Working under the supervision of the in-house Medical Director and Program Manager, in a social detox setting that serves all member in the community through support, providing promotion of health and abilities, prevention of illness and injury, and alleviation of suffering through the assessment and treatment of physical and behavioral health conditions. As a member of a multidisciplinary team, provides ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2quY4Ew
via IFTTT
Τετάρτη 17 Μαΐου 2017
Paramedic for Social Detox unit - Common Ground
Pediatric nasal surgery prior to puberty is not only safe, but may prevent facial deformity in certain patients.
Pediatric nasal surgery: timing and technique.
από Gary, Celeste C. στο Current Opinion in Otolaryngology & Head and Neck Surgery - Published Ahead-of-Print
Μετάφραση άρθρου
Purpose of review: Timing of pediatric nasal surgery has always been a controversial topic. Concern over disrupting growing parts of the face and causing permanent facial deformity has led to a primarily conservative approach. Many surgeons feel that it is prudent to wait until the patient has completed nasal growth after puberty to pursue nasal surgery. Recent findings: Recently, this attitude has been challenged with evidence that not only is nasal surgery in the pediatric age group not a detriment to facial growth, but failure to correct significant nasal deformity may actually cause dysmorphic facial growth secondary to obligate mouth breathing. Because of this, recent studies have focused on determining safe surgical techniques for pediatric nasal surgery, including inferior turbinate reduction, septoplasty and rhinoplasty. Research focus on this topic has also been expanded to include quality-of-life measures after nasal surgery. Summary: Pediatric nasal surgery prior to puberty is not only safe, but may prevent facial deformity in certain patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
The Mapping of Predicted Triplex DNA:RNA in the Drosophila Genome Reveals a Prominent Location in Development- and Morphogenesis-Related Genes
Double-stranded DNA is able to form triple-helical structures by accommodating a third nucleotide strand. A nucleic acid triplex occurs according to Hoogsteen rules that predict the stability and affinity of the third strand bound to the Watson-Crick duplex. The "triplex-forming oligonucleotide" (TFO) can be a short sequence of RNA that binds to the major groove of the targeted duplex only when this duplex presents a sequence of purine or pyrimidine bases in one of the DNA strands. Many nuclear proteins are known to bind triplex DNA or DNA:RNA, but their biological functions are unexplored. We identified sequences that are capable of engaging as the "triplex-forming oligonucleotide" in both the pre-lncRNA and pre-mRNA collections of Drosophila melanogaster. These motifs were matched against the Drosophila genome in order to identify putative sequences of triplex formation in intergenic regions, promoters and introns/exons. Most of the identified TFOs appear to be located in the intronic region of the analyzed genes. Computational prediction of the most targeted genes by TFOs originating from pre-lncRNAs and pre-mRNAs revealed that they are restrictively associated with development- and morphogenesis-related gene networks. The refined analysis by Gene Ontology enrichment demonstrates that some individual TFOs present genome-wide scale matches that are located in numerous genes and regulatory sequences. The triplex DNA:RNA computational mapping at the genome-wide scale suggests broad interference in the regulatory process of the gene networks orchestrated by TFO RNAs acting in association simultaneously at multiple sites.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2qyopzC
via IFTTT
A Generalized Linear Model for Decomposing Cis-regulatory, Parent-of-Origin, and Maternal Effects on Allele-Specific Gene Expression
Joint quantification of genetic and epigenetic effects on gene expression is important for understanding the establishment of complex gene regulation systems in living organisms. In particular, genomic imprinting and maternal effects play important roles in the developmental process of mammals and flowering plants. However, the influence of these effects on gene expression are difficult to quantify because they act simultaneously with cis-regulatory mutations. Here we propose a simple method to decompose cis-regulatory (i.e., allelic genotype, AG), genomic imprinting (i.e., parent-of-origin, PO), and maternal (i.e., maternal genotype, MG) effects on allele-specific gene expression using RNA-seq data obtained from reciprocal crosses. We evaluated the efficiency of method using a simulated dataset and applied the method to whole-body Drosophila and mouse trophoblast stem cell (TSC) and liver RNA-seq data. Consistent with previous studies, we found little evidence of PO and MG effects in adult Drosophila samples. In contrast, we identified dozens and hundreds of mouse genes with significant PO and MG effects, respectively. Interestingly, a similar number of genes with significant PO effect were detect in mouse TSCs and livers, whereas more genes with significant MG effect were observed in livers. Further application of this method will clarify how these three effects influence gene expression levels in different tissues and developmental stages, and provide novel insight into the evolution of gene expression regulation.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2pNfGfH
via IFTTT
Essential Function of the Serine Hydroxymethyl Transferase (SHMT) Gene During Rapid Syncytial Cell Cycles in Drosophila
Many metabolic enzymes are evolutionary highly conserved and serve a central function for catabolism and anabolism of cells. The serine hydroxymethyl transferase (SHMT) catalysing the conversion of serine and glycine and vice versa feeds into the tetrahydrofolate mediated C1 metabolism. We identified a Drosophila mutation in SHMT (CG3011) in a screen for blastoderm mutants. Embryos from SHMT mutant germline clones specifically arrest the cell cycle in interphase 13 at the time of the mid blastula transition (MBT) and prior to cellularisation. The phenotype is due to a loss of enzymatic activity as it cannot be rescued by an allele with a point mutation in the catalytic center but by an allele based on the SHMT coding sequence from E. coli. Onset of zygotic gene expression and degradation of maternal RNAs in SHMT mutant embryos are largely similar to wild type embryos. The specific timing of the defects in SHMT mutants indicates that at least one of the SHMT-dependent metabolites becomes limiting in interphase 13, if it is not produced by the embryo. Our data suggest that mutant eggs contain maternally provided and SHMT-dependent metabolites in amounts which suffice for early development until interphase 13.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2qy47Xa
via IFTTT
Single-incision totally extraperitoneal inguinal hernia repair is feasible and safe in patients on antithrombotic therapy: A single-center experience of 92 procedures
Abstract
Introduction
The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair for patients on antithrombotic therapy.
Methods
A total of 365 patients who underwent SILS for totally extraperitoneal inguinal hernia repair between January 2011 and November 2015 were analyzed retrospectively. Antithrombotic drugs were stopped preoperatively, and bridging intravenous heparin therapy was given according to the operative risk of each patient. Data on the patients' characteristics and perioperative outcomes were collected from their medical records.
Results
Ninety-two patients (25%, 92/365) were treated with antithrombotic drugs preoperatively. The mean operative times for unilateral and bilateral hernia repairs were 96 min and 94 min (P = 0.5), respectively, in the antithrombotic therapy group and 140 min and 130 min (P = 0.2), respectively, in the control group. Bleeding volume was minimal in all patients. There was no significant difference in the conversion rate. The mean postoperative hospital stay was 2.5 days in the antithrombotic therapy group and 2.1 days in the control group (P = 0.1). Postoperative complications were seen in 16% (15/92) of patients in the antithrombotic therapy group and in 11% (29/273) of patients in the control group (P = 0.2). Pulmonary embolism was seen in one patient (0.4%, 1/273) in the control group.
Conclusions
SILS for totally extraperitoneal inguinal hernia repair with bridging heparin therapy can be performed safely for patients on antithrombotic therapy.
from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2qTR4lQ
via IFTTT
Motor Recovery Beginning 23 Years After Ischemic Stroke
It is widely believed that most stroke recovery occurs within 6 months, with little benefit of physiotherapy or other modalities beyond a year. We report a remarkable case of stroke recovery beginning 23 years after a severe stroke due to embolization from the innominate artery and subclavian artery, resulting from compression of the right subclavian artery by a cervical rib. The patient had a large right fronto-parietal infarction with severe left hemiparesis, and a totally non-functional spastic left hand. He experienced some recovery of hand function that began 23 years after the stroke, a year after he took up regular swimming. As a result, intensive physiotherapy was initiated, with repetetive large muscle movement and a spring-loaded mechanical orthosis that provides resistance to finger flexors and supports finger extensors. Within two years he could pick up coins with the previously useless left hand. Functional MRI studies document widespread distribution of the recovery in both hemispheres. This case provides impetus not only to more intensive and prolonged physiotherapy, but also to treatment with emerging modalities such as stem cell therapy, exosome and micro-RNA therapies.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2rsQmba
via IFTTT
Responses of Purkinje cells in the oculomotor vermis of monkeys during smooth pursuit eye movements and saccades: comparison with floccular complex
We recorded the responses of Purkinje cells in the oculomotor vermis during smooth pursuit and saccadic eye movements. Our goal was to characterize the responses in the vermis using approaches that would allow direct comparisons with responses of Purkinje cells in another cerebellar area for pursuit, the floccular complex. Simple-spike firing of vermis Purkinje cells is direction selective during both pursuit and saccades, but the preferred directions are sufficiently independent so that downstream circuits could decode signals to drive pursuit and saccades separately. Complex-spikes also were direction selective during pursuit, and almost all Purkinje cells showed a peak in the probability of complex-spikes during the initiation of pursuit in at least one direction. Unlike the floccular complex, the preferred directions for simple-spikes and complex-spikes were not opposite. The kinematics of smooth eye movement described the simple-spike responses of vermis Purkinje cells well. Sensitivities were similar to those in the floccular complex for eye position, and considerably lower for eye velocity and acceleration. The kinematic relations were quite different for saccades versus pursuit, supporting the idea that the contributions from the vermis to each kind of movement could contribute independently in downstream areas. Finally, neither the complex-spike nor the simple-spike responses of vermis Purkinje cells were appropriate to support direction learning in pursuit. Complex-spikes were not triggered reliably by an instructive change in target direction; simple-spike responses showed very small amounts of learning. We conclude that the vermis plays a different role in pursuit eye movements compared to the floccular complex.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2quFJrc
via IFTTT
Long-lasting increase in axonal excitability following epidurally applied DC
Effects of direct current (DC) on nerve fibres have primarily been investigated during or just after DC application. However, locally applied cathodal DC was recently demonstrated to increase the excitability of intraspinal preterminal axonal branches for more than one hour. The aim of this study was, therefore, to investigate whether DC evokes a similarly long-lasting increase in the excitability of myelinated axons within the dorsal columns. The excitability of dorsal column fibres stimulated epidurally was monitored by recording compound action potentials in peripheral nerves in acute experiments in deeply anaesthetized rats. The results show that (i) cathodal polarization (0.8-1.0 µA) results in a several-fold increase in the number of epidurally activated fibres, (ii) the increase in the excitability appears within seconds, (iii) lasts for more than an hour and (iv) is activity-independent as it does not require fibre stimulation during the polarization. These features demonstrate an unexplored form of plasticity of myelinated fibres and indicate the conditions under which it develops. They also suggest that therapeutic effects of epidural stimulation may be significantly enhanced if it is combined with DC polarization. In particular, by using DC to increase the number of fibres activated by low-intensity epidural stimuli, the low clinical tolerance to higher stimulus intensities might be overcome. The activity independence of long-lasting DC effects would also allow using only brief periods of DC polarization preceding epidural stimulation to increase the effect.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2rt47H7
via IFTTT
Context effects on smooth pursuit and manual interception of a disappearing target
In our natural environment, we interact with moving objects that are surrounded by richly textured, dynamic visual contexts. Yet, most laboratory studies on vision and movement show visual objects in front of uniform grey backgrounds. Context effects on eye movements have been widely studied, but it is less well known how visual contexts affect hand movements. Here we ask whether eye and hand movements integrate motion signals from target and context similarly or differently, and whether context effects on eye and hand change over time. We developed a track-intercept task requiring participants to track the initial launch of a moving object ("ball") with smooth pursuit eye movements. The ball disappeared after a brief presentation, and participants had to intercept it in a designated "hit zone". In two experiments (n = 18 human observers each), the ball was shown in front of a uniform or a textured background that was either stationary or moved along with the target. Eye and hand movement latencies and speeds were similarly affected by the visual context, but eye and hand interception (eye position at time of interception, and hand interception timing error) did not differ significantly between context conditions. Eye and hand interception timing errors were strongly correlated on a trial-by-trial basis across all context conditions, highlighting the close relation between these responses in manual interception tasks. Our results indicate that visual contexts similarly affect eye and hand movements, but that these effects may be short-lasting, affecting movement trajectories more than movement end points.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2quMzgf
via IFTTT
Cortical amplification models of the experience-dependent development of selective columns and response sparsification
The development of direction-selective cortical columns requires visual experience, but the neural circuits and plasticity mechanisms that are responsible for this developmental transition are unknown. To gain insight into the mechanisms that could underlie experience-dependent increases in selectivity, we explored families of cortical amplifier models that enhance weakly biased feed-forward signals. Here, we focused exclusively on possible contributions of cortico-cortical connections and took feed-forward input to be constant. We modeled pairs of interconnected columns that received equal and oppositely biased inputs. In a single-element model of cortical columns, we found 2 ways that cortical columns could receive biased feed-forward input and exhibit strong but unselective responses to stimuli: 1) within-column recurrent excitatory connections could be strong enough to amplify both strong or weak feed-forward input, or 2) columns that received differently-biased inputs could have strong excitatory cross-connections that destroy selectivity. A Hebbian plasticity rule combined with simulated experience with stimuli weakened these strong cross-connections across cortical columns, allowing the individual columns to respond selectively to their biased inputs. In a model that included both excitatory and inhibitory neurons in each column, an additional means of obtaining selectivity through the cortical circuit was uncovered: cross-column suppression of inhibition-stabilized networks. When each column operated as an inhibition-stabilized network, cross-column excitation onto inhibitory neurons forced competition between the columns, but in a manner that did not involve strong null direction inhibition, consistent with experimental measurements of direction selectivity in visual cortex. Experimental predictions of these possible contributions of cortical circuits are discussed.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2rsQ2cz
via IFTTT
Anisomorphic Cortical Reorganization in Asymmetric Sensorineural Hearing Loss
Acoustic trauma or inner ear disease may predominantly injure one ear, causing asymmetric sensorineural hearing loss (SNHL). While characteristic frequency (CF) map plasticity of primary auditory cortex (AI) contralateral to the injured ear has been detailed, there is no study that also evaluates ipsilateral AI to compare cortical reorganization across both hemispheres. We assess whether normal isomorphic mirror image relationship between the two hemispheres is maintained or disrupted in mild-to-moderate asymmetric SNHL of adult squirrel monkeys. At week 24 following induction of acoustic injury to the right ear, functional organization of the two hemispheres differs in direction and magnitude of interaural CF difference, percentage of recording sites with spectrally non-overlapping binaural activation, and the concurrence of peripheral and central activation thresholds. The emergence of this anisomorphic cortical reorganization of the two hemispheres is replicated by simulation based on spike-timing-dependent plasticity, where: 1) AI input from the contralateral ear is dominant, 2) reestablishment of relatively shorter contralateral ear input timing drives reorganization, and 3) only AI contralateral to the injured ear undergoes major realignment of interaural frequency maps that evolve over months. Asymmetric SNHL disrupts isomorphic organization between the two hemispheres and results in relative local hemispheric autonomy, potentially impairing performance of tasks that require binaural input alignment or interhemispheric processing.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2qyD4uM
via IFTTT
Learning temporal context shapes the prestimulus alpha oscillations and improves the visual discrimination performance
Time is an inseparable component of every physical event that we perceive, yet it is not clear how the brain processes time or how the neuronal representation of time affects our perception of events. Here, we asked subjects to perform a visual discrimination task, while we changed the temporal context in which the stimuli were presented. We collected electroencephalography (EEG) signals in two temporal contexts. Predictable blocks: stimuli were presented after a constant delay relative to a visual cue, and unpredictable blocks: stimuli were presented after variable delays relative to the visual cue. Four sub-second delays of 83, 150, 400 and 800 ms were used in the predictable and unpredictable blocks. We observed that predictability modulated the power of prestimulus alpha oscillations in the parieto-occipital sites and this modulation only occurred in the longest delay period, 800 ms, in which the predictability also improved the behavioral performance of the subjects. Moreover, learning the temporal context shaped the prestimulus alpha power: modulation of prestimulus alpha power grew during the predictable block and correlated with performance enhancement. These results suggest that the brain is able to learn the sub-second temporal context of stimuli and use this to enhance the sensory processing. Furthermore, the neural correlate of this temporal prediction is reflected in the alpha oscillations.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2quSfXT
via IFTTT
Pilot Prospective Study of Post-Surgery Sleep and EEG Predictors of Post-Operative Delirium
Delirium, a fluctuating disturbance of attention and awareness that develops over a short time period, occurs post-operatively in 37% of patients and is associated with poor outcomes, cognitive decline, longer hospital stays, and increased costs, morbidity and mortality (Dyer et al., 1995; Flink et al., 2012; Shim and Leung, 2012). Yet, interventions are extremely limited. It is impossible to identify the impending onset of delirium early enough to allow development or implementation of preventative therapies.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2rsE56B
via IFTTT
Radiological lumbar stenosis severity predicts worsening sagittal malalignment on full-body standing stereoradiographs
Patients with degenerative lumbar stenosis (DLS) adopt a forward flexed posture in an attempt to decompress neural elements. The relationship between sagittal alignment and severity of lumbar stenosis has not previously been studied.
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2qxzhh2
via IFTTT
Perioperative neurologic complications during spinal fusion surgery: incidence and trends
Perioperative neurologic complications after spine surgery may increase morbidity and healthcare costs related to the procedure.
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2pMd5Tw
via IFTTT
Comparative analysis of peri-operative complications between a multicenter prospective cervical deformity database and the nationwide inpatient sample database
Complication rates for adult cervical deformity are poorly characterized given the complexity and heterogeneity of cases.
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2qxEYf2
via IFTTT
Paramedic - ProTransport-1
ProTransport-1 is hiring Paramedics! ** Sign-On Bonus Up to $5,000 ** ProTransport-1 is the premier provider of comprehensive medical transport services in the San Francisco Bay area, Central Valley and Sacramento areas. With a customer-friendly vision and cutting-edge technological solutions, we are one of the "Fastest Growing Private Companies in America," according to INC. Magazine. Founded ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2qxMpTj
via IFTTT
EMT - ProTransport-1
ProTransport-1 is hiring EMT's! ProTransport-1 is a leading provider of patient logistics services to hospital systems. Headquartered in Northern California, ProTransport-1 partners with top healthcare systems throughout the Bay Area, Sacramento and the Central Valley to offer a diverse range of comprehensive, trendsetting services. The company features associated brands from coast to coast and ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2qxLyCp
via IFTTT
Paramedic - ProTransport-1
ProTransport-1 is the premier provider of comprehensive medical transport services in the San Francisco Bay area, Central Valley and Sacramento areas. With a customer-friendly vision and cutting-edge technological solutions, we are one of the "Fastest Growing Private Companies in America," according to INC. Magazine. Founded on the principles of "Professional, Courteous, and On-Time" ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2rgx0tL
via IFTTT
Long-Term Follow-Up of Adolescents Treated for Rumination Syndrome in an Inpatient Setting.
Objectives: While several studies have demonstrated the short-term benefit of the behavioral treatment of rumination syndrome (RS), few have investigated the long-term outcomes. Studies reporting long-term benefit have involved combined pediatric and adult samples, or have examined outcomes of patients involved in various types of treatment. The purpose of the current study was to examine several aspects of long-term outcome in adolescent patients who took part in the same intensive, interdisciplinary, inpatient behavioral treatment approach. Methods: Self-report measures were completed by 47 adolescent patients (mean age = 15.9) around one year or more from discharge from our inpatient program. Measures indexed changes in rumination, medical outcomes (e.g., use of supplemental nutrition), somatic symptoms, and quality of life. Results: Most patients reported continued improvement in their rumination over time, with 20% reporting cessation of rumination for at least 6 months. The majority of patients no longer required supplemental nutrition and reported improvements in somatic symptoms and quality of life. Patients who reported greater improvement in rumination also reported more significant improvements in their somatic symptoms and quality of life. Conclusions: Intensive behavioral treatment of RS leads to long-term improvement in rumination as well as other related factors, including somatic symptoms and quality of life. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2qT2NAP
via IFTTT
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2qT2NAP
via IFTTT
Cancer Biotherapy: More Than Immunotherapy
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 111-114.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2rg9aOH
via IFTTT
Circadian Gene CLOCK Affects Drug-Resistant Gene Expression and Cell Proliferation in Ovarian Cancer SKOV3/DDP Cell Lines Through Autophagy
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 139-146.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2pVe1Ri
via IFTTT
Clinical Significance and Tumor-Suppressive Function of miR-516b in Nonsmall Cell Lung Cancer
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 115-123.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2rgt0cn
via IFTTT
APJ Is Associated with Treatment Response in Gastric Cancer Patients Receiving Concurrent Chemoradiotherapy and Endostar Therapy
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 133-138.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2pVc3QN
via IFTTT
First-in-Human PET/CT Imaging of Metastatic Neuroendocrine Neoplasms with Cyclotron-Produced 44Sc-DOTATOC: A Proof-of-Concept Study
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 124-132.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2rgvjw6
via IFTTT
Contributors
Source:Anesthesiology Clinics, Volume 35, Issue 2
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qsBzjo
via IFTTT
Forthcoming Issues
Source:Anesthesiology Clinics, Volume 35, Issue 2
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qsV9f9
via IFTTT
Pharmacology
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Lee A. Fleisher
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pXySTt
via IFTTT
Pharmacology
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Alan D. Kaye
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qsVLSd
via IFTTT
The Future of Pharmacology in Anesthesia Practice
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Alan D. Kaye
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pXlmiC
via IFTTT
Anticoagulation and Neuraxial/Peripheral Anesthesia
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Mudit Kaushal, Ryan E. Rubin, Alan D. Kaye, Karina Gritsenko
Teaser
Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges. In addition to discussing NAGs, we also review the existing American Society of Regional Anesthesia guidelines for heparin, low-molecular-weight heparin, and antiplatelet agents.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qsVjmM
via IFTTT
Pharmacology of Antiemetics
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Alan D. Kaye, Elyse M. Cornett, John Chalabi, Natale Z. Naim, Matthew B. Novitch, Justin B. Creel, Preya Jhita, Thomas N. Trang, Jacquelyn R. Paetzold, Nicholas Darensburg, Burton D. Beakley, Richard D. Urman
Teaser
Postoperative nausea and vomiting (PONV) is associated with delayed recovery and dissatisfaction after surgical procedures. A key component to management is identifying risk factors and high-risk populations. Advances in pharmacologic therapeutics have resulted in agents targeting different pathways associated with the mediation of nausea and vomiting. This review focuses on these agents and the clinical aspects of their use in patients postoperatively. Combination therapies are reviewed, and studies demonstrate that when 2 or more antiemetic agents acting on different receptors are used, an overall improved efficacy is demonstrated when compared with a single agent alone in patients.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pXwDPT
via IFTTT
Pharmacology of Octreotide
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Reza M. Borna, Jonathan S. Jahr, Susanna Kmiecik, Ken F. Mancuso, Alan D. Kaye
Teaser
Many patients presenting with a history of foregut, midgut neuroendocrine tumors (NETs) or carcinoid syndrome can experience life-threatening carcinoid crises during anesthesia or surgery. Clinicians should understand the pharmacology of octreotide and appreciate the use of continuous infusions of high-dose octreotide, which can minimize intraoperative carcinoid crises. We administer a prophylactic 500-μg bolus of octreotide intravenously (IV) and begin a continuous infusion of 500 μg/h for all NET patients. Advantages include low cost and excellent safety profile. High-dose octreotide for midgut and foregut NETs requires an appreciation of the pathophysiology involved in the disease, pharmacology, drug–drug interactions, and side effects.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qsY6fN
via IFTTT
Perioperative Pharmacologic Considerations in Obesity
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Simon Willis, Gregory J. Bordelon, Maunak V. Rana
Teaser
Obesity has increased in incidence worldwide. Along with the increased number of obese patients, comorbid conditions are also more prevalent in this population. Obesity leads to changes in the physiology of patients along with an altered response to pharmacologic therapy. Vigilant perioperative physicians must be aware of the unique characteristics of administered agents in order to appropriately provide anesthetic care for obese patients. Because of the variability in tissue content in obese patients and changes in pharmacokinetic modeling, a one-size-fits-all approach is not justified and a more sophisticated and prudent approach is indicated.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pXJstn
via IFTTT
Pharmacogenomics in Anesthesia
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Ramsey Saba, Alan D. Kaye, Richard D. Urman
Teaser
A significant number of commonly administered medications in anesthesia show wide clinical interpatient variability. Some of these include neuromuscular blockers, opioids, local anesthetics, and inhalation anesthetics. Individual genetic makeup may account for and predict cardiovascular outcomes after cardiac surgery. These interactions can manifest at any point in the perioperative period and may also only affect a specific system. A better understanding of pharmacogenomics will allow for more individually tailored anesthetics and may ultimately lead to better outcomes, decreased hospital stays, and improved patient satisfaction.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qt1Rlv
via IFTTT
Pharmacogenomics in Pain Management
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Ramsey Saba, Alan D. Kaye, Richard D. Urman
Teaser
There is interpatient variability to analgesic administration. Much can be traced to pharmacogenomics variations between individuals. Certain ethnicities are more prone to reduced function of CYP2D6. Weak opioids are subject to interpatient variation based on their CYP2D6 type. Strong opioids have variations based on their transport and individual metabolism. Several cytochrome enzymes have been found to be involved with ketamine but there is no strong evidence of individual polymorphisms manifesting in clinical outcomes. Nonsteroidal anti-inflammatory drugs have adverse outcomes that certain CYP variants are more prone toward. There are now recommendations for dosing based on specific genomic makeup.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qxrQGD
via IFTTT
Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines
Source:Anesthesiology Clinics, Volume 35, Issue 2
Author(s): Anair Beverly, Alan D. Kaye, Olle Ljungqvist, Richard D. Urman
Teaser
Perioperative multimodal analgesia uses combinations of analgesic medications that act on different sites and pathways in an additive or synergistic manner to achieve pain relief with minimal or no opiate consumption. Although all medications have side effects, opiates have particularly concerning, multisystemic, long-term, and short-term side effects, which increase morbidity and prolong admissions. Enhanced recovery is a systematic process addressing each aspect affecting recovery. This article outlines the evidence base forming the current multimodal analgesia recommendations made by the Enhanced Recovery After Surgery Society (ERAS). We describe current evidence and important future directions for effective perioperative multimodal analgesia in enhanced recovery pathways.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pMlxlz
via IFTTT
Cancer Biotherapy: More Than Immunotherapy
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 111-114.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2qxEWnD
via IFTTT
Circadian Gene CLOCK Affects Drug-Resistant Gene Expression and Cell Proliferation in Ovarian Cancer SKOV3/DDP Cell Lines Through Autophagy
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 139-146.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2pMjZYU
via IFTTT
Clinical Significance and Tumor-Suppressive Function of miR-516b in Nonsmall Cell Lung Cancer
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 115-123.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2qxlc39
via IFTTT
APJ Is Associated with Treatment Response in Gastric Cancer Patients Receiving Concurrent Chemoradiotherapy and Endostar Therapy
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 133-138.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2pMqLhg
via IFTTT
First-in-Human PET/CT Imaging of Metastatic Neuroendocrine Neoplasms with Cyclotron-Produced 44Sc-DOTATOC: A Proof-of-Concept Study
Cancer Biotherapy & Radiopharmaceuticals May 2017, Vol. 32, No. 4: 124-132.
from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2qxn0JC
via IFTTT
An evolutionary medicine perspective on Neandertal extinction
Source:Journal of Human Evolution, Volume 108
Author(s): Alexis P. Sullivan, Marc de Manuel, Tomas Marques-Bonet, George H. Perry
The Eurasian sympatry of Neandertals and anatomically modern humans – beginning at least 45,000 years ago and possibly lasting for more than 5000 years – has sparked immense anthropological interest into the factors that potentially contributed to Neandertal extinction. Among many different hypotheses, the "differential pathogen resistance" extinction model posits that Neandertals were disproportionately affected by exposure to novel infectious diseases that were transmitted during the period of spatiotemporal sympatry with modern humans. Comparisons of new archaic hominin paleogenome sequences with modern human genomes have confirmed a history of genetic admixture – and thus direct contact – between humans and Neandertals. Analyses of these data have also shown that Neandertal nuclear genome genetic diversity was likely considerably lower than that of the Eurasian anatomically modern humans with whom they came into contact, perhaps leaving Neandertal innate immune systems relatively more susceptible to novel pathogens. In this study, we compared levels of genetic diversity in genes for which genetic variation is hypothesized to benefit pathogen defense among Neandertals and African, European, and Asian modern humans, using available exome sequencing data (three individuals, or six chromosomes, per population). We observed that Neandertals had only 31–39% as many nonsynonymous (amino acid changing) polymorphisms across 73 innate immune system genes compared to modern human populations. We also found that Neandertal genetic diversity was relatively low in an unbiased set of balancing selection candidate genes for primates, those genes with the highest 1% genetic diversity genome-wide in non-human hominoids (apes). In contrast, Neandertals had similar or higher levels of genetic diversity than humans in 12 major histocompatibility complex (MHC) genes. Thus, while Neandertals may have been relatively more susceptible to some novel pathogens and differential pathogen resistance could be considered as one potential contributing factor in their extinction, the expectations of this model are not universally met.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2rruNI7
via IFTTT
Editorial Board
Source:Journal of Human Evolution, Volume 107
from Genetics via xlomafota13 on Inoreader http://ift.tt/2qtbUav
via IFTTT
Transient and stable vector transfection: pitfalls, off-target effects, artifacts
Publication date: Available online 16 May 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Aleksei A. Stepanenko, Henry H. Heng
Transient and stable vector transfections have played important roles in illustrating the function of specific genes/proteins. The general assumption is that such a platform could effectively link a given gene/protein to gained phenotypes, revealing the mechanism of how a gene works. However, in reality, increased studies have surprisingly noticed some unexpected results. In this review, we demonstrate that an assumption that empty vector-transfected cells preserve the cytogenetic and phenotypic characteristics, and represent the adequate control in transfection experiments is not universally valid. A DNA vector, a transfection reagent, expression of an antibiotic resistance (trans)gene, expression of a reporter (trans)gene, and selection by acute/chronic antibiotic treatment may evoke cellular responses that affect the biochemical processes under investigation. We exemplify a number of studies, which reported obvious genomic, transcriptomic and phenotypic changes of tumor cells after transient/stable transfection of an empty vector. To further address the common mechanisms of these unexpected findings, we will apply the genome theory of somatic evolution to explain stress-mediated system dynamics and the limitations of predicting the system behavior solely based on targeted genes. We conceptualize that the diverse experimental manipulations (e.g., transgene overexpression, gene knock out/down, chemical treatments, acute changes in culture conditions, etc.) may act as a system stress, promoting intensive genome-level alterations (chromosomal instability, CIN), epigenetic and phenotypic alterations, which are beyond the function of manipulated genes. Such analysis calls for more attention on the reduced specificities of gene-focused methodologies.
Graphical abstract
from Genetics via xlomafota13 on Inoreader http://ift.tt/2rs88ft
via IFTTT
Multiple Sclerosis Disease-Modifying Drugs in Children and Adolescents
The vast majority of drugs for the treatment of multiple sclerosis (MS) have been developed and approved for the adult patient population. The place of these drugs in the treatment of children remains undefined not only in Russia, but also throughout the world. Despite the fact that studies of new drugs in the pediatric patient population is part of the routine practice of large pharmaceutical agencies such as the FDA and the EMA, treatment recommendations FOR pediatric MS patients are based less on long-term systematized experience of clinical studies as on a professional consensus of international expert associations, particularly the International Pediatric Multiple Sclerosis Study Group (IPMSSG). Clinical trials include small numbers of patients of pediatric age, minor compared with the number of participants in adult studies. There is therefore a need to develop new assessments evidencing the efficacy and safety of drugs for the treatment of MS in children and adolescents. This article presents the views of the IPMSSG on the treatment of pediatric MS, taking account of the characteristics of the Russian legislation and experience of Russian specialists.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2pTIK1k
via IFTTT
The Melanocortin Signal System of the Hypothalamus and Its Functional State in Type 2 Diabetes Mellitus and Metabolic Syndrome
Changes in the functional activity of the melanocortin signal system of the hypothalamus, which is involved in regulating feeding behavior and peripheral homeostasis, play an important role in the etiology and pathogenesis of type 2 diabetes mellitus and metabolic syndrome. This review discusses current concepts of the structural-functional organization of the melanocortin signal system and its interactions with other hypothalamic signal systems. Data on impairments to melanocortin signal cascades in hypothalamic neurons are presented – these may be the primary causes of type 2 diabetes mellitus and metabolic syndrome or the result of hormonal changes arising in the conditions of these metabolic disorders. Recently developed approaches to restoring the functions of the melanocortin signal system are discussed as one pathway to the treatment and prophylaxis of type 2 diabetes mellitus and metabolic syndrome.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2rf6ot7
via IFTTT
Treatment with Ex Vivo Expanded Autologous Regulatory CD4 + CD25 + Foxp3 + CD127 low T Cells Restores the Balance of the Immune System in Patients with Remitting Multiple Sclerosis
Objective. To assess the clinical efficacy and safety of autologous (patient's own) Treg cells – CD4+CD25+Foxp3+CD127low – isolated from the blood of patients with remitting multiple sclerosis (RMS). Patients with autoimmune diseases have decreased numbers and impaired suppressor functions of peripheral Treg cells circulating in the blood. With the aim of correcting the defect in peripheral Treg, precursor cells were isolated and expanded outside the patient's body (ex vivo), and an increased number of autologous (patient's own) Treg cells were given in the form of Treg vaccine. Materials and methods. An ex vivo cultivation method was developed which increased the number of Treg cells by factors of 30–40 over 5–7 days. Ex vivo expanded cells contained more than 90% CD4+CD25+Foxp3+CD127low Treg cells and had high levels of suppressor activity. A total of 14 patients with MS took part in a pilot trial and received s.c. ex vivo expanded Treg cells at doses of (2.8–4.5)·108 cells per injection. Observations were continued for one year. Results and discussion. Blood Treg levels in patients increased by factors of 1.5–2. No adverse reactions were seen during the study period; exacerbation frequency decreased, and the index of disability stabilized. It is suggested that ex vivo expanded Treg may compensate for impairments to the functions of peripheral Treg and can be used for the adoptive immunotherapy of RMS.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2pTZdCx
via IFTTT
Comparison of the Results of Using β-Interferon-1a Formulations 30 μg for Intramuscular Administration and β-Interferon-1a 44 μg for Subcutaneous Injections in Daily Clinical Practice for the Treatment of Multiple Sclerosis
Objective. To compare results of the treatment of multiple sclerosis (MS) with Genfaxon, CinnoVex, and Rebif. Materials and methods. These agents were used to treat patients living in the Moscow West Administrative District (80 patients) from September 2014 to October 2015. Among these, 30 patients received Genfaxon, 20 received CinnoVex, and 30 received Rebif. Results and conclusions. CinnoVex was withdrawn from 25% of patients receiving it because of clinical inefficacy, with identical exacerbation frequencies before and after treatment. Treatment with Genfaxon for one year produced a significant reduction in exacerbation frequency. The main problem encountered with Genfaxon was a high frequency of side effects. This caused some patients to terminate treatment. Patients receiving Rebif showed a significant reduction in exacerbation frequency, though adverse events also occurred during the first year of treatment. The characteristics of the actions of bioanalogs seen here were generally consistent with previous observations. This identifies the need for an increase in the quality of β-interferon-1a bioanalogs used for the treatment of MS.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2rf9BJ7
via IFTTT
Spotlight: Angel Armor's unparalleled ballistic solutions protect those who protect the public
Company: Angel Armor Headquarters: Colorado Signature Product: Ballistic Armor Website: http://ift.tt/1MXu5Hy Q&A Questions: 1. Where did your company name originate from" The name came from the essence of what an angel stands for and the emotion that an angel's presence provides. An angel's first words to those they protect are, "Do not be afraid." An angel brings ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2qrSHp9
via IFTTT
Perforated emphysematous cholecystitis managed by endoscopic transpapillary gallbladder drainage
Abstract
An 88-year-old woman with dementia was diagnosed as having perforated emphysematous cholecystitis with localized peritonitis. Because she was at high risk for surgery, gallbladder drainage was required before surgery. Endoscopic transpapillary gallbladder drainage instead of percutaneous transhepatic biliary drainage was performed because bile could leak from the puncture site to free space around the perforated gallbladder. After the insertion of a nasobiliary drainage tube, the gallbladder was drained and cleaned with saline solution. Subsequently, a nasobiliary drainage tube was replaced with a double-pigtail stent because she was at high risk of dislodging the nasobiliary drainage tube. Although clinical improvement was observed, she was treated conservatively without surgery. She was followed up for 6 months without developing cholecystitis. For perforated cholecystitis without developing panperitonitis, endoscopic transpapillary gallbladder drainage would be an effective option as a bridge to surgery for the initial treatment and as an alternative to surgery for long-term management for a later treatment. This is the first reported case of perforated emphysematous cholecystitis with localized peritonitis treated with endoscopic transpapillary gallbladder drainage.
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pM4ekI
via IFTTT
Reducing Trunk Compensation in Stroke Survivors: A Randomized Crossover Trial Comparing Visual vs. Force Feedback Modalities
Publication date: Available online 17 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bulmaro Adolfo Valdés, Andrea Nicole Schneider, Hendrik Fridolijn Machiel Van der Loos
ObjectiveTo investigate whether the compensatory trunk movements of stroke survivors observed during reaching tasks can be decreased by force and visual feedback, and examine whether one of these feedback modalities is more efficacious than the other in reducing this compensatory tendency.DesignRandomized Crossover TrialSettingUniversity research laboratoryParticipants15 community dwelling older adults: 5 female, 64 ± 11 years old, with hemiplegia from non-traumatic hemorrhagic or ischemic stroke (> 3 months post-stroke), recruited from stroke recovery groups, the research group's website and the community.InterventionIn a single session, participants received augmented feedback about their trunk compensation during a bimanual reaching task. Visual feedback (60 trials) was delivered through a computer monitor, and force feedback (60 trials) through two robotic devices.Main Outcome MeasuresPrimary: Change in anterior trunk displacement measured by motion tracking camera. Secondary: trunk rotation; Index of curvature (measure of straightness of hands' path toward target); RMS error of hands' movement (differences between hands position on every iteration of the program); Completion time for each trial; Post-test questionnaire to evaluate users' experience and system's usability.ResultsBoth Visual (-45.6% (45.8) change from baseline, p=0.004) and Force (-41.1% (46.1), p=0.004) feedback were effective in reducing trunk compensation. Scores on secondary outcome measures did not improve with either feedback modality. Neither feedback condition was superior.ConclusionsVisual and force feedback show promise as two modalities that could be used to decrease trunk compensation in stroke survivors during reaching tasks. It remains to be established which one of these two feedback modalities is more efficacious than the other as a cue to reduce compensatory trunk movement.
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2rs7Aq8
via IFTTT
Effects of air stacking maneuver on cough peak flow and chest wall compartmental volumes of amyotrophic lateral sclerosis subjects
Publication date: Available online 17 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Antonio Sarmento, Vanessa Regiane Resqueti, Mario Emílio Teixeira Dourado-Júnior, Lailane Saturnino, Andrea Aliverti, Guilherme Augusto de Freitas Fregonezi, Armele de Fátima Dornelas de Andrade
ObjectivesTo assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy controls positioned at 45° body inclination.DesignCross-sectional study with a matched-pair design.SettingUniversity hospital.ParticipantsTwelve persons with ALS and twelve age-matched healthy.Main outcomesCPF, chest wall compartmental inspiratory capacity (ICCW), vital capacity (VCCW), tidal volume (VTCW) and operational volumes, breathing pattern and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography.ResultsCompared to controls, significant lower CPF (P=.007), ICCW (P<.001), VCCW (P<.001) and VTCW (P<.001) were found in ALS. Immediately after air stacking, CPF (P<.001) and ICCW (P<.001) significantly increased in both groups with values returning to basal only in controls. After air stacking, the abdominal compartment (P=.004) was determined to be the most responsible for the inspired volume in ALS. Significant higher VCCW (P=.05) was observed in ALS five minutes after air stacking, with the ribcage compartment (P=.049) the main responsible for volume change. No differences were found in VCCW and compartmental volumes of control subjects. VTCW (P<.001) significantly increased during the protocol in controls, mainly due to end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume as well as end-expiratory volume of both groups. No significant differences were found in VTCW, operational volumes and breathing pattern in persons with ALS.ConclusionAir stacking is effective in increasing CPF, ICCW and VCCW of persons with ALS with no hyperinflation. Differences in compartmental volume contributions are probably due to lung and chest wall physiological changes.
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2qSMQdY
via IFTTT
Randomised control trial of the impact of a brief tele-support intervention on initial attendance at physiotherapy group sessions for pelvic floor problems
Publication date: Available online 17 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Lisa A. Osborne, C. Mair Whittall, Ruth Emanuel, Simon Emery, Phil Reed
ObjectiveTo assesses the efficacy of a brief telephone call to patients on a waiting list for physiotherapy treatment for pelvic floor dysfunction on initial attendance.DesignA three-armed randomized control study.SettingAn outpatient physiotherapy clinic at a hospital.Participants130 consecutively referred women patients (mean age of 51.47, range = 26-84) with a variety of pelvic floor dysfunction problems.InterventionSupport phone call (2 to 10 min) 3 days prior or 3-days after receiving an appointment invitation letter to physiotherapy sessions.Main Outcome MeasuresAttendance at the initial physiotherapy group session.ResultsGroups receiving a phone call demonstrated 80% attendance at the session, with no significant difference between these groups. The group receiving no call had significantly lower attendance rates (50%) than the phone call groups. The telephone support was more effective for those people who were older, came from less economically deprived areas, and had been on the waiting list for less time.ConclusionBrief tele-support may be an effective method to enhance patient attendance at treatment, but it may work best when targeted at certain groups of individuals.
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2rrDbIt
via IFTTT
Prospective External Validation of Three Preoperative Risk Scores for Prediction of New Onset Atrial Fibrillation After Cardiac Surgery.
BACKGROUND: Postoperative atrial fibrillation (POAF) is associated with early and late morbidity and mortality of cardiac surgical patients. Prophylactic treatment of atrial fibrillation (AF) has been recommended to improve outcome in cardiac surgical patients at high risk of developing POAF. Reliable models for prediction of POAF are needed to achieve that goal. This study attempted to externally validate 3 risk models proposed for preoperative prediction of POAF in cardiac surgical patients: the POAF score, the CHA2DS2-VASc score, and the Atrial Fibrillation Risk Index. METHODS: This was a prospective cohort study of 1416 adult patients who underwent nonemergent coronary artery bypass graft and/or valve surgery in a single cardiac surgical center between February 2014 and September 2015. A risk score for each of the 3 prediction models was calculated in each patient. All patients were followed for up to 2 weeks, or until hospital discharge, to observe the primary outcome of new onset AF requiring treatment. Discrimination was assessed using receiver operating characteristic curves. Calibration was assessed using the Pearson [chi]2 goodness-of-fit test and calibration plots. Utility of the score to implement AF prophylaxis based on the risk of POAF, in comparison to strategies of treating all patients, or not treating any patients, was assessed via a net benefit analysis. RESULTS: Of the 1416 patients included in this study, 478 had the primary outcome (33.8%). The areas under the receiver operating characteristic curve for prediction of POAF in the population subsets for which the scores were validated were as follows: 0.651 (95% confidence interval [CI], 0.621-0.681) for the POAF score, 0.593 (95% CI, 0.557-0.629) for the CHA2DS2-VASc score (P
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrflf1
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrflf1
via IFTTT
Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single Blinded, Randomized Controlled Trial.
BACKGROUND: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of preoperative warming versus usual care among women receiving intrathecal morphine, which is thought to exacerbate perioperative heat loss. METHODS: A prospective, single-blinded, randomized controlled trial compared 20 minutes of forced air warming (plus intravenous fluid warming) versus no active preoperative warming (plus intravenous fluid warming) in 50 healthy American Society of Anesthesiologists graded II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery. The primary outcome of maternal temperature change was assessed via aural canal and bladder temperature measurements at regular intervals. Secondary outcomes included maternal thermal comfort, shivering, mean arterial pressure, agreement between aural temperature, and neonatal outcomes (axillary temperature at birth, Apgar scores, breastfeeding, and skin-to-skin contact). The intention-to-treat population was analyzed with descriptive statistics, general linear model analysis, linear mixed-model analysis, [chi]2 test of independence, Mann-Whitney, and Bland-Altman analysis. Full ethical approval was obtained, and the study was registered on the Australia and New Zealand Clinical Trials Registry (Trial No: 367160, registered at http://ift.tt/17L6Qgm). RESULTS: Intention-to-treat analysis (n = 50) revealed no significant difference in aural temperature change from baseline to the end of the procedure between groups: F (1, 47) = 1.2, P = .28. There were no other statistically significant differences between groups in any of the secondary outcomes. CONCLUSIONS: A short period of preoperative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine. A combination of preoperative and intraoperative warming modalities may be required for this population. (C) 2017 International Anesthesia Research Society
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrwR2V
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrwR2V
via IFTTT
Patient Blood Management in Major Orthopedic Surgery: Less Erythropoietin and More Iron?.
Erythropoietin (EPO) is proposed preoperatively to reduce blood transfusion in anemic patients (hemoglobin
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qt8UuE
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qt8UuE
via IFTTT
Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data.
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrwNjH
via IFTTT
Perioperative Care of the Concussed Patient: Making the Case for Defining Best Anesthesia Care.
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qt8S60
via IFTTT
Use of the Fluid Challenge in Critically Ill Adult Patients: A Systematic Review.
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rryC07
via IFTTT
An Etomidate Analogue With Less Adrenocortical Suppression, Stable Hemodynamics, and Improved Behavioral Recovery in Rats.
BACKGROUND: ET-26 hydrochloride (ET-26HCl) is a novel etomidate analogue designed to alleviate the adrenocortical suppression caused by etomidate while retaining the rapid sedative-hypnotic onset and stable hemodynamic features of etomidate. This study compared the anesthetic effect, hemodynamic stability, and recovery profiles of ET-26HCl, etomidate, and the sedative-hypnotic drug propofol in rats. METHODS: The metabolic half-life of ET-26HCl was determined in vitro using high performance liquid chromatography analysis of samples of rat plasma and liver homogenates taken from 3 animals. Hypnotic median effective doses (HD50) of ET-26HCl, etomidate, and propofol were determined by up-and-down methods. Anesthesia effect and mean arterial pressure were estimated using equivalent intravenous (IV) doses of propofol, etomidate, and ET-26HCl in the rats. Serum concentrations of corticosterone were analyzed by enzyme-linked immunosorbent assay. The ability of rats to recover from the sedative-hypnotic effects of the drugs was evaluated using open field and Morris water maze tests at equipotent doses of propofol, etomidate, ET-26HCl, and normal saline. RESULTS: The metabolic half-life of ET-26HCl was 81 +/- 6 minutes in rat plasma and 126 +/- 12 minutes in incubation liver homogenate (mean +/- standard deviation), respectively. In vivo experiments showed that the potency of ET-26HCl to cause a loss of righting reflex in rats was 3 times lower than that of etomidate in the rats. IV propofol caused a greater decrease in mean arterial pressure relative to the baseline (-27.9 mm Hg) than did ET-26HCl (-10.7 mm Hg) and etomidate (-19.4 mm Hg) at equipotent doses. Serum corticosterone levels after drug administration were significantly higher in the ET-26HCl group than in the etomidate group at equivalent doses when measured 15 (P
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qtduJE
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qtduJE
via IFTTT
Cancellation of Elective Cases in a Recently Opened, Tertiary/Quaternary-Level Hospital in the Middle East.
Case cancellations have a negative financial impact due to revenue loss and the potential costs of underutilized time. The goals of this study at a recently opened hospital in the Middle East were to measure the cancellation rates for elective surgical or endoscopic cases and to identify the reasons for cancellation. During the 1-month study period, 170 (22.4%) of the 760 scheduled cases were cancelled. Cultural norms and patient no-shows on the day of surgery accounted for the majority of case cancellations. Understanding local factors on hospital functions may be vital for organizations expanding into new geographic areas. (C) 2017 International Anesthesia Research Society
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrcjHC
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rrcjHC
via IFTTT
Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia.
BACKGROUND: Increased hemoglobin (Hb) concentration accompanying hypoxemia is a compensatory response to maintain tissue oxygen delivery. Near infrared spectroscopy (NIRS) is used clinically to detect abnormalities in the balance of cerebral tissue oxygen delivery and consumption, including in children with congenital heart disease (CHD). Although NIRS-measured cerebral tissue O2 saturation (ScO2) correlates with arterial oxygen saturation (SaO2), jugular bulb O2 saturation (SjbO2), and Hb, little data exist on the interplay between these factors and cerebral O2 extraction (COE). This study investigated the associations of ScO2 and [DELTA]SaO2-ScO2 with SaO2 and Hb and verified the normal range of ScO2 in children with CHD. METHODS: Children undergoing cardiac catheterization for CHD were enrolled in a calibration and validation study of the FORE-SIGHT NIRS monitor. Two pairs of simultaneous arterial and jugular bulb samples were drawn for co-oximetry, calculation of a reference ScO2 (REF CX), and estimation of COE. Pearson correlation and linear regression were used to determine relationships between O2 saturation parameters and Hb. Data were also analyzed according to diagnostic group defined as acyanotic (SaO2 >= 90%) and cyanotic (SaO2
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qt8RPu
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2qt8RPu
via IFTTT
Television Viewing Time and Inflammatory-Related Mortality.
Purpose: Television (TV) viewing time is associated with increased risk of all-cause, cardiovascular and cancer mortality. While TV time is detrimentally associated with key inflammatory markers, the associations of TV time with other inflammatory-related mortality (with a predominant inflammatory, oxidative or infectious component, but not attributable to cancer or cardiovascular causes), are unknown. Methods: Among 8,933 Australian adults (4,593 never-smokers) from the baseline (1999/2000) Australian Diabetes, Obesity and Lifestyle Study (median follow-up, 13.6 years), we examined TV time in relation to non-inflammatory and inflammatory-related mortality (not attributable to cancer or cardiovascular causes, hereafter 'inflammatory-related' mortality). Because smoking has a significant inflammatory component, we also examined this relationship in never-smokers. Results: Of 896 deaths, 248 were attributable to cardiovascular disease, 346 to cancer, 130 to other inflammatory-related causes (71 for never-smokers), and 172 to non-inflammatory related causes (87 for never-smokers). Following multivariate adjustment for age, sex, education, household income, smoking status, alcohol intake, energy intake, diet, and cardiometabolic risk biomarkers (Model 3), every additional h/d of TV time was associated with increased risk of inflammatory-related mortality in the overall population (HR 1.12; 95% CI 1.00, 1.25) and in never-smokers (1.18; 1.00, 1.40). These results were attenuated after additional adjustment for leisure-time physical activity. Following multivariate adjustment (Model 3), no association was observed for non-inflammatory mortality in the overall population (0.95; 0.85, 1.07), but risk tended to decrease for never-smokers (0.85; 0.75, 1.02). Conclusion: In summary, before adjustment for leisure-time physical activity, TV time was associated with increased risk of inflammatory-related mortality. This is consistent with the hypothesis that high TV viewing may be associated with a chronic inflammatory state. (C) 2017 American College of Sports Medicine
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2pUJWRM
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2pUJWRM
via IFTTT
Pulmonary Vascular Function and Aerobic Exercise Capacityat Moderate Altitude.
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2rfOu9q
via IFTTT
Systolic and Diastolic LV Mechanics during and following Resistance Exercise.
Purpose: To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist and untwisting rate ('LV mechanics'). Methods: LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7-12 s) double leg press exercise at two intensities (30% and 60% of maximum strength, 1-repetition-maximum, 1RM). Speckle tracking analysis generated LV strain, twist and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. Results: Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased while SVR and LV wall stress increased (P 0.05). Immediately following exercise, systolic LV mechanics returned to baseline levels (P
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2pUzolV
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2pUzolV
via IFTTT
Breaks in Sitting Time: Effects on Continuously Monitored Glucose and Blood Pressure.
Purpose: We examined the effects of interrupting prolonged sitting with multiple 2-min walking breaks or one 30-min continuous walking session on glucose control and ambulatory blood pressure (ABP). Methods: Ten overweight/obese, physically inactive participants (5 men; 32+/-5 y, BMI 30.3+/-4.6 kg[middle dot]m-2) participated in this randomized four-trial crossover study, with each trial performed on a separate, simulated workday lasting 9h: 1) 30 min of continuous walking at 71+/-4% HRmax (30min-MOD); 2) 21x2-min bouts of moderate-intensity walking at 53+/-5% HRmax (2min-MOD), each performed every 20 min (42 min total); 3) 8x2-min bouts of vigorous-intensity walking at 79+/-4% HRmax (2min-VIG), each performed every h (16 min total); 4) 9h of prolonged sitting (SIT). Participants underwent continuous interstitial glucose monitoring and ABP monitoring during and after the simulated workday spent in the laboratory, with primary data analysis from 12:30 h to 07:00 h the next morning. Results: Compared with SIT (5.6+/-1.1 mmol[middle dot]L-1), mean 18.7-h glucose was lower during the 2min-MOD (5.2+/-1.1 mmol[middle dot]L-1) and 2min-VIG (5.4+/-0.9 mmol[middle dot]L-1) trials and mean 18.7-h glucose during the 30min-MOD trial (5.1+/-0.8 mmol[middle dot]L-1) was lower than all other trials (P
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2rfJ4v4
via IFTTT
from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2rfJ4v4
via IFTTT
Send off for National EMS Memorial Bike Ride
Safe travels to the 2017 National EMS Memorial Bike Ride.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qsrEdS
via IFTTT
Send off for National EMS Memorial Bike Ride
Safe travels to the 2017 National EMS Memorial Bike Ride.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qsrEdS
via IFTTT
Send off for National EMS Memorial Bike Ride
Safe travels to the 2017 National EMS Memorial Bike Ride.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qsrEdS
via IFTTT
Spotlight: Angel Armor's unparalleled ballistic solutions protect those who protect the public
Angel Armor offers five distinct product lines that exceed industry standards
from EMS via xlomafota13 on Inoreader http://ift.tt/2qt7tg2
via IFTTT
Identification of a de novo variant in CHUK in a patient with an EEC/AEC syndrome-like phenotype and hypogammaglobulinemia
The cardinal features of Ectrodactyly, Ectodermal dysplasia, Cleft lip/palate (EEC), and Ankyloblepharon-Ectodermal defects-Cleft lip/palate (AEC) syndromes are ectodermal dysplasia (ED), orofacial clefting, and limb anomalies. EEC and AEC are caused by heterozygous mutations in the transcription factor p63 encoded by TP63. Here, we report a patient with an EEC/AEC syndrome-like phenotype, including ankyloblepharon, ED, cleft palate, ectrodactyly, syndactyly, additional hypogammaglobulinemia, and growth delay. Neither pathogenic mutations in TP63 nor CNVs at the TP63 locus were identified. Exome sequencing revealed de novo heterozygous variants in CHUK (conserved helix-loop-helix ubiquitous kinase), PTGER4, and IFIT2. While the variant in PTGER4 might contribute to the immunodeficiency and growth delay, the variant in CHUK appeared to be most relevant for the EEC/AEC-like phenotype. CHUK is a direct target gene of p63 and encodes a component of the IKK complex that plays a key role in NF-κB pathway activation. The identified CHUK variant (g.101980394T>C; c.425A>G; p.His142Arg) is located in the kinase domain which is responsible for the phosphorylation activity of the protein. The variant may affect CHUK function and thus contribute to the disease phenotype in three ways: (1) the variant exhibits a dominant negative effect and results in an inactive IKK complex that affects the canonical NF-κB pathway; (2) it affects the feedback loop of the canonical and non-canonical NF-κB pathways that are CHUK kinase activity-dependent; and (3) it disrupts NF-κB independent epidermal development that is often p63-dependent. Therefore, we propose that the heterozygous CHUK variant is highly likely to be causative to the EEC/AEC-like and additional hypogammaglobulinemia phenotypes in the patient presented here.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2rrxbyq
via IFTTT
Send off for National EMS Memorial Bike Ride
Safe travels to the 2017 National EMS Memorial Bike Ride.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qsrEdS
via IFTTT
NEMSMA releases new position paper on paramedicine nomenclature
National EMS Management Association PLATTE CITY, Mo. — The National EMS Management Association has issued a new Position Paper promoting common language in the field of Paramedicine. NEMSMA is advocating that the term "Paramedicine" be used to describe the discipline of pre-hospital medicine (historically called EMS) and that the term "paramedic" become the standard reference ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2pTL6gz
via IFTTT
Remember 2 Things: Narcan use
Narcan is quick and effective, but it also leaves you prone to making two common mistakes. With these quick tips, Steve Whitehead gives advice so you don't make either of them.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qqXh7o
via IFTTT
Remember 2 Things: Narcan use
Narcan is quick and effective, but it also leaves you prone to making two common mistakes. With these quick tips, Steve Whitehead gives advice so you don't make either of them.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qqXh7o
via IFTTT
Remember 2 Things: Narcan use
Narcan is quick and effective, but it also leaves you prone to making two common mistakes. With these quick tips, Steve Whitehead gives advice so you don't make either of them.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qqXh7o
via IFTTT
Girl, 13, dies after being pulled from Lake Michigan
Tianna Hollinside was taken to the hospital after paramedics performed CPR
from EMS via xlomafota13 on Inoreader http://ift.tt/2qrEUiz
via IFTTT
5 EMS back injury prevention tips
To be in the EMS profession for the long haul, following these simple lifting tips every day will pay off in the future
from EMS via xlomafota13 on Inoreader http://ift.tt/2pW0eck
via IFTTT
Facilitation of mossy fibre driven spiking in the cerebellar nuclei by the synchrony of inhibition
Abstract
Large projection neurons of the cerebellar nuclei (CbN cells), whose activity generates movement, are inhibited by Purkinje cells and excited by mossy fibres. The high convergence, firing rates, and strength of Purkinje inputs predict powerful suppression of CbN cell spiking, raising the question of what activity patterns favor excitation over inhibition. Recording from CbN cells at near-physiological temperatures in cerebellar slices from weanling mice, we measured the amplitude, kinetics, voltage-dependence, and short-term plasticity of mossy fibre-mediated EPSCs. Unitary EPSCs were small and brief (AMPAR, ∼1 nS, ∼1 ms; NMDAR ∼0.6 nS, ∼7 ms) and depressed moderately. Using these experimentally measured parameters, we applied combinations of excitation and inhibition to CbN cells with dynamic clamp. Because Purkinje cells can fire coincident simple spikes during cerebellar behaviours, we varied the proportion (0–20 of 40) and precision (0–4 ms jitter) of synchrony of inhibitory inputs, along with the rates (0–100 spikes s−1) and number (0–800) of excitatory inputs. Even with inhibition constant, when inhibitory synchrony was higher, excitation increased CbN cell firing rates more effectively. Partial inhibitory synchrony also dictated CbN cell spike timing, even with physiological rates of excitation. These effects were present with ≥10 inhibitory inputs active within 2–4 ms of each other. Conversely, spiking was most effectively suppressed when inhibition was maximally asynchronous. Thus, the rate and relative timing of Purkinje-mediated inhibition set the rate and timing of cerebellar output. The results suggest that increased coherence of Purkinje cell activity can facilitate mossy-fibre-driven spiking by CbN cells, in turn driving movements.
This article is protected by copyright. All rights reserved
from Physiology via xlomafota13 on Inoreader http://ift.tt/2qrqDlS
via IFTTT
Cortical contributions to sensory gating in the ipsilateral somatosensory cortex during voluntary activity
Abstract
An important principle in the organization of the somatosensory cortex is that it processes afferent information from the contralateral side of the body. The role of the ipsilateral somatosensory cortex (iS1) in sensory gating in humans remains largely unknown. Using electroencephalographic recordings over the iS1 and electrical stimulation of the ulnar nerve at the wrist we examined somatosensory evoked potentials (SSEPs; P14/N20, N20/P25, and P25/N33 components) and paired-pulse SSEPs between (interhemispheric inhibition) and within (intracortical inhibition) the iS1 at rest and during tonic index finger voluntary activity. We found that the amplitude of the P25/N33, but not other SSEP components, was reduced during voluntary activity compared with rest. Interhemispheric inhibition increased the amplitude of the P25/N33 and intracortical inhibition reduced the amplitude of the P25/N33, suggesting a cortical origin for this effect. The P25/N33 receives inputs from the motor cortex, therefore, we also examined the contribution of distinct sets of cortical interneurons by testing the effect of ulnar nerve stimulation on motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation over the ipsilateral motor cortex with the coil in the posterior-anterior (PA) and anterior-posterior (AP) orientation. Afferent input attenuated PA, but not AP, MEPs during voluntary activity compared with rest. Notably, changes in interhemispheric inhibition correlated with changes in PA MEPs. Our novel findings suggest that interhemispheric projections between S1s and intracortical circuits, likely from somatosensory and motor cortex, contribute to sensory gating in the iS1 during voluntary activity in humans.
This article is protected by copyright. All rights reserved
from Physiology via xlomafota13 on Inoreader http://ift.tt/2pWcxFx
via IFTTT
Angiogenesis during pregnancy: all routes lead to MAPKs
Abstract
During pregnancy, uterine vasculature undergoes dramatic adaptation to meet the nutrient demand of fetal development and growth, leading to increased uterine blood flow to perfuse the placenta.
This article is protected by copyright. All rights reserved
from Physiology via xlomafota13 on Inoreader http://ift.tt/2qrif5X
via IFTTT
Relative contributions of maternal western-type high fat high sugar diets and maternal obesity to altered metabolic function in pregnancy
Abstract
Human epidemiological and experimental animal studies have shown that maternal obesity (MO) combined with high energy Western-style high fat-high sugar (HFHS) obesogenic diets can have adverse effects on mothers and fetuses during pregnancy and lactation and predispose offspring to later life metabolic dysfunction.
This article is protected by copyright. All rights reserved
from Physiology via xlomafota13 on Inoreader http://ift.tt/2pWnDuo
via IFTTT
Cloning, expression, molecular modelling and docking analysis of steroidogenic acute regulatory protein (StAR) in Clarias batrachus
Abstract
The steroidogenic acute regulatory protein (StAR) plays a key role in transferring cholesterol across the inner mitochondrial membrane. In this study, the StAR gene was isolated from the gonads of Clarias batrachus. The gene has an open reading frame of 857 bp and encodes 285 amino acids with a predicted molecular weight of 32 kDa. The signalP analysis predicted that StAR would be a non-secreted protein that lacks a signal peptide. The subcellular localization demonstrated that the presence of the StAR protein was higher in mitochondria (41.8%), followed by the nuclear region (37.1%) and cytoplasm (11.1%). The StAR protein was found to interact highly with cyp11a1, followed by the cytochrome P450 family 11 proteins and the START5 domain. The homology modelling revealed that the protein has 4 helices and twisted U-shaped 10 beta sheets numbered from αA to αD and β1 to β10, respectively. Molecular modelling analysis showed that resveratrol and eurycomanone has high binding affinity with the StAR protein. The C. batrachus StAR transcript was found to be expressed exclusively in the gonads, kidney, and liver. These results overall lay a solid foundation for understanding the structure of StAR protein in fish. The identification of 3D structures and binding sites will help in designing a structure-based drug of StAR agonists for the treatment of impaired steroidogenesis.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2pU1nCd
via IFTTT
RNA binding protein QKI contributes to WT1 mRNA and suppresses apoptosis in ST cells
Abstract
The RNA binding protein quaking (QKI), a key member of the STAR family, as an upstream gene could involve in much process including cell proliferation, apoptosis, differentiation and so on. However, the roles of QKI in germ cell, especially in swine testis (ST) cells, was not clear currently. And apoptosis plays important roles in the growth and development. The purpose of the present study was to clarify the relationship between QKI and apoptosis in ST cells. Firstly, our results showed that pEF1α-QKI and shQKI3 have clear effects on expression levels of QKI. Secondly, we established that QKI directly binds to WT1 3′UTR by binding with QRE-1 (2046–2052 bp, ACTAAC) only. Furthermore, QKI overexpression significantly increased the expression levels of WT1 and Bcl-2. QKI also has the effect on delaying the degradation of WT1 mRNA. In addition, we verified that QKI had a significantly suppressed apoptosis in ST cells. Finally, pBI-WT1 could make up for shQKI3-induced decrease in WT1, Bcl-2 mRNA levels and suppress apoptosis in ST cells. The results demonstrated that QKI was an important regulatory factor that affects apoptosis by targeting WT1 gene.
from Genetics via xlomafota13 on Inoreader http://ift.tt/2rfg0nz
via IFTTT
Nasotracheal prolonged safe extubation in acute respiratory failure post-thyroidectomy: An efficacious technique to avoid tracheotomy? A retrospective analysis of a large case series.
| Related Articles |
Nasotracheal prolonged safe extubation in acute respiratory failure post-thyroidectomy: An efficacious technique to avoid tracheotomy? A retrospective analysis of a large case series.
Int J Surg. 2017 May;41 Suppl 1:S48-S54
Authors: Ferraro F, Gambardella C, Testa D, Santini L, Marfella R, Fusco P, Lombardi CP, Polistena A, Sanguinetti A, Avenia N, Conzo G
Abstract
BACKGROUND: Acute respiratory failure is a rare life threatening complication following thyroid surgery and its incidence is reported as high as 0.9%. Clinical presentation of severe acute respiratory failure is characterized by dyspnea, inspiratory airways distress, hypoxia and its standard current management is the orotracheal intubation and safe extubation. In case of persistent distress, tracheotomy is mandatory. The Authors, analysing a large acute respiratory failure clinical series, describe an innovative treatment of this severe condition: the nasotracheal prolonged safe extubation.
METHODS: Patients treated at our Intensive Care Unit for acute respiratory failure following thyroid surgery from January 2004 to December 2013, were reviewed. Demographic data including gender, age, clinical presentation, laryngoscopic findings, management and outcome during a 24-months follow-up after treatment were collected and evaluated. Moreover, the strategy for prolonged nasotracheal safe extubation was carefully described.
RESULTS: Nineteen out of the 2853 patients scheduled for thyroid surgery (0.66%) at our University Hospital, developed post-operative acute respiratory failure. All of them were treated by nasotracheal prolonged safe extubation. The success rate in avoiding highly invasive treatment was of 84.2%, since only 3 patients needed definitive tracheotomy (15.7%).
CONCLUSIONS: In our series, the prolonged safe extubation reduced the almost totality of expected tracheotomies in patients with acute respiratory failure following thyroid surgery (84.2%), demonstrating its feasibility and efficacy. It was a well tolerated and minimal invasive procedure that allowed a good respiratory ability and a fast clinical resolution of the laryngeal functional impairment.
PMID: 28506413 [PubMed - in process]
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rpU9Gw
via IFTTT
Remember 2 Things: Narcan use
Narcan is quick and effective, but it also leaves you prone to making two common mistakes. With these quick tips, Steve Whitehead gives advice so you don't make either of them.
from EMS via xlomafota13 on Inoreader http://ift.tt/2qqXh7o
via IFTTT
Prospective randomised trial of neoadjuvant chemotherapy during the wait period following pre-operative chemoradiotherapy for rectal cancer; Results of the wait trial
Colorectal Disease
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pTkGLN
via IFTTT
Many US travelers don’t get recommended measles vaccine
Reuters Health News
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2reg0E5
via IFTTT
Alpha-Fetoprotein is a significant prognostic factor for gastric cancer: Results from a propensity score matching analysis after curative resection
European Journal of Surgical Oncology
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pT9C1h
via IFTTT
Warmer air temps tied with increasing gestational diabetes risk
Reuters Health News
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2rekY3K
via IFTTT
A simple morphological classification to estimate the malignant potential of pancreatic neuroendocrine tumors
Journal of Gastroenterology
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pT0zNJ
via IFTTT
Circulating cathelicidin levels correlate with mucosal disease activity in ulcerative colitis, risk of intestinal stricture in Crohn’s disease, and clinical prognosis in inflammatory bowel disease
BMC Gastroenterology
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2revxE1
via IFTTT
Esophageal dilation in head and neck cancer patients: A systematic review and meta-analysis
The Laryngoscope
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pTmOmM
via IFTTT
Hepatitis C Virus Infection Among Reproductive-Aged Women and Children in the United States, 2006 to 2014
Annals of Internal Medicine
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2re7Uvo
via IFTTT
Tobacco use is not associated with groin hernia repair, a population-based study
Hernia
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pTkEDF
via IFTTT
A meta-analysis of n-3 polyunsaturated fatty acids effects on circulating acute-phase protein and cytokines in gastric cancer
Clinical Nutrition
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2refYvX
via IFTTT
Prediction of difficult laparoscopic cholecystectomy for acute cholecystitis
Journal of Surgical Research
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pSMBvC
via IFTTT
Patients with cirrhosis who have coronary artery disease treated with cardiac stents have high rates of gastrointestinal bleeding, but no increased mortality
Alimentary Pharmacology and Therapeutics
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2rezVCX
via IFTTT
Gov't report: Efforts to reduce US uninsured stalled in 2016
AP
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pTsBsu
via IFTTT
Antenatal maternal Hepatitis B care is a predictor of timely perinatal administration of Hepatitis B immunoglobulin
Internal Medicine Journal
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2reuTGI
via IFTTT
Comparative effects of liraglutide 3 mg versus structured lifestyle modification on body weight, liver fat and liver function in obese patients with non-alcoholic fatty liver disease: A pilot randomized trial
Diabetes, Obesity and Metabolism
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pT0yt9
via IFTTT
Misbalance in type III collagen formation/degradation as a novel serological biomarker for penetrating (Montreal B3) Crohn's disease
Alimentary Pharmacology and Therapeutics
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2rexFLS
via IFTTT
Overall survival and clinical characteristics of BRCA-associated cholangiocarcinoma: A multicenter retrospective study
The Oncologist
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2pTkjAQ
via IFTTT
The significant pathways and genes underlying the colon cancer treatment by the traditional Chinese medicine phy906
Evidence-based Complementary and Alternative Medicine
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2qQoAcA
via IFTTT
Long-term outcomes after endoscopic ultrasound-guided ablation of pancreatic cysts
Endoscopy
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2rpYLNr
via IFTTT
High expression of Tumor necrosis factor receptor-associated factor 2 promotes tumor metastasis and is associated with unfavorable prognosis in gastric cancer
Journal of Gastroenterology and Hepatology
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2qQoB08
via IFTTT
Use of an anaesthesia workstation barrier device to decrease contamination in a simulated operating room
Abstract
Background. Strategies to achieve reductions in perioperative infections have focused on hand hygiene among anaesthestists but have been of limited efficacy. We performed a study in a simulated operating room to determine whether a barrier covering the anaesthesia workstation during induction and intubation might reduce the risk of contamination of the area and possibly, by extension, the patient.Methods. Forty-two attending and resident anaesthetists unaware of the study design were enrolled in individual simulation sessions in which they were asked to induce and intubate a human simulator that had been prepared with fluorescent marker in its oropharynx as a marker of potentially pathogenic bacteria. Twenty-one participants were assigned to a control group, whereas the other 21 performed the simulation with a barrier device covering the anaesthesia workstation. After the simulation, an investigator examined 14 target sites with an ultraviolet light to assess spread of the fluorescent marker of contamination to those sites.Results. The difference in rates of contamination between the control group and the barrier group was highly significant, with 44.8% (2.5%) of sites contaminated in the control group vs 19.4% (2.6%) of sites in the barrier group (P<0.001). Several key clinical sites showed significant differences in addition to this overall decrement.Conclusions. The results of this study suggest that application of a barrier device to the anaesthesia workstation during induction and intubation might reduce contamination of the intraoperative environment.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2quF3QF
via IFTTT
Emergency front-of-neck access: scalpel or cannula—and the parable of Buridan’s ass †
Maintaining oxygenation is the principal purpose of airway management. Oxygen delivery in airway crises is aimed at preventing cardiac arrest and limiting hypoxic consequences before quickly moving on to secure the airway or wake the patient up if appropriate. Currently, there is debate12 concerning the most appropriate method to facilitate oxygenation during a 'can't intubate, can't oxygenate' (CICO) scenario while a definitive airway is secured. Emergency front-of-neck access (FONA) courses include a critical analysis of cannula cricothyroidotomy as part of their curricula. This has been driven by widespread acceptance and teaching of Heard's algorithm.3 However, concerns124–6 have been raised over the high failure rate of cannula cricothyroidotomy in CICO management when compared with surgical access, and its future omission has been advocated. The Canadian Airway Focus Group7 excludes cannula cricothyroidotomy from their recommendations unless the clinician is very experienced with jet ventilation. They state that options should be limited to either the percutaneous needle-guided wide-bore cannula or an open surgical technique.
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pIQB5Q
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2pIQB5Q
via IFTTT
Εγγραφή σε:
Αναρτήσεις (Atom)