups. Conclusion: Intravenous dexmedetomidine infusion 0.3 μg/kg/h produces effective sedation in patients undergoing surgery with spinal anesthesia while ensuring patient cooperation for positioning and without any recall of the procedure in postoperative period.

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A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Ashish Kannaujia, Saipriya Tewari, Alka Verma

Anesthesia: Essays and Researches 2017 11(2):535-536



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Lignocaine versus ropivacaine infiltration for postpartum perineal pain

Jyoti P Deshpande, Girish Y Saundattikar

Anesthesia: Essays and Researches 2017 11(2):300-303

Background: Millions of women worldwide undergo postpartum perineal repair under local infiltration. Inadequate postpartum pain management can negatively impact a mother's physical and psychological recovery. Aims: To study and compare the analgesic effect and maternal satisfaction with lignocaine versus ropivacaine infiltration for postpartum perineal pain relief. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind prospective randomized study carried out on 100 parturients of aged 18–40 years who had spontaneous vaginal delivery, comparing 1% lignocaine and 0.75% ropivacaine infiltration for the repair of selective episiotomy or perineal injury. Time of the first analgesic (TFA) demand, maternal satisfaction at 24 h, and visual analog scale (VAS) pain score were studied. Statistical Analysis: Chi-square test and Student's t-test were used and P< 0.05 was considered as significant. Results: VAS pain score was significantly lower at 2 and 4 h in ropivacaine group versus lignocaine group (P < 0.0001). Significantly, longer TFA (10.2 ± 1.54 vs. 2.20 ± 0.44 h, P< 0.0001) and higher percentage of maternal satisfaction (86% vs. 44%) were observed in ropivacaine as compared to lignocaine group (P < 0.0001). Conclusions: Prolonged analgesia and higher rate of maternal satisfaction were found when ropivacaine infiltration was used for perineal repair as compared to lignocaine.

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The postdural puncture headache and back pain: The comparison of 26-gauge atraucan and 26-gauge quincke spinal needles in obstetric patients

Mehmet Salim Akdemir, Ayhan Kaydu, Yonca Yanlı, Mehtap Özdemir, Erhan Gökçek, Haktan Karaman

Anesthesia: Essays and Researches 2017 11(2):458-462

Background: The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles. Aims: The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes. Materials and Methods: After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P< 0.05 was considered statistically significant for all analyses. Results: There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05). Conclusions: The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.

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Financial implications of intravenous anesthetic drug wastage in operation room

Suvarna Kaniyil, A Krishnadas, Arun Kumar Parathody, KT Ramadas

Anesthesia: Essays and Researches 2017 11(2):304-308

Background and Objectives: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. Methods: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated. Results: The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26). Interpretation and Conclusions: Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs.

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The analgesic efficacy of dexamethasone added to ropivacaine in transversus abdominis plane block for transabdominal hysterectomy under subarachnoid block

Jyoti P Deshpande, Poonam S Ghodki, Shalini P Sardesai

Anesthesia: Essays and Researches 2017 11(2):499-502

Background and Aims: Ultrasound-guided transversus abdominis plane (TAP) block has been proven as a safe and effective analgesic technique for several lower abdominal surgeries. Various adjuvants have been used to intensify the quality and prolong the local anesthetic effect. We evaluated the analgesic efficacy of dexamethasone addition to ropivacaine in TAP block following open abdominal hysterectomy. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind, prospective, randomized study was carried out on sixty patients aged 40–60 years posted for elective open abdominal hysterectomy comparing bilateral TAP block using 20 ml of 0.5% ropivacaine + 1 ml of 0.9% saline (control Group R) or 20 ml of 0.5% ropivacaine + 4 mg dexamethasone (Group RD). The aim of our study was to observe postoperative pain score (visual analog scale [VAS]), time for first analgesic (TFA) demand, total analgesic consumption, and incidence of nausea or vomiting. Statistical Analysis: Chi-square test and Student's t-test were used, and P< 0.05 was considered as statistically significant. Results: Postoperative VAS pain scores were significantly lower at 4, 6, and 12 h in Group RD as compared to Group R (P < 0.05). Significantly longer TFA (13.2 ± 7.6 vs. 7.1 ± 4.6 h, P< 0.001) with lesser tramadol requirement in first 24 h (50.2 ± 34 vs. 94 ± 35 mg, P< 0.001) were observed in Group RD as compared to Group R. Incidence of nausea or vomiting was statistically insignificant between the groups (P > 0.05). Conclusions: Addition of dexamethasone to ropivacaine TAP block prolonged the postoperative analgesia and reduced analgesic requirement following abdominal hysterectomy.

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Dexmedetomidine as an anesthetic adjuvant in intracranial surgery

Ankita Batra, Reetu Verma, VK Bhatia, Girish Chandra, Shashi Bhushan

Anesthesia: Essays and Researches 2017 11(2):309-313

Background: The basic principle of neuroanesthesia is to provide hemodynamic stability, provision of optimal operative conditions, maintenance of cerebral perfusion pressure, and cerebral oxygenation. Aim: This study was undertaken to see the effect of dexmedetomidine infusion on hemodynamics and its ability to act as an anesthetic adjuvant in patients undergoing supratentorial tumor surgery. Setting and Design: Prospective randomized control double blind study. Subjects and Methods: In this study, we compared two groups with 25 patients in each group. Group C patients received saline infusion during surgery and 4 μg/kg of fentanyl intravenously (i.v.) at the induction and at pin head application. Group D patients received dexmedetomidine infusion during surgery at the rate of 0.4 μg/kg/h and 2 μg/kg of fentanyl i.v. at the induction and at pin head application Statistical Analyses Used: Parametric data were analyzed using Student's t-test. The categorical data were studied using Chi-squared test or Fisher's test as appropriate. Results: The vitals remained within 20% of baseline in both groups during the study period except at the time of extubation where the rise in heart rate was more than 20% in control group. The requirement of thiopentone for induction was significantly less in dexmedetomidine group. In dexmedetomidine group, less number of patients required intraoperative fentanyl (P < 0.05), and the time to rescue analgesic was also more in Group D (P < 0.05). Conclusion: Dexmedetomidine infusion started before surgery maintains hemodynamic stability intraoperatively and is effective in attenuating the cardiovascular responses to intubation, skull pin application, and extubation. It decreases the requirement of other anesthetic agents as well.

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Continuous positive airway pressure prevents hypoxia in dental patient with obstructive sleep apnea syndrome under intravenous sedation

Anton A Kasatkin, Aleksei P Reshetnikov, Aleksandr L Urakov, Dmitrii Y Baimurzin

Anesthesia: Essays and Researches 2017 11(2):528-530

Use of sedation in patients with obstructive sleep apnea (OSA) in dentistry is limited. Hypoxia may develop during medication sleep in dental patients with OSA because of repetitive partial or complete obstruction of the upper airway. In this regard, anesthesiologists prefer not to give any sedative to surgical patients with OSA or support the use of general anesthesia due to good airway control. We report a case where we could successfully sedate a dental patient with OSA using intraoperative continuous positive airway pressure (CPAP) without hypoxia. Use of sedation and intraoperative CPAP in patients with OSA may be considered only if the effectiveness at home CPAP therapy is proven.

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Hemodynamic responses at intubation, change of position, and skin incision: A comparison of multimodal analgesia with conventional analgesic regime

Keelara Shivalingaiah Savitha, Radhika Dhanpal, MS Vikram

Anesthesia: Essays and Researches 2017 11(2):314-320

Background: Lumbar spine surgery is associated with hemodynamic variations at intubation, change of position, and skin incision. A balanced anesthesia with multimodal analgesia (MMA) is necessary to attenuate these changes. Aim: To assess the relative effectiveness of preemptive MMA compared with the conventional analgesic regime in suppressing the hemodynamic response to endotracheal intubation, prone positioning, and skin incision. Settings and Design: A randomized, prospective study involving 42 patients belonging to the American Society of Anesthesiologists Physical Status 1 and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Materials and Methods: Forty-two patients were randomly allocated into Groups A and B. Group A (study group) received diclofenac, paracetamol, clonidine, and bupivacaine with adrenaline skin infiltration and Group B (control group) injection paracetamol and saline with adrenaline skin infiltration. Statistical Analysis Used: Hemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) between the groups following intubation, prone position, and skin incision were noted and compared using repeated measure analysis of variance. One sample t-test was used to compare the standard mean concentration with the means of the study and control groups. P< 5% being considered statistically significant. Results: In the study group, HR, SBP, DBP, and MAP were lower at intubation and change of position as compared to the control group and were statistically significant. Conclusion: Preemptive MMA with balanced anesthesia is effective in attenuating the hemodynamic responses to multiple noxious stimuli during lumbar spine surgery.

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An audit of comparison of perioperative outcomes with the introduction of standardized preoperative evaluation form at a tertiary care hospital in rural India

Shraddha Vidyadhar Naik, Bilal Mohammad, Vitthal K Dhulkhed

Anesthesia: Essays and Researches 2017 11(2):426-430

Introduction: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures. Aim: The aim of the study was to conduct an audit to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized pre-operative evaluation form. Study Design: This was a retrospective study, using a sample of 3000 files of patients who underwent elective surgery in a tertiary care hospital of rural India. We devised 11 quality indicators, looking at factors in the pre-operative, peri-operative and post-operative period, and used them to audit 3000 patient records in our Hospital. Results: We found several areas where quality could be significantly improved;last minute postponement/change of plan of planned surgeries has reduced from 134 (8.9%) to 23 (1.53%) cases after implementation of standardised PEF. 784 (52.26%) patients were not formally handed over to the theatre recovery staff before implementation of standardised PEF compared to 147(9.8%) after implementation of standardised PEF. Conclusion: This audit found several areas of practice that fall below expected standards before the introduction of standardised PEF, but after the introduction of standardised PEF there is a significant improvement in quality of pre anaesthetic evaluation and overall outcome of the patient. We therefore advocate the use of such standardised PEFs for performing preoperative and perioperative assessment of surgical patients.

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To study the efficacy of intravenous dexamethasone in prolonging the duration of spinal anesthesia in elective cesarean section

Priyanka Sunil Shalu, Poonam Sachin Ghodki

Anesthesia: Essays and Researches 2017 11(2):321-325

Background and Aims: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. This randomized, double-blind study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia. Methods: A total of sixty patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, group SD and group SN, including thirty patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg through spinal anesthesia. Group SD received injection dexamethasone 8 mg intravenously, and group SN received injection normal saline (NS) 2 cc immediately after spinal anesthesia. Duration of sensory block, motor block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Whenever demanded rescue analgesia was given in the form of injection tramadol 100 mg. Results: The mean duration of sensory block (min) in group SD and group SN was 162.50 and 106.17, respectively which was highly significant. Similarly, time to the requirement of first rescue analgesia was prolonged in group SD (8.67 h) as compared to group SN (4.40 h). Significant changes were also seen in VAS score in postoperative period after 1 h of surgery in group SD and group SN. Duration of motor block, intra- and post-operative hemodynamic parameters were comparable in both the groups. No side effects were recorded in both the groups. Conclusion: We concluded that administration of dexamethasone 8 mg intravenously prolongs the duration of postoperative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia.

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Anesthesiologist's role in relieving patient's anxiety

Brij Mohan, Rajan Kumar, Joginder Pal Attri, Veena Chatrath, Neeru Bala

Anesthesia: Essays and Researches 2017 11(2):449-452

Introduction: Anesthesia and surgery have proved to be highly anxiety provoking and with the rise of elective surgery, its aspect of patient's experience has become prominent in time. However, our fault as anesthesiologists is that we have not made people get versed with what we people as anesthesiologist do in the operating room. Hence, keeping in view all this, a study was carried out, in which video information/images regarding anesthesia and surgical procedure was shown to patients on PowerPoint Presentation. Different images showing previous patient's hospital journey were shown to educate patients. Methods: Two hundred patients scheduled to undergo elective surgery were taken and were divided into two groups of 100 each. Patients (study group or Group I) were shown video clippings/images of other previously operated patients and their hospital journey including surgery and anesthesia for which patient came in hospital. The study was carried out on the patient in each group while Group II was treated in normal way and not shown any type of images/videos. Hamilton Anxiety Rating Scale was used as a criterion to measure the level of anxiety in Group I and II at four different intervals that are before pre anesthetic check up (PAC), after showing videos and images in Group I, 1 h before surgery and 8 h after surgery. Statistical Analysis: The results of observation of both the groups at different intervals time were statistically compared and analyzed. These characteristics were analyzed using the "Chi-square tests" and "unpaired t-test." Results: Video and images information if done preoperatively have been shown to reduce patient's anxiety, although little is known regarding the effects of the method. Conclusion: Showing videos/images of hospital journey for educating the patients before the operation is beneficial to patients undergoing elective surgery.

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Randomized controlled trial for evaluating the analgesic effect of nalbuphine as an adjuvant to bupivacaine in supraclavicular block under ultrasound guidance

Nazia Nazir, Shruti Jain

Anesthesia: Essays and Researches 2017 11(2):326-329

Introduction: Benefits of regional anesthesia can be prolonged by adding adjuvants to local anesthetics. This study was designed to test the efficacy of adding nalbuphine to bupivacaine in supraclavicular brachial plexus blockade using ultrasound (US) guidance. Methodology: This was a prospective, randomized, double-blind study involving sixty patients of either sex undergoing elective orthopedic procedures of upper limb. In control Group C (n = 30), 30 mL of 0.375% bupivacaine + 1 mL normal saline and in study Group N (n = 30), 30 mL of 0.375% bupivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under US guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia (DOA), and any adverse events. Data between the groups were analyzed using independent t-test with SPSS 16.0 software. Results: In Group N, there was a statistically significant shorter time to onset of sensory blockade (4.89 ± 1.5 vs. 14.62 ± 1.73 min, P = 0.000), longer duration of sensory block (373.17 ± 15.56 min vs. 157.82 ± 11.02 min, P = 0.000), shorter onset time to achieve motor block (8.83 ± 1.9 min vs. 18.76 ± 1.75 min, P = 0.000), longer duration of motor block (313.92 ± 16.22 min vs. 121.87 ± 16.62 min, P = 0.000), and prolonged analgesia (389.33 ± 14.52 min vs. 171.65 ± 19.79 min, P = 0.000). Conclusion: Nalbuphine when added to bupivacaine as an adjuvant in supraclavicular block significantly shortened the onset of sensory and motor block and enhanced the duration of sensory and motor block and DOA.

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Comparison between conventional and ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries

Kiran Abhayakumar Honnannavar, Mahantesh Shivangouda Mudakanagoudar

Anesthesia: Essays and Researches 2017 11(2):467-471

Introduction: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Hence, this study was planned for comparing the efficacy of conventional supraclavicular brachial plexus block with ultrasound-guided technique. Subjects and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and C (Group C). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting paresthesia is less compared to ultrasound, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was not statistically significant. The success rate of the block is more in ultrasound group than conventional group which was not clinically significant. The incidence of complications was seen more in conventional method. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic.

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Effect of pregabalin premedication on the requirement of anesthetic and analgesic drugs in laparoscopic cholecystectomy: Randomized comparison of two doses

Prasoon Gupta, Anudeep Saxena, Lalita Chaudhary

Anesthesia: Essays and Researches 2017 11(2):330-333

Background: Preoperative medication has a vital role in anesthesia. Pregabalin (PG) is a newer drug of gabapentinoid class and is six times more potent than gabapentin. Our study was designed to evaluate the effect of PG as premedication on the perioperative anesthetic requirement and analgesia. Materials and Methods: The study was conducted on ninety patients of American Society of Anesthesiologists Grade I and II of age group 20–60 years, allocated to one of the three groups of thirty patients each. Group I received tablet diazepam 10 mg HS and 5 mg 1 h before surgery, Group II received capsule PG 75 mg HS and 150 mg 1 h before surgery, and Group III received capsule PG 75 mg HS and 300 mg 1 h before surgery. Patients were induced with injection fentanyl citrate, thiopentone sodium, and rocuronium bromide and maintained by 66% N2O + 33% O2gas mixture with sevoflurane and intermittent boluses of fentanyl. Results: Perioperative consumption of thiopentone sodium was 5.59 ± 0.49 mg/kg in Group I, 4.29 ± 0.53 mg/kg in Group II, and 4.06 ± 0.59 mg/kg in Group III; fentanyl was 1.55 ± 0.42 μg/kg in Group I, 1.00 ± 0.00 μg/kg in Group II, and 1.05 ± 0.20 μg/kg in Group III; sevoflurane (%) was 1.20 ± 0.31 in Group I, 0.933 ± 0.25 in Group II, and 1.00 ± 0.00 in Group III. Perioperative requirement of thiopentone sodium, opioid, and inhalational agent was significantly less in Group II and III when compared with Group I. Maximum number of patients required postoperative rescue analgesia within 0–2 h of surgery in Group I, 2–4 h of surgery in Group II, and 6–8 h after surgery in Group III. Patients were more comfortable and asleep with a longer pain-free postoperative period in PG groups. Conclusion: PG premedication effectively reduced the consumption of all anesthetic agents during induction and maintenance of anesthesia as compared to diazepam. Patient's postoperative comfort and pain-free duration were also greater with PG premedication; more so with PG 300 mg as compared to PG 150 mg.

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Improving the Sexual Health of Young People With Mobility Impairments: Challenges and Recommendations

This mixed-method study (a) describes challenges to providing sexual health services to youth with mobility impairments from the perspective of health care providers and experts and (b) describes and compares sexual health–related experiences of youth with mobility impairments.

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Surveillance after positive colonoscopy based on adenoma characteristics

Patients with adenomatous polyps are at increased risk for developing colorectal cancer based on the characteristics and number of polyps, but less is known about the individual and combined contribution of these factors. This study aimed to better characterize the risk of advanced adenoma and cancer in patients with positive baseline colonoscopy.

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Brain network dynamics in the human articulatory loop

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Fractional amplitude of low-frequency fluctuations is disrupted in Alzheimer’s disease with depression

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The Influence of Cognitive Impairment on the Fitness–Cognition Relationship in Multiple Sclerosis

Introduction: Cognitive processing speed impairment (PSI) is common and debilitating in persons with multiple sclerosis (MS). Exercise training has been proposed as a behavioral approach for possibly managing MS-related processing speed dysfunction, largely based on cross-sectional studies of the relationship of cardiorespiratory fitness and cognitive processing speed. However, there is minimal evidence supporting exercise training as a treatment for MS-related PSI, as the vast majority of the existing studies have examined exercise and cardiorespiratory fitness effects on cognition in samples of noncognitively impaired persons with MS. To that end, the current cross-sectional investigation examined whether cardiorespiratory fitness was differentially associated with processing speed in persons with MS with and without PSI. Methods: Sixty-four persons with MS undertook the Symbol Digit Modalities Test for establishing groups with and without MS-related PSI, a modified flanker task for measuring processing speed performance, and an incremental exercise test to exhaustion on a cycle ergometer for measuring cardiorespiratory fitness in a single testing session. Bivariate correlations were performed on cardiorespiratory fitness and processing speed outcomes in PSI group subsamples. Results: In the sample without PSI, cardiorespiratory fitness was not significantly associated with processing speed (P = 0.08). However, in the sample with PSI, cardiorespiratory fitness was significantly associated with processing speed (P = 0.01), such that lower cardiorespiratory fitness was strongly associated with slower processing speed. Conclusions: This study provides preliminary evidence of a significant association between cardiorespiratory fitness and processing speed in persons with MS-related PSI. Such an investigation provides the first direct support for aerobic exercise training as a possible behavioral approach for managing/treating MS-related cognitive impairment, beyond merely improving cognitive performance.

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Cold Water Mediates Greater Reductions in Limb Blood Flow than Whole Body Cryotherapy

Purpose: Cold-water immersion (CWI) and whole body cryotherapy (WBC) are widely used recovery methods in an attempt to limit exercise-induced muscle damage, soreness, and functional deficits after strenuous exercise. The aim of this study was to compare the effects of ecologically valid CWI and WBC protocols on postexercise lower limb thermoregulatory, femoral artery, and cutaneous blood flow responses. Methods: Ten males completed a continuous cycle exercise protocol at 70% maximal oxygen uptake until a rectal temperature of 38°C was attained. Participants were then exposed to lower-body CWI (8°C) for 10 min, or WBC (−110°C) for 2 min, in a randomized crossover design. Rectal and thigh skin, deep, and superficial muscle temperatures, thigh, and calf skin blood flow (laser Doppler flowmetry), superficial femoral artery blood flow (duplex ultrasound), and arterial blood pressure were measured before, and for 40 min post, cooling interventions. Results: Greater reductions in thigh skin (CWI, −5.9°C ± 1.8°C; WBC, 0.2°C ± 0.5°C; P

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Cortical and Physical Function after Mild Traumatic Brain Injury

Purpose: The aim of this study was to prospectively examine the association between intracortical inhibition and functional recovery after mild traumatic brain injury (mTBI). Methods: Twenty individuals with mTBI and 20 matched control participants were assessed using transcranial magnetic stimulation, the Attentional Network Test, and gait analysis. Hierarchical linear modeling was used to longitudinally examine potential differences between groups and relationships in the pattern of recovery in cortical silent period (CSP) duration, cognitive reaction time, and single- and dual-task walking speeds across five testing time points. Individuals with mTBI were assessed within 72 h of injury, and again at 1 wk, 2 wk, 1 month, and 2 months postinjury. After initial testing, control participants followed a similar timeline. Results: At the 72-h time point, the group with mTBI had longer reaction time (b = −91.76, P = 0.01), similar single-task walking speed (b = 0.055, P = 0.10), and slower dual-task walking speed (b = 0.10, P = 0.012) compared with control participants. The CSP duration also tended to be longer in individuals with mTBI than controls at the 72-h time point (b = −16.34, P = 0.062). The change is CSP duration over time was not significantly associated with the change in reaction time (b = −0.19, P = 0.47), single-task walking speed (b = 0.0001, P = 0.53), or dual-task walking speed (b

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Individual Variation in Hunger, Energy Intake, and Ghrelin Responses to Acute Exercise

Purpose: This study aimed to characterize the immediate and extended effect of acute exercise on hunger, energy intake, and circulating acylated ghrelin concentrations using a large data set of homogenous experimental trials and to describe the variation in responses between individuals. Methods: Data from 17 of our group's experimental crossover trials were aggregated yielding a total sample of 192 young, healthy males. In these studies, single bouts of moderate to high-intensity aerobic exercise (69% ± 5% V˙O2 peak; mean ± SD) were completed with detailed participant assessments occurring during and for several hours postexercise. Mean hunger ratings were determined during (n = 178) and after (n = 118) exercise from visual analog scales completed at 30-min intervals, whereas ad libitum energy intake was measured within the first hour after exercise (n = 60) and at multiple meals (n = 128) during the remainder of trials. Venous concentrations of acylated ghrelin were determined at strategic time points during (n = 118) and after (n = 89) exercise. Results: At group level, exercise transiently suppressed hunger (P

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ASC Methylation and Interleukin-1β Are Associated with Aerobic Capacity in Heart Failure

Background: Aerobic capacity, as measured by peak oxygen uptake (V˙O2), is one of the most powerful predictors of prognosis in heart failure (HF). Inflammation is a key factor contributing to alterations in aerobic capacity, and interleukin (IL)-1 cytokines are implicated in this process. The adaptor protein ASC is necessary for inflammasome activation of IL-1β and IL-18. ASC expression is controlled through epigenetic modification; lower ASC methylation is associated with worse outcomes in HF. The purpose of this study is to examine the relationships between ASC methylation, IL-1β, and IL-18 with V˙O2peak in persons with HF. Methods: This study examined the relationship between ASC methylation, IL-1β, and IL-18 with V˙O2peak in 54 stable outpatients with HF. All participants were NYHA class II or III, not engaged in an exercise program, and physically able to complete an exercise treadmill test. Results: Mean V˙O2peak was 16.68 ± 4.7 mL·kg−1·min−1. V˙O2peak was positively associated with mean percent ASC methylation (r = 0.47, P = 0.001) and negatively associated with IL-1β (r = −0.38, P = 0.007). Multiple linear regression models demonstrated that V˙O2peak increased by 2.30 mL·kg−1·min−1 for every 1% increase in ASC methylation and decreased by 1.91 mL·kg−1·min−1 for every 1 pg·mL−1 increase in plasma IL-1β. Conclusions: Mean percent ASC methylation and plasma IL-1β levels are associated with clinically meaningful differences in V˙O2peak in persons with HF. Inflammasome activation may play a mechanistic role in determining aerobic capacity. ASC methylation is a potentially modifiable mechanism for reducing the inflammatory response, thereby improving aerobic capacity in HF.

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Clinical Guide to Positional Release Therapy

No abstract available

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Inflammation Relates to Resistance Training–induced Hypertrophy in Elderly Patients

Purpose: Aging is associated with a gradual loss of muscle mass, which some have suggested to be accelerated by short periods of muscle disuse due to medical illness. We investigated the effect of hospitalization on skeletal muscle mass in acutely ill geriatric patients with focus on the relationship between systemic inflammatory marker C-reactive protein (CRP) and changes in muscle mass, as well as the influence of resistance training upon muscle mass. Method: Unilateral leg press resistance exercise was conducted daily during the hospital period. Outcomes included changes in whole body and regional lean mass, maximal voluntary contraction of the knee extensors, leg extension power, and functional performance. Activity level was measured using ActivPAL accelerometers, and CRP levels were obtained from blood samples. Results: Sixteen subjects completed the study (eight men and eight women, age = 84.8 ± 1.9 yr, mean ± SE). Lean mass at the midthigh region of the trained leg increased by 2.4% ± 1.1% (P

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Protein Supplementation Does Not Affect Myogenic Adaptations to Resistance Training

It has been proposed that protein supplementation during resistance exercise training enhances muscle hypertrophy. The degree of hypertrophy during training is controlled in part through the activation of satellite cells and myonuclear accretion. Purpose: This study aimed to determine the efficacy of protein supplementation (and the type of protein) during traditional resistance training on myofiber cross-sectional area, satellite cell content, and myonuclear addition. Methods: Healthy young men participated in supervised whole-body progressive resistance training 3 d·wk−1 for 12 wk. Participants were randomized to one of three groups ingesting a daily 22-g macronutrient dose of soy–dairy protein blend (PB, n = 22), whey protein isolate (WP, n = 15), or an isocaloric maltodextrin placebo (MDP, n = 17). Lean mass, vastus lateralis myofiber-type–specific cross-sectional area, satellite cell content, and myonuclear addition were assessed before and after resistance training. Results: PB and the pooled protein treatments (PB + WP = PRO) exhibited a greater whole-body lean mass %change compared with MDP (P = 0.057 for PB) and (P = 0.050 for PRO), respectively. All treatments demonstrated similar leg muscle hypertrophy and vastus lateralis myofiber-type–specific cross-sectional area (P

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Bracing of the Reconstructed and Osteoarthritic Knee during High Dynamic Load Tasks

Purpose: Lateral compartment osteoarthritis accompanied by abnormal knee biomechanics is frequently reported in individuals with knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate changes in knee biomechanics produced by an adjusted and unadjusted varus knee brace during high dynamic loading activities in individuals with lateral knee osteoarthritis after ACLR and valgus malalignment. Methods: Nineteen participants who had undergone ACLR 5 to 20 yr previously and had symptomatic and radiographic lateral knee osteoarthritis with valgus malalignment were assessed. Quantitative motion analysis experiments were conducted during hopping, stair ascent, and descent under three test conditions: (i) no brace, (ii) unadjusted brace with sagittal plane support and neutral frontal plane alignment, and (iii) adjusted brace with sagittal plane support and varus realignment (valgus to neutral). Sagittal, frontal, and transverse plane knee kinematics, external joint moment, and angular impulse data were calculated. Results: Relative to an unbraced knee, braced conditions significantly increased knee flexion and adduction angles during hopping (P = 0.003 and P = 0.005; respectively), stair ascent (P = 0.003 and P 0.05). Conclusion: A knee brace, with or without varus alignment, can modulate knee kinematics and external joint moments during hopping, stairs ascent, and descent in individuals with predominant lateral knee osteoarthritis after ACLR. Longer-term use of a brace may have implications in slowing osteoarthritis progression.

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Terbutaline Accumulates in Blood and Urine after Daily Therapeutic Inhalation

Purpose: This study investigated pharmacokinetics of terbutaline after single and seven consecutive days of inhalation in exercising trained men. Methods: Twelve healthy trained men underwent two pharmacokinetic trials comparing single dose (2 mg) and seven consecutive days (2 mg·d−1) of inhaled terbutaline. After inhalation of terbutaline at each trial, subjects performed 90 min of bike ergometer exercise at 55%–65% of maximal oxygen consumption after which they stayed inactive. Blood and urine samples were collected before and after inhalation of terbutaline. Samples were analyzed by high-performance liquid chromatography–tandem mass spectrometry. Results: Maximum serum concentration of terbutaline (Cmax) (6.4 ± 1.2 vs 4.9 ± 1.2 ng·mL−1, P = 0.01) (mean ± 95% confidence interval) and area under serum concentration–time curve from 0 to 4 h after inhalation (AUC0–4) (16 ± 3 vs 13 ± 2 ng·mL−1·h−1, P ≤ 0.005) were higher after 7 d of inhalation compared with the first day. Seven days of terbutaline inhalation resulted in accumulation of terbutaline in urine, in which total urine excretion of terbutaline was higher after 7 d of inhalation compared with the first day (274 ± 43 vs 194 ± 33 μg, P ≤ 0.001). These differences were partly attributed to systemic accumulation of terbutaline after consecutive days of inhalation, in that baseline serum and urine samples revealed incomplete elimination of terbutaline. Conclusion: Terbutaline accumulates in serum and urine after consecutive days of inhalation. For doping control purposes, these observations are of relevance if a urine threshold and decision limit is to be introduced for terbutaline on the World Anti-Doping Agency's list of prohibited substances because asthmatic athletes may use their bronchorelievers for consecutive days.

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Visual Motion Processing Subserves Faster Visuomotor Reaction in Badminton Players

Introduction: Athletes participating in ball or racquet sports have to respond to visual stimuli under critical time pressure. Previous studies used visual contrast stimuli to determine visual perception and visuomotor reaction in athletes and nonathletes; however, ball and racquet sports are characterized by motion rather than contrast visual cues. Because visual contrast and motion signals are processed in different cortical regions, this study aimed to determine differences in perception and processing of visual motion between athletes and nonathletes. Methods: Twenty-five skilled badminton players and 28 age-matched nonathletic controls participated in this study. Using a 64-channel EEG system, we investigated visual motion perception/processing in the motion-sensitive middle temporal (MT) cortical area in response to radial motion of different velocities. In a simple visuomotor reaction task, visuomotor transformation in Brodmann area 6 (BA6) and BA4 as well as muscular activation (EMG onset) and visuomotor reaction time (VMRT) were investigated. Stimulus- and response-locked potentials were determined to differentiate between perceptual and motor-related processes. Results: As compared with nonathletes, athletes showed earlier EMG onset times (217 vs 178 ms, P

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A Validation Study of the Fitbit One in Daily Life Using Different Time Intervals

Purpose: Accelerometer-based wearables can provide the user with real-time feedback through the device's interface and the mobile platforms. Few studies have focused on the minute-by-minute validity of wearables, which is essential for high-quality real-time feedback. This study aims to assess the validity of the Fitbit One compared with the ActiGraph GT3x + for assessing physical activity (i.e., steps, time spent in moderate, vigorous, and moderate–vigorous physical activity) in young adults using traditional time intervals (i.e., days) and smaller time intervals (i.e., minutes and hours). Methods: Healthy young adults (N = 34) wore the ActiGraph GT3x+ and a Fitbit One for 1 wk. Three aggregation levels were used: minute, hour, and day. Mixed models analyses, intraclass correlation coefficients, Bland–Altman analyses, and absolute error percentage for steps per day were conducted to analyze the validity for steps and minutes spent in moderate, vigorous, and moderate–vigorous physical activity. Results: As compared with ActiGraph (mean = 9 steps per minute, 509 steps per hour and 7636 steps per day), the Fitbit One systematically overestimated physical activity for all aggregation levels: on average 0.82 steps per minute, 45 steps per hour, and 677 steps per day. Strong and significant associations were found between ActiGraph and Fitbit results for steps taken (B = 0.72–0.89). Weaker but statistically significant associations were found for minutes spent in moderate, vigorous, and moderate–vigorous physical activity for all time intervals (B = 0.39–0.57). Conclusions: Although the Fitbit One overestimates the step activity compared with the ActiGraph, it can be considered a valid device to assess step activity, including for real-time minute-by-minute self-monitoring. However, agreement and correlation between ActiGraph and Fitbit One regarding time spent in moderate, vigorous, and moderate–vigorous physical activity were lower.

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Mortality Risk Reductions from Substituting Screen Time by Discretionary Activities

Purpose: Leisure screen time, including TV viewing, is associated with increased mortality risk. We estimated the all-cause mortality risk reductions associated with substituting leisure screen time with different discretionary physical activity types, and the change in mortality incidence associated with different substitution scenarios. Methods: A total of 423,659 UK Biobank participants, without stroke, myocardial infarction, or cancer history, were followed for 7.6 (1.4) yr, median (interquartile range [IQR]). They reported leisure screen time (TV watching and home computer use) and leisure/home activities, categorized as daily life activities (walking for pleasure, light do-it-yourself [DIY], and heavy DIY) and structured exercise (strenuous sports and other exercises). Isotemporal substitution modeling in Cox regression provided hazard ratios (95% confidence intervals) for all-cause mortality when substituting screen time (30 min·d−1) with different discretionary activity types of the same duration. Potential impact fractions estimated the proportional change in mortality incidence associated with different substitution scenarios. Results: During 3,202,105 person-years of follow-up, 8928 participants died. Each 30-min·d−1 difference in screen time was associated with lower mortality hazard when modeling substitution of screen time by an equal amount of daily life activities (0.95, 0.94–0.97), as well as structured exercise (0.87, 0.84–0.90). Reallocations from screen time into specific activity subtypes suggested different reductions in mortality hazard: walking for pleasure (0.95, 0.92–0.98), light DIY (0.97, 0.94–1.00), heavy DIY (0.93, 0.90–0.96), strenuous sports (0.87, 0.79–0.95), and other exercises (0.88, 0.84–0.91). The lowest hazard estimates were found when modeling replacement of TV viewing. Potential impact fractions ranged from 4.3% (30-min·d−1 substitution of screen time into light DIY) to 14.9% (TV viewing into strenuous sports). Conclusion: Substantial public health benefits could be gained by replacing small amounts of screen time with daily life activities and structured exercise. Daily life activities may provide feasible screen time alternatives, if structured exercise is initially too ambitious.

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Sedentary Behavior, Cadence, and Physical Activity Outcomes after Knee Arthroplasty

Purpose: This study comprehensively examined sedentary behavior and physical activity patterns in people with severe knee osteoarthritis awaiting total knee arthroplasty (TKA) and in individuals after TKA. Methods: Preoperative (n = 32, mean ± SD = 69.9 ± 5.3 yr) and 1-yr postoperative participants with TKA (n = 38, 67.9 ± 7.3 yr) wore ActiGraph GT3X+ activity monitors for 6.8 ± 0.6 d. Total sedentary time, time in long sedentary bouts (≥30 min), and physical activity outcomes (steps, time in moderate-to-vigorous physical activity [MVPA], cadence) were examined. Results: There were no differences between pre- and postoperative groups for total sedentary time (9.3 ± 1.4 vs 9.2 ± 1.4 h·d−1, P = 0.62) and number of long sedentary bouts per day (median [interquartile range] = 3.4 [1.9] vs 3.1 [2.0], P = 0.37). Daily steps, peak 30-min cadence, and peak 1-min cadence values were greater in people after TKA compared with those awaiting surgery (5935 [3316] vs 3724 [2338], 55.6 [31.0] vs 35.9 [19.3], and 91.5 ± 20.6 vs 70.0 ± 23.7, respectively, all P

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Change in Sedentary Time, Physical Activity, Bodyweight, and HbA1c in High-Risk Adults

Purpose: In recent years, there has been a migration toward the use of glycated hemoglobin (HbA1c) in determining glycemic control. This study aimed to quantify the associations between changes in body weight, sedentary time, and moderate to vigorous physical activity (MVPA) time with HbA1c levels for a 3-yr period among adults at high risk of type 2 diabetes. Methods: This study reports baseline and 3-yr follow-up data from the Walking Away from Type 2 Diabetes study. ActiGraph GT3X accelerometers captured sedentary time and MVPA. Linear regression examined the independent associations of changes in sedentary time, MVPA, and body weight with HbA1c between baseline and 3-yr follow-up. Results: The sample composed of 489 participants (mean age = 64.2 ± 7.3 yr, body mass index = 31.7 ± 5.1, 63.4% male) with valid baseline and follow-up accelerometer, body weight, and HbA1c data. After adjustment for known confounders, an increase in MVPA time (per 30 min·d−1) was associated with a decrease in HbA1c percentage (β = −0.11 [−0.18 to −0.05], P = 0.001), and an increase in body weight (per 6 kg) was associated with an increase in HbA1c percentage (β = 0.08 [0.04–0.12], P

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Modeling Perceived Exertion during Graded Arm Cycling Exercise in Spinal Cord Injury

Purpose: RPE may be useful for exercise testing and prescription in individuals with spinal cord injury (SCI), although the roles of differentiated central and peripheral fatigue during exercise are not clear. We aimed to model differentiated RPE responses during graded arm cycling in individuals with SCI and to describe their relationship to cardiorespiratory outcomes. Methods: Thirty-six individuals with SCI (13 paraplegia and 23 tetraplegia) completed a maximal graded arm cycling exercise test to volitional exhaustion (5 W·min−1 paraplegia; 10 W·min−1 tetraplegia). Participants were asked to report central RPE (CRPE) and peripheral RPE (PRPE) every minute using the Borg category ratio (CR10) scale until termination of exercise. Heart rate and breath-by-breath respiratory outcomes were collected throughout the exercise test. Ventilatory threshold (VT) was assessed using the ventilatory equivalents method. Results: Cardiorespiratory indices increased linearly during graded arm exercise. By contrast, both CRPE and PRPE responses were best fit to a quadratic model with positively accelerating growth in individuals with paraplegia (P

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Differential Motor Unit Changes after Endurance or High-Intensity Interval Training

Purpose: Using a novel technique of high-density surface EMG decomposition and motor unit (MU) tracking, we compared changes in the properties of vastus medialis and vastus lateralis MU after endurance (END) and high-intensity interval training (HIIT). Methods: Sixteen men were assigned to the END or the HIIT group (n = 8 each) and performed six training sessions for 14 d. Each session consisted of 8–12 × 60-s intervals at 100% peak power output separated by 75 s of recovery (HIIT) or 90–120 min continuous cycling at ~65% V˙O2peak (END). Pre- and postintervention, participants performed 1) incremental cycling to determine V˙O2peak and peak power output and 2) maximal, submaximal (10%, 30%, 50%, and 70% maximum voluntary contraction [MVC]), and sustained (until task failure at 30% MVC) isometric knee extensions while high-density surface EMG signals were recorded from the vastus medialis and vastus lateralis. EMG signals were decomposed (submaximal contractions) into individual MU by convolutive blind source separation. Finally, MU were tracked across sessions by semiblind source separation. Results: After training, END and HIIT improved V˙O2peak similarly (by 5.0% and 6.7%, respectively). The HIIT group showed enhanced maximal knee extension torque by ~7% (P = 0.02) and was accompanied by an increase in discharge rate for high-threshold MU (≥50% knee extension MVC) (P 0.05). Conclusions: HIIT and END induce different adjustments in MU discharge rate despite similar improvements in cardiopulmonary fitness. Moreover, the changes induced by HIIT are specific for high-threshold MU. For the first time, we show that HIIT and END induce specific neuromuscular adaptations, possibly related to differences in exercise load intensity and training volume.

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The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism

Purpose: This study aimed to investigate the effect of feeding carbohydrate and protein (CHO + PRO), immediately or 2 h after an exhaustive run, on the bone turnover response in endurance runners. Methods: Ten men (age = 28 ± 5 yr, height = 1.74 ± 0.05 m, body mass [BM] = 69.7 ± 6.3 kg) performed treadmill running at 75% V˙O2max, until exhaustion, on three occasions. Blood was collected before and immediately, 1, 2, 3, 4, and 24 h postexercise, for measurement of β-CTX, P1NP, parathyroid hormone, PO4, ACa, and Ca2+. This was a randomized, counterbalanced, placebo-controlled, and single-blinded crossover study. The three trials were (i) placebo (PLA), where the PLA solution was ingested immediately and 2 h postexercise; (ii) immediate feeding (IF), where CHO + PRO (1.5 g·kg−1 BM dextrose and 0.5 g·kg−1 BM whey) was ingested immediately postexercise and PLA 2 h postexercise; and (iii) delayed feeding (DF), where PLA was ingested immediately postexercise and CHO + PRO solution 2 h postexercise. Data were analyzed using repeated-measures ANOVA and Tukey's HSD post hoc test. Results: At 1 and 2 h postexercise, β-CTX concentrations were lower in the IF trial compared with the DF and PLA trials (P ≤ 0.001). At 3 h postexercise, β-CTX concentrations were higher in the PLA trial compared with the IF (P ≤ 0.001) and DF trials (P = 0.026). At 4 h postexercise, β-CTX concentrations were lower in the DF trial compared with the IF (P = 0.003) and PLA trials (P ≤ 0.001). At 4 h postexercise, P1NP was higher in the IF trial compared with the DF (P = 0.026) and PLA trials (P = 0.001). At 3 h postexercise, parathyroid hormone was higher in the IF trial compared with the DF trial (P ≤ 0.001). Conclusions: After exhaustive running, immediate ingestion of CHO + PRO may be beneficial, as it decreases bone resorption marker concentrations and increases bone formation marker concentrations, creating a more positive bone turnover balance.

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Effects of High-Intensity Training on Physiological and Hormonal Adaptions in Well-Trained Cyclists

Purpose: Investigate development of specific performance adaptions and hormonal responses every fourth week during a 12-wk high-intensity training (HIT) period in groups with different interval-training prescriptions. Methods: Sixty-three well-trained cyclists performing a 12-wk intervention consisting of two to three HIT sessions per week in addition to ad libitum low-intensity training. Groups were matched for total training load, but increasing HIT (INC) group (n = 23) performed interval-sessions as 4 × 16 min in weeks 1–4, 4 × 8 min in weeks 5–8, and 4 × 4 min in weeks 9–12. Decreasing HIT (DEC) group (n = 20) performed interval sessions in the opposite order as INC, and mixed HIT (MIX) group (n = 20) performed all interval-sessions in a mixed distribution during 12 wk. Cycling-tests and measures of resting blood hormones were conducted pre, weeks 4, 8, and 12. Results: INC and MIX achieved >70% of total change in workload eliciting 4 mmol·L−1 [la−] (Power4mM) and V˙O2peak during weeks 1–4, versus only 34%–38% in DEC. INC induced larger improvement versus DEC during weeks 1–4 in Power4mM (effect size, 0.7) and V˙O2peak (effect size, 0.8). All groups increased similarly in peak power output during weeks 1–4 (64%–89% of total change). All groups' pooled, total and free testosterone and free testosterone/cortisol ratio decreased by 22% ± 15%, 13% ± 23%, and 14% ± 31% (all P

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Compensatory Changes in Energy Balance Regulation over One Athletic Season

Purpose: Mechanisms in energy balance (EB) regulation may include compensatory changes in energy intake (EI) and metabolic adaption (MA), but information is unavailable in athletes who often change EB components. We aim to investigate EB regulation compensatory mechanisms over one athletic season. Methods: Fifty-seven athletes (39 males/18 females; handball, volleyball, basketball, triathlon, and swimming) were evaluated from the beginning to the competitive phase of the season. Resting and total energy expenditure (REE and TEE, respectively) were assessed by indirect calorimetry and doubly labeled water, respectively, and physical activity energy expenditure was determined as TEE − 0.1(TEE) − REE. Fat mass (FM) and fat-free mass (FFM) were evaluated by dual-energy x-ray absorptiometry and changed body energy stores was determined by 1.0(ΔFFM/Δtime) + 9.5(ΔFM/Δtime). EI was derived as TEE + EB. REE was predicted from baseline FFM, FM, sex, and sports. %MA was calculated as 100(measured REE/predicted REE-1) and MA (kcal) as %MA/100 multiplied by baseline measured REE. Average EI minus average physical activity energy expenditure was computed as a proxy of average energy availability, assuming that a constant nonexercise EE occurred over the season. Results: Body mass increased by 0.8 ± 2.5 kg (P

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Two Loci Contribute Epistastically to Heterospecific Pollen Rejection, a Postmating Isolating Barrier Between Species

Recognition and rejection of heterospecific male gametes occurs in a broad range of taxa, although the complexity of mechanisms underlying these components of postmating cryptic female choice is poorly understood. In plants, the arena for postmating interactions is the female reproductive tract (pistil), within which heterospecific pollen tube growth can be arrested via active molecular recognition and rejection. Unilateral incompatibility (UI) is one such postmating barrier in which pollen arrest occurs in only one direction of an interspecific cross. We investigated the genetic basis of pistil-side UI between Solanum species, with the specific goal of understanding the role and magnitude of epistasis between UI QTL. Using heterospecific introgression lines (ILs) between Solanum pennellii and S. lycopersicum, we assessed the individual and pairwise effects of three chromosomal regions (ui1.1, ui3.1, and ui12.1) previously associated with interspecific UI among Solanum species. Specifically, we generated double introgression ('pyramided') genotypes that combined ui12.1 with each of ui1.1 and ui3.1, and assessed the strength of UI pollen rejection in the pyramided lines, compared to single introgression genotypes. We found that none of the three QTL individually showed UI rejection phenotypes, but lines combining ui3.1 and ui12.1 showed significant pistil-side pollen rejection. Furthermore, double introgression lines that combined different chromosomal regions overlapping ui3.1 differed significantly in their rate of UI, consistent with at least two genetic factors on chromosome three contributing quantitatively to interspecific pollen rejection. Together, our data indicate that loci on both chromosomes 3 and 12 are jointly required for the expression of UI between S. pennellii and S. lycopersicum, suggesting that coordinated molecular interactions among a relatively few loci underlie the expression of this postmating prezygotic barrier. In addition, in conjunction with previous data, at least one of these loci appears to also contribute to conspecific self-incompatibility, consistent with a partially shared genetic basis between inter- and intraspecific mechanisms of postmating prezygotic female choice.

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Surveillance after positive colonoscopy based on adenoma characteristics

Patients with adenomatous polyps are at increased risk for developing colorectal cancer based on the characteristics and number of polyps, but less is known about the individual and combined contribution of these factors. This study aimed to better characterize the risk of advanced adenoma and cancer in patients with positive baseline colonoscopy.

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Microtubule Motor Proteins and the Mechanisms of Synaptic Plasticity

Microtubule motor proteins – kinesins and dyneins – play an important role in intracellular transport. Impairments to axon transport can influence neurotransmitter release and short-term presynaptic plasticity. Impairments to dendritic transport, particularly recycling of synaptic receptors, affect postsynaptic plasticity. This review seeks to follow the link between microtubule motor proteins and the mechanisms of synaptic plasticity from the point of view of their involvement in transporting proteins and organelles, where their role in the mechanisms of synaptic plasticity has been demonstrated.

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Changes in Nociceptive Thresholds and Adenylyl Cyclase System Activity in Skeletal Muscles in Rats with Acute and Mild Type 1 Diabetes

Diabetic peripheral neuropathy (DPN) is one of the commonest complications of type 1 diabetes mellitus (DM1). The aims of the present work were to study the dynamics of the development of pain-type DPN and the functional status of the hormone-sensitive adenylyl cyclase signal system (ACSS) in the skeletal muscle of rats with models of acute and mild DM1 and to investigate the influences on these of insulin therapy using different routes of hormone administration – intranasal and peripheral. The nociceptive threshold in rats decreased in both models of DM1; the stimulatory effects of guanine nucleotides (GIDP) and adrenergic agonists (isoproterenol, BRL-37344) on adenylyl cyclase (AC) also decreased. The AC-stimulating effect of relaxin decreased in animals with acute DM1, while the change in mild DM1 was minor. Peripheral administration of insulin to rats with acute DM1 increased the nociceptive threshold and partially restored the AC effect of the β3 agonist BRL-37344. Intranasal administration of insulin to rats with mild DM1 also led to an increase in the nociceptive threshold and partially restored basal and BRL-37344-stimulated AC activity in the skeletal muscle of diabetic animals. Thus, skeletal muscle in rats with acute and mild DM1 showed impaired nociceptive sensitivity and ACSS function, which was partially restored by treatment of animals with insulin given peripherally (acute DM1) or intranasally (mild DM1).

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GABA Receptors in the Modulation of Fear Memory Extinction

γ-Aminobutyric acid (GABA) is a the main inhibitory transmitter in the central nervous system, which determines the efficiency of neuronal interactions. GABA receptors play a key role in various stages of fear memory – formation, consolidation, retention, reconsolidation, and extinction. Extinction is an important behavioral phenomenon which allows the body to adapt its behavior to changes in the surrounding world. Fear memory extinction constitutes "new" learning, which interferes with the expression of a previously acquired conditioned fear reaction. This review summarizes our own and published data on the GABAergic modulation of fear memory extinction and the potential for pharmacological correction of impairments to this process by actions on GABA_A and GABA_B receptors.

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Morphometric Evaluation of the Neuroprotective Action of an Extract of Astragalus Membranaceous in the Brains of Rats during Restraint Stress

The aims of the present work were to analyze histological and morphometric changes in the brain in rats subjected to restraint stress and to evaluate the neuroprotective action of an Astragalus membranaceous extract (AE). Experiments were performed on three groups of Wistar rats (six per group): group 1 consisted of intact rats, group 2 of controls, i.e., animals subjected to restraint stress for 18 h, and group 3 of animals given p.o. AE (50 mg/kg) for seven days and subjected to restraint stress. The level of stress-induced brain injury was assessed morphometrically, on the basis of the proportions of unaltered neurons, hyperchromic shrunken neurons, and neurons with signs of dystrophy in layers III–V of the cerebral cortex and hippocampal field CA1, per unit area. Restraint stress in rats led to clear neuron damage in the cerebral cortex and hippocampus. AE limited stress-induced neuronal injury: the proportion of hyperchromic shrunken neurons in the cerebral cortex and hippocampus decreased by factors of 3 and 4.6, respectively, from the level seen in controls.

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The Potential of Music Therapy in Neurology Using Multiple Sclerosis as an Example

Review of studies of music therapy provides evidence of its important role in the nondrug treatment of patients with acute and chronic diseases, including demyelinating disorders. Existing research has demonstrated the efficacy of music therapy in terms of both improving patients' social skills, improving cognitive functions, decreasing the severity of depression and anxiety, and improving sleep and decreasing pain in patients with multiple sclerosis.

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Potential of Positron Emission Tomography for Studies of the Mechanisms of Development of Multiple Sclerosis (published data and authors’ results)

This article presents published data and results from our own studies of the use of positron emission tomography (PET) with different radiotracers in multiple sclerosis (MS). Information on the principles of PET is given and grounds are presented for performing PET studies with different radiopharmaceuticals. PET investigation results obtained in MS with different courses are presented, including investigations to identify the locations of neuron damage in the cortical gray matter, to assess microglial activation, and to study the link between glucose metabolism in the brain and the severity of cognitive impairment in MS, yielding new data on the pathogenesis and mechanisms of development of the disease.

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Results of an Open Prospective Trial of β-Interferon Bioanalogs

Objective. To study the safety and efficacy of bioanalog multiple sclerosis disease-modifying drugs (MS DMD) using an example population consisting of patients living in the Yaroslavl District (the Yaroslavl cohort) in a prospective, nonrandomized, open, long-term trial. Materials and methods. A total of 203 patients were recruited into the study and received bioanalog MS DMD for 30 months in compliance with the instructions for use. Efficacy was evaluated in terms of exacerbation frequency, dynamics of EDSS scores, and changes in the number of foci on T2-weighted images (T2-WI) on MRI scans. Safety was assessed by determining the proportions of patients experiencing adverse events during treatment. Reference points were values at baseline and 30 months. Results. A significant decrease in exacerbation frequency was seen with all bioanalogs as compared with baseline (by 0.30 with CinnoVex, 0.29 with Genfaxon, 0.13 with Ronbetal/interferon β-1b, and 0.36 with Infibeta). Use of all study analogs except Infibeta was associated with significant increases in EDSS scores (by +0.31 with Cinnovex, +0.38 with Genfaxon, +0.66 with Ronbeta/interferon β-1b, and +0.26 with Infibeta). MRI data showed increases in the numbers of foci in groups receiving CinnoVex (by 16.6%), Genfaxon (by 14.4%), and Ronbetal (by 10.6%), and a decrease in the number of foci on T2-WI in patients treated with Infibeta (by 14.5%). The most marked generalized reactions were seen on treatment with CinnoVex (influenza-like syndrome in 66% of cases); local reactions were most marked in the Genfaxon group, occurring in 82% of cases. Conclusions. Differences in the safety and efficacy profiles of individual bioanalogs of original MS DMD again draw attention to the need for detailed study of the effects of drugs in the framework of postmarketing trials, including maintaining drug company-independent registers of patients receiving the various MS DMD.

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Effects of Cold Stress on the Functional Activity of Mouse Peritoneal Macrophages in Conditions of Opiate Receptor Blockade

We report here studies of the effects of 10- and 60-min cold stress on the formation of reactive oxygen species (ROS) and cytokine production by peritoneal macrophages and corticosterone levels in conditions of opiate receptor blockade. Exposure of mice to a temperature of –20°C for 10 min led to suppression of ROS production by macrophages, and this effect was prevented by administration of naloxone. In animals exposed to 60-min stress, conversely, naloxone-dependent stimulation of ROS production was seen. Neither variant of cold stress had any significant effect on interleukin-1β production. TNF-α production on the background of 60-min cooling was stimulated in a naloxone-dependent manner in both unstimulated and zymosan-stimulated cultures. Production of IL-10 by macrophages increased regardless of the duration of cold exposure, with and without stimulation, and stopped on the background of opiate receptor blockade. Thus, the direction of action of acute cold stress on macrophage function depended on the parameter measured and the duration of exposure; opiate receptor blockade significantly modified the immunoregulatory effects of cold.

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Local Protein Synthesis in Dendritic Terminals and Its Regulation in Normal Conditions and during Plastic Changes

This review discusses the features and basic mechanisms of regulation of compartmentalized protein synthesis in dendrites. The current literature on this question is analyzed. Results of numerous experiments using molecular-biological, cytological, and physiological methods are presented. The review also contains information on various nervous system diseases for which a connection with impairments to protein translation in dendrites has been demonstrated.

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The Mobility of AMPA-Type Glutamate Receptors as a Key Factor in the Expression and Maintenance of Synaptic Potentiation

The dynamics of the expression of post-tetanic potentiation of the focal response (the P spike) in the synaptic system consisting of Schaffer collaterals and field CA1 pyramidal neurons were studied in hippocampal slices from ICR mice. Potentiation was induced by high-frequency stimulation of Schaffer collaterals (1 sec, 100 Hz). At 10 sec, all slices in the group demonstrated an increase in the amplitude of the P spike in response to test stimuli. Slices with sharp increases in amplitude to maximal levels were seen, along with slices showing smooth increases in P-spike amplitude. Studies with the transport vesicle formation blocker brefeldin A assessed the relationship between the dependence of the phase of post-tetanic potentiation on intracellular transport. Brefeldin A was added to the perfusion solution before tetanic stimulation. This treatment of slices for 60 min had no effect on the magnitude of the basal P spike or the expression of post-tetanic potentiation, though it impaired the subsequent phase, i.e., maintenance of potentiation. A drop in P-spike amplitude was seen. The integrative activity of the system supporting the delivery of glutamate receptors to dendritic spines in the numbers and at the times required for rapid changes in and prolonged maintenance of the effectiveness of neurotransmission is discussed.

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Mechanisms of Neuron Loss in Alzheimer’s Disease

One of the main elements in the pathogenesis of Alzheimer's disease consists of larger decreases in the numbers of neurons in various parts of the brain than seen in normal ageing. The relevance of studying the pathogenesis of this process arises from the fact that neuron loss starts at the early, preclinical stage of Alzheimer's disease, when amyloid plaques and neurofibrillary tangles (the main morphological signs of the disease) have still not formed; neuron loss correlates with the extent of clinical signs of the disease. Data have now accumulated on the likely pathogenetic mechanisms of neuron loss. The aim of the present literature review was to summarize these data.

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Current Concepts of the Intrathecal Humoral Immune Response and the Diagnostic Significance of the Detection of Oligoclonal Immunoglobulins in Multiple Sclerosis

Multiple sclerosis (MS) is a presumptively autoimmune demyelinating diseases of the central nervous system. We present here a literature review including a list of potential antigens inducing the autoimmune response, these including myelin and nonmyelin structures. None of the antibodies to any of these antigens has sufficient specifi city and sensitivity for use in routine laboratory practice. Oligoclonal immunoglobulins identified by isoelectric focusing (IEF) are currently the main immunological markers for MS. The sensitivity and specifi city of the IEF method are 90% and 85%, respectively. The present article also discusses additional markers such as oligoclonal IgM and the MRZ reaction.

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Va. ambulance agency receives risk management performance award

Richmond Ambulance Authority RICHMOND, Va. — The Richmond Ambulance Authority has been awarded a Virginia Municipal League Insurance Programs (VMLIP) Risk Management Performance Award for 2017. RAA was recognized Friday, May 12th at VMLIP's 2017 Annual Meeting held in Glen Allen. Each year, Risk Management Performance Awards are presented to members with a proactive risk management attitude ...

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Lowe's, Va. tech develop exosuit with lift-assist technology

The suit is designed to support employees by helping them lift and move product through the store

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Structural variants caused by Alu insertions are associated with risks for many human diseases [Genetics]

Interspersed repeat sequences comprise much of our DNA, although their functional effects are poorly understood. The most commonly occurring repeat is the Alu short interspersed element. New Alu insertions occur in human populations, and have been responsible for several instances of genetic disease. In this study, we sought to determine...

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Failure to replicate a genetic signal for sex bias in the steppe migration into central Europe [Biological Sciences]

Goldberg et al. (1) used genome-wide ancient DNA data (2) from central European Bronze Age (BA) populations and their three ancestral sources of steppe pastoralists (SP), Anatolian farmers (AF), and European hunter-gatherers (HG) to investigate whether the SP migration into central Europe after 5,000 years ago (3, 4) was sex-biased....

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