Τετάρτη 12 Ιουλίου 2017

Adaption of the human population to the environment: Current knowledge, clues from Czech cytogenetic and “omics” biomonitoring studies and possible mechanisms

Publication date: Available online 12 July 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Andrea Rossnerova, Michaela Pokorna, Vlasta Svecova, Radim J. Sram, Jan Topinka, Friedo Zölzer, Pavel Rossner
The human population is continually exposed to numerous harmful environmental stressors, causing negative health effects and/or deregulation of biomarker levels. However, studies reporting no or even positive impacts of some stressors on humans are also sometimes published. The main aim of this review is to provide a comprehensive overview of the last decade of Czech biomonitoring research, concerning the effect of various levels of air pollution (benzo[a]pyrene) and radiation (uranium, X-ray examination and natural radon background), on the differently exposed population groups. Because some results obtained from cytogenetic studies were opposite than hypothesized, we have searched for a meaningful interpretation in genomic/epigenetic studies.A detailed analysis of our data supported by the studies of others and current epigenetic knowledge, leads to a hypothesis of the versatile mechanism of adaptation to environmental stressors via DNA methylation settings which may even originate in prenatal development, and help to reduce the resulting DNA damage levels. This hypothesis is fully in agreement with unexpected data from our studies (e.g. lower levels of DNA damage in subjects from highly polluted regions than in controls or in subjects exposed repeatedly to a pollutant than in those without previous exposure), and is also supported by differences in DNA methylation patterns in groups from regions with various levels of pollution.In light of the adaptation hypothesis, the following points may be suggested for future research: (i) the chronic and acute exposure of study subjects should be distinguished; (ii) the exposure history should be mapped including place of residence during the life and prenatal development; (iii) changes of epigenetic markers should be monitored over time.In summary, investigation of human adaptation to the environment, one of the most important processes of survival, is a new challenge for future research in the field of human biomonitoring that may change our view on the results of biomarker analyses and potential negative health impacts of the environment.



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Silicone tracheobronchial stent: A rare cause for bronchoesophageal fistula and distortion of airway anatomy

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Bhupesh Kumar, Ganesh Kumar Munirathinam, Goverdhan Dutt Puri, Anand Kumar Mishra, Virendra Kumar Arya

Annals of Cardiac Anaesthesia 2017 20(3):355-358

Silicone tracheobronchial stents are being increasingly used in a large number of patients for the treatment of tracheal stenosis. One very rare complication due to tracheobronchial stenting is bronchoesophageal fistula (BEF), which has been associated with the use of metallic stents. We report intraoperative management of a patient undergoing repair of a BEF, following previous insertion of a silicone Y-stent that is soft in texture and has not been implicated for this complication till date. In addition, misalignment of this silicone tracheobronchial Y-stent resulted in a tracheal mucosal bulge proximal to the stent that vanished after its removal.

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Risk factors of postcardiotomy ventricular dysfunction in moderate-to-high risk patients undergoing open-heart surgery

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Christoph Ellenberger, Tornike Sologashvili, Mustafa Cikirikcioglu, Gabriel Verdon, John Diaper, Tiziano Cassina, Marc Licker

Annals of Cardiac Anaesthesia 2017 20(3):287-296

Introduction: Ventricular dysfunction requiring inotropic support frequently occurs after cardiac surgery, and the associated low cardiac output syndrome largely contributes to postoperative death. We aimed to study the incidence and potential risk factors of postcardiotomy ventricular dysfunction (PCVD) in moderate-to-high risk patients scheduled for open-heart surgery. Methods: Over a 5-year period, we prospectively enrolled 295 consecutive patients undergoing valve replacement for severe aortic stenosis or coronary artery bypass surgery who presented with Bernstein-Parsonnet scores >7. The primary outcome was the occurrence of PCVD as defined by the need for sustained inotropic drug support and by transesophageal echography. The secondary outcomes included in-hospital mortality and the incidence of any major adverse events as well as Intensive Care Unit (ICU) and hospital length of stay. Results: The incidence of PCVD was 28.4%. Patients with PCVD experienced higher in-hospital mortality (12.6% vs. 0.6% in patients without PCVD) with a higher incidence of cardiopulmonary and renal complications as well as a prolonged stay in ICU (median + 2 days). Myocardial infarct occurred more frequently in patients with PCVD than in those without PCVD (19 [30.2%] vs. 12 [7.6%]). By logistic regression analysis, we identified four independent predictors of PCVD: left ventricular ejection fraction <40% (odds ratio [OR] = 6.36; 95% confidence interval [CI], 2.59–15.60), age older than 75 years (OR = 3.35; 95% CI, 1.64–6.81), prolonged aortic clamping time (OR = 3.72; 95% CI, 1.66–8.36), and perioperative bleeding (OR = 2.33; 95% CI, 1.01–5.41). The infusion of glucose-insulin-potassium was associated with lower risk of PCVD (OR = 0.14; 95% CI, 0.06–0.33). Conclusions: This cohort study indicates that age, preoperative ventricular function, myocardial ischemic time, and perioperative bleeding are predictors of PCVD which is associated with poor clinical outcome.

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Methylene blue for post-cardioplumonary bypass vasoplegic syndrome

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Neha Pangasa, Rohan Magoon, Vandana Bhardwaj, Amita Sharma, Ameya Karonjkar, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(3):381-382



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Neutrophil gelatinase-associated lipocalin as a biomarker for predicting acute kidney injury during off-pump coronary artery bypass grafting

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Muralidhar Kanchi, R Manjunath, Jos Massen, Lloyd Vincent, Kumar Belani

Annals of Cardiac Anaesthesia 2017 20(3):297-302

Background: Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality, and economic burden. In this study, we assessed the usefulness of estimating serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in predicting AKI in patients with stable chronic kidney disease (CKD) and undergoing off-pump coronary artery bypass grafting (OP-CABG). Patients and Methods: We prospectively studied sixty nondialysis-dependent CKD patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 who required elective OP-CABG. Patients were randomized into two groups, Group D received dopamine infusion at 2 μg/kg/min following anesthesia induction till the end of the surgery and Group P did not receive any intervention. Serum creatinine, NGAL, brain natriuretic peptide, and troponin-I were estimated at specified intervals before, during, and after surgery. The results of the study patients were also compared to a simultaneous matched cohort control of thirty patients (Group A) without renal dysfunction who underwent OP-CABG. Results: No patient required renal replacement therapy, and no mortality was observed during perioperative and hospitalization period. Six patients from control group (n = 30), ten patients from placebo group (n = 30), and 12 patients from dopamine group (n = 30) developed stage 1 AKI. However, we did not observe any stage 2 and stage 3 AKI among all the groups. There was a significant increase in serum NGAL levels at the end of surgery and 24 h postoperatively in placebo and dopamine groups as compared to the control. Conclusion: The measurement of NGAL appears to predict the occurrence of AKI after OP-CAB surgery. However, large multicentric studies may be required to confirm the findings of this study.

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Idarucizumab (Praxbind) for reversal of pradaxa prior to emergent repair of contained ruptured transverse arch aneurysm

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Erol Vahit Belli, Teng Lee

Annals of Cardiac Anaesthesia 2017 20(3):369-371

Idarucizumab before cardiopulmonary bypass was used for the reversal of dabigatran during an emergent frozen elephant trunk repair of a transverse arch aneurysm. Reversal was successful and minimal not massive transfusion was required with no abnormal sequelae seen with use before cardiopulmonary bypass.

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Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention

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Ali Soroush, Saeid Komasi, Mozhgan Saeidi, Behzad Heydarpour, Danilo Carrozzino, Mario Fulcheri, Paolo Marchettini, Massimo Rabboni, Angelo Compare

Annals of Cardiac Anaesthesia 2017 20(3):303-308

Background: Patients' beliefs about the cause of cardiac disease (perceived risk factors) as part of the global psychological presentation are influenced by patients' health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor. Materials and Methods: In this cross-sectional study, data of 313 coronary artery bypass graft (CABG) patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors' checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions. Results: Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05), there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001). The patients underestimated the role of aging (98.8%), substance abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%), family history (90.3%), and hypertension (90%) more than diabetes (86.1%), smoking (72.5%), and stress (54.7%). Conclusion: Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i) increase the awareness of actual risk factors and (ii) promote an appropriate lifestyle after CABG surgery.

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Appropriate size of double-lumen tubes in Asians

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Chitra Rajeswari Thangaswamy

Annals of Cardiac Anaesthesia 2017 20(3):388-388



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Cardiovascular operation: A significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia

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Seri Tsuru, Mayuko Wakimoto, Takeshi Iritakenishi, Makoto Ogawa, Yukio Hayashi

Annals of Cardiac Anaesthesia 2017 20(3):309-312

Background: Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading this complication. From our clinical experience, we have an impression that patients undergoing cardiovascular operations tend to be associated with this complication. Aims: We designed a large retrospective study to reveal the incidence and risk factors predicting the occurrence and to examine whether our impression is true. Settings and Designs: This was a retrospective study. Methods: We retrospectively studied 19,437 adult patients who were intubated by an anesthesiologist in our operation theater from 2002 to 2008. The tracheal intubation was performed by a resident anesthesiologist managing the patients. Only patients whose postoperative voice was disturbed more than 7 days were referred to the Department of Otorhinolaryngology-Head and Neck Surgery and examined using laryngostroboscopy by a laryngologist to diagnose arytenoid cartilage dislocation/subluxation. We evaluated age, sex, weight, height, duration of intubation, difficult intubation, and major cardiovascular operation as risk factors to lead this complication. Statistical Analysis: The data were analyzed by logistic regression analysis to assess factors for arytenoid cartilage dislocation/subluxation after univariate analyses using logistic regression analysis. Results: Our analysis indicated that difficult intubation (odds ratio: 12.1, P = 0.018) and cardiovascular operation (odds ratio: 9.9, P < 0.001) were significant risk factors of arytenoid cartilage dislocation/subluxation. Conclusion: The present study demonstrated that major cardiovascular operation is one of the significant risk factors leading this complication.

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Management of a case of double aortic arch with tracheal compression complicated with postoperative tracheal restenosis

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Hemang Gandhi, T Vikram Kumar Naidu, Amit Mishra, Pankaj Garg, Jigar Surti, Visharad Trivedi, Himanshu Acharya

Annals of Cardiac Anaesthesia 2017 20(3):362-364

Tracheal stenosis in association with the double aortic arch (DAA) is uncommon; however, it carries a high risk of morbidity, mortality, and restenosis. Although surgery is the mainstay of managing a case of the DAA with tracheal stenosis, management of tracheal restenosis requires a multidisciplinary approach. In this case report, we present our successful experience in managing a child of DAA with tracheal stenosis who developed tracheal restenosis after sliding tracheoplasty of trachea.

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Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study

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Rabie Soliman, Mohammed Mofeed, Tarek Momenah

Annals of Cardiac Anaesthesia 2017 20(3):313-317

Objective: The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. Design: This was a double-blind randomized study. Setting: This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. Patients and Methods: The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. Intervention: The study included sixty patients, classified into two groups (n = 30). Group A: Propofol was administered as a bolus dose (1–2 mg/kg) and then a continuous infusion of 50–100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1–2 mg/kg and then infusion of 20–60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. Main Results: The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05). The total fentanyl increased in Group A more than Group B (P = 0.045). The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020). The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively). Conclusion: The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.

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Sugammadex to reverse neuromuscular blockade in a child with a past history of cardiac transplantation

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Karen Miller, Brian Hall, Joseph D Tobias

Annals of Cardiac Anaesthesia 2017 20(3):376-378

Sugammadex is a novel agent for the reversal of neuromuscular blockade. The speed and efficacy of reversal with sugammadex are significantly faster than acetylcholinesterase inhibitors, such as neostigmine. Sugammadex also has a limited adverse profile when compared with acetylcholinesterase inhibitors, specifically in regard to the incidence of bradycardia. This adverse effect may be particularly relevant in the setting of a heart transplant recipient with a denervated heart. The authors present a case of an 8-year-old child, status postcardiac transplantation, who required anesthetic care for laparoscopy and lysis of intra-abdominal adhesions. Sugammadex was used to reverse neuromuscular blockade and avoid the potential adverse effects of neostigmine. The unique mechanism of action of sugammadex is discussed, previous reports of its use in this unique patient population are reviewed, and its potential benefits compared to traditional acetylcholinesterase inhibitors are presented.

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Randomized comparative study of intravenous infusion of three different fixed doses of milrinone in pediatric patients with pulmonary hypertension undergoing open heart surgery

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Neeraj Kumar Barnwal, Sanjeeta Rajendra Umbarkar, Manjula Sudeep Sarkar, Raylene J Dias

Annals of Cardiac Anaesthesia 2017 20(3):318-322

Background: Pulmonary hypertension secondary to congenital heart disease is a common problem in pediatric patients presenting for open heart surgery. Milrinone has been shown to reduce pulmonary vascular resistance and pulmonary artery pressure in pediatric patients and neonates postcardiac surgery. We aimed to evaluate the postoperative outcome in such patients with three different fixed maintenance doses of milrinone. Methodology: Patients were randomized into three groups. All patients received fixed bolus dose of milrinone 50 μg/kg on pump during rewarming. Following this, patients in low-dose group received infusion of milrinone at the rate of 0.375 μg/kg/min, medium-dose group received 0.5 μg/kg/min, and high-dose group received 0.75 μg/kg/min over 24 h. Heart rate, mean arterial pressure (MAP), mean airway pressure (MaP), oxygenation index (OI), and central venous pressure (CVP) were compared at baseline and 24 h postoperatively. Dose of inotropic requirement, duration of ventilatory support and Intensive Care Unit (ICU) stay were noted. Results: MAP, MaP, OI, and CVP were comparable in all three groups postoperatively. All patients in the low-dose group required low inotropic support while 70% of patients in the high-dose group needed high inotropic support to manage episodes of hypotension (P = 0.000). Duration of ventilatory support and ICU stay in all three groups was comparable (P = 0.412, P = 0.165). Conclusion: Low-dose infusions while having a clinical impact were more beneficial in avoiding adverse events and decreasing inotropic requirement without affecting duration of ventilatory support and duration of ICU stay.

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Asystole following neuromuscular blockade reversal in cardiac transplant patients

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Njinkeng J Nkemngu

Annals of Cardiac Anaesthesia 2017 20(3):385-386



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The blalock and taussig shunt revisited

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Usha Kiran, Shivani Aggarwal, Arin Choudhary, B Uma, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2017 20(3):323-330

The systemic to pulmonary artery shunts are done as palliative procedures for cyanotic congenital heart diseases ranging from simple tetralogy of Fallots (TOFs)/pulmonary atresia (PA) to complex univentricular hearts. They allow growth of pulmonary arteries and maintain regulated blood flow to the lungs till a proper age and body weight suitable for definitive corrective repair is reached. We have reviewed the BT shunt with its anaesthtic considerations and management of associated complications.

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View Point

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Prabhat Tewari

Annals of Cardiac Anaesthesia 2017 20(3):285-286



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Interesting images: Multiple coronary artery aneurysms

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Jonathon M Howard, Omar Viswanath, Alfredo Armas, Orlando Santana, Gerald P Rosen

Annals of Cardiac Anaesthesia 2017 20(3):331-332

We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

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Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele

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Saipriya Tewari, Puneet Goyal, Amit Rastogi, Aarti Agarwal, PK Singh

Annals of Cardiac Anaesthesia 2017 20(3):359-361

Large posterior mediastinal masses may lead threatening complications such as critical tracheobronchial compression. Airway management in these individuals is a challenge and being a lower airway obstruction; rescue strategies are limited. We encountered one such case of a large esophageal mucocele causing extrinsic tracheobronchial compression. We have described the anesthetic management of this case using awake fiber-optic assessment followed by intubation. Close communication with the surgical team, meticulous planning of airway management, and early drainage of the mucocele are the cornerstones of management in such patients.

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Inadequate venous drainage-transesophageal echocardiography as rescue

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Monish S Raut, Arun Maheshwari, Sumir Dubey, Ganesh Shivnani, Sandeep Joshi, Arvind Verma, Swetanka Das

Annals of Cardiac Anaesthesia 2017 20(3):333-334

Malposition of venous cannula can cause inadequate venous drainage during cardiopulmonary bypass. It would be good clinical practice to use TEE to check the position of inferior venous cannula to avoid this problem at the earliest.

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A rare case of acyanotic congenital heart disease, large patent ductus arteriosus with pre-ductal coarctation of descending thoracic aorta with patent ductus arteriosus closure and extra anatomical bypass grafting

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Zara Wani, Deepak Tiwari, Rajeev Gehlot, Deepak Kumar, Sushil Chhabra, Meenaxi Sharma

Annals of Cardiac Anaesthesia 2017 20(3):365-368

We report a case of 18-year-old female patient with large patent ductus arteriosus (PDA)-preductal coarctation of descending thoracic aorta. She underwent large PDA closure with a prosthetic graft from ascending aorta to descending thoracic aorta by mid-sternotomy on cardiopulmonary bypass machine under total hypothermic circulatory arrest.

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An antenatal diagnosis: Congenital high airway obstruction

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S Miital, A Mittal, R Singal, S Singal, G Sekhon

Annals of Cardiac Anaesthesia 2017 20(3):335-336

Congenital high airway obstruction (CHAOS) is a rare lethal fetal malformation characterised by obstruction to the fetal upper airway, which can be partial or complete. Antenatal diagnosis of CHAOS is important due to recent management options. Diagnosis is made with secondary changes such as hyperechoic enlarged lungs resulting in mediastinal compression, ascites, hydrops, flattened or everted diaphragms and dilated distal airways. We reported a case of CHAOS, antenatally on ultrasonography (USG) at 20 weeks of gestation.

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The Nuclear and Mitochondrial Genomes of the Facultatively Eusocial Orchid Bee Euglossa dilemma

Bees provide indispensable pollination services to both agricultural crops and wild plant populations, and several species of bees have become important models for the study of learning and memory, plant-insect interactions and social behavior. Orchid bees (Apidae: Euglossini) are especially important to the fields of pollination ecology, evolution, and species conservation. Here we report the nuclear and mitochondrial genome sequences of the orchid bee Euglossa dilemma Bembé & Eltz. Euglossa dilemma was selected because it is widely distributed, highly abundant, and it was recently naturalized in the southeastern United States. We provide a high-quality assembly of the 3.3 giga-base genome, and an official gene set of 15,904 gene annotations. We find high conservation of gene synteny with the honey bee throughout 80 million years of divergence time. This genomic resource represents the first draft genome of the orchid bee genus Euglossa, and the first draft orchid bee mitochondrial genome, thus representing a valuable resource to the research community.



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Assessment of the Drug–Drug Interaction Potential Between Theacrine and Caffeine in Humans

Journal of Caffeine Research , Vol. 0, No. 0.


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Application of neurite orientation dispersion and density imaging or diffusion tensor imaging to quantify the severity of cervical spondylotic myelopathy and assess postoperative neurological recovery

Surgical outcome and the severity of cervical spondylotic myelopathy (CSM) are unpredictable and cannot be estimated by conventional anatomical MRI. The utility of diffusion tensor imaging (DTI) to quantify the severity of CSM and assess postoperative neurological recovery has been investigated. However, whether conventional DTI should be applied in a clinical setting remains controversial. Neurite orientation dispersion and density imaging (NODDI) is a recently introduced model-based diffusion-weighted MRI technique that quantifies specific microstructural features related directly to neuronal morphology.

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Assessment of the Drug–Drug Interaction Potential Between Theacrine and Caffeine in Humans

Journal of Caffeine Research , Vol. 0, No. 0.


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Continuous sweep versus discrete step protocols for studying effects of wearable robot assistance magnitude

Different groups developed wearable robots for walking assistance, but there is still a need for methods to quickly tune actuation parameters for each robot and population or sometimes even for individual user...

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Comparison between sEMG and force as control interfaces to support planar arm movements in adults with Duchenne: a feasibility study

Adults with Duchenne muscular dystrophy (DMD) can benefit from devices that actively support their arm function. A critical component of such devices is the control interface as it is responsible for the human...

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HAMILTON-T1: Neonatal transport ventilation with Intermountain Life Flight

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The Intermountain Life Flight team, based in Salt Lake City (UT), shares their experiences with the HAMILTON-T1 transport ventilator for transports of neonatal and pediatric patients.Intermountain Life Flight is the longest running and most experienced medical transport team serving Utah and the intermountain West. On average, Life Flight transports 4,000 patients each year, half of which are pediatric and neonatal patients. Life Flight operations include 7 helicopters, 3 airplanes, 8 specialty medical transport teams and almost 400 employees.

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HAMILTON-T1: Setup and Preop Checks

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This video gives you a short introduction on how to set up the HAMILTON-T1 transport ventilator and perform the pre-op checks.

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Meet our automatic cuff pressure controller: IntelliCuff

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Michael Jugl, our product manager for IntellICuff, gives you a quick overview on what automatic cuff pressure control with IntelliCuff is all about. For more information visit: http://ift.tt/2tNQ2pP

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HAMILTON-T1: Neonatal transport ventilation with Intermountain Life Flight

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The Intermountain Life Flight team, based in Salt Lake City (UT), shares their experiences with the HAMILTON-T1 transport ventilator for transports of neonatal and pediatric patients.Intermountain Life Flight is the longest running and most experienced medical transport team serving Utah and the intermountain West. On average, Life Flight transports 4,000 patients each year, half of which are pediatric and neonatal patients. Life Flight operations include 7 helicopters, 3 airplanes, 8 specialty medical transport teams and almost 400 employees.

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HAMILTON-T1: Setup and Preop Checks

Hamilton-T1-Vid-Thumb.jpg

This video gives you a short introduction on how to set up the HAMILTON-T1 transport ventilator and perform the pre-op checks.

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Meet our automatic cuff pressure controller: IntelliCuff

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Michael Jugl, our product manager for IntellICuff, gives you a quick overview on what automatic cuff pressure control with IntelliCuff is all about. For more information visit: http://ift.tt/2tNQ2pP

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The new IntelliCuff pressure controller

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The well-known IntelliCuff pressure controller on HAMILTON-G5 and HAMILTON-S1 is now also available as an advanced stand-alone device which is ready for use with all types of mechanical ventilators. With its unique features, this handy device is designed to be a new reference in the area of automated cuff pressure controllers. With the IntelliCuff we demonstrate our commitment to make ventilation more efficient, and above all, safer. For more information visit: http://ift.tt/2tNQ2pP

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HAMILTON-T1: Neonatal transport ventilation with Intermountain Life Flight

hqdefault.jpg

The Intermountain Life Flight team, based in Salt Lake City (UT), shares their experiences with the HAMILTON-T1 transport ventilator for transports of neonatal and pediatric patients.Intermountain Life Flight is the longest running and most experienced medical transport team serving Utah and the intermountain West. On average, Life Flight transports 4,000 patients each year, half of which are pediatric and neonatal patients. Life Flight operations include 7 helicopters, 3 airplanes, 8 specialty medical transport teams and almost 400 employees.

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HAMILTON-T1: Setup and Preop Checks

Hamilton-T1-Vid-Thumb.jpg

This video gives you a short introduction on how to set up the HAMILTON-T1 transport ventilator and perform the pre-op checks.

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Meet our automatic cuff pressure controller: IntelliCuff

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Michael Jugl, our product manager for IntellICuff, gives you a quick overview on what automatic cuff pressure control with IntelliCuff is all about. For more information visit: http://ift.tt/2tNQ2pP

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The new IntelliCuff pressure controller

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The well-known IntelliCuff pressure controller on HAMILTON-G5 and HAMILTON-S1 is now also available as an advanced stand-alone device which is ready for use with all types of mechanical ventilators. With its unique features, this handy device is designed to be a new reference in the area of automated cuff pressure controllers. With the IntelliCuff we demonstrate our commitment to make ventilation more efficient, and above all, safer. For more information visit: http://ift.tt/2tNQ2pP

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HAMILTON-T1: Neonatal transport ventilation with Intermountain Life Flight

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The Intermountain Life Flight team, based in Salt Lake City (UT), shares their experiences with the HAMILTON-T1 transport ventilator for transports of neonatal and pediatric patients.Intermountain Life Flight is the longest running and most experienced medical transport team serving Utah and the intermountain West. On average, Life Flight transports 4,000 patients each year, half of which are pediatric and neonatal patients. Life Flight operations include 7 helicopters, 3 airplanes, 8 specialty medical transport teams and almost 400 employees.

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HAMILTON-T1: Setup and Preop Checks

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This video gives you a short introduction on how to set up the HAMILTON-T1 transport ventilator and perform the pre-op checks.

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Meet our automatic cuff pressure controller: IntelliCuff

hqdefault.jpg

Michael Jugl, our product manager for IntellICuff, gives you a quick overview on what automatic cuff pressure control with IntelliCuff is all about. For more information visit: http://ift.tt/2tNQ2pP

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The new IntelliCuff pressure controller

Intellicuff-1.jpg

The well-known IntelliCuff pressure controller on HAMILTON-G5 and HAMILTON-S1 is now also available as an advanced stand-alone device which is ready for use with all types of mechanical ventilators. With its unique features, this handy device is designed to be a new reference in the area of automated cuff pressure controllers. With the IntelliCuff we demonstrate our commitment to make ventilation more efficient, and above all, safer. For more information visit: http://ift.tt/2tNQ2pP

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The new IntelliCuff pressure controller

Intellicuff.jpg

The well-known IntelliCuff pressure controller on HAMILTON-G5 and HAMILTON-S1 is now also available as an advanced stand-alone device which is ready for use with all types of mechanical ventilators. With its unique features, this handy device is designed to be a new reference in the area of automated cuff pressure controllers. With the IntelliCuff we demonstrate our commitment to make ventilation more efficient, and above all, safer. For more information visit: http://ift.tt/2tNQ2pP

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Paramedic for Inpatient Population – Part Time - Florida Hospital

Florida Hospital Orlando seeks to hire a Paramedic who will embrace our mission to extend the healing ministry of Christ. Job Summary As a Paramedic, you will make providing service your priority while caring for the whole person in a faith-based atmosphere The Advanced Technician II performs patient care under the direction of and as assigned by the Charge nurse, registered nurse and/or physician ...

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Paramedic for Inpatient Population - Florida Hospital

Florida Hospital seeks to hire a Paramedic who will embrace our mission to extend the healing ministry of Christ. Job Summary: The Advanced Technician II performs patient care under the direction of and as assigned by the Charge nurse, registered nurse and/or physician or their designee. Performs general clinical, non-clinical and clerical services necessary to expedite the efficient functioning of ...

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Telrepco now offers NJ NASPO contract to qualified government agencies

Telrepco is pleased to announce that in addition to GSA and CT NASPO contracts, we now have NJ NASPO contract available for your procurement needs. Qualified government agencies can now utilize the NJ NASPO contract #MNWNC-124, Panasonic contract # 89880, to enjoy discounted pre-bid pricing on new Panasonic Toughbooks and accessories as well as Panasonic in-car and body worn cameras. Our goal at Telrepco ...

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Exercise to Support Indigenous Pregnant Women to Stop Smoking: Acceptability to Māori

Abstract

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance.



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Exploring Factors Influencing Childhood Obesity Prevention Among Migrant Communities in Victoria, Australia: A Qualitative Study

Abstract

Despite the availability of numerous obesity prevention initiatives in developed countries including Australia, rising childhood obesity levels have been found among migrant communities which contribute to widening obesity-related disparities in these countries. We sought to understand the factors influencing the participation of migrant communities in childhood obesity prevention initiatives. We conducted a qualitative study using semi-structured interviews among 48 migrant parents from African, Middle Eastern, Indian and Vietnamese origins living in disadvantaged areas of Victoria, Australia to explore their views on childhood obesity and its prevention. Thematic analysis showed low obesity literacy among migrant communities, cultural influences negatively impacting their healthy lifestyle behaviours and cultural, family-level and community-level barriers impacting their participation in childhood obesity prevention initiatives. There is an urgent need to improve obesity literacy among migrant communities using bicultural workers in order to improve their responsiveness to childhood obesity prevention initiatives. Health interventionists are urged to incorporate culturally-mediated influences in the design of obesity prevention programs to achieve energy balance and maintain healthy weight among migrants. Such culturally appropriate approaches have the potential of reducing the widening ethnic-related obesity disparities in Australia.



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Effects of progressive resistance training on cardiovascular autonomic regulation in patients with Parkinson`s Disease: a randomized controlled trial

Publication date: Available online 10 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hélcio Kanegusuku, Carla Silva-Batista, Tiago Peçanha, Alice Nieuwboer, Natan D. Silva, Luiz A.R. Costa, Marco T. de Mello, Maria E.P. Piemonte, Carlos Ugrinowitsch, Cláudia L.M. Forjaz
ObjectiveTo evaluate the effects of a progressive resistance training (RT) on cardiac autonomic modulation and on cardiovascular responses to autonomic stress tests in patients with Parkinson disease (PD).DesignRandomized clinical trial.SettingThe Brazilian Parkinson Association.Participants30 patients with PD (modified Hoehn and Yahr stages 2-3) were randomly divided into 2 groups: a progressive RT group (PDT) and a control group (PDC). In addition, a group of paired healthy control subjects without PD (HC) was evaluated.InterventionsPDT group performed 5 resistance exercises, 2 to 4 sets, 12 to 6 repetitions maximum per set. PDC group maintained their usual lifestyle.Main Outcome MeasuresPDT and PDC groups were evaluated before and after 12-weeks. HC group was evaluated once. Autonomic function was assessed by spectral analysis of heart rate (HR) variability and cardiovascular responses to autonomic stress tests (deep breathing, Valsalva maneuver and orthostatic stress).ResultsCompared with baseline, normalized low-frequency component of HR variability decreased significantly after 12 weeks in the PDT group only (PDT = 61±17 vs. 47±20 nu and PDC = 60±14 vs. 63±10 nu, interaction P<0.05). Similar result was observed for systolic blood pressure fall during orthostatic stress that also reduced only in the PDT group (PDT = -14±11 vs. -6±10 mmHg and PDC = -12±10 vs. -11±10 mmHg, interaction P<0.05). In addition, after 12 weeks, these parameters in the PDT achieved values similar to the HC group.ConclusionIn patients with PD, progressive RT improved cardiovascular autonomic dysfunction.



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Can primary care for back and/or neck pain in the Netherlands benefit from stratification for risk groups according to the STarT Back Tool-classification?

Publication date: Available online 12 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jasper D. Bier, Janneke J.W. Sandee-Geurts, Raymond W.J.G. Ostelo, Bart W. Koes, Arianne P. Verhagen
ObjectiveTo evaluate whether current Dutch primary-care clinicians offer tailored treatment to patients with lower-back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT).DesignProspective cohort study with 3 month follow-upSettingPrimary careParticipantsGeneral practitioners (GPs) and physiotherapists (PTs) included patients with non-specific LBP and/or NP.InterventionsPatients completed a baseline questionnaire, including the Dutch SBT, for either LBP or NP. A follow-up measurement was conducted after 3 months to determine recovery (using the Global Perceived Effect (GPE) scale), pain (using the Numeric Pain-Rating Scale (NPRS)) and function (using the Roland Disability Questionnaire (RDQ) or the Neck Disability Index (NDI)). A questionnaire was sent to the GPs and PTs to evaluate the provided treatment.Main outcome measuresPrevalence of patients' risk profile and clinicians' applied care, and the percentage of patients with persisting disability at follow-up. A distinction was made between patients receiving the advised treatment and those receiving the non-advised treatment.ResultsIn total, 12 GPs and 33 PTs included patients. After 3 months, we analyzed 184 patients with LBP and 100 patients with NP. In the LBP group, 52.2% of the patients were at low risk for persisting disability, 38.0% were at medium risk and 9.8% were at high risk. Overall, 24.5% of the LBP patients received a low-risk treatment approach, 73.5% a medium-risk and 2.0% a high-risk treatment approach. The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients (respectively 21.1% and 10.0%), and fair for medium-risk patients (51.4%). In the NP group, 58.0% of the patients were at low risk for persisting disability, 37.0% were at medium risk and 5.0% were at high-risk. Only 6.1% of the patients with NP received the low-risk treatment approach. The medium-risk treatment approach was offered the most (90.8%) and the high-risk approach was applied in only 3.1% of the patients. The specific agreement between the risk profile and received treatment for NP patients was poor for low-risk and medium-risk patients (resp. 6.3% and 48.0%); agreement for high-risk patients could not be calculated.ConclusionCurrent Dutch primary care for patients with non-specific LBP and/or NP does not correspond to the advised stratified-care approach based on the SBT as the majority of patients receive medium risk treatment. The majority of "low-risk" patients are over-treated and the majority of "high-risk" patients are undertreated. Although the stratified-care approach has not yet been validated in Dutch primary care, these results indicate that there may be substantial room for improvement.



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Endoscopic Cyanoacrylate Injection with Post-injection Audible Doppler Assessment of Gastric Varices: A Single-Institution Experience

Abstract

Background and Aims

Gastric varices (GV) have higher rates of morbidity and mortality from hemorrhage than esophageal varices. Several studies have shown the safety and efficacy of cyanoacrylate (CA) injection for acute gastric variceal hemorrhage. We report data from our experience with CA injection for GV before and after routine use of post-injection audible Doppler assessment (ADA) for GV obturation and describe long-term outcomes after this therapy.

Methods

We retrospectively identified patients who had documented GV, underwent CA injection, and had at least 2 weeks of follow-up. We recorded and analyzed the survival and rebleeding rates with patient demographics, clinical data, and endoscopy findings between two groups of patients who were categorized by CA injection prior to and after inception of the ADA technique.

Results

Seventy-one patients were identified with 16 patients analyzed in a group where ADA was not used (Pre-ADA) and 55 analyzed where ADA was used (Post-ADA). No rebleeding events were observed within 1 week of initial CA injection. No embolic events were reported after any initial CA injection within 4 weeks. The rate of bleed-free survival at 1 year was 69.6% in the Pre-ADA group and 85.8% in the Post-ADA without statistical significance. The all-cause 1-year mortality was 13.8% in the Pre-ADA group and 10.7% in the Post-ADA group without statistical significance.

Conclusions

ADA of CA-injected GV does not appear to significantly affect adverse events or clinical outcomes; however, our findings are limited by small sample size and cohort proportions allowing for significant type II statistical error. Further prospective investigation is required to determine the impact of ADA on clinical outcomes after GV obturation.



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Magnifying NBI Patterns of Gastric Mucosa After Helicobacter pylori Eradication and Its Potential Link to the Gastric Cancer Risk

Abstract

Background

Gastric cancer develops after successful H. pylori eradication in patients with severe atrophic gastritis. We classified atrophic and non-atrophic mucosa of gastric body using magnifying NBI endoscopy in patients after successful H. pylori eradication.

Materials and Methods

One hundred and twenty-five patients after successful H. pylori eradication (median period after eradication: 36 months) were enrolled. Magnifying NBI patterns in the uninvolved gastric body were divided into the following: restored-small, round pits, accompanied with honeycomb-like subepithelial capillary networks; atrophic-well-demarcated oval or tubulovillous pits with clearly visible coiled or wavy vessels. The subjects were also classified into the three types: Grade 0—restored pattern is shown in all or almost the entire area of gastric body; Grade 1—mixture of restored and atrophic pattern, there is a considerable portion of the atrophic area in the lesser curvature; Grade 2—atrophic pattern is shown in all or almost the entire area of the gastric body.

Results

Sensitivity and specificity for atrophic type for detection of histological intestinal metaplasia were 95.9 and 98.3%, respectively. No association was observed between the prevalence of Grades 0, 1 and 2 and duration after eradication, while grades 1 and 2 were significantly frequent in gastric cancer patients diagnosed both before (27/35: 77%) and after (23/31: 74%) eradication, compared to the cancer-free subjects (15/59: 25%) (P < 0.001). The grades 1 and 2 were also common in patients who underwent H. pylori eradication for gastric ulcer.

Conclusions

Magnifying the NBI pattern well correlates with pathological status of gastric mucosa after H. pylori eradication and may predict gastric cancer occurrence.



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Implications of Impaired Endurance Peffects of endurance training orformance following Single Bouts of Resistance Training: An Alternate Concurrent Training Perspective

Abstract

A single bout of resistance training induces residual fatigue, which may impair performance during subsequent endurance training if inadequate recovery is allowed. From a concurrent training standpoint, such carry-over effects of fatigue from a resistance training session may impair the quality of a subsequent endurance training session for several hours to days with inadequate recovery. The proposed mechanisms of this phenomenon include: (1) impaired neural recruitment patterns; (2) reduced movement efficiency due to alteration in kinematics during endurance exercise and increased energy expenditure; (3) increased muscle soreness; and (4) reduced muscle glycogen. If endurance training quality is consistently compromised during the course of a specific concurrent training program, optimal endurance development may be limited. Whilst the link between acute responses of training and subsequent training adaptation has not been fully established, there is some evidence suggesting that cumulative effects of fatigue may contribute to limiting optimal endurance development. Thus, the current review will (1) explore cross-sectional studies that have reported impaired endurance performance following a single, or multiple bouts, of resistance training; (2) identify the potential impact of fatigue on chronic endurance development; (3) describe the implications of fatigue on the quality of endurance training sessions during concurrent training, and (4) explain the mechanisms contributing to resistance training-induced attenuation on endurance performance from neurological, biomechanical and metabolic standpoints. Increasing the awareness of resistance training-induced fatigue may encourage coaches to consider modulating concurrent training variables (e.g., order of training mode, between-mode recovery period, training intensity, etc.) to limit the carry-over effects of fatigue from resistance to endurance training sessions.



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Selected In-Season Nutritional Strategies to Enhance Recovery for Team Sport Athletes: A Practical Overview

Abstract

Team sport athletes face a variety of nutritional challenges related to recovery during the competitive season. The purpose of this article is to review nutrition strategies related to muscle regeneration, glycogen restoration, fatigue, physical and immune health, and preparation for subsequent training bouts and competitions. Given the limited opportunities to recover between training bouts and games throughout the competitive season, athletes must be deliberate in their recovery strategy. Foundational components of recovery related to protein, carbohydrates, and fluid have been extensively reviewed and accepted. Micronutrients and supplements that may be efficacious for promoting recovery include vitamin D, omega-3 polyunsaturated fatty acids, creatine, collagen/vitamin C, and antioxidants. Curcumin and bromelain may also provide a recovery benefit during the competitive season but future research is warranted prior to incorporating supplemental dosages into the athlete's diet. Air travel poses nutritional challenges related to nutrient timing and quality. Incorporating strategies to consume efficacious micronutrients and ingredients is necessary to support athlete recovery in season.



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Complex regional pain syndrome: diagnosis and treatment

1D012E023E00

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Association of the Familial Coexistence of Child Stunting and Maternal Overweight with Indigenous Women in Guatemala

Abstract

Objectives This study investigated the association of the familial coexistence of child stunting and maternal overweight with indigenous women in Guatemala. Methods We selected 2388 child–mother pairs from the data set of the Living Standards Measurement Study conducted in Guatemala in 2000. This study examined the association between maternal and household characteristics and the nutritional status of children aged 6–60 months and mothers aged 18–49 years by using multivariable logistic regression models. Results Compared with non-indigenous households, a significantly higher percentage of indigenous households exhibited stunted child and overweight mother (SCOM) pairs (15.9 vs. 22.2%). Compared with normal-weight mothers, overweight mothers were less likely to have stunted children [adjusted odds ratio (AOR) 0.66, 95% confidence interval (CI) 0.50–0.88]. However, compared with mothers who were not short and overweight, short and overweight mothers were significantly more likely to have stunted children (AOR 1.80, 95% CI 1.19–2.73) and were more likely to be indigenous women living in urban areas (AOR 3.01, 95% CI 1.19–7.60) or rural areas (AOR 3.02, 95% CI 1.28–7.14). The order of observed prevalence of SCOM pairs in different types of households was as follows: urban indigenous (25.0%), rural indigenous (21.2%), rural non-indigenous (19.8%), and urban non-indigenous households (10.7%). Conclusions for Practice Urban indigenous households were more likely to have SCOM pairs. This study provided useful information for identifying the most vulnerable groups and areas with a high prevalence of the familial coexistence of child stunting and maternal overweight.



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The GPX1 Pro 198 Leu polymorphism in gastric cancer patients with and without Helicobacter pylori infection

Abstract

Helicobacter pylori infection could induce oxidative stress. Oxidative stress is involved in the pathogenesis of gastric diseases. Glutathione peroxidase 1 (GPX1), is part of the enzymatic antioxidant defense, preventing oxidative damage. The aim of the present study was to assess the association of GPX1 Pro198Leu genotypes with gastric cancer in patients with and without H. pylori infection in a population of Northern Iran. The present case-control study consisted of 50 patients with gastric cancer and 78 cancer-free subjects as controls. Extraction of DNA was performed on bioptic samples and the GPX1 genotypes were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The frequencies of GPX1 Pro/Pro, Pro/Leu and Leu/Leu genotypes in controls were 21.8, 71.8 and 6.4%, respectively. However, in gastric cancer patients, the frequencies of 34, 56 and 10% were observed for Pro/Pro, Pro/Leu and Leu/Leu genotypes, respectively (p = 0.185). In 38 (76%) patients infected with H. pylori, the frequencies of Pro and Leu alleles were 94.7 and 3.3%, respectively. There was a higher frequency of combined genotype of Pro/Leu + Leu/Leu (94.7%) in H. pylori positive patients than that in patients without H. pylori infection (75%, p = 0.047). The presence of this genotype tended to increase the risk of H. pylori related gastric cancer by 5.88–fold (p = 0.069) in our population. Our findings indicated the absence of association between the GPX1 Pro198Leu polymorphism and the risk of gastric cancer in an Iranian population. However, we detected an association between H. pylori related gastric cancer with GPX1 Pro/Leu + Leu/Leu genotype.



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Perineural invasion is a prognostic factor and treatment indicator in patients with rectal cancer undergoing curative surgery: 2000-2011 data from a single-center study

Anticancer Research

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CONUT predicts survival after gastric cancer resection

Reuters Health News

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Bone marrow tolerance during postoperative chemotherapy in colorectal carcinomas

Journal of Gastrointestinal Oncology

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'Brain training' program doesn't improve self control

Reuters Health News

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Partners of patients with ulcerative colitis exhibit a biologically relevant dysbiosis in fecal microbial metacommunities

World Journal of Gastroenterology

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Physicians persist in ordering unnecessary ECGs

Reuters Health News

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Hepatitis C virus NS5A region mutation in chronic hepatitis C genotype 1 patients who are non-responders to two or more treatments and its relationship with response to a new treatment

World Journal of Gastroenterology

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Ectopic pregnancy in women with inflammatory bowel disease - A 22 year nationwide cohort study

Clinical Gastroenterology and Hepatology

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The gamma-glutamyl transpeptidase to albumin ratio predicts significant fibrosis and cirrhosis in chronic hepatitis B patients

Journal of Viral Hepatitis

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Association between gastrointestinal bleeding and 3-year mortality in patients with acute, first-ever ischemic stroke

Journal of Clinical Neuroscience

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Liver biopsy findings in patients with hematopoietic-cell transplantation

Human Pathology

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Treatment discontinuation, adherence, and real-world effectiveness among patients treated with ledipasvir/sofosbuvir in the United States

Infectious Diseases and Therapy

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Modeling HCV cure after an ultra-short duration of therapy with direct acting agents

Antiviral Research

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Coffee drinking linked to longer survival

Reuters Health News

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A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia

Neurogastroenterology & Motility

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Clinical study on the medical value of combination therapy involving adoptive immunotherapy and chemotherapy for stage IV colorectal cancer (COMVI study)

Anticancer Research

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The effect of anxiety and depression on the risk of irritable bowel syndrome in migraine patients

Journal of Clinical Neuroscience

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Effect of Helicobacter pylori infection on outcomes in resected gastric and gastroesophageal junction cancer

Journal of Gastrointestinal Oncology

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Biomarkers for visceral hypersensitivity in patients with irritable bowel syndrome

Neurogastroenterology & Motility

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Chromoendoscopy versus narrow band imaging in UC: A prospective randomised controlled trial

Gut

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Public Health Insurance and Health Care Utilization for Children in Immigrant Families

Abstract

Objectives To estimate the impacts of public health insurance coverage on health care utilization and unmet health care needs for children in immigrant families. Methods We use survey data from National Health Interview Survey (NHIS) (2001–2005) linked to data from Medical Expenditures Panel Survey (MEPS) (2003–2007) for children with siblings in families headed by at least one immigrant parent. We use logit models with family fixed effects. Results Compared to their siblings with public insurance, uninsured children in immigrant families have higher odds of having no usual source of care, having no health care visits in a 2 year period, having high Emergency Department reliance, and having unmet health care needs. We find no statistically significant difference in the odds of having annual well-child visits. Conclusions for practice Previous research may have underestimated the impact of public health insurance for children in immigrant families. Children in immigrant families would likely benefit considerably from expansions of public health insurance eligibility to cover all children, including children without citizenship. Immigrant families that include both insured and uninsured children may benefit from additional referral and outreach efforts from health care providers to ensure that uninsured children have the same access to health care as their publicly-insured siblings.



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Tobacco Use Prevalence and Outcomes Among Perinatal Patients Assessed Through an “Opt-out” Cessation and Follow-Up Clinical Program

Abstract

Purpose Cigarette smoking in the perinatal period is associated with costly morbidity and mortality for mother and infant, yet many women continue to smoke throughout their pregnancy and following delivery. This report describes tobacco use prevalence among perinatal smokers identified through an "opt-out" inpatient smoking cessation clinical service. Description Adult women admitted to the peripartum, delivery, and postpartum units at a large academic hospital were screened for tobacco use. Smokers were identified through their medical record and referred to a bedside consult and follow-up using an interactive voice response (IVR) system to assess smoking up to 30 days post-discharge. Assessment Between February 2014 and March 2016, 533 (10%) current and 898 (16%) former smokers were identified out of 5649 women admitted to the perinatal units. Current smokers reported an average of 11 cigarettes per day for approximately 12 years. Only 10% reported having made a quit attempt in the past year. The majority of smokers (56%) were visited by a bedside tobacco cessation counselor during their stay and 27% were contacted through the IVR system. Those counselled in the hospital were twice as likely (RR 1.98, CI 1.04–3.78) to be abstinent from smoking using intent-to-treat analysis at any time during the 30 days post-discharge. Conclusions This opt-out service reached a highly nicotine-dependent perinatal population, many of whom were receptive to the service, and it appeared to improve abstinence rates post-discharge. Opt-out tobacco cessation services may have a significant impact on the health outcomes of this population and their children.



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Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya

Abstract

Purpose In 2009 the Kenyan Government introduced health system reforms to address persistently high maternal and newborn mortality including deployment of skilled birth attendants (SBAs) to health facilities in remote areas, and proscription of births attended by traditional birth attendants (TBAs). Despite these initiatives, uptake of SBA services remains low and inequitably distributed. This paper describes the development of an SBA/TBA collaborative model of maternal health care for pastoralist communities in Laikipia and Samburu. Description A range of approaches were used to generate a comprehensive understanding of the maternal and child health issues affecting these pastoralist communities including community and government consultations, creation of a booklet and film recognising the contributions of both TBAs and SBAs that formed the basis of subsequent discussions, and mixed methods research projects. Based on the knowledge and understanding collectively generated by these approaches we developed an evidence-based, locally acceptable and feasible model for SBA/TBA collaborative care of women during pregnancy and childbirth. Assessment The proposed collaborative care model includes: antenatal and post-natal care delivered by both SBAs and TBAs; TBAs as birth companions who support women and SBAs; training TBAs in recognition of birth complications, nutrition during pregnancy and following birth, referral processes, and family planning; training SBAs in respectful maternity care; and affordable, feasible redesign of health facility infrastructure and services so they better meet the identified needs of pastoralist women and their families. Conclusion The transition from births predominantly attended by TBAs to births attended by SBAs is likely to be a gradual one, and an interim SBA/TBA collaborative model of care has the potential to maximise the safety of pastoralist women and babies during the transition phase, and may even accelerate the transition itself.



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National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period.

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation. (C) 2017 International Anesthesia Research Society

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Bilateral Patellar Tendon Tears After a Fall From Standing Position: Do You Mind Systemic Diseases and Medications?.

No abstract available

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